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Ayurveda Journal of Health

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CONTENTS

CALL FOR PAPERS

Editor-in-Chief

Editors

Managing Editors

Editorial Consultant

Science Editor

Advisory Board

Editorial Board

Copy Editor: Advertising:

Diana I. Lurie

Sue Clark Rammohan Rao Wendy Weissner

Bal Ram Singh

Genevieve Ryder

Vijayendra S. Murthy

Jay Glaser

Suhas Kshirsagar

Light Miller Subhash Ranade

Robert R. Ryder Bal Ram Singh

Kul Anand Shekhar Annambhotla Bhaswati Bhattacharya

Anthony Biduck L. Eduardo Cardona-Sanclemente

Par tap Chauhan Cynthia-Ambika Copple William Courson

Julie Deife Prashanti deJager Kamini Desai

Alakananda Devi Alex Hankey Mukesh Jain

Jaisri Lambert Anne MacIntyreVijayendra S. Murthy

Avinash Patwardhan Sunanda Ranade Sanjeev Rastogi

Jennifer Rioux Pratibha Shah Amritpal Singh

Vandana Tilak Felicia Tomasko

Jessica Albernaz

John Douillard David Frawley

Marc Halpern R.P. Jain

Ujwala Jatin

Mark Vinick

Abby M. Geyer

Vasant Lad

Vivek Shanbhag

Jerry Solfvin Swami Tirtha

Bala V. Manyam Thomas Mueller

WINTER 2015 • VOLUME 13, ISSUE 1 • ISSN 2372-1804

Opinion Editorial

Columns

Commentaries

Features

Conference Report

Announcements

Many Thanks to the Reviewers of AJH

From the Editor's Desk 06

Jyoti on . . . Dr. Suhas Kshirsagar 08

Saffron–Fennel Winter Tagine 11

— Anjali Deva

Science Discovery 13

— Diana I. Lurie

Science-Based Evidence-Based Ayurveda 15

— Remya Krishnan

Regulatory Issues Facing the Ayurvedic Profession in the U.S. 18

— Wynn Werner

Global Perspectives: Ayurveda in South America 21

and the Caribbean

— Xenobia N. Delgado

Managing Prana: Integrating Yoga & Ayurveda for 26

Therapeutic Purposes — A Commentary

— Arun Deva

Vyadhi (Disease): Inputs from the Yoga-Sutras and Its 32

Commentaries on a Predominantly Ayurvedic Terminology

— M. Jayaraman

Effect of a Ten-Day Yoga-Based Vacation Program on 37Short-Term and Working Memory in Schoolchildren

— B.N. Hema, G.M. Kashinath & H.R. Nagendra

International Consortium of Ayurvedic Science and 40

Technology (I-COAST) Launched by the Institute of

Advanced Sciences, U.S.A.

— Bal Ram Singh

Sixth World Ayurveda Congress Sees Enhanced Involvement 42

of Govt. of India, Dept. of AYUSH

— Bal Ram Singh

45

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Ayurveda Journal of HealthVOL. XIII, ISSUE 1, WINTER 2015

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I am writing to you as 2014 draws to a close. It has been a very eventful year for the Ayurveda Journal of Health! 2014 saw the launch of our new name and ourcompletely redesigned cover that reflects our goal of integrating the very effective traditions and practiceof Ayurveda with modern biomedical science. Ourthanks for all the positive feedback we have received

for the changes we are making to AJH . Your support,interest, and contributions are absolutely essential tothe success of AJH , and we are very grateful for thesupport of our contributing authors, reviewers,advertisers, and you, our subscribers. A great dealof work and creativity goes into each issue, and whilethe work of our authors is clearly recognized, we alsoowe a debt of thanks to our reviewers who workdiligently behind the scenes to ensure the high qualityof the peer reviewed articles that are published in

AJH . In recognition of their work, we have an

acknowledgement to all the volunteers who reviewedarticles for AJH between August 2013 and December2014 that was inadvertently left out of the Fall 2014issue. Without their efforts, we could not sustain thehigh quality of AJH .

Some new changes that are coming for 2015include the elimination of themes for each issue. Oureditorial board agreed that potential authors shouldnot feel as if their contribution wouldn’t fit with aparticular theme of an issue, and then not submittheir article to AJH . In fact, our goal is to encourage

articles that cover a broad range of topics in orderto provide you with a comprehensive base of knowledge. We will make an effort to publish relatedarticles in the same issue, and you will see in thisWinter 2015 issue that we have commentaries on thestate of Ayurveda from around the world amongour additional featured articles. We are also initiating

an announcements page tokeep the Ayurvedic Commu-nity abreast of importantmeetings, trainings, andnew initiatives. Please feelfree to contact me to placean announcement on our

announcement page([email protected]).

We start the Winter 2015issue with an interview (Jyoti on . . .) with Dr. SuhasKshirsagar, the Director of “Ayurvedic Healing” anIntegrative Wellness Clinic in Santa Cruz, Californiaand author of The Hot Belly Diet. He discusses howhis experience as an Ayurvedic Physician practicingin the U.S. led him to write his new book, and howhe has modified the traditional practices of Ayurvedato resonate with the Western lifestyle. We next have

a recipe for saffron-fennel winter tagine by AnjaliDeva, a perfect warming and comforting dish forthe dark depths of winter! Our science discoveryarticle focuses on yoga therapy for stroke patients,and this issue also includes an original research articlethat examines the effect of a ten day yoga basedvacation program on short term and workingmemory by Dr. Kashinath G. Metri and colleagues.

This issue also contains four commentaries onAyurveda across the world. Dr. Remya Krishnanfocuses on the multiple challenges facing evidence- based Ayurveda in India, and the need forestablishing evidence-based guidelines of practice.Wynn Werner summarizes the regulatory issuesfacing the Ayurvedic profession in the U.S., andXenobia Delgado gives us a fascinating overview of Ayurveda in South America and the Caribbean.Finally, Arun Deva has written a very thought

From Editor’s Desk

Diana I. Lurie

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provoking article on managing prÀõa in the contextof integrating yoga and Ayurveda.

Keeping with the theme of integratingAyruveda and Yoga, we have an extremelyinteresting article by Sanskrit scholar Dr. M. Jayaraman on the integration of yoga and Ayurveda

as written in the Yoga-SÂtras and its commentaries.This is an intriguing analysis of the concept of diagnosis and treatment of disease as mentionedin the Yoga-SÂtras. Our last feature is an article byDr. Bal Ram Singh who describes his significant newinitiative I-COAST, an international consortium of Ayurvedic Science and Technology. This newconsortium involves scientists, scholars, andphysicians from all over the world workingtogether in order to understand and advancefundamental and applied Ayurveda in terms of

modern science and technology. Dr. Singh has also

submitted a meeting report on the Sixth WorldAyurveda Congress in New Delhi, November 6-9,2014.

Finally, we close the issue with our newannouncements page (with important announcementsfrom the newly established Council for Ayurveda

Research (CAR), the National Ayurvedic MedicalAssociation (NAMA), and the Association of Ayurvedic Professionals of North America(AAPNA)) and our thanks to our reviewers.

During the short, dark days of winter (at leastin the Western hemisphere!), we turn to ourAyurvedic practice to bring us comfort, warmth, andpeace. After the joy and stress of the holidays, wereflect on the year gone by, and look ahead to thespring and renewal. May the New Year bring youand your loved ones an abundance of good things!

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diet and intro-duced them tokhichaçi , anAyurvedic superfood, which con-tains all the

needed nutri-ents. They lovedthe food andsimple lifestyle,and the results were phenomenal.

DL: In your book, you lay out a very detailed 30-

day plan for stimulating digestion and

achieving an optimal weight based on the

principles of Ayurveda. What do you consider

the single most important thing an individual

can do to stimulate agni?SK: The single most important thing one can do to

restore agni is to eat super light in the evening.When the sunlight is tender in the morning, eata light breakfast; when the sun is bright in thesky, eat your main meal; and then have a lightdinner as the sun is setting. Ideally, one shouldnot consume food after sunset. According toAyurveda, when you sleep during the nightyour heart rate, pulse rate, even your metabolicrate slows down and the food remains

undigested in the system. This creates the toxictissue sludge or Àma. Sipping hot water or herbaltea throughout the day is also an important partof the hot belly diet plan.

DL: What do you think will be the most

challenging aspect of your plan for the

average American?

DL: How did your experience as an Ayurvedic

physician in both India and the U.S. lead

you to write your new book, The Hot Belly

Diet ?

SK: As an Ayurvedic physician, I always like tofind the “root” cause of a disease or imbalance.Obesity and pre-diabetic changes were theunderlying cause of multiple symptoms of mypatient population and I kept on repeating thesame thing over and over. That’s when Irealized that I should write a book about notonly losing weight, but gaining health. I chosea tag line for my book, which was “ReKindleyour Fire and ReKindle your Life.” So far Ihave thousands of people who have gonethrough the program and feel fabulous. They

lose weight and regain their passion for Life,and as we all know Ayurveda is the “Scienceof Life.”

DL: Can you give us a couple of examples of how

you have modified the traditional practices

of Ayurveda into something that the average

person in the West feels comfortable with?

SK: Roughly 67% of Americans consume more than70% of their calories after 3 p.m. and from anAyurvedic perspective that was the mainreason that they were gaining weight. It is an

established scientific fact that, “eat late to gainweight and sleep late to gain weight”

So I put them on an Ayurveic lifestyle of increasing agni and lowering Àma. I startedencouraging them to have a light breakfast, agood balanced lunch, and a super light dinner before 6 p.m. I eliminated bad foods from their

Director of “Ayurvedic Healing”

an Integrative Wellness Clinic in Santa Cruz, California. Author of The Hot Belly Diet .

Interviewed by Diana I. Lurie

Dr. Suhas Kshirsagar

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SK: No snacking in between meals. It was sodifficult to sell the concept to “fast in betweenmeals.” We are so used to snacking in betweenmeals and that weakens agni, creates Àma, andmakes our blood sugar fluctuate. Blood sugarfluctuation mimics hunger but it is a falsehunger, and a sign of disconnection from your body signals. If you sip hot water in betweenmeals and have only 3 meals a day you improvethe basal metabolic rate and start burning theunwanted fat. It took some days for people toget used to it, but many people stick to it evenafter the program. This keeps the weight off and retrains their relationship with food.

DL: In the U.S., low income and obesity often go

hand in hand because people with limited

financial resources don’t have the ability to

buy fresh, high quality foods. What advicewould you give to those that cannot afford

to buy good quality food on a regular basis?

SK: Yes, new research shows that for each $1 of menu items purchased at a fast food place, $179in health care costs is incurred over manyyears. Cheap food is bad health; it allcontributes to obesity and a multitude of healthissues. My advice was to shop only at localFarmer’s markets, cook your own food, andkeep it very simple. Many people started

growing their own foods and became membersof a local Organic Co-op.

DL: You include a well-researched section on the

importance of exercise in maintaining health,

and suggest a number of exercise programs

(including simply walking) that people can

engage in. In your practice, how have you

dealt with (1) people who are very resistant

to exercise, and (2) people who are over-

exercising?

SK: Yes, both extremes are bad. The sedentary

habit is worse than smoking. I encouragedclients to start walking daily A.M. & P.M. Thenthey were encouraged to join a gym especiallyif they liked to work out together. Soonenough, they were ready to join a yoga classand it made a huge shift in their attitude aboutfood and lifestyle. The people who exercisedtoo much were asked to change the pattern,such as going for a nature hike or a dance classor participating in a team sport. It was morefun and they enjoyed it a lot. From an

Ayurvedic perspective, more vigorous exercisefor a kapha type, gentle flow for a vÀta type,and more outdoor and natural workouts for apitta type were very effective.

DL: In the U.S., we seem to live our lives always

projecting our efforts, thoughts, and emotions

out into the external world. What have you

found to be the most effective strategy that

helps people to focus on their internal world?

SK: Meditation was the most important advice weoften gave to everyone. Mindfulness makes you

connect with your body signals and you aremore likely to respect them. Being self-awarewas the key to their successful weight loss.

DL: Finally, what do you believe to be the most

important thing that we as a society can do

to improve our health?

SK: Follow an Ayurvedic routine that stimulatesyour digestive fire.

• Eat specific foods and drink hot liquidsthat feed and fuel your metabolism rather

than slow it down, ultimately supportingdigestive balance and efficiency.

• Fast in between meals (no snacking), forthe sensation of hunger is essential toweight loss and overall health.

• Make lunch the most important meal of the day. Studies show that eating more

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Suhas Kshirsagar BAMS, MD (Ayurveda) is aworld-renowned Ayurvedic physician and educatorfrom India born of a traditional †g-vedic family. Heholds a MD in Ayurvedic Medicine, with a GoldMedal from Pune University in India. Dr. Kshirsagarhas traveled worldwide popularizing AyurvedicMedicine, setting up clinics, training health

professionals, and providing Ayurvedic consultationsfor thousands of patients. He is an internationalmotivational speaker, experienced clinician andresearcher, and a Medical Astrologer. He often sharesthe stage with Dr. Deepak Chopra, Dr. Wayne Dyer,and Tony Robbins. He is a featured presenter for theDr. Oz Show, and several other television and radioprograms. Dr. Kshirsagar is currently the Director of “Ayurvedic Healing” an Integrative Wellness Clinicin Santa Cruz, California.

calories midday can result in greaterweight loss, and that late lunches and bigdinners can be detrimental to weight-lossefforts and general health — even if thetotal calories consumed in a day are thesame.

• Pause for a moment to center your self in awareness. Take a deep breath andenjoy because the wisdom lies in eatingless and eating right.

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Saffron

Saffron is derived from the flower of Crocus sativusof the genus family Iridaceae. Saffron crocus is anautumn-flowering perennial plant that grows 8-12inches in height and can bear up to four flowers.The flowers develop a three-pronged vivid crimsonstigma or receptive tip of the carpel. The stigmas

are then meticulously plucked, piled, and dried untilthey reach market. Saffron is used in various cuisinesas a seasoning and coloring agent for its deep yellow-orange color.

Research on the health benefits of saffron isongoing, although many studies have already beenconducted. The elements of interest within saffroninclude crocin, crocetin, picrocrocin, and safranal,which demonstrate health promoting propertiesincluding alleviation of gastric disorders,cardiovascular disease, insulin resistance, insomnia,and anxiety.1 Saffron has also been studied as apotential antidepressant and cognitive enhancer.2

According to five preliminary double-blind studies,use of saffron at 30 mg daily is more effective thanplacebo, and equally effective as a standard treatmentfor major depression.3

Fennel

Foeniculum vulgare is a flowering plant species lesscommonly known than its cousins, celery and carrots.A hardy perennial herb with feathery leaves, it ishighly aromatic and tastes of anise. The edible bulbcontains many flavonoids that include antioxidantssuch as rutin and quercetin. Fennel contains nutrientssuch as vitamin C, folate, and potassium. Anethole,one component of its volatile oil, is found to reduceinflammation in animal studies.4

Tagine

Historically, tagine isa Berber dish fromnorthern Africa thatis named after thetype of pottery it iscooked in. Moroccan

style tagines ares l o w - c o o k e d ,savory stews withspices such asginger, cumin, andturmeric commonlyused. Customarily,the cone-shaped lid of the earthenware pot trapssteam and returns the condensed liquid to the potmaking it practical for areas where water supply islimited.

Here is a hearty, warming, and nourishing recipefor a savory tagine that can be eaten on a coldwinters day. Table 1 provides Ayurvedic nutritionalinformation on the ingredients present in this recipe.

Recipe (Serves 4 Adults)

INGREDIENTS

• 1 tablespoon fennel seeds• 1 tablespoon cumin seeds• 4 tablespoons coconut oil

• 1 teaspoon saffron• 2 leeks (white and light green parts diced)• 2 large bulbs of fennel (chopped into 1 inch

pieces, save fronds for garnish)• 1 cup cherry tomatoes (halved)• 1 cup garbanzo beans (soaked overnight)• 2 tablespoons organic tomato paste (optional)• 5-6 cups vegetable broth, or water• 1 cup couscous

Saffron–Fennel Winter Tagine

Anjali Deva

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Table 1: The Ayurvedic Nutritional Value of Tagine Ingredientsa-d

Sweet = madhura; Bitter = tikta; Astringent = kaÈÀya; Sour = amla; Salt = lavaõa, Pungent = kaÇu

Type Taste (Rasa) Potency (VÁrya) Post-Digestive (VipÀka) Action

Saffron Pungent, Bitter, Sweet Cooling Sweet VPK

Leek Pungent Cooling Pungent (neutral if cooked) VK, P+

Fennel Sweet, Pungent Cooling Sweet VPK

Tomato Sour Warming Sour VK, P+Coriander Sweet, Bitter, Pungent Cooling Cooling VPK

Cumin Bitter, Pungent Cooling Pungent VPK

Garbanzo Beans Astringent, Sweet Cooling Sweet V+, PK

Paprika Pungent Warming Pungent VK, P+

Coconut Oil Sweet Cooling Sweet VP, K+

Turmeric Pungent, Bitter, Astringent Warming Pungent VPK

Ginger Powder Pungent, Sweet Warming Sweet VK, P+ in excess

Cinnamon Pungent, Astringent, Sweet Warming Sweet VK, P+ in excess

Rosemary Pungent, Bitter Warming Pungent VK, P+

(a-d) Sources: (a) Textbook of Ayurveda by Dr. Vasant Lad; (b) The Ayurvedic Cookbook by Amadea Morningstar and Urmila Desai;(c) The Ayurveda Bible by Anne Mcintyre; and (d) The Yoga of Herbs by Dr. David Frawley and Dr. Vasant Lad.

• 4 teaspoons spice blend: equal parts ground paprikÀ, turmeric, cinnamon, rosemary, andginger powder

Method

Heat the coconut oil in a medium-sized, heavy- bottomed stockpot. When hot, add in cumin andfennel seeds, gently sauté over medium heat for 4-5minutes or until fragrant. Add in leeks and saffron,sauté for 7-10 minutes until leeks are softened andsteam has released the color of the saffron. Add inthe fennel pieces and cook until golden, turning themoccasionally. Toss the cherry tomatoes and garbanzo beans in with the leek–fennel mixture. Stir in thetomato paste and vegetable stock or water. Coverthe pot, bring to a boil and let simmer for 30-45minutes or until the garbanzo beans are tender. Addin salt and pepper to taste once finished cooking.

In a separate pan, bring 2 cups of water to a boil.Once boiling, stir in couscous. Remove the pan fromthe flame, cover and let sit for 5-10 minutes. Uncoverthe couscous and fluff it with a fork.

Serve bowls of couscous covered with the tagineand garnished with fennel fronds while still warm.Enjoy!

References

1 J.P. Melnyk, S. Wang, and M.F. Marcone, 2010, Chemicaland Biological Properties of the World’s Most ExpensiveSpice: Saffron, Food Research International, 43: 1981-89.

2 A. Modabbernia, and S. Akhondazedeh, 2013, Saffron,Passionflower, Valerian and Sage for Mental Health,PsychiatrClin North Am, 36(1): 85-91.

3 EBSCO CAM Review Board, 2014, What is Saffron Usedfor Today?, Retrieved from New York University,Langone Medical Center site: http://www.med.nyu.edu/content?ChunkIID=41087

4 D. Madison, C. Hirsheimer, and M. Hamilton, VegetableLiteracy: Cooking and Gardening with Twelve Families fromthe Edible Plant Kingdom, with over 300 Deliciously Simple

Recipes, 1st edn.Anjali Deva is a graduate of the Kerala AyurvedaAcademy with certification as an Ayurvedic WellnessCounselor. She currently resides in Los Angeles, CAwhere her passion for cooking, Ayurveda, and yogaruns strong. She is continuing her education in hopesof creating a bridge between culinary arts andAyurvedic theory. Follow her for more recipes at www.RootedRasa.com

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Schmid A.A., Miller K.K., Van Puymbroeck M.,DeBaun-Sprague E. Complementary Therapy in

Medicine, 22:994-1000. 2014

Type of Study

The goal of this study was to evaluate the changes inphysical function in people with chronic stroke

following an eight week yoga therapy program.Physical parameters that were assessed included rangeof motion (ROM), pain, endurance, and strength.These four parameters were evaluated because theyare often affected after stroke, and rehabilitationefforts frequently focus on these variables.

Individuals with compromised functional abilityor neurological disorders utilize complimentary andalternative medicine (CAM) to a greater extentcompared to people without such conditions. Inparticular, as yoga is becoming more popular in the

West, it is being increasingly used in rehabilitationprograms. Studies have shown that yoga improvesmany parameters in a variety of patient populations,including people with neurological dysfunction andolder individuals. However, few studies havefocused on the beneficial effects of yoga in strokepatients. There is a need to improve functionaloutcomes following stroke because nearly sevenmillion people in the U.S. suffer from the chroniceffects of stroke. Significantly, only 14% of theseindividuals make a complete recovery after one year.

In addition, following stroke, many individuals donot engage in physical activity because they arefearful or dislike exercise. It is thought that yogamight be a physical activity that is perceived to besafe and beneficial, and therefore more appealing tostroke patients. Yoga may not only improve physicalfunction, but may also help patients to overcome theperceived restraints to physical activity. Two

previous case studies haveshown that yoga improved balance, dexter ity, andaspects of quality of life instroke patients. The currentstudy extends these find-ings, and examines ROM,

strength, endurance, andpain in stroke patientsfollowing the eight weekyoga therapy program.

Hypothesis

An eight week yoga therapy program will improve ROM,

strength, endurance, and reduce pain in stroke patients.

Research Design

Participants: Participants were recruited from local

stroke support groups, previously completed strokeresearch studies, or identified through approvedchart reviews. Inclusion criteria included patientsthat were older than 18 years of age, had completedall stroke inpatient and outpatient rehabilitation,were able to stand with or without a device, couldanswer questions and follow directions. Exclusioncriteria included a serious medical contraindication,inability to ensure transportation to the yogasessions, and those receiving palliative care. After a baseline assessment, participants were randomly

assigned to a yoga or usual care control in a 2:1 ratio.A total of 47 people were enrolled in the study and84% of the participants completed the study.

Intervention: Patients participated in group yogatherapy sessions with no more than 10 people pergroup. Each yoga session was one hour long andparticipants engaged in two yoga sessions per weekfor eight weeks. The yoga was taught by a certified

Yoga Leads to Multiple Physical ImprovementsAfter Stroke: A Pilot Study

Science Discovery

Diana I. Lurie

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yoga therapist, and included breathing and relaxationwhile sitting, standing, and supine, and modifiedhatha yoga poses.

Outcome Assessments: Pain was assessed using thePEG, a 3-item functional measure of pain. Cervicaland hip ROM was measured using a goniometer.

Upper body strength was measured with an armcurl test, and lower body strength was assessed withthe chair-to-stand test. Endurance was measuredwith the six minute walk, a reliable post-strokeassessment that is an item on the Senior fitness test.A paired t-test or Wilcoxon signed rank test with aBonferroni adjustment was used to analyze thesefour aspects of physical functioning.

Results

The yoga therapy group showed significant

improvement in many aspects of physical function.In terms of ROM, bilateral neck ROM and passivehamstring ROM significantly improved. Upperextremity strength significantly improved, butinterestingly, lower extremity strength did not.There were also significant improvements inendurance with the yoga group able to walk fartherin the 6 minute walk test compared to controls.Finally, pain scores significantly improved after theeight week yoga program.

Importance of Study

This study demonstrates that only 16 yoga sessionsover an eight week time-span can significantlyimprove multiple parameters of physical function instroke patients. It is noteworthy that the yogasignificantly decreased pain scores in this patientpopulation, because post stroke pain may not beadequately addressed medically after stroke. Theimprovements in ROM could be related to thestretching and prolonged physical poses of yoga andwhich lengthen major muscle groups and activates

stretch receptors. This leads to improved flexibilityand physical strength. It was a little surprising thatlower extremity strength (chair to stand test) didnot significantly improve with yoga, while the upperextremity strength (arm curls) did significantlyimprove. This may be because many of theparticipants practiced arm curls on their own athome. Endurance also significantly improved in theyoga participants and this is important because

endurance is correlated with improved functionaloutcomes in chronic stroke patients. Improvedendurance may also suggest improved aerobiccapacity, which is thought to contribute to a reducedrisk of future strokes.

The authors also note that in addition to these

improvements in the physical body, yoga also mayhelp stroke patients to reconnect the mind and bodyafter a stroke. This improved body awareness mayhelp patients towards a better recovery following astroke event, because inattention to detail and thephysical body may contribute to falls following astroke. The primary limitations to this study werethat there was a relatively small sample size, the yogagroup was larger than the control group, and it wasan unblinded trial. The assessor was involved withthe yoga therapy, and therefore knew which patients

were in the yoga group and the control group.However, the assessor was a physical therapist withdecades of experience. Future studies should includea true double-blind study design to confirm that thechanges are truly associated with the yoga therapy,as well as a longer term outcomes test to see howlong these positive changes in physical function persist.

Despite these limitations, this study providesstrong evidence that yoga therapy is beneficial tostroke patients, and may improve pain, ROM,strength, and endurance. Yoga appears to have a

positive impact on physical function, but may alsoimprove quality of life parameters. In light of thesefindings, yoga should potentially be utilized as atherapeutic tool for recovery following stroke.

Diana I. Lurie , Ph.D., is a Professor of Neuropharmacology in the Skaggs School of Pharmacy, at The University of Montana. She isa Neuroscientist and teaches Neuroscience andAnatomy and Physiology. Dr. Lurie also directsa research laboratory focusing on brain

development and injury, and the response of thenervous system to natural products, includingAyurvedic herbs. Dr. Lurie teaches a course inAyurveda and lectures in the areas of alternativemedicine and natural products at The Universityof Montana. She maintains an Ayurvedic wellnesspractice in Missoula, Montana and offersworkshops to the Missoula community.Contact at: [email protected]

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Today, modern medicine is based on the concept of evidence based medicine (EBM). The term evidencein EBM today refers to data procured by theapplication of any medicine. Or in other words,evidence is considered valid when it is based on astatistically significant conclusion about a rigorouslydefined cohort. For example, drug x is tested to check

whether it is effective in the treatment of a particulardisease for a specifically defined group of patients.Or else the effects of drug X are compared with thatof drug Y to see which one works better. Drug X isalso compared with a placebo to determine if atherapeutic effect is definitively due to the drugtreatment. Within the framework of EBM, the risk– benefit ratio for all clinical trials is analyzed and thisexternal evidence is considered along with clinicalexpertise and patient values.

Seeking global acceptance, the Ayurvedic

community is naturally driven to analyze Ayurvedicconcepts through the lens of EBM. NumerousAyurvedic classical medicines and raw drugresources are being re-evaluated using randomizedcontrolled trials and placebo controlled trials, andresearchers feel confident about their researchefforts. However, when the results end inuncertainty or when methodologies fail tocorroborate traditional knowledge, the researchersnever bother to question whether the researchobjective or research methodologies are appropriate

for evaluating Ayurveda; instead, they blindly followconventional methods. To say it another way,Ayurvedic researchers are — more often than not— blindly “doing” rather than “thinking;” they areadopting the “current ways” rather than the “rightways.”Ayurvedic research is currently moving awayfrom the basic principles of Ayurveda and towardsstudying medicines for specific diseases, and the use

of complex statisticalanalysis.

So how do wedefine evidence in themedical field? Whatconstitutes the mostacceptable evidence in

Ayurveda? What stan-dards are to beadopted to verify thequality of evidence inapplied clinical research of Ayurveda? In my opinion,evidence in Ayurveda is not mere data, butencompasses science as defined as a set of permanently valid rationales, which when accuratelyapplied in accordance to the circumstances, yieldsconsistently accurate results. That which was validyesterday, but uncertain or invalid today or

tomorrow, is simply not counted as evidence in anAyurvedic framework. Therefore, the evidence inthe Science of Medicine of Ayurveda can beconsidered in two ways, evidence gained through basic research as well as evidence gained throughapplied, clinical research. Evidence generatedthrough basic research incorporates well-proven andestablished theories, principles, and aphorisms in the basic science of Ayurveda as described in Ayurvedictexts which forms the scientific backbone of Ayurveda. Applied research is defined as the clinical

observations and findings obtained by conductingclinical research based on the standards of themethodologies mentioned in basic science. In fact,such clinically applied research will create the mostscientifically validated practices in Ayurveda.Ayurvedic evidence does not simply comparewhether drug A is better than drug B, or checkswhether drug X is better than placebo, or verifies

Science-Based Evidence-Based AyurvedaPromises and Challenges

Remya Krishnan

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whether the benefit of a drug outweigh its risks.Instead, applied clinical research in Ayurvedaconfirms the traditional valid diagnostic, prognostic,and treatment principles that are well defined in the basic science of Ayurveda.

Science-Based Evidence-Based Ayurveda

(SBEBA) is the term used to describe the accuratescientific appraisal and employment of the principlesof basic science in Ayurveda in the care of patients.The most important clinical action of a physician inAyurveda is not “do no harm” but rather “makeintended effects.” Ayurvedic medical treatises haverepeatedly emphasized the importance of removinguncertainty in the process of decision-making. Thecurrently adopted tools of probability-basedstatistics and randomized controlled trials aretherefore not scientific methods of clinical decision-

making in Ayurveda because these techniquesintroduce uncertainty. The adoption of theseparameters in research and practice of Ayurveda byour own Western scientific standards is the reasonfor the uncertainty that is currently prevalent inAyurvedic practice and research. The application of cognitive short cuts (heuristics) to help solve complexclinical problems is never successfully applicable inevery individual patient with their own set of uniquecircumstances.

Critical Appraisal

Critical appraisal is required for the optimalapplication of basic science evidence in clinicalsituations. Currently, an organized system of criticalappraisal has not been implemented by Ayurvedicprofessionals; and this is the major reason forirrational prescribing by Ayurvedic physicians.There should be a definite hierarchy of evidence formedical practice, where by the accurate employment

of such evidence could easily aid a physician to reachthe most accurate diagnosis. To address this problem,I have developed an appraisal technique called“Evidence Triad Approach” which is described inmy book, Evidence Based Ayurveda & RationalPrescribing (2012). The evidence-based approach of Ayurveda is far-superior to the data-based approachin medical decision-making. Just because a drug ortechnique tested well in one situation does not meanthat it is always appropriate.

Ayurvedic doctors currently follow variable,non-standardized, and unscientific clinical practicestyles based on their personal experience, opinionof teachers and colleagues, influence of continuingmedical education (CME) courses or simply randomapplication of medicines. No CMEs are found thatdiscuss the evidence-based management of diseases

but rather focus upon “effect of medicine(s)” which by itself is demeaning and disparaging to the medicalprofession. Economic incentives to physicians areanother major modifying factor that influencephysicians. Financial issues exert a large influenceand add pressure in clinical practice. This is mostapplicable to situations where both prescribing anddispensing are done in the same unit.

Practical Solutions

Let us not be afraid to use some common sense to

know that we need to count more on science-basedevidence and not mere “statistics-based evidence.”Applied clinical research should be focused with thegoal of streamlining the evidence-based policies of Ayurveda in accordance with current requirements.For this to occur, a science-based evidence approachmust be initiated. There should be regular SBEBAawareness campaigns as well as programs forcommunity education and participation. Suchprograms should involve school children, employers,and employees in both the government and private

sectors. In addition, motivation programs, trainingprograms for emergency management, andprevention programs should also be conducted inall Ayurvedic institutes in India.

Policies

It is extremely important to formulate, document,review, and optimize SBEBA guidelines in

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accordance to the changing health care requirements.A manual containing current standard scientific datashould be created and distributed to all staff members in Ayurvedic teaching hospitals. Thescientific criteria chosen from science-based evidencefor diagnosis and management should be confirmedand established and the treatment response should be accurately measured using both subjective andobjective parameters. Once the protocols are fixed,Ayurveda doctors in every part of the world shouldunanimously adopt them. Because SBEBA is relevantto a diverse array of patients, it is important that allAyurveda doctors — irrespective of their specialties,and including those without specialization as wellas paramedical staff — should be appropriatelytrained and made aware of scientific policies andprocedures of SBEBA.

Quality of Medical Decision-making

There should be a standardized prescription auditregularly conducted that evaluates the quality of medical prescribing based on SBEBA in every partof the world. It should be chiefly based on thesecriteria:

a. Quality of the medical decision and scientificreasoning for the evidence chosen fortreatment.

b. Quality in the execution of the treatment

protocol.c. Evaluation of the clinical outcome and its

scientific documentation.

Conclusion

The strength of a medical system is truly based onthe clarity and objectivity of its background science.SBEBA is a core component that is often poorlyrecognized by today’s Ayurvedic health careprofessionals. The major difficulty in implementingSBEBA is the above reason itself — lack of

recognition of science-based evidence. Ayurvedicphysicians and faculty are still ill-informed of Ayurvedic basic science-based standards and criticalappraisal techniques. Evidence-based guidelines andpolicies should be endorsed by the governmentthrough AYUSH by calling upon experts in the field,and compulsory training programs should be

initiated on the appraisal and diagnostic techniquesof Ayurvedic evidence for Ayurvedic physicians aswell as faculty. Pilot studies have revealed that theprotocols of SBEBA prove to be equally beneficial in both acute as well as in chronic ailments. Thedevelopment of SBEBA requires intensive planning,funding, accurate regulatory policies, etc. Accurateimplementation and undertaking of this project willresult in a revolutionary and positive change intoday’s health care scenario. The best scientificallyoptimized Ayurvedic health care protocols target the judicious utilization of our scarce medicinal plantresources and implement the best-scientific and cost-effective solutions for all acute and chronic healthproblems.

Other Publication Links Related to SBEBA

Krishnan, Remya, 2013, Need of prescribing standards in

Ayurveda, IJAPR, 1(3): 1-3.Krishnan, Remya, 2013, Comprehending Evidence Based

Ayurveda, IJAPR, 1(1): 1-3.

Krishnan, Remya, 2012, Drug discovery in Ayurveda, Journalonline, All Things Healing, August 6.

Krishnan, Remya, 2012, Evidence Based Ayurveda & RationalPrescribing, 1st edn. (Kindle version in Amazon).

Dr. Remya Krishnan BAMS, MD (Ayurveda), Ph.D.

(Ayurveda) is presently working as an AssociateProfessor and Head of the Department of AyurvedicClinical Pharmacology (Dravyagunavijnana) at RajivGandhi Ayurveda Medicial College, Bhopal. She hascreated an updated, novel scientific version of Ayurveda technically termed as Science-BasedEvidence-Based Ayurveda (SBEBA), which she haspresented in her recently published book. Dr. Remyahas eleven years of clinical experience, eight years of teaching experience, and seven years of researchexperience in Ayurveda. Dr. Remya has alsopresented scientific papers in several national andstate seminars, and has delivered keynote addresses

and lectures in CME (Continued Medical Extension)programs for physicians all over India. She haspublished articles in several journals and nationalnewspapers such as the Indian Express Daily and inhealth editions of various leading state and nationaldailies. She has also participated in many televisioninterviews on Ayurveda.

contact at: [email protected]

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In states without licensing, Ayurvedic practitionersface issues similar to other unlicensed health careprofessionals such as herbalists, homeopaths, andnaturopathic physicians. State laws govern thepractice of health care.

The practice of Ayurveda is not currently licensedin any state. However, this does not mean that

Ayurveda can be practiced freely without regard toexisting statutes. Every state has multiple regulationsresulting from the previous licensure statutes of otherhealth care professions, such as medical practice,nursing, chiropractic, and family counseling. Everyperson offering health care to the public must be awareof, and comply with, all of these various statutes.Although every state is unique in the exact wordingof its statutes and what professions are licensed, thereare many broad commonalities.

NAMA (National Ayurvedic MedicalAssociation), at its founding, identified several goalsrelated to licensure:

• To support the establishment of licensing forthe practice of Ayurvedic medicine.

• To promote, assist, and cooperate with localand state Ayurvedic associations in imple-menting our mission and purposes.

• To affect public policy and legislation in allmatters pertaining to Ayurveda.

• To establish and maintain standards of education, ethics, professional competency,and licensing.

All professions seem to go through the samesteps:

1. the number of individual and independentpractitioners grows;

Regulatory Issues Facing theAyurvedic Profession in the U.S.

Wynn Werner

2. those practi-tioners forman association formutual support;

3. the associationcreates standardsfor membership;

4. the association becomes politi-cally active andinstrumental increating statelegislation for the profession;

5. the association or related groups create nationalstandards, and competency exams;

6. the associations work for full nationalreciprocity so that practitioners can move from

state to state without the need for additionaleducation and training or taking a particularstate’s board exams.

The Ayurvedic profession in the U.S. is currentlyat steps 4 and 5. However, a relatively new legalconcept has surfaced called “Health Freedom” andthis has impacted the traditional licensure process.Health Freedom can be thought of in the same waythat “the public domain” is thought of in computersoftware. In this case, there is a public domain of health care practice in some professions who are not

currently (or possibly ever) licensed. The concept isthat these practitioners should be able to practiceand, in fact, an overwhelming majority of the publichas demonstrated that they receive services fromthis group of health care providers and pay cash fordoing so.1

For the first time, this brings up the interesting

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discussion of which option is right for the Ayurvedicprofession: licensing or health freedom, or somecombination of both? There are already a few stateswith Health Freedom legislation.2 Health Freedomcreates a safe legal environment for the practitioner.In some states it also creates better protection forthe public by mandating certain disclosures by thepractitioner and certain restrictions on their practiceas well as penalties for non-compliance. So what doeslicensure do that Health Freedom legislation doesnot? First of all, it is important to note that HealthFreedom by its very nature is inclusive of allunlicensed professions. Probably the most importantdifference is that only licensing creates minimumcompetency standards for a specific profession. Thisdoes, of course, prevent those who cannot meet thesestandards from practicing and, in doing so, “protectsthe good name” of the profession, creating in thepublic mind a standard of practice for the profession.

Not all practitioners support licensing, because itdoes define who can and cannot practice and furtherdetermines what a practitioner can and cannot do.Until the Health Freedom legislation, there has never been a time when a profession and its practitionershad a choice. Ayurveda in particular has a very broadscope of practice, and historically as it has developedin the West, a very diverse group of practitioners witha great variation in their education and training. There

are practitioners who have studied at formalAyurvedic medical schools, those who have studiedmany years with a master teacher, and those with500 to 1,500 hours or more of education and training.Some practitioners offer a full medical practice dealingwith all major diseases and some offer a more limitedpractice devoted to wellness and lifestyle consulting.It is no small task to take all of this into considerationwhile supporting all practitioners, the public’s needs,and honoring a thousands of years old tradition inthis modern society.

Many people are interested in getting Ayurvedichealth care covered by their medical insurance.Although there seems to be no reason why thiscannot happen, it is true that currently almost nohealth care insurance covers Ayurveda or othercomplementary and alternative health care practices.Why is this? Well, the answer is undoubtedlycomplicated by politics and money but is surely tied

in with the long-standing tradition of licensing,standardization, evidence-based scientific research,and acceptance of the Ayurvedic profession by thescientific and medical communities. Integrativeresearch is not going to be easy because many of thefundamental concepts of the scientific community,such as standardization of research protocols, arefundamentally opposite to Ayurvedic thinking. Howcan whole herbs be standardized? How can all studysubjects be given the same treatment whenfundamental to Ayurveda is individualizedtreatment, and the likelihood of modifying thetreatment as time goes on? Research is traditionallydesigned to find out something. When its purposeis to prove something to someone, it necessarilyneeds to be in the format and language of the personor community you are trying to convince. There areplenty of research studies and published articles onAyurveda but few meet the standards of the modernscientific community.

Most Westerners are interested in Ayurveda because it incorporates the body, mind, and spirit.It considers the individual holistically, in thecontext of one’s entire life. It has understandingsthat are hundreds, if not thousands, of years oldabout many of the chronic diseases that plaguehumanity today. But for true healing to occur, itrequires the participation of a competent physician,

an accurate diagnosis and treatment plan, a personthat the patient can rely upon for support. Perhapsmost importantly, it requires the full, activeparticipation of the patient who is willing and ableto undertake the recommendations, even when itmeans changing cherished diets, behaviors, andfacing unresolved emotions and feelings that have been ignored for years.

Although a remarkably scientific discipline andone that has been practiced consistently for thousandsof years, Ayurveda has a hard time conforming to

“modern” ideas of what is scientific. May be, if all of humanity’s worries and illnesses were understoodand under control, modern medicine could afford tocontinue to discount established disciplines such asAyurveda. However, what if Ayurveda holds someof the answers for pressing social issues like diabetes,degenerative diseases, and a host of others? One of the first steps in embracing these possibilities is to

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create the legal environment in which Ayurvedicpractitioners can practice.

References1 David M. Eisenberg, Ronald C. Kessler, Cindy Foster,

Frances E. Norlock, David R. Calkins, and Thomas L.Delbanco, 1993, Unconventional Medicine in the UnitedStates: Prevalence, Costs, and Patterns of Use, The NewEngland Journal of Medicine, 328(4): 246-52.

2 National Health Freedom Coalition: www.nationalhealthfreedom.org

Wynn Werner is a founding board member of theNational Ayurvedic Medical Association (NAMA)and has served on the board of directors for the past13 years including terms as president and treasurer.Wynn is the Administrator of Ayurvedic Institute inAlbuquerque, NM and has served in this positionsince 1991. He teaches in the Institute’s AyurvedicStudies program as well as for other schools andconferences on legalities and risk management in thepractice of Ayurveda. Wynn was also part of a smallgroup that researched, drafted, and shepherded intolaw the New Mexico “Health Freedom Act” in 2009titled “The Unlicensed Health Care Practitioner Act.”

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The Caribbean region has a deep and complex historyof natural medicine. “Bush Medicine” is historicallythe instinctive health care option exercised in theCaribbean and in parts of South America. The artfulcollaboration between African and indigenous Indianmedicinal practices resulted in Caribbean BushMedicine; and through the course of history,

Ayurveda comfortably adapted to this culturalmilieu. Much like Ayurveda’s Indian history,Caribbean medicine survived its suppression byBritish, Dutch, Spanish, French, and Portuguesecolonial rule. East Indians generally arrived in theregion during the mid-nineteenth century asindentured servants, and carried with themextremely strong cultural ties to their homeland,India. With a history of East Indian indenturedservitude, Trinidad and Tobago and Guyana (SouthAmerica) in the British West Indies, developed

majority Indo-Caribbean populations of over 50%.This Indo-Caribbean population retained historicalAyurvedic practices that began to intersect with Afro-Caribbean and indigenous Indian health modalities.

The first indentured populations were able toretain their traditions because of their strong ties tothe Indian homeland. While indentured servitudewas a brutal form of paid labor, indentured servantswere given the option of returning home to India,according to the stipulations of their labor contractsin the islands. In her text, The Path of Practice:

Ayurvedic Book of Healing with Food, Breath and Sound,M. Tiwari documents the cultural stamina thatallowed her ancestors to withstand the brutalitiesof indentured servitude:

My great-grandparents were exported from India,as if they were bales of cotton. Along withthousands of their countrymen, they endured aterrifying passage that lasted three to four months

Xenobia N. Delgado

over turbulent seas.En route to the WestIndies, many Indianwomen were raped

by Brit ish soldiers ;their husbands were

beaten and cast out tosea or left stranded

on isolated shores.The spirits of thosewho survived were

broken for the rest of their lives, and theviolations they suffered remained indeliblystamped into the psyches of generations thatfollowed. . . . By the time I was growing up inGuyana in the late 1950s, my grandparents andtheir compatriots had re-created the lushlandscape of India. They had also kept alivetraditional Indian practices of weaving basketsand fishing nets; carving stone mortars, pestles,and grinding stones; and constructing theirhouses in time-honored ways.1

East Indian perseverance resulted in long-lasting bonds to the Indian homeland, even pr ior toGuyanese independence. Still, the small contractualflexibility granted by the colonial powers allowedEast Indians to relive their homeland, and preservecultural practices. Enslaved Africans were not paidfor their labor or allowed to return to Africa. They

remained firmly detached from the shelter of culturalreference points to Africa, and braved an entirelynew existence afresh.2 Due to these culturalnegotiations, popular Ayurvedic medicinal productslike bitter melon, turmeric, ginger, aloe vera, coconutoil, and so on, are extremely popular amongst localnatural health practitioners of varying ethnicities,and are widely available in the Caribbean.

Global PerspectivesAyurveda in South America and the Caribbean

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Cultural Background and Popular Herbs

In Guyana, herbal medicine is largely an outcome of cultural miscegenation, but the primary origin of herbal medicine in Guyana, and the greater regionof South America and the Caribbean, is with theshrinking indigenous Indian population. Indigenous

Indian knowledge of the terrain was historicallyunrivaled, as they understood how the growth of their surrounding landscape enhanced their lives.For example, both Afro-Guyanese and Indo-Guyanese peoples adopted bitter cassava into theirdiet, a vegetable widely used by indigenous Indians.The Indians learned that the vegetable containedpoisonous substances that could damage the kidneyand liver, and developed an extraction method thatmade the vegetable safe for human consumption.With correct preparation, the bitter cassava was used

for food, and its leaves for a variety of domesticneeds. Aside from food, it was also be used toprepare casareep, a widely used flavoring agent andfood preservative by all Caribbean ethnicities.3

While the majority Indo-Guyanese populationpractice Ayurveda, such practices may not even berecognized as “Ayurvedic,” but simply a means of personal care that evolved in the cultural context. Thiskind of daily practice by a large majority of thepopulation helps to promote the collaboration of Ayurveda with Afro-Guyanese and indigenous

medicinal practices, and also facilitates recognition of Ayurveda and Bush Medicine in the country. AfterIndependence, during the 1960s, Caribbean medicinetended to take a back seat to more Westernizedapproaches to health care and development, becausethe goal of Caribbean independence leaders was tocompete on an equal footing in a global economic

context. Many practitioners of South American andCaribbean traditions in the healing arts, religion, andeducation systems, struggled for public recognitionof cultural practices that continued in a hidden privatesphere. These same practices were oppressed in thepublic space as the leadership of the newly-independent region continued the dehumanizingcontradictions of colonial life.4 The socio-politicalclimate was as such that the practice of herbalism andBush Medicine, including Ayurveda, was typically branded as savagery and barbarism in both the publicand private spheres.

Enslaved Africans were imported to Guyana inthe sixteenth century. The actual tradition of Africanhealing can be traced back to before 3200 BCE duringthe early period of African dominance and Egyptianleadership. North Africa was home to a number of

skilled medical practitioners who created a varietyof natural medicines to prevent and cure illness.5

Through cultural and tribal exchanges, suchmedicinal knowledge spread throughout thecontinent. Keenly aware of the importance of dietand nutrition for survival, enslaved Africans carriedtheir rich tradition of medical discovery with themon their journey to the Americas. Afro-Guyaneseenslaved people commonly relied on fruit like karelÀ(bitter melon, cerasee) in their diet, as a means of survival during colonial rule. The observance of

cultural dietary practices survived the independenceperiod; as a result, karelÀ continues to form anessential component of the Guyanese diet. It offersa variety of nutritional benefits and its naturalchemical composition contains material that is almostidentical to insulin. It is therefore extremely beneficial in regulating blood sugar levels.

Research by Schauss on the sour sop fruit(graviola) further demonstrates the culturalconnectivity between Ayurveda and Bush Medicine.Sour sop is a fruit used in Ayurveda to reduce fever,

regulate blood pressure, and stimulate therespiratory system. It also works as a tonic andabortifacient. The fruit has been used to treat scorpionstings, kidney disease, nervous conditions, ulcers,and wounds, and each part of the plant has medicinaluse. The roots are used to suppress muscle spasmsand also attack parasites in the body, while the leaveshelp to reduce fever. In Trinidad and Tobago the

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sour sop leaves are also used to managehypertension. The bark is processed into a tonic, andthe flowers help to relieve coughing and relatedcongestion. The unripe fruit can help to prevent andcure scurvy and the seeds have astringent andinsecticidal properties. The fruit is widely usedthroughout South America and the Caribbean inBarbados, Brazil, Guyana, Dominica, Curaçao,Guatemala, Guyana, Haiti, Jamaica, Puerto Rico,Peru, Suriname, and the Amazon region. In SouthAmerica and the West Indies the fruit is widelyrespected for its cancer fighting properties andfavorable results in treating cancer patients.6

There are several other plants, herbs, andvegetables that are used across the Caribbean thatshare medicinal value with Ayurveda. Turmeric, oneof the most popular Ayurvedic herbs, in African and

Caribbean Medicine is used as an astringent diuretic,to prevent gas, and stimulate blood flow in the pelvicarea. It is also said to enhance mental functioningand well-being. In Haiti it is used to treat feverswith jaundice. In Guyana and other South Americancountries like Peru, it is used internally to treathepatitis and malaria, and is also used externally forherpes, bruises, wounds, and rheumatism. In Bolivia,turmeric is used for mental health to preventexcessive menstrual pain, and scurvy. In Trinidadand Tobago, turmeric’s use has also extended into

veterinary medicine.7

Castor oil is a well-known medicinal product inAyurveda. In Jamaica, once the toxic parts of thecastor seed are removed from the shrub, the seedscan be used to produce a richly colored black castoroil. The black castor oil is used as a laxative, to purgechildren of intestinal worms, and is an abortifacient.Warmed black castor oil is also widely used in Jamaica to soothe ear aches, excessive wax, eyeconditions, and to clean and treat wounds. It cancure biliousness and is also extremely popular in

treating hair and skin conditions. Black castor oil is beneficial in the treatment of cancer, with its anti-tumor and anti-microbial properties. The leaves of the plant are used in bush baths and poultices forrelief of head and stomach aches, arthritis,rheumatism, and other conditions.8

Rasa (taste) is a fundamental principle inCaribbean natural medicine as it is in Ayurveda. The

bitter taste is highly valued for its therapeutic effectsfor Ayurvedic physicians and practitioners. In fact,Dr. Robert Svoboda quotes Dr. Vasant Lad statingthat, “[b]itter is better.”9 In the Caribbean, wild rice bitters are valued for the medicinal benefits of their bi tt er tas te . The na tura lly occurr ing orga nicchemicals that are bitter work to boost the immunesystem and work against many diseases. Wild rice bi tt er s are us eful in the tr eatment of canc er ,inflammation, kidney stones, and respiratoryinfections. It is also said to have sedative effects andworks to relieve pain.10

In some parts of the Caribbean, wild rice bittersare considered to be in the same family with bittermelon and neem. When speaking about childhoodin Guyana, older Guyanese people will often recallthat they used to pick the neem that grew wild and

abundant, and bring it home to be boiled whole inthe coal pot.11 The tea would have a strong bittertaste with purgative effects typically used as aninternal cleanse. Beverages and bush teas made fromthe green parts of rice bitters and other bitter herbslike neem are frequently taken to treat illnesses suchas colds, fevers, diabetes, diarrhea, dysentery,constipation, and high blood pressure. They are alsohighly regarded in terms of dermatological care and blood purification, and used to bathe skin ulcers andsores.12 Bitter cassava, sour sop, castor oil, bitter

melon, turmeric, and neem provide just a fewexamples amongst an array of medicines thatdemonstrate the cultural fusions that continue tooccur in the development of herbalism in the region,and lay the groundwork for further cultural pointsof contact and connectivity in natural medicine.

Mental Health

The manasprak¦ti (mental constitution) is afundamental principle of Ayurvedic psychology andmental health. The concept is critical in defining the

individual personality. By achieving the appropriate balance within the manasprak¦ti, the individual cannavigate the emotional road of life:

Manasprak¦ti belongs to sattva, rajas, and tamas prak¦ti. Sattva: The illuminating, pure or goodquality which leads to clarity and mental serenity.Sattva is full of love. Sattva is light, light giving,full of knowledge. Rajas: The quality of mobility

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or activity which makes a person active, energetic,tense and willful. Tamas: The dark andrestraining quality which obstruct andcounteracts the tendency of rajas to work and of sattva to reveal. Tamas is full of destruction.Tamas is heavy, covering and obstructing light.In spite of this different nature they help mutually

in creation. The quality of sattva leads towardsthe divine and tamas towards the demonic whilein between these two stands rajas.13

This mental classification system coincides withAfrican diasporic traditions, because members of theAfrican Diaspora tend to rely on mind-bodymedicine, qualities of mind, and the healing mentalstates through faith activity. Faith healing,particularly for mental disorders, works as a formof alternative medicine.14 The ready acceptance of mind-body medicine in cultures of African heritage

has made the fusion of Ayurvedic psychologicalprinciples and Caribbean medicine that much easier.

This reliance on faith healing amongst Caribbeanpopulations is not unique to the English-speakingislands, but also highly regarded in the French andSpanish-speaking islands. For example, faith healingis very popular in Puerto Rico, a Caribbean islandand U.S. commonwealth territory. Puerto Ricans usemedicinal cassera (naturopathic healing modalities)in conjunction with espiritismo (faith healing) where

the control of the mind is essential in the healing of the body.15 Such faith healing traditions thatincorporate mind-body medicine are an historicalnecessity in South American and Caribbean cultures,to survive the continuous turbulent history of culturalcontact in the region.

Future Viability

Like India, most independent Caribbean economiesare medium income, but economic conditions lendto an abundance of lifestyle diseases. In 2010, The

University of the West Indies held an internationalsymposium in conjunction with the High Commissionof India, concluding that Trinidad and Tobago, ahigh-income economy and leader in the region, mustadvance Ayurveda and Bush Medicine in the regionto mitigate the impact of poor health economics.16, 17

Additionally, island economies depend on tourism,with health and wellness tourism forming a part of

this economic niche. Health and wellness retreatsflourish in islands such as Dominica, Tobago,Antigua, Anguilla, and so on. Consequently, regionalorganizations such as the Caribbean TourismOrganization seek to harness the market throughstandardization.

Creating a recognizable and viable system of natural medicine in the Caribbean has its challenges,largely because the beauty of natural medicine is thatit often flourishes precisely because of its non-institutional character. As such, natural medicine isaccessible to the everyday person despite attemptsto repress its practice. An additional barrier is thetumultuous nature of Caribbean history itself,particularly since the independence period in the1960s. Most islands experienced independence at thistime with the exception of regions such as Haiti and

a few other islands that remain French, British, andAmerican colonies. Caribbean nationhood has furtherunveiled many economic and socio-politicaldifficulties, including racial rivalries between Afro-Caribbeans, Indo-Caribbeans, and other ethnicities.Yet, herbal medicinal practices have breached theseracial divides. So, while the regional politicalmachinery continues to debate over the best methodsto implement universal health care, some form of universal care is in practice on the ground, as theeveryday person continues to use natural methods

to care for themselves and their families.References

1 M. Tiwari, 2002, The Path of Practice: The Ayurvedic Book of Healing with Food, Breath and Sound, Delhi: MotilalBanarsidass, pp. 24-26.

2 L. Horne, 2003, The Evolution of Modern Trinidad andTobago, Chaguanas: Eniath’s Printing Company, p. 49.

3 X. Delgado, 2011, CV Barrow: Growing up in GuyanaPost-WWII , Interviewed October 1.

4 N.E. Lewis, K. Lewis, Pan-African Indigenous Herbal Medicine Technology Transfer, African Traditional HerbalResearch Centre, Uganda, Blackherbals.com. Accessed

on December 3, 2014.5 Ibid.6 A.G. Schauss, 2009, Sour Sop ( Annona muricata L.):

Composition, Nutritional Value, and Medicinal Uses,and Toxicology, in R.R. Watson, V.R. Preedy, eds.Bioactive Foods in Promoting Health, Oxford: AcademicPress, pp. 621-43.

7 Traditional Uses for Turmeric, Natural Standard: The Author ity on In tegrat ive Medicine . www.

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naturalstandard.com. Accessed in October 2011.8 M. Warner, 2007, Herbal Plants of Jamaica , Oxford:

MacMillan Caribbean, pp. 85-89.9 R. Svoboda, 1998, Prakruti: Your Ayurvedic Constitution,

Wisconsin: Lotus Press, p. 25.1 0 M. Warner, 2007, op. cit., pp. 139-40.1 1 X. Delgado, 2011, op. cit.1 2

M. Warner, 2007, op. cit.1 3 K.V. Indapukar,V. Jagtap, R. Sharma, N. Sharma, 2014,Fundamental Survey and Study of Relation BetweenManasprakruti and Personality Types with the Help of Myers-Briggs Type Indicator (MBTI), International

Ayurvedic Medical Journal, 2(3): 262-63.1 4 R. Baser, K.M. Bullard, L.M. Chatters, J.S. Jackson, B.E.

Perron, R.J. Taylor, A.T. Woodward, 2008,Complementary and Alternative Medicine for MentalDisorders Among African Americans, Black Caribbeans,and Whites, American Psychiatric Association PsychiatricService, 60: 1342-49.

1 5 Caribbean Folk-Medicine: An Alternative orComplement to Biomedical Health Care?, https://

www2.bc.edu/~rusch/Jonah.htm. Accessed in October2011.

1 6 Ayurveda: A Holistic Approach to Health.w w w . t r i n i d a d e x p r e s s . c o m / n e w s /100095314.html?m=y&mobile=y. Trinidad Express.Accessed in December 3, 2014.

1 7 UWI: Ayurvedic Medicine Could Help Economy.www.newsday.co.tt/business/0,125170.html. August 4,2010. Accessed in December 3, 2014.

Xenobia Delgado earned her MA in InternationalAffairs in 2001, and worked on international projects

in Latin America, the UK, Washington DC, and theCaribbean. In 2008, she completed her doctorate andtaught Critical Race Theory at the College of SaintRose in New York. Upon graduation she became aVisiting Assistant Professor of History at WhitworthUniversity. While working as an Independent Scholarfor publishing houses like Sage and the GreenwoodPress, she commenced her studies in Ayurveda. In2012 she earned a Counselor certification from SaiAyurvedic College and an Ayurvedic Therapistdiploma in 2014 from CAISH.

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PrÀõa has been described as life-force. That would be the animating of matter with both energy andconsciousness. One ancient text explains it as “thatwhich is in constant movement.” In the CarakaSaÚhitÀ, the “go to” classical text of Ayurvedicmedicine, the superior physician is one who isskilled in managing prÀõa and the inferior physician

only manages disease.Yoga is a challenging concept to define. Especially

now as it transits into the Western hemisphere wherelanguage has not been built to express its finernuances. Yet we see numerous attempts at definition.In other words, definition has become a personalendeavor. It has brought an intimacy to its expression,implying that, if anything, yoga is personal.

Yoga can be expressed in as shallow a manner ascurrent fitness trends. In fact, a variety of suchnovelties is sprouting up all over the landscape andincludes such transient concepts as spinning yoga,water yoga, hot yoga, and wine and yoga; so onemay get the impression that yoga is the yoking of specific movements to whatever one can imagine!

On the other end of the spectrum we have thetraditionalists who see it as sacrosanct and scoff atthe idea of yoga being physical. Yes it includes Àsana, but as a small part of a much larger picture thatincludes austerities, vegetarianism, strict rules of conduct, and may include the worship of specific

Vedic deities.Nothing is new here. We have been attempting

to define yoga since time immemorial. The Bhagavad-GÁtÀ defines it as “skill in action” and applies it tothe doings of a warrior, Arjuna. The Yoga-Sutras of Pataðjali describe it as complete cessation of theactivities of the mind. The HaÇha-Yoga-PradÁpikÀrequires strict austerities including living away from

Managing PrÀõaIntegrating Yoga & Ayurveda for

Therapeutic Purposes: A Commentary

Arun Deva

others. It includesspecific practices (kriyÀs)that are quite for-midable; especially forthose who wish to useyoga for simply main-taining their health

paradigm. Then of course there are theaggressive sÀdhus whosplit into various campsand end up fightingeach other, very oftenin the name of a higherdeity like ViÈõu or Œiva.

In the late nineteenth century, SwamiVivekananda used yoga to promote peace and love,a trend continued by many others who followed

westward. More recently yoga has become a practicethat favors group sessions of a specific duration,usually 1-1.5 hrs. These are taught by young, athletic,fit, and flexible teachers with anywhere upwards of 200 hrs of training in basic, and sometimes,unrecognizable, Àsanas. The age of the yoga-guru,carrying forward ancient lineages and teachings,seemed to be going the way of the dinosaur. Whileprofessional, business-like teachers, studios, andyoga stars begin to appear as the new wave in yoga,tenuous threads indeed are holding the connection

between lineages and current teachings!Although this trend has resulted in an explosion

of practitioners, many of whom have benefited fromthe practice, another new phenomenon has arisen.Yoga-related and yoga-caused injuries. Perhaps theywere always a fallout possibility, but a majordifference in traditional teaching styles was the years

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of inherited and seasoned teachings passed downin the strict gurukula traditions. This style of teachingadhered to the principles of individuality. Thepractice was tailored to the student, especially tothe older student, who may not be as flexible as, saya youth of ten. A very difficult tradition to maintainin our current teaching formats.

As a result, yet another breed of yogaprofessionals has arisen: yoga therapists. Notlimiting their skills to treating injured students andteachers, they also offer yoga as a therapy for varioushealth conditions. This is certainly a laudable newdirection. Not that yoga has been bereft of its healingaspects prior to this. No matter how far back yougo, there is some reference to its healing potential.

In 1989, in what may have been a prescient move,the International Association of Yoga Therapists

(IAYT) was formed. Its roots were, for the most part,in a very important modern-day yoga lineage, thelatter-day teachings of Sri T.K.V. Krishnamacharya,whom many consider the father of modern yoga. Heseems to have also been quite adept in using yoga asa therapeutic tool. And he had studied and was, some believe, a master of Ayurveda. It may be worthpointing out that yoga has for centuries come downto us through lineages, many of which remainunrecorded or at least unknown to those outside thelineage. As some of these lineages come to light, what

also becomes apparent is the understanding of Ayurveda that lies inherent within them and givesthese traditions the ability to apply therapeuticprinciples through yoga practices. An earlierunderstanding of this connection can be foundspecifically in the HaÇha-Yoga-PradÁpikÀ, and can beinferred quite easily as far back as the specific healthand dietary advice given in the Bhagavad-GÁtÀ. Evenfurther back, if we can relate yoga to its originalnature, into the Vedas, and specifically the Atharvavedafrom within which threads of much of what we now

consider yoga and Ayurveda are revealed.It is essential if practicing therapy, any therapy,

that the practitioner has some training in bothdiagnosis and application of appropriate therapies.It is not enough to know the tools, it is mostimportant to know how, when, in what manner, andmost importantly, to whom they are being applied.

This requires training in yoga practices that obviouslygoes beyond what is taught or even to be expectedin yoga teacher training programs. Recently, IAYT,in recognition of this truth, finished the process of creating standards for yoga therapy, much beyondthose required for accepted yoga teacher trainings.Building upon this base of 200 hrs, they have movedinto requiring competencies and assessment skills(that schools are required to test for) adding up to avery respectable 800 hrs of additional training at thevery least.

This thorough and comprehensive training is based primarily upon present Western medicalpractices, whose language is not very old, andcertainly requires interpretation to interface with thelanguage of yoga and a yogic understanding of health and disease. While most effective, it can be

acknowledged as disease based. There is very littlein this language to address the prÀõa approach wementioned right at the start. However, this prÀõaapproach is the cornerstone of yogic medicine. Infact, when we talk about the haÇha of yoga or thepractical application of yogic practices, we should be aware that the original commentator on the HaÇha-Yoga-PradÁpikÀ stated unequivocally that haÇha-yoga’sessence is the management of prÀõa!

As we go into the study of the ancient texts, wefind that an interface between medicine and therapy

already existed. In fact, the language of the Vedas isshared and then filtered into all its different branchesand just as when it comes to philosophy, we findSÀÚkhya informing yoga, for therapeutic purposesit also infuses the language of Ayurveda, thelanguage of medicine that they all deferred to.

There has been created a current division between yoga therapy and Ayurvedic yoga therapy based on these distances in languaging andapplication. The difficulty may very well lie inAyurvedic yoga therapy being a sort of knee-jerkresponse in its approach to the application of Ayurvedic principles. It seems that we need to createyet another language of yoga therapy, whereinAyurvedic yoga therapy means which Àsana/

prÀõÀyÀma/meditation will pacify/aggravate whichdoÈa or sub-doÈa or which vÀyu (there are fiveprimary ones) and so it becomes yet another

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clinically-based approach. This is quite possibly a fatalmisunderstanding of the Ayurvedic usage of yogapractices. It is not so much the application of Ayurvedicprinciples such as the doÈas that is of primeimportance, it is the integration of both yogic andAyurvedic tools that create complementary therapiesfor removing imbalances. In this approach, the deepercausal factors are not only addressed but the freeingof prÀõa from the grips of disease once again allowsthe body to be nourished and vitalized.

This is not a new field of yoga therapy at all. Itis the bringing forth of the hidden secrets alreadyinherent in all our original yoga and Ayurveda texts.It is just learning once again to “see,” to “listen,” to“feel,” to “taste,” and to “smell” the earth, the water,the fire, the air, and the ether that we are. To learnto use the language of reality as seen by the original

seers when they had to explain who we are and whatwe are made of. While it may seem our currentmedical terminology is more scientific, perhaps it isnot necessarily more interpretative of the actualreality of our beings. Though some scholars may findthe original language archaic and naïve, it is in factundeniable, even by our current scientific models.

The problem may be a difference in language between what is perceived as art, not science, andthus unproven. Our science has been reduced to anevidence-based, experimental art! An art with very

little life-force. On the other hand, there is a meetingpoint between science and life, which is expressed inthe ancient writings, where the author might addressspirituality in one sÂtra, and give a medical formulain the next! A place where science and art meet tocreate not just an understanding but a “breathing”into our perceptions of “life” and its well-being.

The issue then is one of whether we need twoobjective approaches to yoga therapy. ClinicalAyurveda, which is also extremely valid, can easily be folded into current approaches to yoga therapy.Indeed, IAYT already accounts for this in theircurriculum, with a base amount being mandatoryand with schools having the ability to add more aselectives. And this could be the basis for a yogatherapist being additionally trained in the traditionof Ayurveda, as they are in Western medicine, so asto interface and have a wider base of diagnostic tools

and a wider range of therapies. An agreement between IAYT and NAMA (National AyurvedicMedical Association) could easily define theAyurveda parameters for such a clinical therapistwith Ayurveda training, quite separate from anAyurvedic Yoga Therapist (AYT).

The yoga therapy of an AYT is based on theconnections between yoga and Ayurveda thatalready exist. For example, in the use of Àsana, atherapist who understands the movement of prÀõacan identify and address blockages in the movementof this prÀõa in the physical body itself. Andunderstanding the five movements of prÀõa and theusage of them through Àsana could help the clientremove, through Àsana, this blockage. Think of thevalue of such a therapy in classical trauma situations,where the flow may have been blocked for a very

long time, and can now be allowed to complete itsmovement through the appropriate channels! Anunderstanding, not only of this prÀõa and itsmanifestation as vÀyu and then as the five sub-vÀyus, but also the channels of flow, not just the subtlestones such as nÀçÁ s but also the more medical (inAyurveda) channels such as srotas!

This therapy is more subjective. It dependsprimarily on the expertise of the therapist. Anexpertise that includes such elusive tools as intuition.It is the training of this inherent intuitive power, the

unlocking of its latency within the desire to heal,that forms the backbone of a truly skilled therapist.This is not an immeasurable quality. It is as practicalas learning to drive a car. After considerable practiceit becomes intuitive. But on first drive, it requires atrust in the teacher’s own understanding andinstructing forth this ability to steer, applyaccelerator and brake, and to coordinate the threewith all that is happening in the environment the caris negotiating! Most definitely this is an art. It iscertainly science that informs art, but it is art that

expresses the science. They are inseparable here. Just as a surgeon requires training as well as

inherent skill and love for his “art” and is a uniquespecialist in our current “by the numbers” medicalsystem, perhaps an AYT would require specializedskills too. Requiring not just a love for both yogaand Ayurveda but an inherent skill honed

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respectably by deep training in both. As well asfurther training in how to merge the two.

So, what would be the purpose of such aspecifically trained yoga therapist? It would be to bring back the original intention of both yoga andAyurveda: the effective management and increased

excellence (sÀra) of prÀõa in the client.The title “Ayurvedic Yoga Therapist,” upon closeexamination, reveals three aspects to the building of this prÀõa. First that it be based on Ayurvedicprinciples, second that it employs yoga, and thirdthat this combination has the ability to createeffective therapy. It would be a mistake to believe,however much we want to, that 10 days, or afortnight, or a three month intensive training in the basic principles of Ayurveda is suff ic ient forunderstanding how to use it as both a diagnostic

tool and as a model for the therapeutic applicationof yoga. Which seems to be the current trend inawarding the title of “Ayurvedic Yoga Therapist.”

Ayurveda as a diagnostic tool requires skill inreading a client’s tongue, face, body and, often, thepulse. It requires skill in questioning the client abouttheir lifestyle, diet, and exercise habits. It includesexamination or skilled questioning about a client’surination and elimination, as well as a proper

understanding about the state of their digestion, theirchildhood experiences, their current job, and domesticstatus. The state of their imbalances (vik¦ti) and, mostimportant, an ability to confidently establish anunderstanding of the client’s inherent nature ( prak¦ti)so as to have a baseline of what would be perfecthealth for that particular client. It includes diagnosinga condition as easily curable, curable with difficulty,not curable but only manageable and so on.

Ayurveda is an ancient science that is forevershifting its practices to whatever is necessary inadjusting therapy to the present need, the presentenvironment, the present condition of the client. Itsprinciples are foundational and fixed within our verynature: our consciousness; our five element bodies;the vitality that moves through us and connects usto everything else that is vital; to our personality

based on the movement of air, fire, and water withinus; to the tissues that nourish us; the wastes thatprotect

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AJH - Winter 2015