Ayurvedic Herbal Medicine
and its Relation to Chinese Herbal Medicine
Ayurveda, the ancient tradition of India, is often translated as the "science of life," but this is a poor representation of the term. Science refers to a method of study that was developed long after Ayurveda; reading Ayurvedic texts, one sees a religious document rather than a scientific one. In the book Oriental Medicine: An Illustrated Guide to the Asian Arts of Healing, an ancient etymological definition is given:
It is called ayurveda because it tells us (vedayati) which substances, qualities, and actions are life-enhancing (ayusya) and which are not.
In other words, Ayurveda is an instruction for enhancing life. Ayurvedic medicine has some relevance to Chinese traditional medicine. Both systems are instructional, rather than scientific, and are fundamentally aimed at enhancing life. Both are additionally focused at treatment of specific diseases that plagued ancient societies for centuries.
Nearly half of the most commonly-used herbs in each of these two Asian medical systems (India and China) are the same or similar and their actions are described in somewhat overlapping terms. For example, in both systems, herbs are described according to the symptoms they treat, their warming or cooling nature, and their influence on the body humors. What differs is the basic set of categories of disharmony: the diagnostic and therapeutic groupings. In traditional Chinese medicine the correspondence systems of yin and yang and the five elements have a strong influence, as do the depictions of certain bodily humors (qi, blood, moisture, and essence), and the internal organ systems (zangfu). In Ayurvedic medicine, although the total system is quite complex, there is a dominance of the three dosha (tridosha) system: kapha, pitta, vata (also called vayu). These three function within a body that is described primarily in terms of stages of transformation (following the path of ingested food as it is converted into essential substances that comprise the body) rather than by physical structures and functional organs.
The reliance on a triad of influences on health and disease sometimes forces Ayurvedic medicine into a relatively simplistic system, which has had the effect of strangling its development compared to Chinese medicine. Several books on Ayurvedic medicine that have been presented to the West expend most of their pages on classifying individuals and their symptoms into these three groupings, and then present foods, herbs, physical therapies that are classified primarily by their effects on the three doshas. As stated by P. Kutumbiah in his book Ancient Indian Medicine: "The doctrine of the tridosha plays an important role in ancient Indian medicine. It is the basis of its diagnosis, pathology, and therapeutics. A correct appreciation of it is, therefore, essential for a proper understanding of Indian medicine....In the later medical works, it underwent great elaboration owing to the influence of the cosmological speculations and consequently suffered much violence to make it fall in line with them." The enforced alignment with so-called "cosmological speculations" was a problem that also affected Chinese medicine, where the five element and six qi (environmental influences) systems had a stifling effect because everything was forced to fit, even when reason and experience indicated otherwise.
Chinese medicine made an escape from its philosophical binds through constantly reworking of the basic system by strong-minded and experienced commentators. Ayurvedic medicine did not have a similar transformation, and so it struggles with certain inconsistencies that date back to a much earlier age without having been addressed, at least in any preserved writings, in the interim.
Ayurvedic, Chinese, and other traditional systems are today yielding their theoretical and experiential frameworks to investigation by modern scientific techniques, applied mainly for the purpose of illustrating the effectiveness of remedies that have been developed over the centuries. In this context, the underlying theoretical framework fades away, and the tested substances become the focus of a new international effort at preventive health care and disease treatment. Herbal formulas developed today rely on a combination of traditional and modern indications for the use of the medicinal materials.
The Chinese and Ayurvedic medical systems each rely heavily on a pair of texts that are revered as statements of all the fundamental principles within the tradition. In the Chinese system, these texts are the Suwen (Basic Questions) and Lingshu (Spiritual Pivot), which together form the Huangdi Neijing (Yellow Emperor's Classic of Internal Medicine), written around 100 B.C. Although both of these Chinese texts are referenced by subsequent authors of Chinese medical works, the Suwen is considered the principal text, laying out such basic theories as the five elements, application of acupuncture, and the cause and progression of diseases.
In the Ayurvedic system, the two texts are the Caraka Samhita (Compendium of Caraka; also spelled Charaka) and the Susruta Samhita (Compendium of Susruta), both estimated to have been written around 100 A.D. These are huge volumes, many times the size of the Chinese works (an English translation of the two Indian texts runs 2,700 pages, while the translation of the two Chinese texts runs only 600 pages). The Susruta, though it contains a diversity of information, is mostly known as a text on surgery; the Caraka, by contrast, is relied upon as the primary source for information about basic Ayurvedic theory and about herbal medicine. Therefore, it is the quoted source book for virtually any discussion of Indian herbs and, in that sense, it may be likened to the Suwen of the Chinese tradition.A 5-volume translation of the Caraka Samhita, revised for publication in 1996, is available from India. However, just as occurs in the Chinese writings, quotes from the Caraka are to be found in virtually every text and few practitioners outside of India go back to the original work to study the principles. It should be briefly mentioned that there is a third Indian text that is usually grouped with Caraka and Susruta, called Vagbhata Samhita; however, this one is relatively infrequently referenced, because, according to Kutumbiah, "the object of the author was to gather up into a harmonious whole the more or less conflicting medical systems current in his time, especially those contained in the compendia of Caraka and Susruta." As such, this text is often seen as a source for academic checking of the two more famous texts, rather than having much influence as an independent work.
Kutumbiah sums up the situation regarding traditional medical texts in India this way: "The creative period of ancient Indian medicine ends with the samhitas of Caraka and Susruta. Caraka accomplished the final synthesis of Indian medicine, and Susruta that of surgery. Their works have thereafter held undisputed sway in Indian medicine up to the present time. The Indian medical writers after Caraka and Susruta were only their imitators and abstractors. No real original work was accomplished after them."
The Chinese Suwen and Indian Caraka each present steps to take in one's daily life to promote health; they also describe causes of disease (such as environmental, dietary, and emotional factors), present information about specific diseases and disease progression, and offer therapeutic measures. Whereas the Suwen mainly recommends acupuncture as the therapy to be used for diseases, the Caraka mainly presents herbs, oil massages, and enemas. In that aspect, the Caraka is comparable to a different pair of Chinese books, the Shanghan Lun (Treatise on Diseases Caused by Cold Pathogens) and Jingui Yaolue (Miscellaneous Diseases and Their Treatment). Those texts mainly present herbal therapies. The use of therapeutic massage (with specific oils according to the disorder being treated) and heavy reliance on enemas (usually made with an oil base) is unique to the Ayurvedic system; application of oils internally and topically, is often referred to in recent books as oleation.
For information about herbs and their properties, the Chinese have relied heavily on the work of Li Shizhen in his 16th century compendium Bencao Gangmu (Grand Compendium of Herbs) at least until the 20th century, when numerous revised Materia Medica books appeared. Li's work is part of a continuous tradition of revised and expanded Materia Medica dating back to the Shennong Bencao Jing (Herbal Classic of Shennong) that was written around 100 A.D. The Chinese herbal tradition is traced in a modern book called History of Medicine: Pharmaceutics, by Paul Unschuld. A portion of the contents of the Bencao Gangmu (only that involving plant materials) was translated into English, with commentaries about current conditions in China at the end of the 19th century by Smith and Stuart, in their book Chinese Herbal Medicine.
Ayurvedic medicine has not had as rich a tradition of Materia Medica works, with much reliance placed still on the contents of the Caraka. In 1908, Dr. K. M. Nadkarnia published a two-volume Indian Materia Medica, a guide to Ayurveda that is still considered the standard text. Comparable to the Smith and Stuart book in the timing of its publication, it combines information from ancient traditional practices, current Ayurvedic practices, and reports from Europeans (such as analysis of active constituents, pharmacology, and European uses of the same herbs). Unlike the Chinese Materia Medica books, this Indian text makes no references to previous works on Indian herbs, does not outline any history of the development of the drugs, does not indicate when an herb was introduced into practice, and, except for occasional references to Caraka, doesn't quote earlier authors on Ayurvedic medicine, except for those working right around the time of its publication, mainly R.N. Chopra.
The proper translation and understanding of the key element of the Ayurvedic tradition, the tridosha, remains at the heart of making Ayurveda accessible to those who did not grow up with and assiduously study this field. As to understanding the tridosha system, in the introduction to the Indian Materia Medica, this is offered:
The doshas-vayu, pitta, and kapha-constitute the tripod on which Ayurveda stands. To understand their theory perfectly and correctly is by itself a long and arduous study. The subject being a very complicated one, it cannot be explained within a few pages. Also, it has been defined by different experts in different ways, but the basic principles to which they all point to are the same.
This comment is followed by concerns about translation of tridosha terms to English, taken from an address on Hindu Medicine given at the Hindu University in Benaras (ca. 1920):
The theory of vayu, pitta, and kapha was also a great discovery, which, unfortunately, has been much misunderstood by Western scholars judging by the wrong mercenary translations, rendering these terms as wind, bile, and phlegm. The proper explanation of this theory will take up a treatise by itself, but let me observe here in passing that the word vayu does not imply wind in Ayurvedic literature, but comprehends [encompasses] all the phenomena which come under the functions of the central and sympathetic nervous systems; that the word pitta does not essentially mean bile, but signifies the functions of thermogenesis or heat production and metabolism, comprehending in its scope the process of digestion, coloration of blood [e.g., production of red blood cells], and formation of various secretions and excretions which are either the means or the ends of tissue combustion [catabolism], and that the word kapha does not mean phlegm but is used primarily to imply the function of thermo-taxis or heat regulation and secondarily formation of the various preservative fluids, e.g., mucus, synovia, etc., though the crude products of pitta and kapha have been sometimes called by these names [bile and phlegm, respectively]....
These concerns about translation are comparable to those that arise with the Chinese system, in which, for example, the use of modern names for internal organs seems inappropriate to the depiction of traditional organ systems (e.g., pi translated as spleen, or shen translated as kidney); similarly, the off-hand translation of qi as energy leads to all kinds of misunderstandings, even among practitioners.
Dr. Nadkarni, after further expressing regret that the full theory cannot be expounded for want of space, states the following about the tridosha system:
To be more explicit, I may add that these principles, known as vayu, pitta, and kapha, occur in two forms:
1. An invisible or essential form, which mainly guide the physiological processes pertaining to them naturally;
2. A crude or visible form, the products (as secretions or excretions) of those processes induced by these essential terms.
The relation between the two forms is very close, so that the derangement of the essential form of one principle gives rise at once to increased or morbid secretions and excretions of that principle. The failure to recognize the difference between these two forms of the principles has given rise to the erroneous rendering of pitta as bile and kapha as phlegm. The rendering of vayu as wind is preposterous....
The two forms of the doshas, essential and crude, may be likened (very roughly) to the connection in the Chinese system between an element and its associated manifestation. For example, there are the associations of wood (the underlying element) with wind, liver, and tendon (its manifestations); or of the earth element with dampness, spleen, and muscles, etc. The situation may also be likened to the understanding of the six qi described in Chinese medicine (fire, cold, damp, wind, dryness, and moisture): there is the influence of these factors on the body and there is the corresponding manifestation of disease. Thus, for example, heat (fire) adversely influences the body, and can eventually yield a fire syndrome, which might manifest as fever, inflammation, dark colored discharge, or other characteristics defined by the tradition. The influence is one thing and the syndrome is another thing, but they can be described by the same term (in the example: fire). In a parallel manner, the Ayurvedic system describes an influence-one or more of vayu, pitta, and kapha-and there are the material results of those influences, which might be referred to as humors, secretions, and excretions.
These two-influence and manifestation-are easily confused, and it is seen in the Ayurvedic medical literature that the flow of thought back and forth between these two aspects leads one to easily forget which is the focus of concern. Further, as occurs in both the Chinese and Ayurvedic systems, each of these influences is not solely pathological, despite the frequent reference to their role in pathology. They are pathological when there is an excess or deficiency or some other type of deviation from normal (such as imbalanced level or inappropriate interaction between any two); otherwise, they are essential to life. In fact, in the traditional Ayurvedic system, when vayu, kapha, and pitta are in their normal measure they are called dhatus (supporters of the body), while they are called doshas (faults) if they are producing imbalance. So it is that one can become disoriented by considering a fundamental entity, defined by a single word such as feng (in China) or vayu (in India), as being both essential and pathological, a causative factor and a result, a symbol and a manifestation.
As to the idea that translating vayu as wind is preposterous, one can understand the terminology conundrum by reading the description of this dosha in the primary text on Ayurveda, the Caraka Samhita. On the one hand, vayu is described this way:
When moving in the world in an excited state, without doubt, vayu achieves the following functions: It breaks the summit of mountains. It uproots trees. It agitates seas. It swells the waters of lakes causing them to rise upwards. It causes the currents of rivers to run in opposite directions. It makes the earth tremble. It urges the clouds. It causes frost, thunder, dust, sand, fish, frogs, snakes, ashes, blood, stones, and lightning to fall down on the earth. It causes excess of virtues, absence of virtues, and contrariety of virtues in respect of the six seasons. It causes failure of crops. It produces disease and plagues. It destroys many objects.
This description sounds like wind as we all know it, at least as it occurs in hurricanes and tornadoes (it is only so destructive in the "excited state"). When describing vayu as an aspect of the human body, it takes on a different form. Here is the description of its favorable side, when not "excited" (the parenthetical statements being clarifications included by the translators):
The wind upholds the constituents of the body (such as blood, flesh, marrow, fat, etc.) and their courses through the body. It exists in the five-fold form of prana, udana, samana, vyana and apana. It is the urging cause of movements of diverse kinds. It restrains the mind (from all undesirable objects) and concentrates it (on objects that are desirable). It causes all the (ten) senses (of knowledge and action) to perform their functions. It bears all the objects of the senses (after contact with the senses) to the mind. It holds together all the elements of the body. It assists the cohesion of the particles of the body. It causes speech. It is the prime cause of touch and sound, and the root of scent and touch. It is the origin of joy and cheerfulness. It excites the heat of fire. It dries up all faults. It throws out all impurities. It pierces through all the ducts of the body, gross and fine. It gives form to the embryo in the womb. It furnishes evidence of the existence of life. The wind, when unexcited, achieves all these functions.
The idea that wind encompasses all the functions of the central nervous system, as Nadkarni has explained in semi-modern terminology to his audience, doesn't seem to fit all that well with the above description. The Caraka Samhita continues:
When excited within the body, vayu pains the body with diverse afflictions. It destroys and injures strength, complexion, happiness, and duration of life. It agitates the mind. It injures all the senses. It kills the embryo and causes miscarriage. It maims the embryo (by suspending the development of particular parts). It holds the fetus longer than usual. It causes fear, grief, stupefaction, cheerlessness, and delusions. It destroys life.
Here, the agitation of mind, injury to senses, and the development of various mental states and delusions that result from agitated wind seems consistent with a role of the central nervous system. Still, the translation term for vayu as wind is probably as good as one can do to capture this diverse traditional concept that clearly go beyond what we know the central nervous system to encompass. The term wind in Chinese medicine is equally problematic; it also has some connections with the central nervous system (wind diseases often involve involuntary muscular conditions and abnormal sensory conditions, which are related to central nervous system activity), perhaps more so than in the Indian system. Vayu, unlike pitta and kapha, has its own chapter in the Caraka Samhita; in fact, it has two full chapters. It is the condition that requires the most explanation, and did so even in ancient times.
The description of pitta as bile is actually the one that goes most against the grain. This translation, first made centuries ago, has its origins in ancient Greek medicine, which influenced European medicine and its terminology until the 19th century. According to the Greek tradition, there were three humors in the body: blood, phlegm, and bile (which could be subdivided into two forms: yellow and black). The term bile was simply carried over to explain the Indian system; in both traditional systems, it was associated with burning sensation and feverish condition, though that is nearly the full extent of the connection. For those who have experience with traditional Chinese medicine, the term "fire" fits better than bile as a description for pitta, and it is sometimes used by writers as a substitute term for bile (as in the current work). In the Ayurvedic system, there is a subdivision of pitta, called agni, which is often translated as digestive fire. Here again, the term fire seems to be acceptable.
Phlegm is the term used for the Chinese concept tan; it works reasonably well in that system if one is willing to expand the definition of phlegm considerably beyond its generally accepted applications in the West. The term phlegm also fits kapha sufficiently to be usable, though it remains far from ideal. So long as one understands that the translation terms are applicable to broad traditional concepts rather than limited modern definitions, one should be able to make use of them in communicating among practitioners, if not in easily describing the system to patients.
The translation problems aside, it is unfortunate that even when time and space permits, the elaboration of the concept of the three doshas does not come out much more clearly, as anyone can realize by reading several Ayurvedic texts. However, that is also the case with some Chinese concepts like qi, which have so many depictions-sometimes contradicting one another-that it is difficult to pin down any particular meaning. One eventually learns how to make clinical use of these terms and the concepts behind them through regular study of the available literature.
To sum up tridosha in a few words, one of the leading Western authorities on Ayurveda, Robert Svoboda, in his book Ayurveda: Life, Health and Longevity, has said this:
The three doshas are invisible forces that can be demonstrated in the body only by inference. Comparisons with the wind, bile, and phlegm of Hippocratic medicine ignore their non-physical character. Wind, bile, phlegm, and other bodily constituents are merely the vehicles of the three doshas, substances that carry these forces and through which display their qualities and perform their actions....The three doshas enable the spiritual and mental planes of existence to express themselves through the physical body. Vata is in charge of all motion in the body and mind. Everything that moves, from a molecule to a thought, moves because of vata, and every motion of any kind influences every other motion....Pitta is in charge of all transformation in the organism. Digestion of food by the gut, of light by the eyes, and of sensory data by the brain are examples of pitta's activities. Kapha is the stabilizing influence in the living being. It lubricates, maintains and contains, and its various activities, like those of vata and pitta, are interrelated.
The famous Chinese physician Li Gao (Li Dongyuan; 1180-1251 AD) believed that most diseases that arise internally are linked to weakness of the stomach/spleen system. This system, first and foremost, involves the digestive processes. Li's most famous remedy, Ginseng and Astragalus Combination (Buzhong Yiqi Tang) has the property of improving digestive function, enhancing the nutritive status of the body, and treating a wide range of disorders secondary to the lack of adequate qi and blood. Similarly, in the Ayurvedic system, the Caraka states that digestive system problems are the root of disease. Here is a description by Rob Svoboda:
How the doshas affect the body and mind is expressed in a verse from Caraka: 'The balance and aggravation of the doshas is at all times due to the relative strength or weakness of the digestive fire. Therefore, one must always protect the digestive fire, and prohibit all activities which might weaken it.' All diseases are due to angimandya-weakness of the digestive fire [angi = digestive fire, mandya = weakness], with the exception of one condition, in which the fire becomes exceptionally intense. Prajnaparadha [prajna = mental alertness, wisdom; paradha = failing, impairment, violation of] is a sort of weakness of the mental digestion, which is transmitted via various paths to the body.
The body's digestive fire is normal when there is normal desire for food, no discomfort after eating, no belching and no heaviness or other symptoms during digestion; when a sense of well-being and satisfaction occurs [after a meal]; and when all wastes have normal consistency, do not contain undigested food, and are excreted at normal times. The mind's digestive fire should be examined in a similar way, prajnaparadha is clearly indicative of weak mental digestion.
Like all fires, the body's digestive fire changes from moment to moment. It becomes weak as a result of: overuse of cold and liquid substances, especially ice water, especially in winter; overeating or undereating; overconsumption of heavy food, such as meat; eating before the previous meal has been digested; improper food combining; restraint of natural reflex urges, which cause vata to move in improper directions; disturbances of sleep; consumption of food to which one is not habituated; consumption of food at the wrong time (according to the seasons, the climate, one's age and health, and so on); overactivity (especially sexual) or underactivity; and mental causes, especially envy, fear, anger, greed, anguish, wretchedness, misery, and sorrow.
Students of Chinese medicine will recognize immediately most of the prohibitions and cautions, such as concerns about cold (weakening spleen and kidney yang), too much liquid (causing spleen dampness), excessive sexual activity (depleting essence), and the role of the emotions in causing disease. In the Ayurvedic system there may be even more emphasis than in the Chinese system on the importance of food in attaining and maintaining health. There is also the concern about restraint of natural urges, which coincides with or contradicts Taoist approaches, depending on the author of the Taoist instructions and the particular urge under consideration.
An immediate adverse result of such factors as digestive fire weakness, dietary improprieties, and the other things that affect food digestion (such as emotions, type of food, amount eaten), is the production of ama. This term refers to something that is incomplete, unprocessed, raw. The implication is that incompletely digested food materials can pass out of the digestive system and travel through the body, causing all kinds of diseases. The Chinese tradition has a similar concept: undigested food produces a pathological phlegm that can cause many diseases, including cardiovascular blockage, mental derangement (from "phlegm-mist" blocking the orifices), and joint pain, to mention a few. Indeed, Chinese writers have suggested that when there are strange, difficult to diagnose, or difficult to treat diseases, it is a sign that pathological phlegm is involved. Another formula developed by Li Gao, Pinellia and Gastrodia Combination (Banxia Baizhu Tianma Tang), is specifically aimed at treating the results of phlegm accumulation from undigested food. It is indicated for recurrent headaches and vertigo, compulsive sleeping after eating, weakness of hands and feet, hypertension associated with gastrointestinal weakness, headache and vertigo due to hypotension, abdominal distention, gastroptosis, sinusitis, cold hands and feet, heavy feeling in the legs, anemia, and fatigue. The formula is comprised primarily of digestive aids and tonics for the spleen.
In the Chinese system, properly digested food produces normal qi and blood that promotes health; in the Ayurvedic system, it produces rasa, which has the same function, helping to form healthy blood. The improperly digested food produces pathological phlegm (kapha) and accumulated mass (ama) that is a source of disease.
A number of spicy herbs, such as ginger, cardamom, atractylodes, citrus, pogostemon, and raphanus are used by Chinese physicians to enliven the stomach function, promote complete digestion of food, and alleviate food stagnation. To an even greater extent, the Indian system relies on spicy herbs, including a variety of peppers (especially long pepper and black pepper), cumins, asafoetida, basil, and turmeric to stimulate the digestive fire, calm the overproduction and agitation of kapha, and prevent the accumulation of ama. In the Chinese system, but not in the Ayurvedic system, sweet herbs, such as ginseng, astragalus, jujube, maltose, and licorice, are utilized to benefit the functions of the spleen, which represents an important aspect of the digestive system. Indeed, as an indicator of divergence between the Chinese and Ayurvedic herb approaches to this problem, in Ayurvedic formulas, one Indian herb, ashwaganda, commonly takes the place of all of these sweet Chinese herbs, yet it has a bitter quality rather than being sweet. Investigating the overlap and divergence between herb selection and treatment strategies for these two systems can inspire practitioners to broaden their understanding of traditional medical principles and also help to alert them to the exceptions to the seemingly solid rules that are laid down in the ancient texts.
While some diseases are of short duration and mainly affect one part of the body, others progress to affect additional parts of the body and can eventually engulf the entire organism. In early Chinese texts, especially the Neijing and the Shanghan Lun, very detailed accounts of disease progression are given. The concept of six disease stages (taiyang, shaoyang, yangming, taiyin, shaoyin, and jueyin) is associated with the impact of cold pathogenic factors. This classification was later joined by four disease stages (wei, qi, ying, xue) associated with hot pathogenic factors. The idea of disease stages has directed the Chinese thinking about diagnosing and treating diseases with herbs.
In the Ayurvedic system, the concept of disease progression is somewhat different. As described by Rob Svoboda: "Weakness of the digestive fire is the root cause of all diseases, vata is the chief cause of the development of all diseases, and ama is the principal nourisher of disease." The primary stages are accumulation, aggravation, and overflow:
Accumulation: As a result of exposure to causative factors, one or more of the doshas accumulates in its seat: kapha in the stomach, pitta in the small intestine, and vata in the colon. Each produces its own characteristic symptoms: kapha creates lethargy, heaviness of the limbs, pallor, bloating, and loss of appetite with weakened digestion; pitta produces burning sensations, increased body heat, a bitter taste in the mouth, yellowness of the skin, acidity of the stomach, and increased anger; vata causes weakness and dryness of the body, desire for warmth and hot articles, stiffness and fullness of the abdomen, flatulence and/or constipation, disturbed sleep, and increased fear. The doshas are easiest to remove from the system at this stage.
Aggravation: In this stage, which literally means rage, the doshas continue to increase and put pressure on their reservoirs, intensifying the symptoms they have produced. It is still fairly easy to remove the doshas even at this stage, but while treating them, their reservoir organs, which have been stressed by their ire, need also to be strengthened. The doshas do not always accumulate before they become enraged; if the causes are strong enough, aggravation may occur directly.
Overflow: If aggravation is permitted to proceed unchecked, the doshas escape their homes, wandering about the body like vagabonds, searching for a place to camp. All the previous symptoms worsen, and kapha may produce vomiting, pitta may produce diarrhea, and vata may produce colicky pain in the colon and painful defecation, with the liberation of copious quantities of gas. Overflow can also occur without previous accumulation or aggravation of the doshas in their reservoir organs if they are displaced by the force of aggravated vata, which may be directly disturbed by exposure to strong imbalancing causes, such as excessive desire (especially sexual), sleeplessness, excessive talking and activity (especially on an empty stomach), sudden vomiting or diarrhea (particularly if self-induced), intense joy or sadness, and the restraint of any of the natural reflex urges.
Following these initial stages, if the disease is not properly treated, the doshas will find a location where they can concentrate themselves, and will then begin to transform the normal body functions and structures into a seriously diseased condition. The disease will then manifest the specific symptoms according to: the constitution of the individual; the way the disease progressed; and any factors that currently influence the body or mind. Localization, manifestation, and specialization of the disease process are the final three stages in the Ayurvedic system of six disease stages.
For the herbalist, perhaps the important thing to know about the herbs and the doshas (or the physical manifestations of the doshas) is that vata is cold and dry in nature, kapha is cold and moist in nature, and pitta is hot and moist in nature. By analyzing the symptoms and constitution of the patient, one determines the prevalence of each of the physical manifestations of the doshas (and the degree of influence exerted by the non-material aspects of each of the doshas), and selects herbs or prepared herbal formulas to harmonize the influences and correct the physical imbalances, based on the characteristics of the herbal materials.
So long as one is careful not to rigidly link Indian and Chinese traditional ideas, it is possible to make reasonable comparisons of the properties of herbs and their therapeutic actions. For example, rather than describing excess and deficiency conditions, as done in the Chinese system, the Ayurvedic system tends to depict, on the one hand, excitation or disturbance ("vitiation"), and, on the other hand, what might be termed sluggishness of the doshas. Still, these imbalances correspond, in practice, with the Chinese excess and deficiency concepts. These linkages are roughly as follows:
Overall, pitta and vata are especially distinguished in the Indian system by the hot versus cold properties. Vata and kapha are distinguished in the Indian system primarily by the dry versus moist properties.
An example of an herb used essentially the same way in the two traditional medical systems is asafoetida. The strongly fragrant spice is considered in both systems to be very warming (China: chill-dispelling; India: increases pitta), and to resolve accumulation of stagnated fluids (China: dispels moisture and phlegm; India: releases kapha). These similarities in application are found in many of the spicy, warm herbs that promote digestive functions.
Asparagus root is an example of an herb that is described in similar ways but used differently in the two systems. It is relied upon in the Chinese tradition to nourish yin and clear heat. The Indian description corresponds well: it is used to increase kapha (moist, cool) and reduce pitta (hot). However, in India, asparagus is frequently used as an aphrodisiac, and said to invigorate vata, but it is not reported to have such effects in the Chinese system. Indeed, in the Indian Materia Medica, herbalists are reminded to distinguish the white and black types of musli, one being a variety of asparagus (safed musli) and the other being curculigo (kali musli), both used as aphrodisiacs and considered similar in nature. In the Chinese systems, these two herbs would be contrasted: asparagus for nourishing yin and cooling heat and curculigo for invigorating yang and dispelling cold. The difference between the Ayurvedic and Chinese analysis of asparagus is based on the somewhat unique concept of vata, which is invigorating yet cold.
A therapeutic approach that has become very important in the practice of modern Chinese medicine, vitalizing blood circulation, was first promoted heavily by Wang Qingren, in the early part of the 19th century. While the concept of treating disease by getting rid of blood stasis and promoting circulation was present earlier in the Chinese medical system, it was not particularly emphasized other than for treatment of injuries (including the result of difficult childbirth). During the Jin-Yuan period, when there were four competing schools of thought about the main causes of disease and corresponding methods of treatment, the problems addressed were stomach/spleen deficiency (Li Gao's approach, as mentioned above), yin deficiency, yang deficiency, and fire excess; blood stasis was not among the concerns. Treatment of blood stasis has become a central feature of much of the Chinese herbal research and clinical applications related to chronic disease.
In the practice of Ayurveda, stimulation of blood circulation and treatment of "static blood" does not show up as a major concern of internal medicine, though the ubiquitous massage therapy has the effect of invigorating blood circulation. Unlike the Chinese system, reform work was not carried out in the Ayurvedic field, so the shift seen in the Chinese system to address blood stasis is still not a central concern in the Ayurvedic system. Nonetheless, some of the traditional Ayurvedic herbs that are widely used, such as arjun, myrrh, and turmeric, are categorized by the Chinese as blood-vitalizing herbs and contribute this effect incidentally to what is traditionally described in the medical system.
One of the dominant descriptions of herb properties in both the Chinese and Ayurvedic systems is based on the taste of the herbs. The taste groups are similar in the Ayurvedic and Chinese systems:
Ayurvedic: sweet, sour, salty, pungent (acrid), bitter, and astringent
Chinese: sweet, sour, salty, pungent (acrid), bitter, and bland
The difference is that the Ayurvedic system has shown no interest in bland-tasting herbs, which was a category developed in the Chinese system centuries after the initial five tastes had been the standard, but Ayurvedic medicine has a strong interest in the astringent taste. In Chinese herbal medicine, there is a small group of astringent herbs listed, but their tastes are described as sour or bitter, rarely as astringent. In fact, for most of the practice of Chinese medicine, only two of the astringent herbs are repeatedly used, schizandra and cornus, both being very sour (contributing an astringent action via the puckery sour quality). Only in the case of diarrhea do the Chinese rely on such highly astringent tasting herbs as pomegranate rind (adopted from Indian practice via Sumatra), and this herb is mentioned in Oriental Materia Medica as having an astringent taste.
According to the Ayurvedic approach, the tastes contribute the following effects to herbs:
|Sweet||increases dhatus (supporters of the body), improves the complexion, strengthens the body, heals wounds and ulcers, and purifies the rasa and the blood|
|Sour||carminative, digestive, expels wind from the bowels, and accumulates [draws together] secretive impurities (waste material that is secreted) in the tissues|
|Salty||purifies tissues, digestive, relaxing, separates impurities, accumulates [draws together] excretions in the system, causes the body to lose tone (relaxes it), clears the outlets of the system, produces softness of all the structures of the body|
|Pungent||increases digestive power, purifies the body, prevents obesity, causes relaxation of the ligaments of the joints and of the system in general; diminishes formation of milk, semen, and fat.|
|Bitter||separates the doshas, appetizing, digestive, and purifying, improves secretion of breast milk, and reduces the quantity of feces, urine, perspiration, fat, marrow, and pus.|
|Astringent||hemostatic, heals ulcers, checks all discharges, separates impurities from tissues, reduces obesity and superfluous moisture.|
In order to influence the doshas, one usually combines certain tastes together within a formula, as follows:
|Dosha||To Increase, Supplement||To Decrease, Calm|
|Vata||pungent, bitter, astringent||sweet, sour, salt|
|Kapha||sweet, sour, salt||pungent, bitter, astringent|
|Pitta||sour, salt, pungent||sweet, bitter, astringent|
Thus, for example, if a patient has agitation of vata, and insufficiency of the kapha and pitta, involving a weak digestive function and stiffness of the joints, the herbalist would combine (or select a formula containing) sweet, sour, and salty agents, with a small amount of pungent taste. Taste is only one of the qualities that herbalists in India rely upon (other qualities include cooling or heating, heavy or light); however, aside from the individual properties and traditional indications of herbs, this aspect is probably the most important.
There are differing opinions about the action of each of the herbs on the doshas. For many herbs, the doshic effects are not formally recorded and can only be implied by an interpretation of the tastes and the symptomatic effects of the herbs. Also, there is some diversity in translating to English the two basic actions of herbs on the doshas: haram (interpreted as reducing, calming, removing, etc.) and karam (interpreted as supporting, supplementing, increasing, etc.). For the presentation here, the following terms for the influence of herbs on the doshas have been selected to have a positive connotation (consistent with the favorable action of the herbs) and to fit the differing characteristics of the individual doshas:
|Effect On Doshas||Vata
In addition, it may be stated that an herb balances two doshas, or all three doshas. Balancing refers to coordination of their functions so as to produce a healthier condition, or reducing one and increasing another to attain the desired levels. For many herbs, the action on the doshas is not mentioned in their description, possibly because it is not thought that the action of the herb on the doshas is a significant factor in determining how it will be used.
In both the Indian and Chinese traditions, one can describe three basic phases in the historical development of understanding of how herbs contribute to human health. First, there is the ancient period in which herbs have symbolic significance as well as specific therapeutic attributes. The therapeutic attributes were based on observation of nature and interpretation of those observations in terms of relatively simple systems of categorization. This ancient period extended until the development of the investigative techniques associated with modern science. The next period was that of early science, which affected India and China, as well as most of the rest of the world, during the 19th century and the beginning of the 20th century. During this period crude analysis of herbs could be carried out, the idea of reporting specific medical cases or collecting many case histories of similar nature arose, and herbal medicines were described in terms of botanical names, constituents, and reported use for diseases defined by modern medicine. The third period, which we are now working within, involves the development of advanced scientific analysis, with the ability to find individual chemical constituents, test them in controlled laboratory experiments, and then attempt the difficult task of validating traditional claims by clinical trials.
In the context of this book, in which traditional medicine is the primary focus, the ancient views are of particular interest. The book Garden of Life (by Naveen Patnaik; 1993 Aquarian Books, New Delhi and London), offers some insights into the traditional concepts and the development of the key Indian herbs as foods, spices, and/or medicines. Here are some quotations for selected herbs:
Ayurvedic herbs are often prescribed in combinations, typically involving 2-8 herbs, though numerous very large formulas are recorded in the ancient texts. Rejuvenating preparations are called rasayanas, corresponding, roughly, to the Chinese concept of restorative formulas that nourish the kidney and liver, replenish the yin, blood, and essence, and tonify the qi. For example, here is the way in which the myrobalans fruits are prescribed as rasayanas in Caraka Samhita:
After the food from the previous meal is completely digested, take one fruit of chebulic myrobalan; before the next meal take two fruits of beleric myrobalan; and just after meals four fruits of emblic myrobalan. All these fruits should be taken with honey or ghee. The rasayana of the three myrobalans (triphala) should be taken for a whole year....Another preparation of triphala rasayana is as follows: take a thin new iron leaf and keep it laved with the paste of the three myrobalans for a whole day and night. Take out the paste the next day and use it with honey and water. When the medicine is digested, one should take such food as is mixed with copious quantity of ghee and milk. From the use of this rasayana for a full year, one becomes free from decrepitude and disease and lives for a hundred years. Another preparation of triphala rasayana is as follows: the three myrobalans should be used with licorice powder or with bamboo manna reduced to powder, or with powder of long pepper, or with honey and ghee, or with sugar [other additions are gold, acorus, rock salt]....If used for a full year, any of these rasayanas would sharpen the understanding and the memory, and infuse strength. It would impart longevity. It is deserving of high praise.
The references to use of honey and ghee have parallels with the Chinese system of formulation. Jujube fruits and honey were long used in the Chinese system as the sticky substrate to produce pills and are credited, along with the tea ingredient maltose (sugar derived from barley grain), with the property of benefiting the digestion as well as making the medicine easier to take. Where the Indians use ghee (clarified butter made by heating it and removing the foam that forms on top and the sediment that settles to the bottom), the Chinese used rice porridge. Both have mucilaginous, protective, and therapy-enhancing effects. The Indian use of ghee may have become standard because this substance is especially protective for the stomach and intestines against the spicy effect of the herbs that are frequently relied on to strengthen the digestive fire. Additionally, the Ayurvedic system strongly emphasizes use of oils: for massage, in enemas, to irrigate the sinuses, and to be consumed in the diet as a means of healing, especially for calming vata (as Svoboda stated: vata is the chief cause of the development of all diseases). The Chinese describe the use of porridge both to protect the stomach against the cold action of certain herb and mineral drugs and also as a means of enhancing the production of qi by the stomach. As mentioned earlier, the Chinese system is particularly partial to sweet-tasting substances (which includes the grains), as a way of tonifying the body. A well-nourished body is able to fend off external wind and also prevent the development of internal wind. In the Ayurvedic system, a well-oiled body is able to accomplish the same.
In modern practice of Ayurvedic medicine, herbs are prepared in tablets or capsules and neither honey nor ghee is usually included. Persons who have sensitive digestive systems might consider consuming a small amount of one or both of these substances, or others that have similar qualities (e.g., milk, yogurt; preferably warmed to room temperature) when utilizing spicy combinations, such as those aimed at invigorating the digestive fire and reducing accumulation of phlegm. As indicated above in the description of a rasayana, even the non-spicy myrobalans fruits were said to be improved by adding honey or ghee. For those who wish to follow this tradition, the method is to use about 1/3 teaspoon of one of these substances with each dose of the modern tableted or encapsulated formulas, such as the famous Triphala. When taken three times daily, the total amount of honey or ghee is one teaspoon, or about 3 grams, a small amount (for those concerned about sugar or fat content). In the Indian texts, taking rice along with herbs is also mentioned; often, the rice is mixed with milk, honey or sugar, and ghee (ordinary butter can be used instead of ghee, which has a much longer shelf life and can be preserved at room temperature). In our own culture, where there is such an excess of sugars and fats, it may seem odd to recommend these things medicinally, but the recommended accompanying diet is dominated by lentils and vegetables, making simple sugars, butter, and milk or yoghurt a welcome addition that has no adverse effects in moderation.
During the past twenty-five years, numerous schools of Chinese medicine have opened in the West, and there has been a vast movement to get this type of medical therapy accepted. Currently, in the U.S., 36 states license, certify, or at least formally allow the practice of acupuncturists as health professionals. Three things made this development possible:
These circumstances have not arisen with Ayurvedic medicine. Although Ayurvedic dietary principles are easily taught through books and classes, these are not interpreted as a medical practice by other medical professions. The main part of Ayurvedic medical practice that is recognized as a medical intervention is herbal prescribing. Herbs are an internal medicine that corresponds somewhat closely to the use of drugs. In fact, most practitioners of herbal medicine, as a means of conveying that their herbs are likely to work, point to the fact that a large percentage of modern drugs are either derived from herbs directly or are synthetic versions of drugs that were originally derived from herbs. Therefore, bringing herbal prescribing to the West as a primary practice, as would be necessary for the Ayurvedic system encounters significant difficulties. There is considerable resistance to it from medical authorities. Acupuncturists added herbal prescribing as a secondary practice after a certain acceptance of acupuncture was already in place.
Although there are a large number of people from India in the U.S., there are no large Indian communities like those found in the Chinatowns. Therefore, there aren't the communities for traditional Ayurvedic doctors to work in. The government of India has shown no interest in promoting the sales of Ayurvedic medicines abroad nor in having foreigners come to India to study Ayurvedic medicine (sufficient numbers of foreigners come to India for other aspects of their culture, but the main Ayurvedic colleges, which are government sponsored, are basically off-limits to foreigners). Increasingly, plants collected for making Ayurvedic medicines are becoming endangered through over collection with lack of adequate cultivation, especially in the mountainous regions.
As a result of these various circumstances, there are very few teachers of Ayurvedic medicine in the U.S., no formal licensing of Ayurvedic practitioners, and only a few small schools that teach this medical tradition (the main one is Dr. Vasant Lad's school in New Mexico). The herbs are imported in relatively small quantities (compared to the amounts of Chinese herbs that are imported) by a few companies, which either market to a small group of health professionals (mainly naturopathic physicians) or direct to the public or both.
Examples of Herbs Used in Both Ayurvedic and Chinese Medicine
|Unique Ayurvedic Uses||Unique Chinese Uses||Uses in Common|
|hysteria, nervous disorders, especially for women and children||cold pain in the heart||digestive weakness, colic, flatulence, diarrhea; main action is to promote digestion|
|impotence, infertility, leukorrhea, diarrhea||dry cough, dry mouth and throat, constipation; moist quality of the herb nourishes yin||tonification therapy|
|fever, skin ailments||renal disease, post-partum disorders; disperses water stagnation||food stagnation|
|none||reduces phlegm, controls pain, expels wind||improves appetite, digestion, and alleviates flatulence, diarrhea, and various gastric ailments|
|cough||eye disorders||alleviates fevers, mild laxative|
|urinary diseases, fever, rheumatism||spermatorrhea||chronic diarrhea, hemorrhoids, cough, leukorrhea,|
|leukorrhea, menstrual disorders, asthma, hemorrhoids, diarrhea||chilling pain of the loins and knees, numbness||impotence, tonic effects|
|rheumatism||none||inhibits parasites, enhances digestion, treats lung diseases|
|none||invigorates yang||promotes digestion, resolves phlegm|
|dysuria||harmonizes all herbs||promotes digestion, treats lung diseases and sore throat|
|asthma||headache||promotes digestion, controls pain|
|gout, rheumatism||fever (food therapy)||promotes digestion|
|stimulates appetite, promotes digestion, relieves flatulence||carbuncle, amenorrhea, mass in abdomen||relieves pain|
|none||none||sedative, controls pain|
|intermittent fevers||none||inhibits parasites, topical use for skin eruptions|
|constipation||hemorrhoids||fevers, inhibits intestinal worms|
|diarrhea||eye disorders||cooling, treats lung diseases|
|rheumatism (topical), tonic, galactagogue||headache, fidgets, thirst, diarrhea||reduces fevers|
|promotes digestion||hematuria, ulcerations||cooling|
|edema, paralysis, jaundice||bleeding, menstrual disorders||painful swellings|
|cooling||warming||controls pain, inhibits infections (used topically for skin eruptions)|
|sedative, diaphoretic||skin eruptions, tumors||treats lung diseases, hepatitis|
|anti-diarrheal||none||bitter stomachic, diuretic, alleviates jaundice, kills intestinal parasites|
|Antipyretic, tonic for those with consumptive diseases||cough, throat swelling, vomiting||clear heat, detoxify, alleviate swellings, relieve pain|
|aphrodisiac, uterine disorders||controls itching, clears vision, relieves depression, alleviates headache||none|
|intermittent fevers||smoothes menstruation||treats wounds, relieves pain|
TERMS USED TO DESCRIBE THE ACTION OF HERBS
|adaptogen||helps the body respond to adverse conditions, normalizes physiological response|
|antacid||reduces excess stomach acid|
|anthelmintic||inhibits intestinal worms|
|anticonvulsant||strong antispasmodic, usually for epilepsy, tetany|
|antidiarrheal||treats diarrhea, especially chronic condition|
|anti-dysenteric||treats diarrhea, especially severe diarrhea associated with acute infection|
|antiemetic||reduces nausea and helps prevent vomiting|
|antihypertensive||lowers blood pressure in cases of high blood pressure|
|anti-inflammatory||reduces inflammation (e.g., in arthritis, skin diseases, infections)|
|antipyretic||reduces fever (antipyretic herbs are described as febrifuge)|
|antirheumatic||relieves joint and muscle pain due to rheumatism (as opposed to injury)|
|antispasmodic||alleviates muscle contractions|
|aperient||produces mild laxative effect|
|aphrodisiac||promotes sexual interest and function|
|astringent||reduces discharge of fluids (e.g., diarrhea, leukorrhea, copious sputum)|
|bronchodilator||alleviates wheezing by dilating lung passages|
|carminative||alleviates gas and bloating|
|cholagogue||promotes secretion of bile|
|demulcent||provides soothing effect on mucous membranes (has slippery, coating action)|
|digestive||provides general improvement of digestive function|
|diuretic||promotes urination, usually in cases of edema|
|emenogogue||promotes initiation of menstrual bleeding|
|expectorant||promotes release of sputum|
|galactagogue||promotes milk production in nursing mothers|
|hepatoprotective||reduces liver inflammation caused by chemicals, viruses, etc.|
|hypoglycemic||reduces blood sugar in cases of elevated sugar levels (i.e., diabetes)|
|hypolipemic||reduces elevated blood lipids (e.g., high cholesterol, high triglycerides)|
|laxative||promotes bowel movements, usually in cases of constipation|
|lithotriptic||helps remove stones (i.e., gallstones, kidney stones, urinary gravel)|
|nervine||calming and improving nervous system functions in sensitive individuals|
|refrigerant||has a cooling effect on a non-fever condition, such as experienced on hot days|
|sedative||calming; usually has prompt effect|
|stimulant||enlivens nervous system and metabolism|
|stomachic||improves digestive function of the stomach, improves appetite|
|tonic||helps overcome weakness|
|uterine sedative||reduces uterine contractions (i.e., cramping)|
|uterine stimulant||promotes uterine contractions (i.e., during menstruation)|