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Ayurveda

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Overview

The History of Ayurveda

The Principles of Ayurveda

The Practice of Ayurveda

What Is the Scientific Evidence for Ayurveda?

How to Choose a Practitioner of Ayurvedic Medicine

Safety Issues

References

Principle Proposed Uses

Other Proposed Uses

Overview

FDA Warning:

The presence of heavy metals in some Ayurvedic products makes them potentially harmful. Studies have found detectable levels of lead, mercury, and arsenic. Labeled as "Indian" or "South Asian," these products are sold online and in stores. The Food and Drug Administration (FDA) does not review or approve Ayurvedic products, which can be especially harmful to children. For more information, read the FDA's warning.

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

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

The History of Ayurveda

The roots of Ayurveda lie in the ancient Sankhya school of Indian philosophy, developed many thousands of years ago. The first major classic of Ayurveda, the Caraka Samhita, was written between the second and fourth centuries BC, but it is believed to be based on a much older oral tradition.¹ This text sets out all the fundamental principles of Ayurveda but concentrates most of its attention on digestion (described as internal fire, or agni). Another early classic, the Susruta Samhita, focuses on surgical techniques. The Astanga Hridayam, written in about 500 AD, sets out most of the detailed principles of Ayurveda, including the dosha and subdosha. (See The Principles of Ayurveda for more information.)

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

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

The Principles of Ayurveda

Even a basic introduction to the principles of Ayurveda exceeds the scope of this article. Consider the following information as nothing more than a taste of this vast medical system.

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

There are many other aspects of the body considered in Ayurveda as well. These include 20 attributes, 5 sub-doshas, 7 tissues, 4 states of agni, and 14 bodily systems. Health exists when all aspects of the body are in proper balance; disease occurs when that balance is disturbed. Excess vata, for example, might lead to arthritis, anxiety, and fatigue. Excess kapha, on the other hand, is said to cause obesity and diabetes.

The Practice of Ayurveda

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

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

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

In addition to cooking spices, Ayurveda also uses purely medicinal herbs, which include andrographis, ashwagandha, Bacopa monnieri (Brahmi), boswellia serrata, Coleus forskohlii, dandelion, gotu kola, gymnema, guggul, neem, phyllanthus, Picrorhiza kurroa, Salacia oblonga, and tylophora. Minerals such as silver, mercury, and lead may be used as well (see Safety Issues below).

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

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

What Is the Scientific Evidence for Ayurveda?

It is undoubtedly true that all people are different, and that the ideal form of medicine should take such differences into account. Ayurveda’s strength in this regard is one of its sources of appeal. However, the mere fact that medicine ought to treat people individually does not imply that Ayurveda’s individualized treatment techniques are actually grounded in reality. They could be wishful thinking rather than an insight into the truth.

It is very difficult to scientifically validate entire systems of health. In medicine, only double-blind, placebo-controlled trials produce scientifically reliable results. However, there is really no way to fit Ayurvedic medicine into such a format. Try to invent a method for keeping people in the dark regarding whether or not they are, for example, taking enemas, and you will see the difficulty.

One study did attempt to test the effectiveness of whole-person Ayurvedic treatment.⁵⁹ In this trial, sixty people with diabetes were randomly assigned either to standard diabetes education classes or to a course of care involving exercise, Ayurvedic diet, meditation, and Ayurvedic herbal treatment. As it happened, the results failed to show much in the way of statistically significant benefits with the Ayurvedic treatment. However, even if results had been seen, they would be of minimal validity. Why? Because simply to receive a complex, exciting course of treatment usually results in improvement, regardless of what treatment is used. The causes of this surprising and nonintuitive phenomenon are discussed in Why Does This Database Rely on Double-blind Studies?.

The bottom line is that it is very difficult, if not impossible, to make a scientifically grounded statement regarding the effectiveness of Ayurveda as a whole. However, we do have some evidence for a subset of Ayurveda: its herbal therapies.

Many Ayurvedic herbs taken alone have undergone varying levels of study. Most of these are described elsewhere in this database, under the articles titled andrographis (for colds and flus), ashwagandha, boswellia (for rheumatoid arthritis, asthma), Coleus forskohlii (for asthma), dandelion (as a diuretic, to help treat fluid retention), fenugreek (for diabetes), garlic (for high cholesterol, heart disease), gymnema (for diabetes), ginger (for nausea), gotu kola (for varicose veins), guggul (for high cholesterol), neem, phyllanthus (for hepatitis), turmeric (for dyspepsia), and tylophora (for asthma).

Other Ayurvedic herbs that have been studied in double-blind, placebo-controlled trials are discussed below. In addition, we discuss fixed combinations of multiple herbs that have undergone such trials.

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

A couple of studies have at least begun the process of examining classical Ayurvedic diagnosis to determine whether or not it has a relationship to physical reality. One study failed to find an expected correlation between Ayurvedic diagnosis and severity of symptoms in ankylosing spondylitis and low back pain.⁵⁰ Another small study found that different Ayurvedic practitioners did in fact independently come up with similar diagnosis and treatment plans in three people with rheumatoid arthritis.⁵¹

Single Herbs

Angina: Terminalia arjuna

In a double-blind study, 58 men with chronic stable angina received either Terminalia arjuna (500 mg every 8 hours), the drug isosorbide mononitrate (40 mg daily), or a matching placebo for 1 week each.⁶ The results indicated that use of T. arjuna was more effective than placebo for angina, and approximately as effective as the medication.

In another study, 105 men with coronary heart disease received either placebo, vitamin E, or T. arjuna (500 mg daily) for 30 days.⁷ The results indicated that the herb reduced cholesterol levels. However, the researchers inexplicably decided to make this an “open label” study, meaning that participants and researchers knew which treatment was which. Because of this, the results are essentially meaningless. (For more on the reasons why, see Why Does This Database Rely on Double-blind Studies?)

Hepatitis: Picrorhiza kurroa

In a double-blind trial of 33 people with acute viral hepatitis, use of the herb Picrorhiza kurroa at a dose of 375 mg three times daily significantly speeded recovery time as compared to placebo.⁸

Memory and Mental Function: Bacopa monniera (Brahmi)

The Ayurvedic herb Bacopa monniera (brahmi) has a traditional reputation for improving memory. However, a 12-week, double-blind, placebo-controlled trial of 76 people that tested the potential memory-enhancing benefits of brahmi generally failed to find much evidence of benefit.² The only significant improvement seen among the many measures used was in one that evaluated retention of new information. Although this may sound at least a little positive, in fact it means little. Here is why: When a study uses many different techniques to assess improvement, mere chance ensures that at least one of them will come up with results. Properly designed studies should focus on one test of benefit alone (the primary outcome measure) that is selected prior to running the trial. The use of multiple tests is sometimes called “fishing for results,” and it is frowned upon.

If several independent studies use multiple tests of improvement, and the pattern of response is reliably maintained, then the results begin to appear more significant. Unfortunately, this does not seem to be the case with brahmi. In a previous double-blind, placebo-controlled study enrolling 46 people, use of brahmi over a 2-week period produced quite a different pattern of benefits.³ In another double-blind, placebo-controlled study of 38 people, short-term use of brahmi failed to produce any measurable improvements in memory.⁴

Other studies have failed to find benefit using a combination of Ginkgo biloba and brahmi, whether in the short term or over a period of several weeks.^5,52

Combination Therapies

Allergies and Immunity: Septilin

Septilin is a fixed combination containing the following ingredients:

Commiphora mukul
Tinospora cordifolia
Rubia cordifolia
Emblica officinalis
Moringa pterygosperma
Glycyrrhiza glabra

This combination therapy has shown promise for the treatment of allergic rhinitis. In a double-blind study, 190 people were given either the herbal combination or a standard antihistamine (chlorpheniramine).⁹ The results over 7 days indicated that the two treatments were equally effective.

Another study found general evidence for an antihistamine-like effect. In this double-blind, placebo-controlled trial of 32 healthy people, use of Septilin for 4 weeks significantly reduced the allergic reaction caused by injection of histamine under the skin.¹⁰

Septilin has also been tried as a treatment for improving immunity.¹¹ In a double-blind, placebo-controlled study of 40 children with persistent low-grade infections (such as chronic sore throat or sinus infection), use of Septilin for 1 month led to significant improvement compared to placebo.¹²

Various Brain-related Disorders: Mentat—Fixed herbal combination containing Bacopa monniera and almost 30 other ingredients

The proprietary Ayurvedic mixture Mentat has been studied for numerous brain-related conditions. For example, in a 3-month, double-blind, placebo-controlled study of 50 adult students, use of Mentat appeared to improve memory and attention and reduce stress.¹³ Similarly, in a 3-month, double-blind, placebo-controlled trial of 42 people in high-stress jobs who complained of fatigue, use of Mentat decreased symptoms.¹⁴

In several double-blind, placebo-controlled trials, Mentat has shown promise for normalizing the behavior of children with attention deficit disorder, developmental disabilities, or brain damage.^15-19

Other double-blind, placebo-controlled trials found evidence that this combination therapy might be helpful for depression,²⁰epilepsy,²¹ decreasing amnesia caused by electroconvulsive therapy (ECT),²² reducing frequency of febrile seizures (seizures caused by fever),²³ enhancing recovery from aphasia (loss of speech caused by stroke),²⁴ and improving memory in people with anxiety.²⁵ Mentat has also shown promise for bed-wetting.²⁶

Acute Hepatitis: Kamalahar

Kamalahar is a fixed combination containing the following ingredients:

Tecoma undulata
Phyllanthus urinaria
Embelia ribes
Taraxacum officinale
Nyctanthes arbortistis
Terminalia arjuna

In a double-blind, placebo-controlled study, 52 people with acute hepatitis were randomly assigned to receive placebo or this combination herbal therapy at a dose of 500 mg three times daily for 15 days. The results indicate that the herbal combination improved liver function to a significantly greater extent than placebo.²⁷

Other Liver-Related Conditions: Liv.52

Liv.52 is a fixed combination containing the following ingredients:

Capparis spinosa
Cichorium intybus
Solanum nigrum
Terminalia arjuna
Cassia occidentalis
Achillea millefolium
Tamarix gallica

In a poorly reported 5-week, double-blind, placebo-controlled study of 30 children with hepatitis A, use of this combination formula apparently improved the rate of recovery compared to placebo.²⁸ Benefits were also seen in a 6-week study of 34 people with acute hepatitis A.²⁹

Another double-blind, placebo-controlled study evaluated the effectiveness of Liv.52 in a variety of liver conditions.³⁰ A total of 104 people were enrolled in this trial and divided into three groups depending on the liver condition they had: cirrhosis, acute hepatitis, and chronic hepatitis (type not stated). Participants with cirrhosis were treated for 24 months, those with chronic active hepatitis were treated for 12 months, and participants with hepatitis A were treated for only 6 weeks. Use of Liv.52 was associated with substantially better outcomes than placebo. Apparent benefits were also seen in a 6-month, double-blind, placebo-controlled study of 36 people with cirrhosis.⁵⁶ However, in a 6-month, double-blind study of 80 people with alcoholic liver disease ( alcoholic hepatitis or cirrhosis), Liv.52 failed to provide any benefits.⁴⁸

Frozen Shoulder: Rumalaya—Fixed oral and topical combination containing almost 15 herbs

In a placebo-controlled trial of 100 people with rotator-cuff injury (“frozen shoulder”), use of this tablet and cream combination significantly improved results compared to little improvement in the placebo group.³¹

Weight Loss and Cholesterol Reduction: Three Fixed Combinations

In a 3-month, double-blind, placebo-controlled study, 70 overweight people were divided into four groups: placebo; triphala guggul (a mixture of five Ayurvedic ingredients) plus Gokshuradi guggul (a mixture of eight Ayurvedic ingredients); triphala guggul plus Sinhanad guggul (a mixture of six Ayurvedic herbs); or triphala guggul plus Chandraprabha vati (a mixture of 36 Ayurvedic ingredients).³² Reportedly, all three Ayurvedic ingredients produced significant weight loss and improvements in cholesterol relative to placebo; furthermore, the improvements produced by each of the treatments were close to identical.

Osteoarthritis: Articulin-F and RA-11

Articulin-F is a fixed combination containing the following ingredients:

In a 3-month, double-blind, placebo-controlled trial of 42 people with osteoarthritis, use of this combination therapy significantly improved pain and disability compared to placebo.³³

Another double-blind study found benefit with RA-11, a combination therapy containing most of the same ingredients as Articulin-F, but substituting ginger for zinc.⁶⁰

Diabetes: Five Different Fixed-Combinations—Diabecon, Cogent DB, Inolter, Hyponidd, and Pancreas Tonic

The herbal combination of Diabecon contains:

Gymnema sylvestre
Eugenia jambolana
Tinospora cordifolia
Pterocarpus marsupium
Ficus glomerata
Momordica charantia
Ocimum sanctum

Cogent DB contains:

Azidiracta indica
Phyllanthus emblica
Terminalia bellerica
Terminalia chebula
Tribulus terrestris
Trigonella foenum graecum
Curcuma longa
Syzygium cumini
Rotula aquatica

Hyponidd contains:

Yashad bhasma
Asphaltum
Momordica charantia
Curcuma longa
Cassia auriculata
Emblica officinalis
Eugenia jambolana
Enicostemma littorale
Gymnema sylvestre
Pterocarpus marsupium
Tinospora cordifolia
Melia azadirachta
Swertia chirata

Pancreas Tonic includes the following ingredients:

Aegle marelose
Azardirachta indica
Cinnamon
Fenugreek
Ficus racemosa
Gymnema sylvestre
Momordica charantia
Pterocarpus marsupeum
Syzigium cumini
Tinospora cordifolia

In a 6-month, double-blind, placebo-controlled trial, 40 people with type 2 diabetes who had failed to respond fully to oral drugs received either this combination of Ayurvedic herbal therapy or placebo.³⁴ The results indicated that the herbal therapy was modestly helpful.

In a more recent 2011 review, researchers found 7 randomized trials evaluating the use of a variety of Ayuvedic herbal mixtures as a possible treatment for type 2 diabetes.⁶⁶ The review included trials on on a Diabecon, Cogent DB, Inolter, Hyponidd, and Pancreas Tonic lasting 3-6 months. Compared to placebo or usual care, the mixtures of Diabecon, Cogent DB, and Inolter significantly reduced HbA1c levels (an indicator of blood sugar control over the previous 3 months) and fasting blood sugar levels.

Several animals studies had indicated that Pancreas Tonic might offer benefits in diabetes. Based on this, a 3-month, double-blind study of 36 people with type 2 diabetes was undertaken.⁵³ The results appeared to indicate that use of Pancreas Tonic can improve blood sugar control . A 2011 review, though, did not find evidence to support the use of Pancreas Tonic to reduce HbA1c levels in people with type 2 diabetes.⁶⁶

Acne: Fixed Topical and Oral Combination

This fixed topical and oral combination contains the following ingredients:

Aloe barbadensis
Azadirachta indica
Curcuma longa
Hemidesmus indicus
Terminalia chebula
Terminalia arjuna
Withania somnifera

In a 4-week, double-blind study, 53 people with acne received one of four therapies: real herb in oral tablets and as topical cream; real herb in oral tablets and as topical gel; real herb in oral tablets with placebo gel; or placebo tablet with placebo topical treatment.³⁵ The results appear to indicate that while oral herb alone is not helpful, oral herb plus topical herb can improve acne symptoms.

Improving Immunity: DefensePlus

DefensePlus™ is a fixed combination containing the following ingredients:

Tinospora cordifolia
Withania somnifera
Ocimum sanctum
Emblica officinalis

Test tube and animal trials suggest that this combination product may strengthen the immune response.³⁶ Promising results have also been seen in two unpublished human trials. One was a double-blind, placebo-controlled trial of children ages 5 to 18 who experienced recurring bouts of tonsillitis.³⁷ The results showed that participants taking the herbal combination were less likely to require surgical treatment for the condition (tonsillectomy). The other double-blind, placebo-controlled study found that use of this herbal combination along with standard therapy improved recovery from eye conditions requiring antibiotics.³⁸

Rheumatoid Arthritis: RA-1

RA-1 is a fixed combination containing extracts of ashwagandha, boswellia, ginger, and turmeric.

A 16-week, double-blind, placebo-controlled trial of 182 people with rheumatoid arthritis evaluated the potential effectiveness of this formula.³⁹ Participants in both groups improved significantly; however, according to most measures of disease severity, the benefits of the herbal combination were no greater than those of placebo.

Hemorrhoids: PILEX—Fixed Combination oral and Topical Herbal Treatment

This combination therapy was evaluated in a double-blind, placebo-controlled trial of 100 people with hemorrhoids.⁴⁰ The results indicated that the benefits were seen in 50% of those using the herbal treatment as compared to only 20% in the placebo group.

Hypertension and Angina: Alba— Terminalia arjuna and Approximately 40 Other Herbs

In a double-blind study of 43 men and women with hypertension, use of the proprietary herbal combination Alba proved approximately as effective for controlling blood pressure as the drug methyldopa.⁴¹ Additionally, in a double-blind, placebo-controlled trial of 25 people with angina, use of this combination therapy reduced chest pain and improved heart function.⁴²

One study of somewhat questionable reliability reported that the herb Eclipta alba (also known as Bhringraja or Keshraja) can improve blood pressure when taken by itself at a dose of 3 g daily.⁶¹ This study also claimed to find reductions in cholesterol levels.

Aging: Geriforte—Fixed Herb Combination Containing Approximately 40 Herbs

A fixed combination of Ayurvedic herbs has been marketed as a general “tonic” for seniors. Several poorly designed and/or incompletely reported placebo-controlled trials suggest that this herbal combination might possibly improve cholesterol levels, general well-being, and mood in seniors.^43-46

Astha 15—Fixed Herb Combination Containing 15 Herbs

One double-blind comparative study provides weak evidence that the herbal combination called Astha 15 might be helpful for mild asthma.⁵⁷

How to Choose a Practitioner of Ayurvedic Medicine

There is no widely accepted licensure for the practice of Ayurvedic medicine. However, there are several schools that offer extensive training. These schools generally require from 500 to 3,500 hours of training. Some of the better-known schools include the following:

The Ayurvedic Institute
Address: 11311 Menaul, NE Albuquerque, NM 87112
Phone: (505) 291-9698
Web site: http://www.ayurveda.com
E-Mail: info@ayurveda.com

California College of Ayurveda
Address: 1117A East Main Street, Grass Valley, CA 95945
Enrollment: (866) 541-6699
General Information: (530) 274-9100
Web site: http://www.ayurvedacollege.com
E-Mail: info@ayurvedacollege.com

American Institute of Vedic Studies
Address: PO Box 8357, Santa Fe, NM 87504
Phone: (505) 983-9385
Web site: http://www.vedanet.com
E-Mail: vedicinst@aol.com

Safety Issues

Ayurvedic therapy presents numerous potential safety concerns. One serious problem is that many Ayurvedic herbs have never undergone a formal safety evaluation, and those that have been evaluated have not necessarily been proven harmless. For more information on safety risks with individual Ayurvedic herbs, see the following articles: andrographis, ashwagandha, boswellia, Coleus forskohlii, dandelion, fenugreek, garlic, ginger, gotu kola, guggul, gymnema, neem, phyllanthus, turmeric, and tylophora.

Most of the proprietary herbal formulas described in this article have undergone a certain amount of safety testing by the manufacturer and were found reassuringly nontoxic; however, verification of safety by independent laboratories that maintain modern standards remains limited. Some traditional Ayurvedic formulas may contain toxic levels of heavy metals, especially lead, mercury, and arsenic.^{54, 58} According to one study, approximately one in five US and Indian produced Ayurvedic medicine contained detectable amounts of at least one of these heavy metals.⁶³ In one particularly dramatic and tragic case report, a brain-damaged child born to a mother using an Ayurvedic formula was found to have the highest bloods levels of lead ever recorded in a living newborn.⁴⁹ Analysis of the formula revealed a very high lead content, along with toxic levels of mercury.

There are other concerns as well. For example, oral silver, a traditional Ayurvedic remedy, can cause permanent gray-black staining of the skin and mucous membranes.⁴⁷

The dietary recommendations made within the context of Ayurvedic theory could conceivably lead to inadequate intake of essential nutrients, and hence malnutrition. However, most reputable Ayurvedic practitioners are well aware of modern nutrition knowledge and take care to make reasonable recommendations within that context.

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

In a case report, a patient taking the antidepressant sertraline had two relapses of depression soon after taking an Ayurvedic herbal mixture containing Terminalia chebula and Commiphora wighteii. The authors interpreted this as a likely adverse drug-herb interaction.⁶²

Finally, one study found that an Ayurvedic herbal formula called Trikatu (a mixture of black pepper and ginger) can reduce the effectiveness of the standard anti-inflammatory drug diclofenac.⁵⁵ This finding was somewhat surprising as black pepper is generally thought to enhance the absorption of and activity of various medications through a number of known chemical interactions.

References►

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