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Scientific Basis for Ayurvedic Therapies.

L.C. Mishra (Ed.), Scientific Basis for Ayurvedic Therapies, First Edition, CRC Press, Boca Raton, ISBN 0-8493-1366-X, 2004 (626pp., US$ 99.95, Hardcover).

Unlike most ayurvedic science publications in America, this text is edited by a scholar trained in both biomedical and ayurvedic medicine. As an ayurvedic physician later trained in laboratory science, Dr. Mishra has created a text focusing on the physical-chemical basis of clinical practice using ayurveda. Mishra and colleagues at the University of Southern California have been maintaining a database of ayurveda in the US, conducting basic and clinical research trials for the past decade, and publishing in several peer-reviewed alternative medicine journals. His team has focused its work on the elucidation and research of clinical aspects of ayurvedic herbal use in the US.

Dr. Mishra received his first degree, a BIMS (Bachelor of Indian Medicine & Surgery), from the Bundelkand Ayurvedic College in Jhansi, Uttar Pradesh, India in 1954, focusing his work on ayurvedic herbs; the BIMS is now known as a BAMS (Bachelor of Ayurvedic Medicine & Surgery), as India now officially recognizes six systems of medicine. Alongside his Ph.D. in biochemical pharmacology from SUNY Buffalo in 1967, Dr. Mishra also received a baccalaureate in 1958 and master's in 1959 in pharmacy from Banaras Hindu University, Varanasi, Uttar Pradesh. Moreover, he has worked as a chemist at an antibiotics industry, as a professor of a medical college, as a bench scientist with NIH funding and as a researcher in American academia. It is this combination of insight as a clinician and researcher in two countries that makes the book a bridge for pharmacologists, pharmacognosists, clinicians, chemists, and holistic medical practitioners internationally.

At first glance, one may wonder: why another book on ayurveda? India is filled with such books, with 4-5 new titles emerging each month globally: a translation of the same classic texts with different correlations, specialties, and attempts at scholarly analysis. This book however, is neither another translation of ancient texts nor another collection of monographs of plants in the long line of CRC tradition: it is a bridge.

A system of medicine practiced continuously for the past 5000 years, it is believed that ayurveda originated in the Indus Valley and spread east through the Indian subcontinent as an oral tradition integrated into four principal instructive texts on life: the Vedas. Approximately, 3000 years ago, excerpts from the Vedas relevant to health and medicine were collected into a series of written, focused compendia: the Charaka Samhita and the Sushrut Samhita. Six such texts form the basis for modern interpretation, study and practice.

Providing a systemic overview of ayurveda in chapter one, Professor PNV Kurup, vice-chancellor of one of the largest ayurvedic colleges in India, states that in India alone, ayurveda is a Rs. 40,793 million (USD$816 million) industry. Recognized by the WHO as an official medical science, ayurveda flourishes and continues to spread around the planet. There are 190 colleges in India, in addition to the traditional system of gurukala, or apprenticeship-based learning, practiced in rural areas and among many of the most knowledgeable elderly experts. Though no official licensing is available in the US, curriculum initiatives are forming through several independent groups. This chapter lacks, however, the global overview it claims, giving almost no detail on the many research, education and commerce initiatives in Europe and the US that are also underway. While access and cost issues that promote ayurveda in India are not applicable in the US due to regulatory issues, they are generally not addressed.

As the introduction aptly points out, "most books published in the West on Ayurveda offer little or no information about current biochemical, pharmacological, and clinical investigations." Furthermore, the authors are aware that "basic research on ayurvedic therapeutics has not been adequately integrated into disease management protocols available to most consumers, whether they align themselves with mainstream or complementary medicines."

Indeed, one of the largest hurdles for proponents of ayurveda is to appropriately translate the fundamental principles--and the vocabulary--into terms that are comprehensible to biomedical scientists and clinicians who run the agendas, funding, approval and popularization of medicine and the healthcare industry. Unfortunately, the worthy aspects of ayurveda have not been properly conveyed in a compelling way. In addition defense of ayurveda is too often presented in terms that are not of value in mainstream medicine, such as unquestioned traditions and the wisdom of sages.

Mishra does the needful: he writes to an audience of scientists, botanists, chemists, pharmacologists and pharmacognosists who love explanations using mainstream physiology and biochemistry. He uses correlations between ayurvedic conceptions of pathogenesis and the corresponding explanation of the same phenomenon in modern medical terms.

For example, Type II diabetes mellitus has been well-described in ancient ayurvedic texts as madhumeha. Diabetes was only categorized in mainstream medicine in the 1600s when Willis noted diabetic urine to taste sweet and hypothesized glucosuria. The book details clinical correlations for diabetes found in ancient ayurveda and contrasts them with what was documented in science by the DCCT (Diabetes Control and Complications Trial) in 1993. Moreover, the book discusses pathophysiology according to the systems of doshas (body constitutions) and dhatus (tissues). Clinical research evidence for six herbs and seven combination herb regimens are described, using both ayurvedic and scientific concepts, for reducing the clinical symptoms of impaired glucose tolerance.

As a clinician-scientist himself, Mishra also writes for the clinician and attempts the bridge that most have not dared to: a basic science book for the practicing holistic physician. The book is organized by clinical condition and discusses clinical research issues.

The first 6 chapters discuss the pharmacognosy and clinical practice management system of ayurveda, introducing terminology, therapeutic modalities, research designs, treatment theories, and placement of ayurveda in global context. Existing research is presented on modalities used in ayurveda, such as massage, detoxification using oils and enemas, lifestyle changes, nasal cleansing and of course herbs.

Chapters 7-32 then route their way through the body, either systematically (e.g., hepatic disorders, eye diseases, gynecological diseases, male reproductive dysfunction) or by clinical multi-system conditions (obesity, diabetes, irritable colon, benign growths, allergic reactions).

The chapters are presented in standard clinical and scientific format. After some epidemiology and historical context of the disease, the author plunges into etiology as conceived by ayurveda, then into pathogenesis as conceived by conventional physiology. Clinical manifestations are described and contrasted using terms from ayurveda and biomedicine. Diagnosis and clinical management are presented, then biomedical scientific data for those treatment are outlined, providing a listing of international references for further reading. Each chapter features 4-15 herbs used for the clinical condition, providing condensed information on taxonomy, chemistry, dosage, formulations, indications, and botanical elements. Four appendices and an index complete the book, giving the reader a sense that the argument of "no data for efficacy" may no longer be viable.

Does the book succeed in creating a bridge for mainstream MDs, biomedical scientists and ayurvedic clinicians? Mishra does several things, that have been lacking in other texts: (1) Whereas most ayurvedic texts focus on scientific evidence for herbs only, Mishra provides data on several modalities. (2) He presents the challenge of providing studies analyzing only one active compound because that is what is considered valid in science, but poses the reality that herbs and drugs are generally used in combination and thus questions the utility of current scientific methodology for clinical research. (3) Mishra teaches us ayurvedic concepts of structure-function by using lucid comparisons and correlations between biomedical and ayurvedic constructs of anatomy & physiology. (4) Mishra uses a healthy well-balanced combination of 46 international contributors from the fields he seeks to bridge. (5) The emphasis on the book is not in downgrading mainstream medicine or ayurveda: it presents language for building a bridge to validate both.

Bhaswati Bhattacharya

Weill-Cornell Medical College, New York, USA

Jerry Cott

FDA, Rockville, MD 20857, USA

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Author:Bhattacharya, Bhaswati; Cott, Jerry
Publication:Phytomedicine: International Journal of Phytotherapy & Phytopharmacology
Geographic Code:1USA
Date:Nov 1, 2005
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