Full Background and Explains about Ayurveda

Date updated: March 08, 2007
Natural Standard Research Collaboration

Synonyms

Abhyanga, Ayurvedie, Ayurvedaha, Ayurvedic herbs, dosha, kapha, Maharishi Ayur-Veda, panchakarma, pitta, prakriti, prana, pranayama, rasayana, science of life, tridosha, vata, vikriti, yoga.

Background

Ayurveda, which originated in ancient India over five thousand years ago, is probably the world's oldest system of natural medicine. When translated, its name is referred to as "science of life", and it stems from the ancient body of spiritual teachings known as the Vedas. Some medical historians believe Ayurveda was also the original basis for Chinese medicine.

Ayurveda is an integrated system of specific theories and techniques employing diet, herbs, exercise, meditation, yoga, and massage or bodywork. The goal of Ayurveda is to achieve optimal health on all levels: physical, psychological and spiritual.

In India, Ayurveda involves the eight principal branches of medicine: pediatrics, gynecology, obstetrics, ophthalmology, geriatrics, otolaryngology (ear, nose, and throat), general medicine, and surgery. It is used by 80% of the Indian population today, although it exists side by side with conventional medicine. There are more than a quarter million practitioners of Ayurveda in India and there are entire hospitals based on this approach to medicine.

Ayurveda made its way to the West mainly through Europe where it still has a strong presence today. However, in modern times and particularly in western countries, the practice of Ayurveda is less focused on its spiritual roots than on its use as a form of complementary or alternative medicine.

Ayurveda is practiced in the West by health care professionals who are licensed in a variety of disciplines such as M.D.'s, osteopathic physicians (D.O.'s), naturopaths, acupuncturists, nurses, massage therapists and chiropractors. It is also practiced by lay people who are not licensed but function as health counselors, educators or consultants. To practice this discipline the standard length of training in India is five years, but there are no agreed upon standards in the West.

The West offers two major currents of training and practice. The first is offered by a diverse variety of teachers and practitioners, many of whom are either from India or were trained there. The second consists of devotees of Maharishi Mahesh Yogi, the Indian spiritual teacher who introduced Transcendental Meditation (TM) to the West. In 1980 this group coined the term "Maharishi Ayur-Ved," which incorporates TM as part of an Ayurvedic approach.

Ayurveda relies heavily on the individual's willingness to participate in lifestyle and behavior changes.

Theory

Similar to other traditions of nature-based medicine, Ayurveda teaches that vital energy - referred to as prana -- is the basis of all life and healing.

As prana circulates throughout the human body it is governed by the five elements: earth, air, fire, water, and ether. These terms represent subtle qualities of prana energy and how it expresses itself in our bodies. Health is a state of balance and harmony among the five elements, and illness occurs when there is imbalance or lack of harmony among them.

The five elements combine with one another into pairs called doshas. There are three doshas: vata (ether and air), pitta (fire and water), and kapha (earth and water).

Certain doshas predominate in each person from conception to determine their personal energetic constitution - called their prakriti - that stays with them for life. Each person's prakriti has an identifiable pattern in which one or more doshas are dominant. Thus there are seven prakritis possible: vata, pitta, or kapha; the combinations of vata-pitta, pitta-kapha, or vata-kapha; and the most complex, vata-pitta-kapha.

Illness or imbalance is referred to as the person's vikriti. The vikriti is described in terms of how the doshas are out of balance in comparison to the prakriti.

Ayurveda gives the highest priority to prevention, health promotion and enhancement. When illness is present, however, it offers a complete system for treatment. The overall goal is always to foster balance and harmony among the doshas, and to purify and harmonize the entire mind/body system.

Disease entities or pathogens (germs, viruses) are not the main focus of treatment. Rather it is the person's level of balance and harmony between the doshas and elements and the consequent level of the body's resistance to illness that is of concern.

The health practices of Ayurveda are selected according to the person's prakriti and what energetic imbalances may be present. Foods, herbs, exercises and other treatments are all chosen on the basis of their ability to regulate certain doshas.

Food and diet: The regulation of diet as a form of therapy is a central ideal; an individual's mental and spiritual development as well as temperament can be influenced by the quality and quantity of food consumed. An important principle in Ayurveda is that "there is nothing in the world that is not a medicine or food."

Foods and herbs are described in terms of their energetic qualities rather than the chemical properties of Western scientific understanding.

Food should be eaten according to one's prakriti (constitution). Certain foods should not be combined, and certain foods should be eaten at different times of day.

Spices are used to aid digestion or counteract the energetic qualities of different foods.

Chronobiology: Ayurveda holds that each 24-hour cycle is divided into four-hour segments that are governed by the doshas. From 10 to 2 (both a.m. and p.m.) is a pitta period, from 2 to 6 is a vata period, and from 6 to 10 is a kapha period. These time periods are believed to correspond with nature, and dictate optimal times for certain activities or bodily functions such as exercise, work, rest, digestion, fasting or healing. Practitioners guide patients to plan their activities to be in harmony with these natural principles of timing. For example, the mid-day pitta period is the time of strongest digestive function and should be the time of the largest meal; food should not be consumed during the night pitta period as this is a time of restoration and healing of vital organs.

Diagnosis:In an Ayurvedic theory, "diagnosis" means determining one's prakriti and what imbalances are present (vakriti), not by labeling specific diseases with Western terms. Ayurvedic theory calls for diagnosis using a variety of sources of information. A practitioner usually conducts an extensive individual interview for taking a health history, which may include written questionnaires. This information is followed by pulse diagnosis (palpating the wrist to determine subtle qualities of the pulse). Practitioners may also evaluate the appearance of the tongue, face, lips, nails and eyes for diagnostic information. Some use laboratory tests of blood, urine, and stools to assist with diagnosis.

Treatment: Treatment theory focuses on a comprehensive treatment plan (rasayana) that may combine dietary changes, herbs, meditation, breathing exercises (pranayama), Ayurvedic massage (abhyanga), yoga postures (asanas), detoxification and rejuvenation programs (panchakarma), and lifestyle changes. Thus the bulk of the responsibility for treatment rests with the patient through integrating the recommendations into their daily lifestyle.

Most practitioners do not perform actual treatments or healing in the office, although some massage therapists will perform Ayurvedic massage.

Typically the initial consultation is the longest, lasting from forty-five to ninety minutes. Follow-up consultations may be spaced several weeks or even months apart to monitor progress. These will usually be brief office visits involving diagnostic review and a fine-tuning of the treatment regimen.

Research support: Ayurveda is predominantly a "person-specific" approach. This means that two individuals with the same symptom might be treated very differently in terms of herbal remedies, lifestyle changes, yoga postures, diet, or other factors. Such individualization makes it difficult to design Western-style clinical trials of Ayurveda treatment regimes. Nonetheless, several specific herbal formulations have been studied in Western-style clinical trials.

Evidence

Anal fissure

There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for an anal fistula (1;2).

Grade: C

Angina

Abana is a combination herbal and mineral formulation traditionally used in Ayurveda for cardiovascular health. Its main ingredients areTerminalia arjuna, Withania somnifera, Terminalia chebula, Phyllanthus emblica, Nardostachys jatamansi,
Tinosporia cordifolia, Glycyrrhiza glabra, Zingiber officinale,andNepeta hindostana. There is evidence from two studies that abana may reduce the frequency and severity of angina pain (3;4).

Arjuna (Terminalia arjuna)is a type of bark powder traditionally used as an anti-ischemic and cardio protective agent in hypertension and ischemic heart diseases. It may be a safe and effective anti-angina agent comparable to isosorbine mononitrate (ISMN) and better tolerated (5).

Grade: C

Asthma

There is evidence from one well-designed trial that daily supplementation with gum resin ofBoswellia serrata, known in Ayurveda as Salai guggal, may reduce dyspnea, rhonchi, and the number of attacks in bronchial asthma (6).

Another herb, Devadaru (Cedrus deodara), may have antispasmodic effects and reduce symptoms in bronchial asthma, particularly for patients with shorter histories of asthma and lower frequencies of attacks (7).

Grade: C

Atherosclerosis

Evidence suggests that carotid intima-media thickness (IMT), a measure of atherosclerosis, may be reduced with a comprehensive program including diet, exercise, stress reduction and a combination herbal formula (Maharishi Vedic Medicine) -- particularly in patients with a marked congenital heart disease (CHD) risk (8).

Studies also suggest that Maharishi Amrit Kalash (MAK) -4 and MAK-5, two modern formulations of traditional Ayurvedic herbal remedies, may inhibit low density lipoprotein (LDL) oxidation in patients with hyperlipidemia. Thus they may be useful in the prevention and treatment of artherosclerosis (9). The ingredients in MAK-4 are raw sugar, ghee (clarified butter), Indian gallnut, Indian gooseberry, dried catkins, Indian pennywort, honey, nutgrass, white sandalwood, butterfly pea, shoeflower, aloewood, licorice, cardamom, cinnamon, cyperus, and turmeric. MAK-5 includes Gymnema aurentiacum, black musale, heart-leaved moonseed, Sphaerantus indicus, butterfly pea, licorice, Vanda spatulatum, elephant creeper, and Indian wild pepper.

Grade: C

Cardiac disease

Abana is a combination herbal and mineral formulation that has been traditionally used in Ayurveda for improved cardiovascular health. There is evidence from two studies that abana may improve cardiac function (3;4).

Grade: C

Cognitive function

The herb Brahmi (Bacopa monnieri) is used in a number of Ayurvedic preparations for a variety of ailments. There is evidence from well-designed studies that it may improve memory (10) and cognitive functioning (11) in adults.

Another study suggests that the herbal preparation Maharishi Amrit Kalash (MAK-4) may enhance attention capacity or alertness, and thus reverse some of the detrimental cognitive effects of aging (12).

Grade: C

Colitis

Preliminary evidence suggests that the gum resin of Boswellia serrata may improve or alleviate symptoms in patients with chronic colitis with minimal side effects (13). More studies are needed to confirm this finding.

Grade: C

Congestive heart failure

Preliminary evidence suggests that sodium nimbidinate, made from the traditional Ayurvedic herb Nimba/Neem/Arishta (Azadirachta indica), may be an effective diuretic in patients with congestive heart failure (14;15). More studies are needed to confirm this effect.

Grade: C

Constipation (in advanced cancer treatment)

Evidence from one small study suggests that a liquid Ayurvedic herbal preparation called Misrakasneham, containing 21 different herbs as well as castor oil, ghee, and milk, may benefit cancer-patients in the management of opioid-induced constipation (16). Further studies are needed to evaluate this treatment in palliative care.

Grade: C

Coronary heart disease

Evidence indicates that Ayurveda's comprehensive purification and detoxification regime known as panchakarma in heart disease patients may lead to increased VIP (a vasodilator), acute reduction in total cholesterol, reduction in lipid peroxide (a measure of free radical damage), and a significant reduction in anxiety (17).

A study of Arjuna (Terminalia arjuna), a type of bark powder that is traditionally used as an anti-ischemic and cardio protective agent in hypertension and ischemic heart diseases, found evidence that it may reduce cholesterol and lipid peroxide levels as well as have significant antioxidant action that is comparable to vitamin E in coronary heart disease patients (13).

Grade: C

Diabetes

Several studies have been conducted with various Ayurvedic treatments, with mixed or modest results:

The traditional antidiabetic remedy Coccinia indica may help improve glucose tolerance in adult-onset diabetes (18).

An herbal tea containing Salacia reticulata (Kothala Himbutu tea) may improve glycemic control and reduce the need for Glibenclamide treatment in patients with type II diabetes mellitus (19).

Drinking an aqueous suspension of the vegetable pulp from the herb Momordica charantia, a bitter vegetable popularly known as Karolla, may reduce serum glucose levels in people with moderate non-insulin dependent diabetes (20).

A traditional Ayurvedic formula called Pancreas Tonic, taken in a powder capsule form, may bring intermediate term glucose control in type II diabetic patients with HbA(1c) levels between 10.0% to 12.0% (21). The ingredients arePterocarpus Masupium, Gymnema sylvestre, Momardica Charantia,Syzigium Cumini, fenugreek, cinnamon,Azardirachta Indica, Ficus Racemosa, Tinospora CordifoliaandAegle Marelose.

The Ayurvedic herb Vijayasar (Pterocarpus marsupium), also called Bijaka, Pitasara, or Pitashalaka, may help modulate blood glucose levels in newly-diagnosed or untreated non-insulin dependent diabetes mellitus (22).

In all the above remedies, better-designed trials are needed to determine the true clinical efficacy.

Grade: C

Depression (mild to moderate)

Evidence from one small study suggests that a traditional Ayurvedic formula containing extracts of four Indian herbs, Ashvatha, Kapikachu, Dhanvayasa, and Bhuriphali (the GS-02 formulation), may have benefits similar to conventional anti-depressant medication (23). Further studies are needed to confirm these results.

Grade: C

Encephalitis (viral)

Preliminary evidence suggests that the aqueous extract ofO.sanctumleaves may benefit patients with viral encephalitis (24). However, formal clinical trials are needed to evaluate this approach.

Grade: C

Giardiasis

Evidence from a well-designed study suggests that the Ayurvedic formula Pippali Rasayana, prepared from Palash (Butea monosperma[Lamk] Kuntze; Leguminaceae) and Pippali (Piper longumL.; Piperaceae), may be an effective treatment for intestinal giardiasis infection (25).

Grade: C

Hepatitis (viral)

Evidence from one well-designed study suggests that the traditional herbal preparation Kamalahar may reduce clinical signs as well as indicators of liver damage such as serum bilirubin, SGPT (serum glutamic pyruvic transaminase) and serum alkaline phosphatase in acute viral hepatitis (26). Kamalahar containsTecoma undulate, Phyllanthus urinaria, Embelia ribes, Taraxacum officinale, Nyctanthes arbortistis, andTerminalia arjuna.

Another well-designed trial suggests that root powder from the herb Picrorhiza kurroamay may improve levels of bilirubin, SGOT (serum glutamic-oxaloacetic transaminase) and SGPT in viral hepatitis (27).

Grade: C

Hyperlipidemia

There is preliminary evidence that the herb guggulu (Commiphora), administered as a purified gum, may reduce serum cholesterol and serum triglyceride levels, increase HDL and decrease LDL levels (28). More studies are needed to validate this use.

Grade: C

Hypertension

Abana is a combination herbal and mineral formulation that has been traditionally used in Ayurveda for cardiovascular health. There is evidence from two studies that abana may reduce blood pressure (3;4).

Grade: C

Insomnia

There is evidence from one well-designed study that a traditional Ayurvedic formula (Blissful Sleep, Maharishi Ayurvedic Products International) containing valerian (Valeriana wallichi), rose petals (Rosa centifolia), muskroot (Nardostachys jatamansi), heartleaved moonseed (Tinospora cordifolia), winter cherry (Withania somnifera), pepper (Piper negrum), ginger (Zingibar officinalis), aloeweed (Convolvulus pluricalis), and licorice root (Glycyrrhiza glabra) may decrease sleep latency (time needed to get to sleep) in people with sleep-onset insomnia, with no side effects (29).

Grade: C

Irritable bowel syndrome (IBS)

A compound Ayurvedic preparation withAegle marmelos correaandBacopa monniere Linnis a traditional herbal preparation used for digestive disturbances and diarrhea. There is evidence from one study suggesting that this combination may have short-term benefits for patients with IBS in general, and in particular those with diarrhea. However, benefits may not be maintained in the long term (30). More studies are needed to evaluate this treatment.

Grade: C

Osteoarthritis (OA)

There is evidence from one well-designed study that an Ayurvedic formula containing roots of Withania somnifera, the stem of Boswellia serrata, rhizomes of Curcuma longa and a zinc complex (Articulin-F) may contribute to significant improvement in symptoms of osteoarthritis (31).

Another study suggests that Guggul (Commiphora mukul) administered daily as a powder capsule supplement may reduce pain and improve functioning in OA (32).

Grade: C

Parkinson's disease

There is evidence that the traditional herbal remedyM. pruriensmay improve symptoms in Parkinson's disease (33), and that it may offer advantages over conventional L-dopa preparations in the long term management of the disorder (34).

One study has suggested that symptoms of Parkinson's disease may be reduced with use of an Ayurvedic formula called HP-200, which is derived from Mucuna prurient (35).

More studies are needed to verify what can be expected from these treatments.

Grade: C

Retinopathy

Evidence from one well-designed study suggests that the Ayurvedic herb
Saptamrita Lauha may aid in the rapid absorption of hemorrhages and prevention of their recurrence in retinopathic eyes of diabetic and hypertensive patients (36).

Grade: C

Rheumatoid arthritis (RA)

There is some evidence that a traditional Ayurvedic herbal formula RA-1 may reduce joint swelling but not other symptoms in rheumatoid arthritis (37). RA-1 containsWithania somnifera(ashwagandha),Boswellia serrata(gugulla),Zingiberis officinale(ginger) andCircuma longa(circumin).

A resin that is extracted fromBoswellia serrata(H15, indish incense) is regarded in Ayurvedic medicine as having anti-inflammatory properties. However, evidence from one study showed no benefit in patients with RA (38).

More studies are needed to determine efficacy of these treatments in RA.

Grade: C

Stomach disorders (gastritis and dyspepsia)

There is preliminary evidence from two studies that the herb amalaki (Emblica officinalis/ Phyllanthus emblica), a fruit used in a variety of Ayrvedic remedies including the popular general tonic Chyavanaprash, may reduce symptoms of gastritis and dyspepsia (39;40).

There is also evidence that the Ayurvedic herb Asparagus racemosus (Shatavari) may reduce gastric emptying time at a rate comparable to that of the drug metoclopramide which is commonly used for dyspepsia (41).

Some of this research has been with healthy subjects however, and further clinical trials are needed using the above remedies to evaluate their efficacy.

Grade: C

Weight loss

Evidence is inconclusive on whether the traditional herb Guggulu (Medohar) may contribute to weight loss in obese patients (42). More studies are needed to examine this treatment.

Grade: C

Shigellosis

One study compared the three Ayurvedic preparations bel (Aegle marmelos), thankuni (Hydrocotyle asiatica), and gandhavadulia (Paederia foetida) with ampicillin in shigellosis, and found them to have no effect (43).

Grade: D

No Evidence

Acne (44;45), cervical spondylosis, cholesterol, constipation, facial palsy, gastrointestinal indications, gynecological problems, heartburn, heart disease, hepatoprotection, impotence, indigestion, infections, inflammation (2), intervertebral disc prolapse, irritable bowel syndrome (30), jaundice, lumbar spondylosis, memory, menopausal symptoms, migraine, ocular disorders, paralysis, sciatica gouty arthritis, sleeplessness, systemic lupus erythematosus, trigeminal neuralgia skin diseases, urological problems.

Safety

Safety is the main concern when considering herbal preparations. Ayurvedic herbs are potent, and some contain constituents, which could be potentially toxic if taken in large amounts or over a long period of time. For this reason, the supervision of a trained practitioner is recommended and encouraged.

It is important that the herbs come from a trustworthy source. Adulteration with Western pharmaceutical substances has been reported with some commercial Ayurvedic products coming from India, and there have also been reports of the accidental or intentional presence of toxic metals in imported herbs.

Contraindications to the use of Ayurveda include traumatic injuries, acute pain, advanced disease stages, and those requiring surgery.

Sweet Flag, Vacha, (Acorus calamus)is presently classified as an unsafe herb for internal usage by the FDA (The National Institute of Ayurvedic Medicine, http://niam.com/corp-web/acorus.htm).

Amlaki (amla, Emblica officinalis) should be avoided at bedtime to prevent harmful effects on teeth (46).

Pippali (Piper longum) used in asthma should be avoided in patients with peptic ulcer disease and should be consumed with milk (47).

Guggul should be used cautiously in patients with peptic ulcer disease. Users should avoid sour food, alcohol and heavy exercise (46).

Terminalia hebula (harda) is a powerful purgative to stimulate GI motility and should be avoided in pregnancy (48).

Mahayograj Guggul contains lead and is often prescribed for rheumatoid arthritis with the warning that it should not be taken for long periods of time because of the theoretical possibility of lead poisoning.

Ayurvedic preparations can often change the bioavailability of allopathic drugs so a medical professional should be consulted before combined use (49).

It is important not to self-diagnose, but rather to work with a qualified Ayuervedic practitioner who can assess individual contraindications of Ayurvedic treatments.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Lisa Scully, PharmD (Massachusetts College of Pharmacy); William Collinge, PhD, MPH (Collinge & Associates); Nicole Giese, MS (Boston University); Dana A. Hackman, BS (Northeastern University); Kristopher Swinney, PharmD (Massachusetts College of Pharmacy & Health Sciences-Worcester); Isabell Syelsky, PharmD (Northeastern University); Brian Szczechowski, PharmD (Massachusetts College of Pharmacy & Health Sciences-Worcester); Catherine Ulbricht PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).

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