ARTICLE IN PRESS

doi:10.1016/j.ph

Phytomedicine 12 (2005) 771–772

www.elsevier.de/phymed

BOOK REVIEW

L.C. Mishra (Ed.), Scientific Basis for Ayurvedic

Therapies, First Edition, CRC Press, Boca Raton, ISBN

0-8493-1366-X, 2004 (626pp., US$ 99.95, Hardcover).

Unlike most ayurvedic science publications in Amer-ica, this text is edited by a scholar trained in bothbiomedical and ayurvedic medicine. As an ayurvedicphysician later trained in laboratory science, Dr. Mishrahas created a text focusing on the physical-chemicalbasis of clinical practice using ayurveda. Mishra andcolleagues at the University of Southern California havebeen maintaining a database of ayurveda in the US,conducting basic and clinical research trials for the pastdecade, and publishing in several peer-reviewed alter-native medicine journals. His team has focused its workon the elucidation and research of clinical aspects ofayurvedic herbal use in the US.

Dr. Mishra received his first degree, a BIMS(Bachelor of Indian Medicine & Surgery), from theBundelkand Ayurvedic College in Jhansi, Uttar Pra-desh, India in 1954, focusing his work on ayurvedicherbs; the BIMS is now known as a BAMS (Bachelor ofAyurvedic Medicine & Surgery), as India now officiallyrecognizes six systems of medicine. Alongside his Ph.D.in biochemical pharmacology from SUNY Buffalo in1967, Dr. Mishra also received a baccalaureate in 1958and master’s in 1959 in pharmacy from Banaras HinduUniversity, Varanasi, Uttar Pradesh. Moreover, he hasworked as a chemist at an antibiotics industry, as aprofessor of a medical college, as a bench scientist withNIH funding and as a researcher in American academia.It is this combination of insight as a clinician andresearcher in two countries that makes the book a bridgefor pharmacologists, pharmacognosists, clinicians, che-mists, and holistic medical practitioners internationally.

At first glance, one may wonder: why another bookon ayurveda? India is filled with such books, with 4–5new titles emerging each month globally: a translationof the same classic texts with different correlations,specialties, and attempts at scholarly analysis. This bookhowever, is neither another translation of ancient textsnor another collection of monographs of plants in thelong line of CRC tradition: it is a bridge.

A system of medicine practiced continuously for thepast 5000 years, it is believed that ayurveda originated inthe Indus Valley and spread east through the Indian

ymed.2005.01.005

subcontinent as an oral tradition integrated into fourprincipal instructive texts on life: the Vedas. Approxi-mately, 3000 years ago, excerpts from the Vedas relevantto health and medicine were collected into a series ofwritten, focused compendia: the Charaka Samhita andthe Sushrut Samhita. Six such texts form the basis formodern interpretation, study and practice.

Providing a systemic overview of ayurveda in chapterone, Professor PNV Kurup, vice-chancellor of one ofthe largest ayurvedic colleges in India, states that inIndia alone, ayurveda is a Rs. 40,793 million (USD$ 816million) industry. Recognized by the WHO as an officialmedical science, ayurveda flourishes and continues tospread around the planet. There are 190 colleges inIndia, in addition to the traditional system of gurukala,or apprenticeship-based learning, practiced in ruralareas and among many of the most knowledgeableelderly experts. Though no official licensing is availablein the US, curriculum initiatives are forming throughseveral independent groups. This chapter lacks, how-ever, the global overview it claims, giving almost nodetail on the many research, education and commerceinitiatives in Europe and the US that are also underway.While access and cost issues that promote ayurveda inIndia are not applicable in the US due to regulatoryissues, they are generally not addressed.

As the introduction aptly points out, ‘‘most bookspublished in the West on Ayurveda offer little or noinformation about current biochemical, pharmacologi-cal, and clinical investigations.’’ Furthermore, theauthors are aware that ‘‘basic research on ayurvedictherapeutics has not been adequately integrated intodisease management protocols available to most con-sumers, whether they align themselves with mainstreamor complementary medicines.’’

Indeed, one of the largest hurdles for proponents ofayurveda is to appropriately translate the fundamentalprinciples — and the vocabulary — into terms that arecomprehensible to biomedical scientists and clinicianswho run the agendas, funding, approval and popular-ization of medicine and the healthcare industry.Unfortunately, the worthy aspects of ayurveda havenot been properly conveyed in a compelling way. Inaddition, defense of ayurveda is too often presented interms that are not of value in mainstream medicine, suchas unquestioned traditions and the wisdom of sages.

ARTICLE IN PRESSBOOK REVIEW / Phytomedicine 12 (2005) 771–772772

Mishra does the needful: he writes to an audience ofscientists, botanists, chemists, pharmacologists andpharmacognosists who love explanations using main-stream physiology and biochemistry. He uses correla-tions between ayurvedic conceptions of pathogenesisand the corresponding explanation of the same phe-nomenon in modern medical terms.

For example, Type II diabetes mellitus has been well-described in ancient ayurvedic texts as madhumeha.Diabetes was only categorized in mainstream medicinein the 1600s when Willis noted diabetic urine to tastesweet and hypothesized glucosuria. The book detailsclinical correlations for diabetes found in ancientayurveda and contrasts them with what was documen-ted in science by the DCCT (Diabetes Control andComplications Trial) in 1993. Moreover, the bookdiscusses pathophysiology according to the systems ofdoshas (body constitutions) and dhatus (tissues). Clinicalresearch evidence for six herbs and seven combinationherb regimens are described, using both ayurvedic andscientific concepts, for reducing the clinical symptoms ofimpaired glucose tolerance.

As a clinician-scientist himself, Mishra also writes forthe clinician and attempts the bridge that most have notdared to: a basic science book for the practicing holisticphysician. The book is organized by clinical conditionand discusses clinical research issues.

The first 6 chapters discuss the pharmacognosy andclinical practice management system of ayurveda,introducing terminology, therapeutic modalities, re-search designs, treatment theories, and placement ofayurveda in global context. Existing research is pre-sented on modalities used in ayurveda, such as massage,detoxification using oils and enemas, lifestyle changes,nasal cleansing and of course herbs.

Chapters 7–32 then route their way through the body,either systematically (e.g., hepatic disorders, eye diseases,gynecological diseases, male reproductive dysfunction) orby clinical multi-system conditions (obesity, diabetes,irritable colon, benign growths, allergic reactions).

The chapters are presented in standard clinical andscientific format. After some epidemiology and histor-ical context of the disease, the author plunges into

etiology as conceived by ayurveda, then into pathogen-esis as conceived by conventional physiology. Clinicalmanifestations are described and contrasted using termsfrom ayurveda and biomedicine. Diagnosis and clinicalmanagement are presented, then biomedical scientificdata for those treatments are outlined, providing alisting of international references for further reading.Each chapter features 4–15 herbs used for the clinicalcondition, providing condensed information on taxon-omy, chemistry, dosage, formulations, indications, andbotanical elements. Four appendices and an indexcomplete the book, giving the reader a sense that theargument of ‘‘no data for efficacy’’ may no longer beviable.

Does the book succeed in creating a bridge formainstream MDs, biomedical scientists and ayurvedicclinicians? Mishra does several things that have beenlacking in other texts: (1) Whereas most ayurvedic textsfocus on scientific evidence for herbs only, Mishraprovides data on several modalities. (2) He presents thechallenge of providing studies analyzing only one activecompound because that is what is considered valid inscience, but poses the reality that herbs and drugs aregenerally used in combination and thus questions theutility of current scientific methodology for clinicalresearch. (3) Mishra teaches us ayurvedic concepts ofstructure-function by using lucid comparisons andcorrelations between biomedical and ayurvedic con-structs of anatomy & physiology. (4) Mishra uses ahealthy well-balanced combination of 46 internationalcontributors from the fields he seeks to bridge. (5) Theemphasis on the book is not in downgrading main-stream medicine or ayurveda: it presents language forbuilding a bridge to validate both.

Bhaswati BhattacharyaWeill-Cornell Medical College, New York, USA

Jerry CottFDA, Rockville, MD 20857, USA

E-mail address: cottj@cder.fda.gov