CHAPTER 32 CONTEMPORARY AYURVEDA
HISTORY
Ayurveda is a holistic system of natural health care that originated in the ancient Vedic civilization of India. During centuries of foreign rule in India, beginning in the fifteenth century, Ayurvedic institutions declined or were suppressed, and much of the Ayurvedic knowledge was fragmented, misunderstood, and not used in its totality. Ayurveda has been revived in its completeness, in accordance with the classical texts, by Maharishi Mahesh Yogi in collaboration with leading Ayurvedic scholars and physicians, known as vaidyas. This specific reformulation of Ayurveda is known as Maharishi Ayurveda (MAV).
The Sanskrit name Ayurveda is a compound of two words: Ayus, which means “life” or “life span,” and Veda, which means “knowledge,” with a connotation of completeness or wholeness of knowledge. The element of “wholeness” in Ayurvedic knowledge has profound clinical significance: the MAV clinician uses more than 20 treatment approaches that deal with the full range of the patient’s life: the body, mind, behavior, environment, and, most importantly, the patient’s consciousness, his or her “innermost life.” MAV considers consciousness to be of primary importance in maintaining optimal health and emphasizes meditation techniques to develop integrated holistic functioning of the nervous system.
MAV includes a sophisticated theoretical framework that provides clinical insight into the functioning of both mind and body. Understanding of the patient’s mind-body type is essential to diagnosis and treatment, and special emphasis is placed on the therapeutic effects of diet and healthy digestion, as well as techniques to balance behavior and emotions. An extensive materia medica describes the therapeutic use of medicinal plants, and there is a detailed understanding of biological rhythms, which form the basis for daily and seasonal behavioral routines to strengthen the immune system and homeostatic mechanisms.
Ancient Ayurvedic texts typically begin with a thorough description of strategies of prevention before discussing modalities for treatment.
The Ayurvedic classics include three major texts (Brihat Trayi), the Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya of Vagbhata, and three minor texts (Laghu Trayi), the Sarngadhara Samhita, Bhavaprakash Samhita, and Madhava Nidanam. Most of these texts have been translated into English (Charaka Samhita, 1977; Madhavakava, 1986; Sarngadhara, 1984; Sushruta Samhita, 1963; Vagbhata, 1982). These texts address eight main sections of Ayurveda: Shalya—surgery in general; Shalakya—head and neck surgery for supraclavicular diseases; Kaya Chikitsa—treatment, diagnosis, and internal medicine; Kaumarya Birtya—pediatrics, obstetrics, and gynecology; Agad Tantra—toxicology and medical jurisprudence; Bhut Vidya—psychosomatic medicine; Rasayana—materia medica to promote vitality, stamina, resistance to disease, and longevity; and Vajikarana—fertility and potency. (See also Chapter 29.)
In addition to preventive techniques, MAV offers a holistic theory of prevention. Western medical attempts to develop preventive medical strategies, although laudable, conspicuously lack such a theory. As for the fields of diagnosis and treatment, MAV offers a large body of procedures and protocols, including a set of noninvasive diagnostic techniques, and addresses certain deficiencies of Western allopathic medicine. For example, functional diseases, such as irritable bowel syndrome and poor digestion, account for approximately one third of patient visits to family practitioners. Western medicine, however, lacks well-developed theories or methods of treatment for these disorders.
Another area of concern is iatrogenic (physician-caused) diseases, which are estimated to be the third leading cause of death in the United States (Starfield, 2000). A study of hospitalized patients found that 36% had iatrogenic illnesses (Steel et al, 1981). At least one serious “adverse event” (another term for iatrogenic occurrence) resulting from inappropriate care lengthened the hospital stay of 17.7% of hospital patients (Andrews et al, 1997), and nearly 14% of the adverse events led to death (Berwick et al, 1999). A large percentage of iatrogenic illnesses are the result of side effects from drugs. Adverse drug reactions have now become the fourth leading cause of death in the United States (Lazarou et al, 1998). To consider one example, Western approaches to cancer treatment can have severe side effects, and some antitumor drugs contribute to the development of new cancers. MAV modalities have been effective in reducing the side effects of several of these treatments (Dwivedi et al, 2005; Misra et al, 1994; Sharma et al, 1994; Srivastava et al, 2000), and laboratory research has shown that some MAV herbal preparations reduce cancer growth directly (Patel et al, 1992; Penza et al, 2007; Prasad et al, 1992, 1993; Sharma et al, 1990, 1991).
MAV is being practiced in clinics worldwide in India, Europe, Japan, Africa, Russia, Australia, and South and North America by specially trained physicians, many of whom also practice privately. In various ways, MAV directs its objectives not only to individual patients, but also to the life of society as a whole.
THEORETICAL BASIS: A “CONSCIOUSNESS MODEL” OF MEDICINE
MAV’s contribution to patient care and clinical practice results from the model of health and disease on which it is based. Whereas Western medicine bases its model for understanding health and disease on the material of the body, the MAV model is based on the body’s nonmaterial substrate, which is conceived as a field of pure intelligence. Western medicine’s paradigm may seem more scientific, but in certain respects, Ayurveda’s may be seen to presage today’s advanced theories of physics.
From the time of Newton until the early twentieth century, the field of physics was based on a materialist approach to the natural world (see Chapter 1). The allopathic medical paradigm, developed in the nineteenth century, is based on this theory of materialism; it views the body as a complex machine. However, discoveries by twentieth-century physicists have undermined this materialist worldview and uncovered a fundamental role for consciousness in the physical world. Because the nature and importance of consciousness are not usually considered in allopathic medicine, twentieth-century physics provides a useful background for understanding MAV.
According to the materialist theory that dominated physics until the 1900s, the universe is made up of solid, discrete bits of matter. These particles affect each other only through direct interactions. Four basic principles support this “common sense” view of reality, as follows:
In the materialist theory the consciousness of the scientist is considered separate from the material objects being studied. The knower (consciousness) and the known (object) are thought to exist in completely distinct domains. This separation is thought to be the basis of “objective” science. Throughout the history of science, however, the separation of consciousness from the apparently material world has led to theoretical difficulties. For example, if consciousness is completely separate from matter, it is difficult to explain how consciousness could arise from the purely mechanical interactions of solid matter within the brain.
In the twentieth century the terms of this discussion were changed by the fundamental discoveries of quantum physics. Experiments performed in the first quarter of the twentieth century indicated that subatomic particles, the supposed building blocks of nature, did not appear to be composed of solid matter. In some of these experiments, particles behaved as if they were waves. In others, electrons took instantaneous, discontinuous quantum jumps from one atomic orbit to another, with no intervening time and no journey through space—an impossible act for a classic particle. It also was shown that an individual subatomic particle cannot have both a precise position and a precise momentum simultaneously (the “uncertainty” principle), another situation that would not apply to a solid material particle. Finally, it was found that electrons can, with predictable regularity, tunnel through a solid barrier that, classically, would be impenetrable.
On the basis of these findings, the basic principles of quantum mechanics (often known as the Copenhagen interpretation) challenge the materialist worldview, as follows:
The Copenhagen interpretation was not put to experimental test for decades, which left some physicists unconvinced that solidity, causality, locality, and reductionism had to be abandoned. In the 1980s, however, a number of different experiments produced results that consistently contradicted the theories of materialism (often called local realism) and consistently confirmed the predictions of quantum mechanics (Aspect et al, 1981; Rarity et al, 1990). These studies found that once two particles have interacted, they are instantaneously correlated nonlocally, over arbitrarily vast distances—an impossibility in materialism.
These results do not invalidate materialism altogether. In the everyday world of “large” objects, the mechanistic causation of Newtonian physics is approximately correct, which is why much of medicine has been able to rely on it without apparently ill consequences. However, at the fundamental, subatomic level, materialism conflicts both with theory and with frequently replicated experimental evidence. This gives rise to a fundamentally different worldview. Many physicists now argue that nature is composed of probability waves that are a function of intelligence alone, not of discrete physical particles. The equations of quantum mechanics thus describe a world made of abstract patterns of intelligence.
In view of these uniformly idea-like characteristics of the quantum-physical world, the proper answer to our question, “What sort of world do we live in?” would seem to be this: “We live in an idea-like world, not a matter-like world.” There is, in fact, in the quantum universe no natural place for matter. This conclusion, curiously, is the exact reverse of the circumstance that in the classic physical universe there was not a natural place for mind. (Stapp, 1994)
Quantum field theory, the most accurate version of quantum mechanics, can be related to the core tenet of MAV’s paradigm. In quantum field theory the probability wave for a particle is described as a fluctuation in an underlying, nonmaterial field (known as a force field or matter field). Furthermore, in the most recent superunified theories, physicists have described all the force and matter fields that make up the universe as modes of vibration of one underlying, unified field, sometimes called the superfield or superstring field. All the order and intelligence of the laws of nature arise from this one fundamental, nonmaterial field, as does all matter. Not only are particles really just waves, but those waves ultimately are made of an underlying field, as ocean waves are made of ocean water. This field is one of pure intelligence, having the attributes that we associate with consciousness. This lends support to the statement of the quantum mechanical pioneer Max Planck, who said, “I regard consciousness as primary. I regard matter as derivative from consciousness,” and of Sir Arthur Eddington, the physicist who first provided evidence in support of Einstein’s general theory of relativity, who said, “The stuff of the world is mind-stuff” (Eddington, 1974).
Unified field theory may seem worlds away from the concerns of a clinician. The current allopathic approach assumes that the body can be explained by material reductionism, as if it were machinery. MAV, by contrast, has viewed it as an abstract pattern of intelligence. Because this latter view appears to be consistent with fundamental science, it is not unreasonable to consider that it might contribute to the clinician’s capacity to promote health. Let us examine how MAV’s “consciousness model” is applied in clinical practice.
APPLICATION OF THE CONSCIOUSNESS MODEL IN MAHARISHI AYURVEDA
Transcendental Meditation
To understand the most basic application of the consciousness model, we must briefly touch on physics again. Vedic thought discusses a unified field of pure, nonmaterial intelligence and consciousness whose modes of vibration manifest as the material universe. These modes of vibration are called Veda. The Vedic description is strikingly similar to that of physics but emphasizes an idea less often discussed in physics: that the unified field is the field of pure consciousness. The differentiation between consciousness and matter, between knower and known, loses its significance at the level of the unified field.
These various modes of vibration known as Veda are described and written down in the voluminous Vedic literature. The different aspects of Vedic literature have been found to correspond with specific areas of the human physiology (Nader, 1993).
In MAV the ultimate basis of disease is losing one’s connection to (or, to use a central Vedic description, one’s memory of) the unified field, which is the innermost core of one’s own being and experience. This loss is known technically as pragya-aparadh. The ultimate basis of prevention and cure is restoring one’s conscious connection to (or memory of) this innermost core of one’s being and experience. This reconnection is the basis of an integrated approach to health care; integration of the different layers of life begins with reconnecting one’s life to the substrate on which all its layers are based. The innermost core of one’s experience is considered identical to the home of all the laws of nature that operate throughout the universe. The body contains, at its basis, the total potential of natural law, and all of MAV’s modalities aim to enable the full expression of the body’s inner intelligence.
The foremost means for accomplishing this are the Vedic techniques for developing consciousness, the most important of which is Transcendental Meditation (TM). The term transcendental indicates that the mind transcends even the subtlest impulses of thought and settles down to the simplest state of awareness (in MAV terms, identical to the unified field). This state of awareness is known technically as Transcendental Consciousness (TC).
Interestingly, a large body of published research has demonstrated that, during the subjective experience of TC, the body’s metabolism and electroencephalogram (EEG) tracings take on a unique pattern of profound physiological rest and balance, with a metabolic reduction significantly deeper than that experienced during sleep or eyes-closed rest (Gallois, 1984; Wallace, 1970). Periods of clear experience of TC have been characterized by suspension of respiration without oxygen deprivation (Badawi et al, 1984; Farrow et al, 1982), stabilization of the autonomic nervous system (Orme-Johnson, 1973), and a decrease in plasma levels of lactate, a chemical marker of metabolic activity (Jevning et al, 1983) and cortisol levels (Jevning et al, 1978). Simultaneous with this metabolic rest, blood flow to the brain increases markedly (Jevning et al, 1978), and the brain displays a state of “restful alertness,” characterized by greatly increased coherence between the EEG patterns of different areas of the brain, that is, stable phase relations between two EEG signals as measured by Fourier analyses that attain correlations of more than 0.95 (Badawi et al, 1984; Levine, 1976).
The state of TC can thus be defined physiologically and experientially. This corroborates MAV’s view of TC as the fourth major state of human consciousness, in the sense that the three common states of waking, sleeping, and dreaming can be defined physiologically as well. MAV also discusses three higher states of consciousness in which the full potential of consciousness progressively unfolds. Long-term TM practitioners have reported that the experience of TC, which first occurred only during their practice of the TM technique, now subjectively coexists with waking and sleeping states. Several studies have investigated this integrated state, and results show that the increased EEG coherence that is characteristic of the TM practice appears to become a stable EEG trait during computer tasks (Travis et al, 2002). Long-term TM practitioners have significantly higher levels of frontal EEG coherence during performance of computer tasks than subjects who do not practice TM (Travis et al, 2006).
MAV views unfolding consciousness as the most important strategy of both disease prevention and cure. Consistent with this theory, data suggest that regular experience of TC has significant health benefits. Such research supports the MAV concept that “remembering” the unified field enlivens the orderly patterns that prevail in a healthy body. For example, TM has been found in several studies to retard biological aging (Glaser et al, 1992; Wallace et al, 1982). In a Harvard study of elderly nursing home residents that compared TM with two other types of meditation and relaxation techniques over 3 years, the TM group had the lowest mortality rate and the greatest reductions in stress and blood pressure (Alexander et al, 1989). A follow-up study that evaluated the long-term effects of TM on mortality in patients with systemic hypertension showed that TM practice was associated with a 23% decrease in all-cause mortality and a 30% decrease in the rate of cardiovascular mortality compared with other behavioral interventions and usual care (Schneider et al, 2005a). Several studies have found that TM significantly reduces high blood pressure (Cooper et al, 1978; Schneider et al, 1992, 2005b; Wallace et al, 1983). In a randomized controlled trial Schneider et al (1995) found TM to be approximately twice as effective as progressive muscle relaxation in reducing hypertension in older African Americans. Barnes et al (2004) studied the effect of TM on African American adolescents with high normal blood pressure and found that the TM group had greater decreases in daytime systolic and diastolic blood pressure than a control group who received health education. A recent meta-analysis of nine randomized controlled trials indicated that the regular practice of TM is associated with a significant reduction in systolic and diastolic blood pressure (Anderson et al, 2008). A previous meta-analysis of 17 randomized controlled trials indicated that practice of TM was associated with significant reductions in blood pressure, whereas simple biofeedback, relaxation-assisted biofeedback, progressive muscle relaxation, and stress management training did not result in statistically significant reductions (Rainforth et al, 2007).
A study of adolescents by Barnes et al (2001) found that TM had a beneficial effect on cardiovascular functioning, as measured by blood pressure, heart rate, and cardiac output. Studies of TM have shown that it significantly reduces cholesterol level (Cooper et al, 1978, 1979) and levels of lipid peroxide, fat that has been damaged by free radicals and can in turn cause damage of its own (Schneider et al, 1998). A noninvasive method of detecting free radical activity is the measurement of human ultra-weak photon emission, with lower emission intensities indicating lower levels of free radical activity. A study of long-term TM practitioners showed lower emission intensities in the TM group than in controls who did not meditate (Van Wijk et al, 2006). A follow-up study showed that TM practitioners had significantly lower emission intensities than practitioners of other meditation techniques and controls who did not practice meditation (Van Wijk et al, 2008). A study measuring catecholamine levels in TM practitioners showed that epinephrine and norepinephrine levels were significantly lower in the TM group than in the control group, although anxiety levels were similar in both groups (Infante et al, 2001). This indicates that the regular practice of TM results in a low hormonal response to daily stress. Because TM has been shown to reduce several important risk factors for heart disease (TM decreases high blood pressure, cholesterol level, and lipid peroxide level, and modulates the body’s response to stress), TM should be helpful in the treatment of heart disease (Barnes et al, 2006). Research has borne this out—patients with heart disease were challenged by exercising on a bicycle, and those who practiced TM showed better results on several heart-related parameters (Zamarra et al, 1996). A randomized controlled clinical trial showed that practice of TM is associated with a reduction in atherosclerosis—hardening of the blood vessels that can lead to heart attack or stroke (Castillo-Richmond et al, 2000). A randomized controlled study of African Americans with congestive heart failure showed that those practicing TM had significantly improved functional capacity as measured by a 6-minute walk test, compared with the health education control group. The TM group showed a significant decrease in depression compared with controls and had fewer rehospitalizations during the 6-month follow-up period (Jayadevappa et al, 2007).
The metabolic syndrome is regarded as a risk factor for coronary heart disease. Insulin resistance is considered a key component of the metabolic syndrome and is associated with hypertension. A randomized controlled trial of TM in patients with coronary heart disease showed that blood pressure and insulin resistance was significantly improved in the TM group compared with a health education control group (Paul-Labrador et al, 2006). A pilot study of postmenopausal women showed that TM reduced cortisol response to a metabolic stressor (Walton et al, 2004). This may play a role in the preventive effects of TM on cardiovascular disease and coronary heart disease, because elevated cortisol levels may be involved in producing the metabolic syndrome.
A meta-analysis of research on meditation and trait anxiety conducted at the Stanford Research Institute found that TM is approximately twice as effective as other meditation techniques in reducing trait anxiety (Eppley et al, 1989). Orme-Johnson and Walton (1998) conducted an analysis of meditation and relaxation techniques that showed TM to be more effective than other approaches in reducing anxiety, improving psychological health, and reducing tobacco, alcohol, and drug use. These and similar studies and meta-analyses (Alexander, Robinson, Orme-Johnson et al, 1994; Alexander, Robinson, Rainforth, 1994; Alexander et al, 1991) seem to corroborate MAV’s theory, in that relaxation and other types of meditation appeared to be a less significant variable compared with experiencing the fourth state of consciousness (i.e., TC) via TM. Hundreds of other published studies of TM have documented a wide range of benefits in such areas as intellectual development and rehabilitation (many of these studies are reprinted in Chalmers et al, 1989a, 1989b, 1989c; Orme-Johnson et al, 1977; and Wallace et al, 1989).
Regular practice of TM has also been found to reduce health care costs significantly, as measured by insurance statistics; TM practitioners needed hospitalization for illness or surgery 80% less often than a matched control group (Orme-Johnson, 1987). A study of Canadian citizens enrolled in the government health insurance program showed that over a 6-year period, practice of the TM technique reduced government payments to physicians by 13% each year (Herron et al, 2000). A subsequent study of Canadian citizens over the age of 65 showed even greater reductions in medical expenditures. Mean physician payments for the TM group decreased 24% annually compared with those for controls. There was a 5-year cumulative decline of 70% in physician payments compared with those for controls (Herron et al, 2005). This suggests that a TM program would be a valuable component of any comprehensive health care cost containment strategy or health care system reform effort.
Prevention, Pathogenesis, and Balance
Viewing the body as a pattern of intelligence is the basis of a central tenet of MAV: for optimal health, it is necessary to maintain the body’s natural state of internal balance. This tenet has applications for strengthening immunity, as well as for prevention, diagnosis, and treatment. The natural state of balance is understood in terms of another important Ayurvedic concept: three principles known as doshas govern the functioning of the body. The three doshas are vata, pitta, and kapha. Each has specific qualities and governs certain physiological activities. The doshas are not thought of as specifically physiological but as subtle principles that emerge early in the manifestation of the unified field. Therefore they are understood to operate throughout nature.
The doshas are considered to be derived from combinations of still subtler expressions, the five mahabhutas, or “great elements.” The physicist John Hagelin, a major contributor to grand unification theory, has pointed out that physics also identifies five basic “elements,” known as spin types. All the force and particle fields of physics belong to one of these five categories, and the characteristics of the five spin types correspond closely to those of the five mahabhutas.
Vata governs flow and motion in the body. It is at the basis of the activity of the locomotor system. Vata controls functions such as blood circulation, the expansion and contraction of the lungs and heart, intestinal peristalsis and elimination, activities of the nervous system, the contractile process in muscle, ionic transport across membranes (e.g., the sodium pump), cell division, and the unwinding of DNA during the process of transcription or replication. Vata is of prime importance in all homeostatic mechanisms and controls the other two principles, pitta and kapha.
Pitta governs bodily functions concerned with heat and metabolism, and directs all biochemical reactions and the process of energy exchange. For example, it regulates digestion, functions of the exocrine glands and endocrine hormones, and intracellular metabolic pathways such as glycolysis, the tricarboxylic acid cycle, and the respiratory chain.
Kapha governs the structure and cohesion of the organism. It is responsible for biological strength, natural tissue resistance, and proper body structure. Microscopically, it is related to anatomical connections in the cell, such as the intracellular matrix, cell membrane, membranes of organelles, and synapses. On a biochemical level, kapha structures receptors and the various forms of chemical binding.
When the doshas are balanced in their natural states and bodily locations, they produce health; when aggravated or imbalanced, they produce disease. A balanced pitta dosha, for example, ensures healthy digestion, but an aggravated pitta can cause ulcers and acid indigestion. MAV holds that all disease results from disruption of the natural balance of the doshas, and immune strength results from maintaining balance of the doshas. As Table 32-1 shows, the natural dosha balance can be thrown off by a wide variety of factors, such as unhealthy diet, poor digestion, unnatural daily routine, pollutants, and certain behaviors. The balance is restored by a variety of dietary and behavioral modalities, as well as other modalities discussed in this chapter, such as TM and herbal mixtures.
Each dosha has five subdivisions that govern different aspects of the body. For example, bhrajaka pitta, one of the subdivisions of pitta, relates to the skin. When balanced, it gives luster to the skin; when aggravated, bhrajaka pitta results in acne, boils, and rashes.
The concept of doshas—underlying metabolic principles—simplifies the practitioner’s tasks and increases his or her effectiveness. The tridosha concept can help in clarifying the possible side effects of any treatment, customizing treatments for a specific patient, predicting risk factors and tendencies toward specific diseases, and noticing clusters of apparently unrelated syndromes that may have a similar underlying cause.
Some of these aspects result from the doshas’ ability to provide the basis for a more precise description of the individual’s natural state of balance. An individual may have a natural predominance of one or more doshas. These doshas need not be present in equal proportion to ensure physiological balance, but they need to be functioning in harmony with one another. This state is called prakriti. When the doshas are out of balance, they create vikriti, which results in disorder and disease. Box 32-1 describes the classic characteristics of vata, pitta, and kapha prakritis. More common than these are mixed prakritis, which involve various combinations of the three classic types, such as vata-pitta, or pitta-kapha. These also describe the normal state of balance for individuals who possess them. Treatment in MAV is tailored to the individual patient through careful evaluation of both prakriti and vikriti.
BOX 32-1 Classic Characteristics of Vata, Pitta, and Kapha Prakritis
Because MAV views disease as resulting from disruption of the natural balance of the doshas, the doshas play a key role in MAV’s approach to understanding pathogenesis. In Western medicine a disease is detected as a result of its symptoms. The emergence of symptoms, however, must be preceded by earlier stages of imbalance. MAV identifies six stages of pathogenesis, the first three of which have highly subtle symptoms with which allopathic medicine is not familiar. These first three stages involve aggravation of the normal functioning of the doshas. A skilled MAV diagnostician can detect these early pathogenic stages before overt symptoms emerge, using the techniques discussed in the next section.
Diagnosis
MAV adds a number of diagnostic techniques to the clinician’s repertoire. All of them are noninvasive and reveal much information about underlying imbalances and about specific illnesses. Chief among these techniques is nadi vigyan (pulse diagnosis), which allows one to retrieve detailed information about the internal functioning of the body and its organs through signals present in the radial pulse. This information involves not only the cardiovascular system but other bodily systems as well. From the pulse, the diagnostician gains information about the functioning of the bodily tissues, the state of the doshas, and much more. Pulse diagnosis reveals early stages of imbalance that precede full-blown symptoms. In this and other MAV diagnostic modalities, perceiving the body as a pattern of intelligence enables physicians to retrieve enormous amounts of information in a noninvasive manner.
Pharmacology
Perception of the body in terms of patterns of intelligence is also demonstrated in MAV’s approach to pharmacology, which makes sophisticated use of thousands of herbs and other plants.
Western pharmacology, applying the mechanistic model of the body, isolates and then synthesizes single active ingredients from herbs and plants. For example, the Ayurvedic remedy willow bark was the source of acetylsalicylic acid, and the Ayurvedic remedy rauwolfia was the source of reserpine. The active ingredient model reflects a weakness of the scientific method: its inability to deal with complex systems and its requirement that the researcher radically simplify a process to evaluate it (Sharma, 1997). In contrast, Ayurvedic pharmacology, called dravyaguna, uses the synergistic cooperation of substances as they coexist in natural sources. It uses single plants or, more often, mixtures of plants whose effects are complementary. Such synergistic effects are gaining consideration in Western medical research, which is finding, for example, that combinations of antioxidants may halt oxidative damage and cancer cell growth more effectively than the single substances acting alone.
In terms of MAV’s consciousness model, the effectiveness of herbal mixtures relative to active ingredients can be explained by the idea that plants, especially herbs, are concentrated repositories of nature’s intelligence that, when used properly, can increase the expression of that intelligence in the body. Research and experience with MAV herbal mixtures known as rasayanas shows that synergism enhances the free radical–scavenging properties of herbs and mitigates the harmful side effects that often accompany Western drugs (Sharma, 2002).
According to MAV, rasayanas promote longevity, stamina, immunity, and overall well-being (Sharma, 1993). Research has shown several rasayanas to have significant antioxidant properties (Bondy et al, 1994; Cullen et al, 1997; Dwivedi et al, 1991, 2005; Engineer et al, 1992; Hanna et al, 1994; Niwa, 1991; Sharma et al, 1995). The rasayana known as Maharishi Amrit Kalash (MAK) is approximately 1000 times more effective at scavenging free radicals than vitamin C, vitamin E, and a pharmaceutical antioxidant (Sharma et al, 1992).
MAK has been researched extensively in laboratory, animal, and clinical settings, and has been found to have a wide range of significant beneficial properties. MAK prevented and treated breast cancer (Sharma et al, 1990; Sharma et al, 1991); prevented metastasis of lung cancer (Patel et al, 1992); caused nervous system tumor cells (neuroblastoma) to regain normal cell functioning (Prasad et al, 1992); enhanced the effect of nerve growth factor in causing morphological differentiation of nervous system tumor cells (pheochromocytoma) (Rodella et al, 2004); inhibited the growth of skin cancer cells (melanoma) (Prasad et al, 1993); and inhibited liver cancer (Penza et al, 2007). In clinical studies, MAK has been shown to reduce the side effects of chemotherapy without reducing the efficacy of the cancer treatment (Misra et al, 1994; Srivastava et al, 2000).
MAK also reduces several risk factors for heart disease. It prevented human platelet aggregation (Sharma et al, 1989) and reduced atherosclerosis in laboratory animals by 53% (Lee et al, 1996). In clinical studies of patients with heart disease, MAK reduced the frequency of angina, improved exercise tolerance, and lowered systolic blood pressure and lipid peroxide levels (Dogra et al, 1994, 2005). A study of hyperlipidemic patients showed that MAK increases the resistance of low-density lipoprotein to oxidation, which is important for the prevention of atherosclerosis (Sundaram et al, 1997).
A strong immune system is vital to the maintenance of health. Several studies have shown that MAK significantly enhances immune functioning (Dileepan et al, 1990, 1993; Inaba et al, 1995, 1996, 1997, 2005). MAK has also demonstrated antiaging effects. It improved age-related visual discrimination in older men (Gelderloos et al, 1990) and has been shown to rejuvenate the antioxidant defense system and protect against mitochondrial deterioration in the aging central nervous system (Vohra et al, 1999, 2001a). In the aging brain, MAK reduced lipid peroxidation and lipofuscin pigment accumulation, restored normal oxygen consumption, and enhanced cholinergic enzymes (Vohra et al, 2001b, 2001c). It has also been shown to decrease the number of dark neurons in the brain, which indicates that MAK protects the neurons from injury (Vohra et al, 2002).
A modified form of MAK, known as Amrit Nectar tablets, has powerful antioxidant properties. In a study of the inhibition of lipid peroxidation, an aqueous extract of Amrit Nectar tablets was 16 times more potent and an alcoholic extract was 166 times more potent than vitamin E, a well-known antioxidant. Amrit Nectar tablets also protected against the toxic side effects of the chemotherapeutic drugs doxorubicin (Adriamycin) and cisplatin (Dwivedi et al, 2005).
Diet
Western medical research is accumulating increasing evidence that diet plays a critical role in the development of heart disease and cancer. The American Cancer Society reports that about one third of the cancer deaths that occur each year in the United States are from cancers for which diet is a significant risk factor (Cancer Facts and Figures, 2008). Scientists estimate that 60% to 70% of cancers could be prevented by simple changes in diet and lifestyle (Sharma et al, 2002). It is known that a diet rich in the wrong types of fat creates a higher risk of heart disease, the number one killer in the United States today (American Heart Association, 2007; Sharma et al, 1998). Ayurveda has long considered problems of diet and digestion to be among the central causes of all disease and has considered improvement of diet and digestion to be crucial to almost any therapeutic regimen. Ayurveda views faulty diet as not only contributing to specific degenerative diseases, but also throwing off the body’s natural balance, thus weakening immunity.
MAV’s approach to diet rests on the consciousness model. Food is viewed as providing not only matter and energy to the body but also intelligence, order, and balance. This brings to mind the observation of the Nobel laureate physicist Erwin Schrödinger that food helps the body resist the second law of thermodynamics, which normally leads any complex system into chaos (Schrödinger, 1967). In this view, when we eat, we are eating not only nutrients but also “orderliness.” MAV dietetics considers not only the nutritional value and caloric content of food but also the food’s impact on the body’s underlying state of balance. Food affects the doshas, and diet must be suited to the individual’s vikriti and prakriti. It must also reflect the climate and season, as well as specific health conditions.
The influence of food on the doshas is specific to the food, but can usually be determined by knowing to which generic categories of taste and qualities the food belongs. According to MAV, the six categories of taste are sweet, sour, salty, pungent, bitter, and astringent. The six major categories of qualities are heavy, light, oily, dry, hot, and cold. Box 32-2 summarizes how taste and food qualities affect the doshas, and Box 32-3 gives examples of foods that possess these various qualities and tastes.
BOX 32-2 Tastes and Food Qualities: Effects on the Doshas
| Tastes | |
| Decrease Vata | Increase Vata |
| Sweet | Pungent |
| Sour | Bitter |
| Salty | Astringent |
| Decrease Pitta | Increase Pitta |
| Sweet | Pungent |
| Bitter | Sour |
| Astringent | Salty |
| Decrease Kapha | Increase Kapha |
| Pungent | Sweet |
| Bitter | Sour |
| Astringent | Salty |
| Major Food Qualities | |
| Decrease Vata | Increase Vata |
| Heavy | Light |
| Oily | Dry |
| Hot | Cold |
| Decrease Pitta | Increase Pitta |
| Cold | Hot |
| Heavy | Light |
| Oily | Dry |
| Decrease Kapha | Increase Kapha |
| Light | Heavy |
| Dry | Oily |
| Hot | Cold |
As an example of how this information would be applied clinically, a patient with kapha syndromes (e.g., sinusitis, certain types of obesity) would be advised to minimize consumption of heavy, oily, and cold foods, as well as foods with sweet, sour, and salty tastes. It would be recommended that the patient give predominance to foods exhibiting the remaining qualities and tastes.
MAV recommends a lactovegetarian diet for optimal health. Meat is more difficult to digest and has been linked to numerous diseases, including heart disease, cancer, and diabetes. MAV also recommends eating fresh fruits and vegetables. These emphases map well with emerging Western findings on diet, which have shown significant health benefits from a meatless diet and from increased consumption of fruits and vegetables (“Vegetarianism: addition by subtraction,” 2004). A long-term study of vegetarians revealed that eating fresh fruit daily results in a significant reduction in mortality from ischemic heart disease, cerebrovascular disease, and all causes combined (Key et al, 1996). Higher consumption of fruits has also been associated with lower risks of lung, prostate, and pancreatic cancers. Vegetarians have lower risks of obesity, hypertension, diabetes, arthritis, colon cancer, prostate cancer, fatal ischemic heart disease, and death from all causes (Fraser, 1999; Kwok et al, 2000). A long-term study of male Seventh-Day Adventists found that meat eating correlated positively with all forms of mortality measured (Snowdon, 1988).
Multiple studies have demonstrated that eating meat increases the risk of heart disease, whereas a vegetarian diet affords protection against heart disease. A study of Seventh-Day Adventists showed a significant association between beef consumption and fatal ischemic heart disease in men, compared with vegetarians. The lifetime risk of ischemic heart disease was decreased by 37% in male vegetarians compared with nonvegetarians (Fraser, 1999). The risk of developing ischemic heart disease is also significantly lower in older vegetarian women than in older nonvegetarian women (Kwok et al, 2000). The Health Professionals Follow-up Study found consumption of red meat to be associated with coronary artery disease in men (Ascherio et al, 1994). Other studies also indicate that vegetarians have a significantly lower incidence of coronary heart disease (Claude-Chang et al, 1992; Dwyer, 1988; Slattery et al, 1991). Patients on a vegetarian diet show reduced frequency, duration, and severity of angina; regression of atherosclerosis; and improvement in coronary perfusion (Segasothy et al, 1999). Long-term vegetarians have a reduced risk of lipid peroxidation (Krajcovicova-Kudlackova, Simoncic, Babinska et al, 1995; Krajcovicova-Kudlackova, Simoncic, Bederova et al, 1995) and lower levels of cholesterol (Key et al, 1999; Kwok et al, 2000).
A vegetarian diet has shown protective effects against cancer, whereas eating meat has been correlated with the development of various types of cancer. Nonvegetarians have a significantly higher risk of developing colon cancer and prostate cancer (Fraser, 1999). Women who eat red meat daily are at twice the risk of developing colon cancer compared with women who eat red meat less than once a month (Willett et al, 1990). The association between red meat and colon cancer was elucidated in a clinical study that showed increased levels of endogenous N-nitrosation due to increased nitrogenous residues from red meat (Bingham et al, 2002). A large prospective study, the National Institutes of Health–AARP Diet and Health Study, found that eating red meat was associated with a significantly elevated risk of colorectal cancer, lung cancer, esophageal cancer, and liver cancer. Eating processed meats resulted in a significantly elevated risk of colorectal cancer and lung cancer (Cross et al, 2007). A study of vegetarian diet found a 40% reduction in cancer mortality in non–meat eaters compared with meat eaters (Thorogood et al, 1994). Increased consumption of fruit has been associated with lower risks of lung, prostate, and pancreatic cancers (Fraser, 1999).
Type 2 diabetes mellitus is another chronic disease that has been associated with meat intake. In a 17-year prospective study of Adventists, subjects who ate meat at least weekly had a 74% increase in diabetes risk compared with those who did not eat meat (Vang et al, 2008). The Nurses’ Health Study showed that consumption of red meat and processed meats were both associated with an increased risk of diabetes in women (Fung et al, 2004). Processed meats were also implicated in diabetes in the Nurses’ Health Study II, in which increased processed meat consumption was strongly associated with a progressively higher risk for diabetes in women. This study was also found that consumption of bacon, hot dogs, sausage, salami, and bologna were all individually associated with a higher risk of diabetes (Schulze et al, 2003). Similar results were seen in the Women’s Health Study: higher consumption of total red meat, higher consumption of processed meat, and higher consumption individually of bacon and hot dogs were all significantly associated with increased risk of diabetes in women (Song et al, 2004). Findings are comparable for men: the Health Professionals Follow-up Study showed that frequent consumption of processed meat was significantly associated with a higher risk of diabetes (van Dam et al, 2002). Eating fruits and vegetables provides protection against diabetes. A 12-year prospective study showed that higher fruit and vegetable intake is associated with a substantially decreased risk of diabetes (Harding et al, 2008).
A vegetarian diet has proven beneficial in other chronic disorders as well. The prevalence of hypertension was shown to be lower among long-term vegetarians than among nonvegetarians in a study of Seventh-Day Adventists (Brathwaite et al, 2003). Diets rich in fruits and vegetables significantly reduced blood pressure in the Dietary Approaches to Stop Hypertension (DASH) clinical trial (Appel et al, 1997). This study also found that increasing fruit and vegetable consumption decreases urinary calcium excretion, which has positive implications for bone health (Appel et al, 1997). Several population-based studies have shown that eating fruits and vegetables is beneficial for axial and peripheral bone mass and bone metabolism in men and women of all ages (New, 2003). Considering all the benefits of a vegetarian diet, it is not surprising that studies have shown vegetarians to have a longer life span (Fraser, 1999; Fraser et al, 2001; Singh et al, 2003). A long-term study found that vegetarians have a mortality rate that is half that of the general population (Key et al, 1996).
The hazards of a meat-based diet may be due to characteristics of the meat itself as well as multiple aspects involved in the production, preservation, processing, and cooking of meat and meat products (Cross et al, 2007; Singh et al, 2003). Saturated fat in meat contributes to atherogenesis and carcinogenesis. Heme iron in meat contributes to higher oxidative stress, which is linked to both heart disease and cancer. Meat increases the endogenous formation of N-nitroso compounds, which are carcinogenic. Processed meats containing nitrite preservatives are an exogenous source of N-nitroso compounds. Smoked and salted meats containing N-nitrosodimethylamine are a carcinogenic risk. Heterocyclic amines and polycyclic aromatic hydrocarbons are known mutagens that are formed during high-temperature cooking of meat (e.g., grilling). Other hazards of ingesting meat relate to what the animals themselves have eaten, for example, feed containing herbicides and pesticides that become concentrated in the fatty tissues and membranes of the meat. Cattle feed supplemented with rendered cattle carcasses has been implicated in the development of the transmissible prion disease known as “mad cow disease.” Antibiotics administered to livestock may contribute to antibiotic resistance in those who consume their meat.
The benefits of a vegetarian diet relate to lower intake of saturated fat, cholesterol, and animal protein and increased intake of complex carbohydrates, dietary fiber, trace minerals, vitamins, and a myriad of biologically active phytochemicals (Lampe, 1999; Leitzmann, 2005). Clinical dietary studies of plant foods and their constituents have shown that fruits and vegetables affect the human biological system in many beneficial ways. They have antioxidant properties, stimulate the immune system, modulate detoxification enzymes, and alter cholesterol synthesis and hormone metabolism. Many phytochemicals have overlapping mechanisms of action and can have synergistic or additive effects. It is noteworthy that the protective effects of fruit and vegetable consumption observed in the epidemiological studies are not seen with pharmacological doses of the plant foods or their constituents. The benefits were observed when these foods were eaten as part of the subjects’ diet (Lampe, 1999).
Digestion
MAV focuses not only on what one eats but also on how one digests it. The emphasis on digestion contrasts with Western allopathic medicine, which deals with digestion only when it is significantly disrupted. In MAV, excellent digestion is considered critical to robust health. MAV contains a number of techniques for improving digestion and treating digestive disorders. They center on the concept of agni, which literally means “fire” and refers to metabolic and digestive activities that convert foodstuff into bodily substances. Ayurveda describes 13 types of agni in the body. Their importance in Ayurvedic health care is suggested by the fact that one of the eight branches of Ayurveda, Kaya Chikitsa (internal medicine), focuses on the strength or weakness of the agnis. This emphasis on digestion becomes clearer when we consider the end product of poor digestion, which Ayurveda calls ama. Ama plays a key role in pathogenesis, interacting with aggravated doshas and causing them to “stick” to areas where they do not belong. Healthy digestion reduces the amount of ama produced.
The central role of food and digestion is demonstrated particularly well by consideration of another central MAV concept: the importance of a substance called ojas. Ojas is said to be the finest manifestation of the unified field, which serves as a sort of glue to link consciousness and matter. Ojas maintains the integrity of the seven bodily tissues (dhatus), which are plasma (rasa), blood (rakta), muscle (mamsa), fat (meda), bone (asthi), bone marrow and nervous system (majja), and sperm and ovum (sukra). The end product of truly healthy diet and digestion is said to contain significant amounts of ojas. According to an MAV expression, “Like a bee that gets honey from the flowers, we get ojas from our food.” Most MAV therapies and behavioral advice are designed to maximize the presence of ojas, and almost all MAV proscriptions are designed to minimize the depletion of ojas.
The manner in which food is eaten is considered to have an effect on healthy digestion. Food should be eaten in a warm, congenial, and uplifting atmosphere. Arguing or any other negativity at meals interferes with digestion, producing ama instead of ojas. Positive, loving emotions enhance digestion and increase the abundance of ojas.
Pañchakarma (Purification Therapies)
To rid the body of accumulated ama, pollutants, and other pathogenic impurities that disrupt or block the natural expression of the body’s inner intelligence, MAV emphasizes the importance of purification therapies. Foremost among these is Pañchakarma (or Panchakarma; see Chapter 29), which literally means “five activities.” Pañchakarma includes five main treatment modalities:
Daily treatments, administered for 2 to 14 days or longer, are recommended with each change of the seasons. Certain aspects of Pañchakarma can also fit easily into a patient’s daily preventive regimen. Preliminary research has shown that regular Pañchakarma reduces several cardiovascular risk factors, including cholesterol (Sharma et al, 1993; Waldschütz, 1988). Sesame oil, which is used topically and for colonic irrigation in Pañchakarma, has been shown to inhibit in vitro malignant melanoma growth (Smith et al, 1992) and human colon adenocarcinoma cell line growth (Salerno et al, 1991). Preliminary research on Pañchakarma has shown that it reduces levels of fat-soluble toxicants in humans. Levels of polychlorinated biphenyls (PCBs) and agrochemicals were reduced by 50% in subjects who received Pañchakarma. PCBs have been banned for years, but previous exposure can result in a lingering accumulation of the toxicant in fat tissue. Lipophilic toxicants have been associated with hormonal disorders, suppression of the immune system, reproductive disorders, cancer, and other diseases (Herron et al, 2002).
Behavior, Emotions, and the Senses
MAV regards behavior, speech, and emotions as having a significant impact on health. This concept springs naturally from the model that places consciousness at the basis of the body. Emotions can be understood as fine fluctuations of consciousness (or the unified field); as such, their impact on the more expressed physical levels of the body is immense. Recently, Western medicine has begun to investigate the effect of emotions on health, with interesting findings; Ayurveda has discussed this field for millennia. Ayurvedic texts include detailed discussions of lifestyle and behavior and their impact on health. Interestingly, traditional virtues—such as respect for elders, teachers, loved ones, and family members; pardoning those who wrong you; practicing nonviolence; and not speaking ill of others—are understood to promote the health of the individual’s mind and body, as well as of the community and society.
According to Ayurveda, information entering through the five senses (sight, sound, taste, touch, and smell) is digested and metabolized in its own specific ways, and the by-products influence physiology. Thus, sensory input is considered to have an impact on health. This idea is applied clinically, not only in terms of behavioral advice but also in the form of sensory therapies such as aromatherapy and sound therapy. The use of sound therapy includes music (called Gandharva Veda) and primordial sounds used for their healing qualities. A study of MAV primordial sound therapy (specifically, Vedic sounds known as Sama Veda) found that it reduces human tumor cell growth significantly, whereas hard rock music tends to increase growth significantly (Sharma et al, 1996) (see Chapter 31).
Biological Rhythms
In MAV, attuning the patient’s lifestyle to natural biorhythms is considered a crucial element of prevention and treatment. MAV gives a detailed analysis of circadian and circannual rhythms, with recommendations for daily and seasonal routines. These include advice such as rising and retiring early, and eating one’s main meal at lunchtime when the digestive “fires” are strongest. Many other recommendations are also given; as always, this advice must be tailored to the individual. Emerging Western data on biorhythms correlate well with the ancient Ayurvedic knowledge. Again, the idea of a connection between patterns of order in nature and in the human body was obvious to Ayurveda millennia ago.
The three-dosha concept plays a key role in understanding these connections. Different times of the day are associated with different doshas, as are different seasons and the different stages of the human life cycle (Box 32-4). For example, the summer is dominated by pitta (the dosha that governs heat and metabolism), whereas the spring is dominated by kapha (which has qualities of coolness and moisture). Childhood is dominated by kapha (which governs structure, substance, and growth) and old age by vata. In fact, physicians see a preponderance of kapha-based disorders, such as colds and respiratory illnesses, in children and an ever-increasing number of vata disorders, such as constipation and lighter, shorter, and more frequently interrupted sleep, in elderly patients. They also see more kapha-type disorders in spring and pitta disorders in summer. Understanding the concept of doshas is helpful in treating these ailments.
COLLECTIVE HEALTH AND THE ENVIRONMENT
MAV holds great promise in several areas of collective health. In terms of infectious disease and epidemics, the Western approach of using antibiotics has an inherent limitation and risk caused by the process of natural selection, which produces new, resistant strains of microbes. As a result, overreliance on antibiotics can foster the development of serious new infectious diseases. MAV’s focus on strengthening immunity and its techniques for dealing directly with epidemics offer a more effective and safer means of ensuring collective health.
In terms of chronic disease, Western medicine has long recognized that preventing and treating these disorders requires changes in lifestyle, diet, and behavior. However, allopathic medicine has been at a loss as to how to effect these changes in patients for a prolonged time. Research has shown that those who practice TM are better able to give up harmful habits such as cigarette smoking, alcohol consumption, and illegal drug use, and incorporate healthy dietary and lifestyle changes (Alexander et al, 1994b; Gelderloos et al, 1991; Monahan, 1977). MAV offers other time-tested modalities that benefit individual patients, such as daily routine and purification procedures, which could be useful in large-scale applications. MAV also offers an overall theory of prevention involving elements such as the three-dosha concept that could be of value for research on preventive medicine.
The most significant public health approach of MAV deals with larger social disorders and the dangers they pose. War, crime, and violence are rarely considered subjects of public health policy, but their implications for health are obvious. As with individual disease, MAV understands these as originating not in material factors but ultimately in consciousness—in this case, both individual and collective consciousness. Just as an abstract field of consciousness underlies the individual’s mind and body, such a field underlies societal trends. Society reflects the influence of its members not only in a linear, additive way—in the sense that a green forest is made of green trees—but also through a field effect—in the sense that a gravitational field’s influences are not localized. If the individual consciousness of a sufficient number of members of a society is coherent, harmonious, and life supporting, those influences spread through the “field” of the collective consciousness of the society, influencing the society as a whole.
This idea has been tested in a number of different settings. A study conducted in 1983 during the Lebanon War found that when a sufficiently large group of practitioners of the TM and advanced TM-Sidhi techniques meditated together as a group in Israel, war deaths in Lebanon were significantly reduced compared with casualty rates on days when the number of practitioners meditating together decreased below a certain threshold (Orme-Johnson, Alexander et al, 1988). This study was replicated and extended; the results showed that the group practice of meditation techniques in a series of seven assemblies occurring over a 2.25-year period of the Lebanon War had a significant beneficial impact, including an estimated 48% reduction in conflict, 71% reduction in war fatalities, and 68% reduction in war injuries during the assemblies (Davies et al, 2005). Studies in other localities have also shown beneficial effects, usually involving reductions in the rate of violent crime (Dillbeck et al, 1981, 1988; Orme-Johnson and Gelderloos, 1988). For example, a 1993 study in Washington, DC, showed that when a large group of practitioners of the TM and TM-Sidhi programs assembled to meditate during the summer, there was an 18% reduction in violent crime compared with levels that had been predicted on the basis of previous years’ crime levels and weather trends (Hagelin et al, 1999).
There has been much discussion and debate regarding these observations and the validity of what has been called the Maharishi effect. A psychoneuroendocrine mechanism for the observed societal effects has been investigated in a prospective time series study. It was found that day-to-day increases in the size of a group practicing the TM program were predictive of biochemical changes in nonpractitioners living and working up to 20 miles away from the TM group. There were changes in the levels of cortisol, a major stress hormone, and 5-hydroxyindoleacetic acid (5-HIAA), the main metabolite of serotonin, a widely distributed neurotransmitter in the brain that is associated with a sense of well-being. As the size of the TM group increased, excretion of cortisol decreased, excretion of 5-HIAA increased, and the ratio of excretion rates of 5-HIAA to cortisol increased. This preliminary study supports the hypothesis that group practice of the TM technique reduces stress and increases well-being on a biochemical level in individuals who are not in physical contact or in communication with the meditators (Orme-Johnson, 2005; Walton et al, 2005).
FUTURE DIRECTIONS
Many central elements of Ayurveda, such as the ideas that diet and emotions play a crucial role in disease and prevention, were not taken seriously by Western medicine a generation ago but are now major themes of research. Other areas of Ayurveda might prove to be of value in both clinical work and research. Already, study of the TM technique and herbal preparations have produced bodies of significant research findings whose implications have yet to be fully explored. Other areas in which research is just beginning include using a biostatistical approach to quantify the three doshas (Joshi, 2004); using the scientific framework of systems analysis to establish the three doshas as universal properties of all living organisms (Hankey, 2001, 2005); and identifying a genetic basis for prakriti (Patwardhan et al, 2005, 2008).
The clinical use of Ayurveda appears to be most dramatic when applied to diseases that Western medicine finds it difficult to treat, such as poor digestion, heart disease, cancer, and other chronic diseases (Janssen, 1989; Orme-Johnson, 1987). Its clinical value extends to other areas not discussed previously, including pediatrics, in which it has been found to reduce significantly the incidence of childhood ailments such as frequent colds, and gynecology, in which it has been shown to reduce the severity of menstrual and premenstrual disorders. Ayurveda is a comprehensive system of health care that uses multiple modalities for the treatment of disorders. Clinical research trials are generally designed to investigate single treatments for ease of interpretation and characterization of the results; however, this type of investigation fragments Ayurvedic treatment. A randomized trial of a whole-system Ayurvedic protocol was conducted in patients who were newly diagnosed with type 2 diabetes. The experimental group received instruction in TM and yoga stretches, dietary instructions in accordance with Ayurvedic principles, recommendations for daily routine and exercise, and an Ayurvedic herbal supplement. This preliminary study found statistically significant improvements in those patients in the Ayurvedic group who had higher baseline values of glycosylated hemoglobin (Elder et al, 2006).
Several medical institutions have incorporated Ayurveda into their teaching curricula. In the future it is likely that Ayurveda will gain further recognition as an effective system of natural health care. Its comprehensive modalities can be used to create health and well-being in the individual and in society as a whole.
Chapter References can be found on the Evolve website at http://evolve.elsevier.com/Micozzi/complementary/