OTHER STORIES
30 Mar 2009

Beyond massage

by Ayurveda Admin

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Diseases can be depressing. Especially when cure looks impossible. Despite humankind making big advances in science, technology and medical science, there are people amidst us suffering from diseases which are serious and some, chronic. They may have exhausted all options. For them, they can try nature. Try Ayurveda. It is a matter of great pleasure and pride for all those who believe, profess and practise Ayurveda that its acceptability is increasing globally, day by day. People all over the world seek the ancient Indian system of medicine for cure of diseases, some really chronic.

But unfortunately, the image Ayurveda has got in the immediate past is that of message therapy. True, Sodhana Chikitsa is an integral part of Ayurveda, but it has a more meaningful, deep and useful branch called samana chiktsa. When the cost of treatment skyrockets the world over, Ayurveda has low-cost and effective treatment methodologies. Our effort is to project this aspect of Ayurveda: the Samana Chikitsa branch and its strengths. We have met with people who have specialised in six areas: eye diseases, auto-immune diseases, cancer, fistula, infertility and psoriasis.

The attempt is not to claim that Ayurveda offers ready cure to all diseases. Our stress is far from that. If a patient approaches the right physician at the right time, Ayurveda has a solution, and the physician expects utmost cooperation from the patient. The definitions and descriptions of diseases in classical texts may not be easily digested by the generation which lives on fast-food. For them Ayurveda has very little to offer. The cure is a joint effort of all stake holders—the patient, the physician, the drugs, the people around them, the diet, the nature in which the patient lives…

As a science which has evolved with nature, and one with a philosophy which encompasses the mind, body and soul, the prescriptions of Ayurveda may not be approved instantly by all. But the fact is that those who approach Ayurveda as a last resort are benefitted. Most doctors we approached for this special package supported that patient should approach alternative medicine before all options are over. “I wish we had a strong interdisciplinary and integrated approach to diseases such as cancer,” Dr C D Sahadevan, who specialises in cancer treatment, told us. We share his concern.

Samana and sodhana

Most new converts to Ayurveda stop at body massage when they start out seeking to understand the prowess of this ancient branch of medicine. It is a wonderful system that has minute details about body massage, they exclaim. They very passionately refer to panchakarma processes and even explain their benefits. In the humdrum, the true karma of Ayurveda—to bring relief to living beings through a holistic approach and by the administration of medicine—is forgotten. Samana chikitsa (pacification therapy), the branch of Ayurveda which treats patients by administering medicine, is often ignored or forgotten, while Sodhana chikitsa, or elimination therapy which encompasses panchakarma, has become the popular face of Ayurveda.
samana1
Both Samana Chikitsa and Sodhana Chikitsa define diseases on the basis of the tridosha theory and prescribe methods to cure them, with a difference though. Samana Chikitsa attempts at restoring the normality of the vitiated tridoshas by pacifying them through medication whereas Sodhana Chikitsa seeks to eliminate the vitiated ‘doshas’ from the body and relieve it from illnesses. While Samana Chikitsa was instrumental in popularizing Ayurveda in the past, Sodhana Chikitsa is its torchbearer today. And I feel there is today an imbalance in the importance people, including Ayurveda practitioners, attach with the two. This imbalance can vitiate Ayurveda in its true mission and hence should be corrected at the earliest.

A proper understanding of the way Ayurveda approaches bodily conditions will help differentiate between the two, and why one is preferred over the other in a given situation. Ayurveda says the disturbed normalcy of the doshas could set off a chain reaction, troubling the other body elements such as dhatus and malas. There can be many reasons why the doshas are vitiated—some may be natural, such as seasonal variations and some man-made, such as the abuse or misuse of functions of sense organs, wrong body and food habits and suppression of body urges. But once the process is set in motion, then the body begins to suffer.

Ayurveda takes a holistic look at etiopathogenesis—the cause, development and progress of a disease. Its mandate is to intervene in the process at any stage, attempt to reverse it and restore, if possible, the doshas to their normalcy. This is where samana comes to play its role. Ayurveda identifies the three phases of a disease as mild, moderate and severe and is treated according to the stage at which the patient suffers from it. The first two conditions—mild and moderate—are not emergency stages, and the physician should generally start off with Samana Chikitsa. He should examine whether a patient responds to the treatment or not, and then decide on the next course. The physician follows the principle of science as symptoms, studies the impact of drugs on the symptoms and then proceeds. He could resort to Sodhana Chikitsa if the disease is at the severe stage.

Ayurveda’s efficacy in treating most diseases comes from the fact that it has a complete tool to address it. It does not, like other branches, looks only at the present, but sees the past and the present and will assess what to do to secure a safe future. However, these tools are to be used very carefully and with the highest application of mind. That Ayurveda can offer solutions to several diseases considered chronic and defies treatment is because it has a comprehensive and holistic system to address the abnormality of the human body, treat it and bring to the normal stage.

But this is no easy task. A physician should be able to judge what is best for a patient and for the treatment of one particular stage of a disease. A proper understanding of the patient as well as the disease, and the determination of an efficient tool to handle it, are the keys in this process. I feel that the new-found popularity of Ayurveda through panchakarma sometimes stops the physician from objectively looking at the patient and the disease and then deciding the course of treatment.

Samana Chikitsa is easy on the patient because it attempts at treating the tridoshas and restores them to normalcy, while shodhana attempts at expelling the vitiated doshas. All that is associated with sodhana are severe: mostly it would necessitate hospitalisation. The patient and the treatment would be under the strict control of the physician, and the patient would have to submit The writer, son of eminent Ayurveda physician and ideologue K Raghavan Thirumulppad, is Reader, Ayurveda Medical College, Thripunithura.himself completely to the treatment and the physician. As a result, the cost of treatment would also go up.

This is not to say Sodhana Chikitsa should not be practiced, but to suggest that samana should always be the first option, unless the situation so warrants. A physician should decide on the treatment, which can very well be sodhana, only after a careful assessment of the patient’s condition. The patients, especially those who are newly introduced to Ayurveda, also must understand this difference. I have friends who have had patients walking in asking for a sirovasti. All that such people had heard about is panchakarma. This image will not help Ayurveda, its practitioners or the patients. If we sincerely wish to propagate Ayurveda, then we must do it the correct way. It will benefit all the stakeholders.

Of the ideal Patient

Of the ideal Patient
Ayurveda seeks to help people lead a healthy life. Its development as a branch of medicine has close links with the life and nature where it has grown. For example, the climatic conditions and the awareness of the people of Kerala were conducive for it to take deep roots over the centuries. The people also had a perfect understanding of Ayurveda and its line of treatments. But today, it’s no more the same, with people being forced to choose a lifestyle different from the old. Their approach to Ayurveda has also changed. But one needs to be mindful of the basics of Ayurveda and its approach to diseases to derive the maximum benefit.

Ayurveda has a systematic approach towards diseases and the patient. It seeks to help the body regain its immunity by self-rectification. As a holistic branch of medicine, Ayurveda concentrates more on prevention than on cure. And when treatment is found necessary, the stress is on the correction of food and lifestyle and on the avoidance of the causative factors. Ofcourse, medicines and procedures do play a part in the treatment procedure. Ayurveda treats the body as a whole, and is mindful of the relation between the body and the mind. The treatment is planned only after considering the different aspects of the patient, disease, climatic changes, habitat, etc. The physician decides on the treatment after studying the body constitution (prakruthi) of the patient, based on the Tridosha theory and deciding to which group such as Vata, Pitha or Kapha constitution a patient belongs. This because Ayurveda suggests that any derangement to the balance of the tridoshas will be manifested as disease and their harmony as health. That is why two patients having the same disease will get different kind of treatments in Ayurveda.

Of disease

Ayurveda has solutions and remedies for various systemic disorders of every hue such as fever, bleeding disorders, cough, asthma, anemic disorders, jaundice, cardiac disorders, cancer (arbudam) and various skin diseases. Ayurveda also has effective treatment regimes for gynecological, obstetric, toxicological, surgical and ENT disorders.

Of time

Most Ayurvedic physicians say patients come to them at the chronic stage, after having experimented with every other system of medicine. Ayurveda is considered the last resort and so, precious time must have already been wasted by the time they come to an Ayurveda practitioner. This delay seriously affects the efficacy of treatment. Ayurveda insists that the sooner a patient begins the treatment, the better. This is because in the early stages of the disease, the conditions which favour the disease are minimal; the pathogens mild in nature and the amount of accumulated toxic materials, less. The disease could then be treated either with Sodhana Chikitsa (purification therapy which cleans up the toxic or morbid materials in the body) or with Samana Chikitsa (pacification therapy) with internal medicines.

Of the physician

Ayurveda classics beautifully illustrate the qualities of a good physician. He should be well-versed and have proficiency in his subject, must have studied under a good teacher and possess a good understanding of the science. He should be well-experienced and efficient so that he can perform all the treatment procedures. He should have a very pleasant demaneour with very high standards of personal hygiene.

Of the patient

Ayurveda has a balanced view on the patient. It says the patient should be wealthy so that he can afford the treatment, and at the same time, the physician should take care of a poor patient as his son.

“Anaathan rogino yatra putravat samupacharet” (The doctor should consider a patient who has no support and is like an orphan as his own child). The patient should have a clean character which will impress others as well as the physician. He must be obedient to the physician. He should follow the prescription and advice of the physician, and he should have good mental stability.

Of treatment

Ayurveda literatures insist that a physician decide on the treatment after carefully assessing the patient and his strength and ability to withstand it. The physician has to decide whether to go in for Samana Chikitsa or Sodhana Chikitsa after assessing the nature of the patient and the stage of the disease. If the disease is in its early stages, and the patient is weak, then samana chikitsa is preferred, and if the diseases in an advanced stage, and the patient can stand tough treatment methodologies, then Sodhana Chikitsa is prescribed. Sodhana Chikitsa aims at purifying the body of toxic materials which are responsible for the diseases. Purification can be achieved through the upward (mouth or nose) or downward movement (anal canal or through urethra) i.e., through the nearest root where the morbid materials are most accumulated more.
Even when one is cured, the patient will be advised and trained to avoid the causative factors of the disease (nidana parivarjanam eva chikitsa). He will also be advised to correct his lifestyle so that he returns to a healthy and normal life.

Of Pathya

Pathya, or discipline in food and lifestyle, is key to the success of treatment. So much so that there are slokas which suggest that if one were to follow pathya, then there is no need of medicine. And if one does not follow the pathya, then there is no point taking medicines. This is because apathya, or lack of observance of pathya, will trigger the causative or promotive factors of the disease.

The fear of observing pathya often scares people from Ayurveda. One must understand that dietary and lifestyle controls are imposed to ensure that the body returns to proper health and that the disease does not recur. So, this regimen will be decided based on the nature of the disease. It is true that certain physicians have prescribed pathya indiscriminately, putting people off Ayurveda.

Of taking medicine

Ayurveda advocates nearly eleven different times for the administration of medicine. These are selected depending on the pathology of the disease. That is why taking the medicine at the correct time, that which is prescribed by the physician, is very important. Otherwise, the expected effect will not be seen.

Of disease-free life

Prevention is better than cure. Following the right daily, seasonal and night regimens and a diet of prescribed food will help a person keep diseases away. And even if we do all these, toxic substances could accumulate in the body. Ayurveda also prescribes methods for the periodical cleansing of the body to keep one healthy.