Ayurveda - Kerala : A healthy revival of Ayurveda

by Parveen Chopra

It's like a brick kiln of hopes and desires, hot and claustrophobic. On this sticky August evening, there must be over a hundred people milling around in a small hall. Many have been stewing for hours, waiting for just a frenetic three-minute interview and pulse-reading by the good doctor. Hope here has neither class nor color nor gender; its' seekers include rich Gujarati businessmen and dirt poor, illiterate tribal women.

There are babies' squalls erupting out of this thicket and children running around. Somehow, amidst this mess, order finds its place: Queues—one to see the assistant doctors who prescribe diet, another for the dispensary, and so on.

Soon, like a DNA strand, a queue shuffles into existence in front of me, too. Ah, the doctor wants to show off. He is sending me patients who uniformly report remarkable recoveries from problems so varied and complex that few would believe something as gentle as ayurveda can handle: an athletic young man emotionally kayoed by a bout of impotence; a pale, skinny 25-year-old who bares, like a freak show artist, various parts of his anatomy to show me the scars of a lifetime of multiple diseases and complex treatments.

And one of the fattest people I have ever seen, a prosperous-looking safari-suit-clad man, claims he has sloughed off 100 pounds after he flew down for treatment about a month ago from England.

Welcome to Dr Pankaj Naram's clinic—rather one of his four clinics in one city alone: Mumbai, India. Forty-five-year-old Dr Naram's roaring practice is an eye-opener to me. Sitting in Delhi, I was only familiar with the name of Brihaspati Dev Triguna, who rifles like a professional card hand through 500 patients a day. But here I was face-to-face with Dr Naram who handles, with a felicity as great as Triguna's, 400 patients a day.

The jetsetting vaidya (traditional Indian doctor) spends a quarter of a year in Europe and the USA where his students run half a dozen ayurveda clinics. He claims that his transcontinental practice is worth $2 million. I realized that there must be many more popular and eminent vaidyas working away with the diligence and quiet, proud expertise of goldsmiths in this gigantic country, but whose renown is local and locked in because the media doesn't go there.

Clearly, India remains the world's largest repository of alternative (complementary, to be politically correct) medicine which successful treats more people everyday than 'modern' medicine can even dream of. Traditional and alternative therapies may be witnessing a healthy revival the world over, but here they never went out of circulation.

Ayurveda is the oldest existing health care system. Ayurveda's growth graph in the past decade has been impressive. Middle and upper class people who had shifted their allegiance completely to allopathy, are again trying out ayurveda and other therapies, after bad experiences with allopathy. The Indian government, with an eye on nationalistic legitimacy, is also promoting ayurveda.

Besides, private enterprise is active in what can be called the Kerala school of ayurveda. The result is the blossoming of panchkarma clinics and hospitals al lover India. The panchkarma are the five internal cleansing procedures akin to the six in yoga. They are: vasti (enema), vamana (vomiting), virechana (purgation), nasya (application of herbal preparations through the nostrils), and rakta moksha (therapeutic release of toxic blood).

In Europe and America, new ayurveda hospitals are now focusing almost exclusively on panchkarma and allied treatments, perhaps because getting medicines ratified by drug authorities is a time-consuming and expensive process.

Ayurveda literally means the science of life. It follows that prevention of disease, promotion of health and longevity are given the requisite importance in addition to the curative aspect. Like the four Hippocratic humors, ayurveda's starting point is the tridosha (vata, pitta and kapha) theory.

Charaka's treatise, the primary and the oldest known ayurvedic text, says that the equilibrium of the three doshas in the body means health and their imbalance manifests as disease. To Ayurveda's detriment, the three doshas are translated crudely as wind, bile and phlegm. But a book published by the Kottakkal-based Arya Vaidya Sala, the premier ayurveda institution in Kerala, India, clarifies that vata includes functions of the central and sympathetic nervous system; pitta signifies metabolism and heat production, including digestion and formation of various secretions and excretions; and kapha implies heat homeostasis and formation of mucus.

In ayurveda's larger scheme, the balanced working order of dhatus (elements) and malas (wastes) is also considered vital. And they get vitiated when the three doshas are out of kilter. The seven dhatus, which produce each other in an ascending order, are: rasa (body fluids like plasma and lymph), blood, muscle, fat, bile, marrow, and shukra (sperm/ovum). Malas are stool, urine and sweat. The concept of jathragni, or gastric fire, is another of ayurveda's contribution to health care. Ayurveda further holds that all diseases originate from a little known element called aam. When, due to slackened digestion (weakened gastric fire), the essences of improperly digested food enter the body fluids, the contaminated mix is called aam.

Vaidyas use a two-pronged strategy: strengthen the digestive fire and remove aam. The texts suggest two main therapies: shamana (through medicines, etc) and shodhana (cleansing and rejuvenation) through panchkarma and rasarana. During treatment, pathya (diet and other regimen) is to be strictly adhered to.

VAIDYA BRIHASPATI DEV TRIGUNA
My first stop on the ayurveda trail is Triguna. For a man who has felt the pulse of kings and presidents, his clinic is unpretentious. It is located in a squalid little village named Sarai Kale Khan behind Delhi's Nizamuddin railway station. There are rows of benches in a shed-Iike structure which on a working day resembles a repository railway platform. Outside it, however, you may spot some six-door cars of wealthy and powerful patients parked next to rickety bicycles and hawkers' carts.

Eighty-two years old, brawny and turbaned, Triguna exudes an old world charm and sagacity as he sits in a room behind the shed. Despite the chaos outside, he is all concentration as he feels the pulse of each patient who is ushered in. He tells the patient what his or her present trouble is, but such is his stupendous proficiency that he apparently comes to know the patient's past and future medical history.

As an ayurveda verse goes: "Every raga finds resonance on the veena's strings; and the nuances of every disease reverberate in the pulse." Pulse-reading over, Triguna mumbles some Sanskrit and Hindi phrases to his son and comrade, Devendra Triguna, sitting next to him, who writes out the diagnosis and the prescription. His fame may rest on his accurate and sophisticated pulse diagnosis but patients return because his medicines—which are made in his own pharmacy, mostly from herbs grown in his herb garden—work.

"Medicine should be patient-specific and season-specific," he says with indisputable finality. That rules out patent medicines, except general tonics. Since Triguna consults free, the only money he makes is from the 25 per cent margin on the sales of remarkably inexpensive medicinies. "Half of our work is thanks to allopathy, " remarks the former president of the All-India Association of Ayurveda Practitioners in classical Mahar Hindi, with a touch of irony.

Triguna Mahesh Yogi is obviously alluding to the fact that modern medicine, armed with "magic bullets", successfully attacks acute diseases, only to create chronic problems and then throws in the towel. Triguna claims that ayurveda is effective in all chronic cases—in asthma and arthritis, in particular, and in ailments of the stomach, liver and kidneys.

Triguna has been associated with Maharishi Mahesh Yogi, the TM guru who first introduced ayurveda to the western world and launched the career of Dr Deepak Chopra. Says Triguna's son, Devendra: "Deepak used to work as an interpreter for my father when he went on world tours in the late '80s on Maharishi's invitation. Deepak showed interest and by and by picked up knowledge of ayurveda."

In his autobiography Return of the Rishi, Chopra showers fulsome praise on Triguna as the master physician. The Delhi-born doctor had his pulse read by Triguna and was told: "You think too many unnecessary thoughts. You are always trying to beat a deadline." The prescription: "Slow down. Watch more sunsets. Spend more time with your wife and children."

For Maharishi Ayurved, Triguna helped create Amrit Kalash, the rejuvenation formula which has sold worth over one million in the USA alone. Currently, he is offering his consultancy to the panchkarma clinic in Khosla Hospital in Delhi as well as some ayurveda hospitals in Germany and the USA run by the Maharishi's organization.

DR PANKAJ NARAM
Compared to the steady arid staid Triguna, Dr Naram's has been a mercurial rise. "After qualifying in ayurveda, I set up my practice, which was a dismal failure. The turning point came when I apprenticed with Baba Ramdas Swami, a centurion who lived on the outskirts of Mumbai and wrought miracles while treating people," recalls the stocky doctor who, I suspect, wears platform shoes to prop up his personality.

Before bequeathing his knowledge of ayurveda and pulse diagnosis, the swami tested Dr Naram's keenness for a long time and made him swear, among other things, not to charge any consultation fee. Since then, Dr Naram's success story, within the space of a decade, reads like a fairy tale. He claims he has been successfully treating all kinds of conditions, including AIDS.

He has helped thousands of infertile couples conceive, "to offer tangible, living proof of what ayurveda can do". He also employs long-forgotten techniques like panchoti, which uses acupressure to restore balance in body structure—tested by seeing that the navel is equidistant from the two nipples. He has 10 doctors working for him in India alone, and has set up two factories producing medicines and herbal cosmetics.

About his workshops abroad, he relates this story: "Once, in London, the dates of Deepak Chopra's workshop clashed with those of mine. Yet, 350 people attended my workshop compared to 200 at the famous man's." Interestingly, Dr Naram talks the seductive language of the New Age. "I am not in the business of treating patients. I am trying to improve their quality of life, to create is gainful opportunities for others to be happy."

The name of the institution he is setting up in Kandivli, Mumbai, is indicative of the sheer breadth of his ambition: Ayushakti Ayurveda Center for Health and Beauty, Energy and Tranquillity. Besides a 14-bed nursing home, panchkarma clinic and beauty center, it will hold conferences and educational programs on diet, lifestyle and positive attitude. It will also have a vegetarian ayurvedic restaurant and an outlet for organic food, snacks; bodycare products, remedies and medicines.

About the secret of his growing practice, he says: "I am not using steroids or black magic, as some might suspect." Then, after some reflection, he adds: "Yes, I do give energy—of love—to a patient and perhaps that cures." He appears to work from an altered state of consciousness when dealing with his patients—eyes shut, the words seeming to come from some place else.

His gracious wife, Smita Naram, who looks after the pharmacy, reveals some more secrets of their success: "We modified the medicine mixes mentioned in the ancient texts because they were formulated when a majority of the people were kapha-dominant. Today, 70-80 per cent are pitta-dominant because of their sedentary lifestyles. The weakened digestive fire creates a lot of aam. Besides, medicines today have to take into account pollution, stress, chemical-soaked and spicy foods."

The Narams have also made an innovation in ayurveda manufacturing process. They discovered that for some reason, the herbs had lost much of their potency. Consequently, results came only after many dosages. "After many hits and misses, we rediscovered a process to prepare concentrates," says Smita.

DR BALAJI TAMBE
Dr Balaji Tambe has earned considerable fame for his panchkarma treatment and his celebrity clientele that includes Bal Thackeray, the Shiv Sena supremo, and Sharad Pawar, former Union minister of India. He has set up a panchkarma hospital, under the name of Shri Balaji Health Foundation, near Lonavla, a hill station two hours from Mumbai.

Sunil Tambe, who manages the setup and is training with his father, says there is tremendous interest in ayurvedic therapy evidenced by the fact that while it was the last resort 15 to 20 years ago, it is now the first choice of those diagnosed with either diabetes or heart disease. These two categories comprise 70 per cent of their patients.

The Tambe center has a success rate of 70 per cent in reversing diabetes, while 45 per cent go on to resume a normal diet, including sugar and other carbohydrates. The main treatment in both diabetes and heart ailments is panchkarma. For heart treatment, special techniques such as hrud basti and kundalini (spinal) massage are also administered.

While symptoms like breathlessness disappear in the first phase itself, for total reversal, about eight months are needed. Dr Tambe personally administers to his heart patients—one of his recipes for them is medicated ghee, or clarified panchkarmic butter (generally considered lethal for the heart) to unglue sticky toxins from the body.

Lion-maned, 58-year-old engineer-turned-ayurveda expert, Dr Tambe, is also a kind of guru. The nursing home is part of Atmasantulana (Equilibrium of the Soul) Village, a commune/ashram. Of its 25 life members, 20 are young foreigners, mostly German. They work as therapists in the panchkarma clinic and the pharmacy unit and handle other chores. Yoga and meditation are part of the routine at the village. Treatment charges, excluding medicines, are Rs 17,000 for one month.

THE KERALA SCHOOL OF AYURVEDA
Despite pockets of adherents all over India, the vast corpus of panchkarma practice has traditionally been preserved in Kerala. Add to this the fact that this southern Indian state is the laboratory for many other specialized treatments, and what you get is a distinct Kerala school of ayurveda. Panchkarma are rendered more potent than the cleansing procedures of yoga and nature cure by the liberal use of herbal medicines mixed in oil, ghee, etc.

Before embarking on the elaborate treatment, the body is prepared with snehana (oil massage) and svedana (sweating): Feudal lords in Kerala are reported to have routinely used some of these treatments once a year to keep fighting fit. The Kerala school's specialities include: pizhichil ('zh' is pronounced as 'd')—the squeezing of lukewarm medicated oil from pieces of linen on the trunk and the extremities; dhara—the pouring of an unbroken stream of oil, milk or buttermilk on the forehead in an arc or ellipse; navarakizhi—massage with small linen bags filled with a particular kind of cooked rice.

Up to five paramedics give these treatments as the patient lies on a saucer-shaped wooden gurney called droni. Usually, only one of these treatments is prescribed for seven days or its multiples. These treatments have been found to be especially effective in degenerative diseases like rheumatism, arthritis, spondylosis, and in paralysis, hysteria, and other psychosomatic ailments.

Although practitioners claim that even psychopathological problems are amenable to ayurveda, few are ready to treat violent patients. There are, however, some ayurveda hospitals in Kerala with facilities for treating psychiatric problems. Since they call for complete rest, panchkarma and allied treatments are only offered to inpatients. For the more elaborate and protracted anti-aging program, called kaya kalpa (literally, a new body), which involves the application of rasayana, or rejuvenation tonics, the client is, in fact, sequestered.

Kaya kalpa, however, has become a rarity. There are many reasons that these treatments have been preserved and refined in Kerala alone. For one, the climate of this coastal state that boasts two rainy seasons, is ideal for such treatments. Another reason is historical.

Vagbhatta (whose Ashtanga Hridya is the Bible for Kerala's vaidyas), was the last of the well-known students of Charaka and is said to have moved to Kerala where he taught 18 students all of ayurveda's eight disciplines, which span the entire gamut from general medicine to psychiatry and even modern aphrodisiacs. The illustrious lineage of the 18 students, going back two millennia, are known as Ashta (eight) Vaidyas. Today, only three or four Ashta Vaidya families remain in the profession.

THE ARYA VAIDYA SALA
Dr P.S. Varier, who founded the trail blazing Arya Vaidya Sala in 1902 at Kottakkal, a small town 28 km from Calicut airport, was not an Ashta Vaidya. But he did have the good fortune of having one, K. Vasudevan Moosad, as his guru. Before embarking on his mission of revitalizing and modernizing ayurveda, he also steeped himself in allopathy to see whether he could distill the best of this system.

He set up a charitable ayurveda hospital, an ayurveda college and a unit to manufacture for the first time, standardized ayurvedic medicines scientifically and hygienically. The practice till then was to make the patients themselves collect herbs and prepare decoctions, etc. Today, the Vaidya Sala has two nursing homes and a herb garden in Kottakkal.

It also runs 13 OPD clinics in various cities including New Delhi, and has over 700 outlets for its 500-odd medicines. The total number of patients treated every year average 11 lakh. Getting admitted to the Vaidya Sala nursing home is far from easy: you may have to book yourself in up to a year in advance. The cost of treatment: Rs 1,000 to Rs 3,500 a week. Over 20 per cent of the patients here are foreigners. The capacity of the nursing home in three blocks is 120. There is also a 110-bed charitable hospital which offers both ayurveda and allopathy.

THE ARYA VAIDYA PHARMACY (COIMBATORE) LTD
One large Kottakkal-style setup is in Coimbatore, Tamil Nadu, India. Called The Arya Vaidya Chikitsalayam and Research Insititute, it was started in 1959 by P.V. Raffia Varier, whose son, K.S. Varier is now the chief physician. There is a 100-bed hospital, a medical laboratory, a research institute and a pharmacy, with many branches in other towns.

Treating arthritis is its speciality , said Karin Grimmeisen, a 30-something teacher from Germany, who took treatment for the disease there. "Yes, my limbs have limbered up. But as long as I was there, I felt drained out and very lethargic," she added. A star product of Arya Vaidya Pharmacy is Ayushman Jeevani, made from a plant called arogyapacha (Tichopus zeylanicus) touted as India's answer to ginseng. It is an anti-stress, anti-fatigue, appetite-promoting and restorative herbal tonic.

KERALA AYURVEDA PHARMACY
Founded in 1945 at Aluva in Kerala by the ayuredic scholar K.G.K. Panicker, the enterprises of the group now have been brought under a single corporate management: Kerala Ayurveda Pharmacy Ltd (KAPL). It operates three hospitals, in Chennai, Trichy and Aluya, a health resort in Bangalore on a 10-acre plot, and a chain of 19 Ayurclinics in Kerala and outside. On offer are also rejuvenation therapies. KAPL is also manufacturing and marketing ayurvedic medicines and traditional formulations.

ASHTAVAIDYA C.N. NAMBOODIRJ
I manage to track down one practicing Ashta Vaidya in Trithala, 100 km from Trichur in interior Kerala. C.N. Namboodiri, 67, receives me dressed only in a Spartan lower garment and a caste mark on his forehead. The Namboodiris once held stern sway in all spheres of life in Kerala. They are on a descending curve now and, true to form, this vaidya scholar doesn't seem to summon up the drive to create another Kottakkal: "I am not interested in commercialization," he says.

He is content running his modest 20-room nursing home. In broken English, he tells me that in Kerala; it's not the pulse, but looks, touch and personal interview which are used in diagnosis, By looking at me, he correctly identifies my nature as pitta aspected by kapha.

KERALA STYLE
Kerala's pizhichil massage, by itself, is becoming quite popular. At the white sand tourist destination of Kovalam beach, 15 km from Trivandrum, I see every second establishment advertising massage. The more reputed one is the Devaki Health Care Center in Trivandrum. On the periphery of New Delhi, close to the Qutab Minar, is the Kairali Health Club which offers various Kerala treatments in ethnic environs.

Kairali has also started what they call the world's first ayurvedic health resort, set amid 12 acres of lush greenery in Palakkad, Kerala. Besides treating specific illnesses, Kairali clinics offer programs for the healthy, for weight loss, and a shapeup program for postnatal women. In Delhi again, the Ayurveda Kendra, older than Kairali, offers similar services from two center in Chanakya Puri and Safdarjung Enclave.

Jumping on the ayurveda bandwagon, last year Shahnaz Husain opened a panchkarma and Kerala massage center in south Delhi's upmarket Greater Kailash area and introduced herbal cosmetics for pets. The charitable Moolchand Hospital offers panchkarma.

SANTHIGIRI AYURVEDA VAIDYASALA
Those spiritually inclined can try out the 50-bed spartan Santhigiri hospital, run by Guru Karurulkara near his ashram on the outskirts of Trivandrum. He and some of his disciples claim the power of darshan (extrasensory cognition) which is used to diagnose and to determine the karmic cause of disease as well as to prescribe a course of medical treatment leavened with prayer.

Mata Amritanandmayi Math in Kollam district in Kerala has also opened an ayurveda hospital. One discovery I make in Kerala is that the gurus, called gurukkal, of the kalarippayat—the mother of the world's martial art—often doubled as ayurveda physicians, specializing in orthopaedics. They obviously had to learn healing to handle the injuries inevitable during martial arts training.

They also refined the Marma Sashtra, the knowledge of vital or vulnerable points in the human body. Over 100 points are enumerated; some of them instantly fatal when struck. It is no coincidence that C. V. Govindankutty Nair, the guru at the well-known C.V.N. Kalari in the commercial hub of Trivandrum, runs an ayurveda clinic. Ayurveda is modernizing to remain relevant.

What better evidence than the fact that the Faridabad-based Jiva Institute, near New Delhi, India, has brought it online. Besides offering home remedies for common ailments, its website gives information on ayurveda, its treatments, history, principles and design.