Each Western Country Has Different Rules concerning T.M./C.A.M.
The fourth point is that every Western country has different rules concerning Non-Conventional Medicine (N.C.M.). Ayurveda is an N.C.M. outside of India, Nepal and Sri Lanka. For some reason, the Indian government and A.Y.U.S.H. try to push a standard syllabus on different countries regardless of how much their own laws on N.C.M. vary. For example, it is illegal in many countries for ayurvedic practitioners to give their patients ayurvedic medicine, as the pharmaceutical industry controls the distribution of all forms of medicine. The majority of countries in Europe and the Americas forbid Indian-made medicines, yet A.Y.U.S.H. and the B.A.M.S. syllabus only allow an educational curriculum using the medicines that are largely banned in the West (Anonymous 2019f). Obviously, the result is that Ayurveda is never certified as a valid form of Non-Conventional Medicine (N.C.M.).
There are several important points in this category:
- 1. Definition of what a practitioner can legally do therapeutically
- 2. Definition of which therapeutic procedures are legal
- 3. Definition of herbs vs medicine
- 4. Regulatory bodies - self-regulating vs government-regulated
Before addressing each of the above points it is important to note that each country in Europe, South and North America has its own laws governing health and healthcare. Therefore, the following discussion can only be general, as each country needs to be analyzed individually concerning legalities.
Definition of What a Practitioner Can Legally Do Therapeutically
In most Western countries, practitioners are not allowed to diagnose diseases and prescribe medicines. Diagnosis is the domain of medical doctors (allopathic), and only they are able to prescribe medications. This is governed by the medical authorities, who develop and give doctors the medical protocols. This means that ayurvedic doctors or practitioners are not allowed to use any medical terms when diagnosing their patients. They can use general terms, but even using Sanskrit medical terms can be viewed as medical diagnosis and therefore illegal. Additionally, practitioners and therapists are usually not able to give the patient medications (herbs, etc.). Some exceptions exist to this rule, for example, in Great Britain and a few states in the United States. In the majority of the United States, medicines can only be bought in a pharmacy. In general, the pharmaceutical lobby controls the distribution of medicines and does not allow medical doctors to give medicines. For example, this is also true in France, Spain, Portugal, Holland and Germany.
Definition of Which Therapeutic Procedures Are Legal
In many Western countries any therapeutic procedure that is invasive, e.g., enters the body of the patient, can only be done by a medical doctor. In most Western countries this would include Nasya
(nasal), Viricana (purgation) and Vamana (therapeutic vomiting), procedures which are the cornerstones of Pancakarma. It can even go so far as to include self-administered advice given by the practitioner to the patient. For example, telling the patient to avoid eating (fasting) can be construed as an invasive therapy. Giving herbal prescriptions can also be interpreted as an invasive therapy, if they are given internally.
In some countries, like France, Spain and much of the U.S.A., a practitioner is not allowed to tell the patient to return for a consultation. This is considered medical advice and practitioners and therapists are not medical doctors. Asking the patient to return means that the practitioner has made a diagnosis and is following up a treatment.
For example, the following is a list of therapies that are generally considered illegal in the United States (Anonymous 2017):
- • Practitioners may not diagnose medical disease. A practitioner cannot act in the capacity of a licensed physician and provide a diagnosis of a disease using medical terminology
- • Practitioners cannot interfere with the prescriptions or recommendations made by a medical doctor. A practitioner who tells a patient not to take their medications is considered to be practicing medicine without a license
- • Practitioners cannot invade the body or perform any other procedure that penetrates the skin or any orifice of the body
Definition of Herbs vs Medicine
This is a huge gray area that varies from country to country. In many Western countries herbs and herbal preparations are considered “food supplements” and not medicines. In other places there are lists of herbs that are considered medicines vs food supplements. As these lists change from country to country, what may be a supplement in one location will be considered a medicine in the next country. This is the case in Europe where, at the time of writing, no standard list of permitted herbal supplements has been universally accepted, although there is currently a list being proposed for the E.U. member states.
One of the main problems with this approach is that all botanical preparations are medicines and can be misused by lay people. Unfortunately, this happens quite often, resulting in valuable medicinal herbs being outlawed. The problem is not the herb in question, but rather incorrect legislation for botanical medicines. Classifying herbs as “food supplements” allows freedom of use by the public, but without any formal training on how to use them. Most end-users of herbal preparations choose herbs based on the recommendations of the salesperson in the store where they buy them. Obviously, the salesperson has had a few hours of training in the symptomatic use of herbs from a biochemical point of view.
On the other side of this problem, herbs are treated like chemical medicines that cause many secondary effects and are dangerous. Herbs are medicines and should be used correctly, but are far less dangerous than chemical drugs and do not cause secondary effects when used correctly. Grouping them into the same category as chemical drugs is also an error. One aspect of this is that it prevents all practitioners from prescribing herbs to patients when they are grouped with chemical medicines. Herbs are not the same as chemical medicines.
One common misconception is that herbs work like modern medicines in that they target specific places in the body. Medicinal plants, or herbs, have a long history as both medicine and promotors of health in human history. There is little doubt that - when used correctly - herbs can help people recover their health. This being said, it is important to understand that plants do not work in the same way as chemical medicines. Herbs work on homeostasis and metabolism generally. When the whole plant (e.g., the part of the plant traditionally used therapeutically) is used, the therapeutic action is general and less specific. This is exactly why using the whole plant is safe, because its action is general and working more on homeostasis than a specific place in the body.
There is a trend to change the way herbs work, by making concentrated extracts of the plant and either adding it back into the plant or marketing the extract itself as a product. People wrongly think that the extract is the same as the original herb and is as safe as using the whole plant. This is simply not true. In September 2016 I had the good fortune to meet and hear a lecture by Dr Rama Jayasundar, who has a Ph.D. from Cambridge in nuclear science. She is using nuclear magnetic resonance (N.M.R.) spectroscopy to understand medicinal plants as per Ayurveda. She has found that the whole plant in water solutions corresponds perfectly with traditional ayurvedic classification of taste, action, etc. However, when plant extracts were used the classification changed. When alcohol extracts were tested, they also changed. In fact, she found through repeated experimentation that only water-based preparations of the whole plant (e.g., part of the plant used traditionally for a therapeutic result) matched the classical texts and classifications of the herbs. Dr Jayasundar is also an Ayurveda physician and works for the Indian government in research. She is the only person to date with a doctorate in both nuclear physics and Ayurveda.
Traditional healing systems like T.C.M. or ayurvedic medicine have always understood that herbs w'ork in a broad, nonspecific manner. They also have developed many low-tech pharmacological methods to make extracts and increase the potency of herbs. In spite of having the knowledge and skill to do this, the primary way traditional systems of herbal medicine increased potency was by combining whole plants in formulae. The ancients found this to be a safer, more balanced method of administering herbs. This in turn means that they accepted that herbs should be combined with other herbs in order to target specific locations in the body.
Another misconception is that herbs treat specific diseases. This misunderstanding is much like the preceding, in that Western man is conditioned to think of disease as a fixed set of symptoms. This implies that the absence of symptoms indicates health. Herbs rarely, if ever, treat specific diseases because a fixed set of symptoms (e.g., disease) is the result of some underlying malfunction of homeostasis or metabolism. In other words, the “disease” is simply what we can see. The cause of the symptoms is often due to a number of factors. Herbs do work very well to help restore health by working on homeostasis (i.e., the tendency of the body to seek and maintain a condition of balance or equilibrium within its internal environment, even when faced with external changes).
According to Ayurveda the managers of homeostasis are the cause of disease - the three Dosa, or Vata, Pitta and Kapha (Sharma 1981a). When these managers do their job correctly, the body stays healthy. When they function poorly, or are disrupted in their work, then the homeostasis of the body is disrupted and disease results. Hence, traditional systems of healthcare tended to focus on the underlying causes of disorders rather than on the symptoms. This is the focus of functional medicine as previously mentioned. The current obsession with symptoms is a very recent development in medicine and the history of human healthcare. The unfortunate problem is that people want to use herbs according to the modern trend of medicine and herbs simply do not work well on a set group of symptoms, or “disease”. That is to say that herbs do not work well as symptomatic medicines. This is why modern studies rarely show medicinal plants as being effective treatments for diseases. Herbs work best when the cause of the disorder is addressed, not the apparent fixed symptoms.
Another misconception common today concerns dosage and the adage that “more is better”. This is especially a problem in the United States, where Americans see excess as normal. Most herbs work better in lower doses taken over longer periods of time. Plants are safest when used in lower doses and they also work better to regulate or correct the homeostasis when given in low doses. Lower doses are easier to digest and assimilate than higher doses. An old dictum in Ayurveda says, “It is not what you eat, it is what you can digest that gives health”.
Still another misunderstanding is that herbs, or herbal preparations, will work well without changing diet and lifestyle. This in itself is the reason many treatments with herbs fail. It is related to the first two misconceptions that “herbs treat specific locations” and that “herbs treat disease”. As noted before, herbs work generally in the body to correct underlying disturbances. Whenever possible it is best to treat these disturbances before they manifest as diseases with fixed symptoms.
As Benjamin Franklin so aptly put it, “an ounce of prevention is worth a pound of cure”. So, using herbs to treat the underlying state, or foundation, of the body is the traditional approach of using herbs. Still further, all traditional forms of healthcare emphasize diet and lifestyle as the main source of health. Sadly, the symptomatic approach of the “magic bullet to cure every disease” actively denounces any relation of diet and lifestyle to health. This was (and is) needed to remove the possibility that an individual could actually prevent or cure a disorder by his own effort to eat and live right. As symptomatic medicine is economics-based, it was/is important to remove the very idea that patients can improve their health with diet, lifestyle and self-effort.
The fact is that herbs and herbal preparations are not chemicals. They are more like concentrated food. However, they are not strong enough to overcome a poor diet, or a lifestyle that is not suited to the individual. In order for herbs to w'ork well they need support. The patient needs to make an effort to live in a balanced manner and needs to eat real food that can be digested. When herbal treatments are supported with diet and lifestyle, the results are often incredible. Likewise, when diet and lifestyle are not changed, herbs usually fail to make any significant change therapeutically.
Regulatory Bodies: Self-Regulating vs Government-Regulated
Self-regulating vs government-regulated is a very large topic and beyond the scope of this chapter. Nevertheless, this presentation would not be complete without mention of this very controversial subject. Self-regulating Ayurveda Wellness is the current situation in almost all Western countries. Because Ayurveda is not recognized as a medical system, it is it not under government regulation in most countries.
The main disadvantage of self-regulating Ayurveda is that regulation will be done by the largest schools w'ho tend to favor volume teaching of low quality. Smaller schools tend to have less political power, or even interest in regulations, as they tend to focus on the content and quality. The U.S.A. is a perfect example of self-regulating the profession of ayurvedic healthcare practitioners.
In order for governments to regulate Ayurveda, it w'ould need to be considered a medical system and hence have a medical university system which teaches a standard syllabus like in India, Nepal and Sri Lanka. This is not the situation in the West, and so Ayurveda basically remains outside of government control.
One of the exceptions to the above state of affairs is the country of Switzerland. Since 2015 Ayurveda has been part of the health system of Switzerland under two newly developed government-recognized professions with certified national diplomas:
- • One is the Naturopathic Practitioner in Ayurveda-Medicine under the aegis of the Swiss regulatory body of Alternative Medicine
- • The second is the Complementary Therapist in Ayurveda-Therapy under the aegis of the Swiss regulatory body of Complementary Therapy
These two new' Ayurveda professions are designed according to W.H.O., A.Y.U.S.H. and the Swiss regulatory directives. As an additional support the Sw'iss parliament has voted for revision of the law' on therapeutic products (e.g., herbal) with the scope to ease the access to medicines of traditional medical systems, including the Asian remedies from Ayurveda and Chinese medicine.
These two professions can be studied now in officially government-accredited schools. Training in Ayurveda-Medicine and Ayurveda-Therapy are both meant for persons without prior training in healthcare. The health insurance companies reimburse ayurvedic treatments and remedies. Naturopathic practitioners in Ayurveda-Medicine have permission to prescribe and hand out ayurvedic medicines. Under the revised Swiss law' these remedies are recognized as therapeutic products and no longer as food supplements or cosmetics (Anonymous 2019h). In essence the new Swiss model of legalizing ayurvedic medicine and providing educational guidelines and regulation is a first for the West. This is a huge step in the right direction and Switzerland is now' the most advanced country in the West concerning the recognition and integration of ayurvedic medicine into their health and insurance systems. Additionally, the creation of a national diploma issued by the Federal government is currently the best diploma in Ayurveda outside of India, Nepal or Sri Lanka. Switzerland shows us the best aspect of having government regulations and support for Ayurveda as a stand-alone medical system and not grouped together with all other C.A.M. or T.M. methods such as Germany does. It shows that with public initiative the government can support and develop ayurvedic medicine in the West.