The Status of
Ayurvedic Medicine
in the U.S.
Unlike the situation in India where Ayurvedic medicine represents a long-standing tradition that dates back to the founding of Indian civilisation, in America, Ayurvedic medicine is largely unknown. For most of those individuals who are aware of it, this eminent traditional medical system is merely one of many components of the entire field of CAM that is of potential benefit. The majority of people who pursue Ayurvedic medicine show an equal or even greater acceptance in such things as Western herbal medicine, homeopathy, chiropractic therapy, and numerous other materials, health philosophies, and techniques that have no direct connection to India. As such, it is common for a person to show an interest in popularised Indian herbs, such as gotu kola (one of the types of brahmi), myrrh gum (guggul), and withania (ashwaganda), while knowing nothing about the Ayurvedic system to which those herbs belong. Or, a person might become very interested in categorising themselves or other people into three physiological types (pitta, kapha, and vata), with some dietary recommendations to go with the categories, but not to understand the other important aspects of Ayurvedic medicine.
One of the things that keeps Ayurvedic medicine on a somewhat superficial level and mixed in haphazardly with all other complementary medicines in the U.S. is the fact that there are virtually no formally trained medical practitioners who specialise in and are fully devoted to Ayurvedic medicine. There is no licensing for Ayurvedic practitioners; anyone who wishes to employ this medical system as a formal practice must do so under a license to practice some other form of medicine (e.g., a medical doctor or a naturopathic physician). Because these licensed practitioners have already spent many years studying their first profession, they are unlikely to be able to devote the time necessary to become expert in a second medical profession, especially one that is so lacking in formal recognition here. Only a small portion of the Ayurvedic system is accessed.
As a result of this situation, Ayurvedic medicine in the U.S. has two main manifestations that are somewhat isolated from each other. On the one hand, there is a plethora of books that either describe Ayurvedic medicine (sometimes in considerable detail) or purport to do so (but, in actuality, misrepresent it). On the other hand there is the introduction of products, mainly herbal remedies, that are promoted by the distributors as being highly effective. Literature accompanying the products give a brief overview of how they are to be used, and cite any studies that might exist to bolster the claims. The products are either purchased over the counter or are prescribed by one of the aforementioned practitioners who, usually, has their original training in a medical speciality unrelated to Ayurvedic medicine.
There are a very small number of devoted Ayurvedic practitioners here. Two that immediately come to mind are Dr. Vasant Lad and Robert Svoboda. As a reflection of the American situation, both of these highly respected, knowledgeable individuals write books and articles about Ayurvedic medicine and are involved in selling Ayurvedic products having relatively little time to see patients. Dr. Lad has formed an Institute in New Mexico where classes are provided (an eight month programme of classes in the evenings is the core curriculum), whereas Svoboda is a continual traveller (in both India and the West) who gives short lectures at various locations.
The situation facing Ayurvedic medicine in
America should be compared with that of traditional Chinese medicine, because
there are similarities and differences that illustrate the possibilities
and problems of introducing foreign traditional medical systems.
Chinese medicine is a licensed primary health-care
practice in about 60% of the American states and is either a secondary
or tolerated practice in most of the other states. There is a national
testing organisation that most states rely on for determining who can get
a license, and there are more than 30 colleges of Oriental medicine (mainly
Chinese medicine, sometimes with contributions from Korean or Japanese
medical systems), most of which are accredited through a national agency.
Accreditation means that the colleges pass certain minimum standards (there
is an Oriental medicine accreditation board) and the students are eligible
to get government-backed loans to cover their tuition costs. At this time,
there are about 10,000 practitioners who have licenses to practice Chinese
medicine and it is estimated that as many as 12,000,000 office visits per
year take place involving these practitioners. Also, about 4,000 medical
doctors utilise one of the Chinese medical techniques, acupuncture, as
part of their practice (though it is usually a very minor part).
For perspective, just 25 years ago, Chinese medicine was virtually unheard
of and there were no licensed practitioners.
Why is Chinese medicine so well established while Ayurvedic medicine is in such a tenuous condition? I think there are three major reasons.
1. There has been a very large number of Chinese people immigrating into the U.S., especially since the 1970’s (coming mainly from Hong Kong and Taiwan) and they have concentrated themselves into large communities (Chinatowns) that support Chinese culture. Chinese medicine, in a form similar to that used in China, was primarily introduced to the U.S. in California, a state with a large Chinese population which currently has one-third of the licensed practitioners and a large proportion of the students. There are far fewer people from India in America and there are no population centres of India’s people in the U.S. (there is one such centre in Vancouver, British Columbia). Currently, there are five colleges or institutes that provide some training in Ayurveda, but all admit to providing only a limited aspect of the field and the main ones are located in low population states, such as New Mexico (Ayurvedic Institute) and Iowa (College of Maharishi Ayur-Ved) that don’t stimulate national trends as does California.
2. China has been willing to actively export its medical system. Under government sponsorship, China produced translated books and sent them to America (not waiting for Americans to seek them out in China). Several immigrants from China have felt that it was their duty to help Americans gain the benefits of the medical system that they cherished, so that vigorous organisations were established. Since the 1980’s, Americans have been actively invited to China to study Chinese medicine. The crude herbs and finished herbal products have been imported by Chinese immigrants and made available to anyone who wanted them. By contrast, the Indian government is not involved in export of Ayurveda and few Indian writers have made an effort to have their books published for an American audience and distributed in the U.S. Few Ayurvedic practitioners have stepped forward to intensively promote the medical system here, and it has been nearly impossible, until very recently, to get Indian crude herbs or even finished products. Further, the quality of herbal materials from China has been better than those from India in many instances (due to differences in quality control procedures).
3. The Chinese medical system’s basic concepts
of yin and yang and five elements, the unusual practice of acupuncture,
and the intermingling of medical practice performed by doctors with other
health practices that patients can undertake (especially the martial arts
qi-gong, tai-chi, and kung-fu) have attracted attention from a diverse
group of people. By contrast, the three doshas, the emphasis on dietary
restrictions, and the importance of such methods as oil massage and various
purification procedures, has attracted a much smaller audience. One of
the most heavily promoted traditional Ayurvedic practices is Panchakarma
(a purification procedure). Whatever this practice may be like in India,
in the U.S. it is offered as a several day event (requiring the person
to make a major change in their normal schedule and habits) that has a
high expense leaving it open only to the wealthy. By contrast, an acupuncture
session usually lasts about half an hour and can be fit into most schedules,
and it has a modest cost per session; in the 1990’s insurance companies
have begun offering coverage for that practice in response to popular demands.
Although Chinese medicine has gained considerable
ground, it also suffers from conditions in the U.S. that impair deep study
and commitment to the practice of a foreign tradition. Practitioners frequently
adopt numerous non-Chinese methods of CAM to combine with the limited Chinese
medical practices taught at the colleges. Authors in the U.S. then teach
an altered form of Chinese medicine that is more consistent with these
other therapeutic approaches than the traditional system used in China.
One other situation that deserves comparison and contrast is the introduction of yoga to the U.S., probably the most significant import of Indian culture thus far. Several yogis from India came to the U.S. during the 1960’s and 1970’s and provided teachings and guide books and opened centres of study. The practices were diverse, such as those of Vishnudevanada (standard hatha yoga), Iyengar (a new technique of hatha yoga), and Bhajan (kundalini yoga). At the yoga centres, Americans were trained as teachers who could then spread the practices far and wide; eventually a Yoga Journal was produced. Yoga, in turn, produced an interest in meditation, vegetarianism, Indian cuisine, Indian music (mainly as a result of the tradition-breaking action of Ravi Shankar), and other aspects of Indian culture. Yet, interestingly, yoga had very little influence on bringing Ayurvedic medicine to the U.S., and this appears to be because there is so little obvious connection between yoga practice and Ayurvedic medical practices. Rather, some interest in Ayurveda has been stimulated by the Maharishi organisation (that had become popular because of transcendental meditation) and by Dr. Deepak Chopra, who had originally worked with this organisation but who now lectures and writes about natural healing in general, with only a little reference to Ayurveda. The Yoga Journal carries a few ads and very few articles on the subject of Ayurveda. Thus, the opportunity for bringing to America the Ayurvedic medical system along with the popular health-promoting physical practices of yoga was, apparently, missed.
Still, the power of Ayurveda, in terms of the duration of its existence and the size of the country (India) that relies on it, will inevitably lead to a greater influence on America. The future direction of Ayurveda in the U.S. will depend very much on whether or not there is an increased effort on the part of the community of Ayurvedic doctors, professors, and researchers to determine and then meet the requirements of the unique American situation. A well-directed effort could result in Ayurveda having a standing somewhat similar to that of Chinese medicine, while continuation of the laissez-faire approach that seems to have marked this field up to now could mean that bits and pieces of Ayurveda will simply be subsumed into the general arena of CAM. In that case, the export of popular herbs from India to the U.S. to be sold mainly in over-the-counter remedies, perhaps mixed in with Western herbs, vitamins, and other materials (as is being done now) may be the primary result. Ashwaganda, commonly referred to as ‘Indian ginseng’ in order to make it understood by people who know Chinese herbs but not India’s herbs, is marketed in these unique combinations already.
Even if a major effort to introduce the entire
traditional medical system is pursued, it should be recognised that there
are strong forces working in the U.S. at this time that can limit the impact.
First, there is an increasing demand for proof of safety for any treatment
(whether physical therapy or ingested substance). For example, herbs and
herbal formulas that were regarded as entirely safe within traditional
contexts are now being seriously questioned in light of the fact that there
can be adverse interactions with drugs people are using, there can be rare
hypersensitivity reactions, and other problems may arise in the new setting
that had not been evident before in the traditional application. Second,
there is an increasing demand for standardisation, both in the training
of medical practitioners and in the content of remedies that are used.
Standardisation in training is difficult when there are different styles
of practice among the few specialists that come to the U.S. (as was experienced
with the very different yoga styles). Standardisation of herbal materials
is extremely difficult, and usually requires development of non-traditional
products that involve special extracts of individual herbs rather than
the complex preparations that have a long history of use. These forces
must be taken into account by proponents of Ayurvedic medicine in the U.S.;
otherwise, much effort could be wasted on very limited results.
While this outline of the situation with Ayurvedic
medicine in the U.S. may seem discouraging, it is a repeatedly demonstrated
quality of the U.S. culture that dedicated efforts can often pay off rather
quickly. As was seen with traditional Chinese medicine and with Indian
yoga, foreign philosophies and practices can gain a significant level of
professional recognition in just a few decades. A study of their successes
may help direct the path for Ayurvedic medicine.
Subhuti Dharmananda, Ph.D. (biology), has been Director of the Institute for Traditional Medicine (ITM), a U.S. non-profit organisation, for the past 20 years. He is the author of numerous articles on Chinese, Tibetan, and Indian medicine published by ITM to educate practitioners working in the U.S. The Institute operates two clinical facilities in Portland, Oregon and provides technical consultation to numerous other clinics, as well as to writers, researchers, and educators.
Dr. Subhuti Dharmananda, Director, Institute
for Traditional Medicine
2017 SE Hawthorne Blvd.,Portland, Oregon 97214,USA
Fax: 1-503-233-1017, E-mail: itm at itmonline.org, Website: www.itmonline.org
