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Ayurvedic Medicine - Core Concept - Therapeutic Principles and PDF
Ayurvedic Medicine - Core Concept - Therapeutic Principles and PDF
Ayurvedic Medicine - Core Concept - Therapeutic Principles and PDF
AYURVEDIC MEDICINE
Core Concept, Therapeutic Principles,
and Current Relevance
Arvind Chopra, MD, DNB, and Vijay V. Doiphode, MASc, PhD
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
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promote health, however, rather than ght 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 Hridaya (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 rst medicinal system of the world.26 In an attempt to simplify the voluminous CS and SS,
many Ayurvedic texts emergedVagbhata (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 classication of diseases. The current text contains references to the English translations of CS and MN. Key Ayurvedic/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 identied 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.
GENERAL CONCEPT AND FUNDAMENTAL
PRINCIPLES
The Ayurvedic philosophy (Nyaya-Vaisheshika) describes a unifying hypothesis linking the universe with all living and nonliving matter.
Human and plant in the hierarchy of cosmic evolution consist of the
same basic matter (Panchbootas, i.e., earth, water, air, re, and ether).
Consciousness or intelligence (Sattva), motion or action (Rajas), and the
inertia that resists them (Tamas) are the three omnipresent nonmaterial
qualities (Gunas) that govern all material forms of basic matter. These
material and nonmaterial attributes subsequently dictate the medicinal
and healing properties of plants and other healing processes. The human
body is a replica model of the universe. The basic matter also gives birth
to the three life forces or energy called Dosha (often crudely equated
with the biologic humor of the Greek system) that pervade all existing
matter.19, 26 Ayurveda explains the diversity in the universe to be due to
the transformation of the earth matter (as a Panchbootas) on contact
with the re energy. Similarly, all anabolic and catabolic transformations
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tion (Bheda) into recovery, cure, complication, and death. There are
ve main etiologic factors: vitiated Dosha, damaged tissues and their
interaction with Dosha, obstruction to the movement of Dosha, suppression 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 identied by modern chemistry) 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 objectsthe 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 ageuniversal and age-related transformations 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 inuence; (2)
nausea immediately after food intake suggests high Kapha; and (3) heartburn 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, vomiting, cough, thirst, altered consciousness, edema, dysuria, inammatory
swelling, menorrhagia), systemic disorders (e.g., cardiac disorders, nervous system), organ disorders (e.g., eye, nose, head, breast, intestine,
penis, vagina), specic disorders (e.g., rheumatism, arthritis, epilepsy,
insanity, leprosy and skin disorders, smallpox, chickenpox, lariasis),
poisoning, and allergy are contained in individual chapters. There are
separate chapters on gastritis and hyperacidity, abdominal tumors, urinary retention, ulcers, venereal diseases, vaginal tumors, puerperal disorders, 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 immunodeciency syndrome [AIDS], as believed 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 described in a recent publication of MN.29
DIAGNOSTIC APPROACH
Evaluation of each of the ve characteristics of a disease as described in MN (see earlier) forms the basis of the diagnostic approach.
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encouraged to make their own medicines. Some herbomineral preparations take years to make. The Ayurvedic pharmacologic processes take
fullest cognizance of the role of nature and environment in the cultivation
and growth and development of medicinal herbs and minerals. The
Ayurvedic drugs comprise vegetable, animal, and mineral and material
products. Most herbal and mineral medicines in current use were described in CS. To understand the healing properties of herbs10, 22 and
minerals, it is important to realize that the basic plant matter, especially
with reference to its Doshic properties, is no different from that of a
human being (see earlier). Also, the latter theory equates food to a drug
and suggests that every matter in the universe can be used as a drug.
Each drug is characterized principally according to elemental constituents (Pachaboota; see earlier), taste (Rasa), potency (Virya), postdigestive effect (Vipaka), and special action (Prabhava); this physicochemical classication also is referred to as based on the energetics of plants
and minerals in Ayurveda. There are six tastes as determined by the
tongue and the effect of the drug on the body: sweet, sour, salty, pungent, bitter, and astringent. The six tastes transmit the properties of the
Panchbootas. Each taste has a pro-Dosha attribute (e.g., sweet, which is
produced by the combination of earth and water, increases Kapha but
decreases Pitta and Vata). According to the Agni-Soma concept, the six
tastes are classied into two major groupshot/ery (pungent, sour,
and salty) and cold/watery (sweet, bitter, and astringent); medicines
acquire similar adjectives. Also as per their consumption of the bodys
digestive power, all tastes and medicines are either heavy (sweet, salty,
and astringent) or light (sour, pungent, and bitter). To a certain degree,
modern analytical chemistry has been used to assign properties of each
of the tastes: (1) The sour, sweet, pungent, and astringent tastes are
determined by acids, starches and sugars, aromatics, and tannins; (2)
bitterness is due to chemicals such as berberine; and (3) salty taste is
uncommon in plants and usually is found in minerals. Numerous common plants used in daily cooking have medicinal properties: (1) Ginger,
onion, and fennel are sweet and pungent and good for the Vata Dosha;
(2) cinnamon (also astringent), pepper, onion, and mustard are predominantly pungent and good for the Kapha Dosha. Drugs are classied
according to their effects on the Dosha (aggravate if similar and alleviate
if opposite): (1) Sour herbals (e.g., oranges, lime) improve digestive Agni
and reduce Kapha but increase the Pitta and the Vata Dosha; (2) sweet
herbs (e.g., psyllium, sesame seeds) increase Kapha but reduce Pitta
and Vata Dosha. Herbals can have complex effects called postdigestive
(Prabhava), which does not follow the above-mentioned general guidelines of plant energetics (e.g., pungent herbals can reduce virility). Some
experts have included in Prabhava certain occult and spiritual effects of
herbals that can affect the psyche (e.g., cannabis). Plant matter also is
characterized according to the tissues that it works best on (e.g., resin
and sap mostly affect the blood). These plant characteristics are kept
in mind to ensure compatibility while mixing medicinal herbs and
minerals.
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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 ofcinalis (Amlaki),
Zingiber ofcinale (ginger), Curcuma longa (circumin), Tinospora cordifolia
(Auduchi), Allium sativum (garlic), Asparagus racemosus (Shatavari), Terminalia chebula (Haritaki), Boerrhaavia diffusa (punaranava), Centelle asiatica (Mandukaparni), Crotalaria pluricaulis (Shankapushpi), Semecarpus anacardium (Bhallatak), Azadiracta indica (Neem), Vitex negundo (Nirgundi),
Ocimum sanctum (tulasi), Piper longum (pippali), and Aloe vera (ghritkumari). Many of these plants are well known for their antiarthritic properties.6 The fruit of Terminalia chebula is an excellent example of a herbal
medicine used to balance all three Dosha and nds use in diverse
ailments; in the Tibetan system, it is called the king of all medicines.10
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tion (CS, Ch 29, V 129). The authors do not believe such methods are
in use any longer.
OBESITY
Obesity (Medoroga) is one of the oldest documented disorders of
adipose tissues (Medas) in Ayurveda.19 Pendulous hips, abdomen, and
breasts with vitality disproportionately less than the body size is one
such ancient denition of obesity. All the currently known etiologic
factors and consequences of obesity were described in CS. The chief
etiopathologic cause is the deranged Ama and focal concentration of the
Vata Dosha in the stomach. Complications sometimes differ as per the
Prakruti: (1) Kaphadiabetes, stula, and lipomatous growths; (2)
Vataarthritis and constipation; and (3) Pittahypertension, hyperacidity, and renal infections. Management of obesity is a prime example of
the holistic approach. The medications, diet regulation, and exercises
(preferably Yoga) gradually are overtaken by the changes in lifestyle,
preventive measures, and rejuvenation.
VALIDATION AND MODERN RELEVANCE
The ancient Ayurveda dealt with numerous human ailments, and
most of these ailments continue to afict humans. It is likely that the
current Ayurvedic approach is hampered with ancient links and logic,
some of which no longer may be relevant. Extensive clinical observations, intuition and insight, and interpretations that were based largely
on the Hindu Vedic philosophy and the Tri-Dosha hypothesis drove the
ancient system. Times have changed. Ayurveda must adapt to the modern human without losing its core strength and relevance.
Publications10, 13 have tried to convey the interpretation and relevance of the science of Ayurveda to the need of modern times. Recent
controversies, more political than science, regarding the current status
and recognition of Ayurveda in the United Kingdom have been addressed seriously by a lucid historical review35 on the Ayurvedic contributions to the world of medicine. Scholars have begun to ponder the
possibility of futuristic designer drugs customized to the patients illness
and based on an Ayurvedic database; this would match an individuals
diagnosis (based on dosha-prakriti and other etiologic factors as perceived
in Ayurveda; see earlier) and herbal-mineral pharmacopoeia (also containing Ayurvedic characterization of medicinal properties).17 Much of
the development of modern medicine originated from plant-based formulations (e.g., quinine, salicylates, digoxin, reserpine, colchicine, vincristine, docetaxel), which then continued to provide leads for discovery
of newer medicinal molecules. It is likely that those leads will be exhausted, and a new search will be required. The mass screening of plants
is likely to be expensive and inefcient. It is against this background
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that a search (bioprospecting research) for newer leads from ethnic plantbased medicinal systems such as Ayurveda is warranted.17 This search
obtains a greater signicance 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 acceptance 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 scientic explanation for
the variations and idiosyncrasies in the therapeutic responsiveness observed with numerous modern drugs. Modern Ayurvedic physicians
believe that Prakruti has a genetic basis. Phenotyping disease susceptibility 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 scientic means.15
Can Ayurveda be delivered in a capsule? A Medline search using
the word Ayurveda identied 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 fundamental Dosha to the therapeutic outcome. The customized Ayurvedic holistic
approach is difcult to validate. This approach has a tremendous commonsense 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 conrm that view. Despite popular belief, however,
Ayurvedic medicines do have toxicity.3, 6, 14 The authors own uncontrolled 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 unsatisfactory and more so with CAM. Also, little is known about the drug
interactions between Ayurvedic and modern drugs. Indian physicians,
regardless of their basic qualication and experience, often dispense
CAM drugs along with modern drugs. More often than not, patients
often consume multiple CAM drugs along with modern medicines without 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
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composition of some popular indigenous medicines (found to be adulterated deliberately with modern medicines so as to provide quick relief).
The authors often have been surprised to discover the long-term use of
such fake and dangerous medicines by patients who are from better
socioeconomic classes and educational backgrounds. Patients with cushingoid features in the authors rheumatology clinic sometimes are
found to have consumed so-called herbal medicines.
Modern Ayurveda faces the challenging tasks of drug standardization (especially when multicomponent) and validation (clinical and
structure-activity relationships). Despite socioeconomic and logistic
problems in the Third World,7 several Ayurvedic drugs in popular use
today can be evaluated rapidly in controlled clinical situations. Some
kind of a reverse clinical pharmacology model could be put into use
whereby studies to dene pharmacology and mechanism of action follow clinical evaluation. In the modern context of drug development,
the latter would translate into huge nance and time savings. In an
overenthusiastic attempt to discover more effective single molecule
drugs, however, it should not be forgotten that the medicinal strength
of these ancient herbals probably lies in the plant habitat of the formulation and that a reductionist approach may trade off safety for efcacy.
Experimentation should be initiated with the Ayurvedic medicines
that hold a promise,23 at least for difcult-to-treat chronic diseases.
Ayurveda cannot be ignored in the pursuit to make medicine evidence
based. Also there is a possibility of integrating some of the Ayurveda
components into modern medicine. In the latter scenario, Ayurvedic
therapy could occur concurrently or sequentially, depending on the stage
and intensity of the illness. Ayurvedic and allopathic physicians would
have to work together with some understanding of each others pathy.
A futuristic medicinal system of modern medicineAyurveda interface already has begun to emerge in India.
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 signicant contributions to this article.
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Address reprint requests to
Arvind Chopra, MD, DNB
Baba House
765 Dastur Meher Road
Camp, Pune 411001
India
e-mail: archopra@pn2.VSNL.net.in