Ayurveda, taken from the Sanskrit words Ayus meaning life or lifespan and Veda meaning knowledge, originated in India but is now practiced throughout the world. A holistic system of health care that integrates the body, mind, spirit, and natural universe, Ayurveda is based on the belief that illness is the result of a person's lack of balance and harmony with his or her environment (Halpern 2000).

Considered by many historians to be the oldest form of medicine in the world, Ayurveda has been practiced in India for five to ten thousand years. The "contemporary" form of Ayurveda is mostly derived from several sacred Indian texts, known as The Vedas, which were written in Sanskrit between 1500 B.C. and 400 A.D. Due to its distinct world view based on Hindu philosophy and the difficulty in translating and understanding Sanskrit, Ayurveda largely remained an Indian medical practice until fairly recently (Halpern 2000).

Ayurveda is based on the premise that humans are a microcosm of the universe; everything that exists in the world also exists in the human body (Zysk 1996). The five universal elements—ether, air, fire, water, and earth—respectively correspond to the physical principles of space, motion, heat, flow, and solidity in the body. According to Ayurvedic theory, a person's basic constitution is formulated at conception and consists of three types of biologic energies, or doshas, that embody certain qualities, such as hot or cold, light or heavy, and wet or dry. While all three doshas exist in every person, one or two tend to predominate, giving a person unique physical and emotional qualities. An imbalance among the doshas aggravates an individual's primary dosha qualities. Many factors can disturb a person's natural balance, such as stress, an unhealthy diet, the seasons, and strained family relationships; this disturbance is expressed in the body as disease (Halpern 2000).

Ayurveda seeks to correct the imbalance that led to illness, rather than treat the symptoms themselves (Halpern 2000). An important cause of disease according to Ayurvedic theory is believed to be Ama, a sludge-like substance that is the result of improperly digested food and reduced enzymatic activity. Ama blocks channel systems in the body and gravitates toward weak organs (Zysk 1996).

There are two main schools of Ayurveda: traditional Ayurveda and Maharishi Ayurveda (MAV). MAV is a recent reformulation of traditional Ayurveda based on translations from the classical texts by Maharishi Mahesh Yogi. Both schools prescribe herbs, believe that disease results from an imbalance in the doshas, and use many of the same remedies for treating illness. However, MAV expands on traditional Ayurvedic philosophy, emphasizing the role of supreme consciousness in maintaining optimal health, and prescribing Transcendental Meditation (TM) as a method for experiencing the pure consciousness of the universe. MAV also highlights the need to express only positive emotions and to attune an individual's life to the natural circadian rhythms of the body (Sharma 1996).

The three types of doshas are vata, pitta, and kapha. Vata governs motion in the body, such as circulation, breathing, blinking, and the beating of the heart. When vata energy is balanced, there is creativity and vitality; out of balance, vata increases fear and anxiety. Pitta regulates the body's metabolic system, controlling digestion, absorption, nutrition, and body temperature. In balance, pitta promotes contentment and intelligence; out of balance, pitta can cause ulcers and arouse anger. Kapha controls growth in the body. It supplies water to all body parts, moisturizes the skin, and maintains the immune system. In balance, kapha energy is expressed as love and forgiveness; out of balance, kapha leads to insecurity and envy (Halpern 2000).

The digestive system is believed to be the root of most diseases, although the symptoms, course of illness, and prognosis for improvement are expressed differently in each individual. As a remedy for illness, the Ayurvedic practitioner will often recommend a diet with the opposite characteristics of the presenting complaint (Halpern 2000). According to Ayurveda, there are three main areas of the body affected by disease: the primary tissues (dhatus), secondary tissues (upadhatus), and channel systems (srotas). The tissues follow a specific sequential order and are dependent upon each other, in turn, for proper health. Various illnesses are a representation of which dosha is negatively impacting a particular tissue or channel system at a specific time. Disease is treated with remedies that have the opposite qualities, bringing the doshas and the body back into a state of equilibrium. For instance, an imbalance in pitta can lead to the production of excess acid and bile, causing inflammation in the gastrointestinal tract. Since pitta's primary elements are fire and water, balancing the pitta dosha includes eating cool, dry foods as well as taking particular herbs (Halpern 2000).

From a Western perspective, one of Ayurveda's mechanisms of action may be its ability to relieve stress (Halpern 2000). For example, studies show that TM reduces anxiety. Other studies show that Ayurveda also lowers blood pressure and cholesterol, slows the aging process, and improves the course of rehabilitation. In addition, the herbal formulas used in Ayurvedic medicine include combinations of plants that have synergistic antioxidant effects, making them potentially more effective in retarding oxidative damage from free radicals and stopping cancer cell growth than single herbal remedies. Furthermore, Ayurvedic practitioners frequently prescribe a vegetarian diet, which is not inconsistent with current information on the role of meat in health and chronic disease (Sharma 1996).

A visit to an Ayurvedic practitioner includes a detailed medical history, abdominal palpation, and an evaluation of the nails, pulse, skin, tongue, urine, and other physical features (Halpern 2000; Zysk 1996). The etiology of the illness is extremely important, and the Ayurvedic practitioner assesses how a person's lifestyle, diet, habits, and environment have led to the imbalance. In addition, the practitioner evaluates the patient's dosha and the qualities of the illness in order to prescribe remedies that balance the overabundant characteristics (Halpern 2000).

Ayurvedic practitioners draw from more than 20 types of treatment, but the most commonly prescribed are listed below.

• Pranayama—breathing exercises to generate calmness (Lad 1984)
• Abhyanga—rubbing the skin with herbalized oil (usually sesame oil) to increase blood circulation and draw toxins out of the body through the skin (Sharma 1996)
• Rasayana—using mantras (healing incantations) during meditation and specific herbs to rejuvenate a person (Sharma 1996)
• Yoga—combining pranayama, movement, and meditation to improve circulation and digestion and to reduce blood pressure, cholesterol levels, anxiety, and chronic pain
• Pancha karma—cleansing the body of toxins to purify the body and to reduce cholesterol (Lad 1984)
• Herbal medicines—prescribing herbs to restore dosha balance

Central to Ayurveda is the belief that a calm, peaceful mind is necessary for proper health and that all disease has a spiritual origin. Ayurveda thus seeks to calm the mind through the practice of yoga and meditation and to help people return to their true nature as spiritual beings. In addition, an important method for balancing the doshas is five-sense therapy, which includes prescriptions for diet, viewing certain colors believed to influence disease, chanting specific sounds or mantras, inhaling the scents of various essential oils, and being massaged with medicated oils. Finally, the practice of pancha karma includes a one- to four-week regimen, usually at an Ayurvedic center, that incorporates elimination therapies, such as enemas, purgation, and nasal cleansing, with spiritual reflection, oil massages, herbal remedies, and dietary restrictions (Halpern 2000).

Since a lack of harmony between an individual and the environment are believed to have caused disease in the first place, an Ayurvedic practitioner also makes recommendations for lifestyle changes, which are considered the foundation for longevity, optimal health, and true healing (Halpern 2000).

Ayurveda may be useful for allergies, amennorrhea, anxiety, arthritis, asthma, attention deficit disorder, back pain, benign prostatic hypertrophy, chronic bladder infections, candidiasis, preparation for childbirth, chronic fatigue syndrome, chronic otitis media, chronic pain, chronic and recurrent urinary-tract infections, colic, colitis, conjunctivitis, depression, Type II diabetes, endometriosis, allergies, fibrocystic breast disease, fibromyalgia, gastritis, hay fever, headaches, hemorrhoids, hypertension, infertility, insomnia, irritable bowel syndrome, lactation, menopause, menstrual cramps, multiple sclerosis, obesity, ovarian cysts, parasitic infections, pinworms, pneumonia, postpartum care, postpartum depression, premenstrual syndrome, sinusitis, stress, ulcers, uterine fibroids, and vulvodynia, as well as for prevention and general wellness (Halpern 2000).

Although no side effects or adverse outcomes have been reported in the literature to date, the herbal remedies and metal oxides prescribed in Ayurvedic medicine may have safety concerns for certain individuals or may interact with other medications (Halpern 2000).

There have been no contraindications to Ayurvedic treatment reported in the literature to date.

A number of Ayurvedic compounds and herbal remedies have been evaluated for their therapeutic effects. Research shows that Semicarpus anacardium has anti-tumor effects and that Terminalia arjuna reduces high cholesterol levels (National Institute of Ayurvedic Medicine 2000). Animal studies also indicate that Mucuna pruriens helps treat Parkinson's disease, and that a preparation made from putas (Ayurvedic preparations of metallic iron) of Louha Bhasma may be more effective than conventional treatments for iron-deficiency anemia (Halpern 2000; Pandit et al. 1999). Other herbs are being studied as treatments for adult-onset diabetes, asthma, depression, dysmenorrhea, herpes genitalis, hypertension, perimenopausal problems, and premenstrual syndrome, as well as adjunct therapy for acne, chronic constipation, chronic fatigue syndrome, irritable bowel syndrome, obesity, and uterine fibroids (National Institute of Ayurvedic Medicine 2000).

There has been increasing interest in Ayurveda, particularly its botanical remedies, because several traditional Indian herbs have been found to produce potent anti-tumor and immunologic effects (National Institute of Ayurvedic Medicine 2000). In addition, Ayurveda's holistic approach to healthcare and emphasis on lifestyle, diet, and stress reduction are gaining attention as an antidote to the sources of Western diseases and ill health (Sharma 1996).

Ayurveda has many potential future applications due to its ability to enhance immunity and prevent disease. It may also play an effective role in addressing the chronic illnesses highly prevalent in Western culture. In addition, studies on what has been termed the "Maharishi effect" indicate that groups of people practicing TM may reduce crime and aggression on a large scale (Sharma 1996).

Currently, only the California College of Ayurveda in Grass Valley, California, offers complete clinical training in the United States. The school also issues a certificate of Clinical Ayurvedic Specialist. However, there are other institutions across the United States that provide basic education in Ayurveda. Training takes one to two years. None of the 50 states offer licenses to practice Ayurvedic medicine, so specialists can only diagnose and treat disease under the guidance of a licensed provider (Halpern 2000).

For more information, contact the California Association of Ayurvedic Medicine, P.O. Box 2272, Loomis, CA 95650; the National Institute of Ayurvedic Medicine (NIAM), 584 Milltown Road, Brewster, NY 10509, at 914-278-8700 or www.niam.com; or the Ayurvedic Institute, 11311 Menaul Blvd. NE, Albuquerque, NM 87112, 505-291-9698 or www.ayurveda.com.

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Lad V. Ayurveda: The Science of Self-Healing. Santa Fe, NM: Lotus Press; 1984:70-79, 101.

National Institute of Ayurvedic Medicine: Current Research. Accessed on June 30, 2000 at www.niam.com/corp-web/current.htm.

Pandit S, Biswas TK, Debnath PK, et al. Chemical and pharmacological evaluation of different ayurvedic preparations of iron. J Ethnopharmacol. 1999;65(2):149-156.

Sharma HM. Maharishi Ayurveda. In: Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone Inc.; 1996:243-257.

Zysk KG. Traditional Ayurveda. In: Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone Inc.; 1996:233-242.