Introduction of Ayurveda to Chiropractic, Building a Functional Bridge

Introduction

Chiropractic and the ancient system of Ayurveda share the common goal of facilitating complete and balanced transmission of life-force for the patient. Chiropractic focuses on the nervous system through structural bodywork whereas Ayurveda involves a myriad of methodologies. Nonetheless, both systems view the nervous system as the primary interface for the life force that connects human beings to the cosmos. A functional bridge maybe developed between the two systems given this philosophic agreement; specifically for the purpose of integrating a deeper analytical approach to care for the Chiropractor. The following discussion will for that purpose address Ayurveda’s background and principles, methods of analysis and diagnostics and finally methods of treatment. It will also address current scientific and medical research that recognizes the scientific basis of Ayurveda and serves to conceptually bridge Ayurvedic knowledge for advancements in modern medicine and sciences. The paper will finally propose relevancy for integrating a bodywork component of Ayurveda (Marma Chikitsa) into the Sacro- Occipital Technique (SOT) form of Chiropractic.

Basic Concepts of Ayurveda

Ayurveda means “Science of Life” and as the world’s ancient healing system dates back some 5,000 years. Health in Ayurveda is considered a state of balance between body, mind and psyche that parallels the biological constitution at the time of birth (Prakriti Dosha or prototype). Dosha

is considered genetic makeup but is largely influenced by environmental interactions. Ayurveda addresses all aspects of life ranging from daily to seasonal regimens and utilizes a diverse methodology of treatments including diet, herbs, bodywork, Yoga/meditation and more. Ayurveda treats the mind-body-spirit of the patient in a manner that considers all three inseparable and mutually influential. It further considers development of consciousness as a principle objective in the maintenance of health and advocates patient participation beyond the clinical setting. Like Chiropractic, Ayurveda does not treat disease rather it balances and harmonizes internal and external forces in the body so that the patient will express a complete life force.

Ayurveda emerged from the ancient texts of India whose religious expression was largely cosmological (Textbox 1). The enumeration of unmanifest (Avyakta) to manifest (Vyakta) described in these texts, as the creation process, explains how the human body and mind as well as all matter is a manifestation of interactions between five elements (Pancha Mahabhuta). The states of matter are Ether, Air, Fire, Water and Earth and they form the human body in different combinations giving basis for the Ayurvedic theory of Tridosha (Table 1).

• Textbox 1: The roots of Ayurveda are found in the ancient Vedic texts: Rig Veda, Sama Veda, Yajur and Artha Veda. Ayurveda is considered an upaveda or subsystem within the Artha Veda. Although these texts are believed to be more than 10,000 years old, the Charaka Samhita dated 400 C.E. is the oldest known Sanskrit text that deals specifically with Ayurveda. Samkhya is the cosmological science of the Vedas and enumerates the principles of the universe, the dynamics of which Ayurveda employs as an expression for restoring and maintaining health. Samkhya in Sanskrit can be dissected into two words mean Truth (San) and to realize or know (Khya). The Samkhya background gives Ayurveda its unique orientation of establishing health by mirroring balance of the human body and mind with that of the universe.

The Pancha Mahabhuta organize into three specific functions recognized as requisites for any living system: ether and air form Vata Dosha (input-output); fire forms Pitta Dosha (throughput or metabolism); and water and earth form Kapha Dosha (storage). These relationships of input-output, throughput and storage determine regulative behavior at cellular, physiological, systemic and mental levels thus maintaining micro/macrocosmic consistency in Tridosha Theory [1, 2]. Harmonic balance between these elements as they form the Doshas results in health. Ayurveda uses the terms Prakriti to mean primal nature in both the cosmological sense as well as individual biological constitution. As each cell and system is composed of varying amounts of the Pancha Mahabhuta; cells, systems and ultimately the individual is recognized as having Doshic predominance. In this manner Ayurveda establishes Prakriti Dosha as Biopsychological prototype for individuals.

Since Pancha Mahabhuta and Tridosha are considered cosmological expressions in their intangible forms (Textbox 2). Ayurveda observes the human body and all of its processes as a reflection of the universe. Health is achieved by restoring and maintaining functioning of the Doshas to their Prakriti (birth state), eliminating all factors that distort this reflection. The Doshas comprise the human body along with the dhatus (tissues), malas (wastes), gunas (psychological forces) and srotas and nadi (physical and energetic channels).

• Textbox 2: Samkhya delineates a series of 24 developmental stages in the creative process in which the Pancha Mahabhuta are a gross manifestation or end stage for the transmission of sensation and expression of physical structures.

Prakriti examination is a central concept in Ayurveda. It classifies the phenotypes of individuals based on the predominant Dosha at birth, which in turn expresses specific physical, physiological and mental traits- biopsychological prototype. Each person is a unique product of genetic, environmental and psychological factors that influence and alter the equilibrium between Doshas. Vikruti is the term given to doshic imbalance and the disease state that results from maladaptation in input-output, throughput and storage systems. Recognition of Prakriti Dosha and point of deviation (Vikruti) due to changes in the Tridosha is unique to Ayurveda giving specific reference to distortion patterns at cellular, physiological, systemic and mechanical levels. No other health discipline utilizes this concept. Indian scholars in recent years have begun to research the concept of Dosha Prakriti as it pertains to the human genome, a project serving to establish full scientific basis to Tridosha and Ayurveda [1, 2]. The following will briefly discuss the Tridosha in regards to attributes, physiology, visceral and systemic roles as well as psychological expression.

Diagnosis / Inspection

The Charaka Samhita states that it not possible to name every disease because each individual is distinct in clinical presentation and manner of treatment. Although Ayurveda observes and identifies nature of the disease, i.e. symptoms it is more concerned with the imbalance of Doshas that produce the symptoms and are in need of correction. Still Ayurveda

does refer to common diseases by names that correlate clinically with those of the west [10]. Distinguishing between the examination of the disease (Roga Pariksha) and patient (Rogi Pariksha) helps to form a tailor made management plan for the patient. Patient examination consists of Prakriti, disease (Vikruti), age (vaya), tolerance (satmya), mental state (satva), metabolism (aharashakti), physical endurance (vyayama shakti), tissue quality (sara), physical proportions (sanhanana) and finally strength (bala) [1].

The primary methods of diagnosis in Ayurveda are observation/inspection, palpation and history. Additionally Ayurveda utilizes a sophisticated analysis of pulse, urine, stool, eyes, tongue, skin, speech and voice as well as general appearance [5]. Marmani or vital points are also palpated for sensitivities to determine disturbance of Dosha. For example tenderness upon initial pressure that rapidly recedes indicates Vata disturbance. Tenderness felt throughout medium pressure indicates Pitta disturbance and tenderness only felt on deep pressure indicates Kapha disturbance. There are 117 total marma points and they each have unique physiological, visceral and psychological correlations, thus they can be used to determine various sites and levels of dysfunction [8]. Use of Marmani is of central importance to the later discussion for integrating their application into clinical SOT.

Therapeutic Methodologies

Disharmony of Pancha Mahabhuta cause imbalance of Dosha leading to maladaptation in regulative systems. Ayurvedic healthcare addresses the Doshas and Gunas (mental components) on multiple levels to restore balance. This involves eliminating etiological factors and toxins, clearing Srotamsi (channels) and restoring normal balance of Pancha Mahabhuta in accordance with Prakriti Dosha [1]. Treatments are distinguished as reducing or tonifying. The general rule behind therapies in Ayurveda is to eliminate toxins and their factors before tonifying the body.

• Reduction therapies serve to eliminate Ama or toxins, aggravated Doshas, as well as environmental or lifestyle factors- addressing etiological components. This form of treatment is indicated in acute stages of disease and involves practices of discipline, giving things up and changes in lifestyle which promote self-inquiry for eliminating etiological factors [3, 8]. Four main factors are involved in this process: cleansing (Shodhana), palliation (Shamana), rejuvenation (Rasayana) and mental-spiritual healing (Sattvavajaya) [5]. Cleansing is commonly the first step and it involves Panchakarma and Shamana.

• Panchakarma is the better known practice of cleansing and detoxification in Ayurveda. It utilizes five different techniques including basti (medicated enemas), virechana (therapeutic purging), vamana (therapeutic vomiting), nasya (application of medicated oils and powders to the nostrils) and finally rakta moksha (therapeutic release of toxic blood). The Shodhana stage serves to remove Ama and accumulated Doshas from sites present in organs, channels, marmani (vital points) or other weakened sites.

• Oleation and sudation therapies are normally applied prior to Panchakarma and involve softening and liquefying of the Ama and the Doshas and directing their withdrawal to the gastrointestinal tract to be removed using Panchakarma techniques.

• Shamana or palliation therapies are performed when the body is not strong enough to receive Panchakarma and the Doshas are not “ripe” enough to be expelled. It too is performed to reduce Ama but does not dispel the Doshas. The idea here is that sufficient toxins have accumulated and their removal might exacerbate the condition. Shamana has seven parts: herbs for burning toxins and stimulating digestion; fasting; fasting from water; Yoga exercise and mediation; sun and moon bathing; exposure to wind [3].

• Lifestyle changes: based on daily regimens and seasonal changes according to Dosha requisites.

• Tonification therapies are designed to nourish debilitated systems and tissues whose deficiencies were responsible for disease. Tonification methods are indicated in chronic diseases, malnourishment as well as after reduction therapies have been performed.

• Rasayana is a form of rejuvenation and revitalization performed once toxins have been removed from the body and serves to restore the body’s innate intelligence and maintain optimal function [8]. In fact the term can be broken into two parts: Rasa meaning nutrition and Ayana meaning transportation into the body. Rasayanas serve to improve the nutritional value, improve digestion, bioavailability, microcirculation and assimilation. The practices involved are analogous to the modern use of dietary supplements [5]. Rasayana utilizes herbal formulas, bhasmas (mineral preparations) as well as forms of bodywork.

Additional therapies used in Ayurveda include Yoga and massage. The massage or bodywork component, more specifically Marma Chikitsa, is of primary interest to this paper. Marma Chikitsa is the use of vital points found on the different body tissues and junctions to treat diseases strengthen the body as well as evaluate severity of condition. More specifically, it can be used to treat doshic imbalances; dhatu and strotas disturbance; visceral dysfunction; imbalances in Prana, Tejas and Ojas; pain relief by stimulating Agni and eliminating or detoxifying Ama; calm the mind and emotions; enhance awareness and serves as a form of preventative care. Marma Chikitsa is utilized in both reductionist and tonifying treatment programs.

Diet and lifestyle form a pillar of Ayurvedic care inside and outside the clinical setting. Diet and herbs are recommended to patients based on the principle of taste. Ayurveda considers six different tastes based on elemental combination: sweet – earth and water; sour-earth and fire; salty – fire and water; pungent-fire and air; bitter-air and ether; and astringent-ether and earth. Foods, spices and herbs are applied based on relationships of opposites. Each Dosha is composed of, relieved by and aggravated by different elemental combinations. Herbal treatments are utilized based on principles of taste (rasa), properties (guna), energetics (virya), post digestive properties (vipaka) and special effects (prabhava). Bhasmas or mineral herbal formulas are also utilized in different stages of care. These are well known for the uses of oxidized minerals such as gold, copper, mercury, zinc, diamond and others in special herbal formulas.

Ayurveda does not contain a concept of specialization as is common in western medicine. This is because the Ayurvedic physician treats the whole person and all systems and levels, not a specific organ, etc [4]. Nonetheless even though an Ayurvedic physician may specialize in a particular field e.g. ophthalmology he or she will treat the entire body and mind in order to correct and eliminate etiological factors.

Ayurveda and Modern Science and Medicine

Ayurveda has been gaining global attention and interest in the last decade due in part to its holistic approach in therapeutics; that fact that it is among the most extensive and profound conceptual bases within Traditional Medicine Systems (TMS) around the world; and because it has survived for more than 2 millennia as a vibrant medical system [5]. In the inaugural speech for the World Ayurveda Conference held in University of Pune in 2006, Dr. R.A. Mashelkar, Director General of India’s Council of Scientific and Industrial Research (CSIR), announced that India can benefit enormously if it builds a Golden Triangle between modern science, modern medicine and traditional medicine [11]. The purpose being to blend both modern and traditional synergistically to provide accessible and affordable health care to all people of the planet 7. Later in 2009 the First International Congress on Ayurveda held in Milan featured experts from fields in both Ayurveda and modern science that fostered relationships between disciplines involving themes such as quantum physics, epigenetics and modern medicine [6].

Researching the scientific basis of Ayurveda is a new academic field pursued in India, serving to integrate Ayurvedic methodologies into allopathic practices in response to short comings as well as to express the principles of Ayurveda in scientific terms in Ayurvedic schools of India. Excitingly, both Indian allopathic and traditional institutions have shown reciprocating interests. Ayurveda schools in India have been “urging for scientific rooting of Ayurvedic principles” [9]. Additionally, medical institutions, primarily motivated with pharmaceutical interests, have been conducting research in the Ayurvedic field of Dravyaguna (herbalism) to benefit modern allopathic treatments.

Research performed by the CSIR in Ayurveda has been conducted primarily with respect to future pharmaceuticals; cataloguing and investigating the pharmacopeia of Ayurvedic herbal wisdom for identifying biochemical agents at work. Such medical studies have been conducted to evaluate the effectiveness of Ayurvedic herbal wisdom in treating chronic and degenerative disorders including depression, anxiety, sleep disorders, hypertension, diabetes mellitus, Parkinson’s, and Alzheimer’s disease [10].

Other scientists and physicians of both allopathy and Ayurveda have undertaken a mission to present Ayurveda in scientific terms to establish a formal bridge between disciplines. Dr. Lakshmi Mishra’s compendium “Scientific Basis for Ayurvedic Therapies” (2004) and Rastogi’s article “Building Bridges Between Ayurveda and Modern Science” (2010) as well as other articles are invaluable in that respect 5,9. Studies of Tridosha and Prakriti have shown their relevancy in explaining processes of cellular differentiation, gene expression and ultimately genomes and phenotypes. These studies have opened the door to future research regarding epigenetics and their role in environmental or diet related susceptibilities to pathology [1, 2]. The Oxford journal Evidence Based Complementary and Alternative Medicine (eCAM) has also contributed numerous articles in discussion of Tridosha and Ayurveda for scientific validity [12].

Ayurveda and Chiropractic

Dr. Betsy Singh former Dean of Research at Los Angeles Chiropractic College (LACC) along with Dr. Lakshmi Mishra published an article on the use of Ayurvedic therapies for treating arthritis. The article enumerated the Tridosha theory in determining Prakriti Dosha for patients and addressed specific herbs along with diet, lifestyle and Dosha indicated yogasanas [13]. In 1999 Singh established an Ayurvedic medicine research track at the LACC to perform studies on the effectiveness for using Ayurvedic herbs in treating conditions such as osteoarthritis, TMJ and fibromyalgia in conjunction with Chiropractic. Singh stated that “Ayurvedic therapies interface nicely with Chiropractic, with their shared emphasis on wellness, prevention, lifestyle and belief in the body’s innate capacity to heal itself” [14].

Her article “Ayurveda: Good Chiropractic Partner?” truly sets the stage for exploring the possibilities of blending Ayurveda and Chiropractic. It is common place that Ayurvedic therapeutics and its contributions to healthcare discussed in other disciplines are equated almost entirely with herbs (Dravyaguna), which represents a small fraction of the types of therapeutics provided [15]. Interestingly, the therapies and methodologies discussed in Singh’s article did not touch upon Ayurvedic forms of bodywork, specifically Marma Chikitsa. As Chiropractors, it makes sense to utilize Ayurvedic physical strategies in synergy with adjusting. Much research has been performed on Ayurvedic herbalism and its applications in both allopathic and holistic clinical settings. This project will now propose relevancy for integrating Ayurvedic science and its physical applications namely Marma Chikitsa into the Chiropractic field. This may serve to deepen the level of care with regards to better understanding etiological factors, visceral and psychosomatic implications and finally specific therapeutic techniques. This process will not only supplement the level of Chiropractic care, but retain essence of Chiropractic as its ultimate goal is to facilitate unimpeded transmission of life force.

Sacro-Occipital Technique (SOT) with its branch of Chiropractic Manipulative Reflex Technique (CMRT) utilizes somatovisceral and viscersomatic reflex diagnosis to aid diagnosis and therapeutic applications. CMRT utilizes various organ involvement, investigates laboratory analysis testing (e.g., blood, urine, saliva, etc.), and can utilize other types of interdisciplinary diagnostic tools. Aside from co-treatment of patients with musculoskeletal or radicular pain, in 2010 a study [16] illustrated how chiropractic and acupuncture theory can work together to help treat a patient presenting with non-musculoskeletal conditions.

If acupuncture theory and principles along with CMRT can help diagnose and treat patients with non-musculoskeletal conditions it is reasonable that incorporating Ayurvedic principles and theory might also facilitate patient care. Since it is unlikely that one form of healing has all the answers, weaving the theoretical tenants of chiropractic, acupuncture and Ayurveda may help complementary alternative medicine practitioners better serve patients in need. The discussion presented in this paper can be used as a bridging point for Ayurveda its Marma Chikitsa, chiropractic, and particularly SOT’s CMRT. SOT and CMRT may make an ideal partner for such cross-pollination; since it involves a multi-dimensional appreciation for neurophysiology, musculoskeletal as well as visceral relationships addressed in therapeutic protocols. Recently, SOT is espousing a unique philosophy of enhancing patient recovery and health by building relationships with other disciplines [17, 18].