Ayurveda

• RELATED TERM: Ayurvedic herbs
• DEFINITION: A holistic medical system in which treatment is highly individualized and a wide range of methods are incorporated.
• PRINCIPAL PROPOSED USES:
• OTHER PROPOSED USES:

Overview

Ayurveda, the ancient healing system of India, is one of the great healing traditions of the world. Like traditional Chinese medicine (TCM), with which it has many historical connections, Ayurveda is a holistic medical system grounded in a comprehensive philosophical/spiritual view of life.

Ayurvedic treatment is highly individualized and incorporates a wide range of methods, including dietary changes, herbal therapy, exercise, massage, meditation, and numerous special procedures such as cleansing of the nasal passages. Although the scientific base for Ayurveda is not strong, some of its methods have undergone meaningful scientific evaluation, and worldwide interest continues to increase.

One should note, however, that the presence of heavy metals in some Ayurvedic products makes them potentially harmful, especially for children. Studies have found detectable levels of lead, mercury, and arsenic. Often labeled as “Indian” or “South Asian,” these products are sold online and in stores. The U.S. Food and Drug Administration (FDA) does not review or approve Ayurvedic products.

History of Ayurveda. The roots of Ayurveda lie in the ancient Sankhya school of Indian philosophy, developed many thousands of years ago. The first major classic of Ayurveda, the Caraka Samhita, was written between the second and fourth centuries BCE, but it is believed to be based on a much older oral tradition. This early text sets out all the fundamental principles of Ayurveda but concentrates most of its attention on digestion (described as internal fire, or agni). Another early classic, the Susruta Samhita, focuses on surgical techniques. The Astanga Hridayam, written in about 500 CE, sets out most of the detailed principles of Ayurveda, including the dosha and sub-dosha.

Ayurvedic thinking exerted a strong influence during the formation of traditional Chinese medicine, which in turn influenced Ayurveda’s further development. The Ayurvedic technique of pulse-taking may have been derived from Chinese medical theory. Furthermore, translations of Ayurvedic texts influenced Islamic and European medicine.

In modern India, Ayurveda is one of three widely available forms of medicine, along with homeopathy and conventional medicine. It has become increasingly popular in the West as well, largely through the work of Deepak Chopra, Vasant Lad, and Maharishi Mahesh Yogi (the founder of Transcendental Meditation).

Principles of Ayurveda. In Ayurvedic theory, the body is said to contain three primal forces (tridosha) that work in tandem: vata, pitta, and kapha. These dosha, in turn, are formed from combinations of five elements that control the universe: space, air, fire, water, and earth. The dosha vata includes space and air; it controls movement. Pitta is made of fire and water; it controls digestion and metabolism. Kapha is composed of earth and water; it forms the body’s structures. Each person can be said to be dominated by one or two of these dosha and may, therefore, be called a vata, pitta, kapha, vata-pitta, vata-kapha, or pitta-kapha type.

There are many other aspects of the body considered in Ayurveda. These include twenty attributes, five sub-doshas, seven tissues, four states of agni, and fourteen bodily systems. Health exists when all aspects of the body are in proper balance; disease occurs when that balance is disturbed. Excess vata, for example, might lead to arthritis, anxiety, and fatigue. Excess kapha is said to cause obesity and diabetes.

Practice of Ayurveda. The practice of Ayurveda is intrinsically holistic and preventive in intent. Perfect health in the Ayurvedic system involves not only physical wellness but also emotional, mental, and spiritual perfection. Treatment aims to promote and maintain balance to prevent or, when necessary, cure disease.

One of the primary methods of healing in Ayurveda involves diet. Foods are thought specifically to strengthen or weaken various doshas; therefore, people are prescribed a diet according to their constitutions. This method is different from the dietary approaches used in conventional medicine or the natural medicine systems that arose in the West (such as naturopathy). Westerners tend to consider certain foods healthy and others unhealthy; in Ayurveda, what is good for one person is bad for another, and vice versa. For example, a person tending toward an excess of vata might be advised to avoid raw vegetables but to consume nuts and seeds in abundance; someone with an excess of kapha would be given the opposite recommendation. To make matters more complex, dietary recommendations may vary from season to season, and they frequently include numerous details about the optimal ways to prepare and consume foods.

Herbs (both culinary and medicinal) are another mainstay of Ayurvedic treatment. For example, people with a vata constitution are thought to benefit from turmeric, cumin, coriander, ginger, garlic, and fenugreek. However, some of these herbs might not be healthy for a person with a different constitution.

In addition to spices for cooking, Ayurveda also uses purely medicinal herbs, which include andrographis, ashwagandha, B. monnieri (brahmi), B. serrata, Coleus forskohlii, dandelion, gotu kola, Gymnema, C. wightii (guggul), neem, Phyllanthus, P. kurroa, Salacia oblonga, and Tylophora. Minerals such as silver, mercury, and lead may be used too.

Ayurvedic therapy also has an exercise component known as hatha yoga. In general, practicing yoga is believed to promote good health, and certain postures are believed to offer assistance in specific medical conditions.

Like the acupuncture needles of Chinese medicine, Ayurveda has additional characteristic methods. One set of therapies is collectively called panchakarma. This is a method of purification that may involve massage, shirodhara (extended pouring of warm oil on the “third eye” point in the center of the forehead), emetics, purgatives, enemas, cleansing of the nasal passages with various substances, and bloodletting. Additionally, drinking two to four ounces of fresh urine, called urine therapy, is recommended in certain situations.

Scientific Evidence

All bodies are different and effective medicine must consider these differences Ayurveda’s strengths. However, the fact that medicine ought to treat people individually does not imply that Ayurveda’s individualized treatment techniques are grounded in reality. They could be wishful thinking rather than an insight into the truth.

It is very difficult to scientifically validate entire systems of health. Only double-blind, placebo-controlled clinical trials produce scientifically reliable results. However, Ayurvedic medicine is not suitable for such a format.

One study attempted to test the effectiveness of whole-person Ayurvedic treatment. In this trial, sixty people with diabetes were randomly assigned either to standard diabetes education classes or to a course of care involving exercise, Ayurvedic diet, meditation, and Ayurvedic herbal treatment. The results failed to show much in the way of statistically significant benefits with the Ayurvedic treatment. However, even if results had been seen, they would be of minimal validity because receiving a complex, exciting course of treatment usually results in improvement, regardless of what treatment is used.

While evaluating Ayurveda as a whole is impractical, several of its herbal therapies have been assessed in a variety of contexts. Many Ayurvedic herbs taken alone have undergone varying levels of study. These herbs include andrographis (for colds and flus), ashwagandha, boswellia (for rheumatoid arthritis, asthma), C. forskohlii (for asthma), dandelion (as a diuretic, to help treat fluid retention), fenugreek (for diabetes and cholesterol), garlic (for high cholesterol, heart disease), gymnema (for diabetes), ginger (for nausea), gotu kola (for varicose veins), guggul (for high cholesterol), neem (for acne, urinary disorders, and inflammatory diseases), Phyllanthus (for hepatitis), turmeric (for dyspepsia), and Tylophora (for asthma).

Many other Ayurvedic herbal combinations have been studied in trials of lower quality, but because only double-blind, placebo-controlled studies can actually prove the effectiveness of a treatment, those studies are not reported here. Even the double-blind, placebo-controlled studies discussed here fall far short of modern scientific standards, and independent confirmation of results is usually lacking. Nonetheless, the results described are somewhat encouraging.

A few studies have begun the process of examining classic Ayurvedic diagnosis to determine whether it has a relationship to physical reality. One study failed to find an expected correlation between Ayurvedic diagnosis and severity of symptoms in ankylosing spondylitis and low back pain. Another small study found that different Ayurvedic practitioners independently came up with similar diagnoses and treatment plans in three people with rheumatoid arthritis.

Single Herbs

T. arjuna. In a double-blind study, fifty-eight men with chronic stable angina received either T. arjuna (500 milligrams [mg] every eight hours), the drug isosorbide mononitrate (40 mg daily), or a matching placebo for one week each. The results indicated that the use of T. arjuna was more effective than placebo for angina and approximately as effective as the medication.

In another study, 105 men with coronary heart disease received either placebo, vitamin E, or T. arjuna (500 mg daily) for thirty days. The results indicated that the herb reduced cholesterol levels. However, the researchers inexplicably decided to make this an “open label” study, meaning that participants and researchers knew which treatment was which. Because of this, the results are essentially meaningless.

P. kurroa. In a double-blind trial of thirty-three people with acute viral hepatitis, the use of the herb P. kurroa at a dose of 375 mg three times daily significantly speeded recovery time compared with placebo.

B. monniera (brahmi). The Ayurvedic herb B. monniera (brahmi) has a traditional reputation for improving memory. However, a twelve-week, double-blind, placebo-controlled trial of seventy-six people that tested the potential memory-enhancing benefits of brahmi generally failed to find much evidence of benefit. The only significant improvement seen among the many measures used was in one that evaluated the retention of new information. Although this may sound somewhat positive, in fact, it means little. When a study uses many different techniques to assess improvement, mere chance ensures that at least one of them will come up with results. Properly designed studies should focus on one test of benefit alone (the primary outcome measure) that is selected before running the trial. The use of multiple tests is sometimes called “fishing for results,” and it is frowned upon.

If several independent studies use multiple tests of improvement, and the pattern of response is reliably maintained, then the results begin to appear more significant. This does not seem to be the case with brahmi. In a previous double-blind, placebo-controlled study enrolling forty-six people, the use of brahmi for two weeks produced quite a different pattern of benefits. In another double-blind, placebo-controlled study of thirty-eight people, short-term use of brahmi failed to produce any measurable improvements in memory. Other studies have failed to find benefit using a combination of Ginkgo biloba and brahmi, whether in the short term or over a period of several weeks.

Combination Therapies

Septilin. Septilin is a fixed combination containing C. mukul, T. cordifolia, R. cordifolia, E. officinalis, M. pterygosperma, and G. glabra. This combination therapy has shown promise for the treatment of allergic rhinitis. In a double-blind study, 190 people were given either the herbal combination or a standard antihistamine (chlorpheniramine). The results over seven days indicated that the two treatments were equally effective.

Another study found general evidence for an antihistamine-like effect. In this double-blind, placebo-controlled trial of thirty-two healthy people, the use of septilin for four weeks significantly reduced the allergic reaction caused by injection of histamine under the skin.

Septilin has also been tried as a treatment for improving immunity. In a double-blind, placebo-controlled study of forty children with persistent low-grade infections (such as chronic sore throat or sinus infection), the use of septilin for one month led to significant improvement compared with placebo.

Mentat. The proprietary Ayurvedic mixture mentat, which is a fixed herbal combination containing B. monniera and almost thirty other ingredients, has been studied for numerous brain-related conditions. For example, in a three-month, double-blind, placebo-controlled study of fifty adult students, the use of mentat appeared to improve memory and attention and reduce stress. Similarly, in a three-month, double-blind, placebo-controlled trial of forty-two people in high-stress jobs who complained of fatigue, the use of mentat decreased symptoms.

In several double-blind, placebo-controlled trials, mentat has shown promise for normalizing the behavior of children with attention-deficit disorder, developmental disabilities, or brain damage. Other double-blind, placebo-controlled trials found evidence that this combination therapy might be helpful for depression, epilepsy, decreasing amnesia caused by electroconvulsive therapy, reducing frequency of febrile seizures (seizures caused by fever), enhancing recovery from aphasia (loss of speech caused by stroke), and improving memory in people with anxiety. Mentat has also shown promise for bed-wetting.

Kamalahar. Kamalahar is a fixed combination containing T. undulate, P. urinaria, E. ribes, T. officinale, N. arbortistis, and T. arjuna. In a double-blind, placebo-controlled study, fifty-two people with acute hepatitis were randomly assigned to receive placebo or this combination herbal therapy at a dose of 500 mg three times daily for fifteen days. The results indicate that the herbal combination improved liver function to a significantly greater extent than placebo.

Liv.52. Liv.52 is a fixed combination containing Capparis spinosa, Cichorium intybus, Solanum nigrum, T. arjuna, Cassia occidentalis, Achillea millefolium, and Tamarix gallica. In a poorly reported five-week, double-blind, placebo-controlled study of thirty children with hepatitis A, the use of this combination formula apparently improved the rate of recovery compared with placebo. Benefits were also seen in a six-week study of thirty-four people with acute hepatitis A.

Another double-blind, placebo-controlled study evaluated the effectiveness of Liv.52 in a variety of liver conditions. A total of 104 people were enrolled in this trial and were divided into three groups depending on the liver condition they had: cirrhosis, acute hepatitis, or chronic hepatitis (type not stated). Participants with cirrhosis were treated for twenty-four months, those with chronic active hepatitis were treated for twelve months, and participants with hepatitis A were treated for only six weeks. The use of Liv.52 was associated with substantially better outcomes than placebo. Apparent benefits were also seen in a six-month, double-blind, placebo-controlled study of thirty-six people with cirrhosis. However, in a six-month, double-blind study of eighty people with alcoholic liver disease (alcoholic hepatitis or cirrhosis), Liv.52 failed to provide any benefits.

Rumalaya. In a placebo-controlled trial of one hundred people with rotator-cuff injury (frozen shoulder), the use of the tablet and cream combination rumalaya, a fixed oral and topical combination containing almost fifteen herbs, significantly improved results compared with little improvement in the placebo group.

Weight loss and cholesterol reduction. In a three-month, double-blind, placebo-controlled study, seventy overweight people were divided into four groups and given one of the following treatments: placebo; triphala guggul (a mixture of five Ayurvedic ingredients) plus gokshuradi guggul (a mixture of eight Ayurvedic ingredients); triphala guggul plus sinhanad guggul (a mixture of six Ayurvedic herbs); or triphala guggul plus chandraprabha vati (a mixture of thirty-six Ayurvedic ingredients). Reportedly, all three Ayurvedic ingredients produced significant weight loss and improvements in cholesterol relative to placebo; furthermore, the improvements produced by all of the treatments were close to identical.

Articulin-F and RA-11. Articulin-F is a fixed combination containing B. serrata, W. somnifera, C. longa, and zinc. In a three-month, double-blind, placebo-controlled trial of forty-two people with osteoarthritis, the use of this combination therapy significantly improved pain and disability compared with placebo. Another double-blind study found benefit with RA-11, a combination therapy containing most of the same ingredients as articulin-F, but substituting ginger for zinc.

Diabecon. Diabecon is a fixed herbal combination containing G. sylvestre, E. jambolana, T. cordifolia, P. marsupium, F. glomerata, M. charantia, and O. sanctum. In a six-month, double-blind, placebo-controlled trial, forty people with type 2 diabetes who had failed to respond fully to oral drugs received either this combination of Ayurvedic herbal therapy or placebo. The results indicated that the herbal therapy was modestly helpful.

Pancreas tonic. Pancreas tonic is a fixed herbal combination of herbs with an antidiabetic reputation containing A. marelose, A. indica, cinnamon, fenugreek, F. racemosa, G. sylvestre, M. charantia, P. marsupeum, S. cumini, and T. cordifolia. Several animal studies indicated that this traditional herbal formula might offer benefits for diabetes. Based on this, a three-month, double-blind study of thirty-six people with type 2 diabetes was undertaken. The results appeared to indicate that the use of pancreas tonic can improve blood sugar control. However, these studies were primarily conducted in the late 1990s and very early 2000s. Further human trials are necessary.

Fixed topical and oral combination. A fixed topical and oral combination for the treatment of acne contains A. barbadensis, A. indica, C. longa, H. indicus, T. chebula, T. arjuna, and W. somnifera. In a four-week, double-blind study, fifty-three people with acne received one of four therapies: real herb in oral tablets and as topical cream; real herb in oral tablets and as topical gel; real herb in oral tablets with placebo gel; or placebo tablet with placebo topical treatment. The results appear to indicate that while oral herb alone is not helpful, oral herb plus topical herb can improve acne symptoms.

DefensePlus. DefensePlus is a combination containing T. cordifolia, Ashwagandha (Withania somnifera), holly basil (O. sanctum), astragalus, E. officinalis, grapefruit seed extract, vitamin C, echinacea angustifolia extract, Oregon grape root, ginger root extract, yarrow extract, zinc, and extracts of the mushrooms reishi, maitake, and shiitake.

Laboratory and animal trials suggest this combination product may strengthen the immune response. Promising results have also been seen in two unpublished human trials. One was a double-blind, placebo-controlled trial of children aged five to eighteen who experienced recurring bouts of tonsillitis. The results showed that participants taking the herbal combination were less likely to require surgical treatment (tonsillectomy) for the condition. The other double-blind, placebo-controlled study found that using this herbal combination, along with standard therapy, improved recovery from eye conditions requiring antibiotics.

RA-1. RA-1 is a fixed combination containing ashwagandha, boswellia, ginger, and turmeric extracts. A sixteen-week, double-blind, placebo-controlled trial of 182 people with rheumatoid arthritis evaluated the potential effectiveness of this formula. Participants in both groups improved significantly; however, according to most measures of disease severity, the benefits of the herbal combination were no greater than those of placebo. Another sixteen-week randomized controlled study involving 165 individuals with rheumatoid arthritis found positive results using two daily RA-1 tablets manufactured by Artrex. In around 40 percent of participants, using RA-1 alone was sufficient to control symptoms. In the other participants, RA-1 proved to be safe when combined with steroids, disease-modifying antirheumatic drugs, and other medications.

PILEX. The fixed combination oral and topical herbal treatment PILEX was evaluated in a double-blind, placebo-controlled trial of one hundred people with hemorrhoids. The results indicated that the benefits were seen in 50 percent of those using the herbal treatment compared with only 20 percent in the placebo group.

Alba. In a double-blind study of forty-three men and women with hypertension, the use of the proprietary herbal combination alba (T. arjuna and approximately forty other herbs) proved almost as effective for controlling blood pressure as the drug methyldopa. Additionally, in a double-blind, placebo-controlled trial of twenty-five people with angina, the use of this combination therapy reduced chest pain and improved heart function.

One study of somewhat questionable reliability reported that the herb E. alba (also known as Bhringraja or Keshraja) can improve blood pressure when taken by itself at a dose of 3 grams daily. This study also claimed to find reductions in cholesterol levels.

Geriforte. Geriforte, a fixed herb combination containing approximately forty Ayurvedic herbs, has been marketed as a general tonic for older people. Several poorly designed or incompletely reported placebo-controlled trials suggest that this herbal combination might improve cholesterol levels, general well-being, and mood in older adults.

Astha 15. One double-blind comparative study provides weak evidence that the fifteen-herb combination called Astha 15 might be helpful for mild asthma. Further studies are lacking to confirm this finding, but Astha 15 remains a popularly sold supplement purported to improve upper respiratory health and asthma.

Choosing a Practitioner

There is no widely accepted licensure for the practice of Ayurvedic medicine. However, several schools offer extensive training. These schools generally require from 500 to 3,500 hours of training. The oldest Ayurveda school in the United States is the Ayurvedic Institute, founded by Vasant Lad in 1984 in Santa Fe, New Mexico. It later moved to Asheville, North Carolina. Other training programs are available at the California College of Ayurveda in Grass Valley and the American Institute of Vedic Studies in Santa Fe, New Mexico.

Safety Issues

Ayurvedic therapy presents numerous potential safety concerns. One serious problem is that many Ayurvedic herbs have never undergone a formal safety evaluation, and those that have been evaluated have not necessarily been proven harmless.

Most of the proprietary herbal formulas discussed in the foregoing have undergone a certain amount of safety testing by the manufacturer and were found nontoxic; however, verification of safety by independent laboratories that apply modern standards remains limited. Some traditional Ayurvedic formulas contain toxic levels of heavy metals, especially lead, mercury, and arsenic. According to the FDA, one in five Ayurvedic medicines contain detectable amounts of at least one of these heavy metals. In one tragic case report, a child born with brain damage to a woman using an Ayurvedic formula was found to have the highest blood levels of lead ever recorded in a living newborn. Analysis of the formula revealed a high lead content, along with toxic levels of mercury.

Among other concerns is oral silver, a traditional Ayurvedic remedy that can cause permanent gray-black staining of the skin and mucous membranes. The dietary recommendations made within the context of Ayurvedic theory could lead to inadequate intake of essential nutrients and malnutrition. However, most reputable Ayurvedic practitioners are aware of modern nutrition knowledge and make reasonable recommendations within that context.

Various traditional Ayurvedic techniques, such as bloodletting and drinking urine, clearly suggest possible health risks. Most modern Ayurvedic practitioners shun the most worrisome of these methods.

In a case report, a patient taking the antidepressant sertraline had two relapses of depression soon after taking an Ayurvedic herbal mixture containing T. chebula and C. wightii. The authors attributed this to an adverse drug-herb interaction. Another study found that an Ayurvedic herbal formula called trikatu (meaning "three spices," a mixture of black pepper and ginger) can reduce the effectiveness of the standard anti-inflammatory drug diclofenac. This finding was somewhat surprising because black pepper is generally thought to enhance the absorption and activity of various medications through a number of known chemical interactions.

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