By Dr. Venkateswarrao Karuparthi
5104 Kali Era, Chitrabhanu Year, Jyesta month (June 2002)
There has been tremendous interest in Ayurveda recently as an alternative medicine in the US, for example, Guggulu. The research interest on Guggulu will be on the burner as long as the modern medicine recognized the cholesterol problem and scientists like Dr. Moore are interested to investigate. If this Guggulu is safe and effective then why is it not widely used and spreading like a wild fire all over the world?
First reason is ‘bottom line’ economic profitability reasons override the common good and humanity. The pharmaceutical industry cannot survive on research like Dr Moore’s work, because they cannot patent Guggulu and make profits. Currently, lipid-lowering drugs on the market are close to billion-dollar industry, even though all of them have side effects in long-term use and stop working as soon as patient stops taking.
The second reason is evaluation of Ayurveda as an alternative medicine using the model of "modern science" and its research methodology. We are trying to understand Ayurveda through modern science, while the fundamentals of Ayurveda are quite different. The two systems may be integrated to take advantage of each other, but one system cannot be evaluated and researched with fundamentals of the other. However, independent overall clinical outcomes and evidence can be evaluated.
Ayurveda did not discuss the concept of cholesterol, but prescribed Guggulu for disorders like obesity. So, Dr. Moore predicted that it might have lipid-lowering effect seen through the eyes of modern medicine and proved that Guggulu, in fact, lowered the cholesterol levels. Does this mean that this can translate into a ‘magic drug’ that can be mass-produced and used effectively? Not so, if you look carefully into fundamentals of Ayurveda. Further, if you look at the listing of Ayurvedic applications of Guggulu, it is prescribed for arthritis, bronchitis, diabetes, obesity, back pain, throat ulcers and the list goes on. In fact every herb or medicine in Ayurveda has a long list of conditions that it is used to treat. Isn’t this absurd that a single medicine can be used effectively for so many diseases and symptoms? It only makes sense, if you understand Ayurvedic fundamental principles. Isn’t this like a magic pill that works for every thing? Yes, but only for a patient who follows a regimen of a combination of herb, yoga, diet, and a prescribed daily routine according to Ayurveda. A combination of the above to match an individual’s constitution and external environment is more important than any single item from the regimen. So if you use a certain herb or a protocol to treat everybody with, you will not see any statistically significant outcome under the scrutiny of modern medicine. However, if you test the active ingredient, it may work in a statistically significant number of individuals to affect a specific symptom like high cholesterol but not the entire disease process. However, this invariably results in side effects, as the disease is not treated in its entirety. For example, all the cholesterol-lowering drugs that are currently on the market have side effects and limitations. Another example is ayurvedic herb ‘sarpagandha’ to treat hypertension. The modern medicine produced ‘reserpine’ the active ingredient of sarpagandha. This works for hypertension but the side effect profile is so bad that we now abandoned this drug. We have better drugs for hypertension in our medical arsenal now, but with side effects. However, we still haven’t found a drug for hypertension without side effects and work more than a day each time you take the pill. The story is same with every known disease as the emphasis is on disease management rather than a permanent cure. Here, Ayurveda differs from Allopathy.
On a fundamental level, Ayurveda treats the patient who has the disease but not the the symptoms alone. Fundamental to Ayurveda is clinical classification and understanding the patient before even thinking about treatment. This involves identification of ‘prakruti’ (nature) of the patient by intricate clinical methods. This is basically "Bio-Genetic Mind-Body typing" of each patient and perfectly matching his or her treatment regimen. Each individual is unique in their bio-genetic-mind-body type including twins. This means each patient is unique and his or her treatment is different from any other existing in this world. Is this too "Sci-Fi" to be true to achieve just by clinical examination of the patient without labs, microscope etc? No, not really if you understand and follow the fundamental principles of Ayurveda.
Ayurveda explains 6 stages of the disease process.
1.Accumulation: One or more doshas (humors) accumulate
2.Aggravation: the excess dosha starts to spread
3.Dissemination: dosha moves throught the body
4.Localization: dosha settles at weakest location depending on particular biotype of patient involved.
5. Manifestation: Physical symptoms arise at that location (eg: headache or increased acidity symptoms in stomach)
6. Disruption: Disruption of anatomy and physiology of location and full-blown disease.
Ayurveda treats effectively first 4 stages of the disease where the symptoms are very vague and occasional such as stomach acidity, headaches etc., and modern medicine treats these with over the counter (OTC) medicines. During these stages if the patient visits an MD he or she would not find any serious clinical signs or symptoms of the disease and lab tests will be perfectly normal and patient is sent back home. This window of courtship of imbalance of health lasts many years before the tests show any abnormality. Modern medicine starts to recognize symptoms of any disease in the 5th stage and starts to treat 6th stage of disease. So 80 to 90 percent of ill health is waiting to mature to be treated as heart attacks, total knee replacements, open heart surgeries, etc. Thus, one can argue that Ayurveda is a preventive medicine treating healthy population, while modern medicine is for totally sick patients. Ayurvedic clinical methods are sensitive enough to pick up subtle imbalance in the mind and body functioning and so we are treating very very early before localization of the disease. According to Ayurveda the standard of health is very high and perfect health is not mere absence of disease.
How is this done? Ayurveda classifies every patient’s prakruthi (internal nature), which does not change that patient’s mind-body type from birth to death. We know everything from color of hair, eyes, build of the body and behavior of each individual is programmed in genetics and the surrounding environment. As long as one is close to the original constitution, patient stays healthy. Constant inevitable interaction with external surroundings by violating the rules of nature for that particular individual gives rise to imbalanced internal nature, which is vikruthi. It is best to treat any first signs of Vikruthi in any individual. The unique thing of Ayurveda is this clinical reading of genetic expression of each individual’s Prakruthi and its interaction with external nature producing internal derangement Vikruthi.
This clinical reading is done by tridosha (three-humor) theory involving three humors, namely vata (wind), pitta (bile), and kapha (phlegm). Vata controls movement, pitta controls metabolism, and kapha controls structure. Nobody fits into one type but some combination of all three humors. If we consider two predominant humors of one’s constitution, we have at least 6 types of prakruti to be classified, vata-pitta, pitta-vata, pitta-kapha, kapha-pitta, vata-kapha and kapha-vata. The next step an Ayurvedic physician looks at is at least 25 or more gunas (attributes) of each of the dosha and their expression in the patient to narrow down to accurate diagnosis. The next step is to consider 5 sub-types of each dosha and a combination of those each expressing an imbalance or manifestation of symptoms in 10 or more anatomical locations of the body to nail down the way the unhealthy imbalance is spreading in that particular patient. The next thing an Ayurvedic physician will also look for the expression of not only anatomic locations but also 7 dhatus (dhatu means roughly constituent elements or tissues). The above two are also correlated with srotamsi (at least 20 or more channels in the body through which the humors move in the body. We haven’t yet considered other concepts like ojas, tejas, and prana (pure essence of humors), which would be considered by an Ayurvedic physician in the same context to bring back the balance of health and vitality. All the above information is gathered and processed by interview, clinical examination, pulse and tongue evaluation and other tests.
The above is a very brief description of Ayurveda methodology to stimulate reader’s interest. Now let us apply the above methodology, for example, to Guggulu. In a vata-kapha type individual with a vata imbalance and depending on the sub-type of affected vata, the srotamsi (channel) and dhatu (tissue), the imbalance may express as nervous disorder, low back pain or arthritis and counter balancing kapha may produce hyper-cholesterolemia (in ayurvedic terms kapha character is accumulation and stagnation including fat). These conditions can be treated with Guggulu. In a pitta-kapha type individual pitta aggravation imbalance can cause bronchitis, cystitis, throat ulcers and counter-balancing kapha can cause hyper-cholesterolemia, which can be treated with the same Guggulu.
Actually, Guggulu is not used alone usually, but used in combination with other herbs to balance other doshas, to improve accuracy and tailor fit to each patient. Some formulations, to name a few are Kaishor Guggulu, Yogaraj Guggulu, Punarnavadi Guggulu etc. These are essential because if you give a blanket standard treatment of all hyper-cholesterol patients with Guggulu, it may not work. For example if you give Guggulu for the individual with hyper cholesterol of pitta-kapha type you may end up aggravating pitta and have cystitis or bronchitis aggravated. In addition, timing of administration of medicine to each patient is also very important. Diurnal variation of vata, pitta, and kapha times of the day has to be matched to the timing of the intake of medicine.
So, Ayurveda is the ultimate art of holistic medicine where individual ingredient in a formulation is as important as the timing of its administration. An experienced Ayurvedic physician should give these global holistic treatments while closely watching vikruthi. It takes long years of practice gathering clinical acumen to really harness the science and art of Ayurveda unlike modern medicine which is more and more based on technology, labs and procedures. An unfortunate side product of recent hype in alternative medicine is commercialization of these products to claim benefit specific symptoms like hyper-cholesterolemia etc., which was never the intention of Ayurveda in its pristine practice.
On one hand it is important to have studies like Dr. Moore’s to authenticate the scientific basis of these ancient medicines, and on the other hand it is a mistake to try to insert and practice ayurvedic-allopathic medicine thinking that we are integrating the two systems of medicine. The real integration of Ayurveda and modern medicine is achieved by following the principles of Ayurveda with the aid of modern technology. It is very important to follow the methodology of Ayurveda in its entirety, if we want to achieve the goal of over all health of the individual and the society.
References and suggested reading:
1. Text Book of Ayurveda: Fudamental Principles Vasant Lad, M.A.Sc, Ayurvedic Press, Albuquerque New Mexico.
2. Perfect Health: The complete Mind Body Guide Three rivers Press New York
Back to June 2002 TSJ