The relevance of Ayurveda in present day health care system
Dr.Manu Bhasker, Swami Nirmalanandagiri Maharaj
“Soyam Ayurveda shashwato nirdishyathe” claims the Rishi in the charaka samhita1 . The science of Ayurveda is eternal, because it deals with things which are inherent in Nature. The science of Ayurveda, deals with the factors that influence the happiness (health) and the unhappiness ( ill health) of the living beings, the causative factors, the clinical signs and symptoms and the therapeutic approaches. The Rishis were clear that there will be no such times when this science will be irrelevant.
Sincere and tireless efforts have been made in the western world, for the promotion of health and the control of diseases. Because of the efforts of these scientists and health workers we have a huge armamentarium, loaded with vaccines, antibiotics, nuclear imaging techniques, laminar flow operation theaters, anti proliferative agents and so many more diagnostic techniques, to tackle the scourge of diseases.
We will briefly overlook the progress of medicine in the past few centuries. AR Omran, has studied the evolution of health care in the American society and has broadly divided them into the following phases2
1. Age of pestilence and famine ( Before 1900)
2. Age of receding pandemics ( 1900-1930)
3. Age of Degenerative man made diseases ( 1930-1965)
4. Age of delayed degenerative diseases ( 1965-2000)
5. Age of inactivity and obesity
These phases seem to be applicable to the other developed and developing nations as well. In the initial years the main diseases that affected mankind (especially in the west and their colonies) were related to infections and lack of adequate nutrition. The major causes of death were diarrheal diseases, and other epidemics. All effort was directed in controlling these during this era of pestilence and famine. Then the era of industrialization started, initially in the west and subsequently in their colonies. The railway networks were established in the early twentieth century. The transport of non perishable food stuffs like cereals and livestock was facilitated. So the food became more widely available. And also better public health facilities enabled better control of infectious diseases. Not only foodstuffs, but factory rolled cigarettes also became cheaper and easily available. The widespread industrialization shifted the population from the villages to the towns. With the increasing dependence on mechanization, the physical activity levels came down drastically. With the abundant availability of high calorie food stuffs, cigarettes and poor activity levels, the age of degenerative man made diseases set in. These diseases were predominantly cardiovascular diseases, osteoarthritis, obesity, chronic lung disease etc. With the advancement in health care, the mortality associated with these diseases was brought down and average life span improved. Thus the era of delayed degenerative diseases started. With the entertainment revolution, powered by the advancement in technology, now we have to battle problems related to inactivity like childhood obesity. And now the challenges we face are related to the mechanized life and high calorie energy rich fast foods which are manifesting as diabetes, hypertension, dyslipidemia, cardiovascular diseases, strokes, cancers, arthritis etc.
When modern medicine is grappling with these new age man made ‘disasters’, the age old healing traditions of the native cultures have a powerful role to play. In India, the indigenous systems of medicine, like Ayurveda, Sidha , Unani in addition to the ubiquitous folk medicines have played a a key role, in maintaining the health of the society for ages. Prior to the era of colonial rule, these were the only systems available to the people. And from historical records, and accounts of the various travelers that visited the land like Ibn Batuta, Marco Polo, Fahien, Hieun Tsang etc, the local population was reasonably healthy and agile. Marco Polo who visited the present day state of Kerala in the late thirteenth century, was amazed by the cleanliness and levels of hygiene of even the poorest among the society3. Even the ruins of the Indus Valley civilization, demonstrate the value the inhabitants had for sanitation. There was provision for drains along the sides of the roads and each house was provided with a separate bath area4. In Medieval India, Ibn Batuta mentions how each house was surrounded by a garden3. These home gardens were in fact the pharmacy of the household. Primary health care problems like fever, upper respiratory infections, diarrhea, anemia, arthritis, hepatitis, gynaecologic conditions like dysmenorrhea were managed at the home level with timely identification and intervention with simple herbal remedies. Even for bleeding disorders due to low platelet counts they had very effective remedies like the extract of tender papaya leaf consumed with milk. Now this leaf extract has found favor with many practitioners of modern medicine to treat thrombocytopenia associated with dengue5 and potentially along with cancer chemotherapy6 also. Reproductive health and nutrition forms two important aspects of household care. Considerable health care related cost saving can be achieved in this system of care apart from health and nutrition benefits. There was the traditional practice of feeding post partum women with the cakes made from Clerodendrum viscosum roots. Now this practice is seldom continued in modern homes. However this plant extract has been found to have antitumor properties on cervical cell lines7. We can see many ayurvedic practioners resuming the old practice of recommending this plant extract for many gynecologic diseases especially in proven cases of cancer cervix and many other squamous cell carcinomas ( personal communication).
In those days, the mother or the elders in the household were the primary caregivers who had the knowledge of how to manage the common problems. There was a sense of confidence in the ordinary man in managing his health problems. This confidence and responsibility towards one’s own health has been replaced by unnecessary fear and over reliance on the health care provider in the present day scenario. Even for a mild fever, the child will be rushed in an ambulance by the anxious parents and the child will be subjected to a battery of investigations, mainly in an attempt to rule out the most lethal causes of fever. And the days when the child is away from the hospital, he is busy preparing himself to return at the earliest, by his unhealthy food choices like fast foods, overindulgence in video games and overemphasis on academics with little scope for play and leisure. In the olden days, the child is encouraged to abide by the discipline of dina charya , ritucharya etc. How to conduct oneself through the day, what food to consume dependent on the season are all clearly laid out in the ayurvedic manuals. One who abides by these lives a life of joy and health. And when such values are instilled early in life, they tend to last for a lifetime. Thus if we consider carefully, the science of Ayurveda is capable of providing solutions to the present day health problems that we are facing. The age of inactivity and obesity and its attendant diseases, that is looming over our civilization, can be effectively tackled if we abide by the principles of Ayurveda.
The investment in the field of healthcare, both public and private has been growing consistently, in India. In spite of the steadily increasing numbers of superspeciality tertiary care centres, which are equipped to provide the standard of care, tertiary care medical college hospitals, the divide between the urban and the rural population, the haves and the have-nots, in terms to access to quality health care has only widened. It is not uncommon to see children dying due to simple infections, due to lack of access to modern health care providers. In this scenario, when the people are empowered with their own indigenous healing practices in a scientific manner, it will go a long away in promoting health and well being of the society.
In spite of the best of efforts, there are many diseases like the autoimmune diseases, refractory heart failure, pulmonary arterial hypertension , inflammatory bowel diseases, chronic kidney disease, chronic liver disease, neurodegenerative diseases etc which have been defying cure. When the physician has exhausted all the available standardized drugs, the patient is left with the option of enrolling himself in the drug trials which evaluate newer molecules. Or else the patient is offered organ transplantation whenever feasible. In the case of rheumatoid arthritis, newer studies are coming up which have shown ayurvedic medicines to help in symptom control and act as disease modifying agents8. Ayurveda has a holistic approach towards the illness. In the case of rheumatoid arthritis and other autoimmune diseases, it is hypothesized that improper digestion is the source of the inflammation, and so therapy is aimed at correcting the digestive problem and not merely at the troubled joints. The biggest advantage in the system of Ayurveda, is that the patient is freed from the label of having an incurable diagnosis. The patient has a new perspective of his illness. What was incurable rheumatoid arthritis, translates into an imbalance of the three doshas. He starts looking at his illness from a fresh perspective, and this certainly adds to the healing process. Even in the case of terminally ill cancer patients, the ayurvedic therapies help in reducing the morbidity9 and improving the quality of life and sometimes in long term disease remission as indicated by many case reports10.
Nowadays when our markets are being flooded with genetically modified crops, and other food stuffs which have passed through the food processing industry with their load of additives ( harmful or potentially harmful), the ayurvedic adage of food is medicine needs to be promoted. The industry in its greed to make more profits and the governments in their earnestness to eliminate hunger, have been enthusiastically promoting the newer techniques of cultivation, preservation and transport of food. Many a times the safety of the food consumed is overlooked. Monosodium glutamate which was popular as a food additive for long, now suddenly has been considered as being contributing to many health issues like obesity 11 and beta cell depletion12. The artificial coloring agents and the unhealthy sugar sweetened beverages have been linked to the increasingly prevalent problem of ADHD13,14 . In this scenario, there is a need for promoting the traditional diet and also the Ayurvedic concepts of nutrition. In the Ayurvedic texts one can find detailed analysis on the type of food, what is pathyam and apathyam (wholesome and unwholesome) and what forms virudha ahara. Detailed research also needs to be undertaken on identifying the scientific basis of the ayurvedic concepts of diet and nutrition. In the traditional diets, cereals and pulses are consumed in various combinations like chapathi and dhal, rice and bengal gram etc. Research in biochemistry has revealed a sound biochemical basis for promoting such food combinations. This is based on the concept of complementary action of amino acids. The cereals are deficient in leucine and isoleucine, which are essential amino acids ( ie they can not be synthesized in the body and need to be supplemented in diet). While the pulses are rich in methionine (another essential amino acid). Hence combining these tow food stuffs enables a nutritious diet sufficient in all essential amino acids.
Indeed it is time to rediscover the principles of Ayurveda which have been practiced in the past and reintroduce them in our population integrating it with the conventional standard of care in a scientific manner. Ayurveda and other traditional health systems have a significant role to play in improving the current health practices whether it is in the field of nutrition, or bedside clinical care or primary prevention of diseases or community health intervention.
1. Charaka Samhitha Sutra sthana (Chapter 30, sloka 27). Translated by R.K.Sharma, Bhagawan Das
2. Omran AR The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q 1971 Oct ; 49 ( 4): 509 -38
3. Unnikrishnan Payyappallimana, Traditional Medicine in Health System Development: A Case Study of Kerala State, India, Yokohama Journal of Social Sciences, Vol 15, No 3.
4. R.C.Majumdar, A.D.Pusalker, A.K.Majumdar. The Vedic Age – The history and culture of Indian People. Bharathiya Vidya Bhavan.
5. PN Kasture, KH Nagabhushan, A multi centric double blind placebo controlled prospective study to evaluate the efficacy and safety of Carica papaya leaf extract, as empirical therapy for thrombocytopenia associated with Dengue fever. Journal of association of physicians of India, 2016, June 64 (6):15-20
6. Antithrombocytopenic acitivity of carpaine and alkaloidal extract of Carica papaya leaves in busulfan induced thrombocytopenic Wistar rats. Journal of Ethnopharmacology 2016 April 2; 181:20-5
7. First ayurvedic approach toward green drugs: anti cervical cancer cell properties of Clerodendrum viscosum root extract. Anticancer agents Med Chem. 2013 Dec ; 13 ( 10): 1469-76. Swami Nirmalananda, Raja KS
8. Comparable efficacy of standardized Ayurveda formulation and hydroxychloroquine sulfate in the treatment of Rheumatoid arthritis: a randomized investigator – blind controlled study. A Chopra, Saluja M, Girish Tillu, Clinical Rheumatology. 2012 Feb; 31 (2): 259-69
9. Swarna Bhasma in cancer- a prospective clinical study. Soumen Das, Mangal C Das, Ayu. 2012 Jul- Sep; 33 ( 3): 365-367
10. Treatment of relapsed undifferentiated acute myeloid leukemia ( AML- M0) with Ayurvedic therapy. Balendu Prakash. International Journal of Ayurveda Research. 2011 Jan- Mar; 2 (1): 56-59
11. Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey. Ka He, Shufa Du. Am J Clin Nutrition. 2011 June; 93 ( 6): 1328- 36.
12. Monosodium Glutamate Dietary Consumption decreases pancreatic beta cell mass in adult Wistar rats. Piyanard Boonnate, Sakda Waraasawapati. PLoS One. 2015; 10 ( 6): e0131595
13. Ching Jung Yu, Jung Chieh Du. Sugar Sweetened beverage consumption is adversely associated with childhood attention deficit/ Hyperactivity Disorder. Int J Environ Res Public Health. 2016 Jul; 13 ( 7): 678
14. Artifical Food Colors and Attention Deficit Hyperactivity Symptoms: Conclusions to Dye for. L Eugene Arnold, Nicholas Lofthouse and Elizabeth Hurt. Neuro therapeutics. 2012 Jul ; 9 ( 3): 599 – 609