Essentials of Complementary and Alternative Medicine (June 1999)

A
CCUMULATION
During the first stage, the aggravated  dosha begins to accumulate in its respective location:  kapha in the stomach, pitta in the small intestine, and vata in the colon. 
The dosha that accumulates is the result of one or more of the various causes previously listed. This beginning stage is the ideal time to begin therapy; the  dosha is 
more easily removed before the condition spreads beyond its primary location. For this reason, Ayurveda strongly advises seasonal purification at the juncture of the 
seasons to eliminate the accumulation of doshas that tend to occur during the season.
P
ROVOCATION
During the second stage,  vata, pitta, or kapha continue to accumulate in their respective locations and begin to affect the function of these and surrounding organs. 
This stage is also relatively easy to treat, although attention must be taken to strengthen the organs under pressure after the increased  doshas are removed from the 
body. Excess dosha is removed by the traditional Ayurvedic cleansing therapy called  panchakarma. The organ systems are strengthened through herbal supplements 
and modification of diet and lifestyle.
S
PREAD
The third stage is spread. At this stage, the aggravated  dosha moves from its primary location and begins to circulate in the body. The  doshas may move in any 
direction. If vata moves upward, it can cause nausea, vomiting, or a feeling of light-headedness. If it moves downward too rapidly, diarrhea may result.
The tissues and organs of the body are divided into three  margas, or pathways, through which the  doshas flow. When a dosha enters this third stage of spread, it 
begins to travel along one of these pathways. These  margas are as follows:
1. The internal, or gastrointestinal, pathway, which includes the entire alimentary canal.
2. The intermediate pathway, which includes rasa (plasma) and rakta dhatus (blood tissues).
3. The deep, or vital, pathway, which includes all the other  dhatus (mamsa, muscle tissue; meda, fat tissue; asthi, bone tissue; majja, nerve tissue; and 
shukra/artava, reproductive tissue). This pathway also encompasses the essential organs and major vessels and nerves.
D
EPOSITION
During the fourth stage, deposition, the aggravated  dosha settles in a weak area in the bodily tissues and begins to accumulate. It is during this stage that the 
disease's prodromal symptoms begin. The physician must recognize these symptoms so that treatment can be initiated. By stopping the disease process at this stage, 
the body can heal itself more rapidly with less danger of lasting effects.
M
ANIFESTATION AND
 D
IFFERENTIATION
In the fifth stage of manifestation, the diagnosis of the disease and the cardinal signs and symptoms are readily apparent. In Sanskrit, the sixth stage of disease is 
called bheda, which means destruction or differentiation (i.e., tissue damage). When the disease process reaches the sixth stage, it is fully manifest with structural 
changes and complications involving other tissues and systems. The disease is also more difficult to treat at this stage.
THERAPY AND OUTCOMES
Treatment Options
Ayurveda has eight traditional specialities, or branches: surgery, internal medicine, gynecology, pediatrics, ear-nose-throat, psychiatry, toxicology, and geriatrics. 
Ayurveda uses surgery if there is a need. Ayurveda uses gemstones, crystals, metals, even  mantra and sound for the purpose of healing.  Marma therapy, pressing 
points to send energy to the organs and connective tissue, is also used. Ayurveda has a wide scope of practice, including related disciplines such as  jyotisha (Vedic 
astrology), meditation , yoga asanas (yoga), and pranayama (cleansing).
According to Ayurveda, treatment is an action that creates balance among the components of constitution— dosha, dhatu (tissues), and mala (excretas: urine, feces, 
sweat). Ayurveda starts this action through prevention, which involves attention to maintaining the balance of the constitution. Living a proper, preventive lifestyle 
involves knowledge of one's unique constitution ( prakruti) and of how to maintain its balance in the face of all outer and inner challenges and stresses. Strengthening 
the organs and tissues and eliminating toxins from the body before they reach the stage of producing symptoms of disease are equally important. The first line of 
treatment is to remove the cause of the disease. If this is not possible, a basic guideline is to control the  doshas at the stage of accumulation by following an 
anti-doshic regimen.
All Ayurvedic treatment attempts to reestablish the person's unique constitutional balance. As discussed, disease develops when the person's immune function is low 
and the aggravated doshas settle in a weak area and begin to affect the functions of that system. Treatment of symptoms often makes the patient feel better; however, 
this does not address the fundamental cause of the illness, and the problem will likely reappear in the same or another form.
Treatments may be applied to the physical, emotional, and spiritual levels. Looking at the emotional level, most people learn in childhood not to express negative 
emotions (e.g., anger, fear, anxiety, nervousness, jealousy, possessiveness, and greed). As a result, these emotions become repressed and unprocessed. Ayurveda 
proposes that if these negative emotions remain repressed and are not dealt with, emotional toxins and unhealthy behavioral patterns will accumulate in the system. 
Ayurveda teaches a technique of dealing with negativity by observation and release. Recognize the emotion as it arises, observe it without judgment, and then 
release it. This technique helps to transform the unprocessed emotions into processed form. Negative emotions can be dealt with in this way through this awareness 
of emotion and release of it. Fear, anxiety, and apprehension are associated with  vata; anger, hate, and jealousy with pitta; and greed, attachment, and 
possessiveness with kapha. Each of these three aspects of the body can influence and affect the others. For example, if a person represses fear, the kidneys tend to 
be disturbed; anger affects the liver; greed and possessiveness settle in the heart and spleen. Therefore, the emotional makeup of the patient is assessed and taken 
seriously.
P
ALLIATION
A basic Ayurvedic principle states that  jathar agni, the gastric fire, and dhatu agni, the metabolic and regulatory component of each tissue, must be in harmony. If agni 

is low, food is not properly digested; undigested food becomes nonhomogenous, toxic, and morbid, and produces  ama (or toxins) in the system. Ama is the root cause 
of disease. This ama must be eliminated, and panchakarma (Ayurvedic cleansing therapy) is the best treatment for this process. However,  panchakarma should only 
be done with a person who has sufficient energy and strength. If a person is debilitated, tired, or weak, he or she cannot bear  panchakarma and it could further 
complicate his or her condition. For these people, palliation is a better choice. Palliation involves the use of herbs, such as ginger, black pepper, Piper longum, or 
chitrak, in addition to a specific diet appropriate for the person's constitution and condition.
Palliation helps not only to kindle digestive fire, but also to burn the  ama. A person should drink no more than seven or eight cups of water daily because it will only 
slow down digestion, add to the  ama, and create more congestion. Instead of cold water, a person should drink ginger tea, cinnamon tea, or certain herbal teas (e.g., 
mint tea or cumin-coriander-fennel tea). These teas kindle fire, detoxify  ama, and cleanse the srotas, the subtle channels of the body. After this treatment, mild 
laxatives, such as triphala, are given to remove toxins from the colon.
The process of palliation still involves the removal of toxins from the system. However, the approach is more gentle and involves several aspects: herbal medication to 
digest accumulated toxins (ama) and to strengthen the digestive fire ( agni); fasting from food and/or liquids; and sunbathing or windbathing. As this treatment 
continues, proper lifestyle, diet, and exercise must also be employed to sustain the benefits of treatment. With many conditions, treatment by palliation is used first 
and then, when the patient is stronger and the toxins have been moved from the tissues to the hollow organs, purification is appropriate to finish the removal of the 
toxins from the body.
P
ANCHAKARMA
To remove aggravated doshas and ama (toxins), Ayurveda suggests panchakarma. Pancha means five, and karma means action. The five actions associated with 
panchakarma are therapeutic vomiting, purgatives or laxatives, medicated enemas, nasal administration of medication, and purification of the blood.  Panchakarma is 
indicated as a therapy  only in cases in which the patient has sufficient strength and health to tolerate the removal of excess  doshas and toxins. Even then, it should 
only be administered by trained personnel under the supervision of a qualified Ayurvedic physician.
Before the actual operation of purification begins, the body must be prepared to release the toxins. The two preparatory procedures are  snehana (oil massage) and 
swedana (sweat therapy). With snehana, oil is applied to the entire body with a particular type of massage. This procedure helps the toxins to move from the deep 
tissues to the gastrointestinal tract. Oil massage also makes the superficial and deep tissues soft and supple, thus helping to remove stress and to nourish the 
nervous system. Snehana is given daily for three to seven days.  Swedana, sweating, is given every day immediately following the  snehana. An herbal concoction may 
be added to the steam to further loosen the toxins. After three to seven days of  snehana and swedana, the doshas become well ripened. A particular panchakarma 
method is then given according to the individual's constitution and disorder.
Vamana: Therapeutic Vomiting
Therapeutic vomiting ( vamana) is used to treat excess accumulations of kapha in the stomach. After three or four glasses of special herbs or salt water administered 
in the early morning, the tongue is rubbed to induce vomiting. The release of mucus through this therapy can bring immediate relief to congestion, wheezing, 
bronchitis, or breathlessness, and the sinuses will clear. Therapeutic vomiting is also indicated for skin diseases, chronic asthma, diabetes, chronic cold, lymphatic 
obstruction, chronic indigestion, edema, chronic sinus problems, and repeated attacks of tonsillitis. All of these conditions are associated with an imbalance of  kapha.
Virechana: Purgatives and Laxatives
The use of purgatives ( virechana) is helpful in treating  pitta imbalance, which involves inflammation or irritation. Excess secretion of bile accumulated in the 
gallbladder, liver, or small intestine may cause allergic rash or skin inflammation (e.g., acne, dermatitis) as well as chronic fever or jaundice. A number of substances 
can be used for this treatment, including triphala, senna, psyllium, castor oil, or even cow's milk with  ghee (clarified butter). Purgatives should not be given to persons 
with acute fever, diarrhea, severe constipation, or bleeding from the rectum or lungs. Other contraindications include patients with emaciation, weakness, or prolapsed 
rectum.
Basti: Therapeutic Enema
The third action is treatment with therapeutic enema ( basti), which involves introducing medicinal oils or herbal decoctions into the rectum. Medicated enema is the 
action of choice for vata disorders. This treatment alleviates constipation, distention, chronic fever, sexual disorders, kidney stones, heart pain, vomiting, backache, 
and neck pain. Other  vata disorders, including sciatica, arthritis and gout, also respond well to this therapy. Unlike colonics, which are popular with many therapies 
today, the principle reason for use of the enema in Ayurveda is for absorption of medicated oils and herbs through the colon wall. Of course, cleansing does take 
place when the enema is expelled. Oil or decoction enemas should be retained for a minimum of ten minutes, longer if possible.
Nasya: Nasal Administration of Medication
The fourth action, nasal administration of medicated oils and powders, is called  nasya. The nose is a doorway to the brain and to consciousness, and life energy 
(prana) enters the body through breath taken in through the nose. Nasal medication helps to correct the disorders of  prana, which affect the higher cerebral, sensory, 
and motor functions. This treatment is also used for dryness of the nose, sinus congestion, hoarseness, migraine headache, and certain eye and ear problems. Nasal 
medication is contraindicated following a bath, ingestion of food, sex, or alcohol consumption.
Rakta Moksha: Purification of the Blood
The fifth action of panchakarma is purification of the blood ( rakta moksha). Literally,  rakta moksha means liberation of blood, or bloodletting; a more liberal 
interpretation is the cleansing or purification of the blood. In Ayurveda, both historically and in modern times, bloodletting is used in certain cases, either directly or by 
the application of leeches.  Rakta moksha is to remove toxins from the blood in conditions such as skin disorders, enlarged liver and spleen, and gout. However, in 
most Western countries, bloodletting is either illegal or considered to be quackery. Hence various other procedures, usually herbal, are used to cleanse the blood. For 
blood-carried disorders, such as allergy, rash, or acne, the patient could take burdock root tea as a blood purifier.
Ayurveda believes that toxins absorbed into the bloodstream through the gastrointestinal tract create toxemia, the cause of many disorders, such as eczema, 
rheumatoid arthritis, and even the common cold. These toxins circulate throughout the body and may manifest under the skin or in the joint spaces, creating disease. 
Skin disorders, such as urticaria, rash, eczema, acne, scabies, leucoderma, and hives also respond well to blood cleansing, as do cases of gout and enlarged liver 
and spleen. Excess pitta circulating as a waste product in the blood creates these disorders. Therefore, for many  pitta ailments, using herbal blood cleaners or 
extracting a small amount of blood from the vein relieves the tension created by the toxins in the blood. This type of treatment is contraindicated in cases of anemia, 
edema, and weakness, and is not recommended for young children or the elderly. Although the above treatment should only be administered by a physician with 
Ayurvedic training, in some cases the symptoms of excess pitta are relieved by the donation of blood at a blood bank.
R
OUTINE
, R
EJUVENATION
, 
AND
 V
IRILIZATION
After the cleansing process occurs, a program of rejuvenation is recommended with specific herbs appropriate to the  dosha imbalance. For vata, guggulu is used. If 
the person is pitta, shatavari or guduchi are used. For kapha, punarnava, gokshura, or shilajit are appropriate. In this approach, treatment is determined by looking at 
the entire process—what the person's strength is, which  dosha is out of balance, and which  dhatu (tissue) is affected.
According to Ayurveda, all substances have medicinal properties. Ayurveda's knowledge and usage of herbs and other substances were gained from long experience 
and observation and date from early times. In addition to most substances, there are hundreds of herbs commonly used in Ayurvedic preparations, in addition to those 
commonly used for food, such as cinnamon and turmeric. Many different modes of preparation are required and each substance, according to its properties, is 
appropriate for treatment of different imbalances. For example, the common cold has the properties of  kapha—mucus, congestion, thick, and lethargic. The antidote is 
herbs with opposite qualities, such as hot ginger tea.
Once the body, mind, and spirit are essentially free from disease and back in balance, maintaining the vitality of the body and its systems through  rasayana, 
rejuvenation therapy, and vajikarana, virilization therapy, is essential for health and longevity.  Ojas, tejas, and prana are protected by virilization therapy.  Ojas, the 

superfine essence of kapha, is a necessary factor for maintaining immunity. Tejas, the superfine essence of pitta, maintains cellular metabolism. Prana, the superfine 
essence of vata, is responsible for maintaining the continuous flow of information, intelligence, and communication of cells and is necessary for maintaining the life 
force. Specific routines and herbal products are available to assist in maintaining the vital function of these three life-giving forces. Ayurveda contains a science of 
longevity.
C
HROMOTHERAPY
Ayurveda includes chromotherapy as a mode of treatment. Chromotherapy involves the use of specific colored light beamed directly on various parts of the body, 
water placed in the sunlight with specific colored cellophane attached to the jar, or wearing specific colors of clothing. Colors have psychological and physiological 
effects. Red, orange, and yellow are connected with  pitta. Red improves circulation; orange acts as an antiseptic and antibacterial agent; yellow acts as a 
decongestant. These three colors are  pitta-promoting and pacify vata and kapha. Ayurveda also uses the other colors of the rainbow, which are present in sunlight. 
Green is grounding and nourishing, so it is associated with  kapha. Blue is cooling. In India, if a child is jaundiced, the child is put under blue light. The liver heals 
faster and the jaundice is relieved. Blue pacifies  pitta and promotes liver function. Purple and indigo are cosmic colors associated with the higher spectrum and they 
relate to vata dosha.
Treatment Evaluation
Ayurveda addresses the causes of disease and the individual's personal response to these causes. Because each patient is evaluated according to his or her unique 
constitution, any aggravating causes, the present state of imbalance, and the stage of the disease process, there is less emphasis on standard treatments or 
remedies according to presenting symptoms. In Ayurveda, there is less emphasis on treating someone according to the name of the disease and more emphasis on 
treating the subject's imbalance and aggravating causes. Ayurveda goes deeply to the root cause of disease, and the treatment protocol for any given disease may 
vary from person to person and according to the stage and specifics of the disease process. Because of this approach, Ayurvedic treatments are generally not 
standardized. Individuals with similar Western diagnoses may often receive different Ayurvedic treatments.
There is a 5000-year tradition of the success and usefulness of Ayurveda, and there are many articles and studies reported. Ayurveda has developed and is used as 
an integrated system of medicine in which a unified theory guides the assessment and treatment of the patient. Its theory of health and disease, disease 
classifications, language and, in some cases, outcomes are different from those in the West and therefore are difficult (but not impossible) to investigate using modern 
Western approaches. At this point, however, there is no organization of the available literature, and finding studies on a specific area is difficult. There is an interest in 
testing Ayurveda as a medical system, using accepted Western medical style protocols. These studies are in the beginning stages at several university medical 
centers in the United States. For thousands of years, thousands of physicians and millions of patients have believed in and practiced Ayurveda. The question is, can 
this efficacy be proven by Western medicine?
One problem with proving efficacy according to Western protocols is the issue of double-blind trials and the placebo effect. The healing effects caused by the spiritual 
strength of the physician and placebos are acknowledged by Ayurveda and considered significant in many Eastern health care systems. However, these elements are 
generally difficult to quantify and may not be reproducible by every practitioner. In clinical studies to date, it seems that either the Western clinical protocols are 
compromised to allow for the satisfaction of the alternative/complementary side or the alternative/complementary side is unhappy with the changes necessary to 
satisfy Western clinical trial protocols. Many Western clinical trial studies are based on drugs and medicines formulated from a synthetically produced compound that 
can be quantified and standardized. Many of the Eastern approaches to health care, like Ayurveda, have a substantial pharmacopeia that uses only whole herbs. 
These herbs may be processed into tinctures, powders, or combinations, but active ingredients are not separated from the whole; the entire herb is used and is 
therefore difficult to standardize. Despite these difficulties, the benefits of a number of Ayurvedic products and practices have been studied and are summarized in the 
next section.
USE OF THE SYSTEM FOR TREATMENT
Ayurveda in the West
Currently in the West, there is no unification and standardization of Ayurvedic medicine, and there is only a small number of traditionally trained Ayurvedic physicians. 
Although Ayurveda as a medical system is uniquely applicable in almost all medical conditions, the lack of access to fully trained practitioners limits its use for primary 
care. The laws regulating the practice of medicine of course prevent any Ayurvedic physician, no matter how qualified, from practicing medicine in the United States 
without an acceptable license. In addition, the practice of Ayurveda in the United States is limited even for licensed practitioners because of restrictions placed on 
many of its therapies, such as bloodletting and compounds containing specially prepared metals considered toxic in the West (e.g., arsenic or mercury). For this 
reason, many problems are not treated with Ayurvedic medicine in the United States as they are in India.