The Nature Cure

by Andreas Michalsen

  MY FIRST JOURNEY TO INDIA

  In 2007, I decided to go to India for the first time in order to get to know the country and the people, but of course also Ayurveda, firsthand. It was love at first sight. The colors, the diversity of people, the spices, the odors—people who have never driven through an Indian city before wonder where this zest for life and joy come from, especially as the conditions seem more than exhausting and difficult to a German. But I’ll never forget how I was walking through Frankfurt airport after landing in Germany, noticing a completely different kind of stress, and I thought I sensed a lot of tension or even grief in people. Afterward, I asked myself again and again how such an enormous discrepancy between objective standards of living and the subjective enjoyment of life can occur.

  After several days of meditation in an ashram, my wife and I ventured to Kerala to explore Ayurveda on-site. We flew to Kochi, an ancient spice trading center. It was the most horrible flight of my life and it made me significantly more religious. A beautiful hotel from colonial times—the Bolgatty Palace—distracted us from it after we landed. Syal Kumar, who was on home leave in Kerala at the time, talked to a local physician about our respective Ayurvedic treatments—it was the only way I could get a direct impression.

  I was looking forward to the therapy, and expected relaxation from it. But things turned out differently. After the third day with a special diet and different oil treatments, which lasted one and a half hours each, I experienced a tiredness I had never felt before—as if somebody had unplugged me. I hadn’t expected that. I also noted this very strong effect during subsequent Ayurvedic therapies such as Shirodhara, the pouring of liquids over the forehead, or the Abhyanga, the full-body massage. It manifested itself mainly in the form of a great need for sleep. One time, colleagues in Berlin gave me a Shirodhara treatment as a birthday gift. I had made the appointment for 2 to 3 p.m. and thought that this would be a good way to refresh myself before the subsequent meetings. But after the Shirodhara treatment there was no way that I could go through any type of activity—I was so tired that I had to cancel the meetings and lie down in bed at home. But the following day I felt splendid. I know of no other method that can alleviate great stress in such a manner.

  By now studies have proven the profound effect Shirodhara has on relieving stress and anxiety. So far, we are unable to explain why that is so. Maybe reflexive neuroplexus play a part in it, because they are stimulated in a very special way by the continuous application of the oil. There is a reason, after all, for why the forehead area in its symbolism is important in Ayurveda, just as in yoga. It is the “third eye,” a sign of blessing, that can be found in Hindu temples. According to Indian tradition, the forehead chakra is of eminent importance for the human consciousness.

  But most of all, I had experienced both during Shirodhara and the full-body massage of Abhyanga a certain disorientation that is induced in a therapeutic manner that then slows down the constant flow of thoughts. In a classic massage, we can always tell where the hand of the massage therapist is at any given moment. But when we are massaged by two people, i.e., by four hands (sometimes there are even more people involved in the oil treatments), this becomes impossible after only a few minutes. You have to submit to the treatment, have to let go. In addition, there is the effect the medicinal oil has. The process in Shirodhara is similar: The gentle flow of oil that spreads over the entire forehead (the eyes are protected by a blindfold) is applied continuously for up to forty minutes. This unusual experience ultimately leads to a kind of transposition, to a changed perception of the body.

  Why I became so particularly tired during these treatments every time is also related to my constitution. People with a very tight schedule and great intellectual pressure to concentrate often show a vata tendency. According to Ayurveda, too many elements of motion are active in these cases. Shirodhara and Abhyanga slow down the overstimulated senses substantially to induce recreation. But after such therapies, the exhaustion is felt much more strongly, because vata types tend to ignore their need for rest (and instead drink an espresso to counteract the fatigue).

  Back to Kerala. Once my wife and I had recovered somewhat from the flight, we set out to visit Ayurvedic hospitals in the following days. It was impressive. I realized that in India, Ayurveda is used to treat very serious, very severe illnesses. One hospital was close to one of the most accident-prone motorways in the state. After acute care was administered, many of the crash victims were also treated with Ayurveda, just like paraplegic patients with neurological diseases like Parkinson’s or multiple sclerosis. It was clear that everyone was satisfied. The doctors seemed professional, well-trained, and legitimate. They described and explained the treatments to us. It seemed as though Ayurvedic therapy with plant-based drugs was of particularly great value in especially severe diseases.

  INDIA’S RICH PHARMACY OF HERBS AND SPICES

  As a naturopath, I was naturally familiar with phytotherapy, the use of medicinal plants. I value European herbal medicine, but I am aware of its limitations. But Ayurveda uses a special technique of drug therapy that makes it more effective than its European counterpart. It involves two things: On one hand, India’s herbal pharmacy is significantly richer than our European one, because more medicinal plants grow in the local climate. Close to one thousand different herbs are generally utilized in Ayurvedic pharmacies. On the other hand, however, it’s not individual substances that are administered in a maximum dosage, but sometimes up to fifty different components are mixed in various proportions and then administered for therapy in this individualized composition. The principle behind this is evident and resembles that of Chinese phytotherapy: One picks out herbs and plants that in combination fortify the desired effect, but that have different side effects. That’s why these do not add up but stay underneath the perceptional threshold.

  This is a smart principle, but also one of the challenges in bringing Ayurveda to the Western world. Our pharmacology eliminated these kinds of mixtures of substances for the most part in the 1980s, when regulations made it mandatory to identify the most essential agent in each drug and to describe its mechanism of action in a plant monograph. Ever since then, the majority of plant-based drugs have disappeared from the market, because the manufacturers were no longer able to finance elaborate studies or because the mechanism of action wasn’t simply based on one individual substance. Only a few mixtures whose harmlessness had been proven through decades of use survived this legal change.

  Today, phytopharmacology is predominantly “rational”: One identifies the substance to which the effect is ascribed. After a series of laboratory testing, experiments on animals and dose-response studies on humans, the drug with the designated main substance—and only this drug—is approved for therapeutic use. It’s evident that individualized mixtures of substances containing up to fifty individual substances combined in a different way for each patient could never conform to our standards.

  But if Ayurvedic medicaments weren’t considered drugs but rather a nutritional supplement and were then imported, as it is often the case in both the United States and Germany, we would face the problem of insufficient quality- and safety control of the extracts. This can have undesired, even dangerous effects on the patients treated with them. But do we really want to deny the chance to recover the great treasures of Ayurvedic pharmacology simply because they don’t comply with our regulations? This would be a great shame, because the successful healings that I have observed until now by far exceed that which can be explained with the placebo effect or spontaneous recovery.

  The institutions concerned with the regulation of drugs and therapeutic devices would be well advised to convene with the Indian government (or the Chinese authorities) in a constructive manner in order to make these therapeutic options available to the world. A special registration process for Ayurvedic compounds would be the most sensible solution, because ultimately, they cannot be classified as either food
or drugs but are somewhere in the middle.

  It should also be noted that phytopharmaceuticals, or “multi-target” pharmacology, are much more adapted to the biology of the human body than the mono-target approach that we cultivate in Western pharmacology. Though Western pharmacology may be very successful in addressing some diseases, we need to acknowledge that the side effects of drugs have grown to such a magnitude that they themselves are one of the most common causes of deaths.2 Furthermore, they are the reason many patients don’t take their medication as prescribed—in some drugs the lack of compliance reaches between 60 and 70 percent.3

  When I became head of the naturopathic department at the Immanuel Hospital in Berlin two years after my first trip to India, it was my goal to integrate Ayurveda as one of the central pillars there. Fortunately, Christian Kessler, a young internist and Indologist who had attained a great reputation with his knowledge of Ayurveda, was already employed at the Charité. We agreed that it was time to base Ayurveda on solid scientific research and integrate it into treatments. Together with Claudia Witt, who held an endowed professorship for Complementary Medicine at the Charité at the time (today she teaches at the University of Zurich), we conceptualized an extensive study designed to examine the effectiveness of Ayurveda. We got in touch with the European Academy for Ayurveda in Birstein, Germany, whose medical superintendent S. N. Gupta is one of the most internationally renowned experts on Ayurveda, but also with Antonio Morandi at the Center for Ayurveda in Milan, and Ludwig Kronpaß in Bavaria.

  ILLNESSES THAT CAN BE TREATED WITH AYURVEDA

  The longer I researched Ayurveda, the more I realized what could be the most important indicators for this Indian art of healing in Europe:

  Diabetes. There are many interesting plant-based substances that have already been proven to lower blood sugar levels, such as the bitter melon or the herbal mixture Triphala.4

  Neurological diseases. Not only was I able to observe the successful treatment of neurological diseases in Kerala, but also, one of the world’s leading experts on Parkinson’s disease, Horst Przuntek, has dedicated himself to Ayurveda after leaving his position as medical director of the University Hospitals of the Ruhr-University of Bochum. He founded a Department for Neurology and Ayurveda at the Protestant Hospital in Hattingen and since then has been treating patients with multiple sclerosis, Parkinson’s, and other neurodegenerative diseases.

  Early on, Przuntek pointed out that the Ayurvedic treatment of patients with Parkinson’s happened primarily via the olfactory sense (by inunction with nose oil) and the intestine (through the cleansing ritual Panchakarma and diet). Possibly, these treatments target the areas that are considered the point of origin for Parkinson’s according to most recent scientific findings—the olfactory brain on one hand and the microbiome on the other.5 Fascinating. It seems as though Ayurveda already knew two thousand years ago what we are only now discovering through highly technologized molecular biological analyses.

  Rheumatism and arthrosis. In 2011, the American rheumatologist Daniel Furst, together with our close Indian cooperation partner Ram Manohar, presented a study comparing Ayurvedic treatment of rheumatism and arthrosis to the conventional Western treatment using the antirheumatic agent Methotrexate. They were able to show that the treatments were similarly successful.6

  Bowel diseases. And finally, Ayurveda is also successful in treating bowel diseases. In addition to having Christian Kessler at our hospital, we were able to bring Elmar Stapelfeldt as well. Stapelfeldt has expanded the treatment focus of nutritional therapy. Even with naturopathy it’s difficult to treat common disorders like an irritable colon or the ever-increasing number of food intolerances. Therefore, it has been even more surprising to see how the simple therapeutic principles of Ayurveda can help—often without avoiding the apparently responsible foods.

  To me, these indicators seemed the most important argument for implementing Ayurveda in medicine. But in principle, every disease can be addressed with the multimodal treatment principle. The aim of our newly founded Department for Ayurveda was to conduct a meaningful study on the effectiveness of Ayurveda therapy in a common chronic disease. We decided on arthrosis. After many phone calls, and with the support of several Indian Ayurvedic physicians, we ultimately succeeded in getting the Indian embassy in Berlin on board.

  And so we convened in my office at the Immanuel Hospital in Berlin one afternoon and formulated the following goal: A study on the efficiency of traditional multimodal Ayurveda in comparison to the best Western conventional medicine in treating arthrosis of the knees. The Indian ambassador was willing to support us, but he also made it clear that we would have to present our project in Delhi in person. He initiated all the necessary steps.

  A RESEARCH COOPERATION WITH INDIA

  I traveled to Delhi with Mark Rosenberg from the European Academy for Ayurveda. I had prepared a presentation and a lecture that was meant to clarify how important it was to conduct a clinical study on the impact of Ayurveda in order to give this Indian art of healing the recognition it deserved in the West—provided we saw good results. We were unsure whether it would be possible to obtain the initial research funding outside India for such a study.

  At the Federal Ministry of Health, we were met by Jalaja Devi, the state secretary for Ayurveda. When we entered the room, we received skeptical looks from roughly a dozen employees of the ministry. After a few introductory remarks, Mark Rosenberg told them that Ayurveda was enjoying growing popularity in Germany. After that, I described the planned concept of our study, and tried to explain how much I wished that Ayurveda would open itself up to clinical science. Subsequently, we were asked many critical questions that all essentially revolved around the issue of whether we would be able to meet the requirements of Ayurveda. We also spoke about the costs for the study that were due to the great expenses for staff.

  Over and over, we were asked why the German government wasn’t funding such a study. I replied that obtaining German research funding for traditional Indian medicine was a completely futile endeavor at the moment since we would first have to prove that Ayurveda was a therapy that had to be taken seriously. Only when this initial step had been taken with one or two good studies could there be possibilities for German funding of future studies. Finally, Jalaja Devi knocked on the table and the room fell silent. After a short query about whether the Charité belonged to Humboldt University, she explained to the group that this is where the highest standard of Indology outside of the country, maybe even better than in India itself, was taught. This could also be the case for Ayurveda now. Nobody disagreed with her, two assistants entered with contracts, and we posed for a group photo. When Mark Rosenberg and I found ourselves back outside the Ministry of Health, blinking in the spring sun, we couldn’t believe it—we had managed to obtain the financial foundation for the first large-scale clinical study on Ayurveda in the Western world.

  PATIENT HISTORY

  Arthrosis

  Medicinal Herbs Instead of Artificial Joints

  The pain had to be almost unbearable, but the patient, an engineer in her early sixties, kept a straight face. She had severe arthrosis of the knee joints, the wrists, and the ankles. In regular intervals, the pain returned with such intensity that she was unable to work, use a computer, or take the stairs. She agreed to have a surgery to remove calcification in her right middle finger. It achieved nothing. Was she supposed to keep taking more and more pain medication and eventually damage her kidneys because of it? The patient had seen a television report on naturopathic alternatives and came to see us.

  She was being treated by Christian Kessler, our expert on medical Ayurveda. She started to take turmeric (Indian saffron) and incense as nutritional supplements—which are working well for her. Both substances have an anti-inflammatory effect and cause cells to regenerate. The metabolism and digestion are stimulated. Indian phytotherapy, however, does not rely on me
rely one individual agent, but on a mixture of active agents. That’s why one shouldn’t take turmeric isolated in a pill or a powder. Instead, it should be ingested in the form of curry. But to achieve a positive effect it’s necessary to use one teaspoon of pure turmeric powder (in combination with black pepper) every day.

  The patient was overweight, which also put strain on her joints. Her blood pressure was elevated, and she was taking a beta blocker for that. When she came to the clinic for the first time, she weighed 181 lbs. at a height of 5’6”. Within one year she lost 8.8 lbs. by switching to an Ayurvedic-vegetarian diet. She has been able to cut out the beta blockers and her blood pressure is back to normal. She is only allowed to lose weight slowly so that the body can adapt and doesn’t “strike back” with a yo-yo effect. What did the patient eat? Lots of vegetables, usually in the form of soups, chutneys, or curries, prepared at warm temperatures. For the most part, she left out anything that fostered inflammations in her body: wheat, sugar, alcohol, meat.

  In addition to all this, the patient started practicing yoga. Strengthening the muscles, connective tissues, and the spine helps the joints. To fortify this effect, my colleague Kessler and his team gave the patient an Ayurvedic massage with medicinal oils, such as a warm carrier oil like sesame combined with cilantro, cumin, and myrrh, once a week over the course of two months. After each massage she had a sweat bath. This causes the pores to open and enables the oils to penetrate deeper into the tissue. Today the patient is completely free of symptoms.

  AYURVEDA: BOTH PREVENTION AND THERAPY

  Ayurveda is the essence of a holistic healing system. It is concerned with four major areas: