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Ayurveda

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Dhanvantari,an avatar ofVishnu,is the Hindu god associated with ayurveda.
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Ayurveda(/ˌɑːjʊərˈveɪdə,-ˈviː-/;IAST:āyurveda[1]) is analternative medicinesystem with historical roots in the Indian subcontinent.[2]It is heavily practiced throughout India, Nepal, Bangladesh, Pakistan and Sri Lanka, where as much as 80% of the population report using ayurveda.[3][4][5]The theory and practice of ayurveda ispseudoscientificand toxic metals such as lead are used as ingredients in many ayurvedic medicines.[6][7][8][9]

Ayurveda therapies have varied and evolved over more than two millennia.[2]Therapies includeherbal medicines,special diets,meditation,yoga,massage,laxatives,enemas,and medical oils.[10][11]Ayurvedic preparations are typically based on complex herbal compounds, minerals, and metal substances (perhaps under the influence of early Indian alchemy orrasashastra). Ancient ayurveda texts also taught surgical techniques, includingrhinoplasty,lithotomy,sutures,cataract surgery,and the extraction of foreign objects.[12][13]

Historical evidence for ayurvedic texts, terminology and concepts appears from the middle of the first millennium BCE onwards.[14]The main classical ayurveda texts begin with accounts of the transmission of medical knowledge from the gods to sages, and then to human physicians.[15]Printed editions of theSushruta Samhita(Sushruta's Compendium), frame the work as the teachings ofDhanvantari,theHindu deityof ayurveda, incarnated as KingDivodāsaof Varanasi, to a group of physicians, includingSushruta.[16][17]The oldest manuscripts of the work, however, omit this frame, ascribing the work directly to King Divodāsa.[18]

In ayurveda texts,doshabalance is emphasized, and suppressing natural urges is considered unhealthy and claimed to lead to illness.[19]Ayurveda treatises describe three elementaldoshas:vāta,pittaandkapha,and state that balance (Skt.sāmyatva) of thedoshasresults in health, while imbalance (viṣamatva) results in disease. Ayurveda treatises divide medicine into eight canonical components. Ayurveda practitioners had developed various medicinal preparations and surgical procedures from at least the beginning of thecommon era.[20]

Ayurveda has been adapted for Western consumption, notably byBaba Hari Dassin the 1970s andMaharishi ayurvedain the 1980s.[21]

Although some Ayurvedic treatments can help relieve the symptoms of cancer, there is no good evidence that the disease can be treated or cured through ayurveda.[11]

Some ayurvedic preparations have been found to containlead,mercury,andarsenic,[10][22]substances known to beharmful to humans.A 2008 study found the three substances in close to 21% of U.S. and Indian-manufactured patent ayurvedic medicines sold through the Internet.[23]The public health implications of such metallic contaminants in India are unknown.[23]

Etymology

The termāyurveda(Sanskrit:आयुर्वेद) is composed of two words,āyus,आयुस्,"life" or "longevity", andveda,वेद,"knowledge", translated as "knowledge of longevity"[24][25]or "knowledge of life and longevity".[26]

Eight components

Nagarjuna,known for theMadhyamaka(middle path), wrote the medical worksThe Hundred PrescriptionsandThe Precious Collection.[27]

The earliest classicalSanskritworks on ayurveda describe medicine as being divided into eight components (Skt.aṅga).[28][29]This characterization of the physician's art, "the medicine that has eight components" (Sanskrit:चिकित्सायामष्टाङ्गायाम्,romanized:cikitsāyām aṣṭāṅgāyāṃ), is first found in the Sanskrit epic theMahābhārata,c. 4th century BCE.[30]The components are:[31][26][32]

  • Kāyachikitsā:general medicine, medicine of the body
  • Kaumāra-bhṛtya(Pediatrics): Discussions about prenatal and postnatal care of baby and mother; methods of conception; choosing the child's sex, intelligence, and constitution; childhood diseases; and midwifery[33]
  • Śalyatantra:surgical techniquesand the extraction of foreign objects
  • Śhālākyatantra:treatment of ailments affecting openings or cavities in the upper body: ears, eyes, nose, mouth, etc.
  • Bhūtavidyā:pacification of possessing spirits, and the people whose minds are affected by such possession
  • Agadatantra/Vishagara-vairodh Tantra(Toxicology): includes epidemics; toxins in animals, vegetables and minerals; and keys for recognizing those anomalies and their antidotes
  • Rasāyantantra:rejuvenationand tonics for increasing lifespan, intellect and strength
  • Vājīkaraṇatantra:aphrodisiacs;treatments for increasing the volume and viability of semen and sexual pleasure; infertility problems; and spiritual development (transmutation of sexual energy into spiritual energy)

Principles and terminology

Further information:Mahābhūta

The central theoretical ideas of ayurveda show parallels withSamkhyaandVaisheshikaphilosophies, as well as withBuddhismandJainism.[34][35]Balance is emphasized, and suppressing natural urges is considered unhealthy and claimed to lead to illness.[19]For example, to suppress sneezing is said to potentially give rise to shoulder pain.[36]However, people are also cautioned to stay within the limits of reasonable balance and measure when following nature's urges.[19]For example, emphasis is placed on moderation of food intake,[37]sleep, and sexual intercourse.[19]

The threedoshasand the five elements from which they are composed

According to ayurveda, the human body is composed of tissues (dhatus), waste (malas), and humeral biomaterials (doshas).[38]The sevendhatusare chyle (rasa), blood (rakta), muscles (māmsa), fat (meda), bone (asthi),marrow(majja), and semen (shukra). Like the medicine of classical antiquity, the classic treatises of ayurveda divided bodily substances into fiveclassical elements(panchamahabhuta) viz.earth,water,fire,airandether.[39]There are also twentygunas(qualities or characteristics) which are considered to be inherent in all matter. These are organized in ten pairs: heavy/light, cold/hot, unctuous/dry, dull/sharp, stable/mobile, soft/hard, non-slimy/slimy, smooth/coarse, minute/gross, and viscous/liquid.[40]

The three postulated elemental bodily humours, thedoshasortridosha,arevata(air, which some modern authors equate with the nervous system),pitta(bile, fire, equated by some with enzymes), andkapha(phlegm, or earth and water, equated by some with mucus). Contemporary critics assert thatdoshasare not real, but are a fictional concept.[41]The humours (doshas) may also affect mental health. Eachdoshahas particular attributes and roles within the body and mind; the natural predominance of one or moredoshasthus explains a person's physical constitution (prakriti) and personality.[38][42][43]Ayurvedic tradition holds that imbalance among the bodily and mentaldoshasis a major etiologic component of disease. One ayurvedic view is that thedoshasare balanced when they are equal to each other, while another view is that each human possesses a unique combination of thedoshaswhich define this person's temperament and characteristics. In either case, it says that each person should modulate their behavior or environment to increase or decrease thedoshasand maintain their natural state. Practitioners of ayurveda must determine an individual's bodily and mentaldoshamakeup, as certainprakritiare said to predispose one to particular diseases.[44][38]For example, a person who is thin, shy, excitable, has a pronouncedAdam's apple,and enjoys esoteric knowledge is likelyvata prakritiand therefore more susceptible to conditions such as flatulence, stuttering, and rheumatism.[38][45]Derangedvatais also associated with certain mental disorders due to excited or excessvayu(gas), although the ayurvedic textCharaka Samhitaalso attributes "insanity" (unmada) to cold food and possession by the ghost of a sinful Brahman (brahmarakshasa).[38][44][46][47]

Ama (a Sanskrit word meaning "uncooked" or "undigested" ) is used to refer to the concept of anything that exists in a state of incomplete transformation. With regards tooral hygiene,it is claimed to be a toxic byproduct generated by improper or incompletedigestion.[48][49][50]The concept has no equivalent instandard medicine.

In medieval taxonomies of the Sanskrit knowledge systems, ayurveda is assigned a place as a subsidiaryVeda(upaveda).[51]Some medicinal plant names from theAtharvavedaand other Vedas can be found in subsequent ayurveda literature.[52]Some other school of thoughts considers 'ayurveda' as the 'Fifth Veda'.[53]The earliest recorded theoretical statements about the canonical models of disease in ayurveda occur in the earliestBuddhist Canon.[54]

Practice

Physician taking pulse, Delhi, c. 1825

Ayurvedic practitioners regard physical existence, mental existence, and personality as three separate elements of a whole person with each element being able to influence the others.[55]Thisholisticapproach used during diagnosis and healing is a fundamental aspect of ayurveda. Another part of ayurvedic treatment says that there are channels (srotas) which transport fluids, and that the channels can be opened up by massage treatment using oils andSwedana(fomentation). Unhealthy, or blocked, channels are thought to cause disease.[56]

Diagnosis

An ayurvedic practitioner applying oil using head massage

Ayurveda has eight ways to diagnose illness, callednadi(pulse),mootra(urine),mala(stool),jihva(tongue),shabda(speech),sparsha(touch),druk(vision), andaakruti(appearance).[57]Ayurvedic practitioners approach diagnosis by using the five senses.[58]For example, hearing is used to observe the condition of breathing and speech.[39]The study of vulnerable points, ormarma,is particular to ayurvedic medicine.[40]

Treatment procedures

Treatment and prevention

Two of the eight branches of classical ayurveda deal with surgery (Śalya-cikitsāandŚālākya-tantra), but contemporary ayurveda tends to stress attaining vitality by building a healthymetabolic systemand maintaining good digestion andexcretion.[40]Ayurveda also focuses on exercise,yoga,andmeditation.[59]One type of prescription is aSattvic diet.

Ayurveda follows the concept ofDinacharya,which says that natural cycles (waking, sleeping, working, meditation etc.) are important for health. Hygiene, including regular bathing, cleaning of teeth,oil pulling,tongue scraping,skin care, and eye washing, is also a central practice.[39]

Substances used

See also:Medical ethnobotany of India
Ayurvedic preparations displayed in Delhi in 2016

The vast majority (90%) of ayurvedic remedies are plant based.[60]Plant-based treatments in ayurveda may be derived from roots, leaves, fruits, bark, or seeds; some examples of plant-based substances includecardamomandcinnamon.In the 19th century, William Dymock and co-authors summarized hundreds of plant-derived medicines along with the uses, microscopic structure, chemical composition, toxicology, prevalent myths and stories, and relation to commerce inBritish India.[61]Triphala,an herbal formulation of three fruits,Amalaki,Bibhitaki,andHaritaki,is one of the most commonly used[62]Ayurvedic remedies.[63][64]The herbsWithania somnifera(Ashwagandha)[65]andOcimum tenuiflorum(Tulsi)[60]are also routinely used in ayurveda.

Tulsi-flower (holy basil), an ayurvedic herb

Animal products used in ayurveda include milk, bones, andgallstones.[66]In addition, fats are prescribed both for consumption and for external use. Consumption of minerals, includingsulphur,arsenic,lead,copper sulfateand gold, are also prescribed.[39]The addition of minerals to herbal medicine is calledrasashastra.

Ayurveda uses alcoholic beverages calledMadya,[67]which are said to adjust thedoshasby increasingpittaand reducingvattaandkapha.[67]Madya are classified by the raw material and fermentation process, and the categories include: sugar-based, fruit-based, cereal-based, cereal-based with herbs, fermentated with vinegar, and tonic wines. The intended outcomes can include causing purgation, improving digestion or taste, creating dryness, or loosening joints. Ayurvedic texts describe Madya as non-viscid and fast-acting, and say that it enters and cleans minute pores in the body.[67]

Purifiedopium[68]is used in eight ayurvedic preparations[69]and is said to balance thevataandkaphadoshasand increase thepittadosha.[68]It is prescribed for diarrhea and dysentery, for increasing the sexual and muscular ability, and for affecting the brain. The sedative and pain-relieving properties of opium are considered in ayurveda. The use of opium is found in the ancient ayurvedic texts, and is first mentioned in theSarngadhara Samhita(1300–1400 CE), a book on pharmacy used inRajasthanin Western India, as an ingredient of an aphrodisiac to delay male ejaculation.[70]It is possible that opium was brought to India along with or beforeMuslim conquests.[69][71]The bookYoga Ratnakara(1700–1800 CE, unknown author), which is popular inMaharashtra,uses opium in a herbal-mineral composition prescribed for diarrhea.[70]In theBhaisajya Ratnavali,opium andcamphorare used for acute gastroenteritis. In this drug, the respiratory depressant action of opium is counteracted by the respiratory stimulant property of camphor.[70]Later books have included the narcotic property for use as analgesic pain reliever.[70]

Cannabis indicais also mentioned in the ancient ayurveda books, and is first mentioned in theSarngadhara Samhitaas a treatment for diarrhea.[70]In theBhaisajya Ratnavaliit is named as an ingredient in an aphrodisiac.[70]

Ayurveda says that both oil and tar can be used to stop bleeding,[39]and that traumatic bleeding can be stopped by four different methods:ligationof theblood vessel,cauterisationby heat, use of preparations to facilitateclotting,and use of preparations toconstrictthe blood vessels.

Ayurvedic treatment set up used for applying oil to patients,Kerala,2017

Massage with oil is commonly prescribed by ayurvedic practitioners.[72]Oils are used in a number of ways, including regular consumption, anointing, smearing, head massage, application to affected areas,[73][failed verification]and oil pulling. Liquids may also be poured on the patient's forehead, a technique called shirodhara.[74]

Panchakarma

According to ayurveda, panchakarma are techniques toeliminate toxic elements from the body.[75]Panchakarma refers to five actions, which are meant to be performed in a designated sequence with the stated aim of restoring balance in the body through a process of purgation.[76]

Current status

Ayurveda is widely practiced in India, Bangladesh, Sri Lanka, and Nepal[77]where public institutions offer formal study in the form of aBachelor of Ayurvedic Medicine and Surgery(BAMS) degree. In certain parts of the world, the legal standing of practitioners is equivalent to that of conventional medicine.[77]Several scholars have described the contemporary Indian application of ayurvedic practice as being "biomedicalized" relative to the more "spiritualized" emphasis to practice found in variants in the West.[78][76]

Exposure to European developments in medicine from the nineteenth century onwards, throughEuropean colonization of Indiaand the subsequent institutionalized support for European forms of medicine amongst European heritage settlers in India[79]were challenging to ayurveda, with the entireepistemologycalled into question. From the twentieth century, ayurveda became politically, conceptually, and commercially dominated by modernbiomedicine,resulting in "modern ayurveda" and "global ayurveda".[24]Modern ayurveda is geographically located in theIndian subcontinentand tends towards secularization through minimization of the magic and mythic aspects of ayurveda.[24][25]Global ayurveda encompasses multiple forms of practice that developed through dispersal to a wide geographical area outside of India.[24]Smith and Wujastyk further delineate that global ayurveda includes those primarily interested in the ayurvedapharmacopeia,and also the practitioners ofNew Ageayurveda (which may link ayurveda to yoga and Indian spirituality and/or emphasize preventative practice, mind body medicine, orMaharishi ayurveda).[25]

Since the 1980s, ayurveda has also become the subject of interdisciplinary studies inethnomedicinewhich seeks to integrate the biomedical sciences and humanities to improve the pharmacopeia of ayurveda.[25]According to industry research, the global ayurveda market was worth US$4.5 billion in 2017.[80]

The Indian subcontinent

A typical ayurvedic pharmacy,Rishikesh

India

See also:Healthcare in India

It was reported in 2008[8]and again in 2018[81]that 80 percent of people in India used ayurveda exclusively or combined with conventional Western medicine.[8][81]A 2014 national health survey found that, in general, forms of the Indian system of medicine orAYUSH(ayurveda, yoga and naturopathy,unani,siddha,and homeopathy) were used by about 3.5% of patients who were seeking outpatient care over a two-week reference period.[82]

In 1970, theParliament of Indiapassed the Indian Medical Central Council Act which aimed to standardise qualifications for ayurveda practitioners and provide accredited institutions for its study and research.[83]In 1971, theCentral Council of Indian Medicine(CCIM) was established under the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha medicine and Homoeopathy (AYUSH),Ministry of Health and Family Welfare,to monitor higher education in ayurveda in India.[84]The Indian government supports research and teaching in ayurveda through many channels at both the national and state levels, and helps institutionalise traditional medicine so that it can be studied in major towns and cities.[85]The state-sponsored Central Council for Research in Ayurvedic Sciences (CCRAS) is designed to do research on ayurveda.[86]Many clinics in urban and rural areas are run by professionals who qualify from these institutes.[83]As of 2013,India had over 180 training centers that offered degrees in traditional ayurvedic medicine.[59]

To fightbiopiracyand unethical patents, thegovernment of Indiaset up theTraditional Knowledge Digital Libraryin 2001 to serve as a repository for formulations from systems of Indian medicine, such as ayurveda,unaniand siddha medicine.[87][88]The formulations come from over 100 traditional ayurveda books.[89] AnIndian Academy of Sciencesdocument quoting a 2003–04 report states that India had 432,625 registered medical practitioners, 13,925 dispensaries, 2,253 hospitals and a bed strength of 43,803. 209 undergraduate teaching institutions and 16 postgraduate institutions.[90]In 2012, it was reported that insurance companies covered expenses for ayurvedic treatments in case of conditions such as spinal cord disorders, bone disorder, arthritis and cancer. Such claims constituted 5–10 percent of the country's health insurance claims.[91]

Maharashtra Andhashraddha Nirmoolan Samiti,an organisation dedicated to fightingsuperstition in India,considers ayurveda to be pseudoscience.[7]

On 9 November 2014, India formed theMinistry of AYUSH.[92][93]National Ayurveda Day is also observed in India on the birth ofDhanvantarithat isDhanteras.[94]

In 2016, theWorld Health Organization(WHO) published a report titled "The Health Workforce in India" which found that 31 percent of those who claimed to be doctors in India in 2001 were educated only up to the secondary school level and 57 percent went without any medical qualification.[95]The WHO study found that the situation was worse in rural India with only 18.8 percent of doctors holding a medical qualification.[95]Overall, the study revealed that nationally the density of all doctors (mainstream, ayurvedic, homeopathic and unani) was 8 doctors per 10,000 people compared to 13 per 10,000 people in China.[95][96]

Nepal

About 75% to 80% of the population of Nepal use ayurveda.[4][5]As of 2009, ayurveda was considered to be the most common and popular form of medicine in Nepal.[97]

Sri Lanka

Practitioners in 2017 in Sri Lanka, where ayurveda spas are common

The Sri Lankan tradition of ayurveda is similar to the Indian tradition. Practitioners of ayurveda in Sri Lanka refer to Sanskrit texts which are common to both countries. However, they do differ in some aspects, particularly in the herbs used.

In 1980, the Sri Lankan government established aMinistry of Indigenous Medicineto revive and regulate ayurveda.[98]TheInstitute of Indigenous Medicine(affiliated to theUniversity of Colombo) offers undergraduate, postgraduate, and MD degrees in ayurveda medicine and surgery, and similar degrees in unani medicine.[99]In 2010, the public system had 62 ayurvedic hospitals and 208 central dispensaries, which served about 3 million people (about 11% of Sri Lanka's population). There are an estimated 20,000 registered practitioners of ayurveda in Sri Lanka.[100][101]

According to theMahavamsa,an ancient chronicle ofSinhaleseroyalty from the sixth century CE, KingPandukabhaya(reigned 437 BCE to 367 BCE) had lying-in-homes and ayurvedic hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documented evidence available of institutions dedicated specifically to the care of the sick anywhere in the world.[102][103]The hospital atMihintaleis the oldest in the world.[104]

Outside the Indian subcontinent

Maharishi Mahesh Yogiin Amsterdam in 1967

Ayurveda is a system of traditional medicine developed during antiquity and the medieval period, and as such is comparable to pre-modernChineseandEuropean systems of medicine.In the 1960s, ayurveda began to be advertised asalternative medicinein the Western world. Due to different laws and medical regulations around the globe, the expanding practice and commercialisation of ayurveda raised ethical and legal issues.[105]Ayurveda was adapted for Western consumption, particularly by Baba Hari Dass in the 1970s and by Maharishi Ayurveda in the 1980s.[21]In some cases, this involved active fraud on the part of proponents of ayurveda in an attempt to falsely represent the system as equal to the standards of modernmedical research.[105][106][107]

United States

Baba Hari Dasswas an early proponent who helped bring ayurveda to the United States in the early 1970s. His teachings led to the establishment of the Mount Madonna Institute.[108]He invited several notable ayurvedic teachers, including Vasant Lad, Sarita Shrestha, andRam Harsh Singh.The ayurvedic practitioner Michael Tierra wrote that the "history of Ayurveda in North America will always owe a debt to the selfless contributions of Baba Hari Dass".[109]

In the United States, the practice of ayurveda is not licensed or regulated by any state. TheNational Center for Complementary and Integrative Health(NCCIH) stated that "Few well-designed clinical trials and systematic research reviews suggest that Ayurvedic approaches are effective". The NCCIH warned against the issue of heavy metal poisoning, and emphasised the use of conventional health providers first.[110]As of 2018, the NCCIH reported that 240,000 Americans were using ayurvedic medicine.[110]

Europe

The first ayurvedic clinic in Switzerland was opened in 1987 byMaharishi Mahesh Yogi.[111]In 2015, the government of Switzerland introduced a federally recognized diploma in ayurveda.[112]

Classification and efficacy

Ayurvedic medicine is consideredpseudoscientificbecause its premises are not based on science.[113][6]Both the lack of scientific soundness in the theoretical foundations of ayurveda and the quality of research have been criticized.[113][114][115][116]

Although laboratory experiments suggest that some herbs and substances in ayurveda might be developed into effective treatments, there is no evidence that any are effective in themselves.[117][118]There is no good evidence that ayurvedic medicine is effective to treat or cure cancer in people.[11]Although ayurveda may help "improve quality of life" andCancer Research UKalso acknowledges that "researchers have found that some Ayurvedic treatments can help relieve cancer symptoms", the organization warns that some ayurvedic drugs contain toxic substances or mayinteractwith legitimate cancer drugs in a harmful way.[11]

EthnologistJohannes Quackwrites that although the rationalist movement Maharashtra Andhashraddha Nirmoolan Samiti officially labels ayurveda a pseudoscience akin toastrology,these practices are in fact embraced by many of the movement's members.[7]

A review of the use of ayurveda forcardiovascular diseaseconcluded that the evidence is not convincing for the use of any ayurvedic herbal treatment for heart disease or hypertension, but that many herbs used by ayurvedic practitioners could be appropriate for further research.[119]

Research

In India, research in ayurveda is undertaken by the Ministry of AYUSH through a national network of research institutes.[120]

In Nepal, the National Ayurvedic Training and Research Centre (NATRC) researches medicinal herbs in the country.[121]

In Sri Lanka, theMinistry of Health, Nutrition and Indigenous Medicinelooks after the research in ayurveda through various national research institutes.[122]

Use of toxic metals

Rasashastra,the practice of adding metals, minerals or gems to herbal preparations, may includetoxic heavy metalssuch as lead,mercuryand arsenic.[23]The public health implications of metals inrasashastrain India is unknown.[23]Adverse reactions to herbs are described in traditional ayurvedic texts, but practitioners are reluctant to admit that herbs could be toxic and that reliable information on herbal toxicity is not readily available. There is a communication gap between practitioners of medicine and ayurveda.[123]

Some traditional Indian herbal medicinal products contain harmful levels of heavy metals, including lead.[124]For example, ghasard, a product commonly given to infants for digestive issues, has been found to have up to 1.6% lead concentration by weight, leading tolead encephalopathy.[125]A 1990 study on ayurvedic medicines in India found that 41% of the products tested contained arsenic, and that 64% contained lead and mercury.[8]A 2004 study found toxic levels of heavy metals in 20% of ayurvedic preparations made in South Asia and sold in the Boston area, and concluded that ayurvedic products posed serious health risks and should be tested for heavy-metal contamination.[126]A 2008 study of more than 230 products found that approximately 20% of remedies (and 40% ofrasashastramedicines) purchased over the Internet from U.S. and Indian suppliers contained lead, mercury or arsenic.[23][127][128]A 2015 study of users in the United States found elevated blood lead levels in 40% of those tested, leading physician and former U.S. Air Forceflight surgeonHarriet Hallto say that "Ayurveda is basically superstition mixed with a soupçon of practical health advice. And it can be dangerous."[129][130]A 2022 study found that ayurvedic preparations purchased over-the-counter in Chandigarh, India, had levels of zinc, mercury, arsenic and lead over the limits set by the Food and Agriculture Organisation / World Health Organisation. 83% exceeded the limit for zinc, 69% for mercury, 14% for arsenic and 5% for lead.[22]

Heavy metals are thought of as active ingredients by advocates of Indian herbal medicinal products.[124]According to ancient ayurvedic texts, certain physico-chemical purification processes such assamskarasorshodhanas(for metals) 'detoxify' the heavy metals in it.[131][132]These are similar to the Chinesepao zhi,although the ayurvedic techniques are more complex and may involve physical pharmacy techniques as well asmantras.However, these products have nonetheless caused severelead poisoningand other toxic effects.[127]Between 1978 and 2008, "more than 80 cases of lead poisoning associated with Ayurvedic medicine use [were] reported worldwide".[133]In 2012, theU.S. Centers for Disease Control and Prevention(CDC) linked ayurvedic drugs to lead poisoning, based on cases where toxic materials were found in the blood of pregnant women who had taken ayurvedic drugs.[134]

Ayurvedic practitioners argue that the toxicity of bhasmas (ash products) comes from improper manufacturing processes, contaminants, improper use of ayurvedic medicine, quality of raw materials and that the end products and improper procedures are used by charlatans.[132]

In India, the government ruled that ayurvedic products must be labelled with their metallic content.[135]However, inCurrent Science,a publication of the Indian Academy of Sciences, M. S. Valiathan said that "the absence of post-market surveillance and the paucity of test laboratory facilities [in India] make the quality control of Ayurvedic medicines exceedingly difficult at this time".[135]In the United States, most ayurvedic products are marketed without having been reviewed or approved by the FDA. Since 2007, the FDA has placed an import alert on some ayurvedic products in order to prevent them from entering the United States.[136]A 2012 toxicological review of mercury-based traditional herbo-metallic preparations concluded that the long-term pharmacotherapeutic and in-depth toxicity studies of these preparations are lacking.[137]

History

Some scholars assert that the concepts of traditional ayurvedic medicine have existed since the times of theIndus Valley civilisationbut since theIndus scripthas not been deciphered, such assertions are moot.[24]: 535–536 TheAtharvavedacontains hymns and prayers aimed at curing disease. There are various legendary accounts of the origin of ayurveda, such as that it was received by Dhanvantari (orDivodasa) fromBrahma.[17][39]Tradition also holds that the writings of ayurveda were influenced by a lost text by the sageAgnivesha.[138]

Ayurveda is one of the few systems of medicine developed in ancient times that is still widely practised in modern times.[25]As such, it is open to the criticism that its conceptual basis is obsolete and that its contemporary practitioners have not taken account of the developments in medicine.[139][140]Responses to this situation led to an impassioned debate in India during the early decades of the twentieth century, between proponents of unchanging tradition (śuddha"pure" ayurveda) and those who thought ayurveda should modernize and syncretize (aśuddha"impure, tainted" ayurveda).[141][142][143]The political debate about the place of ayurveda in contemporary India has continued to the present, both in the public arena and in government.[144]Debate about the place of ayurvedic medicine in the contemporary internationalized world also continues today.[145][146]

Main texts

Many ancient works on ayurvedic medicine are lost to posterity,[147]but manuscripts of three principal early texts on ayurveda have survived to the present day. These works are the Charaka Samhita, theSushruta Samhitaand theBhela Samhita.The dating of these works is historically complicated since they each internally present themselves as composite works compiled by several editors. All past scholarship on their dating has been evaluated by Meulenbeld in volumes IA and IB of hisHistory of Indian Medical Literature.[2]After considering the evidence and arguments concerning theSuśrutasaṃhitā,Meulenbeld stated (IA, 348),

TheSuśrutasaṃhitāis most probably the work of an unknown author who drew much of the material he incorporated in his treatise from a multiplicity of earlier sources from various periods. This may explain that many scholars yield to the temptation to recognize a number of distinct layers and, consequently, try to identify elements belonging to them. As we have seen, the identification of features thought to belong to a particular stratum is in many cases determined by preconceived ideas on the age of the strata and their supposed authors.

The dating of this work to 600 BCE was first proposed by Hoernle over a century ago,[148]but has long since been overturned by subsequent historical research. The current consensus amongst medical historians of South Asia is that theSuśrutasaṃhitāwas compiled over a period of time starting with a kernel of medical ideas from the century or two BCE and then being revised by several hands into its present form by about 500 CE.[2][20]The view that the text was updated by the Buddhist scholarNagarjunain the 2nd century CE[149]has been disproved, although the last chapter of the work, the Uttaratantra, was added by an unknown later author before 500 CE.[2] Similar arguments apply to the Charaka Samhita, written byCharaka,and the Bhela Samhita, attributed toAtreyaPunarvasu, that are also dated to the 6th century BCE by non-specialist scholars[150][151][152]but are in fact, in their present form, datable to a period between the second and fifth centuries CE.[2][20][12]TheCharaka Samhitawas also updated byDridhabaladuring the early centuries of the Common Era.[153]

Statue ofCharaka,ancient Indian physician, inHaridwar,India

TheBower Manuscript(dated to the early 6th century CE[154]) includes of excerpts from theBheda Samhita[155]and its description of concepts in Central Asian Buddhism. In 1987, A. F. R. Hoernle identified the scribe of the medical portions of the manuscript to be a native of India using a northern variant of the Gupta script, who had migrated and become a Buddhist monk in a monastery in Kucha. The Chinese pilgrimFa Hsien(c. 337–422 CE) wrote about the healthcare system of the Gupta empire (320–550) and described the institutional approach of Indian medicine. This is also visible in the works of Charaka, who describes hospitals and how they should be equipped.[156]

Some dictionaries of materia medica includeAstanga nighantu(8th century) by Vagbhata,Paryaya ratnamala(9th century) by Madhava,Siddhasara nighantu(9th century) by Ravi Gupta,Dravyavali(10th century), andDravyaguna sangraha(11th century) byChakrapani Datta,among others.[157][158]

Illnesses portrayed

Cataractsurgery is mentioned in theSushruta Samhita,to be performed with ajabamukhi salaka,a curved needle used to loosen and remove the obstructing phlegm,[clarification needed]with eye soaked with warm butter and bandaged afterward.[159]

Underwood and Rhodes state that the early forms of traditional Indian medicine identified fever, cough,consumption,diarrhea,dropsy,abscesses,seizures,tumours, andleprosy,[39]and that treatments includedplastic surgery,lithotomy,tonsillectomy,[160]couching(a form of cataract surgery), puncturing to release fluids in theabdomen,extraction of foreign bodies, treatment ofanal fistulas,treating fractures,amputations,cesarean sections,[Vagbhata 1][160][disputed–discuss]and stitching of wounds.[39]The use of herbs and surgical instruments became widespread.[39]During this period, treatments were also prescribed for complex ailments, includingangina pectoris,diabetes,hypertension,andstones.[162][163]

Further development and spread

Ayurveda flourished throughout the Indian Middle Ages.Dalhana(fl. 1200), Sarngadhara (fl. 1300) and Bhavamisra (fl. 1500) compiled works on Indian medicine.[164]The medical works of both Sushruta and Charaka were also translated into the Chinese language in the 5th century,[165]and during the 8th century, they were translated into the Arabic andPersian language.[166]The 9th-century Persian physicianMuhammad ibn Zakariya al-Raziwas familiar with the text.[167][168]The Arabic works derived from the ayurvedic texts eventually also reached Europe by the 12th century.[169][170]InRenaissance Italy,the Branca family of Sicily and Gaspare Tagliacozzi (Bologna) were influenced by the Arabic reception of the Sushruta's surgical techniques.[170]

British physicians traveled to India to observerhinoplastybeing performed using Indian methods, and reports on their rhinoplasty methods were published in theGentleman's Magazinein 1794.[171]Instruments described in theSushruta Samhitawere further modified in Europe.[172]Joseph Constantine Carpuestudied plastic surgery methods in India for 20 years and, in 1815, was able to perform the first major rhinoplasty surgery in the western world, using the "Indian" method of nose reconstruction.[173]In 1840 Brett published an article about this technique.[174]

The British had shown some interest in understanding local medicinal practices in the early nineteenth century. A Native Medical Institution was setup in 1822 where both indigenous and European medicine were taught. After theEnglish Education Act 1835,their policy changed to champion European medicine and disparage local practices.[175]After Indian independence, there was more focus on ayurveda and other traditional medical systems. Ayurveda became a part of the Indian National healthcare system, with state hospitals for ayurveda established across the country. However, the treatments of traditional medicines were not always integrated with others.[77]

See also

Footnotes

  1. ^Vāgbhaṭa's Aṣṭāṅgahṛdayasaṃhitā describes a procedure for the removal of a dead foetus from the womb of a living mother, and of a living child from the womb of a mother who has died (शारीरस्थान २, गर्भव्यापद्, २.२६-२७, २.५३).[161]Both these descriptions speak of removal of the fetus through the uterine passage, rather than from the front lower abdomen as with the caesarian section procedure. The earlier description of the Suśrutasaṃhitā (चिकित्सास्थान १५ "मूढगर्भ" ) is similar. A dead fetus is removed through the uterine passage and vagina. Although Suśruta does not describe removing a living child from a dead mother.

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Cited references

Further reading

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