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Maharishi Ayur-Veda: modern insights into ancient medicine.
JAMA, The Journal of the American Medical Association
May 22, 1991; v265: p2633(3)

Ayur-Veda, the oldest surviving system of medicine, is still widely
practiced, although it is almost unknown in the Western world. The
name itself means the "science of life," and it has always
concentrated on prevention; Ayur-Veda originated in ancient India.
After centuries of suppression by foreign rulers, during which much
of the information was lost, Ayur-Veda is once again being revived
under the direction of Maharishi Mahesh Yogi. Biologic
individuality is central to Ayurvedic medicine, especially
maintenance of the balance of physiological mechanisms. The basic
teachings of Ayur-Veda are briefly described, including
psychophysiological characteristics, pulse diagnosis and
therapeutics. The effects of certain Ayurvedic medications are
described. Diet is a very important aspect of Ayurvedic treatment,
as are circadian (24-hour) and circannual (yearly) rhythms.
Instructions include maintenance of schedules of daily living, such
as getting up and going to bed early, moving the bowels in the
morning, eating the heavy meal at lunch rather than dinner, and
exercise. A healthful environment is considered a necessity for
individual health. Ayur-Veda may contribute new insights and new
therapies to conventional western medicine. Some physicians in
Europe, North and South America, and Japan are beginning to include
these methods in patient care. (Consumer Summary produced by
Reliance Medical Information, Inc.)

AYUR-VEDA is the oldest existing medical system, having its
heritage in ancient India. It is recognized by the World Health
Organization and is still widely practiced.' The All India
Ayur-Veda Congress (representing Ayurvedic physicians) has a
membership of over 300 000, and 108 Ayurvedic colleges in India
grant a degree after a 5-year program. Yet, until recently,
Ayur-Veda has been virtually unknown in the West. Current interest
in disease prevention and health promotion has led to its
investigation by a growing number of Western physicians who are
finding it to add valuable knowledge that is complementary to
modern allopathic medicine.

The word Ayur-Veda comes from two Sanskrit roots: Ayus, meaning
life or life span, and Veda, meaning knowledge or science.
Ayur-Veda is therefore translated as 'the science of life," which
emphasizes its orientation toward prevention. The major textbooks
of Ayur-Veda, the Charaka Samhita' and Sushruta Samhita,' cover the
major branches of medicine under much the same headings as
allopathy. In addition, there are treatises on medical ethics and
the physician-patient relationship. The Ayurvedic pharmacopeia
includes thousands of plants and plant products, many of which are
known therapeutic agents, such as rauwolfia and digitalis.'

Unfortunately, over centuries of foreign rule in India when
Ayurvedic institutions were not officially supported, all were
actively suppressed and much important clinical and theoretical
knowledge became lost or unavailable. Ayur-Veda's effectiveness has
been limited, as practitioners have not used its comprehensive
approaches. A modern revival, taking into account all of these
approaches in accordance with the classical texts, is known as
Maharishi Ayur-Veda. This has taken place under the direction of
Maharishi Mahesh Yogi in collaboration with leading Ayurvedic
physicians.

The Ayurvedic Framework

The principle of biologic individuality is central to Ayurvedic
diagnosis and treatment. Maharishi Ayur-Veda emphasizes host
factors, particularly imbalance resulting from disruption of
homeostatic or immune mechanisms, as the primary factor in the
etiology of disease. It also places importance on mental and
emotional factors, which it sees as critical to the development of
these imbalances.

In examining a patient, the physician trained in Maharishi
Ayur-Veda takes into account the particular pathology and also the
constellation of unique psychophysiological characteristics that
constitute the individual. According to AyurVeda, three irreducible
physiological principles called doshas regulate the different
functions of mind and body. In Sanskrit, the three doshas are
called Vata, Pitta, and Kapha. Everyone is endowed at birth with
some value of afl three doshas, but in each person the exact
proportions vary. This proportion determines the
psychophysiological type. There are 10 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
physician can 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, rheumatic disorders,
constipation, anxiety, and insomnia. Pitta dosha directs all
metabolic activities, energy exchange, and digestion. Pitta
imbalance predisposes to peptic ulcers, hypertension, inflammatory
bowel diseases, skin diseases, and allergic reactions. Pitta
imbalance is also responsible for anger, envy, and jealousy. Kapha
dosha represents structure and cohesion and fluid balance. Kapha
imbalance predisposes toward diseases of the respiratory system,
sinusitis, diabetes mellitus, obesity, atherosclerosis, and tumors.
Kapha imbalance is also responsible for feelings of attachment and
greed.

Knowing the psychophysiological type can help the allopathic
physician diagnose existing disorders and predict risk for future
illnesses. The physician correlates both the Ayurvedic and
allopathic findings and then develops a treatment or prevention
plan integrating both modalities.

Pulse Diagnosis

Through palpation of the radial pulse, skilled Ayurvedic
practitioners are able to diagnose diseases not limited to the
cardiovascular system, such as diabetes, neoplastic disease,
musculoskeletal diseases, and asthma. Moreover, these practitioners
can detect imbalances at early 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. Just below the radial stylus, the index finger is placed
over the Vata pulse, the middle finger is placed over the Pitta
pulse, and the ring finger is placed over the Kapha pulse. The
skill of pulse reading depends on the training, practice, and
alertness of the diagnostician. During training the physician first
takes his or her own pulse many times a day, becoming intimately
familiar with how it changes under different circumstances, before
proceeding to the next stage - doing numerous examinations on
patients.

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 the following four main areas:
mind, body, behavior, and environment. Every patient receives
recommendations in all four areas.'

Mind. -In the Ayurvedic framework, the body is viewed not merely as
a sophisticated machine, but as a physical expression of the
self-interacting dynamics of an 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, which
has been the subject of over 500 studies during the past 20 years.
During the process of Transcendental Meditation, there are
metabolic changes indicative of a state of restful alertness.'
Published studies on this technique have reported associations
between the use of Transcendental Meditation and reduced health
care use; increased longevity and quality of life; and reduced
anxiety, hypertension, cholesterol level, and substance abuse.',"

Body. -These approaches include the use of diet, exercise, herbs,
sensory modalities, and panchakarma (purification procedures that
consist of medicated oil massages, herbalized heat treatments, and
elimination therapies)." These approaches are prescribed for
balancing Vata, Pitta, and Kapha.

Therapeutic actions are maximally effective only if appropriate
dietary measures are instituted to support the restoration of
physiological balance. Ayur-Veda 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.

The Ayurvedic physician also prescribes herbal food supplements.
Ayur-Veda'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.

A select group of Ayurvedic herbal compounds called rasayanas are
described as having the effect of increasing resistance to disease
and promoting longevity. Although further investigation is clearly
needed, recent studies indicate their potential applications. At
the Ohio State University (Columbus), Indiana University
(Indianapolis), University of Kansas (Kansas City), South Dakota
College of Pharmacy (Brookings), the University of Colorado
(Denver), and other institutions, two rasayana compounds, known as
Maharishi Anuit Kalash-4 and -5 (M4, M-5), have been investigated.
Both M4 and M-5 have been found to reduce the incidence of
chemically induced mammary carcinoma in up to 88% of experimental
animals and caused up to 60% of fully formed tumors in control
animals to regress when the animals were subsequently given the
compounds. [12,13] The M4 compound also has been found to prevent
experimental lung cancer metastases in up to 65% of animals tested.
This antitumor activity was unaccompanied by toxic effects.
Maharishi Amrit Kalash-5 has been found to induce morphological
differentiation in 75% of neuroblastoma cells in culture.
Furthermore, continued presence of M-5 in the culture prevented
rapid degeneration of the differentiated cells. In addition, M-5
has been shown to enhance lymphoproliferative response in
antigen-stimulated animals as compared with control animals," and
to reduce platelet aggregation induced by adenosine diphosphate,
arachidonic acid, collagen, and epinephrine. The chemical analysis
of both M4 and M-5 indicates that they contain a mixture of
antioxidants.' Both compounds have been found to decrease free
radicals and reactive oxygen species, including superoxide,
hydrogen peroxide, and hydroxyl radicals generated both in cellular
(neutrophil) and noncellular (xanthine-xanthine oxidase) systems."
This may indicate potential applications in the growing number of
diseases and toxicities linked to free radical-induced damage. "

In hepititis B carriers, Blumberg and colleagues, collaborating
with researchers at the University of Madras, India," conducted a
randomized controlled study of the effects of the plant Phyllanthus
anmna, which they state was "described in the Ayurvedic literature
more than 2000 years ago." Fifty-nine percent of plant-treated
subjects lost surface antigen, compared with 4% of placebo-treated
controls. Some of the subjects were monitored for up to 9 months
and in no case did the surface antigen reappear.

The application of Maharishi Ayur-Veda programs, including herbal
compounds, in the treatment of 10 chronic diseases was analyzed in
a nonrandomized and uncontrolled pilot study conducted in the
Netherlands on 126 patients.' Improvements were seen in patients
with rheumatoid arthritis, bronchial asthma, eczema, chronic
constipation, headache, chronic sinusitis, and hypertension after
3 months of treatment. The treatment protocol included different
Maharishi Ayur-Veda herbal compounds, (ie, MA-130 and MA-299 for
rheumatoid arthritis); dietary programs specific for each disease
according to imbalance in the doshas; rules of Ayurvedic daily and
seasonal routines; and other programs such as panchakarma,
Maharishi Ayur-Veda neuromuscular integration techniques, and the
Transcendental Meditation technique. There was no change in 14% of
these patients and in 7% the clinical condition continued to
progress unrelated to Ayurvedic therapy. There were no deaths.

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.

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. These measures include the collective practice of
the Transcendental Meditation and the Transcendental
Meditation-Sidhi programs, pollution control, proper living
conditions, and hygienic measures." Analysis of psychophysiological
type is important in many of these prescriptions, as individuals
differ in their responses to environment and types of occupations.

Applying Ayur-Veda to Allopathic Medicine

Ayur-Veda 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
psychophysiological, dietary, behavioral, and environmental
determinants of disease can add new depth to the physician's
approach to a wide variety of disorders.

Therapy in Ayur-Veda is prescribed on the basis of imbalance in the
doshas and psychophysiologic type rather than by disease entity as
in allopathic medicine. For this reason, two patients with
hypertension may receive different treatments owing to their
biologic individuality and different causes of the disease as
determined by the Ayurvedic diagnostic process.'

Physicians in North and South America, Europe, and Japan have taken
Ayurvedic training and include its methods in patient care. The
governments and/or medical associations of Brazil, Poland,
Czechoslovakia, and Hungary have sponsored Ayurvedic conferences
and training courses for physicians. In the Soviet Union, an
Institute of Maharishi Ayur-Veda has been established under the
auspices of the Research Centre for Preventive Medicine of the
Ministry of Public Health and more than 1000 Soviet physicians have
taken Ayurvedic training. Training in the United States is
available through the American Association of Ayurvedic Medicine,
Lancaster, Mass.

With rigorous scientific investigation, Maharishi AyurVeda may
provide useful new insights and approaches to the prevention and
treatment of disease. Maharishi Ayur-Veda's perspective may help to
explain phenomena that are not clearly understood by allopathic
medicine, and may give access to therapeutic and preventive
modalities that have been previously ignored or considered
unscientific. If such strategies exist, it is important that they
not be overlooked.

Hari M. Sharrua, MD, FRCPC The Ohio State University College of
Medicine Columbus
Brihaspati Dev Triguna, Ayur-Veda Martand All India Ayur-Veda
Congress New Delhi, India
Deepak Chopra, MD American Association of Ayurvedic Medicine
Lancaster, Mass

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