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61References
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4

Complementary and Alternative Medicinal Systems

Akshay M. Baheti1, Arti G. Swami1, Manasi R. Nimbalkar2, Ranjit Nimbalkar3, Anil T. Pawar
1
Department of Pharmaceutical Sciences, School of Health Sciences and Technology, Dr. Vishwanath Karad MIT World Peace University, Pune, India
2
Department of Kriya Sharir, Ashtang Ayurved Mahavidyalaya, Pune, India
3
Anubandha Health Care, Comprehensive Cancer Care Clinic, Pune, India
1

4.1 Introduction

Two-thirds of the world’s population is thought to obtain their medical care from sources outside conventional med­icine, such as Ayurveda, Unani, Kampo, Latin American folk systems, traditional Hawaiian medicine, Homeopathy, Siddha, etc. [1]. Despite differences in the cultures, lan­guages, geographical locations, worldviews, and health beliefs of the people from where they originated, these medical systems have common characteristics. These include (i) individualized patient diagnosis and treatment; (ii) the use of complex interventions, often involving mul­tiple botanical products; (iii) treating the “whole” patient (physical, mental, and spiritual) instead of just to a single pathology; and (iv) an emphasis on disease prevention. Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine [2]. These practices are defined as “complementary” when used together with conventional medicines and as an “alternative” when they are used to replace them [3]. The currently practiced allopathic medi­cal system is not complete for all health problems, and sometimes, the therapeutic approaches aim to provide symptomatic relief rather than a definite cure. This chapter mainly focuses on the Ayurveda, Siddha, Unani, and Homeopathy systems of medicines.

4.2 Ayurveda System

4.2.1 History of Ayurveda

Ayurveda is derived from two words: Ayuh and Veda. “Science (Veda means Knowledge) of Life” is the literal meaning of Ayurveda. Ayurveda is thought to have ori­gins from the Brahma, who is referred to as the universe’s creator some 3000–5000 years ago. It is believed that the knowledge was passed on to Prajapati by Brahma, from Prajapati to Ashwinikumar, and Ashwinikumar to Indra, and sages received this profound healing knowledge from Indra for the sake of humankind. The knowledge of traditional remedies was transmitted from sages to their followers and then to everyone else through a variety of written and oral traditions. The “Shlokas,” or poetry, con­tained information about diseases, health, diet, lifestyle, and medicinal qualities of the herbs as well. “Rig Veda, Yajur Veda, Sama Veda, and Atharva Veda” are thought to constitute the foundation of the Ayurvedic medicinal system. The Rig Veda, the most well-known of the four Vedas, has descriptions of 1028 Shlokas and 67 plants. The Yajur and Atharva Vedas list 81 and 293 plants, respectively, that are good for medicine. The creator of the Rig Veda and Atharva Veda, “Atreya,” is said to have received this information from Lord Indra, who in turn learned it from Lord Brahma [4, 5]. Agnivesha compiled
68 4 Complementary and Alternative Medicinal Systems
the Vedic wisdom and afterwards, it was revised by Charaka and other scholars, becoming the “Charaka
Samhita.” Ayurvedic medicine as a whole is described in Charaka Samhita, whereas surgical science is covered in Sushruta Samhita [6-9]. Ashtanga Sangraha and
Ashtanga Hrudaya by Vagbhata have tried to compile these both in a nutshell, in a compact manner.

4.2.2 Principles of Ayurveda

Preserving the best possible health for humans is the major goal of Ayurveda. It is possible to prevent a variety of ail­ments by following Ayurvedic principles. The basic princi­ples of Ayurveda comprise panchamahabhuta, tridosha, dhatu, upadhatu, agni, and trimalas.
4.2.2.1 Panchamahabhuta Siddhanta
The five subtle elements, or Panchamahabhuta, are Prithvi (Earth), Jala (water), Agni (fire), Vayu (air), and Akasha (ether/space), which make up all material forms, including the bodies of all living beings [10]. Mass in the material is represented by the earth elements. The capacity for the union of more than one principle is provided by water. Heat provided by fire remains always in latent form with every material phenomenon. Air elements are responsible for all types of movements occurring in living or non-living things. Ether provides space for all the remaining four. These components make up every material phenomenon, no matter how tiny it is. Because of the earth element, even the tiniest particle, when it exists in subatomic form, has some mass. It has a propensity to stick together with oth­ers, which is because of the water element. The fire ele­ment is responsible for the latent heat that is released by such particles during their action. An attribute of the air element is that the particles are always continued in motion. There is some space, an ether element, surround­ing this particle. These components make up various func­tional and structural body parts as shown in Table 4.1.
4.2.2.2 Tridosha
Vata dosha, Pitta dosha, and Kapha dosha are the three doshas. According to this theory, the human body is in a state of health if these three doshas or humours are in bal­ance. Characteristically, a person is classified into Vata prakriti, Pitta prakriti, or Kapha prakriti according to the dominant dosha found in his/her body. An imbalance in any of the one element out of these three causes illness [11].
1. Vata: This kinetic principle oversees all bodily
motions. The Sanskrit root “Va,” which means “move- ments and stimulation or irritation,” is where the name “Vata” originates. Lightness, dryness, rough- ness, non-sliminess, coolness, mobility, and fineness are the attributes that define this principle. As a result, it creates and preserves these physical attributes. When triggered, it enhances these characteristics unnaturally, leading to illness. It carries out all bodily functions that involve movement, including breath­ing, movement of the body, circulation, excretion sen­sations (transmitting sensory impulses), speaking, and the development of the fetus. Although Vata is active throughout the body, its effects are more notice­able in specific areas, such as the lower back and colon.
2. Pitta: This is a thermal principle. The Sanskrit root
“Tapa,” which means “heat,” is where the term “Pitta” originates from. This is characterized by heat, fluidity, sharpness, sourness, pungentness, and a slight wet­ness or oiliness. Therefore, in the body’s normal condi­tion, this creates and preserves these attributes. It causes an abnormal increase in these qualities and produces a disease when provoked. Pitta is responsible for vision, catabolism, digestion, hunger, heat, energy, thirst, valor, anger, and intelligence. Its activities are prominent in the stomach, intestine, and umbilical region.
3. Kapha: Originated from the Sanskrit root “Ka” denot-
ing “water,” this is a hydraulic and uniting principle.
Table 4.1 Functional and structural components.
Panchamahabhuta
Functional components
Structural components
Doshas: Vata, Pitta, and Kapha
Agnis: Jatharagni, Dhatuagni, and Bhutagni
Dhatus: Rasa, Rakta, Mamsa, Medas, Asthi, Majja, and
Shukra
Upadhatus: Stanya, Artava, Sira, Kandara, Twak, Vasa, Snayu, Danta, and Kesha
Malas: Purisha, Mutra, and Sveda
Srotas: Pranavaha, Udakavaha, Annavaha, Rasavaha,
Raktavaha, Mamsavaha, Medovaha, Asthivaha, Majjavaha, Shukravaha, Mutravaha, Purishavaha, and Svedavaha
4.2 Ayurveda System 69
Coldness, sweetness, sliminess or stickiness, heaviness, oiliness, stability, and softness are the characteristics. Thus, it produces and maintains these qualities in the body in its normal state, and it may cause an abnormal increase in these qualities when provoked and may pro­duce a disease. It is responsible for stability, anabolism, potency, tolerance, nourishment, strength, lubrication, and contentment. Its activities are prominent in the head, chest, joints, throat, and upper stomach.
4.2.2.3 Dhatus
These are the fundamental structural elements, similar to different tissues, which include Rasa (similar to plasma), Rakta (red blood cells), Mamsa (muscle tissue), Medas (fat tissue), Asthi (bones), Majja (bone marrow and brain), and Shukra (male reproductive substances).
4.2.2.4 Upadhatus
These are produced from dhatus or byproducts of dhatus and have specific functions in the body. Twak (skin), Sira (blood vessels), Vasa (muscle fat), Stanya (lactation), Kandara (tendons), Artava (female reproductive sub­stances), Snayu (ligaments and nerves), Danta (teeth), Kesha (hair), and Oja (the essence of all the dhatus) are the secondary fundamental structural components. The pri­mary distinction between Dhatus and Upadhatus is that the former can change into different forms, but the latter cannot. Rasa dhatu forms stanya and artava; Rakta forms sira and kandara; Mamsa forms vasa and twak; Meda forms Snayu; Asthi forms danta; Majja forms kesha; and Shukra forms Ojas.
4.2.2.5 Malas
Waste or unwanted substances generated during the pro­cess of digestion and metabolism are referred to as Malas. The three primary Malas are Mutra (urine), Purisha (feces), and Sveda (sweat). If the body’s waste products are not properly expelled, if the balance between the Tridosha is upset, it can result in further issues like constipation, diar­rhea, asthma, rheumatoid arthritis, and other disorders.
4.2.2.6 Srotas
Transportation, transformation or exchange of materials takes place in these areas. These may be very gross, very small, of varying shapes. The Srotas consists of all vessels, tubular structures, empty spaces, and intracellular and extracellular spaces.
4.2.2.7 Agni
This vital concept is in charge of food digestion and Dhatus transformation. Agni operates on three fronts. First-level digestion of food is carried out by Jathargni. Food is con-
verted into aahararasa by the action of jatharagni in the grahani (duodenum). Food is then converted into Rasa Dhatu. Subsequently, one by one, the seven Dhatvagnis (Rasagni, Raktagni, Mamsagni, Medogni, Asthyagni, Majjagni, and Sukragni) act to transform one dhatus into the next. To separate five elemental fractions in the food, second-level Bhutagni acts after jathargni. According to five elements, this again has five subtypes, e.g. Parthivagni for earth element and so on. The vital essence of life, “Ojas,” is the ultimate product in the process. Some by-products and wastes are also produced during this pro­cess that have a significant role in health as well as disease. Jatharagni is closely associated with the body’s Pitta and ultimately Vata. Elevated Pitta levels and related symptoms are seen when the body’s digestive fire increases by an increase in acidity. Controlling the natural microbiota, ensuring appropriate digestion, and supplying the body with energy are all dependent on the digestive fire. Any imbalances cause discomfort in the gastrointestinal tract and lead to pathological consequences, such as constipa­tion, diarrhea, and ulcers [12].
4.2.2.8 Prakriti
People’s varied reactions to the same stimuli can be explained by the Prakriti concept. Depending on which
Doshas predominates, there are seven different forms of prakriti. Inherent characteristics from parents as well as
the mother’s diet and behavior during pregnancy combine to form prakriti. Formation of prakriti in the fetus depends upon the dosha dominance in stribija (ovum), purushbeeja (sperm), diet consumed by garbhini in pregnancy, behavior during pregnancy, dosha dominance according to rutu (season) at the time of conception, and dosha dominance in garbhashaya (uterus). The permutation and combina­tion of these factors decide the prakriti of each individual. An individual’s psychosomatic set-up is governed by this constitutional type throughout the life of the individual.

4.2.3 Ayurvedic Methods of Diagnosis

The terms “Roga” and “Arogya” refer to opposing states in the same organism. They can only be found in living things; neither dead bodies nor inanimate objects contain them. The term “roga” means “disease.” It comes from the word ‘‘ruja’’, which means to suffer or be in pain. The body and the mind are the two locations where pain or suffering origi­nates and manifests. The exact opposite of roga is arogya, or happiness and gladness. Therefore, we cannot examine a disease without a reference to a living person when we need to investigate and understand a clean image of a disease. According to Ayurveda, a variety of factors, including unhealthy food, disturbed lifestyle, infections, and so on,
70 4 Complementary and Alternative Medicinal Systems
contribute to the etiology of diseases. These elements lead to tridosha imbalance, a significant pathogenic outcome that underlies the prevalence of disease.
According to Ayurveda, determining a disease’s diagnosis is crucial to choosing the best line of action for therapy. It is thought that because each person has a unique prakriti (spe- cific constitution), various treatment approaches may be required for the same symptoms. Because an incorrect diag­nosis could make the disease worse, it is crucial to make a proper diagnosis using the right tools for diagnosis [13–17].
The various diagnostic tools of Ayurveda are as follows:
1. Dasavidha Pareeksha a. Dooshyam: Structural and functional examination b. Desham: Consideration of geographical belonging
of the diseased person
c. Balam: Consideration of the strength of the dis-
eased person
d. Kalam: Consideration of climatic conditions spe-
cific to disease prevalence
e. Analam: Analysis of the patient’s digestive system f. Prakriti: Examination of patient’s thridoshic
constitution
g. Vayas: Consideration of age factors h. Satvam: Consideration of the mental status of the
diseased person
i. Satmyam: Patient’s habits, such as smoking, drink-
ing, and daily regimen
j. Aharam: Nature food habitants
2. Ashtasthana Pareeksha a. Nadi: Examination of pulse b. Mootram: Examination of urine c. Malam: Examination of stool d. Jihva: Examination of the tongue e. Shabdam: Voice and speech analysis f. Sparsham: Touching sensation. Skin for the tem-
perature, inflammation, etc
g. Drik: Examination of eyes and vision. It indicates
mental unrest and physical diseases, or moods of the person.
h. Akriti: Analysis of whole body built-up; strong or
weak, etc. The patient’s face may be observed for the expression of emotional upset, rage, worry, grief, anxiety, depression, fatigue or elation; physi­cal changes-pallor or plethora, leanness, plump­ness, puffiness, cyanosis, jaundice, etc.
4.2.3.1 Ayurvedic Treatment
The two primary goals of Ayurvedic treatment are i) pre­vention and the promotion of healthy individuals. and ii) treatment of diseased ones. The treatment of disease can broadly be classified as follows:
1. Shodhana Therapy (Purification Treatment): The
process involves purification internally and externally. It involves panchakarma and pre-panchakarma proce­dures. Metabolic management is the focus of pancha­karma treatment. Besides conferring therapeutic benefits, it provides a desired purification effect. This treatment is especially helpful in respiratory diseases, neurological disorders, certain vascular or neurovas­cular states, musculoskeletal disease conditions, degenerative, and metabolic disorders.
2. Panchakarma Treatment: The term “Panchakarma”
(“Pancha”: five and “Karma”: a method of treatment) is fivefold specialized techniques of therapy, viz. “Vamana” (therapeutic emesis), “Virechana” (thera­peutic purgation), “Anuvasana” and “Niruha Basti” (enemata), “Nasya Karma” (errhines), and “Raktamokshana” (blood-letting). Panchakarma ther­apy’s main objectives are to nourish the body’s dhatus tissues and rid the body of any buildup of toxins, pol­lutants, or stagnant malas. Once this is achieved, it becomes very easy to prevent the process of premature aging and rejuvenate all body dhatus [18, 19]. Some other procedures other than panchakarma which are practiced commonly in Ayurvedic clinics are Abyanga,
Shirodhara, Swedana, Udvartana, Kati basti, and Hridaya basti. Some of the most common pancha-
karma treatments are summarized below:
3. Shamana Therapy (Pacifying Treatment): It con-
sists of the suppression of vitiated humours (doshas). Shamana pacifies the disturbed humours and brings them back to normal without creating an imbalance of other humours. This treatment is achieved using diges­tives, exercise, appetizer drugs, and also some proce­dures like exposure to the sun, fresh air, etc.
a. Abyanga: A soothing, herbal oil massage that stim-
ulates lymphatic and arterial circulation to flush out pollutants.
b. Shirodhara: Putting a stream of warm, herb-
infused oil on the forehead can make a very relax­ing impact on the body, mind, and soul.
c. Udvartana: After massaging the skin with a lym-
phatic massage, an exfoliating herbal paste is applied. Radiant skin and the discharge of accumu­lated lymphatic toxins are the outcomes.
d. Swedana: The patient’s head and heart are kept
cold while the rest of their body is heated during this therapeutic steam bath. Sweating flushes off bodily, mental, and emotional poisons that are deeply ingrained in the tissues.
4. Pathya Vyavastha (Prescription of Diet and
Lifestyle): Indications and contraindications for
nutrition, exercise, habits, and emotional state are