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What is Ayurveda, and what does it say about digestion?

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What is Ayurveda? Ayurveda is a traditional medical system from India, set down in the Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya, with the earliest layers dated by scholars to the last centuries BCE or first centuries CE. It sorts people and foods into three categories, vata, pitta and kapha, and describes digestion as agni, a fire. The NCCIH says about 240,000 American adults use it and that few well-designed trials support it.

The three doshas as Ayurveda describes them: vata is air and space and governs movement, pitta is fire and water and governs transformation and digestion, kapha is earth and water and governs structure and cohesion; prakriti is the mix a person is said to be born with.
Source: Ravishankar and Shukla, 2007; Charaka Samhita tradition as summarized in standard texts. Chart by SuppleGut, free to reuse with a link to this page.

Ayurveda is the traditional medical system of India, and it is where the words on a growing share of gut-supplement labels come from: triphala, agni, pitta, ama. This guide covers where the system comes from, how it is organized, how a practitioner approaches a digestive complaint, who uses it, and what the human trials of its gut remedies show. Each term is defined one by one in the glossary guide, and the Ayurveda section lists every guide in the series.

Where Ayurveda comes from

The NCCIH, the US government’s center for complementary health research, describes Ayurveda as one of the world’s oldest medical systems and one that remains among India’s traditional health care systems. Indian accounts trace its principles to the Vedas, with figures as early as 1500 BC; historians date the surviving medical texts much later.

Three works form the classical core, known together as the Brhat Trayi, the “big three”. The Charaka Samhita is the school of internal medicine, the Sushruta Samhita the school of surgery, and the Ashtanga Hridaya of Vagbhata a further major treatise. The dates scholars give are ranges, because all three were reworked by later editors:

How the system is structured

Ayurveda describes the body through a small set of categories. They are the tradition’s own vocabulary, and none of them is a measurement in modern physiology.

Whether practitioners can apply the categories consistently has been tested once that we could find. In a Berlin study, four Ayurvedic experts each examined 30 patients with knee osteoarthritis; agreement was fair to poor (kappa values between 0 and 0.4) for central items such as prakriti and agni (Kessler et al., Journal of Alternative and Complementary Medicine, 2019).

How a practitioner approaches a gut complaint

In the tradition’s account, care starts with a detailed history: what is eaten and when, bowel habit, sleep, stress and the person’s constitution. An examination follows, including the pulse and the tongue, and the practitioner forms a view of which dosha is out of balance and how strong agni is. Treatment is then ordered, with diet and daily routine first, single herbs and formulas second, and for some patients the five cleansing procedures called panchakarma, which include purgation (virechana) and medicated enemas (basti).

Four gut formulas turn up often enough to show up on retail shelves:

Who uses Ayurveda today

In India it is a state-recognized system. Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa and homeopathy sit under the Ministry of AYUSH, which was set up as a standalone ministry in 2014. Ayurvedic doctors hold the BAMS degree (Bachelor of Ayurvedic Medicine and Surgery), a four-and-a-half-year course followed by a one-year internship.

In the United States the NCCIH says about 240,000 adults use Ayurvedic medicine. It adds that there is no significant regulation of Ayurvedic practice or education and that no state requires a practitioner to hold a license. Products are sold as dietary supplements; Ayurveda in the United States and Europe covers training, regulation and the market.

What the human evidence looks like

The NCCIH’s summary is that few well-designed clinical trials and systematic reviews suggest Ayurvedic approaches are effective, that most trials are small or not well designed, and that there is little scientific evidence for most health issues. For the gut the picture is similar, and it is mostly trials of single herbs and formulas rather than of the whole system:

The detailed trial tables sit in Does triphala work? and Ayurvedic herbs for digestion: what the trials show.

Safety, and what a buyer can check

Some Ayurvedic preparations include metals, minerals or gems, a branch of practice called rasa shastra. A 2004 survey bought 70 products made in South Asia from Boston-area stores and found lead, mercury or arsenic in 14 of them, 20% (Saper et al., JAMA, 2004). A 2008 survey of 193 products bought online found 20.7%, and 40.6% of the rasa shastra products (Saper et al., JAMA, 2008). These are findings about the products sampled, not about every product. The FDA says such products typically are not labeled as containing heavy metals.

What a buyer can check is limited: the Latin names on the label, a Supplement Facts panel with amounts, and a third-party heavy-metal test result from the brand. The NCCIH advises people with a health condition, and people who are pregnant or nursing, to talk with a health care provider before using Ayurvedic products. Are Ayurvedic supplements safe? goes through the surveys and the case reports.

The catalog entries behind this guide

herbal Organic India Triphala Capsules The Ayurvedic three-fruit blend, a mild laxative with centuries of use and a handful of small modern trials. Buy it at iHerb$0.76 a day
magnesium Lanural Regularity Reset A three-capsule nightly formula of magnesium oxide, kiwifruit extract and triphala for regularity. Buy it at Amazon$0.92 a day
magnesium Bluegrass Supplements Move Easy A bedtime capsule of magnesium citrate, Cape aloe and triphala, taken as one or two capsules a night, for occasional constipation and regularity.
herbal Revival Point Total Bowel Release A two-capsule-a-day formula of kiwifruit extract, triphala, aloe inner leaf gel and Bifidobacterium lactis for regularity. Buy it at Amazon$1.78 a day

Common questions

How old is Ayurveda?

Indian accounts trace its principles to the Vedas, with figures as early as 1500 BC. Historians date the surviving classical texts much later: the Charaka Samhita to a span from the 4th century BCE to the 2nd century CE, with a revision around the 6th century CE, and the Sushruta Samhita to the last centuries BCE through the 3rd to 4th centuries CE. Vagbhata’s Ashtanga Hridaya is placed around the 6th century CE.

What is a dosha?

Vata, pitta and kapha are the three categories Ayurveda uses to describe how the body works and how people differ. In the usual teaching they stand for movement, transformation and structure. They are the tradition’s concepts and do not correspond to an organ or a lab value; in the Berlin study of four Ayurvedic experts, agreement on constitution and agni was fair to poor.

What does Ayurveda say about digestion?

It describes digestion as agni, a fire that acts on food, and says a weak agni leaves a residue called ama that obstructs the body’s channels. Treatment in the tradition starts with meal timing and diet, then moves to herbs and formulas such as triphala, trikatu, hingvastak churna and avipattikar churna.

Does Ayurveda help irritable bowel syndrome?

One Berlin trial of 69 people compared Ayurvedic and conventional nutritional therapy, and symptom scores fell by 123.8 points against 72.7 at three months. Both arms received diet counseling, there was no placebo group, and the trial was described by its authors as explorative. We found no placebo-controlled trial of a whole Ayurvedic program for IBS.

Is Ayurveda licensed or regulated in the United States?

The NCCIH says there is no significant regulation of Ayurvedic practice or education in the United States and that no state requires a practitioner to have a license. Ayurvedic products are sold as dietary supplements. Ayurveda in the United States and Europe covers the rules.

How many people use Ayurvedic medicine in the United States?

The NCCIH puts it at about 240,000 American adults. In India the Ministry of AYUSH, set up as a ministry in 2014, oversees Ayurveda alongside yoga, Unani, Siddha, Sowa Rigpa and homeopathy, and Ayurvedic doctors train for the BAMS degree.

Do Ayurvedic products contain heavy metals?

Some do. A 2004 survey found lead, mercury or arsenic in 14 of 70 products (20%), and a 2008 survey found them in 20.7% of 193 products bought online, and in 40.6% of products made by the metal-and-mineral method called rasa shastra. The surveys describe the products sampled and do not extend to every product.

Sources

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