According to many scholars, Ayurvedic medicine (also called Ayurveda) is one of the world’s oldest healing systems. The term “Ayurveda” combines the Sanskrit words ayur (life) and veda (science or knowledge). It originated in India more than 3,000 years ago and remains one of the country’s traditional health care systems. The majority of India’s population uses Ayurvedic medicine exclusively or combined with conventional Western medicine. Ayurveda is also practiced in varying forms in Southeast Asia and in other parts of the world.
In Ayurveda, health is viewed as much more than the absence of disease and a great emphasis is placed on prevention. Key concepts of Ayurvedic medicine include; universal interconnectedness, the body’s constitution (prakriti), and life forces (dosha). Its fundamental tenet is that we must reach our unique state of balance in our whole being—body, mind, and consciousness.
Prakriti, Vikruti and Doshas
According to Ayurveda, each person has a constitution or prakriti that is specific to him or her. Prakriti relates to the genetically inherited physical and emotional qualities. It is determined at the time of conception by the combination of three constitutional principles or doshas present in the individual at that time. Ayurveda’s three constitutional principles – vata, pitta, and kapha – can be compared to the biologic ‘humors’ of the ancient Greek system. They are loosely translated as Air, Fire and Earth, respectively.
Our prakriti is fixed throughout our lifetime but it is influenced by the constant interaction with our environment as the body tries to maintain a state of balance. This dynamic equilibrium between our different doshas (life forces) results in an adaptive condition called vikruti. The vikruti reflects one’s ability to adjust to life’s influences, but it should match the prakriti as closely as possible. If the current proportion of the doshas differs significantly from the constitutional proportion, it indicates imbalances, which in turn can lead to illness.
Here is a brief summary of the attributes and bodily functions associated with the different doshas.
|dry, light, cold, rough, subtle, pervasive, mobile, clear||chewing, swallowing, nerve impulses, breathing, muscle movements, thinking, peristalsis, bowel movements, urination, menstruation|
|sharp, penetrating, hot, light, liquid, mobile||digestion, metabolism, temperature maintenance, sensory perception, comprehension, inflammation|
|heavy, cold, dull, oily, smooth, dense, soft, static, liquid, cloudy, hard, thick||skeleton, organs, fatty molecules (lipids)|
Each person has all three doshas present in their constitution in various proportions, resulting in seven potential prakritis:
–Dosha-Predominant : vata-predominant, pitta-predominant, kapha-predominant
–Dual Prakritis (where 2 doshas are equally predominant): vata-pitta predominant, pitta-kapha predominant, vata-kapha predominant
–1 prakriti that has all 3 doshas nearly equally prominent: vata-pitta-kapha predominant
Based on these concepts, Ayurvedic physicians prescribe individualized treatments to restore and maintain the balance between vikruti (current state) and prakriti (basic constitution) taking into account the season and the geography.
The first line of defense in combating imbalances is to remove the root cause of the problem in order for the body to begin to heal itself. The remaining imbalances can be rectified by using opposites. For example, excess heat or acidity in the digestive system would require the ingestion of cooling and soothing herbs like shallaki (Boswellia). Ayurveda emphasizes the importance of supporting the digestive fire for optimal nutrients absorption and proper elimination of waste materials.
Ayurvedic recommendations draw on a number of modalities including diet modifications, lifestyle adjustments, herbal compounds, cleansing processes (Panchakarma), meditation, yoga and breathing techniques (Pranayama), and energetic pressure points (Marma).
Medicinal Herbs in Ayurveda
Unlike the Western pharmacological understanding of herbs based on their chemical constituents, Ayurveda approaches them through their energetic qualities. In addition to a herb’s energetic action (virya), herbs and plants are classified according to their taste (rasa) – sweet, bitter, sour, salty, pungent and astringent- post-digestive effect (vipaka), their action on the doshas, their affinity for the different bodily systems, and to other special properties (prabhava) they may exhibit.
Herbs can be taken separately to address specific health issues, but well balanced constitutional formulas are often more effective. Ayurvedic physicians usually prepare personalized herbal formulas in which herbs are combined cooperatively in a holistic and individualized manner and adjust them accordingly to their patient’s situation changes.
Below is a brief list of Ayurvedic herbs and some of their common indications in non-Ayurvedic terms.
|Indian name||Latin name||Common name||
Properties – indications
|Emblica officinalis||Indian gooseberry||Hyperacidity, constipation, ulcers, hepatitis, colitis, high cholesterol, diabetes, anemia, radiotherapy and chemotherapy|
|Terminalia arjuna||Arjuna myrobalan||Heart, lungs, skin, liver, reproductive tissues, anemia, tumors, asthma, cardiac and circulatory problems|
|General debility, insomnia, low libido, impotence, infertility, multiple sclerosis, enlarged prostate, skin diseases.|
|Bhumyamalaki||Phyllanthus amarus; P. niruri; P. fraternus (US)||Chancra piedra||Jaundice, liver disease, fever, genitourinary disease, edema, gallstones, menorrhagea|
|Terminalia belerica||Beleric myrobalan||Digestive disorders, bronchitis, asthma, Chron’s disease, colitis, parasites, congestion of eyes, ears and nose, insomnia, bladder stones, cardiac congestion.|
|Bacopa||Memory loss, debility, cystitis, headaches, epilepsy, ADHD, Asperger’s syndrome, depression, autism.|
|Curcuma longa||Turmeric||Infections, ulcers, dyspepsia, diabetes, gallstones, skin diseases, conjunctivitis, cysts, endometriosis, dysmenorrhea, fevers, septicaemia, high cholesterol.|
|Terminalia chebula||Chebulic myrobalan||Constipation, hemorrhoids, eye disorders, dysentery, parasites, hemorrhoids, high cholesterol, coughs, conjunctivitis.|
|Shallaki||Boswellia serrata||Boswellia||Antiarthritic, analgesic, anti inflammatory|
|Gymnema sylvestre||Gymnema||Diuretic, astringent, hypoglycemic, refrigerant, stomachic|
|Glycyrrhiza glabra||Licorice root||Wounds, sore throat, colds, coughs, nervous exhaustion, liver, skin conditions,ulcers, cystitis, chronic fatigue.|
Is Ayurvedic medicine effective?
In spite of the thousands of years of existence and application of Ayurvedic medicine, the National Center for Complementary and Alternative Medicine of the National Institutes of Health concludes that there aren’t enough well-controlled clinical trials and systematic research reviews to prove that the approaches are beneficial. However, we must bear in mind that Ayurveda is a holistic and highly individualized medicine for which the so-called ‘well-controlled clinical trials’ model —the gold standard for Western medical research— is poorly suited.
Problems in Clinical Trials of Ayurvedic Medicine
As mentioned previously, prakriti determines the effectiveness of particular herbal medicines and would have to be a major factor to consider as an inclusion/exclusion criterion in clinical studies. The administration of a herb or herbal compound to a subject population of various constitutions may not yield uniform outcomes. Ayurveda also proposes different interventions at different stages of disease, providing another variable difficult to control in a clinical trial.
Another factor to consider is the cost of such clinical trials. The universal standard for pharmaceutical testing is repeated, large-scale, randomized double-blind tests. In order to recuperate the considerable costs of testing to the regulatory standards, pharmaceutical companies have to patent the substances tested and sell them with a substantial profit. Plants cannot be patented, very few research companies are willing to fully invest the time and money necessary to satisfy the regulatory requirements.
With the increased popularity and demand for safe and effective natural remedies, it has become imperative to examine some of the challenging issues that are being faced by clinical research trials with herbal medicines. Some initiatives in that direction are encouraging. For example, statistical analysis reveals that curcumin – derived from Curcuma longa – is the most widely-studied plant-derived medicinal chemical in modern science.
A preliminary clinical trial funded in part by NCCIH in 2011 found that conventional and Ayurvedic treatments for rheumatoid arthritis had similar effectiveness. The conventional drug tested was methotrexate and the Ayurvedic treatment included 40 herbal compounds. Another preliminary clinical trial found that osteoarthritis patients receiving a compound derived from Boswellia serrata gum resin had greater decreases in pain compared to patients receiving a placebo.
Although more clinical trials to assess the safety and efficacy of Ayurvedic herbal remedies and interventions would be desirable, we must remember that Ayurveda has been passed down through the centuries as a complete healing system, evolving to meet the needs of the time, and yet remaining committed to its core principles. Various cultures have drawn upon the ideas of Ayurvedic medicine, and it continues to thrive in both the East and the West. If we move beyond our Western medical paradigm and clinical trials, we are forced to admit that Ayurveda’s long standing tradition and increasing popularity are the best testimony to its efficacy and innocuity.
Ashish K Sharma*,I; Rajesh KumarII; Anurag MishraIII; Rajiv GuptaIII Problems associated with clinical trials of Ayurvedic medicines. Problemas associados com ensaios clínicos de medicamentos Ayurvédicos. Revista Brasileira de Farmacognosia. Rev. bras. farmacogn. vol.20 no.2 Curitiba Apr./May 2010 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-695X2010000200023
Lad, Vasant. Ayurveda – A brief Introduction and Guide.