Are contemporary allopathic medicine and Ayurveda mutually compatible? Is it possible to merge modern biomedical science with ancient healing principles defined millennia ago? Is there any relevance in today’s medical clinic for a paradigm centered substantially around pulse diagnosis, or for therapeutics focused on behavior modification, herbs, mind-body therapies, and detoxification?
Most importantly, what purpose would be served by integrating these paradigms?
These are questions that confront any practitioner who recognizes that contemporary allopathy, despite its strengths, also has limitations, and who also surmises that India’s ancient health practices may have some value.
Qualitative & Quantitative
Modern allopathic medicine derives its strength from its astonishing ability to quantify biochemical processes at the organ system, cellular, and genetic levels. Ayurveda, which evolved centuries before the invention of the microscope or the elucidation of the Krebs cycle, is highly qualitative and descriptive. It reflects a sophisticated understanding of processes and patterns within someone’s body and psyche.
Often, a constellation of symptoms that make little sense in allopathic terms, will fit within patterns described by Ayurveda.
For example, consider a patient who is constipated and also suffers from insomnia. From an allopathic perspective, these problems are separate “departments.” If the “first line” drugs don’t work, many MDs might send this patient for separate consultations with a psychiatrist and a gastroenterologist.
Viewed from an Ayurvedic perspective, the insomnia and constipation are very much related: both reflect an imbalance or dysregulation of Vata—one of the three doshas or basic categories of physiological functions and qualities. Vata governs and influences all movements in the body, especially its rhythms and cycles. Sleep, digestion, and elimination are all cyclic, rhythmic processes.
As it turns out, we can optimize both diagnosis and therapeutics through the judicious blending of allopathic and ayurvedic paradigms.
Two Angles on Diabetes
Consider the condition we know as type 2 diabetes, which of course represents a major public health challenge, impacting 11% adults worldwide, according to a recent analysis of global epidemiological data (Ong KL, et al. Lancet. 2023).
In allopathic terms, it is characterized by hyperglycemia caused by increased insulin resistance, impaired insulin secretion, or both. Through that lens, our “job” as primary care doctors is to optimize blood sugar control through a combination of diet, exercise, oral drugs, and injectables like insulin. We monitor the condition by measuring glucose, insulin, and hemoglobin A1c. We try to prevent the downstream cardiovascular consequences of diabetes by prescribing statins, ACE inhibitors, and the like.
In classical Ayurveda, there’s no specific disease called “type 2 diabetes,” though physicians in ancient India did recognize that some people urinate very frequently, that the urine is sweet, and that this is connected with unhealthy fat accumulation (not all weight gain is considered unhealthy).
What we call type 2 diabetes most closely resembles what Ayurveda calls madumeha, or “honey in the urine.” It’s one of 20 types of prameha (polyuria).
The Three Doshas
Ayurveda views health and disease in terms of the balance or imbalance between the 3 fundamental physiologic or psychometabolic principles called doshas. These are vata, pitta, and kapha. Vata governs all movement in the mind, body, and spirit. Pitta governs heat, digestion, and metabolic transformation; Kapha governs structure and lubrication. Aggravation of one or more of these doshas can lead to imbalances which, left unchecked, eventually result in disease.
A kapha imbalance often manifests as weight gain, lethargy, and then to madumeha. Associated symptoms may include accumulation of “dirt” in the teeth, burning sensation in the hands and feet, oily, excessive thirst, and a sweet taste in the mouth. In qualitative terms, a kapha imbalance is an excess of heaviness, sweetness, and moistness which, in turn aggravates the fat tissue (called medu dhatu in Sanskrit) —a process that we might describe as insulin resistance driving inflammation.
Left uncorrected, a kapha imbalance will gradually pull the other doshas—pitta, and then vata–out of balance, leading to a wide range of multi-system problems.
A Higher Bar
Allopathic medicine recognizes that type 2 diabetes is a “lifestyle” disease, driven by high glycemic diets, and lack of exercise. But in routine practice, our medical systems give that little more than lip service. Prescription drugs are our primary tools for treating diabetes—and most other disorders.
A healthy person is someone in whom the three doshas are in balance and the organ systems are working well together. A healer’s “job,” so to speak, is to help people find their way back to that state. In that sense, the bar for clinical success is actually much higher in Ayurveda than in modern allopathy.
In Ayurveda—which literally means “science of life”—what we call “lifestyle” is central to the origin of most diseases, and it is the primary means by which we can restore health.
Though people have innate tendencies toward particular doshic imbalances, it is really our dietary habits, sleep patterns, exercise, environment, stress levels, and relationships that determine whether they will become problematic.
What we call “unhealthy lifestyle choices” are the result, according to Ayurveda, of praghya aparadh—“mistake of the intellect.” This implies that someone has lost the deep understanding that the normal state is to be healthy and blissful. By getting too caught up in material concerns, and pursuit of external self-validation, people become anxious and upset, leading to unhealthy behaviors like overeating, consumption of excessive sweets, and drug or alcohol abuse.
A healthy person is someone in whom the three doshas are in balance and the organ systems are working well together, allowing the person to experience pure bliss. A healer’s “job,” so to speak, is to help people find their way back to that state.
In that sense, the bar for clinical success is actually much higher in Ayurveda than in modern allopathy.
In the context of diabetes, yes, we have to pay attention to blood sugar. Yes, we have to normalize insulin responsiveness, reduce inflammation, and prevent end-stage heart, retinal, and renal disease. But our ultimate goal is far beyond just getting someone’s blood sugar in range. We need to help our patients restore balance and overcome the praghya aparadh that is the deeper root cause of the illness.
Diagnostically and therapeutically, the two systems complement one another. Each brings strengths that the other lacks. In the case of type 2 diabetes, the Ayurvedic model allows for early detection of imbalances long before disease actually manifests, potentially empowering patients to avoid getting ill.
Ayurveda offers many time-tested dietary, botanical, and detoxification modalities to help restore balance and health. It also includes meditation, movement, and stress reduction practices. These are central to the Ayurvedic approach, not low-priority “complementary” side-dishes as they often are in some Western “integrative” clinics.
Pulse Assessment
Recognition of doshic imbalances is a clinical art that takes time and training to master. Pulse assessment is a key element in Ayurvedic diagnosis. As is written in one of the classic texts:
“The artery pulsating at the base of the thumb indicates life. Happiness and misery, including balanced and imbalanced states of the physiology, should be known from its movements.”
–Sharngadhar Samhita, Purv Khand, m3.1
Pulse diagnosis involves placing the index, middle, and ring fingers on the patient’s radial artery just proximal to the radial styloid (in other words just above the wrist). The vata value of the pulse is detected by the index finger, the pitta value by the middle finger, and the kapha value by the ring finger.
This system includes a set of nuanced, almost poetic descriptions of healthy and imbalanced pulses. For example, the vata pulse detected by the index finger should feel sinuous, like a snake, while the middle pitta pulse should be jumpy like a frog, and the kapha pulse should be smooth like a swan.
To a Western medical mind, trained to think quantitatively, these descriptions may seem vague and impractical. But they are actually quite precise, once you begin to sense and study them.
Ayurvedic pulse diagnosis gives us a way to detect physiological imbalances at a very subtle and early level, allowing us to intervene long before disease begins to manifest.
In the context of type 2 diabetes, it can help delineate the prevailing doshic imbalance, allowing for more targeted therapies such as an appropriate dosha-balancing diet, or a dosha-specific program of spices, aroma oils, and herbs. This allows for a more holistic approach to patient care, ultimately leading to improved glucose control.
In Ayurveda, strong digestion is central to good health. Weak digestion leads to accumulation of toxins, which then get deposited in the tissues, providing substrate for the imbalanced dosha to cause tissue damage. Pulse assessment provides valuable information about a patient’s digestive function.
Further, because it is a gentle, hands-on process pulse assessment fosters the bond between physician and patient, and enhances the healing connection.
An Integrated Approach
The Ayurvedic perspective is very different from that of Western allopathy, yet it provides a compelling model for augmenting conventional care.
Diagnostically and therapeutically, the two systems complement one another. Each brings strengths that the other lacks. In the case of type 2 diabetes, the Ayurvedic model allows for early detection of imbalances long before disease actually manifests, potentially empowering patients to avoid getting ill.
If the disease has already manifested, allopathic diagnostic guidelines and lab testing provide very accurate measures of glycemic control which are useful in planning, implementing, and monitoring treatments.
Because it emphasizes mind-body interventions, Ayurveda goes a long way in helping patients reduce stress, which favorably affects glucose metabolism. For example, the regular practice of Transcendental Meditation® (TM), reduced insulin resistance in a randomized controlled study of patients with metabolic syndrome.
In addition, patients report that TM practice enhances their ability to adhere to a complex behavior change regimen (Elder C, Altern Ther Health Med. 2006).
Ayurveda encourages people to follow a plant- and spice-rich lactovegetarian diet. Vegetarian diets have been shown to improve glycemic control in diabetics (Yokoyama Y, et al. Cardiovasc Diagn Ther. 2014)
Spices like fenugreek and cinnamon, used often in Indian cooking, can favorably modify glycemic levels. There are a range of other herbs which, when coupled to proper medical, dietary, and behavioral regimens, may contribute to improved glycemic control (Elder C. Altern Ther Health Med. 2004)
The best care, then, is an integrated approach merging the best of the Ayurvedic and allopathic paradigms. At Maharishi International University, our Fellowship MS in Integrative Medicine and Ayurveda for Medical Professionals provides doctors, nurse practitioners, physician assistants, and other clinicians with the knowledge base and skills to deliver top notch care that is contemporary and scientific, while at the same time ancient and holistic.
It is the only fully accredited graduate degree program in the country offering Ayurvedic training specifically targeted toward licensed healthcare practitioners: To learn more, please visit: https://www.miu.edu/fellowship-ms-in-integrative-medicine-and-ayurveda
END
Charles Elder, MD, MPH, FACP is the Executive Director of the Fellowship MS in Integrative Medicine and Ayurveda for Medical Professionals at Maharishi International University. He received his MD and MPH degrees from Boston University, did his residency training in internal medicine at the University of Michigan, and served as a primary care physician at Kaiser Permanente Northwest for 30 years.
