Health Care Professional Information

Common Name

Ayurvedic medicine, traditional Indian medicine

Clinical Summary

From the Sanskrit words “ayur” (life) and “veda” (knowledge), Ayurveda originated in India over 3000 years ago. Treatment is patient-tailored and consists of oral formulations containing herbal, mineral, spice, and animal components, mental balance through yoga or meditation, purgatives, and dietary and lifestyle changes. It is available in at least 10 clinics in North America, but there is no licensure for practicing Ayurveda in the United States. Ayurvedic medicinals, which can contain from a few to hundreds of components, are commonly used to treat chronic diseases such as diabetes, rheumatoid arthritis, Parkinson's disease, acne, obesity, and cancer. Many of the more frequently used herbs have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, hypoglycemic, or antiinflammatory properties. Clinical trials show benefit of various formulations in treating acne, rheumatoid arthritis, fibromyalgia (1), diabetes (2), hyperlipidemia (3) (4), anemia (5), hepatitis, obesity, dyspepsia (6), and constipation. The effects of meditation in reducing anxiety, lowering blood pressure, and enhancing general well-being have also been confirmed. The World Bank is funding research in India to evaluate ayurvedic medicines for anemia, edema during pregnancy, and postpartum complications. There is no documented value for Ayurvedic therapies in treating cancer. However, certain modalities can be used to relieve cancer related symptoms and to improve quality of life. Recent studies demonstrate that yoga helps improve sleep pattern in lymphoma patients (7) and also reduces symptoms of stress in breast and prostate cancer patients (8).Little is known about the drug interactions between Ayurvedic and modern drugs. Numerous cases of lead poisoning from Ayurvedic preparations have been reported.

Purported Uses
  • Acne
  • Atherosclerosis
  • Cancer prevention
  • Cancer treatment
  • Cardiovascular disease
  • Depression
  • Diabetes
  • Health maintenance
  • Hepatitis
  • High cholesterol
  • Hypertension
  • Indigestion
  • Infections
  • Memory loss
  • Parkinson's disease
  • Rheumatoid arthritis
  • Weight loss
Mechanism of Action

Ayurveda emphasizes both health maintenance (Svasthavritha) and diagnosis and treatment (Athuravritha). Patients are classified by their prominent dosha, or physical, emotional, and metabolic type, Kapha, Pitta, or Vata, each located in specific organs and associated with two of the five elements (earth, fire, water, air, and ether) and five senses. The dosha represent properties shared by the organs, body, environment and cosmos. When a patient's unique state of dosha is out of balance, illness occurs. Therapy is personalized to the individual's problems and metabolic characteristics to restore individual dosha balance through diet and lifestyle modifications, medicinals (herbs, spices, metals and/or animal products), breathing exercises, and meditation. Detoxification (panchakarma) occurs before medicines begin, including bloodletting, induced vomiting, and bowel purging. The therapeutic approach seeks to cure the disease by reversing the steps that led to it, balancing the dosha (e.g., administering cooling medicines if Pitta, the hot dosha, is predominant) (9) (10).

Clinical trials confirmed that some Ayurvedic botanical formulations can be used to treat acute viral hepatitis (11); acne vulgaris (12); obesity (13); and rheumatoid arthritis (14) (15). Maharasnadi Quathar, a medicinal used to treat rheumatoid arthritis, increases antioxidant enzyme activity, decreases TBARS generation, and improves symptoms in human subjects (16).Many of the more frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, or antiinflammatory properties. (See monographs on these herbs for more information). The herbs most often used to treat diabetes, Gymnema sylvestre, Momordica charantia, fenugreek (Trigonella foenum-graecum ) Coccinia indica, and Pterocarpus marsupium, show hypoglycemic activity in vitro and in vivo. Mucuna pruriens, used in preparations for Parkinson's disease, contains L-dopa (17).Rasayana herbs (said to promote positive health) such as ashwagandha, Asparagus racemosus, Emblica officinalis, Piper longum, and Terminalia chebula show immunostimulant and adaptogenic activities in an animal study (18). Ayurvedic gold preparations (e.g., Swarna Bhasma) have antioxidant and restorative effects in animal models of ischemia (19). The herbal mixtures Maharishi Amrit Kalash-4 and -5 have antioxidant properties, inhibit LDL oxidation in vitro, inhibit platelet aggregation, and cause a reduction in aortic arch atheroma in hyperlipidemic rabbits (20). An in vitro study investigated the activity of extracts from eight plants that are traditionaly used as immunomodulators in Ayurvedic medicine against HIV: Allium sativum, Asparagus racemosus, Coleus forskohlii, Emblica officinalis, Glycyrrhiza glabra, Piper longum, Tinospora cordifolia and Withania somnifera (21). The study found that these extracts significantly reduced viral production in human lymphoid CEM-GFP cells infected with human immunodeficiency virus (HIV-INL4).

Warnings
  • Although heavy metals such as lead, gold, and silver are traditionally used in ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications (22).
  • In the last few decades, commercialized meditation regimens have emerged to the concern of many. They often associate meditation with supernatural abilities. Such claims are not based on scientific evidence and should not be confused with meditation practice in Ayurveda.
  • Improper use of Neti Pots (nasal rinsing devices) has been associated with rare but severe infections. Patients are advised to use only distilled or sterile water in such devices and to clean them properly after use (31).
Adverse Reactions

Reported (General): Headache, gastrointestinal complaints. Several herbs in Ayurvedic preparations can cause photosensitivity, while some contain arsenic or mercury that can produce skin lesions (23) (24).
Common (Mineral tonics): Ayurvedic preparations can contain varying amounts of lead and have caused severe gastrointestinal symptoms and anemia due to lead poisoning (23) (24).
Common (Adhatoda vasica): This herb, often used for respiratory tract ailments, is reported to have oxytocic and abortifacient effects.
(16) (19) (25) (26) (27) (28) (29)

Herb-Drug Interactions

Phenytoin: The Ayurvedic syrup shankhapushpi causes decreased blood concentrations of phenytoin (27).
Guggul induces CYP3A4 activity and may interact with medications that are metabolized by the CYP3A proteins (30).

Literature Summary and Critique

Prakash VB, et al. Sustainable effect of Ayurvedic formulations in the treatment of nutritional anemia in adolescent students. J Altern Complement Med. 2010 Feb;16(2):205-11.
This single-blind, randomized, controlled clinical trial investigated the effect of two Ayurvedic preparations, Sootshekhar Rasa and Sitopaladi Churna, on adolescent nutritional anemia in 1322 anemic students. They were randomly divided into 5 groups: subjects in Group I received starch as a control; subjects in Groups II through IV received daily or weekly doses of the two Ayurvedic supplements in different proportions; and subjects in Group V, received an iron and folic acid tablet. All participants continued treatment for 90 days and were then followed-up for an additional 6 months. At baseline the mean hemoglobin (Hb) level for all groups was 97.4 + 13.2 g/L. All groups were found to have a significant increase in Hb at the 6 month follow-up compared to baseline. However, only the Hb gains in groups III (6.9 + 0.6 g/L and V (3.64 + 0.56 g/L) were found to be statistically significant (p<0.01), compared to the control group. No adverse effects were noted. The investigators concluded that a daily dose of the two Ayurvedic preparations taken in the proportion given to Group III can produce sustainable improvement in nutritional anemia in adolescent students.

Rasmussen LB, et al.Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study. Clin Exp Rheumatol. 2009 Sep-Oct;27(5 Suppl 56):S46-50.
This study investigated the impact of Maharashi Ayurvedic therapies in female patients (n=31) with fibromyalgia. Each patient received individually designed purification therapies (massage, steam bath, enema), dietary advice, herbal therapy recommendations, and instruction in transcendental meditation (TM) . Subjects were given a questionnaire with a scale to rate 7 different outcomes: working ability, generalised pain, tiredness, stiffness, tiredness on arising, anxiety, and depression. Ninety percent (n=28) of the enrolled patients completed the 6 month follow-up. Results indicated that each of the 7 outcome measures were reduced by 25% to 46% at the one and six month follow-up. Compared to baseline, the reduction in all outcome measures was statistically signficant, except for anxiety. Eighteen percent of the patients had almost no fibromyalgia symptoms at the 6 month study endpoint, including 4 subjects who had chosen to practice TM. Study investigators concluded that the symptoms of fibromyalgia significantly improvement after treatment for 6 months with ayurvedic therapies, however further study is needed.

Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess 2001;41.
A systematic review of all published studies of ayurvedic treatments for diabetes mellitus available in English. Seven randomized controlled trials and 10 controlled clinical trials were identified; all evaluated single herbs or herbal formulations. The best quality RCT and smaller trials showed benefit of Coccinia indica; a single trial of holy basil found beneficial effects on fasting blood glucose; fenugreek showed overall cholesterol-lowering effects and, to a lesser extent, improved blood glucose control; Gymnema sylvestre showed improved glucose control in a number of trials; D-400 and Ayush-82, two herbal formulations containing Gymnema sylvestre, showed positive results. No serious adverse events were reported. Most trials had insufficient numbers for statistical power and had design flaws.

Lalla JK, et al. Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. J Ethnopharmacol 2001;78:99-102.
A short communication on a double-blind, randomized, placebo-controlled trial of a mixture of seven herbs (Aloe barbadensis, Azardirachta indica, Curcuma longa, Hemidesmus indicus, Terminalia chebula, Terminalia arjuna, and Withania somnifera) taken orally and applied topically in a cream or aqueous solution in 46 patients. After four weeks, the group receiving active oral and active cream (n=21) experienced the largest improvement in acne, while the group receiving active oral and active aqueous gel (n=20) had less of an improvement, and the small placebo groups and receiving active oral only (n=4) and placebo (n=1) experienced slight improvement and no improvement, respectively.

Chopra A, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-71.
A randomized, double-blind trial evaluating RA-1, a standardized formulation of Withania somnifera (ashwagandha), Boswellia serrata (gugulla), Zingiberis officinale (ginger) and Circuma longa (circumin), in patients with active rheumatoid arthritis. Patients received 444 mg RA-1 extract in split doses (n=89) or placebo (n=93) for 16 weeks and were required to discontinue NSAID therapy 3-5 days prior to entry, but stable prednisolone use not exceeding 7.5 mg was permitted. A significantly greater proportion of patients in the RA-1 group showed >50% reduction in joint swelling. Both the RA-1 group and placebo showed significant improvement from baseline in functional criteria, including joint count pain, joint count swelling, pain VAS, Stanford Health Assessment Questionnaire, and patient and physician global assessment; RA-1 showed numerically, but not statistically, greater improvement than placebo. Adverse events, consisting of headache and nausea, were similar between groups. Subjects were enrolled from free community arthritic camps, which may have led to selection bias towards women and lower socioeconomic classes.

Dosage (Inside MSKCC Only)
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References
  1. Rasmussen LB, Mikkelsen K, Haugen M, Pripp AH, Førre ØT. Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study. Clin Exp Rheumatol. 2009 Sep- Oct;27(5 Suppl 56):S46-50.
  2. Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess 2001;41.
  3. Szapary PO, et al. Guggulipid for the treatment of hypercholesterolemia. A randomized controlled trial. JAMA 2003;290(6):765-772.
  4. Singh BB, Vinjamury SP, Der-Martirosian C, Kubik E, et al. Ayurvedic and collateral herbal treatments for hyperlipidemia: a systematic review of randomized controlled trials and quasi-experimental designs. Altern Ther Health Med. 2007 Jul-Aug;13(4):22-8.
  5. Prakash VB, Prakash S, Sharma R, Pal SK. Sustainable effect of Ayurvedic formulations in the treatment of nutritional anemia in adolescent students. J Altern Complement Med. 2010 Feb;16(2):205-11.
  6. Chawla YK, et al. Treatment of dyspepsia with Amalaki (Eblica officinalis Linn.) - an Ayurvedic drug. Indian J Med Res 1982;76(suppl):95-8.
  7. Cohen L, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a tibetan yoga intervention in patients with lymphoma. Cancer 2004;100(10):2253-60.
  8. Carlson, LE, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004;29:448-74.
  9. Cassileth, BR. The Alternative Medicine Handbook. New York (NY):W. W. Norton & Co;1998.
  10. Chopra A, Doiphode VV. Ayurvedic medicine: core concept, therapeutic principles, and current relevance. Med Clin N Amer 2002;86:75-89.
  11. Antarkar DS, et al. A double-blind clinical trial of Arogya-wardhani - an Ayurvedic drug - in acute viral hepatitis. Indian J Med Res 1980;72:588-93.
  12. Paranjpe P, Kulkarni PH. Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a double-blind randomized placebo-controlled evaluation. J Ethnopharmacol 1995;49:127-32.
  13. Paranjpe P, Patki P, Patwardhan B. Ayurvedic treatment of obesity: a randomized double-blind, placebo-controlled clinical trial. J Ethnopharmacol 1990;29:1-11.
  14. Chopra A. Ayurvedic medicine and arthritis. Rheum Dis Clin N Amer 2000;26:133-43.
  15. Chopra A, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-71.
  16. Thabrew MI, et al. Antioxidant potential of two polyherbal preparations used in Ayurveda for the treatment of rheumatoid arthritis. J Ethnopharmacol 2001;76:285-91.
  17. Nagashayana N, et al. Association of L-DOPA with recovery following Ayurveda medication in Parkinson's disease. J Neurol Sci 2000;176:124-7.
  18. Rege NN, Thatte UM, Dahanukar SA. Adaptogenic properties of six Rasayana herbs used in ayurvedic medicine. Phytother Res 1999;13:275-91.
  19. Shah ZA, Vohora SB. Antioxidant/restorative effects of calcined gold preparations used in Indian systems of medicine against global and focal models of ischemia. Pharmacol Toxicol 2002;90:254-9.
  20. Sundaram V, et al. Inhibition of low-density lipoprotein oxidation by oral herbal mixtures Maharishi Amrit Kalash-4 and Maharishi Amrit Kalash-5 in hyperlipidemic patients. Am J Med Sci 1997;314:303-9.
  21. Sabde S, Bodiwala HS, Karmase A, et al. Anti-HIV activity of Indian medicinal plants. J Nat Med. 2011 Mar 3.
  22. Lead poisoning associated with ayurvedic medications—five states, 2000-2003. MMWR Morb Mortal Wkly Rep 2004 Jul 9;53(26):582-4
  23. Claeson UP, et al. Adhatoda vasica: a critical review of ethnopharmacological and toxicological data. J Ethnopharmacol 2000;72:1-20.
  24. van Vonderen MG, et al. Severe gastrointestinal symptoms due to lead poisoning from indian traditional medicine. Am J Gastroenterol 2000;95:1591-2.
  25. Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess 2001;41.
  26. Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000;143:923-9.
  27. Prpic-Majic D, et al. Lead poisoning associated with the use of ayurvedic metal-mineral tonics. J Toxicol Clin Toxicol 1996;34:417-23.
  28. Spriewald BM, et al. Lead induced anaemia due to traditional Indian medicine: a case report. Occup Environ Med 1999;56:282-3.
  29. Fugh-Berman A. Herb-drug interactions. Lancet 2000;355:134-8.
  30. Dan E, et al. Guggulsterone activates multiple nuclear receptors and induces CYP3A gene expression through the pregnane X receptor. JPET 2004;310:528-535.
  31. Consumer Updates: Is Rinsing Your Sinuses Safe? U.S. Food Drug Administration. Aug 2012. (Accessed Sep 14, 2012)

Consumer Information

How It Works

Bottom Line: There is no documented value for any Ayurvedic therapies in treating cancer. However, recent studies demonstrate that yoga helps improve sleep pattern and also reduces symptoms of stress in cancer patients.

Ayurveda emphasizes both health maintenance (Svasthavritha) and diagnosis and treatment (Athuravritha). Patients are classified by their prominent dosha, or physical, emotional, and metabolic type, Kapha, Pitta, or Vata, each located in specific organs and associated with two of the five elements (earth, fire, water, air, and ether) and five senses. The dosha represent properties shared by the organs, body, environment and cosmos. When a patient's unique state of dosha is out of balance, illness occurs. Therapy is personalized to the individual's problems and metabolic characteristics to restore individual dosha balance through diet and lifestyle modifications, medicinals (herbs, spices, metals and/or animal products), breathing exercises, and meditation. Detoxification (panchakarma) occurs before medicines begin, including bloodletting, induced vomiting, and bowel purging. The therapeutic approach seeks to cure the disease by reversing the steps that led to it, balancing the dosha (e.g., administering cooling medicines if Pitta, the hot dosha, is predominant) (1) (2).

Many of the more frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, or antiinflammatory properties. (See monographs on these herbs for more information). Rasayana herbs (said to promote positive health) such as ashwagandha, Asparagus racemosus, Emblica officinalis, Piper longum, and Terminalia chebula show immunostimulant and adaptogenic activities in an animal study (6). Mucuna pruriens, used in preparations for Parkinson's disease, contains L-dopa (3). Ayurvedic gold preparations (e.g., Swarna Bhasma) have antioxidant and restorative effects in animal models of ischemia (7). The herbs most often used to treat diabetes, Gymnema sylvestre, Momordica charantia, fenugreek, Coccinia indica, and Pterocarpus marsupium, show hypoglycemic activity in vitro and in vivo. The herbal mixtures Maharishi Amrit Kalash-4 and -5 have antioxidant properties, inhibit LDL oxidation in vitro, inhibit platelet aggregation, and cause a reduction in aortic arch atheroma in hyperlipidemic rabbits (4). Maharasnadi Quathar, a medicinal used to treat rheumatoid arthritis, increases antioxidant enzyme activity, decreases TBARS generation, and improves symptoms in human subjects (8). Clinical trials confirmed that some Ayurvedic botanical formulations can be used to treat acute viral hepatitis (16); acne vulgaris (19); obesity (21); and rheumatoid arthritis (14) (20).

Purported Uses
  • To treat acne
    Certain herbal preparations have been shown to be effective in reducing acne.
  • To prevent and treat cancer
    No scientific evidence supports this use.
  • To treat cancer related symptoms
    Recent studies demonstrate that yoga helps improve sleep pattern in lymphoma patients and also reduces symptoms of stress in breast and prostate cancer patients.
  • To treat heart disease No scientific evidence supports this use.
  • To treat depression
    No scientific evidence supports this use.
  • To treat diabetes
    Several herbs used in Ayurveda have blood glucose-lowering effects, but the clinical evidence for their use is not strong.
  • To treat fibromyalgia
    One clinical study found that ayurvedic dietary, herbal, and meditation therapies resulted in a significant improvement of symptoms in patients with fibromyalgia.
  • To lower high cholesterol
    One clinical trial showed that certain herbal preparations could lower blood cholesterol and triglyceride levels in overweight patients, but no other clinical trials have tested this use.
  • To treat Parkinson's disease
    One clinical trial supports the use of one herbal preparation for improving the functional status of patients with Parkinson's disease, but no other scientific evidence supports this use.
  • To treat rheumatoid arthritis
    One clinical trial did not strongly support the use of a certain herbal preparation for treating rheumatoid arthritis. Many herbs used in Ayurveda are thought to have anti-inflammatory effects.
  • For weight loss
    One clinical trial suggested that a few herbal preparations could aid weight loss in overweight patients, but no other clinical trials have tested this use.
Research Evidence

Anemia
In this study 1322 anemic students were randomized to five groups: Group I were the controls; Groups II through IV received daily or weekly doses of two Ayurvedic supplements in different proportions; those in group V were given an iron and folic acid tablet. The treatment was for 90 days and the participants were then followed-up for an additional 6 months. All groups had an increase in their hemoglobin levels at the follow-up, but only Group III reached significant levels. Daily dose of the two Ayurvedic preparations may improve nutritional anemia. 

Fibromyalgia
This study involved 31 patients to find out if Maharashi Ayurvedic therapies help patients with fibromyalgia. Each patient received individually designed purification therapies (massage, steam bath, enema), dietary advice, herbal therapy recommendations, and instruction in transcendental meditation (TM) . Subjects were given a questionnaire with a scale to rate working ability, generalised pain, tiredness, stiffness, tiredness on arising, anxiety, and depression. There was a significant improvement in symptoms after treatment for 6 months with ayurvedic therapies.

Diabetes mellitus
A systematic review of all published studies of ayurvedic treatments for diabetes mellitus available in English was conducted. Seven randomized controlled trials and 10 controlled clinical trials were identified; all tested single herbs or herbal formulas. The trials showed benefit of Coccinia indica; a single trial of holy basil found benefits of fasting on blood glucose; fenugreek lowered cholesterol; Gymnema sylvestre showed improved glucose control; D-400 and Ayush-82, two herbal formulas containing Gymnema sylvestre, showed positive results. However, most trials had small number of patients.

Acne vulagaris
A double-blind, randomized, placebo-controlled trial was conducted to find out if a mixture of seven herbs (Aloe barbadensis, Azardirachta indica, Curcuma longa, Hemidesmus indicus, Terminalia chebula, Terminalia arjuna, and Withania somnifera) was effective against acne. Forty-six patients took the mixture both orally and topically (in form of a cream). After four weeks, the group receiving both the oral formula and topical cream experienced the largest improvement in acne compared to those who received active oral and aqueous gel, and to those who took placebo.

Rheumatoid arthritis
This study tested RA-1, a standardized formula of Withania somnifera (ashwagandha), Boswellia serrata (gugulla), Zingiberis officinale (ginger) and Circuma longa (circumin), in patients with active rheumatoid arthritis. Patients received 444 mg RA-1 extract or placebo for 16 weeks and were required to discontinue any non-steroidal anti-inflammatories (NSAIDs) 3-5 days prior to entry, but stable prednisolone use not exceeding 7.5 mg was permitted. More patients in RA-1 group showed reduction in joint swelling compared to those who took placebo.

Patient Warnings
  • Although heavy metals such as lead, gold, and silver are traditionally used in ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications.
  • In the last few decades, commercialized meditation regimens have emerged to the concern of many. They often associate meditation with supernatural abilities. Such claims are not based on scientific evidence and should not be confused with meditation practice in Ayurveda.
E-mail your questions and comments to aboutherbs@mskcc.org.