Therapeutic Principles of Ayurveda N.SRIKANTH ASSISTANT DIRECTOR CENTRAL COUNCIL FOR RESEARCH IN AYURVEDIC SCIENCES Department of AYUSH Ministry of Health & Family Welfare Government of India

Background Ayurveda, the science of life is one of the ancient and comprehensive systems of health care. Quest for good health and long life is probably as old as human existence. According to Indian philosophy, health is prerequisite to pursue materialistic, social and spiritual upliftment of human being.

Strength of Ayurveda The strength of Ayurveda lies in its three fold holistic approach of prevention of disease promotion of health cure of disease This is achieved through care of body mind soul where physical, mental and spiritual aspects of health are considered.

Background

Principles of Ayurveda therapeutics Comprehensive definition of health Acceptance by the community Emphasis on promotion of Health and Prevention of Diseases Importance of diet and lifestyle Holistic Concept of Health Individualized Approach Universal Approach Stress on Public health and Eugenics Use of natural products

Comprehensive definition of health & Disease Ayurveda defines health as a state of equilibrium of dosha (regulatory and functional entities of the body) dhatu (structural entities) mala (excretory entities) agni (digestive and metabolic factors) and healthy state of sensory and motor organs and mind with their harmonious relationship with the soul

Comprehensive definition of health & Disease The diseased state is defined in Ayurveda as a loss of equilibrium of essential body constituents. The objective of disease management is to bring back the equilibrium, principally through lifestyle management rather than through curative therapies.

Acceptance by the community About 80-90% of population in India is reported to use Ayurveda and other traditional systems of medicine to meet their health care needs. Safety of this system is attributed to time-tested use substantiated by scientific evidences. Besides, synergy of ingredients in conjunction with individual need based treatment plan forms the basis of efficacy and safety of Ayurvedic formulations.

Use of Traditional Medicine CHINA 40% CHILE 71% COLUMBIA INDIA 80-90 % AUSTRALIA 48% BELGIUM 70% CANADA FRANCE 49% USA 42% UK NORTH IRELAND 90% WHO traditional medicine strategy 2002-2005. Document WHO/EDM/TRM/2002.

Study on Role of AYUSH and Local Health Traditions Under National Rural Health Mission(NRHM)* 18 states across India Implications of the NRHM strategy of mainstreaming AYUSH’ in terms Coverage Quality of services Demand of services Validation of Local Health Traditions (LHTs) Outcome 80-90% house holds aware about utility of AYUSH/LHTs Co-located services are Well utilized in some states Utility ; 1. Chronic illness 2. acute illness 3. Health promotion 70% Allopathic doctors viewed AUYSH is not rudimentary *Status and Role of AYUSH and Local Health Traditions Under National Rural Health Mission- Report of a Study;National Health Systems Resource Centre, Ministry of Health & Family Welfare Government of India New Delhi; 2010

Emphasis on promotion of Health and Prevention of Diseases Ayurveda lays great emphasis on preservation and promotion of health and preventing the occurrence of diseases. The treatment modalities of Ayurveda are based on the inherent ability of the living body to rejuvenate, regenerate and restore the natural equilibrium. While treating the patient, Ayurvedic treatment helps to enhance the natural healing process in the body.

Importance of diet and lifestyle The ultimate aim of this medical science is preservation of health and it can be attained in two ways, i.e observation of lifestyle recommendations to prevent the diseases and eradication of already afflicted diseases. The prerequisites to attain the prevention include wholesome diet, conservation of environment, congenial social and cultural atmosphere. Diet is an essential factor for the maintenance of health.

Importance of diet and lifestyle Ayurveda emphasizes on diversified aspects of dietetics and nutrition viz. quality, quantity, processing methods, rationale of combination of food articles, emotional aspects, nature of the consumer, geographical and environmental conditions etc. Advocacy of proper diet and life style, which is congenial to the individual maintains normal body functions thus prevents the diseases.

Holistic Concept of Health Ayurveda considers a living being as a combination of body, mind and soul. All health management approaches are intended to maintain the harmony and homeostasis of these entities. Ayurveda employs holistic and personalized approach to health. The holistic, integrative and systems approach of Ayurveda involving body, mind, and soul is a pivotal attribute. Taking the human being as a whole, the Ayurvedic preventive and therapeutic approaches aim at homoeostasis of this integrated milieu.

Individualized Approach Ayurveda considers that each individual has distinct psycho-somatic constitution(prakriti) and health status. Diverse approaches of clinical examination and diagnosis viz. prakriti Agni srotas shatkriyakala etc. form determinants of individual specific precise tailor-made treatment plan.

Individualized Approach The systems approach embodied with Ayurveda concepts such as disease process, diagnosis principles of drug action processes, dosage forms diet, therapeutics personalized approach towards lifestyle advocacy, disease management are highly appreciated since antiquity which are now the evolving concepts of pharmaco-epidemiology, pharmaco-genomics of modern medical science

Universal Approach According to Ayurveda, the individual (microcosm) is a miniature replica of the universe (macrocosm). Every aspect of the universe is represented in the individual. Any change in the environment affects human being. Therefore, emphasis is laid on social and environmental factors which are interlinked with health.

Stress on Public health and Eugenics The activities of the individual through his thought, word and deed have their good or bad effects on the environment. Ayurveda emphasizes upon healthy body, sound mind, benevolent speech and spiritual practices to create a healthy and happy environment. The pivotal role of eugenics mentioned in Ayurveda is to produce strong, healthy and ideal progeny.

Use of natural products Ayurvedic products are derived mainly from plants and other natural resources. Supportive leads are emerging from revalidation of Ayurvedic drugs. Identification of active principles of some plants has led to discovery of many allopathic drugs. Some pharmacologically proven constituents of the Ayurvedic plants like Aloe vera, Curcuma longa, Withania somnifera, Bacopa monnieri etc. are used globally.

Reverence And Strength Considering health of an individual as dynamic integration of environment, body, mind and spirit, Ayurveda lays great emphasis on preservation and promotion of health and preventing the occurrence of disease Besides, it advocates employing holistic approach to understand all aspects of human life including diagnosis and management of diseases. Ayurveda attributes primary importance to preventive medicine and the maintenance of positive health.

Reverence And Strength The major preventive approaches for maintaining and improving the quality of life include individualized specific daily regimen (Dinacharya) seasonal regimen (Ritucharya) behavioral and ethical considerations (Sadvritta). Healthy lifestyle is emphasized as the determinant of longevity of life, which by and large depends on the Prakriti (bio-identity i.e. body-mind constitution) of an individual.

Therapeutic Streams Proper understanding of Prakriti leads the physician in making right diagnosis, prognosis and treatment plan and in guiding patients as well as disease-free individuals what dos and don’ts they need to follow for restoration and maintenance of health.   The therapeutic streams advocated in Ayurveda comprise -Daivavyapasraya chikitsa (Spiritual measures) -Yuktivyapasraya chikitsa (Pharmacological therapies) -Satvavajaya (Non-pharmacological Psychotherapies) The treatment plan is worked out on the basis of underlying morbidity keeping in mind the strength of the disease and the tolerability of the patient.

IDEAL DRUG/THERAPY An ideal drug or therapy should cure the disease alone, but not to create any adverse/toxic effects and must restore the homeostatis of somatic/psychic environment of human body Safety of a drug also depends upon its dosage. Dose of a drug plays a pivotal role in clinical practice as Ayurveda says ---------“Poison in proper dose acts a wonder drug while an effective drug in higher dose acts as Poison ”.

Four-pronged treatment plan Avoidance of causative and precipitating factors of disease (Nidan parivarjan ) Bio-purification (samshodhan) Use of palliative remedies (samshamana) Health-promoting regimen (pathya Vyavastha) is the hall mark of Ayurvedic therapeutics recommended for physicians to prescribe. Specific diet and lifestyle guidelines are always prescribed along with the drugs and therapies so as to facilitate restoration of bio-humoral balance and health status.

Essentials of therapeutics

Three pillars

Preventive Approaches

Three principles of Therapeutics

Concept of Pathya – Advocacy on Lifestyle and Diet in Health and Disease 29 “Pathyae sathi gadartasya kimoushada savenam---- ----Pathye aasathi gadartasya kimoushada savenam” - Pathyapathyavinichaya

Anupana Anupana is usually water honey ghee jaggery, milk butter milk and herbal decoction which is given along with main drug to help in absorption and drug delivery to the target organ in the body.

Pharmaceutics Bheshaja kala exemplifies the administration of medicines with regard to specific time and frequency in the management of disease. It decides the extent and rate of its digestion, absorption, biotransformation and excretion.

Selection of Therapies The type of therapy to be administered to the patient is planned out on the basis of stage of disease and state of patient which are ascertained by using manifold methods of examination. The due importance is given for a thorough clinical examination and proper understanding of the disease before planning for a treatment. Different principles like shatkriyakala, nidana panchaka are employed for this purpose

Specialized Therapeutic Procedures Ayurveda advocates preventive and curative therapies along with specialized techniques of panchakarma (purification) rasayana (rejuvenation) Various scientific studies and clinical experiences have validated the efficacy and acceptability of these procedures.

Unique Approach Panchakarma is essentially applicable in a wide range of preventive, curative and promotive conditions. These therapies are advocated even in a healthy person to combat seasonal imbalance of dosha. Ayurveda quotes that the disorders treated with this mode of therapy do not recur while those treated with palliative methods do have ample chances of recurrence.

Panchakarma Panchakarma literally means "five types of bio- cleansing therapies". These five therapies of eliminating toxins from the body are vamana (therapeutic induction of vomiting) virechana (therapeutic induction of purgation) shirovirechana/nasya (nasal instillations) niruha basti (therapeutic enema predominantly with medicated decoctions) anuvasana basti (therapeutic enema with medicated oils)

Therapeutic Indications Vamana for diseases of Kapha Virechana for diseases of pitta Basti for diseases of vata.

Principles of panchakarma Classically panchakarma therapy is prescribed and practiced through following schedule viz. (1) purva karma (preparatory procedures) These measures are preceded by snehana (internal or external administration of medicated oils or fats) swedana (induction of sweating) (2) pradhana karma (main procedures) (3) pashchat karma (post procedure measures) followed by samsarjana karma (restorative regimen after panchakarma).

Some Allied panchakarma procedures Abhyanga Sarvanga Dhara or Pizhichil Shirodhara Nadi Sweda Patra Pinda Sweda Kati Basti  Uttara Basti Shashtika Shali Pinda sweda

Safety of Panchakarma When employed skillfully and appropriately, Panchakarma procedures are safe and effective for the prevention and management of a number of health problems. The scientific evidence on clinical safety and efficacy of Panchakarma was re-validated through a number of clinical studies by adopting the classical Ayurvedic notations and contemporary clinical, bio-chemical and pathological parameters. These parameters have shown substantial evidences towards regresssion of many chronic disease.

Rasayana We are aware of known and new diseases of body and mind fast spreading and threatening comfort, peace and welfare of life on earth Attributable to modern scientific technological advances disturbing universal laws of nature

Current day Needs

Current day Needs These factors can be successfully tackled with the unique strength of Ayurveda ie.Rasayana. Rasayana Tantra provides number of herbs having diversified actions on human body

Concept of Rasayana Health promotion and Disease management

The Holistic Rasayana Effect

Benefits of Rasayana Approach Optimum strength of body and senses.    Utterance that always gets Fulfilled/Confidence    The reverence of people   Body-glow Longevity     Heightened memory and intelligence   Freedom from disease     Youth Excellence of luster    Excellence of Complexion and voice all these can be obtained by the use of Rasayanas

Approach A. As Per Scope of Use 1. Kamya Rasayana (Health Promoting) a. Prana Kamya for Vitality and Longevity b. Medha Kamya for Mental Competence c. Sri Kamya for Lusture and Complexion 2.Naimittika Rasayana (Disease specific) B. As Per Method of Use 1.Vatatapika (Outdoor Regimen) 2.Kutipravesika (Intensive Indoor Regimen) C. As Per Contents 1.Ausadhi Rasayana (Drug Rasayana) 2.Ajasrika Rasayana (Dietary Rasayana) 3.Acara Rasayana (Lifestyle Rasayana)

Indication of specific Rasayana Decades Years Losses (Sarangdhara) First 0-10 Balya (Boyishness) Second 11-20 Vriddhi (Growth) Third 21-30 Chhabi (Beauty) Fourth 31-40 Medha (Intellect) Fifth 41-50 Twaca (Skin) Sixth 51-60 Drsti (Vision) Seven 61-70 Sukra (Sexual Ability) Eighth 71-80 Vikram (Strength) Ninth 81-90 Buddhi (Wisdom) Tenth 91-100 Karmendriya (Locomotor Activity)

The concept of Prakriti/ Mizaz: Bio identity/ Psycho somatic constitution The individuals of each prakriti are prone to certain specific disorders. Every individual has differing proportions of each dosha which accounts for differences in preferences, aversions, behavioral patterns and emotional predilections. The proportions of the three doshas present in any individual will determine his or her essential constitutions or prakriti.

Vata/ Vazhi Prakriti Pitta/ Azhal Prakriti Kapha/ Iyyam Prakriti Tall and lean Medium build Good physique, stout Fickle mind Intelligent and impatient Steady, matured mind Very talkative Intelligent Rather silent Dry body, little sweating Excessive sweating Oily body / hair Less hair Early baldness Hairy Irregular appetite/ thirst Excessive appetite and thirst Normal appetite and thirst Constipative tendency Quick motion Normal steady evacuations Skin of earthy colour Pinkish skin Fond of travelling Brave and ambitious Fond of hot oily dishes Dislike hot and oily foods Not so fond of hot and oily dishes Irregular sleep Average sleep Deep sleep Dreams of storms in the sky etc. Dreams of fires and flames Dreams of earth and water

Health seekers code

A Way Forward Evidence base of Ayurveda can offer for global health Credible Therapeutic Modalities Panchakarma a bio-cleansing regimen Ksharsutra a Minimal invasive para -surgical measure for management of fistula-in-ano and piles Rasayana. specialized health promotive & rejuvenative approach for geriatric health care

A Way Forward Evidence base of Ayurveda can offer for global health These modalities Stand alone As add on therapies are proven to have an edge over conventional medical approach in dealing with Chronic and refractory disease conditions sharing huge Global burden Cancer, Rheumatoid arthritis and Allied conditions; Conditions with an allergic component in their etiology (e.g. bronchial asthma, skin allergies, eczema, psoriasis etc.);

A Way Forward Evidence base of Ayurveda can offer for global health Liver disorders; Obesity, Hyper lipidaemia and Atherosclerosis; Diabetes mellitus; Ischemic Heart Disease; Squeal of Cerebro-vascular disorders like Hemiplegia and Paraplegia; Epilepsy; Mental disorders including psychosis, anxiety neurosis, stress disorders

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