The earliest developments of Indian medicine are traced back to India’s Indus valley civilization that flourished from about 2700 to 1500 B.C Ayurveda’s popularity declined between the 10th and 12th centuries A.D. when India was over run by Muslim invaders from the West. The Muslims brought their own Medicine, Unani Tibb, a blend of Islamic medicine and Greek medicine. After the Mughal Empire was established in the 16th Century, influences from the Arab world were also incorporated into Ayurveda. The liberal Muslim ruler Akbar patronized all forms of Indian Medicine and Ayurveda again thrived. This changed however, when India came under British Control.

However, Ayurveda succeeded in facing all these set backs and is a good example of an ancient healing art of India that has emerged as a part of the “New Age” popularity after its unwilling hibernations forced by the cruel forces and circumstances prevalent in the region in the last few centuries.

Vata- The word vata is derived from the verb root ‘Va’ meaning ‘to move, ‘to inform’ and to impel- which are the natural actions of vata. Enthusiasm, respiration, movement, normal transportation of dhatus (nutrients), proper elimination of excreta are the normal functions of vata. It works mainly through brain and nervous system. Vata rules the basis sensitivity and mobility of the mental field. It energises all mental functions from the senses to the subconscious, it allows us to respond mentally to external and internal impulses.
Pitta - The word is derived from the verb –root ‘tapa’ meaning to heat. Thus pitta is concerned with various physiological functions relating to agni (heat) . The digestion of food, body heat, thirst and hunger, vision, luster, cheerfulness and intellect are the normal functions of pitta. Pitta governs transformation in the body and mind as digestion and assimilation on all levels from food to ideas. It is predominant in the digestive systems, particularly in the small intestine and liver where digestive fire operates.

Kapha - The word is derived from 2 letter ‘ka’ (water) and ‘pha’ (flourishes). Kapha means that flourishes in the presence of water. Also known as slesha from root word ‘slish’ meaning to embrace. Binding, providing firmness, heaviness, virility and strength in the body for bearance, patience and absence of greed are the normal functions of kapha. Kapha governs form and substance and is responsible for weight, cohesion and stability. It provides for proper lubrication and discharge of secretions and cushions the nerves, mind and senses. Kapha predominates in the body tissues and in the upper part of the body head, lungs and stomach where mucus accumulates.

At cellular level, vata moves nutrients into cells and wastes out of cells. Pitta digests nutrients to provide energy for cellular function and cell’s structure is governed by kapha.

Ayurveda considers health as an equilibrium state of tridoshas and dosha in a
disequilibrium state causes disease.

Malas
The three malas (excretions) are sveda (Sweet), purisha (faeces) and mutra (urine)

Trigunas
On the mental plane, there are three attributes of energy or gunas – sattva, rajas and tamas - that provide the basis for distinctions in psychological temperament and moral disposition.

Prakriti
The three doshas determine prakriti or human constitution. A person’s prakriti is determined through combinations of vata, pitta and kapha and are also influenced by other extrinsic factors such as diet, lifestyle, behavior, emotions etc., Treatment for disease of a patient should be started only after considering his prakriti .

Diagnosis
Ayurveda teaches that the origin of most diseases is found in either an exogenous or endogenous dosha imbalance or in an inherent or acquired weakness of tissues. Disease process is a reaction between the three doshas and dhathus and is influenced by the environment. There are very precise methods for understanding the disease process before all signs of the disease are manifested. Ayurvedic practioner can determine the nature of disease by examining bodily reactions and for this he mainly depends on Ashtasthana pareeksha – They are;

Ayurvedic medicine is a comprehensive system of medicine that combines natural therapies with a highly personalized approach to maintaining health and to the treatment of the disease. Ayurvedic medicine places equal emphasis on body, mind and spirit, and strives to restore the innate harmony of the individual.It includes mental and spiritual aspects and considers the body types (prakrit) to have far greater influence on a person’s health and well – being than do physical attributes alone. Ayurveda manages diseases by cleaning and detoxifying (sodhana), palliation (samana) rejuvenation (Rasayana) and mental hygiene (sathwa-vajaya chikitsa)

The objective of Ayurveda is “Swasthasya Swasthyarakshanam athurasya vikaraprasamanam” ie. To protect the health of the healthy and relieve the suffering of the sufferer.

The traditional methods used to prepare Ayurvedic drugs are based on the principles of extraction, concentration and purification. The choice of preparation method depends on the part of the plant to be used, on its condition (fresh or dried) and on drug’s anticipated use. Basis ayurvedic preparations are :-

Theoretical background : - According to Ayurveda , body is made up of seven different types of tissues called dhathu. These body tissues are nourished through food material that get digested by action of digestive fire (agni). The digested materials are carried to different tissues through srotas (body channels). At each tissue level, there is a digestive fire that works on food material to activate absorption of nutrients into the corresponding tissue. As a by – product of this process, mala (waste material) is formed which is eventually eliminated. If there is any block in body channels or impairment in the function of any digestive fire nourishment of body tissues does not happen and this results in indigestion of food. This undigested material or waste material (ama) clog the body channels and manifests in different disease conditions. When oleation and sudation are done, waste materials, clogged in the body channels become digested and disintegrated and they move into the Kostha (main channel) During Panchakarma these are expelled through natural orifices. As it is a mechanism to eliminate the waste materials from the body, panchakarma is not only used as a curative but also as preventive and promotive.

Astanga Samgraha, one of the classical texts, says that Panchakarma has to be applied to remove the waste materials accumulated in the different seasons for prevention of diseases caused by seasonal changes. It is mentioned that waste materials accumulated in the body during winter should be eliminated in spring, those accumulated in summer should be eliminated in rainy season and that accumulated in rainy season should be cleared in autumn. In Kerala, during the month of Karkataka (July-August) oil treatment is very popular. This is to alleviate the vata accumulated in the body during summer and aggravated in rainy season.

1. Poorvakarma (Preparatory techniques)
2. Pradhanakarma (Major techniques)
3. Paschatkarma (Post – Panchakarma regimen)

This consists of snehana (oleation) and svedana (sudation)

a. Snehana : - Snehana involves making the body oily or unctuous by giving materials that are oily in nature in high quantity either internally or externally sarpi (ghee), majja (bone marrow), vasa (adipose / fast tissue), taila (oil) are four unctuous materials. The method of administering high doses of unctuous material internally is known as snehapana. Dose is decided according to the severity of the condition, its stage age, digestive capacity of the patient etc., Maximum oleation is given for seven days. Medicine is selected according to the dosha predominant of the disease.

Snehapana is effective in conditions like Amlapitta (Acid gastric), tamaka svasa (bronchial asthma), antarvridhi (hernia), kushtam and visarpam (skin diseases), vataraktha (arthritic conditions) and vatam (rheumatic conditions).

b. Svedana (Sudation)

After oleation, the waste materials blocked in the body channels become unctuous and the channels become lubricated. Through svedana these waste materials are brought to main body channel (mahakoshta) before it is expelled through the main techniques of Panchakarma. Four different methods of applying sudation according to Ashtanga Hridaya are taapa(fomentation by applying heat), Upanaha (warm poultice of different medicinal materials) Usna (steam) and drava (pouring warm liquid). Sudation can be mild, moderate and maximum according to the disease, patient, habitat and season.

Sudation is effective in breathing disorders, hoarseness of voice, diseases of vata, kapha, metabolic dysfunction ( ama) stiffness, feeling of heaviness, aches, sprains, dysuria, tumours etc.,

Apart from being preparatory techniques for Panchakarma these two methods (snehana and Sveda) are after used as part of samana.

2. Pradhana Karma / Major techniques

It consists of five techniques mentioned earlier and is meant to purify a particular dosha (vata, pitta, kapha) in the body.

Vamana - Kapha (Upper part of body)
Virechana - Pitta (middle part of body)
Vasti - Vata (below naval)
Nasya - Kapha (upper part of the body)
Rakthamoksha - Raktha (blood)

a. Vamana / Emesis

After poorvakarma (Sneha, Sveda) if the patient has had a good digestion and pleasant sleep, the patient is made to consume specific types of gruel, milk, fish, curds etc., Next morning the patient is given medicine made of emetic drugs and after a muhurtha (around 48 minutes) the patient starts getting bouts of vomiting. Generally four, six and eight spells are considered good in minimum, medium and maximum types of emesis. After vamana, certain inhalation is given with medicated smoke.

Purgation is mainly done pitta type of conditions. It also takes care of the kapha, which is located in the place of pitta. In Panchakarma procedure virechana is done after vamana. Virechana medication is given in the morning. The materials, dosage etc., are decided based on condition, strength, digestive capacity and bowel habits of the patient, dosha involvement and season.

According to classical texts ten, twenty and thirty evacuations are considered the best for mridu (mild), madhyama (medium) and uthama (maximum) types of purgation respectively.

Virechana is effective in skin diseases, tumours of the abdomen, Anorexia, constipation, spleen disorders, enlargement of abdomen due to fluid collection, abscesses, blood disorders, bleeding through orifices of upper part of the body etc.,

Clarity of intellect, strength of senses, stability of body tissues, increased digestive capacity, delayed aging are the effects of purification therapy if done properly.

c. Vasti (Medicated enema)

Medicated enema is very effective in vata type of disorders. It is also applied in other dosa disorders as well. Vasti is considered as equivalent to half of the treatments in Ayurveda, there are two types of vasti :-

i. Asthapana / Kashayavasti - done with decoction
ii. Anuvasana / Sneha Vasti - done with unctuous materials like oil, ghee etc.,

There is a third type of vasti known as Uthara Vasti to treat genito - urinary conditions.

Vasti is administered with a specially prepared yanthra called vasthi yanthra. Kashaya vasti is done before food and snehavasti after food. There are three types of vasti courses. They are yoga vasti, kalavasti and karma vasti. Yoga vasti includes eight vastis – 4 of kashaya and 4 of sneha in alternate order. Similarly kala consists of 15 vatis and Karma of 30.

There are different types of vasti based on the dose, materials used or action. They are dvadasaprasorithika, madhuthaila, rajayapana, yapana, lekhana vasti, brimhana vasti, pichavasti, ksheera vasti, siddha vasti etc.,

(i) Anuvasana Vasti

It is either given independently or alongwith kashaya vasti. It has both rejuvenative or nourishing and purificatory effect on the body. As the quantity is less this is given with syringe. A particular quantity of oil or ghee is administered through anal orifice. Anuvasana makes the naval region unctuous, it facilitates downward movement of vayu, strengthens the body and nourishes body tissues.

Anuvasana is suitable in patients who have strong digestive power, suffering from vata disorders and excessive dryness.

(ii) Kashayavasti

Usually Kashayavasti is done after virechana. Initially a few snehavastis are done to make pakuvasaya unctuous. Kashaya vasti is done in the morning after doing oil application and sudation. The patient has to lie on the left side of the body. According to dosa, disease strength of the patient and age, kashayavasti is prepared. Honey, salt, oil paste and decoction are added and churned for sometime for making a good mixture. Then it is mildly warmed. It takes 10-15 minutes to pass bowels after vasti. Diet and routine restrictions have to be followed.

Kashayavasthi is mainly intended for purification. It is also given as nourishing or for preventive purposes. The dosage, formulation etc., are decided based on the purposes for which it is given.

Kashayavasti is suitable for persons with abdominal tumours, gout, spleenic disorders pain in abdomen, amenorrhea, urinary calculi, obstruction of semen, flatus and farces and vata diseases.

Uthara Vasti

It is another major technique, which is applied through penis, vagina or urinary tract. This is effective in reproductive problems, Urinary disorders including calculi, uterine, disorders like bleeding, endometriosis, fibroid, vaginal disorders, infertility and delicate pregnancy (with chances of miscarriage).

d. Nasya (Nasal Medication)

Nasya is applied mainly in Kapha disorders and is very effective in disorders above shoulders. There are 2 types of nasya depending on dose, Marsa and pratimarsa. Marsa Nasya is major type and is again divided into uttama, madhyama and adhama types. Pratimarsa is done in a small dose as a daily routine for healthy people, elderly and children. Nasya can be done either by oil / ghee, juice, decoction, paste or powder.

There are 3 types of nasya based on action. They are ;

(i) Sodhana / Virechana (eliminative) is done for headache, heaviness of head, eye disease, disease of throat, ocdema, tumours of the neck, worm infestation, tumours in the body, leprosy, epilepsy and rhinitus (ii) Samana type (pacifying) is done for vata type of headache migraine, loss of voice, dryness of mouth and nose, speech problems etc., samana is done for discoloration on the face, diseases of hair and eyes.

e. Raktamoksha (Blood letting)

Blood becomes impure due to activities and food that aggravate pitta and Kapha. For removing the impure blood, there are four different methods used –

(i) Siravedha ( Cutting the blood vessel). It is done for sciatica, arthritis, mental disorders, head ache, tumours of neck etc.
(ii) Prachana (Blood letting by pricking)
It is done mainly in skin disorders.
(iii) Jalooka (application of medicinal leech)

It is used in persons who are weak, young, old and those who cannot tolerate other methods of blood letting. As leeches have cooling nature they are used in pitta type of disorders. They are commonly used in abdominal swelling, piles, inflammatory abscess, skin disease, arthritic condition, eye disease, poisonous bites, erysipelas etc.

(iv) Sringa , Alabu, Ghatika (Application of horn etc)

This is method of extraction of blood by cupping. Materials like horn (sringa) fruit of a plant (alabes – cucumis- largenarius) or a special type of pot (ghatika) are used. It is done in areas where there is lack of sensations of touch.

Post pachakarma regimen is very important for getting the maximum benefits. After participation, giving suitable materials like rasayanas nourishes the body. This is essential to build up the exhausted body tissues and establishment of normal metabolic and immune functions. One of the important factors of paschaat karma is diet others being sleep and sex. These are also told as thristhamba ( tripod of health- diet, sleep and sex).

a. Aahaara or Peyadi Karma ( Dietary Prescriptions)

Peyadikarma is a method to increase the strength of the digestive fire by giving lighter diet to start with and gradually bringing the patient to his or her normal diet. The preparations are peya (red rice gruel), vilepi (gruel with more quantity of rice), akritha yusa (rice gruel prepared with pulses like green gram), kritha yusa (rice along with green gram soup and spicy foods and condiments), akritha rasa ( meat soup with rice) kritha rasa (rice with meat) and so on.

(a) Vihaara (life style preparations)

A regulated life style also plays an important role in getting maximum benefits of panchakarma. It has to be followed for equal number of days for which panchakarma was done. For a period of time one has to observe strict regimen ( kathina pathya) and later slowly taper into normal lifestyle.

The other techniques that are subsidiary to panchakarma mentioned in classic texts are dhumapana (medicated smoking) gandusa (holding medicated material in the mouth), kavala (gargling), pratisarana (applying paste of drugs to mouth), mukhalepa ( application on face) murdha taila (applying oil on the head), karna poorana (applying medicines in ears), ascyotana (eye drops), anjana (collyrium), tarpana and patapaka ( pooling of medicinal preparations in the eyes)

ABHYANGA

Is herbal oil massage which aids in removing impurities, stimulates both arterial and lymphatic circulation, harmonies, detoxifies, strengthens and revitalizes entire body and relaxes mind and body promoting over all healing. It also stimulates immune system.

UDVARTHANA

Is a message using a course herbal paste or powder to enliven and energize the body. It promotes better digestion, healthier skin, firmer muscle tone, increased circulations and a breakdown of cellulite. It is strongly recommended in obesity.

DHARA

The word “Dhara” means continuous pouring of a liquid substance. Generally medicated oils, decoctions or dhanyamla ( fermented preparations from different grains), thakra dhara (medicated butter milk), ksheera dhara (milk) and sthanya dhara (Breast milk) are used for this purpose. This can be done either on a part of body or to the whole body known as ekanga dhara and sarvanga dhara respectively.

In sarvangadhara, medicated and luke warm oil is poured all over the body for about 45-60 minutes.

In Sirodhara, medicated oil or milk or buttermilk is poured continuously in a steady stream on the forehead from an earthen vessel. This treatment is meant to alleviate fatigue, improve memory, restore equilibrium and is also effective in cases involving insomnia, migraine, ear nose disease, spondylitis and paraplegia. It is an amazingly relaxing therapy which gently relaxes stress and tension from the mind and body.

SIROVASTI

In Sirovasti, a cap like structure usually of leather is attached to forehead and medicated oil is kept pooled over the scalp area for about 45-60 minutes. Its indications and effects are similar to that of sirodhara.

KATIVASTHI

Kativasthi is the localised pooling of medicated luke warm oil over the lower back area. It helps to alleviate stress, pain or swelling in the lower back. It also reduces muscle spasms, increases lower spine rigidity and strengthens the bone tissues of the lower back.

UROVASTHI

Medicated luke warm oil is placed over the chest region by making an herbal paste boundary. It is beneficial in heart disorders, respiratory disorder’s etc.

RASAYANA CHIKILSA ( REJUVENATION THERAPY)

This treatment includes internal rejuvinative medicines and also external treatment procedures like massage. This is to rejuvenate mind, body and soul, to tone up skin, to strengthen all systems so as to achieve ideal health and longevity. This increases ojas (vitality) and improves mental clarity, thereby increasing body resistance.

TRADITIONAL KERALA AYRVEDA THERAPIES

(A) Uzhichil (Oil Application)

This is Abhyanga ie: oil application and massage, a method of bahya snehana or external oleation. This is good for regulating age exhaustions, nourishment of the body, longevity of life, sound sleep, healthy skin and also in vata vitiated disorders.

In Kerala, people who have good knowledge about vital points in the body (marmas) and anatomy do massage in a specialized way. These techniques have not developed sole by as a part of the Ayurvedic tradition. Techniques like uzhichil are part of Kalari (martial art) and Kathakali (a dance form of Kerala). These massages are either done with hands or legs (Chavitti Uzhichil)
(B). Njavarakizhi

Is also known as Shashtikapinda Sveda. This is one of the methods of fomentation of the body parts.

A special kind of rice called navara is cooked along with decoctions (usually made of sida retna) and milk. This porridge is tied in a cloth and made in to Kizhi/ Pottali / (Bag or Poultice) and bag after dipping into a mixture of warm milk and decoctions, is massaged on the body.

Navarakizhi is effective in vata vitiated disorders where there is a depletion of kapha. It is done especially for depletion or wasting of muscle tissue. It is also indicated for different types of neurological disorders, disused atrophy, degenerative conditions of the joints, burning in the body, body weakness sciatica and convalescence in different diseases.

(C ). Ilakizhi

Like in navarakizhi, here application is done by leaves. If the application is by powder then it is called podikizhi. These two are done in vata vitiated disorders with an association of Kapha. Different leaves are fried along with coconut gratings, lemon and salt and made into kizhi or poultice. Before applying kizhi, oil application is done on the body. These are very effective in pain due to swelling, spondylosis, sciatic pains, arthritis complaints, stiffness and inflammatory conditions of joints.

(D) PIZHICHIL

This yet another method of sneha and sveda, which is very popularly used in Kerala, also known as Kayareka. Oil is applied to head and body and gently massage. Following, therapists squeeze warm oil from a cloth on the whole body of the patient continuously from either side. Patient is made to sit and lie down to different positions during the procedure, which lasts for around one hour. After this warm bath is taken. Generally it is done for 7,14, or 21 days.

This is commonly used in all vata types of disorders including hemiplegia paraplegia, pain, stiffness and arthritic condition.

(E) THALAM

Is a unique treatment in which paste made of medicines is applied in the center of head for prescribed time. Formulations like rasnadi choorna, kachooradi choorna are mixed with specific oils in different conditions and applied as thalam. It is also done with Emblica officinalis, Sandal wood and other bitta reducing drugs. This is beneficial in Insomnia, Headaches, Mental disorders etc.

(F) PICHU

In this a thin pad or cotton dipped in oil is put on the head for a period of time. This can be done in mental disorders, insomnia etc. Pichu can also be applied to other parts of body in case of pain etc.

(G) PALPUKA/ KSHEERADHOOMAM

In this milk is boiled with medicines like sida vetura and the body is exposed to the vapour coming out of milk. This is generally used for vata conditions affecting the upper part of the body, especially in facial paralysis etc.

In this, medicine in the form of a paste is applied to the head, covered with leaves of lotus and is kept for sometimes. This is used in a neurological disorders, mental, skin disease affecting scalp, headache for growth of hair etc

IMPORTANCE OF AYUVERDA IN TODAY’S WORLD

Alternative medicines (also termed complementary or unconvential) is emerging as the choice of millions now –a-days. Allopathic drugs are expensive and most have serious side effects, hence there is more and more migrations of patients from conventional medicines to alternative medicines. Alternative medicines aims at a healthy life style and disease preventions, This is what is attracting the people all over the world to other system of medicine like Ayurveda.

On the top of the list of Alternative medicine is Ayurveda, the Indian system of medicine with a strong theoretical base. Aurveda is more than 5,000 years old. Ayurveda with its holistic approach to prevention and cure, is revered for its effectiveness for a wide variety of ailments. It is one of the brightest stars in the evolving medical galaxy in the west. Further more, holistic approach of Ayurveda places equal emphasis on body, mind and spirit for restoring body’s healthy equilibrium.

In the present age, most of the disease are caused by unhealthy dietary and lifestyle habits. And these conditions cannot be corrected by mere intake of medicines. And also, the stress and strain of the competitive world have also affected the mental health of the people. So what is necessary in today’s age is a system of medicine which can strengthen the body and mind of the people, which can cure the disease without weakening other bodily systems and which can advise a correct life style so as to enable the people to lead a healthy and successful life. It is at this point of view Ayurveda is very important as it can meet almost all these challenges.
Classic Ayurvedic treatment can effectively cure and prevent progression and recurrence of majority of diseases affecting people today. Even modern medicine has started accepting the efficacy of Ayurveda in treating many ailments. Degenerative disease like Arthritic complaints, life style disorders like Diabetes and Obesity, Skin disease like Psoriasis, Gastro intestinal disorders , respiratory disorders, Anxiety, Depression, Neurological conditions like paralysis etc can be treated effectively.

TOURISM AND AYURVEDA

According to latest studies, next big opportunities in Indian tourism industry could be Medical Tourism. Medical Tourism has the potential to generate Rs. 10,000 crore. Medical procedures in India are cheaper when compared to U.S and other European countries. Another advantage for India is that it can provide many medical treatment at one place like Ayurveda, Yoga, Meditation and Allopathy.

In the recent years, the number of visitors to India, aiming at experiencing the goodness and efficacy of Ayurvedic practices has been increasing tremendously. The government has taken measures to standardize Ayurveda treatment to meet this challenge.

The South Indian state of Kerala, the land of spices in the hub of Ayurvedic treatment in the country. Kerala’s climate, natural abundance of forests – with a wealth of herbs and medicinal plant and the cool monsoon season are best suited for Aurveda’s curative and restorative packages. Infact, Kerala is the only state which practices this system of medicine with absolute dedication.

Kerala, the confluence of different natural herbal systems, enriched and fine tuned Ayurveda. While sidha and marma systems in South Kerala enriched Ayurvedic system, it joined hands with Kalaripayattu and Kalaritherapy in northern kerala. This resulted in the emergence of a new stream noted for its special procedures and formulations.