Essentials of Complementary and Alternative Medicine (June 1999)

Creation of the Universe: Five Elements
 
Inorganic Universe
 
Types of Energy: Vata, Pitta, and Kapha
Provider–Patient/Client Interactions
 
Patient Assessment Procedures
 
Etiology
 
Stages of Disease
Therapy and Outcomes
 
Treatment Options
 
Treatment Evaluation
Use of the System for Treatment
 
Ayurveda in the West
 
Major Indications
 
Preventive Value
Organization
 
Training
 
Quality Assurance
 
Reimbursement
 
Relations with Conventional Medicine
Prospects for the Future
Chapter References
BACKGROUND INFORMATION
Definition
Ayurveda is an ancient system of healing that has its roots in the Vedic knowledge of ancient India. It is thought by many scholars to be the oldest healing system in 
existence. The knowledge contained in Ayurveda deals with the nature, scope, and purpose of life. This system of healing embraces the metaphysical and physical, 
health and disease, happiness and sorrow, and pain and pleasure. It defines life as the expression of cosmic consciousness (sometimes called God, the Divine, 
Universal Awareness, or the Creator) manifest as the entire sphere of creation. In Vedic knowledge, the purpose of life is to know or realize the Creator (cosmic 
consciousness) and to express this divinity in one's daily life.
Ayur means life, and veda means knowledge. Systematized knowledge becomes a science, and so Ayurveda is considered the science of life. According to this 
system, individual life is a microcosm of the cosmos—an indivisible, unique phenomenon. Ayurveda evolved from practical, philosophical, and spiritual illumination, 
rooted in the understanding of creation. The ancient seers, or  rishis, were highly evolved, spiritual human beings who came to understand creation through deep 
meditation and other spiritual practices. In their search for an understanding of the creation of all things, Ayurveda was evolved. It helps each person understand 
one's unique body, mind, and the nature of daily operating consciousness. According to Ayurveda, this basic knowledge of body, mind, and consciousness is the 
foundation of health and happiness.
History and Development
Ayurveda dates back more than 5000 years. Of the seven ancient philosophies that it incorporates, the Sankhya model of creation and evolution is a system for use in 
daily life. The ancient sages who evolved this philosophy perceived how energy and the laws of nature manifest in all living, nonliving, gross, and subtle things, and 
they developed these precepts into a system of thought.
There are many ancient texts on Ayurveda, all originally written in Sanskrit. Although these works exist in English translation, their format may not be familiar or easily 
translatable into Western concepts. These texts are written in the form of  sutras, which express the essence of the information in poetic form only. In the Ayurvedic 
tradition, it is essential for each student to have a mentor who can expand the student's understanding of Ayurveda and, in essence, provide the keys that unlock the 
layers of meaning contained within these ancient writings.
T
HREE
 I
MPORTANT
 A
YURVEDIC
 T
EXTS
The Caraka Samhita, the Susruta Samhita, and the Astanga Hrdayam Samhita are probably the most important Ayurvedic texts. The Caraka Samhita, which is 
believed to have been written between 200 
BC
 to 400 
BC
 is the oldest and most important ancient writing on Ayurveda. This work is based on an even older oral 
tradition. It presents most of the theoretical edifice of Ayurveda and concentrates on the branch of Ayurveda called  kayacikitsa, or internal medicine. The English 
translation by P. V. Sharma (Chaukhambha Orientalia: Varanasi, India, 1981) is available in four volumes; two volumes are original text and two are commentary 
about the original work. Sharma's translation includes numerous appendices and an index. The translation by Bhagwan Dash and Ram Karan Sharma (Chowkhamba 
Sanskrit Series Office: Varanasi, India, 1992) has commentary incorporated in the original text. Both translations contain the original Sanskrit prose and poetry.
The Susruta Samhita presents the field of Ayurvedic surgery called  salakya, meaning foreign body. This work is also believed to be based on oral material passed 
down from generation to generation. It is thought to have been written soon after the  Caraka Samhita. Although the Susruta Samhita deals with the practice and 
theory of surgery, it is also an important source of Ayurvedic aphorisms. For example, the most commonly quoted definition of health is from Susruta. Translated from 
the Sanskrit, it reads: The person whose doshas (physiology) and digestion are balanced, whose tissue formation, elimination, and bodily processes are proper, and 
who experiences bliss in spirit, sense, and mind is a healthy person. The three-volume translation by K. L. Bhishagratna is the only English version available 
(Chowkhamba Sanskrit Series Office: Varanasi, India, 1991).
The Astanga Hrdayam Samhita is the work of a person named Vagbhata and also dates back to 200 
BC
 to 400 
BC
. Vagbhata's use of the Sanskrit language is poetic 
and melodious, making it easy for students to commit to memory. This exposition deals primarily with  kayacikitsa (internal medicine). Emphasis is placed on treating 
the physiology of the body and on suggestions for therapeutic use of metals and minerals. K. R. Srikantha Murthy has provided an English translation (Krishnadas 
Academy: Varanasi, India, 1991).
O
THER
 I
MPORTANT
 T
EXTS
The Sarngadhara Samhita is a concise exposition of Ayurvedic principles. This treatise is thought to have originated in the fourteenth century. Its subject matter is 
kayacikitsa. The Sarngadhara Samhita is prized for its enumeration and description of numerous pharmacologic formulations and contains perhaps the first textual 
reference to diagnosis by means of the pulse. The work is available in English translation by K. R. Srikantha Murthy (Chaukhambha Orientalia: Varanasi, India, 1995).
Madhava Nidanam, available in English translation by K. R. Srikantha Murthy (Chaukhambha Orientalia: Varanasi, India), deals with the Ayurvedic classification of 
diseases. This work is dated around 700 
AD
 and covers a wide range of diseases. Although this treatise provides detailed descriptions of disease prodroma and 

cardinal signs and symptoms, it does not provide etiologies or suggestions for treatment.  Madhava Nidanam is a book of practical, clinical medicine.
PRINCIPAL CONCEPTS
Creation of the Universe: Five Elements
Kapila, the founder of Sankhya philosophy, outlined five elements in the creation of the universe:  Purusha, Prakruti, Mahad, Buddhi, and Ahamkar.
According to Sankhya, Purusha is male energy. Prakruti is female energy. Purusha is formless, colorless, beyond attributes, and it takes no active part in creation. 
This energy is choiceless, passive awareness.  Prakruti yields form, color, and attributes in the field of action. It is awareness with choice, Divine Will, the One who 
desires to become many. The universe is the child born out of the womb of  Prakruti, the Divine Mother. Prakruti creates all forms in the universe, whereas Purusha is 
the witness to this creation. Purusha and Prakruti merge together to bring cosmic order, or  Mahad (also called universal intelligence). Within  Mahad, or universal 
intelligence, a center arises and from that center,  Buddhi, the individual's intellect, is created. Intelligence is a universal phenomenon; intellect is individual. The radius 
from the Buddhi center creates a small enclosure, a circle. The center of that circle is called  Ahamkar—the ego, the feeling of “I am.”
This feeling of “I am” further manifests through three universal qualities that pervade all creation:
1. Sattva is the pure essence of light, right action, and spiritual purpose. On the universal level,  sattva is vast clear space in the universe; on the individual level, 
sattva is the clarity of perception.
2. Rajas is the principle of movement. On the universal level,  rajas is atmosphere; on the individual level,  rajas is the movement of perception, which becomes 
attention.
3. Tamas is the principle of inertia and darkness. On the universal level,  tamas is the body of the planet solidity in all of nature; on the individual level,  tamas is 
precipitation of perception, which is experience. Without  tamas, there is no experience.
According to Ayurveda, these three universal qualities influence both our minds and bodies.  Rajas is the active vital life force in the body that moves both the organic 
and inorganic universal aspects to  sattva and tamas, respectively. Therefore,  sattva and tamas are inactive potential energies that require the active kinetic force of 
rajas. As a result of the influence of the three universal qualities, the five senses (hearing, touch, vision, taste, and smell), the five motor organs (mouth, hands, feet, 
reproductive organs, and excretory organs), and the mind are differentiated as parts of the organic universe. The five objects of perception (sound, touch, sight, taste, 
and smell) and the five basic elements (space, air, fire, water, and earth) are parts of the inorganic universe.
Inorganic Universe
An Ayurvedic principle states that all organic and inorganic substances are made up of the five basic elements: space, air, fire, water, and earth.
S
PACE
Within the body, each cell occupies space. Through the cellular space, cells communicate with one another. There is a continuous flow of intelligence between every 
cell. Every cell is a center of awareness; every cell has a mind and has the ability to choose what it ingests and what it expels. Therefore, space, which is the first 
expression of consciousness, is the basic need of the bodily cells. Even modern physics states that matter is that which occupies space. Thus, the development of 
matter begins with space.
A
IR
The flow of consciousness, from one cell to another cell in the form of intelligence, is called  prana, the principle of the air element.  Prana is a vital life force that is 
essential for communication on all levels of body, mind, and spirit. The air element is necessary for all subtle and gross movement within the cell, within each organ, 
and within the physical body as a whole. In other words, sensory stimuli and motor responses are the subtle movements of the air principle. Even the movements of 
the heart, respiration, peristalsis, and other involuntary movements are governed by  prana.
F
IRE
The fire element manifests as the metabolic processes regulating the transformation of food into energy. All transformative processes are governed by the fire 
element. The fire element is responsible for governing body temperature and the processes of digestion, absorption, and assimilation of food. Essential to these 
transformation processes are gastric action, hydrochloric acid, digestive enzymes, liver enzymes, and the amino acids present in every cell. Even within each of the 
doors of perception—eyes, ears, nose, tongue, skin—there is a subtle fire component that is necessary for sensory perception and processing these perceptions into 
knowledge.
W
ATER
Water is necessary in the human body for assimilation and for maintaining electrolyte balance. The blood in our bodies is composed of 90% water, and this water 
carries nutrients from one part of the body to the other. Oxygen, food particles, and the molecules of minerals are carried from one cell into another cell, from one 
system to another system, by this continuous river of fluid, the blood plasma. This is the Water of Life.
E
ARTH
From Earth, all organic living bodies, including humans, are created. The solid structures of the body—hard, firm, and compact tissues (e.g., bones, cartilage, nails, 
hair, teeth, and skin)—are derived from the Earth. Earth also contains the inorganic substances that constitute the mineral kingdom.
Types of Energy: Vata, Pitta, and Kapha
In addition to the five basic elements of the inorganic universe, Ayurveda identifies three basic types of energy, or functional principles, that are present in everybody 
and everything. There are no single words in English to describe these principles, so we use the original Sanskrit words:  vata, pitta, and kapha. These three doshas— 
vata, pitta, and kapha—are the active forms of the five elements. They are forces of energy, patterns, and movements, not substances and structures.
D
EFINITIONS
Energy is required to create movement so that fluids and nutrients get to the cells, enabling the body to function. Energy is also necessary to metabolize the nutrients 
in the cells and is needed to create and maintain cellular structure.  Vata is the energy of movement; pitta is the energy of digestion or metabolism; and  kapha is the 
energy that forms the body's structure and holds the cells together. All people have a unique combination of  vata, pitta, and kasha. Some individuals have one dosha 
predominant; others have a predominance of two doshas; still others might have the equal involvement of all three. Although each  dosha is composed of all five basic 
elements, two of these elements are predominant. The cause of disease in Ayurveda is viewed as the lack of proper cellular function because of an excess or 
deficiency of vata, pitta, or kapha and/or the presence of toxins that interfere with  dosha balance.
B
ALANCING THE
 T
HREE
 E
NERGIES
According to Ayurveda, at the moment of fertilization, we are endowed with a certain genetic code and unique psychophysiological constitution, which is determined 
by the proportional combination of  vata, pitta, and kapha of our biological parents. This constitution is called an individual's  prakruti. It governs the individual's 
responses to events and life circumstances, both mental and physiological. It is believed that if one is aware of one's basic constitution and its concomitant 
tendencies, one can take actions—including changing diet, behavior patterns, and emotional responses—to maintain equilibrium with one's constitution, thereby living 
a balanced, happy, and fulfilled life.

In Ayurveda, body, mind, and consciousness work together in maintaining balance. They are simply viewed as different facets of one's being. To learn how to balance 
the body, mind, and consciousness requires an understanding of how  vata, pitta, and kapha work together. According to Ayurvedic philosophy, the entire cosmos is 
an interplay of the energies of the five basic elements—space, air, fire, water, and earth.  Vata, pitta, and kapha are combinations of these five elements that manifest 
as patterns in all creation.
According to Ayurveda, there are seven body types. There are monotypes in which one  dosha is predominant, either vata, pitta, or kapha. There are dual types in 
which two doshas are equally dominant, either  vata-pitta, pitta-kapha, or kapha-vata. And, very rarely, there are equal types, in which all three  doshas are present in 
equal proportions. Every individual has a unique combination of these three  doshas.
Vata
In the body, vata, which is principally composed of space and air, is the subtle energy associated with movement. It governs breathing, blinking, muscle and tissue 
movement, heartbeat, and all movement in the cytoplasm and cell membranes. In balance,  vata promotes creativity and flexibility in a person; out of balance,  vata 
produces fear and anxiety. In the external world,  vata types tend to earn and spend money quickly. They are not good planners and, consequently, may suffer 
economic hardship. On the physical level,  vata people are more susceptible to diseases involving the air principle, such as emphysema, pneumonia, and arthritis. 
Other common disorders caused by imbalanced vata include flatulence, tics, twitches, aching joints, dry skin and hair, nervous system disorders, constipation, and 
mental confusion. The energy of  vata tends to increase with age, regardless of the individual's basic constitution.
Pitta
Pitta, principally made up of fire and water, is expressed as the body's metabolic system.  Pitta governs digestion, absorption, assimilation, nutrition, metabolism, and 
body temperature. In balance, pitta promotes understanding and intelligence in a person; out of balance,  pitta arouses anger, hatred, and jealousy. In the external 
world, pitta people like to be leaders and planners and seek material prosperity.  Pitta people tend to have diseases involving the imbalanced fire principle, such as 
fevers, inflammatory diseases, and jaundice. Common symptoms include skin rashes, burning sensations, ulcers, fever, and inflammations or irritations (e.g., 
conjunctivitis, colitis, sore throats).  Pitta is predominant during adulthood.
Kapha
Kapha, principally comprised of earth and water, is the energy that forms the body's structure—bones, muscles, tendons—and holds the cells together.  Kapha 
supplies the water for all body parts and systems. It lubricates joints, moisturizes the skin, and maintains immunity. In balance,  kapha is expressed as the action of 
love, calmness, and forgiveness. Out of balance, it leads to attachment (e.g., to family, job, lifestyle, possessions), greed, and possessiveness. In the external world, 
kapha tendencies toward groundedness, stability, and attachment help  kapha people earn and hold onto money. They tend to have diseases connected to the water 
principle, such as influenza, sinus congestion, and other mucus-involving diseases. Sluggishness, excess weight, diabetes, water retention, and headaches are also 
common. Kapha is predominant during the years of rapid development, from infancy through late childhood.
PROVIDER–PATIENT/CLIENT INTERACTIONS
Patient Assessment Procedures
There are eight classical clinical modalities that Ayurveda uses for examination. These clinical barometers are the pulse, urine, feces, tongue, speech and voice, 
examination by touch, examination of the eyes, and general physical examination (
Table 11.1
).
Table 11.1. Physical Examination
These eight important limbs are based on darshanam (observation), sparshanam (examination by tactile experience), and  prashnam (inquiry or questioning). Every 
patient is like a living book: to read that book, a physician must develop the ability to use these clinical barometers to properly perceive the diagnosis.
The Ayurvedic physician should have a basic understanding of how the inner organizations of  vata, pitta, and kapha are acting in and reacting to the patient's lifestyle, 
diet, emotions, job, and stress. According to Ayurveda, each constitutional type has an inclination toward certain disorders. For example,  vata individuals or those with 
vata imbalance have a tendency toward constipation, bloating, arthritic changes, sciatica, insomnia, and degenerative arthritis.  Pitta individuals, when out of balance, 
may have conditions such as hyperacidity, peptic ulcer disease, ulcerative colitis, or other inflammatory and infectious diseases. Metabolic disorders, such as slow 
metabolism, underactive thyroid, obesity, diabetes, hypertension, and high cholesterol, are associated with  kapha imbalance. A physician should know the signs and 
symptoms of the aggravation of vata, pitta, and kapha. Then, when a clinical assessment is made, the examiner asks questions to confirm which  dosha is out of 
balance. These observations are also confirmed by examination of pulse, tongue, and general physical examination.
The constitutional imbalances and their causes are understood on clinical grounds, identified through the eight classical modalities discussed previously in this 
chapter. Ayurveda is not only a metaphysical science, it is also a practical clinical science. The Ayurvedic understanding of health, imbalance, and disease is based 
on an understanding of the unique constitution of the individual, the aggravating or debilitating causes, the present imbalance if any, and the resulting pathogenesis.
Etiology
The Ayurvedic physician understands the pathogenesis and etiologic factors of the individual's problem by asking the patient about his/her diet, lifestyle, and 
relationships. The causative factors of the same disease may vary according to what aspect of the individual is imbalanced. Every disease has its origin. For example, 
all vata disorders have their root in the colon.  Pitta disorders begin in the small intestine.  Kapha diseases have their foundation in the stomach and gastric mucosal 
secretions. The condition of these organs is checked.
To help understand the causes of disease, that is, those factors which have weakened the system's ability to defend itself, Ayurveda has classified causes into 
groups:
Acute versus chronic
Genetic or hereditary
Traumatic
Habitual
Dietary, including food poisoning and wrong food combining

Seasonal
Climate
Lifestyle
Age
Metabolic condition
Emotional and psychological makeup
Supernatural and planetary disposition
Acts of God
Certainly bacteria and viruses cause disease, but the physician also asks what affects the patient's ability to defend himself against them. Ayurveda is about 
physiology, not pathogens. The question asked is whether the body is protected by its balanced physiology or is in a state of imbalance and therefore open to 
disease. The body has its own protective mechanism, the doshas. The doshas respond to these causes in an attempt to fight off disease.
Stages of Disease
According to Ayurveda, there are six progressive stages of disease resulting from uncontrolled aggravating causes: accumulation, provocation, spread, deposition, 
manifestation, and differentiation.