preventive healthcare, an ayurvedic perspective

Preventive Healthcare, An Ayurvedic Perspective

Dr. Pratibha Shah

MD (Ay.)

Consulate General of India 2010 2

The Spectrum

Diet Rat Race

Lifestyle Fast Pace

Meditation STRESS

HEALTH DISEASE

Diseases of the new world

Why do we need Prevention?

• Health is a fundamental human right• To improve the quality of life• To bring down the cost of healthcare• To decrease DALYs• To increase QALYs

WHO Constitution: "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being..."

http://www.who.int/hhr/en/

Declaration of Alma-Ata: International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September, 1978

The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal………

http://www.searo.who.int/LinkFiles/Health_Systems_declaration_almaata.pdf

Goals of Ayurved

Broadly speaking, Ayurved states two maingoals namely:• ‘Swasthasya swasthya rakshanam’• ‘Aturasya vikaar prashamanam ch’

(Ch.Su.30/26)

Tenets of Preventive Healthcare in Ayurved

Factors affecting immunity at conception, and in the prenatal

period

• Maternal factors

- Health of the female sex cell

- Health of the Uterus

- Regimen followed during pregnancy,

including diet

Factors affecting immunity at conception…..cont’d

• Maternal factors cont’d

- Mental health of the mother

during pregnancy

- Influencing external factors during

pregnancy

Factors affecting immunity at conception….cont’d

• Paternal factors

- Health of the male sex cell

Activities performed immediately after birth

- Fontanelle are covered with a piece of cotton soaked in ghee

- Baby is administered ‘saindhav lavan’

(rock salt) mixed with ghee orally, for

cleansing

- A lot of anti-septic procedures are

performed, including fumigation

‘Sanskaras’ (rituals) performed in childhood

Out of the 13 – 40 ‘sanskaras’ or rituals that are advised in the childhood period, the most mentionable, from a health point of view is the ‘karnvedhana sansakara’ or piercing of the ears.

It is supposed to confer immunity against respiratory and certain other disorders.

Daily regimen

- Waking up early- Attending to nature’s calls- Cleaning teeth and tongue with any of the prescribed herb twigs- Doing ‘gandoosh’ or ‘kaval dharan’ for multiple health benefits- Eye care with ‘anjan’, ‘tarpan’, ‘putpaak’, ‘sek’, etc.

Dr. Mary Martha Stevens, Chairperson of the Dental Hygiene Department of Wichita State University, found that people who gargled with sesame oil daily had significantly lower (p<0.001) bacteria colony types in sub-gingival probe specimens (“The effects of a sesame oil mouth rinse on the number of oral bacteria colony types.”)

(Presented at the 11th International Symposium on Dental Hygiene, Ottawa, Canada, June 1989)

Daily regimen cont’d

- Nasal cavity and sinus care with ‘nasya’.

- Ear care

- Whole body and specific body part

massage

- Exercise

- Others – shaving, cutting nails, etc.

Studies on benefits of massage

Significant benefits from massaging newborns, such as enhanced weight gain and responsiveness

(Field T, Scafidi F, Schanberg S 1987 Massage of pre term newborns to improve growth and development. Pediatric Nursing 13:385-387)

(Rice R 1977 Neurophysiological development in premature infants following stimulation, Developmental Psychology 13:69-76)

Seasonal regimen

There are 6 ‘ritus’ or seasons according to

Ayurved, namely –

‘Hemant’, ‘Shishir’ (Winter), ‘Vasant’

(Spring), ‘Greeshm’ (Summer), ‘Varsha’

(Monsoon), ‘Sharad’ (Fall).

Characteristics and the dos and don’ts of

each of these seasons, including diet and

regimen are described in great detail.

Giving heed to factors like ‘bala’, ‘kala’, ‘sattva’, etc.

Every individual has a different level of

‘bala’, ‘sattva’ and other individual

attributes. Also, there are factors like ‘kala’,

etc. which need to be taken into

consideration before undertaking any

activity.

Knowing your body type and eating and living accordingly

• Based on dosha predominance, there are 7 body types

• Each body type characteristics are listed with fine details and therefore it is possible to identify every individual’s body type.

• If the individual follows the diet, regimen and lifestyle according to one’s body type, he or she can keep diseases at bay

Taking care of mental health

• Mental health is an important component of one’s health

• Mind and mental attributes have been described in great detail in Ayurvedic texts

• Various means of maintaining mental health like meditation, chantings, charity, etc. have been listed

Recognizing prodromal symptoms

• This is one of the strongest areas of Ayurved.• Prodromal symptoms for virtually every disease

have been elaborately described.• Recognizing prodromal symptoms and starting

preventive care at that stage, is a major tool to prevent a full blown disease.

Others

• A lot of other instructional gems are found throughout the ancient Ayurvedic texts.

• Some pertain to diet – various types of diets, diet categories, seasonal diets, unhealthy/contradictory food combinations, rules to be followed while eating, etc. are found in elaborate detail

• Some pertain to Public Health issues

The three upstambh (pillars) of health

• Aahaar (Diet)

• Nidra (Sleep)

• Brahmacharya (Controlled celibacy)

Importance of Aahaar (diet)

• Of the three pillars of health, aahaar or diet is the most important, and that is why it is mentioned first

• Of all the factors that are responsible for the growth and development of the human body, diet is the most important.

(Ch. Sh. 6/12)

Hitaahaar (Beneficial or conducive diet)

Hitaahaar:• Is panchbhautik (made up of 5 components – Earth,

Water, Fire, Air, Space), because every individual is panchbhautik

• Has shadras (6 tastes), or has all or most of them or has rasas according to prakruti (body type)

• Is liked by the one eating• Is clean and pure• Not very hot• Has been freshly prepared (Ch. Soo. 25/33)(Su. Soo.

46/465)

Importance of hitaahaar

(conducive diet) • It is only hitaahaar that is solely responsible for

shareer vriddhi (growth and development of the body) and maintenance of health. On the contrary, ahitaahaar (inconducive diet) is responsible for disease development.

• Although there are other factors in the development of the body, aahaar is the most important

(Ch. Soo. 25/33)

Fundamentals and rules of Aahaar

• Food should be prepared and served by well wishing people or aids.

• The kitchen/cooking area should be clean and not congested

• For kings, testing for poisoning should be done before food is served.

(Su. Soo. 46/451-453)

Fundamentals and rules of Aahaar (cont’d)

Rules for vessels or containers:• Ghee should be served in cast iron bowls• Drinks like water to be served in silver containers, clay glasses,

glasses made up of alum or glass; or boiled and cooled water can be stored and served in brass containers.

• Drinks like alcohol or cold drinks should be served in containers made up of clay, glass or alum.

(Su. Soo. 46/454-455)

• Fruit juices, soups and liquid food should be served in silver containers.

• Dry accompaniments to the food, and food processed with yogurt should be served in containers made of gold.

• Food and fruits to be served on clean leaves of banana, palash (Butea monosperma), etc.

(Su. Soo. 46/456)

Rules for serving:• The one being served should be seated on even,

clean ground.• The serving area should be pleasant, not a

thorough fare, and should be fragrance, flowers and other things that are pleasant to the senses, around him.

(Su. Soo.46/457)

• Fruits, solids and other dry edibles like paapad (cracker), etc. should be placed on the right side of the plate.

• All liquids like water, fruit juice, soup, alcohol, etc. should be placed on the left side of the plate.

(Su. Soo. 46/458)

• Sweets and jaggery preparations should be placed towards the front portion of the plate.

• After having placed all these accompaniments, the server should carefully and respectfully serve the main dishes in the center of the plate.

• Dishes should be served in order of liking, starting with the least favorite dish and ending with the most favorite.

(Su. Soo.

46/459)

Rules for the one eating:• Should be hungry• Should sit straight on a slightly elevated seat• Should eat in silence focusing on the food• Should eat not too fast, nor too slow, chewing many

times before swallowing• Should rinse mouth when changing rasa• Should drink sips of water in between meals • Should floss with herb twig or silver/brass wire, after

meals (Su. Soo. 46/471, 489)

Rules for the one eating: Do not eat –• Before or after meal time• Less or more• Contaminated, uncovered, spoilt, burnt food.• Left over food• Food that you do not like, or that which tastes

and smells bad• Food that has not been cooked properly• Food that has been reheated, was cooked long

time back or is very cold.

Rule for optimum serving:• According to one’s agni (digestive fire)• Conducive to one’s doshic prakruti (body type

according to dosha)• That which gets digested in time

(Ch. Soo. 5/1-4)

Qualitative assessment:• Assessing the gurutva/laghutva of the diet:

- One must evaluate whether the food is guru (heavy) (milk products like curd, cream, etc., red meat, meat of animals of marshy or wetlands, sesame seeds, etc.) in terms of digestion,

- Or laghu (light) – moong daal (green gram), red rice, bird meat, deer meat, etc.

• Assessing the rasas of the diet:

- A shadras diet is highly advocated. (Ch. Soo. 5/5-6)

Quantitative assessment:• Fill the first 1/2 of stomach with solid diet, guru

diet taken first, followed by laghu diet; but if diet is very heavy, fill only 1/3rd of the stomach with solids

• Fill the next quarter or third with anupaan (adjuvant).

• Leave the rest quarter or one third space for action of different doshas

(Ch. Soo. 5/7)(Ch. Vi. 2/4)(As. Hr. Soo. 8/46)

Other Rules:• Eat solids first• Eat the highly beneficial amalaki (gooseberries)

in the beginning, middle and end of meal• Eat salad in the beginning of the meal• Meals should be taken in a timely manner or

when hungry.• Meals should be taken in the right amount,

neither too much nor too less.

(Su. Soo. 46/468-470)

• One should take into account the characteristics of the season, one’s body type, time of the day and other factors, before selecting their diet.

(Su. Soo. 46/468-470)

After Meals Regimen:• Sit straight for 5-10 minutes, waiting for food to

settle down• At this time, smoke herbal cigars or hookah

and/or chew beetle leaf or other mouth fresheners

• After that, take a stroll (about 100 steps)• After dinner, do the above and then lie down on

your left side.• Surround oneself with pleasantness

Avoid after meals:• Sleep or sit for a long time• Laugh or talk excessively• Avoid unpleasant sensory exposure• Consume large amount of fluids• Excessive physical activity like swimming, horse

riding, etc.

(Su. Soo. 46/495-496)

Anupaan (Adjutant)

Anu means that which follows.

Paan means a drink.

Therefore Anupaan means a drink that follows or

in the context of, a drink that follows meals or is

taken along with it.

Anupaan that is opposite in properties to the meal

that has been taken, but is not contrary to it, is the

best. (Ch. Soo. 27/320-330)(As. Hr. Soo. 8/47-51)(Su. Soo. 46/424-436)

Benefits of Anupaan

A well selected Anupaan confers the following

benefits:• Softening of food• Good digestion and absorption• Satiation• Energy• Nourishment

(Ch. Soo. 27/320-330)(As. Hr. Soo. 8/47-51)(Su. Soo. 46/424-436)

A few common Anupaan

• Water – This is a universal Anupaan; can be taken with any type of food.

• Milk – This is considered the best Anupaan, especially for the weak, tired, infants and aged, people who have fasted, traveled or done excess

physical labor, or have undergone excess of any kind.

• Honey + Water – For the obese

A few common Anupaan

• Herbal alcohols – for the lean, insomnia, fear, etc.

• Meat soups – for the emaciated• Warm water – after any oily preparation• Kanji (a type of vinegar) - after a particularly

or buttermilk heavy meal

For the diseased, the Anupaan should be opposite

to properties of the dosha involved.

Benefits of disciplined eating

• Strength • Stamina• Good complexion• Good health• Happiness • Long life• Vitality

It is rightly said that the jathraagni or the digestive

fire, needs fuel in the form of diet, to sustain itself. (Ch. Soo. 5/8)(Ch. Soo. 27/342)

Diet recommended for frequent use

• Shashtik rice(ripens in 60 days), shali rice• Moong daal (Green Gram)• Saindhav lavan (rock salt)• Amalaki (Gooseberry)• Millet flour• Cow milk• Lean meat• Honey• Aakaash jal (rain water collected at strategic

high points) (Ch. Soo. 5/12)

Diet recommended for infrequent use

• Dried flesh• Dried plants• Lotus stem• Pippali (long pepper), Kshaar (alkalis), Lavan

(salt) • Meat of pig, cow, buffalo; fish• Curd• Bengal gram

(Ch. Soo. 5/10-11)

Diet to be always avoided

Vairodhik aahaar (diet which is harmful due to

processing, combination or other factors):

- Heated honey

- Milk with sour things

- Milk with fish

- Curd taken at night

- Ghee and honey mixed in equal amounts

(Ch. Soo. 26/80-111)

THANK YOU

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