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| Dr. Stuart Rothenberg |
by Stuart Rothenberg, M.D.
For information about "Integrative Ayurveda for Personal Wellness and Professional Training," co-sponsored
by University of Maryland Center for Integrative Medicine, please visit www.ayurveda-courses.org.
Ayurveda, the traditional
medical system of India, is the world’s oldest system of natural medicine and
the original mind-body science. There is currently an upsurge of interest in
Ayurvedic medicine in the North America, both among health professionals and
the general public. Ayurveda offers an extensive, individualized approach to
prevention of disease not typically found in conventional medicine. In
addition, Ayurveda has a holistic approach to treatment of chronic disease that
includes mind, body, behavior, and environment.
Ayurveda also includes a classical system of pulse diagnosis that can be
readily learned and applied in a contemporary setting.
The word Ayurveda comes from two Sanskrit roots: Ayus,
meaning life or life span, and Veda, meaning knowledge or science. Ayurveda is
therefore translated as "the science of life," which emphasizes its
orientation toward prevention. The major textbooks of Ayurveda, the Charaka
Samhita and Sushruta Samhita, cover the major branches of medicine under much
the same headings as conventional allopathic medicine, though with a preventive
and holistic orientation. The Ayurvedic pharmacopeia includes thousands of
plants and plant products, many of which are now familiar therapeutic agents,
such as rauwolfia and digitalis. 1-2
Unfortunately, over centuries of colonial rule in India when
Ayurvedic institutions were not officially supported, and were even actively
suppressed, much important clinical and theoretical knowledge became lost or
unavailable. As a result, Ayurveda's effectiveness became limited, as
practitioners did not have access to the full range of its comprehensive
approaches. A modern revival of Ayurveda, taking into account all of these
approaches in accordance with the classical texts, is known as Maharishi Ayurveda.
This restoration has taken place under the direction of Maharishi Mahesh Yogi
in collaboration with leading Ayurvedic physicians and scholars.3-4
The Ayurvedic Framework
Maharishi Ayurveda emphasizes host factors, particularly
imbalances resulting from disruption of intrinsic self-repair and immune
mechanisms, as the primary factor in the etiology of disease. The Ayurvedic
paradigm is thus reminiscent of Louis Pasteur’s famous statement that “the
invader is nothing, the terrain everything.” Ayurveda holds that underlying the
functioning of the host’s innate homeostatic and “self-healing” mechanisms is
an unmanifest (non-physical) field of biological intelligence, the body’s
“inner intelligence” (Atma). Ayurveda
places central importance on enlivening this most fundamental level of
intelligence in order to promote health and healing from within. It prescribes a variety of modalities,
including mind-body approaches, to accomplish this goal.
The principle of biologic individuality is central to
Ayurvedic diagnosis and treatment. In examining a patient, the practitioner
trained in Maharishi Ayurveda takes into account the particular pathology, but also
the constellation of unique psychophysiological characteristics that constitute
the individual. Thus in Ayurveda, assessment begins with diagnosis of the
individual’s constitutional type or “mind-body type,” which is the starting
point for developing an effective prevention or treatment program. In this,
Ayurveda presages the trend toward “personalized medicine” now emerging within
conventional allopathic medicine. The principle is that foods, medicinals,
behaviors, and lifestyle that may be therapeutic for one individual will be
different from those that will be therapeutic for another individual, depending
upon the individual’s psychophysiological make-up or constitutional type.
According to Ayurveda, three irreducible physiological
principles called Doshas regulate the
different functions of mind and body. These three fundamental physiological
“operators” are understood as the three basic modes of expression of the
underlying field of intelligence. In Sanskrit, the three doshas are called Vata, Pitta, and Kapha. Health
depends upon achieving a state of functional balance of these three operators. Everyone
is endowed at birth with some value of all three doshas, but in each person the
exact proportions vary. This proportion determines the psychophysiological
type. There are ten classic types, derived from the combinations of the three
doshas.
The three doshas are further subdivided into numerous
subdoshas with different locations and functions throughout the body. Imbalance
in the doshas and subdoshas disrupts normal function and is responsible for
various disorders. Since different subtypes of doshas and their combinations
affect different organ systems, the practitioner can learn to correlate the
Ayurvedic diagnosis with the disease classification of allopathic medicine.
Vata dosha represents motion and flow. Physiologically, it
is at the basis of respiration, circulation, and neuromuscular activity. Vata
imbalance predisposes to diseases of the nervous system, chronic pain, cardiac
arrhythmias, hypertension, degenerative arthritis, constipation, anxiety, and
insomnia. Pitta dosha directs all metabolic activities, energy exchange, and
digestion. Pitta imbalance predisposes to peptic ulcers, inflammatory bowel
diseases, skin diseases, allergic reactions, and most inflammatory conditions.
Pitta imbalance is also responsible for anger, hostility, and jealousy. Kapha
dosha represents structure, cohesion, and fluid balance. Kapha imbalance
predisposes toward congestive disorders, sinusitis, diabetes mellitus, obesity,
atherosclerosis, and tumors. Kapha imbalance is also responsible for feelings
of over-attachment and greed.
Knowing the psychophysiological type can help the practitioner
diagnose existing disorders and predict risk for future illnesses. The practitioner
trained in Ayurveda correlates both the Ayurvedic and allopathic findings and
then develops a treatment or prevention plan integrating both modalities.
Diagnosis
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Western practitioners training in Ayurvedic medicine learn a
system of diagnosis similar in many respects to the conventional allopathic model.
Termed the “3-fold” classical Ayurvedic approach, it includes careful
observation of the patient, history taking, and physical examination. However,
a special feature of Ayurvedic diagnosis is the meticulous attention given to
signs and symptoms that are diagnostic of the patient’s constitutional type.
Another unique aspect of the Ayurvedic approach is pulse
diagnosis (nadi vigyan). Through
palpation of the radial pulse, advanced Ayurvedic practitioners are able to
diagnose diseases not limited to the cardiovascular system, such as diabetes,
musculoskeletal diseases, immune disorders, and asthma. However, even Western
practitioners at much earlier stages of training can learn to detect physiological
imbalances at incipient stages, when there may be no other clinical signs and
when mild forms of intervention may suffice.
In Ayurvedic pulse diagnosis, the combinations of the doshas
and subdoshas responsible for the patient's clinical status are felt as
patterns of vibration in the radial artery. Vata, Pitta, and Kapha have
different tactile vibratory qualities—as do their subdoshas. The presence and
locations of these vibratory qualities in the pulse alert the practitioner to
specific patterns of balance and imbalance that underlie and are responsible
for the patient's condition. During training, the practitioner first takes his
or her own pulse many times a day, becoming intimately familiar with how it
changes under different circumstances. Following this initial stage of
training, the practitioner learns to perform pulse examinations on others.
Therapeutics
The main emphasis of Ayurvedic therapeutics is to restore
physiological balance, which equates with restoring balance to the doshas. In
Ayurvedic terms, balance is defined as the condition that maximally enhances
homeostatic and self-repair mechanisms. These strategies are divided into four
main areas: mind, body, behavior, and environment.
Mind.—In the Ayurvedic framework, the body is viewed not
merely as a sophisticated machine, but as a physical expression of the
underlying abstract field of intelligence. Ayurvedic practitioners identify
this underlying field as consciousness and locate consciousness at the basis of
the physiology rather than as an epiphenomenon of the nervous system.
Therefore, Ayurvedic practitioners use mental techniques for the treatment of
diseases, reducing stress, and developing mental potential.
Chief among these techniques is Transcendental Meditation
(TM), which has been the subject of over 350 peer-reviewed published studies, including
a series of randomized controlled trials on TM and cardiovascular disease
funded by over $25 million in grant support from the National Institutes of
Health. During the process of Transcendental Meditation, there are metabolic
changes indicative of a wakeful hypometabolic state (“restful alertness”).
Published studies on this technique have reported associations between the use
of Transcendental Meditation and reduced hospitalization and health care utilization;
increased longevity and quality of life; significant reduction in death, heart
attack, and stroke in heart patients; and reduced anxiety, hypertension, insulin
resistance, and substance abuse. The American Heart Association, in a recent
scientific statement, cited the Transcendental Meditation technique as the only
meditation procedure that has been documented to reduce blood pressure, and
recommended its consideration for inclusion in clinical programs for treatment
of hypertension.5-11
Body. —These approaches include the use of diet, exercise,
herbs, sensory modalities, and panchakarma
(purification procedures that include medicated oil massages, herbalized heat
treatments, and elimination therapies).
Therapeutic actions are maximally effective only if
appropriate dietary measures are instituted to support the restoration of
physiological balance. Ayurveda classifies all foods according to their effects
on Vata, Pitta, and Kapha. With this knowledge, the physician can individually
tailor a diet appropriate to the patient's type and imbalances. Recommendations
are also based on other factors, including seasonal influences and digestive
capacity.2-4
The practitioner trained in Ayurveda also prescribes herbal
food supplements. Ayurveda's description of medicinal plants includes knowledge
of action, timeliness of plant collection, storage, and steps of manufacture.
One principle is paramount—the appropriate portion of the plant should be used
in its entirety, not just the active ingredient. This is believed to produce a
synergistic effect and prevent toxic side effects.12
Behavior.— The Ayurvedic texts predated contemporary
knowledge of circadian and circannual cycles. According to psychophysiological
type, each patient is instructed in daily and seasonal health routines to
maintain the integrity of key biologic rhythms. These include simple
instructions for rising and retiring early, moving the bowels on awakening,
eating the main meal at lunchtime, and exercising properly according to
constitutional type.3-4
Environment. —Ayurvedic texts emphasize the importance of
collective health and the interrelationship between the health of the
individual and that of society. Therefore, collective and environmental health
measures to maintain the health of society and to construct a healthful
environment for living and working play an important role. Analysis of
psychophysiological type is important in many of these prescriptions, as
individuals differ in their responses to environment and types of occupations.3-4
Applying Ayurveda to Allopathic Medicine
Ayurveda adds several new elements to medical practice. Its
system of patient typology provides useful information for predicting risk
factors and tendencies toward specific diseases. Its emphasis on
psychophysiological balance as the key to enhancing the body's own healing
mechanisms and its therapeutic methods to modify dietary, behavioral, and
environmental determinants of disease can add new depth to the practitioner’s
approach to a wide variety of disorders.
The
training program in Ayurvedic Medicine
is
co-sponsored by University of Maryland Center for Integrative Medicine and
Maharishi Ayurveda Association of America. It is available in two tracks:
·
Health
Professionals track: a 66-hour certificate training program
for physicians and other healthcare providers to enable them to incorporate
Ayurveda into their practices
·
Wellness
Educator track: a 56-hour certificate training program
for individuals who wish to be trained as Ayurveda wellness educators, or who
wish to take the program for their own enrichment and knowledge.
Both tracks include training in pulse diagnosis,
body-type assessment, and prescription of individualized prevention and
treatment programs, including nutrition,
detoxification, stress reduction and other non-pharmacological approaches to promote
health and healing from within. Both tracks may be taken online
in a distance learning format as well as live onsite in weekend modules.
For further
information about the training program in Ayurvedic Medicine offered at
the University of Maryland, Baltimore, visit www.ayurveda-courses.org/umd.html.
Or you may email info@ayurveda-courses.org
or call (877) 540-6222.
References:
1. Bodeker G. Evaluating Ayurveda.
Journal of Alternative and Complementary Medicine 2001;7(5):
389-392.
2. Mishra LC (ed.): Scientific Basis for Ayurvedic
Therapies. CRC Press (USA); 2003.
3. Sharma HM, Clark C, Micozzi M: Ayurvedic Healing: Contemporary
Maharishi Ayurveda Medicine and Science. Singing Dragon Press, 2012.
4. Rothenberg
S, Belok S, Fields JZ. The Maharishi Vedic Medicine Chronic Disorders
Program: Introduction and Case Histories. Alternative and Complementary Therapies 2003;9(4):183-190.
5. Anderson J.W., Liu C., and Kryscio R.J., Blood pressure
response to transcendental meditation: A meta-analysis. Am J Hypertens 2008;
21:310-316.
6. Paul-Labrador M., Polk D., Dwyer J.H., et al., Effects of a
Randomized Controlled trial of Transcendental Meditation on components of the
Metabolic Syndrome in Subjects Coronary Heart Disease. Archives of Internal
Medicine, 2006, 166:1218-1224.
7. Schneider, R.H., Alexander, C.N., Staggers, F., Rainforth,
M., Salerno, J.W., Hartz, A., Arndt, S., Barnes, V., and Nidich, S., Long-term
effects of stress reduction on mortality in persons > 55 years of age with
systemic hypertension. American Journal of Cardiology, 2005. 95(9): 1060-1064.
8. Eppley, K., Abrams, A.I., and Shear, J., Differential effects
of relaxation techniques on trait anxiety: A meta-analysis. Journal of Clinical
Psychology, 1989. 45(6): 957–974.
9. Orme-Johnson D.W. and Herron R.E. ,Reduced medical care
utilization and expenditures through an innovative approach. Am J of Managed
Care 1997; 3:135–144.
10. Schneider
RH, Grim CE, Rainforth MA, Kotchen TA, Nidich SI, Gaylord-King C, et al.
Stress reduction in the secondary prevention of cardiovascular disease:
Randomized controlled trial of Transcendental Meditation and health
education in blacks. Circulation: Cardiovascular Quality and Outcomes.
2012;5(6):750-8.
11. Brook, R. D.,
Appel, L. J., Rubenfire, M., et al (2013). Beyond medications and diet:
Alternative approaches to lowering blood pressure : A scientific statement
from the American Heart Association. Hypertension: Journal of the
American Heart Association 2013: Vlm. 61.
12. Williamson, EM (ed.): Major Herbs of Ayurveda. Churchill Livingstone, 2002.
