Ayurveda
Ayurveda (Devanāgarī: the 'science of life') is a system of traditional medicine native to the Indian Subcontinent and practiced in other parts of the world as a form of alternative medicine. In Sanskrit, the word Ayurveda consists of the words āyus, meaning 'life', and veda, meaning 'related to knowledge' or 'science'. Evolving throughout its history, Ayurveda remains an influential system of medicine in South Asia. The earliest literature of Ayurveda appeared during the Vedic period in India. The Sushruta Samhita and the Charaka Samhita were influential works on traditional medicine during this era. Ayurvedic practitioners also identified a number of medicinal preparations and surgical procedures for curing various ailments and diseases.
As per Indian heritage and science, "Ayurveda" is an Upaveda or annexure to the four main vedas (knowledge systems). The famous treaties of Ayurveda are Charaka Samhita by Sage Charaka, which details the prevention and treatment of disease, and Sushruta Samhita of Sage Sushruta, which deals with Ayurvedic surgical procedures. In the Ayurvedic system, the prevention of all types of disease has a prominent place in treatment, including restructuring a patient's lifestyle to align with the course of nature and the four seasons to guarantee complete wellness.
Ayurveda is considered to be a form of complementary and alternative medicine (CAM) within the western world, where several of its methods, such as the use of herbs, massage, and Yoga as exercise or alternative medicine, are applied on their own as a form of CAM treatment. However, such alternative therapy approaches are not unique to Ayurveda because they are also available under the systems of Unani medicine, Greek medicine and Islamic medicine.
Overview of Ayurveda
Ayurveda is grounded in the metaphysics of the 'five [great] Elements' (earth, water, fire, air and ether)—all of which compose the Universe, including the human body. Chyle (called Rasa dhatu), blood (called Rakta dhatu), flesh (called Mamsa dhatu), fat (called Medha dhatu), bone (called Asthi dhatu), marrow (called Majja dhatu), and semen (called Shukra dhatu) or female reproductive tissue (called Artava dhatu) are held to be the seven primary constituent elements of the body. Ayurveda stresses a balance of three substances: vata (wind/spirit/air), pitta (bile) and kapha (phlegm), each representing divine forces. According to Ayurveda, these three regulatory principles—Doshas —are important and traditional beliefs hold that humans possess a unique constellation of them. In Ayurveda, the human body perceives attributes of experiences as 20 Guna and it is believed that building a healthy metabolic system, attaining good digestion, and proper excretion leads to vitality. Ayurveda also focuses on exercise, yoga, meditation and massage; thus, body, mind, and spirit/consciousness need to be addressed both individually and in unison for health to ensue.
Within Ayurveda the practice of Panchakarma is believed to eliminate toxic elements from the body. Eight disciplines of Ayurveda treatment, called Ashtanga, are given below:
- Surgery (Shalya-chikitsa)
- Treatment of diseases above the clavicle (Salakyam)
- Internal medicine (Kaaya-chikitsa)
- Demonic possession (Bhuta vidya): Ayurveda believes in demonic intervention and—as a form of traditional medicine—identifies a number of ways to counter the supposed effect of these interferences. Bhuta vidya has been called psychiatry.
- Paediatrics (Kaumarabhrtyam)
- Toxicology (Agadatantram)
- Prevention and building immunity (rasayanam)
- Aphrodisiacs (Vajikaranam)
History of Ayurveda
Ayurveda traces its origins to the Vedas—the Atharvaveda in particular—and is connected to Hindu religion. The Sushruta Samhita of Sushruta appeared during the 1st millennium BC. On the work of the Sushruta Dwivedi & Dwivedi (2007) wrote:
“The main vehicle of the transmission of knowledge during that period was by oral method. The language used was Sanskrit — the vedic language of that period (2000-500 BC). The most authentic compilation of his teachings and work is presently available in a treatise called Sushruta Samhita. This contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, 64 preparations from mineral sources and 57 preparations based on animal sources.”
Underwood & Rhodes (2008) hold that this early phase of traditional Indian medicine identified and treated fever, cough, consumption, diarrhoea, dropsy, abscesses, seizures, tumours, and skin diseases (including leprosy). Treatment of complex ailments including angina pectoris, diabetes, hypertension, and stones also ensued during this period. Plastic surgery, cataract surgery, puncturing to release fluids in the abdomen, extraction of foreign elements, treatment of anal fistulas, treating fractures, amputations, caesarean sections, and stitching of wounds were known as well. The use of herbs and surgical instruments became widespread with the Charaka Samhita text arguably the principal classic reference. It gives emphasis to the triune nature of each person: body care, mental regulation, and spiritual/consciousness refinement.
An example of the advancement of Ayurveda was that in India, cataract surgery was performed long before Western understanding of the ailment. Ayurveda used a special tool called the Jabamukhi Salaka, which was a curved needle used to loosen the lens and push the cataract out of the field of vision. The eye would later be soaked with warm butter and then bandaged.
The earliest surviving excavated written material which contains the works of Sushruta is the Bower Manuscript, dated to the 4th century AD. The Bower manuscript cites directly from Sushruta, and is of special interest to historians due to the presence of Ayurveda and its concepts in Central Asia. Vagbhata, the son of a senior doctor by the name of Simhagupta, also compiled his works on Ayurveda. Tradition holds that the text Agnivesh tantra, which was written by the legendary sage Agnivesh, a student of the mythological sage Bharadwaja, also influenced the writings of Ayurveda.
The Chinese pilgrim Fa Hsien (ca. 337 - 422 AD) wrote about the health care system of the Gupta empire (320 - 550 AD) and in the process described the institutional approach of Ayurveda, which is also visible in the works of Charaka, who mentions a clinic and how it should be equipped. Madhava (700 AD), Sarngadhara (1300 AD), and Bhavamisra (1500 AD) compiled works on Ayurveda, whilst the medical works of both Sushruta and Charaka were translated into the Arabic language during the Abbasid Caliphate (750 AD). These Arabic works made their way into Europe via intermediaries and in Italy the Branca family of Sicily and Gaspare Tagliacozzi of Bologna became familiar with the techniques of Sushruta.
British physicians travelled to India to see Rhinoplasty being performed by native methods, which saw reports on Indian Rhinoplasty being published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods and was able to perform the first major surgery in the western world by 1815. Instruments described in the Sushruta Samhita were further modified in the Western World.
Ayurvedic Practices
Several philosophers in India combined religion and traditional medicine—notable examples being that of Hinduism and Ayurveda. Buddhism may have been an influence on the development of many of Ayurveda's central ideas — particularly its fascination with balance, known in Buddhism as Madhyamika. Balance is emphasized; suppressing natural urges is seen to be unhealthy, and doing so may almost certainly lead to illness. To stay within the limits of reasonable balance and measure is stressed upon and as such, Ayurveda places an emphasis on moderation in food intake, sleep, sexual intercourse, and the intake of medicine.
Ayurveda incorporates an entire system of dietary recommendations. Chopra (2003)—on the subject of Ayurveda dietetics—writes:
“Ayurvedic dietetics comprise a host of recommendations, ranging from preparation and consumption of food, to healthy routines for day and night, sexual life, and rules for ethical conduct. In contrast to contemporary practitioners of New Age Ayurveda, older Ayurvedic authors tended to be religiously neutral. Even Buddhist authors refrained from trying to convert the patient to follow their particular religious ways.”
For diagnosis in Ayurveda, the patient is questioned and all five senses are employed; the Charaka Samhita recommends a tenfold examination of the patient. The qualities to be judged are: constitution, abnormality, essence, stability, body measurements, diet suitability, psychic strength, digestive capacity, physical fitness and age. Hearing is used to observe the condition of breathing and speech and the study of the vital pressure points or marma is of special importance.
Chopra (2003) identifies five influential criteria for diagnosis in Ayurveda: 'origin of the disease, prodrominal (precursory) symptoms, typical symptoms of the fully developed disease, observing the effect of therapeutic procedures, and the pathological process.'
Hygiene—also a component of religious virtue to many Indians—is a strong belief within Ayurveda, with hygienic living involving regular bathing, cleansing of teeth, skin care, and eye washing. Occasional anointing of the body with oil is also prescribed.
Oils, such as sesame and sunflower oil, are extensively used in Ayurveda and studies have subsequently shown that both these oils contain substantial amount of linoleate in triglyceride form. Oils rich in linoleic acid may have antineoplastic properties.
Ayurveda stresses the use of vegetable drugs and hundreds of different types are used in Ayurveda including cardamom and cinnamon. Fats are used both for consumption and for external use and some animal products may also be used, for example milk, bones, and gallstones. Minerals, including sulphur, arsenic, lead, copper sulphate, gold are also consumed as prescribed and this practice of adding minerals to herbal medicine is known as Rasa Shastra.
In some cases alcohol is used in Ayurvedaas a narcotic for the patient undergoing an operation and with the advent of Islam, opium was also introduced for this purpose. Both oil and tar are used to stop bleeding and oils generally may be used in a number of ways including regular consumption as a part of food, anointing, smearing, head massage, and prescribed application to infected areas.
The proper function of channels (tubes that exist within the body and transport fluids from one point to another) is seen as vital in Ayurveda, and the lack of healthy channels may lead to disease and insanity. Sushruta identifies that blockages of these channels may lead to rheumatism, epilepsy, paralysis, and convulsions as fluids and channels are diverted from their ideal locations. Sweating is favoured as a manner in which to open up the channels and dilute the Doshas causing the blockages and harming a patient with a number of ways to take steam baths and other steam related cures recommended so that these toxins are released.
Current status of Ayurveda
Within India
In 1970, the Indian Medical Central Council Act was passed by the Parliament of India, which aims to standardize qualifications for Ayurveda and provide accredited institutions for its study and research. In India, over 100 colleges offer degrees in traditional Ayurvedic medicine. The Indian government supports research and teaching in Ayurveda through many channels, both at the national and state levels, and helps to institutionalise traditional medicine so that it can be studied in major towns and cities. The state-sponsored Central Council for Research in Ayurveda and Siddha (CCRAS) is the apex institution for promotion of traditional medicine in India. The studies conducted by this institution encompass clinical, drug, literary, and family welfare research.
Many clinics are run by professionals who qualify from these institutes both in the urban and the rural areas. Mukherjee & Wahile cite World Health Organization statistics to demonstrate the popularity of traditional medicine, on which a significant number of the world's population depends for primary health care. In Sri Lanka for example, the number of traditional Ayurveda practitioners is greater than trained modern medicine professionals.
The manufacture and marketing of Ayurvedic medicine has been commercially successful for several pharmaceutical companies. Old manufacturing companies such as Arya Vaidya Sala, Arya Vaidya Pharmacy, IMIS Pharmaceuticals, Dabur, Baidyanath have maintained the classical range, while also patenting certain own formulations, such as Gyncocalm, Jeevani, Eosinophal, Dabur Pancharishta. Similarly, MNCs like Hindustan Unilever Limited, in collaboration with Arya Vaidya Pharmacy, has been promoting its chain of Ayurvedic Massage Therapy Centres in the Brand name of Ayush Therapy Centre, with two of the major centres located at Kalyan and Vashi.
Outside India
Academic institutions related to traditional medicine in India have contributed to Ayurveda's international visibility. Kurup (2003) comments on the role of Gujarat Ayurved University:
“The Gujarat Ayurved University has signed the Memorandum of Understanding (MoU) with nine Ayurvedic institutes functioning in Japan, Australia, the Netherlands, Italy, Argentina, and Germany to coordinate and facilitate the globalization of Ayurveda through academic collaboration. Earlier, Medical (Ayu) Institute of Russia had signed the MoU with the government of India, in which Gujarat Aryurved University is also one of the implementing authorities.”
Ayurveda gained recognition in the Western world as medical scholars, notably Frank John Ninivaggi MD of Yale University School of Medicine, researched and outlined its various postulates in one major textbook form suitable to Western academic science. The National Institute of Ayurvedic Medicine, established by Dr. Scott Gerson, is an example of a research institute that has carried out research into Ayurveda. Gerson has published part of his work on the antifungal activities of certain Ayurvedic plants in academic journals, whilst other foreign scholars such as Dominik Wujastyk in the United Kingdom, have also outlined the postulates and history of Ayurveda.
Journals
A variety of peer reviewed journals focus on the topic of Ayurveda, including the Theoretical and Experimental Journal of Ayurveda and Siddha (TEJAS; published between 1981 and 2008 as Ancient Science of Life) the Journal of Research & Education in Indian Medicine (JREIM), AYU (published quarterly) and The International Journal for Ayurveda Research (published quarterly).
Patents
In December 1993, the University of Mississippi Medical Centre had a patent issued to them by United States Patent and Trademark Office on the use of turmeric for healing. The patent was contested by India's industrial research organization, Council for Scientific and Industrial Research (C.S.I.R), on the grounds that traditional Ayurvedic practitioners were already aware of the healing properties of the substance and have been for centuries, making this patent a case of bio-piracy. The Government of India had become involved in promoting traditional medicine by 1997, with Sharma & Bodeker reporting on the various government activities in relation with Ayurveda:
“In India, the government became involved in traditional drug production when the Central Drug Research Institute patented two new drugs from ancient Ayurvedic formulas. One, a mixture of black pepper, long pepper, and ginger, allows for the dosage of the antibiotic rifampicin to be halved in the treatment of tuberculosis and other mycobacterial infections. The other is a memory tonic produced from the traditional plant called brahmi. Overseas patenting of turmeric and products of the neem tree caused controversy in India and other nations. In August the U.S. Patent and Trademark Office cancelled a U.S. patent on the wound-healing properties of turmeric when the Indian government proved that records had existed for this use for centuries.”
Scientific evidence for Ayurveda
Research into Ayurveda suggests that Terminalia arjuna is useful in alleviating the pain of angina pectoris and in treating heart failure and coronary artery disease. Terminalia may also be useful in treating hypercholesterolemia.
As a traditional medicine, many Ayurveda products have not been tested in rigorous scientific studies and clinical trials. In India, the statutory body of the Central Government, the Central Council for Research in Ayurveda and Siddha (CCRAS), through a national network of research institutes, largely undertakes research in Ayurveda. A systematic review of Ayurveda treatments for rheumatoid arthritis concluded that there was insufficient evidence, as most of the trials were not done properly, and the one high-quality trial showed no benefits. A review of Ayurveda and cardiovascular disease concluded that while the herbal evidence is not yet convincing, the spices are appropriate, some herbs are promising, and yoga is also a promising complementary treatment.
Some Ayurvedic products, mainly herbs used for phytotherapy, have been tested with promising results such as turmeric and its derivative curcumin appearing to have beneficial properties. Among the medhya rasayanas (intellect rejuvenation), two varieties of Salvia have been tested in small trials: one trial provided evidence that Salvia lavandulifolia (Spanish sage) may improve word recall in young adults, and another provided evidence that Salvia officinalis (Common sage) may improve symptoms in Alzheimer's patients. In some cases Ayurvedic medicine may provide clues to therapeutic compounds, for example, derivatives of snake venom have various therapeutic properties. Many plants used as rasayana (rejuvenation) medications are potent antioxidants, whilst Neem appears to have beneficial pharmacological properties as well.
Mitra & Rangesh (2003) hold that cardamom and cinnamon are believed to stimulate digestive enzymes that break down polymeric macromolecules in the human body. Research suggests that Terminalia arjuna is useful in alleviating the pain of angina pectoris and in treating heart failure and coronary artery disease. Terminalia arjuna may also be useful in treating hypercholesterolemia. Azadirachta indica is believed to have immunopotentiating abilities and is used often as an anti-infective. It has been found to enhance the production of IL-2 and increase immunity in human volunteers by boosting lymphocyte and T-cell count in three weeks. Both black pepper and long pepper find application in Ayurvedic medicine in conjunction with ginger to form trikatu—a traditional mixture. Trikatu has been suggested to increase appetite, promote the secretion of digestive juices, and cure certain gastric disorders—particularly achlorhydria and hypochlorhydria.
Safety of Ayurveda
Major safety concerns include adulteration of herbal medicines with toxic metals, and intrinsic toxicity of herbal medications. Some traditional Ayurvedic treatments use toxic metals, herbs, and minerals as part of their remedies. Rasa Shastra, the practice of adding metals, minerals or gems to herbs, increases the likelihood of toxic metals such as lead, mercury, or arsenic in the Ayurveda remedy.
A 2004 study found toxic heavy metals such as lead, mercury and arsenic in 20% of Ayurvedic preparations that were made in South Asia for sale around Boston and extrapolated the data to America. It concluded that excess consumption of these products could cause health risks. A 2008 study found that approximately 20% of Ayurveda remedies (and 40% of rasa shastra medicines) purchased over the Internet from both US and Indian suppliers were contaminated with lead, mercury or arsenic. More than 230 products were included in the study.
Traditionally, the toxicity of these materials are believed to be reduced through processes such as samskaras or shodhanas (for metals), which is similar to the Chinese pao zhi, although the Ayurvedic technique is more complex and may involve prayers as well as physical pharmacy techniques. Rigorous evidence that the metals may be rendered nontoxic is not available, and case reports describe adverse effects to these metals.
There is evidence that using Ayurveda, especially those Ayurvedic medicines involving herbs, metals, minerals, or other materials involves potentially serious risks, including toxicity. Adverse reactions to herbs due their pharmacology are described in traditional Ayurveda texts, but Ayurvedic practitioners are reluctant to admit that herbs could be toxic and the reliable information on herbal toxicity is not easily available.
Following concerns about metal toxicity, the Government of India ruled that Ayurvedic products must specify their metallic content directly on the labels of the product. The harmful effects of the samples are attributed in part to the adulterated raw material and lack of workers trained in traditional medicine. In a letter to the Indian Academy of Sciences, director of the Interdisciplinary School of Health Sciences, University of Pune Patwardhan Bhushan stated that the metal adulteration is due to contamination and carelessness during the much faster modern manufacturing processes, and does not occur with traditional Ayurveda methods of preparation. Publication of the levels of contamination found in the products has resulted in decline of Ayurveda in India as well as abroad.
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