The Present and Future.... Several recent health and natural products magazines have rushed to write about Ayurveda, a system of healthcare till recently left to fend for itself through the centuries. Such explosion of interest must be steered towards organized approach to integrating systems of healthcare rather than give room for quackery and exploitation. I hope there would be institutional support to study Ayurvedic pharmacognosy to identify the benefits offered by New World flora and fauna. Having received my science training and worked in an allopathic medical school environment, it was easy for me to realize how closely allopathy aligned with Ayurveda in purpose, but still stood far apart in the process. I have attempted to compare and contrast these systems, with the hope that an integration will be a reality soon.

The appearance.... Ayurveda would appear to be often mystical, beyond comprehension and antithetic to the way modern scientists have been groomed to function. Surrounded in mystery, supported by 'traditional wisdom' and lacking the 'organized' data to satisfy logical scrutiny, Ayurveda has elicited a spectrum of reactions, from romantic revivalism to reactionary rejection. We should take the time to understand this healthcare system which survived all trials and tribulations through centuries, bearing testimony to its efficacy.

"Aryuvedic Medicine is an example of a well-organized system of traditional healthcare, both preventive and curative. It is still a form of healthcare in large parts of the Eastern World, especially India...." (Encyclopedia Britannica, Macro 23, 906, 1988).

"A more intimate knowledge of this ancient Ayurvedic tradition will inspire the medical scientist to achieve even greater success in the field of medicine and surgery for the benefit of suffering humanity," said Sir Winston Churchill before the Royal College of Physicians in March 1944.

Distance between Health and Disease Health and disease do not function like a light-bulb. From being healthful, a person experiences several subtle changes towards 'diminished health' before becoming overtly ill. An alert provider who recognizes these changes can arrest the deterioration before the disease is manifest. For example, if one is infected with a virus, subtle changes occur during the 'incubation' period. When the changes are profound and the body cannot reverse these 'changes', an 'altered physiology' progresses to disease. Allopathic medicine would call this 'pathophysiology' resulting in the defined 'pathology'.

History of Ayurveda The traditional knowledge of humans' dependence on Nature to 'correct' various observed maladies has been recorded in Rig Veda which dates back to 4500 B.C. Although all the four established Vedas, viz., Rig, Yajus, Sama and Atharva, have recorded immense volume of knowledge on 'life' and 'healthy living', the evolution of a separate philosophy on 'healthy mind in a healthy body' evolved around 2500 B.C. which marked the birth of science of health and medicine, namely Ayurveda. Health is an indication of the well-being of mind, body and spirit, the tripod on which the entire philosophy of Ayurveda rests. Certain segment of society, like ordained families 'dhanvantris' or 'vaidyas' were entrusted the task of maintaining this knowledge.

Ayurveda was ahead of its time The first recorded treatise 'Charaka Samhita' on Ayurveda was written by Charaka (ca.10th Century B.C.), and a century later followed by Susruta Samhita by Susruta. Charaka dealt with medicines and Susruta advanced the knowledge systematically on general principles of illness and details of treatment. The next major treatise, Ashtanga Hridaya Samhita elaborating the principles and practice of medicine was written by Vegabhata in 7^th Century A.D. The wealth of knowledge theretofore evolved into 8 defined branches of Ayurveda.
1. Major Surgery  or  Shalyatantra
2. Minor Surgery (ENT, Oral & Eye surgery)  or  Shalakyachihitsa
3. Internal Medicine & Formulations  or  Kayachikitsa
4. Psychiatry  or  Bhootavidya
5. Pharmacognosy, Pharmacology & Geriatrics  or  Rasayanachikitsa
6. Reproduction, aphrodisiacs, & rejuvenation  or  Vajeekaranatantra
7. Obstetrics, prenatal, perinatal & pediatrics  or  Kaumarabhrityatantra
8. Toxicology, environmental pollution, & antidotes  or  Agadatantra

Geriatrics became important to modern medicine only when baby-boomers came to need the attention that was not available till then. Environment and toxic waste in 'developed countries' following industrialization could have been carefully managed if we had continued Agadatantra. Note that Bhootavidya was the first to offer a systematic approach to psychiatry and create a status for a health perspective for the mind and mental functions.

Growth of Ayurveda The period between 800 and 1550 A.D. saw significant growth of Ayurvedic knowledge. Among them-
Kashyapa Samhita - on maternity and pediatric science,
Chakradatta and Dravyagunasamgraha by Chakrapanidatta, a renowned Ayurvedic practitioner in 11^th Century , combined minerals with herbs,
Madhavanidana by Madhavakar (12^th Century) on diagnostic principles,
Sharngadhara Samhita by Sharngadhara (14^th Century) first systematic materia medica, and
Bhavaprakasha by Acharya Bhava Misra (ca 1550 A.D) a reference source for practitioners even today.

Among the several pharmacy lexicons on medicinal herbs (Nighantu Granthas) Raja nighantu by Narahari Pandit and Madanapala nighantu by Madanapala are the most outstanding ones. This period of immense growth was followed by mindless mutilation of the original manuscripts (written on palm leaves) by alien invaders which hurt the progress made till then. It is laudable that in the recent 50 years, Government of India resuscitated Ayurveda.

Principles & Practice Ayurveda is often erroneously limited to herbs and herbal products for treating specific diseases. Far from it, Ayurveda takes a holistic view of health and disease. Accordingly, health is an indication of optimal biological processes which maintain spiritual, mental and physical activity, directly influenced by food, medication, thought, exercise, and environment. Disease is the result of incremental alteration of such processes due to these exogenous and intrinsic factors. Treatment of disease means use of drugs, correction of diet, alteration in physical and mental activities, and supervised recovery of health. Consequently, any Ayurvedic treatment would last only until the dhosha has been reset. Unless supervised by a competent practitioner or 'vaidya' self-diagnosis and self-medication in Ayurveda may produce unpredictable results.

We are what we are..... The premise that all living beings are made of and are governed by the dynamic energy in the five primordial elements or panchabhoota (pancha = five, bhoota = elements, namely, earth or prithvi, water or jal, fire or agni /tej, air or vayu, and ether / plasma or akash), which influence the trinity, mind, body and spirit is the basis of all Ayurvedic understanding. From this evolved the concepts of physiology and patho-physiology. The dhosha is the physiology or the net effect of the forces or the energy controlling the processes in the body. The dhatus or the tissues of the body which are created, nourished and repaired by the juices and energy from the ingested food, and the mala are the metabolic products. Ayurveda recognizes the existence of prakriti, or the genetically distinct constitution of the individual. Prakriti, under the influence of food, thoughts or environment, develops a state of being 'well' (dhosha in balance) or 'unwell' (deranged dhosha), which over a period of time leads to changes in tissues (dhatus) of body and of mind, which form metabolic products (mala) or result in sickness when the mala is not controlled. Thus, when the dhoshas are in balance, the body and mind experience 'wellness', and when the dhoshas experience derangement; the outcome is patho-physiology.

Dhosha are of 3 kinds- vata, pitta and kapha, mainly the way in which they group to control balance or get deranged to cause imbalance. Therefore, in the Ayurvedic system, an individual is healthy only when the three 'doshas' are in harmony. It is conceivable that a given individual may have vata-prakriti (overtly vata person) or kapha-prakriti and so on. Various conditions, like excessive feelings of pleasure and envy , have been classified as altered dhosha in Ayurvedic systems, amenable to treatment, while modern medicine has often ignored these as 'figment of imagination' but not illness. The groggy feeling in the morning after a full night's sleep is a deranged vata, while modern medicine would wait for it to develop into full-blown 'chronic fatigue syndrome' or 'depression'.

Vata dhosha, which is an attribute of flow of the energy of air and space, explains all biological phenomena controlled by central and autonomic nervous systems. Charaka classified vata dhosha into 5 types based on structure and function of prakriti (prana- breathing, vyana- heart and lungs, udhana -upper gut, samana- intestines, and apana- lower gut, excretions and secretions). Deranged vata dhosha manifests as- dandruff, scaly skin, drop in acuity of intelligence, insomnia, indigestion, vomiting, constipation and more. A vata person is distinctly exalted and laughing.

Pitta dhosha, which depicts the flow of the energy in fire and water, is responsible for all types of transformations in the body following digestion, assimilation, tissue-building, thermogenesis, endocrine functions and more. Pitta controls anger, fear, and bravado, thirst, appetite, digestion and more. There are 5 types of pitta- agharapachak- controls food and digestion, ranjak - controls the way 'rasa' or nutrients and toxins of food are handled in the body, sadhak - controls processing of variety of information and impulses in the brain, bhajak - controls the responses of skin and its chemical activities, and alochak - that controls vision, functioning of eyes. A strong pitta in the brain allows good processing of information, comprehension and decisiveness. Pitta gets deranged with heavy oily or spicy foods, or with tension and anxiety, and in that state expedites aging.

Kapha dhosha depicts the flow of the energy of earth and water- through appropriate fluids kapha controls construction, repair and functions of tissues and cells of the body and brain. Predominance of kapha makes a person compassionate, forgiving and free-from envy. There are 5 types of kapha: bodhak- allowing the sense of taste to function with secretion of saliva, kledhak-forming mucous to protect the stomach and intestines from the fiery contents, tarpak-protects brain from external injury with fluid, shleshak-lubricates and repairs the joints and ligaments, and avalambak- exists as secretions in thorax and pelvis facilitating the organs in these regions to function smoothly. Kapha is also known phlegm. A preponderance of kapha makes a person plump, contented and even slow. When this dhosha is deranged, the person may have emaciation, impotence, decreased secretory functions, dryness, envy, and lethargy.

Dhatu Dhatu means 'to support'. Ayurveda recognizes 7 distinct dhatu or tissues, namely- rasa (fluids such as plasma, lymph, milk, secretary fluids), rakta (blood cells, nourished by rasa dhatu), mamsa dhatu (muscles, ligaments, & skin), meda dhatu (fat and adipose tissue), asthi (bone, teeth), majja (marrow) and shukra (reproductive organs, sperm, eggs, including the desires and urges). In several instances, a dhatu will have associated 'upadhatu' or secondary tissues, e.g., bone is asthi dhatu, and teeth are upadhatu.

Mala are the metabolic end products of the creation, growth and repair of the tissues. Consequently, each tissue or dhatu will have mala. For example, rakthahatu (blood cells) make cytokines which are important to conduct normal functions such as defense, immunity etc., but when the same is over-produced, it is an indication of underlying imbalance in the dhosha, leading to disease.

Communication within and between the players... The cells in the tissues constantly communicate among other parts of the body. This intra- and inter-organ communication is also well recognized in modern medicine e.g., hormones, messenger molecules, ligands, receptors, and ions. Ayurveda says that the communication occurs via channels or srotas. Each of the 7 major tissues (dhatus) have respective srotas. These srotas are described to be active, sending and receiving signals from other tissues and cells. In modern terminology, srotas would be similar to ion channels, ion-gates, receptors and signal transducers.

Interaction with external stimuli Ayurveda describes food items in mysterious terms such as ushna, sheeta, laghu or guru. When translated into English, as hot, cold, light or heavy, respectively, the same would not convey effective meaning. On the contrary, all foods are classified based the predominance of the primordial element it contains. Equally important is the environment, including the seasons. If sheeta food is consumed in winter and fall, it would aggravate kapha, whereas the same would help in summer time. On the contrary, ushna which may be agreeable in winter would cause discomfort and formation in summer-boils. Also, the taste of the food or medicine is known to have influence on the dhoshas. There are 6 tastes- madhur or sweet, amla (sour), lavana (salt), tikta (bitter), katu (pungent), and kashaya or astringent. Their relationships to dhoshas is shown in the table.

Rasa	Vata	Pitta	Kapha
Madhura (sweet)	Pacifies	Pacifies	Aggravates
Amla (sour)	Pacifies	Aggravates	Aggravates
Lavan (salt)	Pacifies	Aggravates	Aggravates
Katu (pungent)	Aggravates	Aggravates	Pacifies
Tikta (bitter)	Aggravates	Pacifies	Pacifies
Kasaya (astringent)	Aggravates	Pacifies	Pacifies

Thus, a 'healthy' person eating madhur or sweet dishes would increase kapha and suppress pitta, resulting in anabolic conditions and weight gain. Eating bitter (tikta) dishes like fenugreek and bitter melon, would increase vata and suppress kapha, causing e.g., weight-loss. It is important to eat a variety of taste and dishes so that an overall balance would result. Therefore there is no single food or a miracle drug in Ayurveda. The myths such as 'bitter is better' or 'raw is healthful' are not endorsed by Ayurveda. Traditional cuisine would even impose specific dishes on specific days of the lunar month, to ensure periodic supply of essential factors in our diet.

Ayurvedic Medicines It is amazing how the seers and great teachers systematically arranged over 1250 plants for their physiological effects on human body. The extensive Indian Materia Medica was further enriched during the Buddhist period by addition of newer plants and plant-derived medicines. Ayurvedic books described the useful plants, their systematic cultivation including the ideal habitat for doing so, the parts to be used, the proper time of collection of such parts, conditions of storage, methods of preparations, toxicology of such preparations, pharmacology of administration, clinical evaluation of treatments in great details that express the extent of advancement of this science in 'ancient' times. Description of several medicinal preparation for parenteral administration (akin to injection of today) as well as transdermal medications (similar to the 'patch') are available in Ayurvedic systems. Such advancement was paralleled by development of chemistry of natural products isolated from flora and fauna, a prime example being the art of isolating essential oils and fragrances from flowers etc. The therapeutic value of an Ayurvedic medicine will be different depending on method of extraction, the nature of medicine, the conditions of harvest, and time and duration for which the medicine is administered. There are indications, restrictions and contraindications associated with every treatment. In addition to plant derived medicines, over 250 medicines derived from animals and equal number from minerals formed the basis of Ayurvedic Formulations.

Basis of Drug Selection in Ayurveda All drugs are characterized by 5 properties- rasa (taste), vipaka (effects of drug metabolites), and guna (physical property) describe the herb, and veerya (potency), prabhava (specific influence) help to select the drug. While effect of rasa is immediate, physiological, psychological, local, and perceivable, that of vipaka is delayed, systemic, physiological and only inferred. Guna is the descriptive text on identifiable property of individual herb or medicine. Ayurveda has elaborate descriptions of methods of preparing drugs to attain variable veerya (potency) which helps achieve appropriate prabhava (effect) on the individual. Similar principles can be found in homeopathic system.

Ayurvedic Treatment There are three elements to achieving and maintaining health:- 1- proper food, medication, and environment, 2- proper physical and mental exercise in the form of yoga and meditation, and 3- regular detoxification in the form of 'panchakarma'. After learning the hard way, allopathic science today calls for 'balanced diet', proper exercise and regular bowel movements.

What is Panchakarma? The accumulation of excess 'mala' in the body and of various toxins would make it difficult for the dhoshas to reset themselves even if appropriate medication are provided. Ayurveda recommends prophylactic and therapeutic detoxification. A vaidya would call it 'panchakarma' or the five methods of detoxification- namely, forced vomiting (vaman), forced diarrhea (virechan), enema (basti), inhalation (nasya), and blood-letting (rakthamokshana). Ideally, panchakarma should be attempted under proper supervision. We must remember that therapeutic and other health benefits of blood donation, or of forced vomiting when a toxin is ingested, etc are recognized by allopathy.

Know what to expect... Unless combined with proper diet and appropriate physical and mental activity, 'health' itself is a myth. For those seeking Ayurvedic care, know that it is holistic, and it handles mind, body and soul as a unit. The concept that medicines, be Ayurvedic or allopathic, are harmless or can by themselves mitigate the illnesses or correct a problem is erroneous. Ayurveda is not a means to extend life to perpetuity; rather it is a means to stay healthy, till the inevitable happens. It would be meaningless to live 200 years if one is kept alive by machines and fed through tubes. Also, no medical system can conquer all emerging maladies. Nothing in this article should be construed that one system is superior to the other. The gains made in diagnostic and laboratory medicine or in surgery in the last 100 years must not be abandoned. In fact, there are other systems of healthcare with very valuable advances worth adopting for the good of humans and environment. In a future issue, we will introduce "Siddha', another traditional system from India, which has also been revived in recent decades. I again make the fervent appeal to the powers that be to stimulate effective integration of various systems in all aspects of healthcare- education, delivery as well as administration.

Additional Reading
Medicinal Plants by S. K. Jain, National Book Trust, 5th Ed, 1994
Indian Materia Medica, K.M. Nadkarni (2 volumes), 3rd Ed, Popular Prakasm, Bombay, 1954
Ayurveda Unravelled by Dhanukar & Thatte, National Book Trust, New Delhi 1996
Indian Medicinal Plants, Arya Vaidya Sala of Kottakal, (5 volumes) 1994
The Vedas by His Holiness Sri Chandrasekarendra Saraswathi, Bharatiya Vidya Bhavan, Bombay, 1993
The Treatise on Indian Medicinal Plants by Chatterjee & Prakash, Publications & Information Directorate, CSIR, New Delhi (4 volumes) 1991
Ayurvedic Drugs and their Plant Sources by Sivarajan & Balachandran, Oxford & IBH Publishing Pvt Ltd, New Delhi, 1994.
Encyclopedia Britannica, Macro 23, 906, 1988.
©1998. M. S. Rajagopalan. All rights reserved.
Author:
M. S. Rajagopalan, PhD (1982) is a Medical Scientist, currently an (v) adjunct Asst. Prof in Microbiology & Immunology in the College of Medicine at U of Kentucky, formerly a student and faculty at Christian Medical College & Hospital, India 1972-84, W.H.O. Research Fellow at U of California, San Francisco, CA 1984-86, and member Instt of Food Technol, Intn'l U of Immunol Soc., & Amer Soc for Microbiology.