Ayurveda: age-old wisdom for balanced health

Ayurveda, an ancient science of life originating in India, transcends time to offer a holistic vision of health. Based on principles dating back thousands of years, this unique discipline encompasses physical, mental and spiritual well-being. The term “Ayurveda” itself combines the Sanskrit words “Ayur” (life) and “Veda” (knowledge). They reflect its very essence as the knowledge of life. Through a profound understanding of the natural elements and vital energies, Ayurveda guides each individual towards a personalised balance . It highlights the essential interconnection between the individual and the universe.

The origins of Ayurveda

Ayurveda, whose roots go back to the Vedas, sacred texts dating from the 2nd millennium BC, has its origins in the Atharva-Veda. As a subordinate Veda of the Atharva Veda, Ayurveda is considered to be nityam (eternal) and apaurusheyam (uncreated by man, revealed). In its early days, the principles of healing were based on sound and speech, with hymns as a means of healing. Recitation alone was believed to have the power to heal. The Vedas, divided into four parts (Rig-Veda, Yajur-Veda, Sama-Veda, Atharva-Veda), hold timeless Knowledge that transcends the ages. Ayurveda, heir to this ancient wisdom, offers a balanced approach to health. It harmoniously links the individual to a thousand years of knowledge.

In mythology

Ayurveda, one of the oldest health systems in the world, takes its name from Sanskrit. It literally means“science of life“. This holistic discipline meticulously analyses the factors involved in health and disease, both physical and mental. Its archaeological roots date back to the 12th century BC. These traces were discovered in the Indus Valley. Its origins are rooted in mythology. Legend has it that Brahma, the creator, transmitted medical science to Daksha Prajapati, who then entrusted it to the Ashvins, divine physicians, and then to Indra, king of the gods. Charaka and Sushruta wrote the first treatises between 400 and 200 BC. They defined two schools of medicine.

Ayurveda, initially transmitted orally, was taught by itinerant therapists. The first medical writings appeared in the Vedas. They described the therapeutic use of plants. Although the Indus civilisation, from which Ayurveda originated, dates back to 5,000 to 10,000 BC, the Ayurvedic medical texts we know are more recent. The mythological basis of Ayurveda is echoed in the Vedas, Sanskrit poems revealed to the rishis. They describe notions of health, disease, the physical and occult sciences, fertility, herbal medicine and anatomy. This Vedic medicine is based on magical rites, prayers and incantations. It used plants to reinforce curative charms. Ayurveda, with its rich mythological and medical history, represents a holistic approach to health that dates back thousands of years.

The six Samhitas of Ayurveda

Ayurvedic literature is structured into six Samhitas (‘treatises’ or ‘collections’24), each bearing the name of its author. The three main ones, written by Charaka, Sushruta, and Vagbhata, are the most significant and constitute the Bṛhattrayī, i.e. “the three majors” of Ayurveda. In parallel, the remaining three form the Laghutrayi, known as “the three minors”. This classification underlines the pre-eminence of the contributions of Charaka, Sushruta and Vagbhata in the development of Ayurvedic science. These essential treatises form the bedrock of Ayurvedic medical knowledge. They provide an in-depth understanding of the principles, diagnosis and treatment.

The three majors

The three minors

The three minor texts of Ayurveda, grouped together under the name of Laghutrayi, make specific contributions to this ancient science.

• Madhava Nidana Samhita focuses on the classification of diseases and their symptoms. It thus offers a detailed understanding of ailments.
• Sharngadhara Samhita describes the Ayurvedic preparations used in Panchakarma. It details the steps involved in pulse diagnosis.
• Bhava-Prakasha Samhita, a voluminous work containing over 10,000 verses. It explores the characteristics of many foods, as well as certain plants and minerals.

An early phase of traditional Indian medicine, as described by Underwood and Rhodes in 2008, identified a variety of ailments, from fevers to coughs. More complex conditions such as angina, diabetes and high blood pressure were also treated. Advanced medical techniques, such as plastic surgery, cataract surgery and various surgical procedures, were known and applied. The medical writings of Sushruta and Sharaka were translated into Arabic during the Abbasid caliphate. This facilitated their subsequent dissemination in Europe.

Nowadays

The expansion ofAyurveda in the Indian subcontinent was achieved gradually through trade with neighbouring nations. These were facilitated by land and sea routes. Until theIslamisation of the Middle East, this discipline occupied a significant place in the region. It was able to develop further in Buddhist territories. It influenced Chinese, Japanese and Tibetan pharmacopoeia.

The arrival of Arabic medicine, also known as Unani medicine, in India during the Afghan invasions at the beginning of the 11th century led to a cohabitation withAyurveda. The two medical systems coexisted for centuries. Their approaches have influenced each other.Ayurveda, based on the theory of the three humours, contrasted with unani medicine . The latter is based on the theory of the four humours. There were notable distinctions in their target audiences.

The colonial period was marked by the successive presence of the Portuguese, Dutch and British in India. This did not lead to the decline ofAyurveda. British doctors adopted Indian methods because of the difficulty and cost of obtaining medical supplies from Europe. However, with Lord Bentick ‘s reforms in 1835, support forAyurveda declined. This led to the abolition of its teaching in colleges.

This period of decline was short-lived. With the emergence of nationalist movements in favour of Indian independence,Ayurveda regained its importance. Since independence in 1947, the Indian government has had to navigate between developing experimental medicine, which is crucial on the international stage, and preserving Ayurvedic medicine, which is particularly prevalent in rural areas with limited medical services.

Today, government diplomas are awarded. These include basic courses in experimental medicine. Practitioners graduating from these programmes can work in primary care centres, volunteer in communities or run private Ayurvedic clinics, particularly in rural areas.

What is Ayurveda?

The fundamental principles of Ayurveda differ considerably from those of Western medicine. They form a coherent system based on complex theories.Ayurveda pursues a threefold objective: maintaining health, curing illness and achievingpersonal fulfilment. According to this tradition, the human being is made up of the five Mahabhutas (the five elements), the three doshas (the basic vital energies), the seven dhatus (the tissues) and the sixteen shrotas (the channels that transport the doshas throughout the body).

The Chakras

The chakras are a fundamental energy system made up of 7 centres distributed along the spinal column. These points play a crucial role in the reception, transmission and channelling of vital energy. They are also known as Chi or Qi in TCM. The energy centres, like circular wheels, react to internal and external energies, receiving the vital energy, or ‘prana’, transmitted by the thousands of channels called ‘nadis’ present in the human body.

There are thousands of chakras, including 7 main ones located along the spine. Each has its own distinct properties. The right balance ensures the fluid circulation of energy, known as “kundalini”. This promotes optimal health, with organs receiving a constant supply of energy.

• Root chakra (muladhara): Located at the level of the perineum and associated with the colour red. It is linked to primary needs, the survival instinct and security.
• Sacral chakra (svadhisthana): Orange in colour, located in the uterus or above the bladder. It governs sexual energy and creativity. It influences the libido and the realisation of projects.
• Solar plexus chakra (manipura): Yellow, under the sternum. It governs the emotions, promotes action and self-control.
• Heart chakra (anahata): In the centre of the chest, green in colour. It is the centre of universal love. In balance, it brings inner peace, compassion and tolerance.
• Lower chakras (Muladhara, Hara, Manipura): These three chakras are linked respectively to metabolism, energy, the reproductive system, the intestines, the immune system, the pancreas, the liver and the gall bladder.
• Upper chakras (Anahata, Vishuddha, Ajna, Sahasrāra): Responsible for emotional balance, breathing, intuition and spiritual connection. These chakras influence crucial aspects such as self-confidence, creativity, and concentration.

Mahabhutas or Panchabhûta

The Mahabhutas, the five great ‘elements’ of the universe, including the human body, are :

• Akasha (IAST: Ākāśa): space
• Vayu (IAST: Vāyu): air
• Agni or tejas: fire
• Jala or Ap: water
• Prithivi (IAST: pṛthivī or pṛthvī): earth

According to Ayurveda, these fundamental elements permeate the entire universe. Their understanding does not appear to be literal. They represent, respectively, the notions of space, movement, heat, flow and solidity. The human microcosm and the macrocosm share these five basic components (panchabhûta): space, air, fire, water and earth. These elements influence the environment and the human body, having specific qualities and powers. They are expressed by the terms “Rasa” (qualities) and “Vîrya ” (powers).

Panchabhûta have six tastes (rasa): sweet, sour, salty, pungent, bitter and astringent. Each has specific qualities and effects on the body. The powers (vîrya) of the panchabhûta include opposites such as cold/hot, heavy/light, wet/dry, fluid/gooey. Their balance is crucial in influencing the doshas and maintaining the body’s harmony. According to Ayurveda, these energetic elements form the basis of all matter, from humans to the universe. They characterise each entity according to its predominant element, with links to the senses, organs and actions.

Doshas

The doshas, representing the three fundamental energies, are crucial for maintaining balance and ensuring health:

• Vāta: kinetic energy;
• Pitta: energy of transformation;
• Kapha: the energy of cohesion.

The doshas are present in varying degrees in each individual. These forces determine tendencies, strengths and weaknesses. The doctrine of the three doshas is essential. The Ayurvedic doctor advises a lifestyle in keeping with prakriti, the individual Ayurvedic constitution. Each dosha, Vāta, Pitta and Kapha, is made up of the five Mahabhutas (elements).

The doshas influence both physical and psychological aspects. These aspects form four specific doshas in each individual: Vāta (breath), Pitta (bile), Kapha (phlegm), and Rakta (blood). These doshas determine the chemical nature of each living organism. For example, Vāta, dominated by air and ether, maintains the balance of the humours and controls the mind.

The individual components of the doshas, such as Vâta/vâyu, represent essential dynamic aspects of the organism. They govern breathing and digestion, and contribute to the balance of the humours. Pitta, associated with fire, is responsible for transformation and sits between the stomach and the intestine. Kapha, associated with water, represents cohesion and ensures the stability of body tissues.

The fourth dosha, Rakta (blood), is considered to be an additional mood, derived from Pitta. Each of the doshas is influenced by external factors such as climate, seasons and eating habits. The doshas are also associated with the guna (qualities), including Sattva (light), Rajas (movement) and Tamas (darkness).

Ayurveda emphasises the need to balance the doshas in order to maintain good health. Individuality, age, schedules, seasons and climate influence the predominance of the doshas. Harmony with one’s constitution, by adjusting diet and lifestyle, is recommended to prevent doshic imbalances and maintain overall health.

Dhatus

The dhatus represent the seven fundamental tissues that make up the framework of the human body:

• Rasa: plasma,
• Rakta: the blood tissue,
• Mamsa: muscles,
• Meda: adipose tissue,
• Asthi: bone tissue, cartilage, nails, hair,
• Majja: spinal cord and nervous tissue,
• Shukra: reproductive tissue.

These dhatus form the body mass. They play a crucial structural role without being directly involved in the causes of disease. According to Ayurveda, they maintain the organisation and metabolism of the body. They are interconnected in such a way that a defect in one dhatu can have an impact on the next.

The influence of the doshas on these tissues is notable. Kapha is in charge of all the tissues (plasma, muscles, fat, marrow, reproductive tissue) because of the body’s earth and water base. Pitta directs the blood, conserving body heat. Vata is responsible for the bones, containing air in their pores.

These dhatus are interdependent. Each dhatu nourishes the next in a continuous sequence. Digestion and transformation of nutrients lead to the maturity of a dhatu. The remaining immature part feeds the next dhatu. Thus, the nutrient essence absorbed initially feeds the Rasa, which in turn feeds the Rakta, and so on. This balance between the doshas and dhatus is essential for maintaining health and well-being.

Shrotas

The srotas represent the channels that feed the body’s tissues. They play a crucial role in regulating internal processes. The first three srotas are directly linked to the environment and the body’s nutrition. Each is under the influence of one of the three doshas:

• Pranahava srota (air channel), governed by Vata.
• Annavaha srota (food channel), governed by Pitta.
• Udakavaha srota (water channel), regulated by Kapha.

Three other channels are responsible for eliminating secretions and waste (malas). The other srotas serve the dhatus (body tissues). Maintaining fluid circulation in these channels is essential for good health. Any disruption can lead to illness.

The shrotas are made up of sixteen channels, both gross and subtle. They are involved in the general processes of assimilation and elimination, carrying the three doshas. The digestive system is the largest shrota. On the other hand, others are only visible under the microscope, at cellular level, revealing their porous nature. Some act only at the molecular, atomic and subatomic levels.

Modern medicine recognises only three of these shrotas: the anna vaha shrota (digestive system), the rakta vaha shrota (circulatory system) and the prana vaha srota (respiratory system). Their optimal functioning is vital. Any dysfunction, often linked to an imbalance in the doshas, can lead to pathological conditions.

Secretions and excretions or Malas

Malas are substances intended to be eliminated from the body. They may take a physical form or be more subtle in nature. This term encompasses various elements. These include faeces, urine, sweat, gas, tears, bloating, sneezing, vomiting, burping and ejaculation, as well as more abstract aspects such as hunger, thirst, sleep and even negative thoughts. The unresolved accumulation of these malas can lead to the appearance of symptoms of illness.

Among the malas, three main elements play a crucial role in maintaining the dynamic balance necessary for health:

• Stools, also known as purisha.
• Urine, known as mutra.
• Sweat, known as prasweda.

These three malas work in synergy to keep the body in balance. Any imbalance in this elementary triad can lead to illness or deficiency. The malas result from the residues generated by metabolism. Food digestion provides the body with essential nutrients, while the surplus is eliminated mainly through faeces. Excess water is eliminated through urine and sweat. In this way, the harmony between the intake and elimination of these elements helps to maintain optimum health.

Temperaments/constitutions: “Prakriti

The three doshas, Vâta, Pitta and Kapha, are linked to air, fire and water respectively. They act according to the modalities of the guna (fundamental qualities). Based on these associations, Ayurvedic doctors describe various human types, both morphophysiological and psychological. Each manifests a specific behaviour.

Opinions differ as to the predominance of a particular dosha in an individual. Some believe that this dominance is innate, others that it is acquired. Others consider that a doshic predominance is abnormal, requiring rebalancing.

Temperaments are described taking into account morphology, skin condition, dander, eyes, heat produced, food tastes, sex life, dreams, affectivity, intelligence and propensity to respect the rules of Dharma. Analogies with animal behaviour are also explored.

• Pittaja subjects (Pitta dominance): Sensitive to heat, malodorous perspiration, average height, excellent appetite, copper-coloured skin, average lifespan, moderate sex life, intelligence, fidelity.
• Kaphaja subjects (Kapha dominance): Bluish-grey complexion, black hair, white eyes, powerful voice, strength and resistance, faithfulness in friendship, comparable to divinities and quality animals.
• Vâtaja subjects (Vâta dominance): Thin, nervous, sensitive to the cold, prominent veins, unstable behaviour, passion for music, propensity to spend money, atheism, animal analogy with the goat, the hare, etc.

There are also bi-humoral types (vâta-pitta, vâta-kapha, pitta-kapha) and a tri-humoral type (vâta-pitta-kapha). Doctors also describe psychological subtypes according to the predominance of the guna (sattva, rajas, tamas). They classify individuals into sattvic (good-oriented), rajasic (passionate and violent) and tamasic (stupid and materialistic) types.

Illness from the Ayurvedic point of view

Smaprapati is an essential concept in Ayurveda, traditional Indian medicine. It represents the process of decline or imbalance of the doshas. Sushruta, one of the pioneers of Ayurvedic medicine, also uses the expression Kriya Kala to describe this dynamic process.

The term Kriya Kala suggests the idea of ‘action in time’. It highlights the fact that the development of doshic imbalances and the progression towards disease do not occur instantaneously, but rather through a series of temporal stages.

Body/mind concept

Charaka Samhita explores the complex relationship between the mind, past actions and previous incarnations, and their impact on the body. According to this perspective, the individual persists throughout the cycle of reincarnations; by contrast, the physical body is ephemeral. Life is seen as a continuum, with karma influencing the subtle body.

Over the course of reincarnations, past actions leave saṃskāras, traces or imprints, in the individual’s psyche. These saṃskāras shape the vāsanās, the deep-seated tendencies that are expressed as desires in the present life, according to Ayurveda.

Ayurveda attributes four main functions to the mind:

• Indriya Abhigraha – the integration of sensory functions,
• Svasya Nigraha – control of the self,
• Uha – reasoning,
• Vichara (IAST: vicāra) – judgement and deliberation.

Some researchers, including Gananath Obeyesekere, suggest that the psychic functioning described in Ayurveda has similarities with psychoanalytical theories. Ayurveda does not establish a dichotomy between somatic and psychological phenomena. Like other pathologies, mental disorders are explained by an imbalance of the doshas.

In the classical Ayurvedic tradition, the notion of ‘possession’ by evil entities was also evoked to explain certain disorders. Ayurveda thus offers a holistic vision, integrating mental, emotional and physical aspects in the understanding of imbalances and illnesses.

Humoral alteration

When altered dosha locate a defective part or organ of the body, they move towards it, stagnate and interact with the local tissues. They thus render the dhâtu vitiated. This gives rise to clinical manifestations; they result from the interaction between the altered dosha, the vitiated dhatus and the affected site or organ (adhisthana). Ayurvedic texts detail the sequence of events. These range from the cause(nidâna), to pathogenesis(samprapti), prodromal signs(purvarupa) and the appearance of the main symptoms(rupa).

The disease is divided into six phases:

• Accumulation of a dosha(sanchaya),
• Aggravation (viciation) of the dosha,
• Spread throughout the body,
• Increase(Samshraya) of the dosha in a specific part of the body,
• Manifestation of symptoms,
• Complications / Differentiation(Bhedaj), indicating the transition to chronicity where the body can no longer defend itself.

Vâyu/Vâta

Clinical manifestations cover a wide spectrum. They range from scoliosis to club foot, from paralysis to priapism, from side stitches to cardiac arrhythmias, from intestinal transit disorders to aphasia. They range from sensory disorders to tremors and mental agitation. A lack of vâyu leads to depression. It results in a reduction in strength, eloquence, alertness and clairvoyance. On the other hand, too much vâyu causes symptoms such as weight loss, rough skin with pigmentation, insomnia, palpitations and weakness with a tendency to faint.

In the oral cavity, a predominance of vâyu is manifested by dry, rough, cracked and thin gums, with recessions and painful, decayed teeth. Certain specific signs point to the diagnosis of a vâyu/vâta disorder. These include subluxation, dislocation, dilation, contraction, depression, excitement, tremors, stinging pain, coarseness, harshness, skin porosity, reddish-dust colour, astringent taste, dehydration, pain, numbness, contractions, rigidity and lameness. Treatments include creamy, evacuating enemas, specific medications, procedures such as oleation, sweating, sternutation, dietary changes, unctions and affusions. All must be carefully adapted to avoid any further imbalance of the dosha.

Pitta

There are 42 manifestations of pitta imbalance. They include hyperthermia, superficial and deep heating, acid eructation, poor digestion, hyperhydrosis, localised cracks, deliquescence of the blood and thinning of the flesh, various rashes, haemorrhages, yellow, green or blue discolouration of the skin, herpes, bitter and metallic tastes, inflammation of the mouth, throat, eyes, urethra and rectum, greenish-yellow and blue discolouration of the eyes, urine, matter and other disorders not listed here. In the oral cavity, excess pitta can manifest itself as sensitive gums. They are prone to inflammation, ulceration, bleeding and allergies.

To treat these disorders, sweet, bitter, astringent and cold foods are used. Methods such as oleation, purgation, various skin applications, etc. can also be used to restore the balance of pitta.

Kapha

Kapha imbalance can lead to up to 21 disorders. A decrease in kapha accentuates dryness. It causes sensations of burning and emptiness, and increases thirst. It leads to weakness. An excess of kapha manifests itself as a whitish complexion, drowsiness, chilliness, apathy, hypothermia and urticaria. Symptoms include itching, heaviness in the limbs, a tendency to be overweight and low motivation to work. Excess kapha increases expectoration, digestive mucus secretion, salivation, throat mucus and excretions.

In the oral cavity, kapha dominance results in thick saliva, dental plaque, tartar and a thick white lingual coating. Treatment involves the use of pungent, bitter, astringent, hot and dry remedies. They are combined with sweating, errhines (medicines introduced into the nostrils) and physical exercise. Emetics facilitate the elimination of excess Kapha by expelling it from the stomach.

Digestion, metabolism and doctrine

Food, which comes from nature and is made up of bhûta, undergoes digestion. This releases these elements and their properties. These bhûta combine to form the constituents of the body. Their balance influences health, while their imbalance gives rise to various pathological disorders.

The six rasa, derived from food, are released during the digestive process. They form a complete nutritive liquid(âharâ-rasa), pushed by the breath towards the heart. They are distributed throughout the body. This liquid nourishes the rasa, which forms the tissues(dhâtu-rasa). It successively forms blood, flesh, fat, bone, marrow and semen.

The substances not used by the body and the residues of metabolism, represented by faeces, urine, eye, ear and nasal secretions, sweat, dander and sebaceous secretion, as well as vâyu, pitta and kapha, form the mala. The balance between dhâtu (humours) and mala determines health. Any imbalance, beyond physiological variations, encourages the onset of disease.

Three factors are necessary for the production of disease: the causes of humoral imbalance(nidâna), the humours vitiated by nidâna(dosha), and the altered dhâtu (dushya). Thus, a cause leads to a humoral imbalance. This in turn has an adverse effect on the tissues. Ayurvedic doctors pay particular attention to vâta, pitta and kapha. They are considered to be dhâtu when balanced and dosha when disturbed. Some add a fourth mood, blood(rakta), which, through its particularities, participates in pathological processes.

Classification of diseases

Ayurvedic physicians present various classifications of diseases. According to Charaka, diseases are distinguished according to their impact on the body andmind, their violent or mild nature, their curable or incurable nature, their susceptibility to palliative treatment, and whether they are exogenous due to supernatural factors or endogenous due to natural causes. In addition, Charaka categorises diseases according to their location in thestomach andintestine, as well as in the central, middle or peripheral systems.

Sushruta establishes three classes of disease. He distinguishes between diseases of external origin, such as injuries caused by weapons or animals, those linked to natural and supernatural factors, such as climatic variations, divine anger (lightning, epidemics), and natural processes (hunger, thirst, old age, sleep disorders). It also classifies illnesses of bodily or mental origin. Sushruta includes pre-conceptional hereditary diseases linked to sperm or egg abnormalities, post-conceptional hereditary diseases resulting from annoyances during pregnancy, as well as humoral diseases (alterations of the doshas) and mental diseases (alterations of the guna).

By way of example, Krishnamurthy points out that factors such asexcessive exercise, prolonged wakefulness, walking, fear, anger and fatty foods can alter the normal activity of the wind and disturb the bile.

As far as mental illness is concerned, its aetiology is based on two specific doshas. These are rajas (activity triggering passions and desires) and tamas (ignorance and inertia), the balance of which guarantees mental health.

Prevention

The practice of disease prevention is aligned with an understanding of the underlying causes.Food and the role of diet in disease prevention are of paramount importance. The properties of foods are determined according to the function of the basic element. For example, sweet foods enrich the blood, marrow and sperm. Acidic foods, on the other hand, stimulate digestion.

Charaka recommendsphysical exercise. He also recommends yoga to balance the dosa through postures and breathing exercises. Proper oral hygiene is also emphasised, with specific recommendations.

Ayurveda proposes a special regimen for preserving health. It acts as a code of conduct for health(Svasthavrtta). This includes the daily code of health conduct(dinacarya), night conduct(ratricarya), and seasonal conduct(rtucarya). Details of lifestyle, diet, exercise, personal and social hygiene(sadvrtta) are described.

The individual is advised not to suppress natural needs. These include actions such as flatulence, bowel movements, belching, sneezing, drinking, eating, sleeping, coughing, breathing hard after exertion, yawning, crying, vomiting and ejaculating.

Ayurveda also recommends a daily regimen called Dinacharya . It includes various morning practices such as waking up at the time of Brahmamuhurtha, emptying the bladder and bowels, meditation, dental hygiene, tongue cleaning, mouthwash, mouth decoction, devotions, herbal smoke inhalation, facial care, eye care, nose care, light exercise, a hot water bath after oil massage, and rest with meditated sleep for 6 to 7 hours.

Treatment

In Ayurvedic curative medicine, the emphasis was placed onindividualised treatment. Actions were based on the causes attributed to the illness, behavioural errors and dietary deviations of the patient. One major therapy was Pancakarma-therapy (‘the five measures’). It aims to restore the balance of the dosas through various techniques. These techniques include vomiting, purgation, enemas, errhines and bloodletting. Studies have shown that patients who undergo this therapy change their medical behaviour after five days. They benefit from a long-term improvement in quality of life.

Indian medicine uses nearly 3,000 plant species to produce medicines. It offers six categories of therapy:

• alleviating therapy (Langhana)
• nourishing (Brimhana)
• drying (Rûkshana),
• oiling (Snehana),
• warming (Svedana),
• and astringent (Stambhana).

Two main methods are reduction (Langhana) and toning (Brimhana).

Reduction aims to detoxify, destroy theAma (toxins) and purify. Practices such as the consumption of digestive plants, fasting adapted to the patient’s dosha and sunbathing are used. Toning, carried out in cases of leanness, weakness or chronic illness, involves a nutritious diet, tonic plants such as ginseng, rest, walking, massage, etc. All therapies involve a variety of remedies. They follow the principles of the “laws of similars and opposites”. The aim of curative treatment is to re-establish dosha balance. Weak dosha are strengthened, excess dosha are reduced and normal levels are maintained. All this is based on the principles of samanya and visesa (homologous versus heterologous). This forms the fundamental basis of all actions in Ayurveda, whether natural or artificial.

How is this traditional medicine practised?

Diagnosis

For the vaidya (Ayurvedic physician), illness does not exist as such; it is merely the expression of an imbalance in the three doshas that needs to be harmonised. The Ayurvedic approach therefore consists first of all in determining the nature of this imbalance, identifying the doshas affected, looking for the causes and then finding a remedy.

The practitioner begins with a visualobservation of the body, called Darshana, where physical characteristics are noted, followed by a tactileexamination, Sparshana, involving palpation, percussion and auscultation of parts of the body and certain internal organs. To establish the nature of the imbalance, the vaidya uses a pulse diagnosis method called Nadi Pariksha. Three fingers are placed on the radial artery of the wrist to gather information about the patient’s doshas, making it possible to determine his or her vikriti (state of imbalance of the doshas).

Once the imbalance has been identified, the vaidya determines its cause byquestioning the patient, known as Prashna, in order to identify any dietary and behavioural errors responsible for the imbalance.Ayurveda attaches great importance to the patient’spersonal history, which is considered to be a determining factor in his or her state of health.

The diagnostic process also includes four phases ofgeneral examination, combining external and internal physical aspects(Srotas). These stages, such asauscultation,physical inspection, palpation andexamination of body odours, are fundamental in preparing the diagnosis and treatment.

The eight points ofclinical examination includepulse examination(Nâdî pariksha),observation of body proportions and behaviour,examination of the face, nails, eyes, tongue, skin, urine and faeces. These points give the therapist an in-depth view of the patient’s constitution, and additional questions are asked to refine the diagnosis, underlining the importance of theanamnesis in the Ayurvedic investigation process.

Panchakarma

Panchakarma (IAST pañcakarma), derived from the Sanskrit pancha (five) and Karma (action), represents a five-stage process of purification and rejuvenation practised inAyurveda, a form of traditional medicine originating in India.

Ayurveda recommends periodic detoxification at each change of season. The duration of a cure can vary from a few days to several weeks, and depending on the patient’s condition, the type of vaidya (Ayurvedic doctor) and the tradition (Northern Ayurveda or Southern Ayurveda), various methods are used to drain and eliminate toxins through the skin and digestive system.

The five stages of Panchakarma include Snehana (the ingestion of clarified butter) and later Virechana (a light purge) aimed at gradually detaching toxins from the cells. This is followed by Abhyanga (oil massage), which uses appropriate massage techniques to help bring toxins to the surface. Svedana (sweating) and Basti (a light enema) help to evacuate these toxins once and for all.

Depending on the patient’s condition, additional techniques can be added to the basic Panchakarma. For example, Nasya strengthens the vital force by treating the sinuses, considered to be the gateway to the brain. Shirodhara, in which a thin stream of warm oil is continuously dripped onto the patient’s forehead, is commonly used for nervous disorders, offering a profound sense of well-being. Pattra Potali, a form of sweating, is used to treat joint problems, among others.

Panchakarma is in line withAyurveda, which aims to eliminate toxins in a precise sequence to maintain balance in the body and mind, thus preventing illness. Procedures may vary according to the patient’s condition, but all converge towards the common goal of eliminating toxins in depth, promoting a holistic approach to health. Certain more specialised procedures, such as Vamana (therapeutic vomiting) and Raktamoksha (bloodletting), are reserved for specific pathologies and are rarely included in the basic Panchakarma.

Diet and hygiene

Ayurveda incorporates a system of essential nutritional recommendations. According to Ananda S. Chopra (2003), a specialist in Ayurvedic dietetics, this encompasses various aspects, from food preparation to daily living habits, including moral rules and sex life.

The Ayurvedic approach avoids generic advice, favouring an individualised approach. Dietary guidelines are determined according to each individual’s Ayurvedic type, taking into account natural rhythms such as the seasons and times of day, which influence the doshas.

Ayurveda categorises each food into six distinct flavours: sweet, sour, salty, bitter, pungent and astringent. Understanding their impact on the individual doshas is crucial to an optimal combination. Compendiums detail the flavours of various foods, while associative tables help to draw up dietary plans adapted to each dosha. A balanced meal, according to Ayurveda, should incorporate all six flavours to fully nourish the body and mind.

Personal hygiene, known as Svastha varta, goes beyond physical cleanliness. It encompasses lifestyle recommendations such as daily routine(Dinacharya), seasonal adjustments(Ritucharya), appropriate behaviour(Sadachara), immune strengthening(Rasayana), maintenance of the reproductive system(Vajikarana), and also includes practices such as bathing, tooth brushing, skin care, and eye cleaning.

Phytotherapy

Dravyaguna, a fundamental branch of Ayurveda, engages in the in-depth study of the properties of medicinal substances, encompassing three crucial aspects: theidentification of plants, the analysis of their therapeutic properties(Upashaya), and the exploration of their practical uses, including preparation, dosage, compatibilities and adjuvants.

In this Ayurvedic discipline, the approach differs markedly from contemporary herbal medicine. Rather than directly targeting the germs responsible for disease, Ayurveda focuses on rebalancing the doshas. In contrast to conventional medicine, which attacks germs with antibiotics, Ayurveda stimulates the Doshas to strengthen the immune system, enabling the body to fight illness naturally.

Plants, which make up over 80% of Ayurvedic remedies, are seen as entities made up of the five fundamental elements. Each part of a plant embodies a specific element:Ether in the fruit,Air in the leaves,Water in the branches and stems, Earth in the roots and Fire in the flowers. Seeds, meanwhile, embody all five elements.

The use of plants in Ayurveda is precise and adapted to the individual composition of each person. Unlike Western herbal medicine, Ayurveda recognises the principle of nature’s intelligence, emphasising that thespecific combination of plants enables effective interaction while avoiding any undesirable side-effects.

Depending on the individual’s constitution, plants are chosen with precision. For example, to reduce Vata, linked to the element Air, we recommend gentle, emollient, tonic and nutritious plants. Similarly, to reduce Pitta, associated with Fire, mild, fresh and bitter plants are recommended, while for Kapha, associated with Water, hot, pungent and bitter plants are preferred.

Ayurvedic herbal medicine

Ayurvedic herbal medicine, rooted in traditional Indian medicine, is a holistic approach that harnesses the therapeutic power of plants to promote health and balance in the body. Based on the principles of Ayurveda, an age-old science, Ayurvedic herbal medicine considers each individual to be unique, with his or her own physical and mental constitution, known as ‘Prakriti’.

Preparation

Administration

Ayurvedic plants for skin disorders

Vitiligo is identified in Ayurveda as theskin condition Shvitra. They share similar symptoms, attributed to an imbalance of the doshas disturbing the dhatus . The Rakta dhatu is particularly affected. It manifests white patches(Pandura Varna). This disease affects 0.25% to 2.5% of the Indian population. The difficulty of treatment depends on the chronicity and the dhatus affected, with current therapies having significant side-effects.

This study aims to develop an active formula without undesirable side effects by exploring Ayurvedic preparations. A specific preparation,Apamarga Kshara Yoga, in the form of a poultice and cream, was studied in a randomised, blind trial with 50 participants meeting the inclusion criteria.

Patients in group A received the poultice. Group B used Apamarga Kshara Yoga cream. Both groups followed a specific diet and took Rasayana Churna orally. The evaluation criteria included the size, colour, number and age of plaques, as well as the body surface area affected.

For group A, there was a significant reduction in colour (57.26%), number (43.80%), body surface area affected (40.58%), and plaque size (42.42%). The results for group B showed a similar reduction, with 55.46% in colour, 40.20% in number, 35.53% in body surface area and 42.45% in plaque size.

The difference between the two groups was statistically insignificant . This indicated that the two forms of Apamarga Kshara Yoga were equally effective in the treatment of vitiligo. These promising results suggest that this non-invasive treatment may become an option in the management of vitiligo . However, larger-scale studies are still needed to confirm these findings. It will also be necessary to identify the active molecules in these Ayurvedic blends.

Some Ayurvedic plants…

A number of plants are used in Ayurvedic treatments, some of which are listed below:

Ashwaganda (Withania somnifera)

Scientific research

In India, Ayurvedic medicine is mainly scrutinised and supervised by a national network of research institutes under the aegis of the government, such as the Central Council for Research in Ayurveda and Siddha (CCRAS) and the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH).

However, even fervent supporters of Ayurveda, including the renowned cardiologist Dr. M.S. Valiathan, recognise the limitations of clinical studies in this field in India. He points out that, despite the high demand in Ayurvedic hospitals, clinical studies meeting the criteria of the World Health Organisation are not very encouraging.

For example, a systematic review of Ayurvedic treatments for rheumatoid arthritis concluded that the available evidence was insufficient due to poor trial design. Some high quality trials showed no benefit, highlighting gaps in Ayurvedic clinical research.

Due to the traditional nature of this medicine, many Ayurvedic products have not been subjected to rigorous scientific studies or clinical trials. In the United States, the National Center for Complementary & Alternative Medicine (NCCAM) points to frequent shortcomings in clinical trials of Ayurvedic remedies, ranging from questionable research protocols to inappropriate control groups, introducing significant bias into the results. These challenges underline the need for a more scientific and rigorous approach to Ayurveda research to establish its credibility on the global medical stage.

Controversies

The branch of Ayurveda known as Rasa Shastra is devoted to the medicinal use of metals. It has been practising the meticulous incorporation of metals into plant- and mineral-based preparations for thousands of years, according to strict methods. However, concerns are emerging about the potential toxicity of these compounds. Their possible harmfulness seems to be recognised in traditional Ayurvedic texts.

One study shows that in 1990, 41% of Ayurvedic medicines tested in India contained arsenic. This figure rises to 64% for lead and mercury. This study gave rise to concern. In 2004, research conducted in the United States revealed high levels of heavy metals in a fifth of Ayurvedic preparations. This highlights contamination problems. Even in 2008, 20% of preparations purchased online, produced in India or the United States, contained lead, mercury or arsenic.

Supporters of Ayurveda maintain that toxicity is eliminated by traditional purification processes called samskaras and shodhanas. However, some laboratories neglect these procedures, leading to the sale of potentially toxic products and causing poisoning

Quality control of Ayurvedic medicines is difficult. There is still insufficient monitoring of products on sale. There is also a lack of testing laboratories. In response to concerns, the Indian government has made it compulsory for Ayurvedic medicines to specify their metal content on the product label. However, challenges remain due to non-compliance with the labelling requirements set out in the Drugs and Cosmetics Act.

The modern manufacture of Ayurvedic medicines has become a thriving industry. It has seen a move towards proprietary formulations using plant extracts. It is thus moving away from ancestral methods. The challenges associated with quality, contamination and the proliferation of falsified medicines underline the need for rigorous regulation and monitoring to guarantee the integrity and safety of Ayurvedic remedies.

Sources

• http://www.bichat-larib.com/publications.documents/5053_SIVANANDAMOORTHY_these.pdf
• https://dumas.ccsd.cnrs.fr/dumas-01629263/document
• https://www.ayurveda-france.org/
• https://www.doctissimo.fr/medecines-douces/medecine-ayurvedique/principales-plantes-ayurvediques
• https://hal.univ-lorraine.fr/hal-01931958/document
• https://fr.wikipedia.org/wiki/Ayurveda