Chiropractic
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Chiropractic (from Greek chiros and praktikos meaning "done by hand") is a health care profession whose purpose is to diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health.[1] It is based on the premise that a spinal joint dysfunction can interfere with the nervous system and result in many different conditions of diminished health. While some chiropractors use the term vertebral subluxation to describe what they treat, others have dropped this concept and concentrate mostly on the musculoskeletal components of spinal injury and rehabilitation of the spine.[2] In contrast, the term subluxation as used in conventional medicine is usually associated with specific conditions which are a direct consequence of injury to joints or associated nerves.
Chiropractic was founded in 1895 by D. D. Palmer, and it is now practiced in more than 100 countries.[3][4]
Chiropractic treatments vary depending on the patient's condition and the type of approach taken by the particular chiropractor. They commonly include spinal adjustments, although other interventions may be used as well.
Today there are four main groups of chiropractors: "traditional straights", "objective straights", "mixers", and "reform".[citation needed] All groups, except reform, treat patients using a subluxation-based system. Differences are based on the philosophy for adjusting, claims made about the effects of those adjustments, and various additional treatments provided along with the adjustment.
Since its inception, Chiropractic has been the subject of controversy, criticism, and outright attacks. It has come from critics within the profession, critics outside the profession, and from researchers in the scientific community. Historically, these have indirectly led to the scientific investigation of chiropractic and an antitrust suit against the American Medical Association. As a direct result of this criticism, as well as the relative dissatisfaction with its medical counterpart, surveys show that chiropractic patients have the highest satisfaction rate among the various healthcare disciplines. [5][6]
Contents[hide]
1 History of the basic premise
1.1 Explanation
2 Origins of Chiropractic and the concept of subluxation
3 Chiropractic’s approach to healthcare
4 History
4.1 Medicine vs. chiropractic
4.2 BJ Palmer re-develops chiropractic
4.3 Straight versus mixer
4.4 The movement toward science
4.5 Wilk et al. vs the American Medical Association (AMA)
5 Safety
6 Scientific investigation of chiropractic
6.1 The Manga Report
6.2 Workers' Compensation studies
6.3 American Medical Association (AMA)
6.4 British Medical Association
7 Practice styles and schools of thought
7.1 Traditional Straight
7.2 Mixer
7.3 Objective Straight
7.4 Reform
8 Manipulation under anesthesia
9 Education, licensing, and regulation
10 References
11 See also
12 External links
12.1 General resources
12.2 Internal criticism
12.3 External criticism
//
[edit] History of the basic premise
Chiropractic was founded in 1895 by Daniel David Palmer to correct what he termed vertebral subluxations. It was originally theorized that a vertebral subluxation was a misaligned vertebrae that pinched a nerve. It was thought that this interfered with the information the nerve was transmitting between the central nervous system and the structures of the body. DD Palmer thought that living things had an Innate Intelligence that used the nervous system to control the body, leading him to conclude that 95% of all health problems were due to vertebral subluxations and the remaining 5% were due to other joint misalignments. In 1996, it was proposed that a vertebral subluxation is more aptly defined as, "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health" [7]
Early on, Palmer described this concept as similar to applying pressure to a water hose that supplies a garden; relieve the pressure and the garden flourishes. While the "pinched garden hose theory" has mostly been abandoned; although it is still may be used in a modified form by some chiropractors to explain a vertebral subluxation; the concept of the subluxation remains integral to a typical chiropractic practice. In 2003, a survey showed that 90% of North American chiropractors believed the vertebral subluxation complex played a significant role in all or most diseases.[8]
[edit] Explanation
Manipulation of the spine, when performed by a chiropractor, is frequently referred to as an adjustment. Though spinal manipulation for back pain has been documented from the time of the ancient Egyptians,[9] and early osteopaths practiced generalized spinal maneuvers, the attempt to precisely correct theoretical vertebral subluxations is a uniquely chiropractic endeavor.
A modern chiropractor may specialize in spinal manipulations only, or may use a wide range of methods intended to address an array of neuromusculoskeletal and general health issues. Examples include massage, strength training, dry needling (similar to acupuncture), functional electrical stimulation, traction, and nutritional recommendations. Some chiropractors specialize in chiropractic sports medicine, which includes manipulation of the extremities, and exercises to increase spinal strength. Chiropractors may also use other complementary alternative methods as part of a holistic treatment approach.
Chiropractors generally cannot write medical prescriptions. Traditionally, they consider the prescription of drugs the province of conventional medicine, with the chiropractor's role being to pursue drug-free alternative treatments. More recently (2003), a survey of North American chiropractors found that a majority supported limited prescription rights.[8] A notable exception is the state of Oregon, which allows chiropractors with minor additional qualification to prescribe over-the-counter drugs.[10] Depending on the country or state in which a Chiropractic school is located, some chiropractors may obtain additional training to perform minor surgery, obstetrics and proctology.[11] When indicated, the doctor of chiropractic consults with, co-manages, or refers to other health care providers.[1]
[edit] Origins of Chiropractic and the concept of subluxation
Autonomic Nervous SystemBlue = parasympatheticRed = sympathetic
Main article: Vertebral subluxation
DD Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He held that a malposition of spinal bones, which protect the spinal cord and nerve roots, interfered with the transmission of nerve impulses. Because half of the nervous system is sensory and the other half motor (control), he postulated that living things had an Innate intelligence, a kind of "spiritual energy" or life force that received the sensory information from the various parts of the body and made a decision as to what the motor nerves should convey. DD Palmer claimed that subluxations interfered with this innate intelligence, and that by fixing them, all diseases could be treated.[12] He qualified this by noting that knowledge of Innate Intelligence was not essential to the competent practice of chiropractic.[13]
The idea that all diseases were the result of a subluxation was in line with the common thinking of the day; that there was one cause for disease. The vitalistic concepts implied an intelligent governing entity that was readily perceived as spiritual constructs by many both inside and outside the profession. Chiropractors used these metaphorical concepts to rationalize their thinking about the body’s self-healing capacity.[14] In 1998, Lon Morgan DC, a reform chiropractor, wrote that: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."[15]
Meridel I. Gatterman DC, educator and writer observed:
"The word subluxation has been ... embodied with a multitude of meaning by chiropractors during the past one hundred years. To some it has become the holy word; to others, an albatross to be discarded ... to add to the confusion, more than 100 synonyms for subluxation have been used. Why then do we persist in using the term when it has become so overburdened with clinical, political, and philosophical ... significance ... that the concept that once helped to hold a young profession together now divides it and keeps it quarrelling over basic semantics? The obvious answer is: The concept of subluxation is central to chiropractic."[16]
Debate about the need to remove the concept of subluxation from the chiropractic paradigm has been ongoing since the mid 1960s. While straights hold firmly to the term and its vitalistic construct, reformers suggest that the mechanistic model will allow chiropractic to better integrate into mainstream medicine without making claims inherent in the term. Anthony Rosner PhD, director of education and research at the Foundation for Chiropractic Education and Research (FCER) considered subluxation and the concept of Occam's razor. He suggests "there is no obvious reason to discard the concept of subluxation, while at the same time maintaining that it is not a rigid entity, but rather an important model and concept; a work in progress that undoubtedly will undergo extensive modification as our concepts of light or psychoanalysis have evolved over half a century."[17]
Despite the term's vitalistic roots, chiropractic today may still use the term Innate Intelligence; however, it has taken on a less metaphysical meaning. Innate Intelligence today is used to describe the self-healing power of the body. Thus, a modern chiropractic view is that by removing the restrictions caused by subluxation, the chiropractor is improving the body's own potential for self-healing.[18]
It should be noted, however, that not all chiropractic institutions subscribe to the vertebral subluxation theory.[19]
[edit] Chiropractic’s approach to healthcare
According to Robert Mootz D.C. and Reed Phillips D.C., Ph.D., although chiropractic has much in common with other health professions, its philosophical approach distinguishes it from modern medicine. Chiropractic philosophy involves what has been described as a "contextual, naturopathic approach" to health care.[20] The traditional, "allopathic" or "medical" model considers disease as generally the result of some external influence, such as a toxin, a parasite, an allergen, or an infectious agent: the solution is to counter the perceived environmental factor (e.g., using an antibiotic for a bacterial infection). By contrast, the naturopathic approach considers that lowered "host resistance" is necessary for disease to occur, so the appropriate solution is to direct treatment to strengthen the host, regardless of the environment. In contemporary clinical practice, one can find elements of both naturopathic and allopathic philosophy among all types of providers.[14] The degree to which a practitioner emphasizes different tenets of these philosophies is one factor that determines the manner in which they practice.
Chiropractic Perspectives That Reflect a Holistic Approach to Patient Care
noninvasive, emphasizes patient's inherent recuperative abilities
recognizes dynamics between lifestyle, environment, and health
emphasizes understanding the cause of illness in an effort to eradicate, rather than palliate, associated symptoms
recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body
appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system
balances the benefits against the risks of clinical interventions
recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
prevents unnecessary barriers in the doctor-patient encounter
emphasizes a patient-centered, hands-on approach intent on influencing function through structure
strives toward early intervention, emphasizing timely diagnosis and treatment of functional, reversible conditions
Source:AHCPR Chapter 2 Chiropractic Belief Systems, Robert D. Mootz DC; Reed B. Phillips DC, PhD
The Chiropractic approach to healthcare stresses the importance of prevention. Former president of National College of Chiropractic, Joseph Janse DC (1909-1985) explains:
"Unless pathology is demonstrable under the microscope, as in the laboratory or by roentgenograms, to them [allopaths] it does not exist. For years the progressive minds in chiropractic have pointed out this deficiency. With emphasis they [chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure. They pioneered the all-important principle that effective eradication of disease is accomplished only when it is in its functional (beginning) phase rather than its organic (terminal) stage. It has been their contention that in general the doctor, the therapist and the clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs as disease, and to think in terms of sick organs and not in terms of sick people. In other words, we have failed to contrast disease with health, and to trace the gradual deteriorization along the downward path, believing almost that mild departures from the physiological normal were of little consequence, until they were replaced by pathological changes..."
Most patients who visit a chiropractor do so initially with a chief complaint related to musculoskeletal problems (especially low back and neck pain), although most chiropractors say they concern themselves with the overall health of the patient. According to a survey by the National Center for Complementary and Alternative Medicine, in 2002, chiropractic was the fourth (7.5%) most commonly used Complementary and alternative medicine (CAM) therapy among adults in the USA.[21][22] The profession has evolved so that treatment consists of hundreds of different techniques.[23] The U.S. Department of Labor's Occupational Outlook Handbook said:
Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices.[24]
Most DCs are in private practice or work in small groups, employing chiropractic assistants as office staff and to perform therapeutic activities. They may also employ massage and physiotherapists as adjuncts to chiropractic care.
[edit] History
Main article: Chiropractic history
DD Palmer
DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing.[12]
Rev. Samuel Weed
Friend and Rev. Samuel Weed suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term "chiropractic." In 1896, DD added a school to his magnetic healing infirmary, and began to teach others his method. It would become known as Palmer School of Chiropractic (now Palmer College of Chiropractic), located in Davenport, Iowa.
[edit] Medicine vs. chiropractic
In September 1899, a medical doctor in Davenport, IA, named Heinrich Matthey started a campaign against drugless healers in Iowa. DD Palmer, whose school had just graduated its 7th student, insisted that his techniques did not need the same courses or license as medical doctors, as his graduates did not prescribe drugs or evaluate blood or urine. However, in 1906, Palmer was convicted for practicing medicine without a license. He chose to turn over his interests in the PSC to his son, BJ and wife, Mabel.
[edit] BJ Palmer re-develops chiropractic
BJ Palmer Developer of Chiropractic 1882-1961
BJ created the Universal Chiropractic Association (UCA) for the purpose of protecting its members by covering their legal expenses should they get arrested.[25] Its first case came in 1907, when Shegataro Morikubo DC of Wisconsin was charged with unlicensed practice of osteopathy. Morikubo was freed using the defense that chiropractic philosophy was different from osteopathic philosophy. The victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy, and BJ Palmer became the "Philosopher of Chiropractic".
[edit] Straight versus mixer
State laws to regulate and protect chiropractic practice were eventually introduced in all fifty states in the US, but it was a hard-fought struggle. Medical Examining Boards worked to keep all healthcare practices under their legal control, but an internal struggle among DCs on how to structure the laws significantly complicated the process. Initially, the UCA, led by BJ Palmer and armed with his philosophy, opposed state licensure altogether. Palmer feared that such regulation would lead to allopathic control of the profession.[26] The UCA eventually caved in, but BJ remained strong in the opinion that examining boards should be composed exclusively of chiropractors (not those who mixed chiropractic with other remedies). Mixers campaigned to alter education standards toward those of medical schools and consistent with the tenets of the medical profession while Palmer resisted any alteration in standards away from his conceptualization of the chiropractic profession.
[edit] The movement toward science
In 1975, the National Institutes of Health brought chiropractors, osteopaths, medical doctors and Ph.D. scientists together in a conference on spinal manipulation to develop strategies to study the effects of spinal manipulation. In 1978, the Journal of Manipulative & Physiological Therapeutics (JMPT) was launched, and in 1981 it was included in the National Library of Medicine's Index Medicus.[27] Joseph Keating dates the birth of chiropractic as a science to a 1983 commentary in the JMPT entitled "Notes from the (chiropractic college) underground" in which Kenneth F. DeBoer, then an instructor in basic science at Palmer College in Iowa, revealed the power of a scholarly journal (JMPT) to empower faculty at the chiropractic schools. DeBoer's opinion piece demonstrated the faculty's authority to challenge the status quo, to publicly address relevant, albeit sensitive, issues related to research, training and skepticism at chiropractic colleges, and to produce "cultural change" within the chiropractic schools so as to increase research and professional standards. It was a rallying call for chiropractic scientists and scholars.[27]
[edit] Wilk et al. vs the American Medical Association (AMA)
Main article: Wilk v. American Medical Association
Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner", and labeled chiropractic "an unscientific cult". Principle 3 of the AMA Principles of Medical Ethics stated:
"A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle."
A Chicago chiropractor, Chester A. Wilk, initiated an antitrust suit against the AMA and other medical associations in 1976 - Wilk et al. vs AMA et al..[28] The landmark lawsuit ended in 1987 when the US District Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this could not have been achieved in a manner less restrictive of competition, for instance by public education campaigns. The AMA lost its appeal to the Supreme Court, and had to allow its members to collaborate with DCs.[5]
Judge Susan Getzendanner, who presided over the Wilk case, said:
"Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country."
She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service." She said no "well designed, controlled, scientific study" had been done, and concluded "I decline to pronounce chiropractic valid or invalid on anecdotal evidence, even though "the anecdotal evidence in the record favors chiropractors."[5]
[edit] Safety
See also: Spinal adjustment#Safety issues
See also: Spinal manipulation#Safety issues
The World Health Organization states that when "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems."[29] The International Chiropractic Association (ICA) suggests that chiropractic is one of the safest health professions and chiropractors have some of the lowest malpractice insurance premiums in the health care industry.[30]
[edit] Scientific investigation of chiropractic
The Testable Principle
The Untestable Metaphor
Chiropractic Adjustment
Universal Intelligence
Restoration of structural integrity
Innate Intelligence
Improvement of Health Status
Body Physiology
Materialistic
Vitalistic
Operational definitions possible
Origin of Holism in chiropractic
lends itself to scientific inquiry
cannot be proved or disproved
Table 1. Two chiropractic system constructs.
Source: Phillips RB, Mootz RD. Contemporary chiropractic philosophy. In Haldeman S (ed). Principles and Practice of Chiropractic, 2nd Ed. Norwalk, CT: Appleton & Lange, 1992. Chart reprinted from Keating J (1995), D.D. Palmer's Forgotten Theories of Chiropractic[5]
Chiropractic researchers Robert Mootz and Reed Phillips suggest that, in chiropractic's early years, influences from both straight and mixer concepts were incorporated into its construct. They conclude that chiropractic has both materialistic qualities that lend themselves to scientific investigation and vitalistic qualities that do not (Table 1).
With relatively little federal funding, academic research in chiropractic has only recently become established in the USA. In 1994 and 1995, half of all grant funding to chiropractic researchers was from the US Health Resources and Services Administration (7 grants totaling $2.3 million). The Foundation for Chiropractic Education and Research (11 grants, $881,000) and the Consortium for Chiropractic Research (4 grants, $519,000) accounted for most of the rest. By 1997, there were 14 peer-reviewed chiropractic journals in English that encouraged the publication of chiropractic research, including The Journal of Manipulative and Physiological Therapeutics (JMPT), Topics in Clinical Chiropractic, and the Journal of Chiropractic Humanities. However, of these, only JMPT is included in Index Medicus. Research into chiropractic, whether from Universities or chiropractic colleges, is however often published in many other scientific journals.[31]
While there is still debate about the effectiveness of chiropractic for the many conditions in which it is applied, chiropractic seems to be most effective for acute low back pain and tension headaches.[32] When testing the efficacy of health treatments, double blind studies are considered acceptable scientific rigor. These are designed so that neither the patient nor the doctor knows whether they are using the actual treatment or a placebo (or "sham") treatment. However, chiropractic treatment involves a manipulation; "sham" procedures cannot be easily devised for this, and even if the patient is unaware whether the treatment is a real or sham procedure, the doctor cannot be unaware. Thus there may be "observer bias" - the tendency to see what you expect to see, and the potential for the patient to wish to report benefits to "please" the doctor. Similarly, it is often difficult to devise a sham procedure for surgical procedures, but it is not impossible. It is also a problem in evaluating treatments; even when there are objective outcome measures, the placebo effect can be very substantial. Thus, DCs have historically relied mostly on their own clinical experience and the shared experience of their colleagues, as reported in case studies, to direct their treatment methods. In this, they are not different to the practice in much of conventional medicine. [original research?]
There is evidence that spinal manipulation is effective for the treatment of acute low back pain, tension headaches and some musculoskeletal issues, but not all studies support this conclusion.[32] A systematic review of systematic reviews in 2006 by Ernst and Cantor concluded that "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."[33] In 2007, Ernst performed another review, drawing similar conclusions.[34] A commentary from a chiropractic and osteopathic journal disputed Ernst and Cantor's conclusion as, "..definitely not based on an acceptable quality review of systematic reviews and should be interpreted very critically by the scientific community, clinicians, patients, and health policy makers. Their conclusions are certainly not valid enough to discredit the large body of professionals utilizing spinal manipulation."[35]
One controlled trial showed a lowering of blood pressure in hypertensive patients similar to taking two blood-pressure lowering drugs at once[36] after alignment of the atlas vertebra.
Sociologist Leslie Biggs interviewed 600 Canadian DCs in 1997: while 86% felt that chiropractic methods needed to be validated, 74% did not believe that controlled clinical trials were the best way to evaluate chiropractic. Moreover, 68% believed that "most diseases are caused by spinal malalignment", although only 30% agreed that "subluxation was the cause of many diseases".[37]
Even when a valid mechanism of action is not determined, it is generally thought sufficient to present evidence showing benefit for the claims made. There is wide agreement that, where applicable, an evidence based medicine framework should be used to assess health outcomes, and that systematic reviews with strict protocols are important for objectively evaluating treatments. Where evidence from such reviews is lacking, this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been rigorously established.
A 2005 editorial in JMPT, "The Cochrane Collaboration: is it relevant for doctors of chiropractic?"[38] proposed that involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The collaboration has 11,500 contributors from more than 90 countries organized in 50 review groups. For chiropractic, relevant review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. The editorial states that, for example, "a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery..."
The Cochrane Collaboration did not find enough evidence to support or refute the claim that manual therapy (including, but not limited to, chiropractic) is beneficial for asthma. Carpal tunnel syndrome trials have not shown benefit from diuretics, non-steroidal anti-inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic and there is not enough evidence to show the effects of spinal manipulation (including, but not limited to, chiropractic) for painful menstrual periods. Bandolier found limited evidence that spinal manipulative therapy (including, but not limited to, chiropractic) might reduce the frequency and intensity of migraine attacks, but the evidence that spinal manipulation is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial for the treatment of migraine, although "spinal manipulative therapy might be worth trying for some patients with migraine or tension headaches."
According to Bandolier, a systematic review of a small, poor quality set of trials provided no convincing evidence for long-term benefits of chiropractic interventions for acute or chronic low back pain, despite some positive overall findings[39] but there might be some short-term pain relief, especially in patients with acute pain.[40] However, the BMJ noted in a study on long-term low-back problems "...improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear."[41] A 1994 study by the U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department of Health and Human Services endorses spinal manipulation for acute low back pain in adults in its Clinical Practice Guideline.
The first significant recognition of the appropriateness of spinal manipulation for low back pain was performed by the RAND Corporation. This meta-analysis concluded that some forms of spinal manipulation were successful in treating certain types of lower back pain. Some chiropractors claimed these results as proof of chiropractic hypotheses, but RAND's studies were about spinal manipulation, not chiropractic specifically, and dealt with appropriateness, which is a measure of net benefit and harms; the efficacy of chiropractic and other treatments were not explicitly compared. In 1993, Dr Shekelle rebuked some DCs for their exaggerated claims: ...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....[42]
There is conflict in the results of chiropractic research. For instance, many DCs claim to treat infantile colic. According to a 1999 survey, 46% of chiropractors in Ontario treated children for colic.[43] In 1999 a Danish randomized controlled clinical trial with a blinded observer suggested that there is evidence that spinal manipulation might help infantile colic.[44] However, in 2001, a Norwegian blinded study concluded that chiropractic spinal manipulation was no more effective than placebo for treating infantile colic.[45]
In 1997, historian Joseph Keating Jr described chiropractic as a "science, antiscience and pseudoscience", and said "Although available scientific data support chiropractic's principle intervention method (the manipulation of patients with lower back pain), the doubting, skeptical attitudes of science do not predominate in chiropractic education or among practitioners". He argued that chiropractic's culture has nurtured antiscientific attitudes and activities, and that "a combination of uncritical rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the value of various chiropractic techniques". However, in 1998, after reviewing the articles published in the JMPT from 1989-1996, he concluded,
"substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline."[46]
[edit] The Manga Report
The Manga Report was an outcomes-study funded by the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga. The Report supported the scientific validity, safety, efficacy, and cost-effectiveness of chiropractic for low-back pain, and found that chiropractic care had higher patient satisfaction levels than conventional alternatives. The report states that "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."[47]
[edit] Workers' Compensation studies
In 1998, a study of 10,652 Florida workers' compensation cases was conducted by Steve Wolk. He concluded that "a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors."[48] Similarly, a 1991 study of Oregon Workers' Compensation Claims examined 201 randomly selected workers' compensation cases that involved disabling low-back injuries: when individuals with similar injuries were compared, those who visited DCs generally missed fewer days of work than those who visited MDs.[49]
A 1989 study analyzed data on Iowa state records from individuals who filed claims for back or neck injuries. The study compared benefits and the cost of care from MDs, DCs and DOs, focusing on individuals who had missed days of work and who had received compensation for their injuries. Individuals who visited DCs missed on average 2.3 fewer days than those who visited MDs, and 3.8 fewer days than those who saw DOs, and accordingly, less money was dispersed as employment compensation on average for individuals who visited DCs.[50]
In 1989, a survey by Cherkin et al. concluded that patients receiving care from health maintenance organizations in the state of Washington were three times as likely to report satisfaction with care from DCs as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.[51]
[edit] American Medical Association (AMA)
In 1997, the following statement was adopted as policy of the AMA after a report on a number of alternative therapies.[52]
Specifically about chiropractic it said,
"Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."
In 1992, the AMA issued this statement:
"It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic. (V, VI)"[53]
[edit] British Medical Association
The British Medical Association notes that "There is also no problem with GPs [doctors] referring patients to practitioners in osteopathy and chiropractic who are registered with the relevant statutory regulatory bodies, as a similar means of redress is available to the patient."[54]
[edit] Practice styles and schools of thought
Contemporary chiropractic can be divided into several approaches to patient care: all are based on non-invasive, non-medication approaches, with many based on the use of manipulation as a treatment for mechanical musculoskeletal dysfunction of the spine and extremities. Most chiropractors advertise themselves as primary care doctors, and consider themselves part of "alternative health care," but there can be large differences between practitioners.[55] Those differences are reflected in the varied viewpoints of multiple national practice associations. While individual chiropractors may share the viewpoints of one or more organizations, most chiropractors are not members of any national organization.
[edit] Traditional Straight
Traditional Straight chiropractors are the oldest movement. They adhere to the philosophical principles set forth by DD and BJ Palmer; that vertebral subluxation leads to interference of the human nervous system and is a primary underlying risk factor for almost any disease. Straights adhere to the chiropractic diagnosis of subluxations, and view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Instead, patients are typically screened for "red flags" of serious disease, and treated based on a practitioner's preferred chiropractic technique. This stance against medical diagnosing has been a source of contention between mixers and straights, because accreditation standards mandate that differential diagnosis be taught in all chiropractic programs so that patient care is safe and relevant to their complaints. Additionally, several state chiropractic licensing boards mandate that patient complaints be diagnosed before receiving care. Traditional straights tend to share the viewpoints found in the International Chiropractors Association (ICA), as well as the Federation of Straight Chiropractors and Organizations (FSCO) and the World Chiropractic Alliance (WCA).
[edit] Mixer
Mixer chiropractors are an early offshoot of the straight movement. This branch originated from naturopathic, osteopathic, medical, and even chiropractic doctors who attended the Palmer College of Chiropractic and then re-organized the treatment system to include more diagnostic and treatment approaches. They eventually split from the traditional straight group and formed various other chiropractic schools including the National College of Chiropractic. Their treatments may include naturopathic remedies, physical therapy devices, or other Complementary and alternative medicine (CAM) methods. While still subluxation based, mixers also treat problems associated with both the spine and extremities, including musculoskeletal issues such as pain and decreased range of motion. Mixers describe vertebral subluxations as a form of joint dysfunction or osteoarthritis. Diagnosis is made after ruling out other known disorders and noting general signs of mechanical dysfunction in the spine. Mixers tend to share the viewpoints found in the American Academy of Chiropractic Physicians, the American Academy of Spine Physicians, and/or the American Chiropractic Association (ACA), and all the major groups in Europe are also members of the European Chiropractors Union.[56]
[edit] Objective Straight
Objective Straight chiropractors[57] are a minority group and a recent off-shoot of the traditional straights. This group is differentiated from traditional straights mainly by the claims made. While traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases, objective straights only focus on the correction of chiropractic vertebral subluxations. Like traditional straights, objective straights typically do not diagnose patient complaints. Their guiding principles are summed up as: "We do not want to diagnose and treat diseases, even diseases of the spine." and "We do not want chiropractic to be practiced as an alternative to medicine."[58] They also don't refer to other professionals, but do encourage their patients "to see a medical physician if they indicate that they want to be treated for the symptoms they are experiencing or if they would like a medical diagnosis to determine the cause of their symptoms."[59] Most objective straights limit treatment to spinal adjustments. Objective straights tend to share the viewpoints found in the Foundation for the Advancement of Chiropractic Education (F.A.C.E.).
[edit] Reform
Reform chiropractors are a minority group who advocate the use of palpation and manipulation to identify and treat osteoarthritis, painful joints, and other musculoskeletal problems. They do not subscribe to the Palmer philosophy of Innate Intelligence and vertebral subluxations, do not believe that spinal joint dysfunction causes organic or systemic disease, and tend not to use alternative medicine methods. They prefer to align themselves more with medical and osteopathic physicians in their views of disease causes, processes and responses to manipulative therapy. Reformers tend to share the viewpoints found in the National Association for Chiropractic Medicine.[60][61]
[edit] Manipulation under anesthesia
Main article: Manipulation under anesthesia
Manipulation under Anesthesia or MUA is spinal manipulation performed while the patient is under general anesthesia. This procedure is used in the hospital setting for patients whose condition is unresponsive to other forms of treatment.
[edit] Education, licensing, and regulation
Main articles: Chiropractic education, Chiropractic schools, Council on Chiropractic Education, and Federation of Chiropractic Licensing Boards
Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and two in Canada, and an estimated 70,000 chiropractors in the USA, 5000 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 50 other countries. In the USA and Canada, licensed individuals who practice chiropractic are commonly referred to as chiropractors, doctors of chiropractic (DC), or chiropractic physicians.
[edit] References
^ a b [http://www.cce-usa.org/2007%20STANDARDS.pdf Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status]. The Council on Chiropractic Education (January 2007). Retrieved on 2007-10-11.
^ Chiropractic Paradigm. Association of Chiropractic Colleges. Retrieved on 2007-10-11.
^ Federation of Chiropractic Licensing Boards, Questions and Answers about Professional Regulation and the Chiropractic Profession, Where are chiropractors regulated?, January 9, 2006.available online
^ Michel Tetrault, DC, Country Chiropractic Support, Chiropractic Diplomatic Corps. available online
^ a b c Wilk vs American Medical Association Summary
Dr. Winterstein testified that chiropractic has changed. And it has changed. And we suggest that one reason that it changed was because of the criticism of its bizarre methods. Now, do you hear in this courtroom anything about one cause/one cure? Sure don't. You hear about neuromusculo reasons, neuromusculo diagnosis, neuromusculo conditions. This is the new parlance. They have done away, for the most port, with the one cause/one cure. I understand there is one small element of chiropractic that still adheres to it. But it's not the major element. ... And they have improved ... Chiropractic, I think is still changing. It began really changing when the accrediting arm of the ACA (American Chiropractic Association), as opposed to the ICA (international Chiropractic Association), was accepted, was recognized by the Department of Education as the sole accrediting body for chiropractic.
^ Vivo M, Chiropractors as Primary Care Providers Dynamic Chiropractic, Jun 4, 2007, accessed October 14, 2007
^ Association of Chiropractic Colleges, Chiropractic Paradigm
^ a b McDonald W (2003) How Chiropractors Think and Practice: The Survey of North American Chiropractors. Institute for Social Research, Ohio Northern University
^ Homola S, "Chiropractic, Bonesetting, and Cultism",Chiropractic, Bonesetting, and Cultism (entire book on-line)
^ http://gov.oregon.gov/OBCE/pdfs/CE_conteducation.pdf
^ Oregon Chiropractic Licensing Information.
^ a b Palmer D.D., The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.
^ Keating J (1995), D.D. Palmer's Forgotten Theories of Chiropractic, A Presentation to the Canadian Memorial Chiropractic College
^ a b AHCPR Chapter II Chiropractic Belief Systems
^ Morgan L (1998) Innate intelligence: its origins and problems J Can Chir Ass 42:35-41 available online
^ Gatterman MI. Foundations of the Chiropractic Subluxation. Baltimore: Williams and Wilkins, 1988:6. referenced in
^ Rosner A (2006) Occam's razor and subluxation: a close shave, Dynamic Chiropractic Aug 2006
^ Nelson CF, Lawrence DJ, Triano JJ, Bronfort G, Perle SM, Metz RD, Hegetschweiler K, La Brot T. Chiropractic as spine care: a model for the profession. Chiropr Osteopat. 2005;13:9. doi: 10.1186/1746-1340-13-9. available online
^ Undergraduate and Graduate Programs, Canadian Memorial Chiropractic CollegePDF online
^ Black D (1990)Inner Wisdom: The Challenge of Contextual Healing. Springville, UT: Tapestry Press
^ More Than One-Third of U.S. Adults Use Complementary and Alternative Medicine, According to New Government Survey (Press Release), May 27 2004, available online
^ Complementary and Alternative Medicine Use Among Adults: United States, 2002 (Report), May 27 2004, available online (PDF format)
^ Burton, Bernard. "Chiropractic Management of Low Back Pain" Cleveland Clinic: Spinal Care 2000 Symposium. March 30, 2000.
^ Bureau of Labor Statistics, Occupational Outlook Handbook
^ Keating J. (1999), Tom Moore Defender of Chiropractic Part 1, Dynamic Chiropractic
^ Phillips R (1998), Education and the Chiropractic Profession, Dynamic Chiropractic
^ a b Keating J Faulty Logic & Non-skeptical Arguments in Chiropractic
^ Robbins J (1996),Medical monopoly: the game nobody wins - excerpt from 'Reclaiming Our Health: Exploding the Medical Myth and Embracing the Source of True Healing', Vegetarian Times available online
^ WHO guidelines on basic training and safety in chiropractic, World Health Organization, Geneva, 2005. ISBN 92-4-159371-7. available online
^ ICA website
^ Chirofind.com Chiropractic Research
^ a b McCrory DC, et al. (2001) Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke University Evidence-Based Practice Center, Durham, North Carolina available online (PDF format)
^ Ernst E (2006) A systematic review of systematic reviews of spinal manipulation J R Soc Med 99:192-6 Available on-line
^ E Ernst Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007;100:330-338
^ G Bronfort, M Haas, Review conclusions by Ernst and Canter regarding spinal manipulation refuted, Chiropr Osteopat. 2006; 14: 14. [1]
^ Bakris, G. (2007) Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007 (May);21 (5):347–352 available online
^ Biggs L (2002) Measuring philosophy: a philosophy index'' JCCA
^ French S, Green S. "The Cochrane Collaboration: is it relevant for doctors of chiropractic?". J Manip Physiol Ther 28: 641-2. PMID 16326231.
^ http://www.jr2.ox.ac.uk/bandolier/booth/painpag/Chronrev/muscskel/CP092.html
^ Assendelft WJJ et al. (1996). "The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling". J Manip Physiol Ther 19: 499-507. PMID 16326231.
^ Meade et al. (1995). "The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling". Brit Med J. PMID 16326231.
^ Shekelle PM (1993) RAND misquoted. ACA J Chir 30:59–63
^ Verhoef MJ, Costa Papadopoulos C. Survey of Canadian chiropractors’ involvement in the treatment of patients under the age of 18. [2]
^ Wiberg JMM et al. (1999) The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. J Manip Physiol Ther 22:517-22[3]
^ Olafsdottir E et al. (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child 84:138-141. [4]
^ Keating J et al. (1998). "A descriptive analysis of the Journal of Manipulative and Physiological Therapeutics, 1989-1996". J Manip Physiol Ther 21: 539-52. PMID 9798183.
^ Manga P, Angus D. (1998) Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services. Retrieved 08 29 2006, from OCA
^ Wolk S. (1988) An analysis of Florida workers' compensation medical claims for back-related injuries. J Amer Chir Ass 27:50-59
^ Nyiendo J. (1991) Disability low back Oregon workers' compensation claims. Part II: Time loss. J Manip Physiol Ther 14:231-239
^ Johnson M. (1989) A comparison of chiropractic, medical and osteopathic care for work-related sprains/strains. J Manip Physiol Ther 12:335-344
^ Cherkin CD, MacCornack FA, Berg AO (1988) Managing low back pain. A comparison of the beliefs and behaviours of family physicians and chiropractors.West J Med 149:475–480
^ http://www.ama-assn.org/ama/pub/category/13638.html
^ http://www.ama-assn.org/ama/pub/category/8332.html
^ British Medical Association, Referrals to complementary therapists
^ James W. Healey, DC (1990) It's Where You Put the Period. Dynamic Chiropractic, October 10, 1990, Volume 08, Issue 21
^ Souza T (2005) Differential Diagnosis and Management for the Chiropractor, Third Edition : Protocols and Algorithms Jones and Bartlett Publishers Inc. 3rd edition
^ Position Paper One - What is Objective Straight Chiropractic?
^ F.A.C.E. three guiding principles
^ Position Paper Five - Referral
^ "The Skeptical Inquirer magazine blasts chiropractic as unscientific 'societal problem'", The Chiropractic Journal, January 1988. Retrieved on 2007-06-07.
^ "Berkeley newsletter says: 'Be wary of chiropractors'", The Chiropractic Journal, October 1992. Retrieved on 2007-06-07.
Saturday, November 17, 2007
Ayurveda
Ayurveda
Chiropractic
Herbalism
Homeopathy
Naturopathic medicine
Osteopathy
Traditional Chinese medicine
Unani
NCCAM classifications
Alternative Medical Systems
Mind-Body Intervention
Biologically Based Therapy
Manipulative and body-based methods
Energy Therapy
See also
Alternative medicine
Complementary and alternative medicine
Complementary medicine
Glossary of alternative medicine
Ayurveda (Devanagari: आयुर्वेद) or Ayurvedic medicine is an ancient system of health care that is native to the Indian subcontinent. It is presently in daily use by millions of people in India, Nepal, Sri Lanka and indirectly through it being the major influence on Unani, Chinese and Tibetan Medicine[citation needed]. The word "Ayurveda" is a tatpurusha compound of the word āyus meaning "life" or "life principle", and the word veda, which refers to a system of "knowledge". Thus "Ayurveda" roughly translates as the "knowledge of life". According to Charaka Samhita, "life" itself is defined as the "combination of the body, sense organs, mind and soul, the factor responsible for preventing decay and death, which sustains the body over time, and guides the processes of rebirth" [1][2] According to this perspective, Ayurveda is concerned with measures to protect "ayus", which includes healthy living along with therapeutic measures that relate to physical, mental, social and spiritual harmony. Ayurveda is also one among the few traditional systems of medicine to contain a sophisticated system of surgery (which is referred to as "salya-chikitsa").
Contents[hide]
1 Overview
2 Eight Branches (Ashthanga) of Ayurveda
3 History
4 Development
4.1 Gurukul system of Ayurveda
5 Tridosha system
6 Ayurvedic tastes
7 Medications
8 Panchakarma and Ayurvedic massage
9 Current status
9.1 Ayurvedic institutions and practitioners
9.2 Practice in the West
10 Criticisms
10.1 Scientific studies and standards
10.2 Safety concerns
10.3 "Miracle Cures"
11 See also
12 References
13 External links
//
[edit] Overview
According to the Ayurvedavatarana (the "descent of Ayurveda"), the origin of Ayurveda is stated to be a divine revelation of the ancient Indian creator God Lord Brahma[3] as he awoke to recreate the universe. This knowledge was passed directly to Daksha Prajapati in the form of shloka sung by Lord Brahma.[4], and this was in turn passed down through a successive chain of deities to Lord Indra, the protector of dharma. According to this account, the first human exponent of Ayurveda was Bharadvaja, who learned it directly from Indra. Bharadvaja in turn taught Ayurveda to a group of assembled sages, who then passed down different aspects of this knowledge to their students. According to tradition, Ayurveda was first described in text form by Agnivesha, in his book the Agnivesh tantra. The book was later redacted by Charaka, and became known as the Charaka Samhitā.[5] Another early text of Ayurveda is the Sushruta Samhitā, which was compiled by Sushrut, the primary pupil of Dhanvantri, sometime around 1000 BCE. Dhanvantri is known as the Father of Surgery, and in the Sushrut Samhita, the teachings and surgical techniques of Dhanvantri are compiled and complemented with additional findings and observations of Sushrut regarding topics ranging from obstetrics and orthopedics to ophthalmology. Sushrut Samhita together with Charaka Samhitā, served as the textual material within the ancient Universities of Takshashila and Nalanda.[6] These texts are believed to have been written around the beginning of the Common Era, and are based on a holistic approach rooted in the philosophy of the Vedas and Vedic culture. Holism is central to ayurvedic philosophy and elements of holism is found in several aspects of ayurveda.[7]
[edit] Eight Branches (Ashthanga) of Ayurveda
The eight branches of Ayurveda are:
Internal medicine - Kayachikitsa
Surgery - Shalya Tantra
Ears, eyes, nose and throat - Shalakya tantra
Pediatrics - Kaumarabhritya Tantra
Toxicology - Agada Tantra
Purification of the genetic organs - Bajikarana (or Vajikarana) Tantra
Health and Longevity - Rasayana Tantra
Spiritual Healing/Psychiatry - Bhuta Vidya
See also: The Eight Armed Ayurveda
[edit] History
A statue of the Hindu God, Brahma. Hinduism believes in the divine origin of Ayurveda
Dhanvantari, the God of Ayurveda
Nagarjuna, a follower of Buddha, was a well known herbologist, known for inventing various new drugs for the treatment of ailments
Documented references to the precise timing of the origins of Ayurveda are not available. The age of Ayurveda has been established on the basis of correlating the evidence with other disciplines as well as circumstantial evidence. Ayurveda is said to have been first compiled as a text by Agnivesha, in his book Agnivesh tantra, which was written during Vedic times.[citation needed] The book was later revised by Charaka, and renamed to Charaka Samhitā (encyclopedia of the physician Charaka).[8] Other early texts of Ayurveda include the Charaka Samhitā and the Sushruta Samhitā[6] The system was orally transferred via the Gurukul system until a script came into existence.
The earliest scripts would have been written on perishable materials such as Taalpatra and Bhojapatra, which could not be readily preserved.[citation needed] The script was later written on stone and copper sheets.[citation needed] Verses dealing with Ayurveda are included in the Atharvaveda, which implies that some form of Ayurveda is as old as the Vedas.[citation needed] Ayurvedic practices have also evolved over time, and some practices may be considered innovations upon earlier Vedic practices, such as the advances made during the Buddhist period in India. [citation needed]
Hinduism attributes the genesis of Ayurveda to several theories in which the knowledge is believed to have been passed on from being to being, initially, through its realization by the divine sages, and gradually into the human sphere by a complex system of mnemonics. Details of Ayurvedic traditions vary between writers, as is expected when oral traditions are transcribed from multiple sources. The earliest authors of Ayurvedic manuscripts recorded divergent forms of the tradition.
The schools of treatment
According to Hindu mythology, three illustrious sages were the pioneer students of Ayurveda. They were,
1. Divodasa Dhanwantari 2. Punarvasu Artreya 3. Kashyapa
Divodasa Dhanwantari and his disciples specialized in Salyachikitsa (surgery) and formed the school of surgery. His important students included Sushruta, Aupadhenava, Vaitarana, Aurabhadra, Pushkalavata, Nimi, Kara, Karaveerya, Gopurarakshita, Bhoja, Kankayana, Galava and Gargava.
Punarvasu Artreya, who was the disciple of Bharadwaja had seven pupils – Agnivesa, Charaka, Bhela, Jatukarna, Parasara, Hareeta and Ksharapaani. They were called the Artreya School of physicians and specialized in Kayachikitsa (general medicine). The Kashyapa School specialized in Kumarabhrutya (paediatrics). Foremost among Kashyapa’s students was Vruddha (the elder) Jeevaka who wrote Kashyapa Samhita. His other disciples were Vasishta, Atri, Bhrigu, Jeevaka, Parvataka and Bandhaka.
Historical evidence
The history of indigenous Indian medical science is probably as old as the Indus Valley Civilisation dating back to 3000 BC. The meticulously planned cities of Harappa and Mohenjodaro are pointers not only to India’s rich cultural heritage but also to its advanced systems of hygiene and health care. The remains of deer antler and bitumen found in Harappa testify to the existence of a medical science. It was between 1200 and 700 BC, subsequent to the Aryan invasion, that the four sacred Vedas were composed. References to diseases, herbs and herbal cures can be seen in all the four Vedas especially in the Rig Veda.
The Atharva Veda has many hymns eulogizing herbs. Many plants were worshipped as deities and invoked by incantations. There were also many Mantras (invocations) to combat jaundice, consumption and hereditary diseases among others. The Atharvan hymns chanted for the cure of diseases were known as Bhaishajyams and those for attaining longevity and prosperity were called Ayushyams. These hymns, especially the Ayushyams are considered to be the foundation for advances in later medicine.
[edit] Development
Ayurvedic practice was flourishing during the time of Buddha (around 520 BC) , and in this period the Ayurvedic practitioners were commonly using Mercuric-sulphur combination based medicines.[9] In this period mercury, sulphur and other metals were used in conjunction with herbs to prepare the different medications.[citation needed] An important Ayurvedic practitioner of this period was Nagarjuna, a Buddhist herbologist, famous for inventing various new drugs for the treatment of ailments. [citation needed] Nagarjuna was accompanied by Surananda, Nagbodhi, Yashodhana, Nityanatha, Govinda, Anantdev, Vagbhatta etc. The knowledge of Ayurveda progressed a lot during this period, including development of newer and more effective medicines, and is therefore termed as the Golden Period of Ayurveda.[citation needed]
After emerging victorious at the Kalinga War, Emperor Ashoka (304 BC-232 BC) influenced by the Buddhist teachings, banned any bloodshed in his kingdom in 250 BC. Therefore many Ayurveda practitioners, who were practicing surgery along with medicine, left the surgical intervention and adopted totally new medicinal treatments. In this period, Ayurveda again evolved and flourished with the invention of new drugs, new methodology and new innovations. The practice of the accompanying surgery slowly died out during this period.[citation needed]
During the regime of Chandragupta Maurya (375-415 AD), Ayurveda was part of mainstream Indian medical techniques, and continued to be so until the colonisation by the British.
Chakrapani Dutta (DuttaSharma) was a Vaid Brahman of Bengal who wrote books on Ayurveda such as "Chakradutta" and others. Chakrapani Dutta was the Rajavaidya of Great King Laxman Sen {some says rajVaid of King Nayapala (1038 - 1055)}. It is believed by some practitioners that Chakradutta is the essence of Ayurveda.
Ayurveda has always been preserved by the people of India as a traditional "science of life", despite increasing adoption of European medical techniques during the time of British rule. For several decades the reputation and skills of the various Ayurvedic schools declined markedly as Western medicine and Western-style hospitals were built. However, beginning in the 1970s, a gradual recognition of value of Ayurveda returned, and today Ayurvedic hospitals and practitioners are flourishing throughout all of India. As well, the production and marketing of Ayurvedic herbal medicines has dramatically increased, as well as scientific documentation of benefits. Today, Ayurvedic medicines are available throughout the world.
See also: The Eight Armed Ayurveda
[edit] Gurukul system of Ayurveda
In the earlier days of its conception, the system of Ayurvedic medicine was orally transferred via the Gurukul system until a written script came into existence.
In this system, the Guru gave a solemn address where he directed the students to a life of chastity, honesty, and vegetarianism. The student was to strive with all his being to heal the sick. He was not to betray patients for his own advantage. He was required to dress modestly and avoid alcohol or drugs. He was to be collected and self-controlled, measured in speech at all times. He was to constantly improve his knowledge and technical skill. At the patient's home, he was to be courteous and modest, directing all attention to the patient's welfare. He was not to divulge any knowledge about the patient and his family. If the patient was incurable, he was to keep this to himself if it was likely to harm the patient or others.
The normal length of the student's training appears to have been seven years. Before graduation, the student was to pass a test. But the physician was to continue to learn through texts, direct observation (pratyaksha), and through inference (anumāna). In addition, the vaidyas attended meetings where knowledge was exchanged. The practitioners also gained knowledge of unusual remedies from laypeople who were outside the huffsteter community such as hillsmen, herdsmen, and forest-dwellers.
See also: Teachings of Ayurveda
[edit] Tridosha system
The central concept of Ayurvedic medicine is the theory that health exists when there is a balance between three fundamental bodily humours or doshas called Vata, Pitta and Kapha.
Vata is the impulse principle necessary to mobilize the function of the nervous system
Pitta is the energy principle which uses bile to direct digestion and hence metabolism into the venous system.
Kapha is the body fluid principle which relates to mucous, lubrication and the carrier of nutrients into the arterial system.
All Ayurvedic physicians believe that these ancient ideas, based in the knowledge discovered by the Rishis and Munis, exist in harmony with physical reality. These Ayurvedic concepts allow physicians to examine the homeostasis of the whole system. People may be of a predominant dosha or constitution, but all doshas have the basic elements within them.
The philosophy of Ayurveda
The emergence of different schools of Sanskrit philosophy like Nyaya, Vaisheshika, Sankhya, Yoga, Vedanta and Mimamsa was another landmark in the history of Indian medicine. The principles expounded in these philosophies facilitated the development within Ayurveda of its theory of humoral pathology which propounds that the human body is composed of Tridoshas, the three humors – Vata, Pitta and Kapha. When these are in equilibrium they are called the Tridhatus. The body in which these three humors are in a state of equilibrium enjoys perfect health; their disequilibrium causes ill health.
Disease management in Ayurveda
The principles of Ayurvedic pharmacology are fundamentally different from those of other systems of medicine, especially evidence-based medicine. Most Ayurvedic medicines are prepared form herbs.
Shamana and Shodhana are the two concepts of disease management in Ayurveda. Shamana means alleviation. Shamana methods mitigate the disease and its symptoms. Shodhana means elimination and Shodhana methods aim at the elimination of the basic cause of disease.
[edit] Ayurvedic tastes
Ayurveda holds that the tastes of foods or herbs have specific physiological effects. Those tastes that transform after digestion (Vipaka) are more powerful.
Sweet - Madhura
Sweet foods nourish, cool, moisten, oil, and increase weight
Sour - Amla
Sour foods warm, oil, and increase weight
Salty - Lavan
Salty foods warm, dissolve, stimulate, soften, oil, and increase weight
Bitter - Katu
Bitter foods cool, dry, purify and decrease weight
Pungent - Tikta
Pungent foods warm, dry, stimulate, and decrease weight
Astringent - Kasaya
Astringent foods cool, dry, reduce stickiness.
[edit] Medications
Ayurvedic practitioners believe that the tulsi (holy basil) plant has medicinal qualities
Ayurveda operates on the precept that various materials of vegetable, animal, and mineral origin have some medicinal value. The medicinal properties of these materials have been documented by the practitioners and have been used for centuries to cure illness and/or help maintain good health. Ayurvedic medicaments are made from herbs or mixtures of herbs, either alone or in combination with minerals, metals and other ingredients of animal origin. The metals, animals and minerals are purified by individual processes before being used for medicinal purposes.
Writers and compilers of Ayurvedic literature such as Charaka, Sushruta, Vagabhatta, Bhav Mishra, Shaligram and others have written about the qualities, characteristics and medicinal uses of the herbs, mineral, metals, chemicals, animal parts, cooked food articles, natural foods, fruits etc. Among them, the Bhav Prakash Nighantu, written by Bhav Mishra, is known for its detail .The composition of the Nighantu part (Ayurvedic Materia Medica) of the Bhav Prakash is part of the classical book. The details of the medicinal herbs are given according to the nature, effects, and curative properties as observed by the Ayurvedic practitioners.
Ayurvedic literature has been written by several authors in languages such as Sanskrit, Hindi, Kannada, Tamil, Telugu and more recently, in English.The Shaligram Nighantu was written in Sanskrit. The Banaushadhi Chandrodaya was written in Hindi.The Indian Materia Medica was written in English.
See also: List of herbs and minerals in Ayurveda
[edit] Panchakarma and Ayurvedic massage
Panchakarma (the five actions or modalities) is a collection of purification techniques that Ayurveda prescribes for some diseases and for periodic cleansing. A course of Pancharkarma typically includes a short-term dietary prescription, massage, herbs, and may include purgatives, sweat baths, medicated enemas, and nasal cleansing.
Ayurvedic massage is a form of treatment for various age related and other common disorders. Some of the advantages which can be cited are pain relief, improved circulation, stress relief, better sleep, flexibility, athletic performance and emotional benefits [citation needed]. Massage therapy can soothe pain, relax stiff muscles, and reduce the swelling that accompanies arthritis [citation needed]. Advocates claim that, with ayurvedic massage, deep-seated toxins in the joints and tissues are loosened and released into the system for elimination through natural toxin-release processes.[10]. There are several different types of ayurvedic treatments such as panchakarma, marma massage and abhyangam.[11] Ayurvedic massage is especially developed in Sri Lanka and the Indian state of Kerala.
See also: Panchakarma
[edit] Current status
In the early 20th century, Ayurvedic physicians began to organize into professional associations and to promote their case for national recognition and funding.[citation needed] This began to become a reality after Indian independence in 1947.[citation needed]
Ayurveda is now a statutory, recognised medical system of health care like other medical systems existing in India. The Central Council of Indian Medicine {CCIM} governs and recommends policies for the research and development of the system. An Encyclopedia on Ayurveda - Ayushveda.com[2] has been developed to promote the knowledge of Ayurveda worldwide.
In India, practitioners in Ayurveda undergo 5 and 1/2 years of training including 1 year of internship in select Ayurveda Medical Schools wherein they earn the professional doctorate degree of Bachelor of Ayurvedic Medicine and Surgery[B.A.M.S.]. A Bachelor's degree with a major in Science [Physics, Chemistry, Biology] and a minor in Sanskrit is desirable for candidates interested in taking up the course.
Select institutions like the Banaras Hindu University, Varanasi, offer higher doctorates and postgraduate training such as MD [Ayurveda] which includes a 3 year residency and a dissertation similar to the MD/MS degrees in modern systems of medicine.
[edit] Ayurvedic institutions and practitioners
Ayurvedic practitioners have been appointed as Honorary Ayurvedic Physician to the President of India. Every year on the occasion of Dhanvantari jayanti, a prestigious Dhanvantari Award is conferred on a famous personality of Medical Sciences including Ayurveda. Kerala is the leading state in India that promotes research and practices of Ayurveda. This has been attributed to Kerala's well established Ayurveda centers, Ayurveda pharmaceutical companies, and Ayurveda medical colleges. For example, there are many Ayurvedic centers (known as Vaidya shalas) all over Kerala. Besides Kerala, others also promoting Ayurveda are Gujarat, Maharastra, and Karnataka.
[edit] Practice in the West
As a result of strong regulations in medical practice in Europe and America, the most commonly practiced Ayurvedic treatments in the west are massage and dietary and herbal advice.
In the United States, the National Institute of Ayurvedic Medicine (established by Scott Gerson) is an example of a research institute that has carried out research into Ayurvedic practices.[12] Gerson has published part of his work on the antifungal activities of certain Ayurvedic plants in medical journals.[13]
Several Pharmecutical companies and Academic Institutions in the west have come into conflict with Indian academic institutions and traditional Ayurvedic practitioners over the intellectual property rights of herbal products researched by the western agencies. The Ayurvedic practitioners have known about the efficacy of such products for centuries and so contend that they carry precedence with regards to patent rights on such products.
On December 1993, the University of Mississippi Medical Center had a patent issued to them by U.S patents and trademarks office on the use of turmeric (U.S. patent No. 5,401,504) for healing. The patent was contested by India's industrial research organization, Council for Scientific and Industrial Research (C.S.I.R), on the grounds that traditional Ayurvedic practitioners were already aware of the healing properties of the substance and have been for centuries, making this patent a case of bio-piracy.[14]
After a complex legal battle, the U.S. Patents and Trademarks Office ruled on August 14, 1997 that the patent was invalid because it was not a novel invention, giving the intellectual property rights to the principle back to the traditional practitioners of Ayurveda. R. A. Mashelkar, director-general of the CSIR, was satisfied with the result, saying:
"This success will enhance the confidence of the people and help remove fears about India's helplessness on preventing bio-piracy and appropriation of inventions based on traditional knowledge[14]"
The turmeric patent was just one of the hundreds that the several academic organizations and Pharmecutical companies in the west have claimed by ignoring Ayurvedic knowledge. Vandana Shiva, a global campaigner for a fair and honest Intellectual Property Rights system, says patents on herbal products derived from Neem, Amla, Jar Amla, Anar, Salai, Dudhi, Gulmendhi, Bagbherenda, Karela, Erand, Rangoon-kibel, Vilayetishisham and Chamkura also need to be revoked.[14]
Seven American and four Japanese firms have filed for grant of patents on formulations containing extracts of the herb Ashwagandha. Fruits, leaves and seeds of the Indian medicinal plant withania somnifera have been traditionally used for the Ayurvedic system as aphrodisiacs, diuretics and for treating memory loss. The Japanese patent applications are related to the use of the herb as a skin ointment and for promoting reproductive fertility. The U.S based company Natreon has also obtained a patent for an Ashwagandha extract. Another US establishment, the New England Deaconess Hospital, has taken a patent on an Ashwagandha formulation claimed to alleviate symptoms associated with arthritis. It is clear that the Ashwagandha plant is catching the attention of scientists and more patents related to Ashwagandha are being filed or granted by different patent offices since 1996.[15]
Ayurvedic wisdom originated in the main Vedas as a part of way of life - a spiritual connection with spirit and nature. This is most evident reading Atharva Veda. Ayurveda was used to remove obstacles on one’s path to Self-Realization. At some point the medical aspects began to take priority over the spiritual forms of healing (ie, focusing on lifestyle, dharma and moksha. Today, these spiritual aspects of Ayurveda have taken a back seat to the medical focus. As Ayurveda becomes a more commercially viable career, the spiritual aspects may continue to lose ground. Yet there are a growing number of practitioners who practice mainly these spiritual therapies and find better results than limiting their approach to the medical, physical realm.
[edit] Criticisms
[edit] Scientific studies and standards
Critics object to the lack of rigorous scientific studies and clinical trials of many ayurvedic products. The National Center for Complementary and Alternative Medicine states that "most clinical trials of Ayurvedic approaches have been small, had problems with research designs, lacked appropriate control groups, or had other issues that affected how meaningful the results were."[16]
In India, scientific research in Ayurveda is largely undertaken by the statutory body of the Central Government, the Central Council for Research in Ayurveda and Siddha (CCRAS), through a national network of research institutes.[17] A large number of non-governmental organisations are also conducting research work on different aspects of Ayurveda[3]. However, "even staunch advocates of Ayurveda like cardiologist Dr. M.S. Valiathan...admit that 'clinical studies that would satisfy the liberal criteria of WHO World Health Organisation have been alarmingly few from India, in spite of patients crowding in Ayurvedic hospitals"'.[16]
[edit] Safety concerns
There is evidence that using some ayurvedic medicine, especially those involving herbs, metals, minerals, or other materials involves potentially serious risks, including toxicity.[18][3][19]
A research study published in the Journal of the American Medical Association[20] found significant levels of toxic heavy metals such as lead, mercury and arsenic in 20% of Ayurvedic preparations that were made in South Asia for sale in America. The Journal found that, if taken according to the manufacturers' instructions, this 20% of remedies "could result in heavy metal intakes above published regulatory standards"[20] Similar studies have been performed in India, and have confirmed these results. Cases of metal toxicity from use of ayurvedic medicines are well known.[21] Some practitioners claimed that "heavy metals are integral to some formulations and have been used for centuries. There is no point of doing trials as they have been used safely and have mention in our ancient texts."[21]
There is a technique of detoxification applied to heavy metals and toxic herbs called samskaras, which is similar to the Chinese pao zhi although the Ayurvedic technique is more complex and may involve prayers as well as physical pharmacy techniques.[22] A study of the effectiveness of the Ayurvedic samskaras was printed in the Journal of Postgrad Medicine[23]:
Crude aconite is an extremely lethal substance. However, the science of Ayurveda looks upon aconite as a therapeutic entity. Crude aconite is always processed i.e. it undergoes 'samskaras' before being utilised in the Ayurvedic formulations. This study was undertaken in mice, to ascertain whether 'processed' aconite is less toxic as compared to the crude or unprocessed one. It was seen that crude aconite was significantly toxic to mice (100% mortality at a dose of 2.6 mg/mouse) whereas the fully processed aconite was absolutely non-toxic (no mortality at a dose even 8 times as high as that of crude aconite). Further, all the steps in the processing were essential for complete detoxification.[24]
The described detoxification is a simple chemical process which involves four successive rounds of boiling the crude root in cow's urine (twice) and cow's milk (twice). This process is claimed to chemically modify both toxic and proposed therapeutic components of the root. It also extracts some of these compounds from the root into the boiling solvents, thereby decreasing their concentration in the final product.
It should also be noted that, while these washes appear to ameliorate the toxicity of the crude root, examinations of finished remedies still exhibit high toxicity and there is no evidence that the processed root has any therapeutic value. A search of the Citation Index, via Web of Science (isiknowledge.com), returned no mention of any therapeutic value for aconite. However, the literature is replete with instances of aconite poisoning, though no mention of specific processing is made in these poisoning cases.
[edit] "Miracle Cures"
Some critics also question the safety of those Ayurvedic drugs that are said to provide "Miracle Cures". [25] The critics argue that simply following age-old Ayurvedic formulas is no guarantee of safety and the fundamental processes and concepts on which these ancient processes are based must be exposed to serious scientific scrutiny.
Chiropractic
Herbalism
Homeopathy
Naturopathic medicine
Osteopathy
Traditional Chinese medicine
Unani
NCCAM classifications
Alternative Medical Systems
Mind-Body Intervention
Biologically Based Therapy
Manipulative and body-based methods
Energy Therapy
See also
Alternative medicine
Complementary and alternative medicine
Complementary medicine
Glossary of alternative medicine
Ayurveda (Devanagari: आयुर्वेद) or Ayurvedic medicine is an ancient system of health care that is native to the Indian subcontinent. It is presently in daily use by millions of people in India, Nepal, Sri Lanka and indirectly through it being the major influence on Unani, Chinese and Tibetan Medicine[citation needed]. The word "Ayurveda" is a tatpurusha compound of the word āyus meaning "life" or "life principle", and the word veda, which refers to a system of "knowledge". Thus "Ayurveda" roughly translates as the "knowledge of life". According to Charaka Samhita, "life" itself is defined as the "combination of the body, sense organs, mind and soul, the factor responsible for preventing decay and death, which sustains the body over time, and guides the processes of rebirth" [1][2] According to this perspective, Ayurveda is concerned with measures to protect "ayus", which includes healthy living along with therapeutic measures that relate to physical, mental, social and spiritual harmony. Ayurveda is also one among the few traditional systems of medicine to contain a sophisticated system of surgery (which is referred to as "salya-chikitsa").
Contents[hide]
1 Overview
2 Eight Branches (Ashthanga) of Ayurveda
3 History
4 Development
4.1 Gurukul system of Ayurveda
5 Tridosha system
6 Ayurvedic tastes
7 Medications
8 Panchakarma and Ayurvedic massage
9 Current status
9.1 Ayurvedic institutions and practitioners
9.2 Practice in the West
10 Criticisms
10.1 Scientific studies and standards
10.2 Safety concerns
10.3 "Miracle Cures"
11 See also
12 References
13 External links
//
[edit] Overview
According to the Ayurvedavatarana (the "descent of Ayurveda"), the origin of Ayurveda is stated to be a divine revelation of the ancient Indian creator God Lord Brahma[3] as he awoke to recreate the universe. This knowledge was passed directly to Daksha Prajapati in the form of shloka sung by Lord Brahma.[4], and this was in turn passed down through a successive chain of deities to Lord Indra, the protector of dharma. According to this account, the first human exponent of Ayurveda was Bharadvaja, who learned it directly from Indra. Bharadvaja in turn taught Ayurveda to a group of assembled sages, who then passed down different aspects of this knowledge to their students. According to tradition, Ayurveda was first described in text form by Agnivesha, in his book the Agnivesh tantra. The book was later redacted by Charaka, and became known as the Charaka Samhitā.[5] Another early text of Ayurveda is the Sushruta Samhitā, which was compiled by Sushrut, the primary pupil of Dhanvantri, sometime around 1000 BCE. Dhanvantri is known as the Father of Surgery, and in the Sushrut Samhita, the teachings and surgical techniques of Dhanvantri are compiled and complemented with additional findings and observations of Sushrut regarding topics ranging from obstetrics and orthopedics to ophthalmology. Sushrut Samhita together with Charaka Samhitā, served as the textual material within the ancient Universities of Takshashila and Nalanda.[6] These texts are believed to have been written around the beginning of the Common Era, and are based on a holistic approach rooted in the philosophy of the Vedas and Vedic culture. Holism is central to ayurvedic philosophy and elements of holism is found in several aspects of ayurveda.[7]
[edit] Eight Branches (Ashthanga) of Ayurveda
The eight branches of Ayurveda are:
Internal medicine - Kayachikitsa
Surgery - Shalya Tantra
Ears, eyes, nose and throat - Shalakya tantra
Pediatrics - Kaumarabhritya Tantra
Toxicology - Agada Tantra
Purification of the genetic organs - Bajikarana (or Vajikarana) Tantra
Health and Longevity - Rasayana Tantra
Spiritual Healing/Psychiatry - Bhuta Vidya
See also: The Eight Armed Ayurveda
[edit] History
A statue of the Hindu God, Brahma. Hinduism believes in the divine origin of Ayurveda
Dhanvantari, the God of Ayurveda
Nagarjuna, a follower of Buddha, was a well known herbologist, known for inventing various new drugs for the treatment of ailments
Documented references to the precise timing of the origins of Ayurveda are not available. The age of Ayurveda has been established on the basis of correlating the evidence with other disciplines as well as circumstantial evidence. Ayurveda is said to have been first compiled as a text by Agnivesha, in his book Agnivesh tantra, which was written during Vedic times.[citation needed] The book was later revised by Charaka, and renamed to Charaka Samhitā (encyclopedia of the physician Charaka).[8] Other early texts of Ayurveda include the Charaka Samhitā and the Sushruta Samhitā[6] The system was orally transferred via the Gurukul system until a script came into existence.
The earliest scripts would have been written on perishable materials such as Taalpatra and Bhojapatra, which could not be readily preserved.[citation needed] The script was later written on stone and copper sheets.[citation needed] Verses dealing with Ayurveda are included in the Atharvaveda, which implies that some form of Ayurveda is as old as the Vedas.[citation needed] Ayurvedic practices have also evolved over time, and some practices may be considered innovations upon earlier Vedic practices, such as the advances made during the Buddhist period in India. [citation needed]
Hinduism attributes the genesis of Ayurveda to several theories in which the knowledge is believed to have been passed on from being to being, initially, through its realization by the divine sages, and gradually into the human sphere by a complex system of mnemonics. Details of Ayurvedic traditions vary between writers, as is expected when oral traditions are transcribed from multiple sources. The earliest authors of Ayurvedic manuscripts recorded divergent forms of the tradition.
The schools of treatment
According to Hindu mythology, three illustrious sages were the pioneer students of Ayurveda. They were,
1. Divodasa Dhanwantari 2. Punarvasu Artreya 3. Kashyapa
Divodasa Dhanwantari and his disciples specialized in Salyachikitsa (surgery) and formed the school of surgery. His important students included Sushruta, Aupadhenava, Vaitarana, Aurabhadra, Pushkalavata, Nimi, Kara, Karaveerya, Gopurarakshita, Bhoja, Kankayana, Galava and Gargava.
Punarvasu Artreya, who was the disciple of Bharadwaja had seven pupils – Agnivesa, Charaka, Bhela, Jatukarna, Parasara, Hareeta and Ksharapaani. They were called the Artreya School of physicians and specialized in Kayachikitsa (general medicine). The Kashyapa School specialized in Kumarabhrutya (paediatrics). Foremost among Kashyapa’s students was Vruddha (the elder) Jeevaka who wrote Kashyapa Samhita. His other disciples were Vasishta, Atri, Bhrigu, Jeevaka, Parvataka and Bandhaka.
Historical evidence
The history of indigenous Indian medical science is probably as old as the Indus Valley Civilisation dating back to 3000 BC. The meticulously planned cities of Harappa and Mohenjodaro are pointers not only to India’s rich cultural heritage but also to its advanced systems of hygiene and health care. The remains of deer antler and bitumen found in Harappa testify to the existence of a medical science. It was between 1200 and 700 BC, subsequent to the Aryan invasion, that the four sacred Vedas were composed. References to diseases, herbs and herbal cures can be seen in all the four Vedas especially in the Rig Veda.
The Atharva Veda has many hymns eulogizing herbs. Many plants were worshipped as deities and invoked by incantations. There were also many Mantras (invocations) to combat jaundice, consumption and hereditary diseases among others. The Atharvan hymns chanted for the cure of diseases were known as Bhaishajyams and those for attaining longevity and prosperity were called Ayushyams. These hymns, especially the Ayushyams are considered to be the foundation for advances in later medicine.
[edit] Development
Ayurvedic practice was flourishing during the time of Buddha (around 520 BC) , and in this period the Ayurvedic practitioners were commonly using Mercuric-sulphur combination based medicines.[9] In this period mercury, sulphur and other metals were used in conjunction with herbs to prepare the different medications.[citation needed] An important Ayurvedic practitioner of this period was Nagarjuna, a Buddhist herbologist, famous for inventing various new drugs for the treatment of ailments. [citation needed] Nagarjuna was accompanied by Surananda, Nagbodhi, Yashodhana, Nityanatha, Govinda, Anantdev, Vagbhatta etc. The knowledge of Ayurveda progressed a lot during this period, including development of newer and more effective medicines, and is therefore termed as the Golden Period of Ayurveda.[citation needed]
After emerging victorious at the Kalinga War, Emperor Ashoka (304 BC-232 BC) influenced by the Buddhist teachings, banned any bloodshed in his kingdom in 250 BC. Therefore many Ayurveda practitioners, who were practicing surgery along with medicine, left the surgical intervention and adopted totally new medicinal treatments. In this period, Ayurveda again evolved and flourished with the invention of new drugs, new methodology and new innovations. The practice of the accompanying surgery slowly died out during this period.[citation needed]
During the regime of Chandragupta Maurya (375-415 AD), Ayurveda was part of mainstream Indian medical techniques, and continued to be so until the colonisation by the British.
Chakrapani Dutta (DuttaSharma) was a Vaid Brahman of Bengal who wrote books on Ayurveda such as "Chakradutta" and others. Chakrapani Dutta was the Rajavaidya of Great King Laxman Sen {some says rajVaid of King Nayapala (1038 - 1055)}. It is believed by some practitioners that Chakradutta is the essence of Ayurveda.
Ayurveda has always been preserved by the people of India as a traditional "science of life", despite increasing adoption of European medical techniques during the time of British rule. For several decades the reputation and skills of the various Ayurvedic schools declined markedly as Western medicine and Western-style hospitals were built. However, beginning in the 1970s, a gradual recognition of value of Ayurveda returned, and today Ayurvedic hospitals and practitioners are flourishing throughout all of India. As well, the production and marketing of Ayurvedic herbal medicines has dramatically increased, as well as scientific documentation of benefits. Today, Ayurvedic medicines are available throughout the world.
See also: The Eight Armed Ayurveda
[edit] Gurukul system of Ayurveda
In the earlier days of its conception, the system of Ayurvedic medicine was orally transferred via the Gurukul system until a written script came into existence.
In this system, the Guru gave a solemn address where he directed the students to a life of chastity, honesty, and vegetarianism. The student was to strive with all his being to heal the sick. He was not to betray patients for his own advantage. He was required to dress modestly and avoid alcohol or drugs. He was to be collected and self-controlled, measured in speech at all times. He was to constantly improve his knowledge and technical skill. At the patient's home, he was to be courteous and modest, directing all attention to the patient's welfare. He was not to divulge any knowledge about the patient and his family. If the patient was incurable, he was to keep this to himself if it was likely to harm the patient or others.
The normal length of the student's training appears to have been seven years. Before graduation, the student was to pass a test. But the physician was to continue to learn through texts, direct observation (pratyaksha), and through inference (anumāna). In addition, the vaidyas attended meetings where knowledge was exchanged. The practitioners also gained knowledge of unusual remedies from laypeople who were outside the huffsteter community such as hillsmen, herdsmen, and forest-dwellers.
See also: Teachings of Ayurveda
[edit] Tridosha system
The central concept of Ayurvedic medicine is the theory that health exists when there is a balance between three fundamental bodily humours or doshas called Vata, Pitta and Kapha.
Vata is the impulse principle necessary to mobilize the function of the nervous system
Pitta is the energy principle which uses bile to direct digestion and hence metabolism into the venous system.
Kapha is the body fluid principle which relates to mucous, lubrication and the carrier of nutrients into the arterial system.
All Ayurvedic physicians believe that these ancient ideas, based in the knowledge discovered by the Rishis and Munis, exist in harmony with physical reality. These Ayurvedic concepts allow physicians to examine the homeostasis of the whole system. People may be of a predominant dosha or constitution, but all doshas have the basic elements within them.
The philosophy of Ayurveda
The emergence of different schools of Sanskrit philosophy like Nyaya, Vaisheshika, Sankhya, Yoga, Vedanta and Mimamsa was another landmark in the history of Indian medicine. The principles expounded in these philosophies facilitated the development within Ayurveda of its theory of humoral pathology which propounds that the human body is composed of Tridoshas, the three humors – Vata, Pitta and Kapha. When these are in equilibrium they are called the Tridhatus. The body in which these three humors are in a state of equilibrium enjoys perfect health; their disequilibrium causes ill health.
Disease management in Ayurveda
The principles of Ayurvedic pharmacology are fundamentally different from those of other systems of medicine, especially evidence-based medicine. Most Ayurvedic medicines are prepared form herbs.
Shamana and Shodhana are the two concepts of disease management in Ayurveda. Shamana means alleviation. Shamana methods mitigate the disease and its symptoms. Shodhana means elimination and Shodhana methods aim at the elimination of the basic cause of disease.
[edit] Ayurvedic tastes
Ayurveda holds that the tastes of foods or herbs have specific physiological effects. Those tastes that transform after digestion (Vipaka) are more powerful.
Sweet - Madhura
Sweet foods nourish, cool, moisten, oil, and increase weight
Sour - Amla
Sour foods warm, oil, and increase weight
Salty - Lavan
Salty foods warm, dissolve, stimulate, soften, oil, and increase weight
Bitter - Katu
Bitter foods cool, dry, purify and decrease weight
Pungent - Tikta
Pungent foods warm, dry, stimulate, and decrease weight
Astringent - Kasaya
Astringent foods cool, dry, reduce stickiness.
[edit] Medications
Ayurvedic practitioners believe that the tulsi (holy basil) plant has medicinal qualities
Ayurveda operates on the precept that various materials of vegetable, animal, and mineral origin have some medicinal value. The medicinal properties of these materials have been documented by the practitioners and have been used for centuries to cure illness and/or help maintain good health. Ayurvedic medicaments are made from herbs or mixtures of herbs, either alone or in combination with minerals, metals and other ingredients of animal origin. The metals, animals and minerals are purified by individual processes before being used for medicinal purposes.
Writers and compilers of Ayurvedic literature such as Charaka, Sushruta, Vagabhatta, Bhav Mishra, Shaligram and others have written about the qualities, characteristics and medicinal uses of the herbs, mineral, metals, chemicals, animal parts, cooked food articles, natural foods, fruits etc. Among them, the Bhav Prakash Nighantu, written by Bhav Mishra, is known for its detail .The composition of the Nighantu part (Ayurvedic Materia Medica) of the Bhav Prakash is part of the classical book. The details of the medicinal herbs are given according to the nature, effects, and curative properties as observed by the Ayurvedic practitioners.
Ayurvedic literature has been written by several authors in languages such as Sanskrit, Hindi, Kannada, Tamil, Telugu and more recently, in English.The Shaligram Nighantu was written in Sanskrit. The Banaushadhi Chandrodaya was written in Hindi.The Indian Materia Medica was written in English.
See also: List of herbs and minerals in Ayurveda
[edit] Panchakarma and Ayurvedic massage
Panchakarma (the five actions or modalities) is a collection of purification techniques that Ayurveda prescribes for some diseases and for periodic cleansing. A course of Pancharkarma typically includes a short-term dietary prescription, massage, herbs, and may include purgatives, sweat baths, medicated enemas, and nasal cleansing.
Ayurvedic massage is a form of treatment for various age related and other common disorders. Some of the advantages which can be cited are pain relief, improved circulation, stress relief, better sleep, flexibility, athletic performance and emotional benefits [citation needed]. Massage therapy can soothe pain, relax stiff muscles, and reduce the swelling that accompanies arthritis [citation needed]. Advocates claim that, with ayurvedic massage, deep-seated toxins in the joints and tissues are loosened and released into the system for elimination through natural toxin-release processes.[10]. There are several different types of ayurvedic treatments such as panchakarma, marma massage and abhyangam.[11] Ayurvedic massage is especially developed in Sri Lanka and the Indian state of Kerala.
See also: Panchakarma
[edit] Current status
In the early 20th century, Ayurvedic physicians began to organize into professional associations and to promote their case for national recognition and funding.[citation needed] This began to become a reality after Indian independence in 1947.[citation needed]
Ayurveda is now a statutory, recognised medical system of health care like other medical systems existing in India. The Central Council of Indian Medicine {CCIM} governs and recommends policies for the research and development of the system. An Encyclopedia on Ayurveda - Ayushveda.com[2] has been developed to promote the knowledge of Ayurveda worldwide.
In India, practitioners in Ayurveda undergo 5 and 1/2 years of training including 1 year of internship in select Ayurveda Medical Schools wherein they earn the professional doctorate degree of Bachelor of Ayurvedic Medicine and Surgery[B.A.M.S.]. A Bachelor's degree with a major in Science [Physics, Chemistry, Biology] and a minor in Sanskrit is desirable for candidates interested in taking up the course.
Select institutions like the Banaras Hindu University, Varanasi, offer higher doctorates and postgraduate training such as MD [Ayurveda] which includes a 3 year residency and a dissertation similar to the MD/MS degrees in modern systems of medicine.
[edit] Ayurvedic institutions and practitioners
Ayurvedic practitioners have been appointed as Honorary Ayurvedic Physician to the President of India. Every year on the occasion of Dhanvantari jayanti, a prestigious Dhanvantari Award is conferred on a famous personality of Medical Sciences including Ayurveda. Kerala is the leading state in India that promotes research and practices of Ayurveda. This has been attributed to Kerala's well established Ayurveda centers, Ayurveda pharmaceutical companies, and Ayurveda medical colleges. For example, there are many Ayurvedic centers (known as Vaidya shalas) all over Kerala. Besides Kerala, others also promoting Ayurveda are Gujarat, Maharastra, and Karnataka.
[edit] Practice in the West
As a result of strong regulations in medical practice in Europe and America, the most commonly practiced Ayurvedic treatments in the west are massage and dietary and herbal advice.
In the United States, the National Institute of Ayurvedic Medicine (established by Scott Gerson) is an example of a research institute that has carried out research into Ayurvedic practices.[12] Gerson has published part of his work on the antifungal activities of certain Ayurvedic plants in medical journals.[13]
Several Pharmecutical companies and Academic Institutions in the west have come into conflict with Indian academic institutions and traditional Ayurvedic practitioners over the intellectual property rights of herbal products researched by the western agencies. The Ayurvedic practitioners have known about the efficacy of such products for centuries and so contend that they carry precedence with regards to patent rights on such products.
On December 1993, the University of Mississippi Medical Center had a patent issued to them by U.S patents and trademarks office on the use of turmeric (U.S. patent No. 5,401,504) for healing. The patent was contested by India's industrial research organization, Council for Scientific and Industrial Research (C.S.I.R), on the grounds that traditional Ayurvedic practitioners were already aware of the healing properties of the substance and have been for centuries, making this patent a case of bio-piracy.[14]
After a complex legal battle, the U.S. Patents and Trademarks Office ruled on August 14, 1997 that the patent was invalid because it was not a novel invention, giving the intellectual property rights to the principle back to the traditional practitioners of Ayurveda. R. A. Mashelkar, director-general of the CSIR, was satisfied with the result, saying:
"This success will enhance the confidence of the people and help remove fears about India's helplessness on preventing bio-piracy and appropriation of inventions based on traditional knowledge[14]"
The turmeric patent was just one of the hundreds that the several academic organizations and Pharmecutical companies in the west have claimed by ignoring Ayurvedic knowledge. Vandana Shiva, a global campaigner for a fair and honest Intellectual Property Rights system, says patents on herbal products derived from Neem, Amla, Jar Amla, Anar, Salai, Dudhi, Gulmendhi, Bagbherenda, Karela, Erand, Rangoon-kibel, Vilayetishisham and Chamkura also need to be revoked.[14]
Seven American and four Japanese firms have filed for grant of patents on formulations containing extracts of the herb Ashwagandha. Fruits, leaves and seeds of the Indian medicinal plant withania somnifera have been traditionally used for the Ayurvedic system as aphrodisiacs, diuretics and for treating memory loss. The Japanese patent applications are related to the use of the herb as a skin ointment and for promoting reproductive fertility. The U.S based company Natreon has also obtained a patent for an Ashwagandha extract. Another US establishment, the New England Deaconess Hospital, has taken a patent on an Ashwagandha formulation claimed to alleviate symptoms associated with arthritis. It is clear that the Ashwagandha plant is catching the attention of scientists and more patents related to Ashwagandha are being filed or granted by different patent offices since 1996.[15]
Ayurvedic wisdom originated in the main Vedas as a part of way of life - a spiritual connection with spirit and nature. This is most evident reading Atharva Veda. Ayurveda was used to remove obstacles on one’s path to Self-Realization. At some point the medical aspects began to take priority over the spiritual forms of healing (ie, focusing on lifestyle, dharma and moksha. Today, these spiritual aspects of Ayurveda have taken a back seat to the medical focus. As Ayurveda becomes a more commercially viable career, the spiritual aspects may continue to lose ground. Yet there are a growing number of practitioners who practice mainly these spiritual therapies and find better results than limiting their approach to the medical, physical realm.
[edit] Criticisms
[edit] Scientific studies and standards
Critics object to the lack of rigorous scientific studies and clinical trials of many ayurvedic products. The National Center for Complementary and Alternative Medicine states that "most clinical trials of Ayurvedic approaches have been small, had problems with research designs, lacked appropriate control groups, or had other issues that affected how meaningful the results were."[16]
In India, scientific research in Ayurveda is largely undertaken by the statutory body of the Central Government, the Central Council for Research in Ayurveda and Siddha (CCRAS), through a national network of research institutes.[17] A large number of non-governmental organisations are also conducting research work on different aspects of Ayurveda[3]. However, "even staunch advocates of Ayurveda like cardiologist Dr. M.S. Valiathan...admit that 'clinical studies that would satisfy the liberal criteria of WHO World Health Organisation have been alarmingly few from India, in spite of patients crowding in Ayurvedic hospitals"'.[16]
[edit] Safety concerns
There is evidence that using some ayurvedic medicine, especially those involving herbs, metals, minerals, or other materials involves potentially serious risks, including toxicity.[18][3][19]
A research study published in the Journal of the American Medical Association[20] found significant levels of toxic heavy metals such as lead, mercury and arsenic in 20% of Ayurvedic preparations that were made in South Asia for sale in America. The Journal found that, if taken according to the manufacturers' instructions, this 20% of remedies "could result in heavy metal intakes above published regulatory standards"[20] Similar studies have been performed in India, and have confirmed these results. Cases of metal toxicity from use of ayurvedic medicines are well known.[21] Some practitioners claimed that "heavy metals are integral to some formulations and have been used for centuries. There is no point of doing trials as they have been used safely and have mention in our ancient texts."[21]
There is a technique of detoxification applied to heavy metals and toxic herbs called samskaras, which is similar to the Chinese pao zhi although the Ayurvedic technique is more complex and may involve prayers as well as physical pharmacy techniques.[22] A study of the effectiveness of the Ayurvedic samskaras was printed in the Journal of Postgrad Medicine[23]:
Crude aconite is an extremely lethal substance. However, the science of Ayurveda looks upon aconite as a therapeutic entity. Crude aconite is always processed i.e. it undergoes 'samskaras' before being utilised in the Ayurvedic formulations. This study was undertaken in mice, to ascertain whether 'processed' aconite is less toxic as compared to the crude or unprocessed one. It was seen that crude aconite was significantly toxic to mice (100% mortality at a dose of 2.6 mg/mouse) whereas the fully processed aconite was absolutely non-toxic (no mortality at a dose even 8 times as high as that of crude aconite). Further, all the steps in the processing were essential for complete detoxification.[24]
The described detoxification is a simple chemical process which involves four successive rounds of boiling the crude root in cow's urine (twice) and cow's milk (twice). This process is claimed to chemically modify both toxic and proposed therapeutic components of the root. It also extracts some of these compounds from the root into the boiling solvents, thereby decreasing their concentration in the final product.
It should also be noted that, while these washes appear to ameliorate the toxicity of the crude root, examinations of finished remedies still exhibit high toxicity and there is no evidence that the processed root has any therapeutic value. A search of the Citation Index, via Web of Science (isiknowledge.com), returned no mention of any therapeutic value for aconite. However, the literature is replete with instances of aconite poisoning, though no mention of specific processing is made in these poisoning cases.
[edit] "Miracle Cures"
Some critics also question the safety of those Ayurvedic drugs that are said to provide "Miracle Cures". [25] The critics argue that simply following age-old Ayurvedic formulas is no guarantee of safety and the fundamental processes and concepts on which these ancient processes are based must be exposed to serious scientific scrutiny.
Saturday, November 10, 2007
Ayurveda Remedies
Ayurveda Remedies
Another simple but very effective remedy is turmeric. One teaspoonful of turmeric powder or paste should be added to a cup of sweetened milk and taken three times a day. This induces an early recovery. It cures malaise and removes constipation, while keeping the lungs clear of phlegm and activating the liver.
Fenugreek seeds can cure cough.
Isabgol Husk cures constipation
Fever, Cold and Malaise One teaspoonful (5 gm) of turmeric powder can be taken three times a day mixed in a cup of warm milk.One teaspoonful (5 ml) of ginger juice three times a day with honey, may be taken. top
Cough Hot fermentation of the chest with sand or rock salt tied in a piece of cloth is useful.Applying mustard oil on the chest and throat can help. top
Headache One teaspoonful (5 gm) of the powder of long pepper could be taken three times per day with water, preferably by adding one teaspoonful of jaggery.For headache associated with sore throat and cold, take one teaspoonful of ginger juice with honey three times a day.top
Indigestion Chewing 2 gm of haritaki pulp with jaggery five minutes before a meal.Taking one teaspoonful of ginger juice with an equal quantity of lemon juice and a pinch of salt twice a day is useful. top
History of Ayurveda
History
Ayurveda - The Meaning The word Ayurveda is made up of two Sanskrit words ayur and veda meaning ‘life' and ‘knowledge' respectively. Taken together they mean the ‘science of life'; in a more limited sense, the term is used to imply the science of medicine.
The Origins of Ayurveda The origins of Ayurveda are shrouded in antiquity. Legend has it that Brahma, the Creator (a part of the Hindu holy trinity of gods) first perceived it and taught it to his sons, Daksha Prajapati. Subsequently, Lord Dhanwantri, the God of healing and the teacher of the medical sciences passed it on the prominent Hindu sages Atreya, Bharadvaja, Kashyapa, Sushruta, Parashara and Charaka. Sage Atreya's disciple Agnivesha is said to have written the original Agnivesha Samhita around 1000 BC which has come down to us in the form of Charaka Samhita. This text is considered an authoritative pronouncement of Ayurvedic doctrine.
Five elements of the Universe
Five layers of the human body
Elements of the Body The universe is made up of the pancha mahabhutas or five primary elements: Fire (Agni), Water (jala), Ether (akasha), Earth (prithvi) and Air (vayu). An individual similarly according to Vedic philosophy, is made up of five layers: the physical body which is the outer layer and four inner layers: the astral body, the psyche, the intellect and the layer at which complete bliss can be felt.
Ayurveda - The Meaning The word Ayurveda is made up of two Sanskrit words ayur and veda meaning ‘life' and ‘knowledge' respectively. Taken together they mean the ‘science of life'; in a more limited sense, the term is used to imply the science of medicine.
The Origins of Ayurveda The origins of Ayurveda are shrouded in antiquity. Legend has it that Brahma, the Creator (a part of the Hindu holy trinity of gods) first perceived it and taught it to his sons, Daksha Prajapati. Subsequently, Lord Dhanwantri, the God of healing and the teacher of the medical sciences passed it on the prominent Hindu sages Atreya, Bharadvaja, Kashyapa, Sushruta, Parashara and Charaka. Sage Atreya's disciple Agnivesha is said to have written the original Agnivesha Samhita around 1000 BC which has come down to us in the form of Charaka Samhita. This text is considered an authoritative pronouncement of Ayurvedic doctrine.
Five elements of the Universe
Five layers of the human body
Elements of the Body The universe is made up of the pancha mahabhutas or five primary elements: Fire (Agni), Water (jala), Ether (akasha), Earth (prithvi) and Air (vayu). An individual similarly according to Vedic philosophy, is made up of five layers: the physical body which is the outer layer and four inner layers: the astral body, the psyche, the intellect and the layer at which complete bliss can be felt.
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