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Ayurvedic Medicine: What Works and What May Work

While the primary emphasis in Ayurveda is on disease prevention and promoting longevity, treatment of illness is an important secondary aim. Proponents consider Ayurveda particularly helpful in dealing with chronic, metabolic, and stress-related conditions. Ayurveda is considered to be potentially more effective when it addresses illness early in the disease process, before extensive tissue and organ damage has occurred.

Ayurveda is also used to alleviate the side effects of toxic allopathic therapies, such as cancer chemotherapy. In addition, it helps patients recover from surgery and encourages healing in a wide range of conditions.

As a stand-alone therapy, Ayurveda generally does not address such problems as traumatic injuries, acute pain, and advanced disease. Surgery is not commonly done by Ayurvedic practitioners today, although it was historically part of Ayurvedic practice.

Following are general conditions that are treated with Ayurveda, often quite effectively.

  • Neurological. Some forty neurological disorders are classified in Ayurveda as vata disorders. Herbs commonly used for neurological disease include Brahmi, which is said to enhance memory, reduce insomnia, and act as a mild sedative, and Centella asiatica, or Gotu kola, valued as a memory enhancer. In the treatment of dementia, Ayurveda uses a number of herbal compounds as memory enhancers, including Withania somnifera (Ashwaganda), Brahmi, and Centella asiatica.

  • Cardiovascular. A number of herbal compounds have been used to prevent atherosclerosis, and to address other risk factors, such as obesity, elevated cholesterol, high blood pressure, and diabetes. Among the most promising is guggul, an extract from the mukul myrrh tree, since it is widely used in India for the reduction of cholesterol.

  • Musculoskeletal. Ayurvedic herbs are used both internally and externally to treat arthritis and muscle disorders. Herbal compounds and massage also help relieve chronic pain.

  • Respiratory. Ailments are treated with yogic breathing and Ayurvedic preparations, including the herbs Sida cordifolia and Tylophora asthmatica, which are used to treat asthma.

  • Gastrointestinal. Ayurvedic preparations have been used to treat upper and lower gastrointestinal disease, and are considered especially useful in liver disease. Irritable bowel disorder, as well as peptic, gastric, and duodenal ulcers, are treated with Ayurvedic herbs. Ginger is recognized as a digestive aid in Ayurveda.

  • Cancer. Ayurveda places a great deal of emphasis on preventing cancer with diet, lifestyle changes, exercise, and the use of various Ayurvedic compounds, most notably the extract of Semicarpus anacardium nut and the flowers of Calotropis procera, as reported by Smit in 1995.

  • Metabolic and endocrine. Diabetes is treated in Ayurvedic medicine with herbal remedies, including guar gum and fennel, which have been shown to lower blood sugar when used as adjuncts to primary drug treatment, according to Sadhukhan in 1994. Ayurvedic herbal preparations are also used to treat obesity, and as antifertility treatments.

  • Mental disorders and psychosomatic illness. Brahmi is highly valued as an anti-anxiety compound, and Rauwolfia serpentina is an Ayurvedic herb that is the source of the antihypertensive and tranquilizing drug reserpine. Substance abuse is treated with herbs, detoxification, diet, and yoga, and so are stress-related conditions, such as tension headache, colitis, and insomnia.

In the past, research on Ayurveda was sparse and often poorly designed. Since Ayurveda has been practiced in India for thousands of years, the efficacy of the system is accepted there without question. However, during the last several decades, a great deal of effort has been made to study the scientific basis of Ayurveda. Much of the more recent research in India has applied Western biomedical research methods. More than forty research institutions in India have conducted clinical trials. In the United States, many of the well-designed studies on Ayurveda have been carried out by adherents of Maharishi Ayur-Ved, who have conducted both basic and clinical research on herbal products. However, USC's Dr. Mishra points out that much of this research is controversial, since it may be biased by a business agenda.

Another factor complicating research is that, as with any comprehensive system of medicine, it is difficult to demonstrate the efficacy of Ayurveda as a whole through RCTs of specific substances. As with all clinical practices, Ayurvedic treatment is individualized for each patient, and consists of extremely complex combinations of interventions.

A few attempts have been made in the United States in recent years to evaluate the efficacy of overall Ayurvedic treatment, or of complex Ayurvedic programs such as pancha karma. In reporting these studies, only last names are given in this chapter, since first names are traditionally omitted in Indian scientific journals and articles.

  • A 1989 pilot study carried out in the Netherlands by Dr. G. W. H. M. Janssen evaluated the effectiveness of multiple Maharishi Ayur-Ved interventions among a group of 126 adults who had ten different chronic diseases, including rheumatoid arthritis, sinusitis, bronchitis, asthma, eczema, psoriasis, diabetes, hypertension, constipation, and headache. Each participant received an individualized nutritional program, herbal preparations, and daily lifestyle guidelines. Seventy-nine percent of the participants showed improvement, 14 percent showed no change, and 7 percent became worse. There were highly significant improvements, or strong trends toward improvement, in all ten of the medical conditions being studied, with complete cures for ten patients. The study suggests that Ayurveda as a whole system does have benefit.

  • During a 1993 study by Dr. Sharma and associates, the researchers evaluated the effects of pancha karma on risk factors for heart disease in thirty-one adults. Patients who participated in a multimodal program were found to have an 80 percent increase in dilation capacity of their circulatory system three months after the treatment, indicating improved function. Total cholesterol was reduced in all the participants, with a reduced measure of free radical damage and significantly reduced anxiety.

  • Among the most recent demonstration projects is one funded by NCCAM and carried out by Dr. David Simon at the Sharp Institute for Human Potential and MindBody Medicine in San Diego. This study compared the effects of an Ayurvedic health promotion program with the effects of a Western program among ninety healthy individuals. Participants were randomized to one of three groups: a group that received no treatment; one that received Ayurvedic treatment in the form of meditation, Ayurvedic diet, and yoga; and a group that received a Western program of Jacobsen progressive relaxation training, a low-fat, low-salt diet, and aerobic exercise. Eighty-eight subjects completed the one-year trial.

In both treatment groups, health-related quality of life was found to be improved, with the Ayurvedic group showing greater improvement than the Western group in health perceptions, and in decreased use of Western prescription medications. Among subjects in the Ayurvedic program, those who were highly adherent to the prescribed therapy showed a decrease in depression. Also, adherence to Ayurvedic meditation was found to be higher than to the Western progressive muscle relaxation technique, which suggests that meditation may be more attractive. Estimated health care costs over the year of the study were more than double for the untreated group, compared with the two treatment groups. Researchers concluded that the health promotion programs, especially the Ayurvedic interventions, were effective.

More studies have been done on specific herbal substances than on the system as a whole. Following is an examination of that research.

  • A 1988 Indian study by Dr. S. K. Verma and colleagues evaluated forty patients with high blood lipids, who were treated with guggul (the crude gum of Boswellia serrata). In the guggul-treated group, serum cholesterol decreased by 7.8 percent, 15.78 percent, and 21.75 percent at the end of the fourth, eighth, and sixteenth weeks, respectively. Triglyceride levels decreased by 6.7 percent, 17.1 percent, and 27.1 percent, with "good" HDL cholesterol showing a gradual increase up to about 35.8 percent by the end of the sixteen weeks. There was also a significant decrease in low-density lipoprotein (LDL) levels. Researchers concluded that guggul was safe and highly effective in lowering the various lipid fractions that are known to contribute to coronary heart disease.

  • In the United States, some of the most significant research on Ayurvedic compounds has been done by advocates of Maharishi Ayur-Ved. A number of studies have evaluated two versions of a traditional metabolic tonic, Maharishi Amrit Kalash, known as MAK-4 and MAK-5. Each of these preparations contains a large number of ingredients, and has shown great versatility in basic and clinical research. A series of test tube studies, funded by the National Cancer Institute, investigated the anticancer properties of MAK-4 and MAK-5. Preliminary studies by Dr. J. T. Arnold and associates in 1991 showed that these substances were able to significantly inhibit cancer cells grown in both human tumor and rat cells. Another study, by Dr. M. L. Prasad and colleagues of the All India Institute of Medical Sciences in New Delhi, found that various forms of MAK-4 and MAK-5 were able to inhibit growth of mouse and human melanoma cells. In a study by Engineer and associates in 1992, MAK-4 and MAK-5 were able to reduce mortality and reduce toxic side effects in mice treated with Adriamycin, a human chemotherapy drug.

  • One innovative 1990 study by Dr. Paul Gelderloos and associates utilized a double-blind study to evaluate the effect of MAK-5 on alertness. As compared with the placebo group, members of the MAK group, all age thirty-five or over, showed significant improvement in their ability to identify a symbol in a cluttered visual array after three and six weeks of treatment. Researchers concluded that MAK may help improve alertness and attentional capacity, and perhaps reverse some of the harmful effects of aging on cognitive functioning.

  • Using a double-blind, placebo controlled trial, Dr. J. L. Glaser of the Maharishi International University in 1991 studied the effects of MAK-5 in forty-six patients with hay fever. Significant reductions in allergy symptoms were produced by MAK-5.

  • Focusing on arthritis treatment, Dr. K. K. Kulkarni and associates in 1991 tested an Ayurvedic formulation consisting of Withania somnifera, Boswellia serrata, Cucurma longa, and a zinc complex. The Ayurvedic formulation produced a significant reduction in the severity of pain and in the disability score, although neither group showed significant changes on X ray.

  • An article by Srivastava in Medical Hypotheses in 1992 reported on fifty-six patients with rheumatoid arthritis, osteoarthritis, or muscle pain who were treated with powdered ginger. More than three-quarters of the arthritis patients achieved relief from pain and swelling, and all of the patients with muscular discomfort had pain relief. None of the patients reported adverse effects.

  • A combination of turmeric and neem (Azadirachta indica) was found by Dr. Victor Charles of the Medical and Cancer Research and Treatment Centre of Nagercoil, India, in a 1992 study of 814 subjects, to be useful in treating scabies, with a 97 percent rate of cure within three to fifteen days of treatment. Such herbal preparations commonly have many fewer undesirable side effects than the pharmacological compounds that are used to treat parasites.

  • During a 1994 study in India by Drs. Dwivedi and Agourwal, a bark preparation of Terminalia Arjuna was evaluated in fifteen patients with stable and unstable angina. Among patients with stable angina there was a 50 percent reduction in anginal episodes, but among patients with unstable angina there was a statistically insignificant reduction in frequency of angina, and these patients also needed to use other medications.

  • In an Indian study by Dogra and associates in 1994, thirty patients were evaluated to determine the effect of MAK-4 and MAK-5 on angina. Eighty percent of patients showed a significant improvement after six months of treatment, with a reduction in the mean frequency of angina from 8.87 to 3.3 episodes per month. Five out of eleven patients with high blood pressure also reported a drop in systolic blood pressure. There was a statistically insignificant rise in HDL. Ten patients showed improved exercise tolerance. No side effects or drug interactions were observed.

  • Another study of Terminalia, by Dr. Arjuna Bharani and associates in 1995, evaluated its effectiveness in congestive heart failure in a double-blind placebo-controlled clinical study of twelve patients with refractory congestive heart failure. Patients receiving Terminalia showed short-term regression of signs of heart failure, and improvement in symptoms such as shortness of breath and fatigue, as compared to placebo. In a two-year extension of the trial, patients continued to show improvements in heart failure, as well as quality of life, for about two to three months. Two patients died during the second phase of the study, but the deaths were apparently not related to the use of Terminalia or placebo therapy.

  • In a 1995 RCT, Drs. Paranjpe and Kulkarni evaluated Ayurvedic formulations used to treat acne vulgaris. Eighty-two patients were randomized into five groups. Four of the groups received different Ayurvedic formulations orally for six weeks, while one group received placebo. One of the formulations, Sunder Bati, produced a significant reduction in acne lesions as compared both to placebo and to the other Ayurvedic formulations, which failed to produce any significant improvement.

  • For a study of more than 260 patients by Dr. Etzel in 1996, a special extract of guggul (the crude gum of Boswellia serrata), known as H-15, was used in the treatment of rheumatoid arthritis. Patients who received H-15 were found to have reduced swelling and pain, compared with those who received placebo. Patients also reported reduction of morning stiffness and were able to cut back on their intake of NSAIDs during the treatment period. Symptoms of rheumatoid arthritis were reduced in 50 to 60 percent of the patients. Unfortunately, this form of guggul is not currently approved for use, since its classification has been changed from a known traditional medicine to an unknown, or new, chemical entity that will require special testing prior to approval.

  • At the Southern Illinois University School of Medicine, Dr. Bala Manyam evaluated the potential of a powdered preparation of the Ayurvedic herb Mucuna pruriens in the treatment of Parkinson's disease. During the twelve-week 1997 study, patients showed significant improvement. Some reported mild side effects. Researchers concluded that the herbal preparation, known as HP-2000, was an effective, low-cost treatment for patients with Parkinson's disease.

  • Conducting a 1998 study of 280 people with acne vulgaris at the University of Poona in India, Dr. V. Shanbhag evaluated the traditional Ayurvedic formula shanka bhasma. Patients were assigned to groups based on their dosha constitution. At the end of the four-week study, the vata and pitta patients showed significant improvement, but the kapha patients did not. This study indicates that individualized treatment based on the doshas may be a meaningful approach.

Guggul, also identified as Commiphora mukul, has been used traditionally in Ayurvedic medicine for the last one thousand years for a variety of inflammatory problems, including rheumatoid arthritis, osteoarthritis, and cervical spondylitis. Guggul also lowers cholesterol and triglyceride levels and helps maintain a healthy HDL/LDL, "good" to "bad" cholesterol, ratio. This improved ratio protects against cardiovascular disease and atherosclerosis, and is also beneficial to the liver.

A number of animal studies have investigated the anti-inflammatory potential of guggul as well as turmeric, which does not show the same side effects and toxicity that are common in the usual anti-inflammatory medications, such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs). There is also preliminary clinical evidence that the traditional Ayurvedic remedy, phyllanthus, may be an effective treatment for hepatitis. Such traditional herbals require further research but offer great promise to be incorporated into a more integrative medicine encompassing both conventional and alternative therapies of proven value.

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Copyright © 2000 by Dr. Kenneth R. Pelletier, Inc.
Reprinted by permission of Simon & Schuster, Inc., New York, New York.

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