AMSA EDCAM INITIATIVE: A National Curriculum For Medical Students

c4. Yoga and Ayurveda

Authors: Manorama M. Venkatraman, PhD; Krishna Kumar, BAMS; Ramkumar Kutty, BAMS;
Ram Manohar, MD (Ayur); Karen Sherman, PhD; Cathryn Booth, PhD.

This module provides guidelines and resources for education and background on alternative
systems of medicine including ​Yoga​ and ​Ayurveda​, and also introduces other systems that
emphasize attunement with the environment such as ​Native American medicines​ and ​Yoruba
medicine​.

Table of Contents
Learning Objectives
Course Format
Definitions
History, Philosophy, and Methods
Major Clinical Applications
Interface with Other CAM Modalities
Research Summary
Landmark Studies
Bibliography
Summary of Similar Courses
Audio/Visual Materials
Websites
Acknowledgements

SUGGESTED LEARNING OBJECTIVES

Upon completion of the Ayurveda, Yoga, Native American and Yoruba medicine learning
components of the curriculum, medical students should be able to:

● understand the different branches of Yoga and distinguish them from Hatha Yoga.
● discuss the philosophical underpinnings and history of Ayurvedic medicine and surgery.
● understand the fundamental principles that distinguish Ayurveda.
● explain the common thread of attunement with nature seen in Native American medicines,
Yoruba medicine and Ayurveda.
● engage in basic Yoga postures.
● know where to find scientific evidence for Yoga and clinical applications for Ayurveda.
● discuss the biochemical basis for Hatha Yoga and its physiological effects.
 ● understand how different traditions use herbal medicines similarly.

SUGGEsted course Format

A majority of medical schools in the U.S. have begun introductory coursework on CAM using
different approaches. Most focus on a few topics or modalities of CAM that are easy to teach or
provide an epidemiologic overview. Formats include pre-orientation workshops, lunch-time
lecture series, longitudinal evening or weekend workshops with faculty, student interest groups
with faculty sponsors, guest speaker series, and /or medical center-sponsored CME courses open
to medical students. Many of these have evolved to a more formal integration of CAM topics
into the existing medical curriculum, either using longitudinal courses or electives. Schools are
encouraged to design innovative approaches to introducing the CAM modalities they choose,
with encouragement to provide balance in education by selecting modalities from each of the 10
core CAM categories.

Because true integration of complementary medicines can be achieved only when coursework is
incorporated into the existing curriculum, AMSA suggests that schools work toward building
lectures, handouts, slides, and cases that can be introduced in existing core courses. This
approach allows the students to actively compare other medical systems with allopathic and
osteopathic medicine and will reinforce basic science and modern clinical practice. It will also
allow exposure to all students, not only those already interested in CAM. Experiential activities
such as field trips, demonstrations, and lab exercises are encouraged and can be appropriately
introduced to complement didactic instruction.

Faculty and community lecturers should be familiar with the topic from a traditional and clinical
perspective, not merely an academic exposure. Emphasis on accurate portrayal of the CAM
modality from professionals is essential to accurate teaching. The resources within this module
should serve that goal and assist educators in providing timely, relevant, and professionally
reviewed materials to medical students.

Definitions

Yoga

The Sanskrit word "Yoga" comes from the root ​yug​ (to join), or yoke (to bind together or to
concentrate). Essentially, the word "Yoga" describes a means of uniting or a method of
discipline: to join the body to the mind and together join to the self (soul), or the union between
the individual self and the transcendental self. In his classical work ​The Yoga Sutras,​ a
2000-year-old treatise on yogic philosophy, the Indian sage Patanjali defines Yoga as "that
which restrains the thought process and makes the mind serene."

Yoga has been practiced in India for thousands of years, and is traditionally used by spiritual
seekers as a system of self-development for purification of the body and mind (G. Feuerstein,
2001). Yoga is proposed to be a preventive as well as curative system of the body, mind, and
spirit.

Ayurveda
Ayurveda, the Sanskrit term for "knowledge of life” or “knowledge of longevity," is a
comprehensive system of traditional health care that emphasizes the relationship among body,
mind, and spirit, with balance of the internal and external environment. It is one of the officially
recognized medical systems in India. Ayurveda seeks to restore an individual’s innate harmony.

Ayurveda is the healing side of Yoga, and Yoga is the spiritual tradition from which Ayurveda
emerged. Through Yoga one prepares the body and mind for self-realization or union with the
Divine. Through Ayurveda one supports the spiritual journey by maintaining body and mind in a
state of balance and well being. Yoga and Ayurveda are so closely intertwined that it is hard to
imagine one without knowledge of the other. Using the wisdom of Ayurveda, a Yoga practitioner
can choose asanas (postures), pranayama (breathing practices) and mantra (sacred sounds)
specific to his or her unique constitution in order to maintain health. The Ayurvedic physician
prescribes specific practices to prevent illness and assist the healing process (adapted from
naturalhealers.com).

Native American medicine

Practiced on the North American continent for thousands of years, the common theme of Native
American medicines is the belief that physical illness can be treated by community, counseling,
ceremony, and communion with nature, as illness is viewed as simultaneously spiritual, mental,
physical and environmental. Because of the interaction and hierarchical embeddedness of these
levels, intervention at any one level should affect any other.

Native Americans stressed development of the inner life that is seen reflected in the outer world.
The events of the outer world spoke to inner processes for the person. For example, a fire is
burning on the mountain at the same time the person is in agony. The agony is dissipated through
some awareness and rain quenches the fire. The fire and the rain were messages about the
internal processes of the person. The traditional belief is that the mountain could have responded
with fire and then the sky with rain, both in response to the human being and now also the
burning mountain.

Yoruba Medicine

Yoruba-based medicines are indigenous to West Africa, and have spread to the Americas mostly
via the slave trade, where revered healers and prophets were sold into slavery and transported to
the southern U.S., Haiti, the Caribbean islands, Colombia, and Brazil. Yoruba was incorporated
into local healing practices as well as the dominating religions of Europe and have evolved to
form health practices seen in santeria, voodoo, juju, and candombre. Yoruba thought and medical
practices are believed to have roots in the Ifa Corpus, a religious text revealed by the mystic
prophet, Orunmila, thousands of years ago. Many Yoruba practitioners believe that the idea that
oneness with the Creative Essence brings about a wholeness in the human essence. A person
seeks to bring himself into alignment (balanced health) with his spiritual being (immortal
reality), and his relationship with the Divine Cause. This is achieved through herbs, spiritual
baths, right living, diet, rituals, and self-development which are used to maintain a healthy and
happy life. Healers using spiritual incantations and lifestyle changes are called babalawos.
Herbal specialists who act as pharmacists and doctors combined are called onisegun.

 History, Philosophy, AND Methods

Ayurvedic texts describe 8 components or arms of Yoga that encompass a philosophy of life: 1)
yama​ (self-restraint); 2) ​niyama (​routines); 3​) asana​ (postures and physical exercises); 4)
pranayama ​(use of breathing to achieve focus); 5) ​pratyhara ​(withdrawal of mind from sense
organs); 6) ​dharana​ (concentration); 7) ​dhyana​ (meditation); and 8) ​samadhi​ (emancipation).
Asana​ and ​pranayama ​have been incorporated alongside Ayurvedic medicine as the basis of a
system of medical therapy.

Most Westerners associate the practice of Yoga with ​Hatha Yoga​, physical exercises
emphasizing the practice of physical postures called ​asanas ​which involve standing poses,
forward, backward, and lateral bends, spinal twists, and inverted poses. This is complimentary
and separate from ​pranayama​ meditation, practiced with asanas as a more comprehensive form
of Yoga.

Ayurveda dates back an estimated 5,000 years and is widely considered to be the oldest form of
health care in the world that uses a comprehensive approach to diagnosis and treatment,
including both medical and surgical techniques. A multifaceted system including components of
herbal medicine, diet modification, oil therapies, massage, Yoga, and meditation, Ayurveda
provides a holistic and integrated approach to the prevention and treatment of illness by both
lifestyle modification and a system of therapies that aims to restore balance to body, mind, and
spirit.

Current practice and knowledge of Ayurveda are based on three classic Sanskrit written texts,
primarily the ​Charaka Samhita​ (circa 1500 BC) whose classification of more than 200 diseases
and 150 pathological conditions and congenital defects is remarkably consistent with WHO
disease classification criteria (Mishra, Singh, Dagenais, 2001). The ​Susruta Samhita​ (1500 BC)
and ​Ashtanga Hridayam ​(500 AD) are the other two classics which deal with surgery and
internal medicine respectively. While the ​Charaka Samhita​ and the ​Susruta Samhita​ undoubtedly
were first compiled by 1000 – 1500 BC, the forms we have now both date from far later, no
earlier than the early centuries AD, as adaptations to new technology were incorporated.

Ayurveda has eight traditional branches: surgery, internal medicine, gynecology/neonatology,

pediatrics, ophthalmology and otolaryngology, psychiatry, toxicology, and geriatrics. Ancient
Ayurveda laid the foundation for its validation process by emphasizing ‘repeated observations’
and acceptance of data as reliable only if of uniform consistency, without any contradictions.

According to Ayurveda, each person has a constitution created at conception that determines
basic physiology and personality. This constitution is the inherent balance of three ​doshas,​ or
subtle biological energies which govern the functions of the body, known as ​vata​ (motion), ​pitta
(metabolism), and ​kapha​ (cohesiveness). ​Doshas ​are reportedly formed in the body from food
and other physiologic processes, and regulate thousands of separate functions in the mind-body
system. ​Dosha​ equilibrium (their quantity, quality, and function relative to each other) is thought
to be essential for optimal health and prevention of disease. An individual’s constitution and
personality is determined by a unique combination of these three ​doshas​. Constitution
determines what will cause imbalance and susceptibility to illness.

Diagnosis​: Ayurvedic diagnostics are not so different from that of conventional medicine and
include a detailed history and physical (including highly specialized examination of the pulse,
tongue, and urine). In addition, the patient’s constitution and personality are determined, as well
as the nature of imbalance among the ​doshas.​

Treatment:​ Ayurveda has a rich tradition of plant pharmacotherapy with a great variety of plants
believed to improve digestion, remove impurities, and balance the ​doshas.​ In Ayurvedic
treatment, the selection and dosage of medicines are specific to the patient and will depend on
which of the three ​doshas​ are out of balance. The traditional treatment system to balance
aggravated ​doshas​ is known as ​panchakarma,​ involving five therapies using purgatives or
laxatives, therapeutic vomiting, medicated enema, nasal administration of medicines, and blood
purification. Dietary and lifestyle interventions are initiated according to the disturbed ​doshas
and based on the ​prakriti​ (physical and mental constitution) of a person. This is accompanied by
spiritual nurturing, physical exercise, and Yoga practice (Lad, 1999).

 MAJOR Clinical Applications

Regular practitioners of Hatha Yoga claim that a balanced program of postures will improve the
physiologic function of nerves, muscles, glands, and visceral organs (Farrell, 1999).
Traditionally, Yoga is believed to work with the breath to facilitate the intake and assimilation
and better movement of ​prana​, or life energy, that travels freely throughout the body. The breath
is thought to be the link between the body and the mind and, thus, the key to achieving both
physical and psychological benefits (Sovik, 2000). Practitioners believe it cleanses the body of
toxins, clears the mind, energizes the body, releases muscle tensions, and increases muscle
flexibility and strength (Anon, 2001). Yoga purportedly increases strength by toning the muscles
and by correcting the tightness and weakness that might otherwise result in such conditions as
torn ligaments and pulled hamstrings (Globus, 2000).

BKS Iyengar is a leading proponent of a technically precise system of Yoga and Yoga
therapeutics applicable for a wide variety of medical problems ranging from high blood pressure
and asthma to constipation and colic. In addition, the programs developed by Dean Ornish for
the treatment of cardiovascular atherosclerosis incorporates Hatha Yoga as an integral
component.

The practice of Yoga alone or with other Ayurvedic therapies has been noted in Ayurvedic texts
to be beneficial in treating certain diseases and conditions such as hypertension, bronchial
asthma, anxiety, and depression, neurosis, gastrointestinal disorders, headache, and insomnia.
The exact mechanism of action of Yoga in such therapeutic contexts is not known. It is thought
that the autonomic nervous system balance is improved by Yoga, resulting in a relatively
hypometabolic state that lessens the energy demands on the body. Preliminary research suggests
that the efficiency of the cardiovascular and respiratory systems are also significantly enhanced
by Yoga (Mishra, Singh, and Dagenais, 2001).

Viniyoga is considered one of the traditional therapeutically-oriented Yoga styles practiced in the
U.S. (Feuerstein, 2001). It focuses on the health of the spine and on the function of each posture,
rather than how accurately the practitioner executes each posture (Kraftsow, 1999). A special
breathing technique is used throughout the postures to help the practitioner focus on the spine
and feel internally how the body is responding to the movement into and out of a posture. Other
therapeutically oriented forms of Yoga include Iyengar, with its emphasis on the use of props
such as blocks, bolsters, and straps to help people maintain proper alignment in poses, and
Integrative Yoga Therapy, founded by Joseph LePage in 1993 to develop programs for
mainstream settings.

Other styles of Yoga popular in the U.S. include Ashtanga, or Power Yoga, with an emphasis on
building strength, stamina, and flexibility; Bikram (Hot Yoga) which includes 26 postures done
in 100°F or more; Jivamukti, a variation of Ashtanga, with an emphasis on spiritual training,
including chanting, meditation and readings; Kripalu, sometimes called the Yoga of
consciousness; and Kundalini Yoga, involving the classic stretching postures and breathing
exercises, coordinated with chanting and meditation to stimulate the release of so-called
Kundalini energy. One of the world's largest schools of Yoga, Sivananda calls for the rigorous
application of Yoga postures, breathing exercises, relaxation, vegetarian diet and study of
scriptures.

Interface with other CAM Modalities

Ayurveda’s primary treatments such as herbal medicine, meditation, exercise, diet and nutrition,
and spirituality encompass several CAM domains, as delineated by NCCAM in 2001. Like
Naturopathy, Ayurveda is an alternative medical system and a biologically-based therapy using
herbs, diet and nutrition. It uses meditation and prayer for balancing the mind, body, and spirit. It
has a specialized and elaborate system of massage (manipulative) therapies. Acupressure is said
to have its origins in Ayurveda’s ​marma-sthan​ (vital points) therapy​. ​Martial arts such as qi
gong, tai chi, and karate were adopted and practiced in Chinese monasteries for centuries and
also originate from Ayurvedic traditions, in particular the traditional Indian martial art known as
kalaripayattu​ of Kerala. Energy healing was first mentioned in Ayurveda 5000 years ago.
Native American medicine shares Ayurveda's philosophy of healing based on the
reestablishment of harmony between self and environment. The concept of universal harmony is
also characteristic of Yoruba-based medicines. The Yoruba believe there is a harmony in the
universe - the circling of the planets, the tides of the earth, the growth of vegetation, the lives of
animals and people all are related. As in Ayurveda and traditional Chinese medicine, the Yoruba
system incorporates environmental and emotional states into the definition of health.
Research Summary

Yoga
Since scientific research on Yoga began in the 1920’s, nearly 2000 studies on Yoga (including
postures, breathing exercises, and meditation) have been published, primarily in India
(Achterberg, 1994). These studies have looked at a vast array of disease conditions and
physiological changes. However, most studies of Yoga are small, poorly designed, inadequately
controlled, and many include co-interventions, leading to questions about the accuracy of the
conclusions (Luskin, 1998). Thus, despite the growing popularity of Yoga in the United States,
there have been very few controlled clinical trials evaluating the effectiveness of Yoga for any
condition and most of these have been of poor quality.

Studies have found that Yoga has a wide range of beneficial physiological and psychological
effects on numerous body systems. After Yoga training, the cardiovascular system appears to
function more efficiently, showing increased endurance and aerobic power, improved blood
flow, lowered systolic and diastolic blood pressure, and decreased heart rate (Pandya, 1999). In a
landmark study, Ornish (1983) showed that Yoga training plus dietary changes was associated
with a drop of 14 points in cholesterol levels in three weeks and with increased work efficiency
of the heart. Another study found reductions in blood pressure, heart and respiratory rate, and
body weight among healthy physical education teachers who had already exercised an average of
nine years before receiving three months of Yoga training (Telles, 1993).

 Yoga has been found to lead to positive changes in respiratory parameters, including increased
chest expansion, vital capacity, and tidal volume (Udupa, 1972; Shivarpita, 1981; Kant, 2000;
Sovik, 2000). However, no clear evidence yet exists that Yoga improves the symptoms of
asthma, even though at least five published studies have investigated this subject. Two recent
systematic reviews focusing on the use of breathing exercises, primarily Yoga-based, concluded
that insufficient evidence exists to reach reliable conclusions (Ernst, 2000; Holloway, 2000).

Additional documented physiological changes that occur after practicing Yoga include: better
ability to cope with stress (Schell, 1994; Baldwin, 1999); decreasing levels of serum cortisol, and
increasing levels of alpha wave activity in the brain (Kamei, 2000); changes in brain activities,
including improvements in cortical activities and inhibition of limbic activities (Pandya, 1999);
enhanced metabolic function (e.g. increased oxidation of fats and improved anabolic functions
(Pandya, 1999); increased levels of mental and physical energy (Wood, 1993); increased spinal
and hamstring flexibility (Baldwin, 1999); and significantly decreased hyperglycemia in
non-insulin dependent diabetics (Jain, 1993). At least some of these physiological changes, such
as diminishment of overt sympathetic tone, are assumed to occur via improved regulatory
function of the autonomic nervous system (Pandya, 1999).

Garfinkel has evaluated Yoga for osteoarthritis of the hand (1994) and for carpal tunnel
syndrome (1998). These pilot studies found significantly greater reductions in pain (both
conditions), and increased grip strength (carpal tunnel), and finger range of motion and
tenderness (osteoarthritis).

Despite a thorough search of the Western biomedical literature, no clinical trials of Yoga for the
treatment of back pain could be found, although the Indian literature reports that Yoga is
beneficial for both acute and chronic pain management (Farrell, 1999). They attribute the
benefits of Yoga to the increased flexibility and strength, decreased pain and stiffness, increased
body awareness, and decreased stress that comes from performing postures (Spilner, 1999).

Ayurveda
There have been several publications on Ayurveda as an entire system of medicine sponsored by
the government of India and Ayurvedic colleges, and by individual publishing houses for
scholarly works, including Chowkhambha, Motilal Banarsidass, and Munshiram Manhoharlal.
Searches are available through the following websites: ​http://www.mlbdbooks.com/help.html
a​nd ​http://www.sagar.com/search/Business/Publishing/index.shtml​. There are a number of
studies on specific treatments and considerable literature on the pharmacological actions of
Ayurvedic herbs and their active ingredients (see Khan and Balick, 2001 for a review of clinical
and other studies of 166 Ayurvedic herbs).

Laboratory and human experimental studies have suggested benefits of Ayurvedic products in
conditions such as Alzheimer’s disease (1997), Parkinson’s disease (Manyam et al.,1999),
rheumatoid arthritis (Etzel, 1996; Chopra, 2000), osteoarthritis (Kulkarni et al., 1991) and
diabetes (Azad Khan, Akhtar, and Mahtab, 1979). Transcendental meditation, a specialized
meditation technique adapted from Ayurveda has been shown to reduce blood pressure
(Schneider et al.,1995; Alexander et al., 1996) improve post-traumatic stress syndrome (Brooks
and Scarano, 1986), decrease anxiety (Epley, Abrams, Shears, 1989), decrease alcohol and drug
abuse (Alexander, Robinson, and Rainforth, 1994) and generally improve psychological health
(Alexander, Rainforth, and Gelderloos, 1991).

Khan and Balick (2001) make the point that although a great deal of the research on Ayurveda
may not stand as strong evidence according to the tenets of evidence-based medicine, it
constitutes a first round of data that can provide the basis for more rigorous clinical trials.
Another point to consider is that many research studies written in regional languages are not
included in the international medical indexes.

Hardy et al. (2002) have conducted a systematic review of the use of Ayurvedic therapies for the
treatment of diabetes. Fifty-four articles containing the results of 62 human clinical studies using
Ayurvedic therapy for diabetes were identified. These studies were analyzed in detail to
determine if evidence existed regarding the efficacy of Ayurvedic therapy for diabetes. The
authors have identified a number of interesting areas for future research in diabetes.

The National Institutes of Health has funded the following studies related to Ayurveda and Yoga:

1. Pharmacokinetics & pharmacodynamics of anti-inflammatory botanicals (David Nix,

University of Arizona).
2. Ayurvedic Herbals: Effects on Lipids and Atherosclerosis (Phillipe O. Szapary, University of
Pennsylvania).
3. Efficacy of Yoga for Self-Management of Dyspnea in COPD (Virginia Carrieri-Kohlman,
University of California, San Francisco).
4. Yoga as a Treatment for Insomnia (Sat Khalsa, Brigham and Women’s Hospital).
5. Effects of Yoga on Quality of Life during Breast Cancer (Alyson Moadel, Yeshiva
University).
6. Evaluating Yoga for Chronic Low Back Pain (Karen Sherman, Center for Health Studies).
7. Yoga and Peak Flow Rates in Pregnant Asthmatics (Judith Balk, Magee Women’s Health
Corp.).
8. Effect of Yoga on Asthma (Prem Kumar, Tulane University).
9. Ayurvedic Meditation and Yoga for Adolescents with Ulcerative Colitis (Lonnie Zeltzer,
University of California, Los Angeles).

 Description of landmark Studies

1. Azad Khan AK, Akhtar S, Mahtab H. ​Coccinia indica in the treatment of patients with
diabetes mellitus​. ​Bangladesh Med Res Counc Bull​ 1979 Dec; 5(2): 60-6.

A randomized controlled trial was performed to assess the hypoglycemic properties of a

preparation of the herb ​Coccinia indica​ on uncontrolled and untreated type 2 diabetic patients.
Thirty-eight patients were randomly allotted to receive either 900 mg of ​Coccinia indica
twice/day for 6 weeks (Arm II, n=16, 23% female, age 51 ​​ 10 years) or placebo (Arm I, n= 16,
14% female, age 44 ​​ 5 years). Ten of the 16 patients receiving ​Coccinia indica​ showed a
marked improvement in the glucose tolerance tests to values closer to normal (p<0.05), while
none in the placebo arm showed marked improvement.

2. Chopra A, Lavin P, Patwardhan B, et al. ​Randomized double blind trial of an

Ayurvedic-derived formulation for treatment of rheumatoid arthritis​. ​J Rheumatol​ 2000;
27(6): 1365-1372.

A 16-week randomized double-blind, placebo-controlled trial of an Ayurvedic drug, RA-1

(​Withania somnifera, Boswellia serrata, Curcuma longa​, and zinc ash) was conducted with 182
patients with active RA. An intention-to-treat analysis showed significant (p < 0.05)
improvement in the active group: the proportion of patients with a 50% reduction in joint
swelling (95% CI approximately 1.52, 29.90) and swollen joint score (95% CI approximately
0.91, 28.73); reduced rheumatoid factor (95% CI approximately -303.7, -2.72); 39% in the RA-1
group versus 30% placebo showed American College of Rheumatology (ACR) 20%
improvement (95% CI approximately -5.48, 24.59) and increased hemoglobin. A continuous
improvement (p < 0.001) in several ACR core set measures and laboratory activity indices
(erythrocyte sedimentation rate, C-reactive protein, interleukin-6) was seen during a subsequent
open-label phase.

3. Chopra A, Lavin P, Chitre D, et al. ​A clinical study of an Ayurvedic (Asian Indian)

medicine in OA knees​. ​Arthritis Rheum 1​ 997; 41(9): S198 (abstract).

Ninety patients with symptomatic (VAS >4 cms) primary osteoarthritis of the knee were
randomized into active (N=45;) and placebo groups (N=45) in a 32-week study. A functional
assessment questionnaire (WOMAC) was used to measure pain, stiffness and difficulty. Results
showed a significant reduction in pain on VAS (p=0.006) and improvements in WOMAC score,
both for combined (p=0.044) and individual components (p=0.012-0.059).

4. Singh RP, Singh R, Ram P, Batliwala PG. ​Use of Pushkar-Guggul, an indigenous

antiischemic combination, in the management of ischemic heart disease​. ​Int J Pharmacog
1993; 31: 147-160.

Inula racemosa​ was studied in combination with ​Commiphora mukul​ (a 1:1 mixture) in 200
patients with ischemic heart disease. Approximately 80% had dyspnea, and all had chest pain,
with ST-segment and T-wave changes on ECG. There was a 39% decrease in total cholesterol,
51% decrease in triglycerides, and 32% decrease in total blood lipids. At the end of the study
period (6 months), 26% had a complete restoration of normal ECG, while another 59% showed
improvement. Patients experiencing dyspnea fell to 32 percent, from a baseline 80%, and 25%
had no chest pain.

5. Dwivedi S, Agarwal MP. ​Antianginal and cardioprotective effects of Terminalia arjuna,

an indigenous drug, in coronary artery disease​. ​J Assoc Physicians India​ 1994; 42: 287-289.

An open study of ​Terminalia​'s effects on stable and unstable angina revealed the following
results for the stable angina patients (Group A; n=15) and unstable angina patients (Group B;
n=5) after 3 months of treatment: a 50% reduction of anginal episodes, reduction of systolic
blood pressure ((p < 0.05), and significant increase in both time to onset of angina and the time
to appearance of ECG ST-T changes (p < 0.001). Both groups showed improvements (p < 0.05)
in left ventricular ejection fraction. In terms of overall clinical condition, treadmill testing, and
ejection fraction, 66% in Group A and 20% in Group B improved.

6. Bharani A, Ganguli A, Mathur LK, Jamra Y, Raman PG. ​Efficacy of Terminalia arjuna in
chronic stable angina: a double-blind, placebo-controlled, crossover study comparing
Terminalia arjuna with isosorbide mononitrate.​ ​Indian Heart Journal​ 2002 Mar-Apr; 54(2):
170-5.

Terminalia arjuna b​ ark extract, 500 mg t.i.d., given to 58 patients with stable angina with
provocable ischemia on treadmill exercise, led to improvement in clinical and treadmill exercise
parameters as compared to placebo therapy. These benefits were similar to those observed with
isosorbide mononitrate (40 mg/day) therapy and the extract was well tolerated.
7. Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR Jr.​ Yoga-based
intervention for carpal tunnel syndrome: a randomized trial​. ​JAMA 1​ 998 Nov 11; 280(18):
1601-3.

In a randomized single-blind, controlled trial, 42 subjects with carpal tunnel syndrome (median
age, 52 years; range) were assigned to the Yoga group (11 Yoga postures twice weekly) for 8
weeks. Controls supplemented their treatment with a wrist splint. Changes from baseline to 8
weeks showed that the Yoga groups had significant improvement in grip strength (increased
from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02),
but changes in grip strength and pain were not significant for control subjects. The Yoga group
had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P =
.008). In this preliminary study, a Yoga-based regimen was more effective than wrist splinting or
no treatment in carpal tunnel syndrome.

8. Thabrew MI, Senaratna L, Samarawickrema N, Munasinghe C. ​Antioxidant potential of two

polyherbal preparations used in Ayurveda for the treatment of rheumatoid arthritis​. ​J
Ethnopharmacol​ 2001; Aug; 76(3): 285-91.

The antioxidant potentials of two Ayurvedic polyherbal formulations were assessed by their
effects on the antioxidant enzymes catalase, glutathione peroxidase (GPX), and superoxide
dismutase (SOD); lipid peroxidation; and concentrations of serum iron and hemoglobin (Hb),
and total iron binding capacity (TIBC). One hundred patients (all female, ages 35 to 65 years)
with RA were assigned to receive one of two formulations (Mahrasnadi and Weldehi). Results
showed that Maharasnadi had greater antioxidant potential than Weldehi. With the Maharasnadi,
the initial activities of plasma SOD, GPX and catalase were enhanced by 44.6, 39.8 and 25.2%,
respectively, and concentrations of the total serum iron and Hb, and the TIBC improved by 26.8,
24.8 and 16.1%, respectively.

9. ​World Health Organization/Indian Council for medical research collaborative study on

the efficacy of Ayurvedic treatment in rheumatoid arthritis​. Coimbatore, India: The
Ayurvedic Trust, 1984.

The World Health Organization (WHO) sponsored its first-ever study of a traditional medical
system at the Ayurvedic Trust in Coimbatore, India, enrolling 240 subjects from 1977 to 1984. In
this open, unblinded study, Ayurvedic physicians administered the treatment; the collaborating
allopathic panel from the Indian Council for Medical Research finalized subject selection and
evaluated the effects of the treatment, using American Rheumatism Association (ARA) criteria
(grip strength; walking time; number of swollen and painful joints; ESR; joint count;
Rheumatoid Factor). The average length of treatment was four months. Tests done at 6-week
intervals showed no evidence of renal, liver, or blood abnormalities as a result of the Ayurvedic
medicines.

The allopathic panel outcome evaluation indicated that there was significant improvement in the
subjects’ condition. Statistically significant results were noted in all parameters from baseline to
end of treatment: grip strength increased from 82mm Hg to 111mm Hg (p < 0.001); walking time
decreased from 7.5 seconds to 4.8 seconds (p < 0.001); swollen joints decreased from 6.6 to 4.3
(p< 0.001); painful joints decreased from 7.8 to 3.6 (p < .001); mean joint count decreased from
74 to 30 (p < 0.001); mean ESR decreased from 59mm to 37mm (p < 0.001). While 60% were
classified as belonging to functional class III or IV at admission, only 12 percent were so
classified at the time of discharge. The overall improvement was significant (p < .001). Eighty
percent had a fall in rheumatoid factor titer, the change in the majority being at least 2 doubling
dilution steps. The improvement was statistically significant (p < 0.01). Subjects evaluated their
condition at discharge more favorably than did the allopathic physicians. Follow-up data on 47
patients at the 6​th​ month after discharge showed that improvement in walking time and joint
circumference were maintained and that mean ESR dropped to 25mm (p < 0.01). Subjects
evaluated their condition at discharge even more favorably than did the allopathic physicians.

10. Herron R, et al. ​Banned PCBs and agrochemicals in blood reduced 50 percent by
centuries-old detoxification procedure.​ ​Alternative Therapies in Health and Medicine​ 2002;
8(5): 93-103.

This study showed that lipophilic medicinal treatments with clarified butter called ​ghee​,
combined with sesame oil massage and enema treatments removed lipid soluble toxins PCB,
pesticides, and metabolites such as beta-HCH in a total of 103 subjects by almost half.

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Summary of Related Courses at health professional programs

The Ayurvedic Institute - New Mexico

[Ayurveda certificate courses including, ​The Ayurvedic Correspondence Course​, taught by Dr. Robert
Svoboda.]
11311 Menaul NE
Albuquerque, New Mexico 87112
505-291-9698
505-294-7572
http://www.Ayurveda.com/

Bastyr University

Ayurvedic Medicine - Electives

Robert Svoboda, lecturer
c/o Lynda Raby
1100 NE 4th Street
Hallandale, FL 33009
http://www.drsvoboda.com/contact.htm

Columbia University Center for South Asian Studies

Electives
Hinduja Center for India Studies

East-West Institute of Alternative Medicine

CME: Integrative Ayurvedic Program for Health Care Providers
Linda J Reynolds, PhD, DAy
Talisman Research Corporation
PO Box 713
Winchester, MA 01890-4113
978-897-0041
linda@lifescinav.com

SUNY Stony Brook Center for India Studies

Indian Systems of Medicine Elective (under construction)

Dr. Sridhar, director
Center for India Studies
E-5350 Melville Library
SUNY at Stony Brook
Stony Brook, NY 11794-3386
631-632-9742
631-751-7050
indiastudies@stonybrook.edu
http://naples.cc.sunysb.edu/CAS/india.nsf/

University of Connecticut School of Medicine

Introduction to Ayurvedic Medicine – M1, M2 Elective Introduction to Yoga – M1, M2 Elective
Amala Guha, PhD, MPH, MA
Assistant Professor of Medicine
Program Director, Complementary and Alternative Supportive Care
Univ of Connecticut School of Medicine
263 Farmington Ave
Farmington, CT 06030-1315
679-4190
guha@nso2.uchc.edu

The Ohio State University College of Medicine

Maharishi Ayur-Veda – M1 Elective
[First-year elective for 4 sessions of 3 hours each. “This mini-module gives a comprehensive
overview of the natural health care system known as Maharishi Ayurveda. Students in this
mini-module are encouraged to actively participate in discussions. Students participate in
determining their own psychophysiological body type and will practice pulse diagnosis.”]
Hari Sharma, MD, FRCPC
Department of Pathology
SL Hall, Room M-407
320 West 10th Avenue
Columbus, OH 43210
614-293-3976
614-293-5984(fax)

University of Vermont College of Medicine

Principles of Ayurveda in Clinical Practice
Felicia Foster, RN, DAy
Department of Cardiology
161 Austin Drive, #61
Burlington, VT 05401
802-862-1781

Weill (Cornell) Medical College,

Wyckoff Heights Medical Center
Ayurvedic Principles and herbs​ – M3
[Included in the Family Medicine core rotation]
Bhaswati Bhattacharya, MD, course director
Bhaswati@aol.com

AUDIO/VISUAL AND WEB-BASED MATERIALS

Ayurveda CD-ROM

[Ayurveda multimedia CD-ROM from Dabur, an Ayurvedic supplement and education

collaborative.]
http://www.dabur.com/

Barefoot Yoga

[A collection of Yoga videos and books.]

http://www.barefootYoga.com/books.html

Yoga Yahoo Directory

[Yoga directory listings with links to teachers, centers, books, and videos.]
http://www.yogadirectory.com/

Websites
Acupuncture Associates Clinic
http://www.drgrotte.com/Courses in Traditional Medicine.htm

[Courses in traditional medicine, including Yoruba, are offered as electives.]

Ayurvedic Foundations
http://www.ayur.com/

[Ayurvedic Foundations conducts workshops and custom training (U.S. and abroad), produces audio cassette
tapes, and provides Ayurvedic lifestyle counseling. Links, online catalog.]

Ayurvedic Health Center

http://www.ayurvedic.com/
[Ayurvedic Health Center website. The basic principles of Ayurveda, home remedies for
common diseases, order Ayurvedic products, study Ayurvedic courses via internet.]

The Ayurvedic Institute

http://www.Ayurveda.com/
[The website for The Ayurvedic Institute at Albuquerque, New Mexico offers courses in
Ayurveda and Yoga. There are over 3400 hours of formal program instructor-led classroom
training offered during a 4 year period.]

Ayurvedic Medicine Resources Webpage

http://www-hsl.mcmaster.ca/tomflem/altmed.html#ayur
[McMaster University’s Alternative Medicine metadirectory includes Ayurvedic Medicine
resources, courses and links]

Ayurvedic Trust and Arya Vaidya Pharmacy

http://avpAyurveda.com/

[This is the website of the Ayurvedic Trust and Arya Vaidya Pharmacy in Coimbatore, India. It offers short
and long-term courses in Ayurveda and Yoga, many of which are for foreign students.]

Deepak Chopra Center

http://www.chopra.com
[This is the website of Deepak Chopra Center. It offers seminars and information on spirituality,
Ayurveda, and Yoga.]

Government of India Ministry of Health & Family Welfare

http://www.mohfw.nic.in/ismh
[This is the official website of the Government of India Ministry of Health & Family Welfare,
under which the Indian Systems of Medicine and Homeopathy division is located. The
government has instituted a program to provide lecturers to Ayurvedic conferences to medical
doctors around the world.]

The National Institute of Ayurvedic Medicine

http://niam.com/corp-web/AVSchool.htm
[This is the website in The National Institute of Ayurvedic Medicine in New York. A certificate
course in Ayurvedic medicine is scheduled to start April 2003.]

International Association of Yoga Therapists

http://www.iayt.org/Yogatherapy.html

Vedic Lifesciences

www.ayuherbal.com/ayueducation.htm
[Ayurvedic herbal medicinal plants, consulting doctors on Ayurveda and pharmacology,
Ayurveda books, education, workshops, literature search.]

The Yoga Journal

www.Yogajournal.com

Yoga Teachers
www.Yogasite.com
[Offers a state-by-state listing of Yoga teachers.]

Acknowledgments

AMSA acknowledges with gratitude the contributions of the following persons to the
development of this module:

Manorama M. Venkatraman, PhD

Assistant Professor, University of Washington School of Nursing

Krishna Kumar, BAMS

Ramkumar Kutty, BAMS
Ram Manohar, MD (Ayur)
Karen Sherman, PhD
Cathryn Booth, PhD

Robert E. Svoboda, BAMS

Adjunct Faculty, Bastyr University. ​http://www.drsvoboda.com/

Bhaswati Bhattacharya, MPH, MD

Director of CAM Education and Research
Assistant Professor of Family Practice in Clinical Medicine
Wyckoff Heights Medical Center, New York, NY

American Medical Student Association (AMSA) Foundation 1

EDCAM Project ​(created November 2002)