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AYURVEDIC MEDICINE
Core Concept, Therapeutic Principles,
and Current Relevance
ORIGIN
From the Center for Rheumatic Diseases-Hermes Doctor House, Bharati Hospital and
Medical College, and Inlaks-Budhrani Hospital (AC); and Department of Ayurvedic
Medicine, University of Pune (VVD), Pune, India
promote health, however, rather than fight disease. The Ayurvedic text,
an offspring of the Atharvaveda, appeared sometime in 1500 to 1000 BC
and described two schools of learning (physicians [Atreya] and surgeons
[Dhanvantari]) and eight branches of clinical science (internal medicine
[Kayachikitsa], surgery [Shalyatantra], pediatrics, toxicology, psychiatry,
ophthalmology and otorhinolaryngology, rejuvenation [Rasayana], and
sexual vitality [Vajikarana]).
Caraka Samhita (CS),25 Sushruta Samhita (SS), and Ashtanga Hri-
daya (600 AD) are the three most revered ancient Ayurvedic reference
texts. Caraka and Sushruta are considered to be the forefathers of the
system. Ayurveda often has been considered as the first medicinal sys-
tem of the world.26 In an attempt to simplify the voluminous CS and SS,
many Ayurvedic texts emerged—Vagbhata (700 AD), Madhav Nidan
(MN),24 Sharangdhera Samhita, and Bhava Prakash (1600 AD). Centuries
later, these ancient texts still are available, although much has been
lost to the vicissitudes of time and altered human perceptions and
translations.
Based on CS with a similar style of verses, MN exclusively deals
with the diagnosis and classification of diseases. The current text con-
tains references to the English translations of CS and MN. Key Ay-
urvedic/Sanskrit terms often are quoted in parentheses and when in
frequent use are italicized. Plural forms of the latter terms are not used
(e.g., a Dosha could be 1 or more). When found relevant, the authors
have quoted the Sanskrit verse (V) and its chapter (Ch). Medicinal plants
have been identified by their modern botanical name, along with the
popular Indian name. In several complex situations, the authors have
exercised their own viewpoint based on popular concepts rather than
some authoritative text.
in the body occur as a result of the existence of the inherent fire (Agni)
energy. The manifest world is traced, however, to the unmanifest called
Prakruti (also spelled as Prakriti). Prakruti signifies nature and individual
human constitution and is driven by a harmonious equilibrium between
cosmic intelligence, ego (Ahamkara), and self-consciousness.31 The prac-
tice of Ayurveda in daily life aims at maintaining that harmony to
ensure optimal health. The overall Prakruti comprises physical (largely
under genetic and intrauterine influences), psychologic, and functional
(Dosha) attributes and remains unchanged for life.
The three Dosha (i.e., Vata, Pitta, and Kapha) are the primary dynamic
physiologic forces and are considered to govern the biomotor, metabolic,
and preservative (homeostasis) activity. Dosha also are formed constantly
in the body from food and other physiologic processes. Vata (material
air ether), the most powerful force, governs motion and controls
cell division, arrangement, and differentiation; impulse transmission
(including cardiorespiratory and all the higher functions in the brain);
movement of body fluids and excreta; parturition; and above all the
mind; it is most relevant to the nervous and musculoskeletal system.
Pitta (material fire) governs metabolism and the formation of tissues
and waste products; it is most relevant to the digestive and endocrine
system. Kapha (material earth water) increases cell mass, promotes
bonding of tissues, prevents destruction of tissues, maintains strength
and immunity, and determines body growth. Each Dosha has its own
characteristic anatomic, physiologic, and psychologic expressions. Vata
is dry, cold, light, and clear. Pitta is hot, light, fluid, and clear. Kapha is
cold, wet, heavy, cloudy, and static. The three Dosha are in equilibrium
(Samya) with respect to their quantity (Pramana), quality (Gunas), and
functions (Karmas) and remain in balance—this is the basis of health
(Arogya). The body adjusts to the numerous changes that continuously
occur in Dosha under the influence of numerous factors (e.g., diet,
seasons, activity, age). Although Vata, Pitta, and Kapha often colonize in
the intestine, stomach, and chest, they are ubiquitous. The gastrointesti-
nal system plays a central role for the health of every other system.
There is a digestive fire (Agni) in the intestines (converts food into a
homogeneous mass), tissues (for assimilation and metabolism and tissue
formation), and certain elements (for special senses). The Dosha equilib-
rium is essential for optimal health and prevention of disease; any
imbalance causes disease.19, 26, 34
Each individual is composed of seven constituents (Dhatu): plasma
(called Rasa and sustains all other tissues), blood, muscle and flesh,
bone, marrow, fat, and semen/ova (Shukara). Waste products (Malas)
can be gross (e.g., urine, feces) or subtle (e.g., epithelial linings of the
eye, smegma). Rasayana (see earlier) aims at strengthening Rasa. Fluids
and life forces travel through channels (Srotas) that connect tissues with
one another and the gut.
The body strength (Bala) has two components—physical strength
and resistance to diseases (Vyadhikshamatwa). The immunity depends
on the quality of tissues (especially Rasa), Kapha, Shukara, and Ojas. Ojas,
78 CHOPRA & DOIPHODE
CONCEPT OF DISEASE
tion (Bheda) into recovery, cure, complication, and death. There are
five main etiologic factors: vitiated Dosha, damaged tissues and their
interaction with Dosha, obstruction to the movement of Dosha, suppres-
sion and alteration in Agni (akin to digestive and metabolic activity),
and formation and accumulation of toxins and Ama (see later).
The Ama hypothesis links the gastrointestinal system with numerous
diseases. Ama, a viscous substance (not yet identified by modern chemis-
try) produced in the gut, is a result of weakened digestion and metabolism
(Mandagni), food indiscretions, and disturbed Dosha equilibrium. The
circulation and abnormal deposition of Ama, often in conjunction with
the Vata Dosha, causes numerous diseases, especially arthritis (MN, Ch
25).
General etiologic factors have been described: (1) incompatibility
between the special senses and their objects—the senses are the real link
with the external world and any deviation in their optimal interaction
with their target causes illness; (2) volitional transgression or crime
against wisdom (Prajnapradha)—willful misuse of body, mind, and
speech; (3) effect of time and age—universal and age-related transforma-
tions and changes contribute to illness. Some common symptoms are a
direct result of alterations in a Dosha or Agni, including the following:
(1) Abdominal distention, diarrhea, constipation, and abdominal colic
often are due to erratic digestive Agni under the Vata influence; (2)
nausea immediately after food intake suggests high Kapha; and (3) heart-
burn 2 to 3 hours after food intake suggests excess Pitta.
MN describes a wide spectrum of diseases contained in 68 chapters.
The symptomatic disorders (e.g., fever, diarrhea, anorexia, hiccups, vom-
iting, cough, thirst, altered consciousness, edema, dysuria, inflammatory
swelling, menorrhagia), systemic disorders (e.g., cardiac disorders, ner-
vous system), organ disorders (e.g., eye, nose, head, breast, intestine,
penis, vagina), specific disorders (e.g., rheumatism, arthritis, epilepsy,
insanity, leprosy and skin disorders, smallpox, chickenpox, filariasis),
poisoning, and allergy are contained in individual chapters. There are
separate chapters on gastritis and hyperacidity, abdominal tumors, uri-
nary retention, ulcers, venereal diseases, vaginal tumors, puerperal dis-
orders, pediatric diseases, pregnancy, vesicle calculus, diabetes, scrotal
swellings, and alcohol intoxication. Disorders such as anemia, jaundice,
and hepatitis are dealt with together. Descriptions akin to pulmonary
tuberculosis (and acquired immunodeficiency syndrome [AIDS], as be-
lieved by the Ayurvedic physicians) are contained in the chapter on
wasting diseases. Peptic ulcer is described along with abdominal colic.
Cervical lymphadenopathy, scrofula, goiter, and tumors are described
together. Fractures of bones are dealt with separately. The probable
modern medicine equivalent of some of the Ayurvedic diseases is de-
scribed in a recent publication of MN.29
DIAGNOSTIC APPROACH
Evaluation of each of the five characteristics of a disease as de-
scribed in MN (see earlier) forms the basis of the diagnostic approach.
80 CHOPRA & DOIPHODE
MEDICINES
The Ayurvedic pharmacology, including preparation of herbal and
mineral compounds, is a distinct and exhaustive subject. Physicians are
82 CHOPRA & DOIPHODE
RASAYANA
compared with the Chinese plant ginseng; the Aswagandha root is used,
which predominantly reduces the Vata and Kapha Dosha (when overused
can cause toxicity owing to excess Ama and Pitta). Some other plants
with well-known Rasayanic properties are Emblica officinalis (Amlaki),
Zingiber officinale (ginger), Curcuma longa (circumin), Tinospora cordifolia
(Auduchi), Allium sativum (garlic), Asparagus racemosus (Shatavari), Ter-
minalia chebula (Haritaki), Boerrhaavia diffusa (punaranava), Centelle asiat-
ica (Mandukaparni), Crotalaria pluricaulis (Shankapushpi), Semecarpus an-
acardium (Bhallatak), Azadiracta indica (Neem), Vitex negundo (Nirgundi),
Ocimum sanctum (tulasi), Piper longum (pippali), and Aloe vera (ghritku-
mari). Many of these plants are well known for their antiarthritic proper-
ties.6 The fruit of Terminalia chebula is an excellent example of a herbal
medicine used to balance all three Dosha and finds use in diverse
ailments; in the Tibetan system, it is called the king of all medicines.10
One of the authors has dealt with the subject of arthritis and rheu-
matism.6 Arthritis was included along with nervous system disorders in
the ancient texts (CS, Ch 28, and MN, Ch 22). The ailments of arthritis
and rheumatism are as ancient as human civilization.6, 33 Vatasonita (CS,
Ch 29), Vatarakta (MN, Ch 23), and Amavata (MN, Ch 25) are described
as painful and swollen forms of arthritis, with differences in clinical
profiles. It is difficult to find a precise description of rheumatoid arthritis
in the ancient texts, but fascinating parallels can be found. The condition
of Amavata (MN, Ch 25, but not described in CS) is described as a
dreadful polyarticular disease with weakness and heaviness of the heart
(MN, Ch 25, V4-5); modern Ayurvedic physicians believe this to resem-
ble rheumatoid arthritis, but the profile could be that of rheumatic fever
arthritis. The vitiated Vata Dosha and Ama are the chief culprits in the
pathogenesis of arthritic disorders. Ancient Ayurveda linked arthritis to
disorders of the gut. This is fascinating because thousands of years later,
modern medicine has established the same link in several forms of
seronegative spondyloarthritis and postinfective/reactive arthritides.
Modern immunologists have begun to characterize specific subsets of T
cells in the intestinal mucosa that often attach on to the synovial tissues.
Pain is considered a multifaceted dimension, and its relief is given
prime importance. The neuropsychologic and the psychosomatic factors
in the cause and treatment of several medical diseases have been de-
scribed extensively in the ancient literature. Some fascinating healing
methods for painful musculoskeletal disorders have been advocated
(e.g., ‘‘the patient lying on a bed moistened with dews of moonrays
covered with flax and lotus leaves and fanned with breeze cooled by
contact of sandy beach should be attended by beloved and sweet spoken
women with their breasts and hands pasted with sandal and with cold
and pleasing touch who remove burning sensation, pain and exhaus-
AYURVEDIC MEDICINE 85
tion’’ (CS, Ch 29, V 129). The authors do not believe such methods are
in use any longer.
OBESITY
that a search (bioprospecting research) for newer leads from ethnic plant-
based medicinal systems such as Ayurveda is warranted.17 This search
obtains a greater significance in terms of socioeconomic impact and the
inherent appeal and acceptance of herbal medicines by the community.
Ethnomedical validation,36 although an emerging science, essentially
is based on knowledge of ancient ethnic medicinal systems. The ancient
Ayurveda emphasized repeated observations (Bhuyo Darshana) and ac-
ceptance of data as reliable only if of uniform consistency (Anvaya)
without any contradictions (Vyatireka) and laid the foundation of the
validation process. Doubts have begun to loom large on the validity and
relevance of some of the ancient hypotheses and paradigms, particularly
with reference to Dosha and Prakruti, in the treatment of diseases. It is
possible that the Doshic Prakruti may provide scientific explanation for
the variations and idiosyncrasies in the therapeutic responsiveness ob-
served with numerous modern drugs. Modern Ayurvedic physicians
believe that Prakruti has a genetic basis. Phenotyping disease susceptibil-
ity may be a Doshic phenomenon. Numerous such hypotheses can be
raised. It may not be feasible and probably is not required to validate the
entire Ayurvedic medicinal system. Some of the fundamental Ayurvedic
theories and practices of therapeutic relevance need to be validated
using modern scientific means.15
Can Ayurveda be delivered in a capsule? A Medline search using
the word Ayurveda identified more than 300 publications since 1996.
Several Ayurvedic medicinal plants have been tested for biologic1, 8, 27, 37
and clinical value.2, 5, 7, 9, 12, 16, 28, 30 None of the Ayurvedic drug trials
mentioned have tried to evaluate the relevance, if any, of the fundamen-
tal Dosha to the therapeutic outcome. The customized Ayurvedic holistic
approach is difficult to validate. This approach has a tremendous com-
monsense appeal, however. Modern medicine, despite its overwhelming
strengths, tends to be uncomfortably impersonal. Physicians should
borrow some of the Ayurvedic techniques of treatment to provide better
comfort and solace to patients.
To a reasonable extent, centuries of clinical use, however anecdotal,
promise inherent safety, and the drug trials referred to in this article to a
large extent seem to confirm that view. Despite popular belief, however,
Ayurvedic medicines do have toxicity.3, 6, 14 The authors’ own uncon-
trolled observations would suggest that toxicity is less in frequency and
intensity compared with modern medicine. The true extent of the latter
is not well documented, and much of it goes unrecognized in clinical
situations such as in India. Medical documentation in India is unsatis-
factory and more so with CAM. Also, little is known about the drug
interactions between Ayurvedic and modern drugs. Indian physicians,
regardless of their basic qualification and experience, often dispense
CAM drugs along with modern drugs. More often than not, patients
often consume multiple CAM drugs along with modern medicines with-
out the knowledge of the physician. Sometimes, Ayurvedic drugs are
found to be substandard, but this problem is being tackled vigorously.24
The Indian news media often has reported detection of the fraudulent
AYURVEDIC MEDICINE 87
ACKNOWLEDGMENT
It has not been possible to refer to all the Ayurvedic reference texts that are taught
and practiced. Also, there are several reputed orthodox Indian Ayurvedic centers that
have been practicing variants of traditional Ayurveda as passed down through generations
of physicians in the family. Dr. J. Patil (Ayurvedic Physician, CRD, Pune), Dr. Sudip Saha
(Physician and IT-Data Consultant, Pune), Prof. B. Patwardhan (Head, School of Health
Sciences, Pune University), Dr. Deepa Chitre (CEO, Ayurcore Inc, San Jose, CA), and S.
Karnatki (Consultant Plant-Chemist, Pune), among several colleagues, have made signifi-
cant contributions to this article.
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e-mail: archopra@pn2.VSNL.net.in