Ayurveda is a traditional health care system of India, based upon Indian philosophical, medicinal, and psychological concepts. Ayur in Ayurveda means ‘life’ and veda, ‘knowledge’. Ayurveda is a science of living a healthy, long life. Its development over the past four thousand years encompasses the following branches of medicine: general medicine, geriatrics, gynaecology, ophthalmology, otorhinolaryngology, pediatrics, and surgery.

Ayurveda: An Ancient Science

The Vedas, the oldest sacred scriptures of India, make mention of Ayurveda. Mythology has it that once upon a time, the number of diseases afflicting mankind were so many that a meeting of sages was held atop the Himalayas to discuss ways to get rid of the problems causing so much ill health among human beings. Indra, the Lord of the Immortals, was approached by Sage Bharadwaja. Indra had learnt about Ayurveda from the Ashwinikumara twins who were the physicians to the gods; they, in turn, had learnt it from Prajapati Daksha, who had received his knowledge from Brahma, the Creator.

On his return, Bharadwaja passed on what he had learnt from Indra to the other sages, one of whom was Punarvasu Atreya. Atreya taught Ayurveda to his six disciples, who, on the basis of their own understanding of the subject, composed treatises which became popular and proved helpful in mitigating human suffering.

This divine origin of Ayurveda finds similarity with the divine origin of the healing arts of other contemporary or near contemporary civilisations. Just as Brahma is said to have revealed Ayurveda to the Indians, so did Thoth and Apollo reveal the Egyptian and Greek systems of medicine to their respective peoples.

Agnivesha, one of the six students of Atreya, wrote a massive treatise on general medicine, which embodied his teachings. Known then as the Agnivesha Tantra, it was later revised by Charaka and came to be known as the Charaka Samhita. Charaka probably lived somewhere between the second century b.c. and the second century a.d. During the ninth century the Charaka Samhita was re-edited and reconstructed by a Kashmiri Pandit named Dridhabala. A number of commentaries have been written on Charaka Samhita over the centuries.

‘That is named Ayurveda (the science of life), wherein are laid down the good and bad of life, the happy and unhappy life, and what is wholesome and what is unwholesome in relation to life, as also the span of life.’
                                                                                                                            Charaka Samhita

Sushruta Samhita is the main source of our knowledge about surgery in ancient India. The author, Sushruta, was a great surgeon and a teacher of repute. He made great improvements in the general techniques of surgery and performed many new and major operations. He also described a variety of surgical instruments. Many commentaries on Sushruta Samhita were written by different authors. The book was also translated into Arabic, and Rhazes, the famous Arab physician, often quoted from it.

Sushruta Samhita describes numerous surgical operations, including those for obstructions in the intestines, removing ureter or bladder stones, and for removal of cataract in the eye. The surgical operation which attracted the attention of the world the most was the one we now recognise as plastic surgery — making a new nose in cases where the original had been cut off. This technique of making a new nose was practised in India till the Middle Ages.

Other ancient classics on Ayurveda include Bhela Samhita, Nava Nitaka (Bower manuscript), Ashtanga Samgraha, and Ashtanga Hridya Samhita, Madhava Nidana of Madhavakara which specialises in diagnosis, and Bhavaprakasha of Bhavamisra. Bhavaprakasha is a voluminous treatise still consulted by Ayurvedic physicians. The author has compiled the best of the available material of previous authors, and set forth his own views and experiences on different aspects of medical practice. The examination of the pulse and use of mercury and opium in the Materia Medica are also discussed.

After the sixteenth century, no major work of Ayurveda has been published; only commentaries on the previous works or books of prescriptions have been written.

Ayurveda at Work

Ayurveda maintains that good health exists when the body, mind, spirit, and environment are in harmony. Proper diet, exercise, a balanced lifestyle, meditation, and psychological well-being go a long way towards ,sound health.

Towards Qood Health: According to the ancient texts, everything in the world is ultimately composed of the five bhutas (elements): prithvi (earth), apa (water), teja (fire), vayu (air), and akasha (ether). This concept called the Panchabhuta theory is strictly adhered to by Ayurveda.

The food that we eat, according to Ayurveda, is composed of these five basic elements. Different combinations of these five elements confer various qualities upon different foods. One of the most important qualities is that of rasa (taste) which may be any one of the six: sweet, sour, saline, pungent, bitter, and astringent, or a combination of these.

In addition to taste, different foods are considered to possess other qualities, such as one of the two given in each of the following combinations: heavy and light, cold and hot, oily and dry, mild and keen, compact and mobile, soft and hard, clean and slimy, smooth and rough, minute and gross, solid and liquid. The theory of tastes and the ten pairs of opposite qualities play an important part in Ayurveda as they dictate the selection of medicines and diet.

The Pancha bhutas are represented in the human body as the dhatus, doshas, and malas. The dhatus are seven in number: ahara rasa (food juice), rakta (blood), mamsa (flesh), medas(fat),asthi(bones),majja(bone marrow), and sukra (semen). They are produced from the food we take.

During the initial process of digestion, when the food begins to be digested, a sweet reaction sets in and foamy kapha appears. Later when the food is half-digested, a second type of reaction which is sour, sets in, and the digested food now passes into the intestine, with a liquid substance called pitta appearing in it. When, at last, what is left of the food reaches the large intestine, it begins to dry up and is converted into a dry mass. During this process, a third type of reaction sets in, which is bitter and astringent; vata appears at this time.
 
Kapha, pitta, and vata, collectively known as the doshas or tridoshas are equivalent to the four humours in Greek medicine: blood, phlegm, yellow bile, and black bile. Each dosha predominates in a particular part of the body: kapha in the chest, pitta in the digestive organs, vata in the large intestine.

The doshas play a supporting role in the body when they are in a proper proportion. However, if present in abnormal proportions, they upset the equilibrium of the dhatus and cause different diseases. It is because of this that they are called doshas or vitiators of the dhatus.

Those parts of the doshas that are excreted as waste matter from the body after the process of digestion is over are called malas, the main malas being mutra (urine), shakrit (faeces), and sweda (perspiration).

Those in whom there is an equilibrium of the doshas remain healthy, while those in whom any one of these doshas predominates, are subject to disease. Towards Curing Disease: There are three things necessary for the onset of a disease: 1) nidanas or predisposing causes which vitiate a dosha; 2) doshas themselves; and 3) dushyas or deranged dhatus. By themselves, the nidanas cannot cause a disease by acting on the dhatus; they must act on the doshas and vitiate them first, after which the vitiated doshas, in their turn, act on the dhatus and produce diseases in them.

When the nidanas act upon the doshas, the latter pass through five stages. The first stage is that of chaya, which means accumulation of doshas in general. The second stage is one of prakopa of doshas which means that the accumulated doshas are spread through the system. The third stage is called prasara: during this stage, there is something like a fermentation of the doshas. This is due to the movement of vayu, which though inanimate, is the cause of all minor activities. Just as when a large quantity of water is accumulated at any place, it breaks the embankment and flows out, so do the doshas flow, sometimes alone and sometimes jointly. In the whole body, in half of it, or whatever part the fermented doshas spread, the symptoms of the disease shower down as it were, like water from the clouds. In the fourth stage, purvarupa, the earliest symptoms manifest themselves. In the fifth stage, that is, rupa, there is a complete development of the characteristic symptoms of the disease.

Though the attributes of the doshas are mutually opposed to one another, they do not always neutralise one another, and can grow simultaneously violent in a system. When more than one dosha is affected, the resulting symptoms get modified, though predominance of the influence on one particular dosha may be clearly visible. Ayurvedic texts describe the characteristics of the principal and accessory doshas that are affected in different diseases.

Diagnostic Steps

Diagnosis in Ayurveda not only means interpreting the disease; it comprises much more. To begin with, a diagnosis is made of the nidanas (predisposing causes), purvarupa (early indications), rupa (actual symptoms), and samprapti (full extent of the disease). Then the diagnosis of the presence of dhatu-vaishamya, that is, the increase or decrease of some of the dhatus as well as those of the doshas and malas is done. This is followed by identifying the stage of dhatu-vaishamya. A disease passes through five stages: chaya, prakopa, prasara, purvarupa, and rupa, each with its own symptoms. To know the stage of the disease is important so as to administer the correct medicine. Furthermore, doshas rarely get excited or deranged singly, and different doshas may be excited or deranged at different stages in different patients having the same disease. All this has to be properly assessed.

Diagnosis is made from the history of disease in a patient, its onset, progression, and the symptoms produced. This, coupled with knowledge about the digestion of the patient, examination of the pulse and of the excretions from the body such as of stool and urine, inform an Ayurvedic physician which dosha is deranged.

Holistic Treatment

In the treatment of diseases, the Ayurvedic physician tries to correct the diagnosed imbalances through appropriate diet and drugs.

Ayurvedic medicines are mostly derived from vegetable sources though mineral compounds and sometimes, drugs of animal origin are also used. These drugs are dispensed in a number of powders, solutions, decoctions, fermented liquids, pills, medicated oils, ghees.

According to Ayurveda, drugs act on the body through the influence of their rasa (taste), vipaka (post-digestive taste), virya (potency), and prabhava (special action). It is essential for a doctor to know the characteristics of each drug before he can judge its efficacy on the body. This applies to all the items of diet as well. Ayurvedic physicians study the properties of the drugs and the items of the diet extensively and elaborately. They also classify these items into categories: parthiva (earthy), apya (watery), agnya (fiery), vayavya (airy), and akashatmaka (ethereal). Such studies help them in selecting the appropriate drugs or diet when a particular dhatu or dosha or a combination of them is decreased, increased, or deranged.

Modern Trends: Over the past few decades, three clear trends in Ayurveda have been observed: one is in connection with the teaching in Ayurvedic colleges; the second, in connection with the use of the techniques and apparatus of allopathy either to assess the severity of disease or to confirm its diagnosis; and the third is in connection with research (on modern lines) on the drugs mentioned and used in Ayurvedic literature and practice.

As regards teaching in Ayurvedic colleges, while they teach everything connected with Ayurveda, they also teach the students the fundamentals of modern basic sciences such as chemistry, physics, botany, and zoology in pre-Ayurvedic classes, the anatomy of the body, and even dissection of the human body as it is done in medical colleges. These institutions make the students familiar with the English names of terms wherever possible. In the clinical subjects, surgery is taught and demonstrated according to modern methods, including strict aseptic precautions and anaesthesia.

The Medical Oath of Charaka

Since ancient times, on successful completion of Ayurvedic studies, students have been required to reaffirm their dedication by taking an oath, excerpted below:

‘Day and night however thou mayest be engaged, thou shalt endeavour for the relief of the patient with all thy heart and soul. Thou shalt not desert or injure the patient even for the sake of thy life or thy living ….

‘Thou shouldst speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome, and moderate. Thy behaviour must be in consideration of time and place and needful of past experience. Thou shalt act always with a view to the acquisition of knowledge.

“… Though possessed of knowledge, one shouldst not boast very much of his knowledge ….

‘There is no limit at all to which the knowledge of Ayuryeda can be acquired, so thou shouldst apply thyself to it with diligence. This is how thou shouldst act.’

The other important point is making the students familiar with the laboratory diagnostic tests needed for the confirmation of the diagnosis of a case. Ayurvedic physicians in some of the well-developed Ayurvedic institutions make use of the clinical pathology laboratory in conducting examination of the blood to assess the severity of anaemia, or the increase in the haemoglobin level as a result of their treatment. They make use of urine examination for evidence of sugar or albumin, and of stool for evidence showing the presence of any worms in the intestines. The blood pressure apparatus is used, as also the stethoscope for listening to sounds in the chest and heart.

The outcome of these tests determines the severity of the disease, confirms the clinical diagnosis, and helps in appropriate and correct treatment of the case.

Modern methods of chemistry, biochemistry, and clinical research are being used to find out the utility of a particular Ayurvedic drug and to find out its active chemical constituents. This is being done in research institutions which are wholly modern in their outlook. The Drug Research Laboratories in Lucknow and Jammu, and other Ayurvedic institutions in different parts of India are examples of such institutions. Though the research is carried out on Ayurvedic herbs and medicines, all the methods and appliances used belong to modern biochemistry and clinical research.

As a result of such researches, many Ayurvedic drugs or drug constituents are being used by different other systems of medicine as well.

Step’by’Step Approach: When, for example, a nine-year-old child who has been suffering for the last five years from breathlessness due to exertion, goes to an Ayurvedic physician, the latter first notes down the case history of the patient. He then asks leading questions such as: whether he has an accompanying cold or cough; whether the breathlessness has any relation to a particular season; whether any other member of the family suffers from the same ailment, and so on. More stress is laid on finding out whether his breathlessness increases or decreases after taking any particular food.

After the history has been elicited, a physical examination is conducted. The main and essential purpose of this is to see which of the doshas of the body has increased, decreased or qualitatively changed, and what effect it has already had on other constituents of the body.

The dahaypriksha, (overall examination of the whole body) is also undertaken, in which the hair, nails, colour and texture of the skin, the build of the body, the height of the patient, his speech, his habits, his sleep, and his dreams are recorded.

Next comes what is called tatva-priksha, that is, identification of which tatva, namely, satva, rajas, tamas, does the patient belong to temperamentally. A satvic type of patient is calm, quiet, and intelligent; a rajasic type, active; and a tamasic type, lazy and obese. Great importance is given to the mental make-up of the person.

The agni-priksha determines how his digestion is in general. Digestion is fast when pitta predominates; it is slow when kapha predominates; and it is either fast or slow when vata predominates.

Examination of the nadi (pulse) is one of the important parts of the physical examination. If the pulse is slow like the gait of a heron or a pigeon, it indicates dominance of kapha; if it is fast like the hopping of a frog, it indicates dominance of pitta; if it is zig-zag like the writhing of a snake, it indicates dominance of vata. The rate and any irregularity of the pulse is also noted. Using these means, an Ayurvedic physician is able to decide which dosha is deranged or dominating.

In the case of the nine-year-old child, he comes to the conclusion that it is vata which is predominant. According to Ayurveda, there are five types of breathlessness: tamaka swasa, maha swasa, chhinna swasa, gambhir swasa, and kshudra swasa. In this particular patient, it is the kshudra swasa which the patient has, because of the dominance of vata dosha.

In order to correct the imbalance of the doshas, various Ayurvedic drugs and preparations are used. Stress is laid on proper diet which can bring back the balance in the doshas. The question now is: will the patient be cured with this treatment? As far as his fatigued or strained heart is concerned, it may show some improvement. But that will be only for a while. Unless the structural defect is removed, the patient cannot expect a cure; that can only be done through modern surgical techniques.

Precautions and Prospects

Attempts have been made to associate or equate vata, pitta, and kapha with different chemical constituents in the blood as we know them today. However the concepts in Ayurveda have not been modified, expanded upon or revised in keeping with new findings which have been authenticated through the use of powerful microscopes or intricate chemical and analytical methods. Ayurveda, therefore, needs to be updated with further research.

If not prepared strictly according to specifications, Ayurvedic drugs can have undesirable side-effects on the patient. Bhasmas (calxes) of different metals and minerals have often been found to play havoc with a patient’s health. This is not due to anything hazardous in the drug itself: there are not many vaids who can recognise a particular drug with surety.

Furthermore, storage and standardisation are other shortcomings. For example, Chyavanaprasha made by two different companies is different in its efficiency.

The diagnosis and treatment in Ayurveda, as we have seen, is based upon sound concepts. These basic concepts which have been passed down through the ages, are part of the culture of the Indian people, whether in the villages or in the cities. When an Ayurvedic physician tells a patient that he has a disease in which vata, pitta, or kapha is deranged or dominant, the patient understands the language of the physician. He not only believes in these concepts but has faith in this line of treatment.

Ayurvedic drugs are easily available. A majority of the drugs of vegetable, mineral or animal origin are available in a kitchen, or in a grocery store. The methods of preparation are also simple. Ayurvedic drugs are less expensive compared to drugs used in allopathic medicine.

Ayurvedic practitioners claim that Ayurvedic drugs are less toxic due to their slow bio-availability. Many herbal medicines are being used today as ingredients of drugs in allopathy.

Ayurveda is not merely a treatment for disease: it is a lifestyle, a manner in which the individual organises his regimen to promote health care. Incorporating it into one’s lifestyle requires an earnest commitment.

 —————————————————————————————Now You Know…

An ancient Indian healing system, Ayurveda is also called ‘the science of living’. Following a methodical approach of diagnosis by eliciting the patient’s family history, examining the entire body, categorising the patient’s temperament, analysing his digestion, and reading the pulse, the Ayurveda physician concludes which of the doshas (humours) is imbalanced. It then proceeds to strengthen the body’s inherent ability to rejuvenate, heal, and restore its natural balance. It stresses on removing the cause of disease rather than its symptoms.

Ayurveda also emphasises a healthy diet and lifestyle to suit each type of constitution. Drugs are easily available and inexpensive but should be purchased from reliable sources.