COMPLEMENTARY AND ALTERNATIVE MEDICINE

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AYURVEDIC MEDICINE
Core Concept, Therapeutic Principles,
and Current Relevance
Arvind Chopra, MD, DNB, and Vijay V. Doiphode, MASc, PhD

There is an unprecedented uprising in the community to demand

safer (and effective) medicines. The enthusiasm for complementary and
alternative medicine (CAM) methods across the world is no longer
historical or anecdotal.4, 18 It is based on the publics perception of what
is good and bad in a medicine. Many would argue against calling
Ayurveda a CAM because conceptually Ayurveda is much more than a
wholesome medicinal system,19, 26 and the term CAM belies a strong
prejudice for modern medicine as the mainstream system. The authors
hope that the reader will look beyond the archival value of Ayurveda as
an ancient ethnomedical system and explore its relevance to modern
times. This exploration is particularly important as physicians endeavor
to nd better therapeutic solutions.
ORIGIN
The term Ayurveda, a Sanskrit word, translates into knowledge (Veda)
of life (Ayur); Veda also means science.20 After being transmitted orally for
thousands of years, the ancient Ayurvedic texts nally were written and
preserved in Sanskrit (an ancient Indian language). Founded on the
collective wisdom of ancient Hindu saints and healers, Ayurveda grew
into a medicinal science. Ancient Ayurveda was meant essentially to

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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in the body occur as a result of the existence of the inherent re (Agni)

energy. The manifest world is traced, however, to the unmanifest called
Prakruti (also spelled as Prakriti). Prakruti signies nature and individual
human constitution and is driven by a harmonious equilibrium between
cosmic intelligence, ego (Ahamkara), and self-consciousness.31 The practice of Ayurveda in daily life aims at maintaining that harmony to
ensure optimal health. The overall Prakruti comprises physical (largely
under genetic and intrauterine inuences), 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 uids and excreta; parturition; and above all the
mind; it is most relevant to the nervous and musculoskeletal system.
Pitta (material  re) 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, uid, 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 balancethis is the basis of health
(Arogya). The body adjusts to the numerous changes that continuously
occur in Dosha under the inuence 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 gastrointestinal system plays a central role for the health of every other system.
There is a digestive re (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 equilibrium 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 esh,
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 componentsphysical strength
and resistance to diseases (Vyadhikshamatwa). The immunity depends
on the quality of tissues (especially Rasa), Kapha, Shukara, and Ojas. Ojas,

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an end product of sequential tissue metabolism, determines body energy,

strength, and immunity and is strengthened by Rasayana. Excess sexual
activity diminishes Ojas. The immunity can be natural, temporal (related
to age and seasons), and developed (through good life practices, including diet, sleep, sexual energy, and rejuvenate therapy).
Ayurveda and Yoga are evolved from the same ancient Vedic philosophy and culture and share a common understanding of health and
disease (the Tridosha hypothesis). Placing emphasis on the psychospiritual aspect of life rather than the physical aspect, Yoga as science aims
to link the individual self to the universal self. Ayurveda promotes Yogic
exercises, which, in contrast to the modern-day stamina and bodybuilding exercises, stress lightness, rmness, exibility, and versatility to
ex, bend, extend, and stretch. Physical tness from the Ayurvedic-Yogic
viewpoint is the capacity to withstand heat, cold, hunger, thirst, and
fatigue. Yoga increases the qualities of Sattva, while reducing Rajas and
Tamas (see earlier). Strict adherence to diet (Yama) and behavior (Niyama) is fundamental to the performance of Yoga.
A relatively unknown component of the Ayurvedic system is the
practice of Ayurvedic pressure regions (Marma), which is akin to the
traditional Chinese acupuncture. The ancients used the knowledge of
these sensitive regions to protect the self and harm the enemy. Subsequently the latter became a therapeutic tool and an essential part of the
surgery curriculum (elaborately dealt with in SS).
Ayurveda is a holistic science. Its practice is customized to the
individuals Prakruti. Appropriate food, sleep, and sexual activity are
mentioned as the three pillars of good health. Personal hygiene (physical
and mental), massage, and exercise are emphasized. Mental discipline
and adherence to moral and spiritual values are a prerequisite for good
health. Ayurveda also promotes the practice of rejuvenation (Rasayana)
and virilication (Vajikarana) in daily life; the practice of Vajikarana aims
at improving the genetic quality of the offspring. Healthy sexual practices for procreation and good health have been described in great detail.19
CONCEPT OF DISEASE
The paradigm of Prakruti-Dosha-Agni hypothesis is crucial to health
and disease. MN describes the ve basic characters of a disease (Ch 1, V
4) that must be evaluated for complete management: etiology (Nidana),
prodrome (Purvarupa), clinical features and signs and symptoms (Rupa),
diagnostic tests and means of alleviation (Upasaya), and pathogenesis
(Samprapti). Indulgence in unhealthy foods and activities leads to deranged Dosha. All diseases to a large extent are caused by vitiated Dosha
(MN, Ch 1, V 14).
The etiopathogenesis29 of any disease occurs in six stages (as described by SS): accumulation of Dosha (Sanchaya); proneness of Dosha to
spread (Prakopa); spread of Dosha (Prasara); relocation of Dosha (SthanaSanshraya); disease manifestation (Vyakti or Samprapti); and differentia-

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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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Ascertaining the Doshic Prakruti (functional constitution) of an individual

through a detailed evaluation of symptoms and clinical examination
(e.g., body frame, weight, skin and hair, eyes, teeth, physical capacity
[including sexual], pulse [is characteristic of each Dosha], and psychologic factors) is fundamental.19, 31 The physician also records in every
patient the aggravated Dosha and the damaged tissues, the state of Agni,
personal inclinations and psychologic factors, deviations in diet and
behavior, and environmental inuences. The Ayurvedic treatment is
highly individualized because the ancients believed that no two individuals suffered from apparently similar disease. Great emphasis has been
placed on early diagnosis (Nidan). Finally, the physician maintains a
close vigil on the patients condition to monitor progress.
All the etiologic factors are ascertained and classied as follows: (1)
inherent (samavayi)material cause that if destroyed can eliminate the
disease and affect the host/substrate; (2) noninherent (asamavayi)
cause that if removed can alter the disease; and (3) initiating and instrumental (Nimitta)the most important causes, which when destroyed
eliminate the disease. In this paradigm, (1) tissues as the site of disease
provide the inherent factors (akin to genetic predisposition or primary
tissue changes per se that may promote the disease process); (2) the
tissue-Dosha interaction (probably akin to mediators, e.g., cytokines,
antibodies, hormones) in disease is driven by noninherent factors (the
Dosha-Dushya Sammarchana); and (3) the Dosha per se are the instrumental cause with accessory (Sahakarni Karanas) inputs from secondary
causes (e.g., diet, activity). Nosologically, a diagnosis is never a single
disease entity but a conglomeration of several etiologic factors.
GENERAL THERAPEUTIC APPROACH
Most of the current therapies are fairly orthodox and unchanged
over time. The basic therapeutic processes and means are extensions of
the practices (especially Shamana and Shodhana; see later) that are
meant to promote health. Reversal of the steps that produce disease (see
earlier) is the main therapeutic approach. To strengthen the host and
prevent relapses is part and parcel of that approach. Ayurveda aims to
cure (Aturasya-vyadhi-parimokshah).
The deranged Dosha and the symptoms are treated vigorously. The
Dosha equilibrium must be restored (soil is more important than the seed
concept), even when dealing with infections and trauma. The offending
Dosha must be reduced (karshana) or strengthened (brimhana); the weakened human organ or system often is strengthened based on the principle of similar (i.e., bone for bone, using powdered animal bones to
strengthen the skeletal system).
Therapy can be palliative (Shamana) and purifying (Shodhana).
Ayurveda uses the concept of purication as a means to eradicate disease
rather than cure as perceived by modern medicine. All therapeutic processes are supervised closely and planned as per the individuals Prakruti.
Although palliative therapy as the initial step is provided to all patients,

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purication is begun only when the individual is found t enough

to sustain the arduous purication processes. Palliation includes early
methods of strengthening or reducing Dosha. Fasting (Upvas) and the
processes of sweating and drying (Swedana and Rukshana) reduce
Dosha. The processes of oleation and lubrication (Snehana) strengthen
Dosha; oily preparations (oral, through medicated enema, or both) and
massages are used.
The vitiated Dosha imbalance in the body is corrected by the purication process called Panchkarma Chikitsa. The Panchkarma (translates
into ve processes) doctrine describes treatment by emetics (Vamana),
purgatives (Virechana), medicated oily enema (Anuvasana Basti), medicated decoction/dry enema (Asthapana Basti/Niruhana), and oleation/
nasal purgation (shirovirechana/Nasya). According to SS, blood purication (Rakta Moksha) is included in the latter processes. The Panchkarma
is a highly specialized component of the Ayurvedic therapy that is
elaborate and complex. It has innumerable variations and interpretations.
The processes of reduction, drying, and sudation treat diseases such
as atherosclerosis, hypertension, diabetes, arthritis, and obesity. A person
of Vata Prakruti is likely to suffer from Vatika type of diseases (e.g.,
nervous system disorders, rheumatism), and preventive measures would
include avoiding all Vata aggravating foods and activity. All other factors
being equal, a dominant Pitta patient would be administered cooling
medicines. A Kapha patient would receive heating medicines (see later
for cooling and heating medicines). Often patients have more than one
dominant Dosha in their Prakruti and disease. The Dosha attributes of the
Ayurvedic medications (see later) and processes are considered while
choosing therapy.
When treating acute and chronic (including tuberculosis and leprosy) infections, Ayurveda does not aim directly to kill the microbes;
restoration of the Dosha balance and host immunity (Rasayana) ensures
elimination of the infectious agent. Numerous Ayurvedic medicinal
plants have shown strong chemotherapeutic and immunomodifying effect, however, in experimentally induced infections.32 Eight types of
fever (Jwara, MN Ch 2) have been described and are treated by the
palliation and purication processes.
Prognostication and limitations of therapy have been dealt with in
great detail (e.g., while treating fever, perspiration, feeling of lightness
of the body, itching in the head, oral ulcers, sneezing, and improved
appetite indicate good response and impending remission (MN, Ch 2, V
75). Also, physicians have been warned not to indulge in therapeutic
misadventures and heroics if the prognosis appears to be poor (e.g.,
rheumatism is likely to be incurable if all the three Dosha are vitiated
[MN, Ch 23, V 14-18]).
MEDICINES
The Ayurvedic pharmacology, including preparation of herbal and
mineral compounds, is a distinct and exhaustive subject. Physicians are

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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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In CS, herbs have been classied into 50 groups according to their

therapeutic action (e.g., vitalizing agents, healing agents, tonics, antihelminthics, antihiccups); 3 groups relate to analgesics, antispasmodics, and
antimyalgics. Voluminous texts on Ayurvedic medicinal plants have
been compiled under the auspices of national Indian medical agencies.20
Herbal preparations are administered orally as powders (churanas),
decoctions (kwatha), and tablets. The formulations also contain extracts
from tree bark, vegetables, spices, pulses, and cereals. Extracts of medicinal plants (e.g., Ricinis communis/castor oil seeds) often are added to
the drug vehicle (e.g., oils, butter, curds, milk) for use in enemas during
the Panchkarama. The minerals (e.g., gold, iron, mercury, zinc, copper)
are prepared as an ash (Bhasma) through complex oxidation processes
that also use medicinal herbs; the process is believed to convert the
metal into a nontoxic form, while retaining the healing properties. Animal sources have been described extensively in CS as medicinal agents,
although the emphasis for good health is on a vegetarian diet. Bones
and esh of goat, sh, pecking birds, and aquatic and marshy animals
are described in CS as the animal sources for preparing certain plantbased formulations but currently nd lesser use. Poultices prepared
from meat preparations and mixed with herbomineral drugs have been
recommended for use to alleviate stiffness, pain, swelling, and immobility of body parts (CS, Ch 29, V 124-155).
The botany and the medicinal properties of some of the currently
popular Ayurvedic herbs have been described lucidly by Frawley and
Lad.10 Dashamula, Triphala, Cyavananprasa, and Guggula are some of
the ancient oral plant-derived, multicomponent drugs in popular use
and available commercially. Many of the spices and substances used
in domestic cooking (e.g., pepper, ginger, circumin, garlic) are used
extensively. Plant and tree gum resins, called gugullu (e.g., Commiphora
mukul, Boswellia serrata), have been used since times immemorial to treat
numerous ailments (especially arthritis and obesity). Complex preparations such as massage oils (e.g., Bala taila in CS: Ch 28, V 142-156)
containing more than 50 ingredients are still in popular use.
RASAYANA
The aims of Rasayana, as summed up in the ancient treatise of CS
and SS, are to increase the bodys resistance to disease (akin to immunity,
called vyadhi-kshamatva), increase life span, and promote intellect and
strength. Numerous research scientists from Ayurveda and modern phytopharmacology have been engaged in researching ancient Rasayana
plants for potent antimicrobial, anticancer, and immunomodulation effect.8, 21, 37 The Rasayana concept has been translated into a hypothesis
that Rasayanic plants cause a nonspecic strengthening of immune response and tolerance to antigenic challenge. Rasayana plants promote
positive health, and the prime example is that of Withania somnifera
(Aswagandha),1, 11, 37 also called winter cherry, which often has been

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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

ARTHRITIS AND RHEUMATISM

One of the authors has dealt with the subject of arthritis and rheumatism.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
proles. It is difcult to nd 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 resemble rheumatoid arthritis, but the prole 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 specic 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 described 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 ax 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-

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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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87

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