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Research article

First published online January 31, 2020

The Universal and the Global: Contextualising European Ayurvedic Practices

V. Sujatha [email protected]View all authors and affiliations

https://doi.org/10.1177/2393861719883067

Abstract

Fifty years ago, South Asian medicines were regarded as ethnomedicines devoid of scientific credibility as they were not verifiable under controlled laboratory conditions. By the 1990s, however, South Asian medicines entered the global health market, specially, Western Europe and North America despite the opposition from scientific lobbies. Ayurveda’s presence in Europe is not comparable to Chinese medicine and is probably fourth or fifth in the scale of importance among other complementary therapies, but it is crucial to note that it entered Europe not riding on Indian migrants or capital investment but as cultural goods promoted by European followers of Indian gurus. In other words, unlike Asian cuisines and garments taken to foreign lands by immigrants, yoga and ayurveda were directly accessed and consumed by the white-middle and upper-middle classes and were paid for privately. Does globalisation of ayurveda mean that it has also become universal? What is the relation between biomedicalisation of ayurveda in India and its spiritualisation in Europe? How is ayurveda transmitted and practiced outside India? What are the issues raised by the globalisation of ayurveda? Based on fieldwork with European practitioners of ayurveda in three European countries, this article intends to address some of these questions by tracing the trajectory of the global ayurveda through the experience of its European practitioners.

The globalisation of Asian medicines and their spread to the postmodern West is a matter of great interest for the history, sociology and anthropology of medicine. Global flows in medicinal knowledge are not new but they acquire specific form in the postmodern era due to a peculiar dynamic of health populism, state policy and market forces. A few decades ago, in the context of the spread of Western medicinal knowledge, the term ‘universal’ was used more often.

Universality of Medical Science

In the history and sociology of science, the term ‘universal’ has been reserved only for modern, Western medicine and all other medical systems, including Asian systems of medicine have been regarded as ethnomedicines that are culturally conditioned. The universal character of biomedicine is said to come from the constancy of its results and replicability of its mathematical and experimental methods, irrespective of context (Raj 2013). According to the mainstream scientific approach, there is only one way in which medicine could be universal namely through replicability.

This article is about the global trajectory of ayurveda that means ‘the science of life’. It is the ancient system of medicine in the South Asian region that is alive and operational until date. Ayurveda has a functional approach to the body in terms of vata, pita and kapha that refer to the three fundamental physio-psychological functions of the body: all movements in body and mind, all metabolic processes of transformation at physical and mental level and all processes responsible for control and stability, respectively (Jayasundar 2012; Sujatha 2012).

The ayurvedic approach to therapeutic management is multimodal and it has a well-developed pharmacology based on about 1,700 medical substances of botanical, animal and mineral origin and about 40,000 different formulae for internal consumption and hundreds for external applications, douches (Unnikrishnan 2004). While procedures of medicinal preparation are laid down in the texts, standardised protocols of treatment that could be followed universally for one and all are not available because of its patient-centric approach. These skills have to be learnt from a teacher, inferred from actual practice, by studying compendiums and by collecting herbs and preparing the medicines.

Mainstream biomedical scientists, state authorities and some schools in the history of science do not regard ayurveda as possessing universality because its formulae have not passed the gold standard of laboratory medicine, namely randomised controlled trials (RCT).

From ‘Standalone’ Biomedicine to CAM

In the twentieth century, Western societies did not expect that there could be a situation where any medical system other than biomedicine could have a presence in public health because their own traditional medicines had died or were underground. But in the twenty-first century, a chemical weary population seeking herbal and holistic inputs keenly adopted alternative and complementary health interventions giving rise to New Age health movements. As Saks puts it (2008: 35),

… health care in the West seems to be coming full circle in that it is now beginning to return to the equivalent of the plural roots of its historic past, albeit in modernized guise with increasing acceptance by the state of more eclectic models of health care as manifested in, inter alia, increasing research support and legally underwritten regulation for complementary and alternative medicine. Significant as they are, ayurveda, with its Indian roots and TCM are only illustrative of Eastern influences on Western health.

Ayurveda is only one of the many complementary and alternative medicine (CAM) therapies in Europe; it is much smaller than Chinese medicine, but is the fastest growing among the CAM today (Nieme and Stahle 2016). It has a small but steadily growing set of practitioners in Europe with an active network for training, procuring drugs and clinical practice. It already has more than three decades of history in the West and there are a good number of writings on the practices and beliefs of global ayurveda (Frank and Stollberg 2002; Reddy 2002; Wujastyk and Smith 2008; Warrier 2014; Zimmerman 1992). The question now is whether the global spread of ayurvedic practices mean that it has also become universal. How do we understand the connotations of universal and global medicine?

Wujastyk and Smith (2008) discuss the divergent trends found in ayurvedic practices in the USA and Europe and identify ‘four paradigms’ in what they refer to as ‘global’ ayurveda, in contrast to ‘modern’ ayurveda in India. The paradigms of global ayurveda are characterised by ‘varying degrees of scientific fidelity, cultural accommodation, discourses of holism and Hindu (or Vedic) practices’ (Wujastyk and Smith 2008: 11). Their essay presents anecdotes of what these ‘paradigms’ may be referring to: New Age ayurveda is for those seeking Eastern spirituality and holism in the healing experience, while advocates of mind–body medicine could be doctors who are engaging with the non-dualism of mind and body in ayurveda and see it as ‘adaptogenic’ medicine. ‘Maharishi Ayurveda’ refers to the specific form that Maharishi Mahesh Yogi proposed in conjunction with his Transcendental Meditation™ (TM), and ‘traditional ayurveda in an urban world’ refers to the ayurvedic practices of college educated ayurvedic physicians.

While there is a rich body of literature providing us the distinction between global ayurveda that is spiritually oriented and modern ayurveda in India that is moving towards scientific validation, the next question will be whether global and modern ayurveda are unconnected. This will be the crux of this article. Based on a micro-level field study of European practitioners of ayurveda conducted in Germany, the Netherlands and Switzerland,¹ this article discusses the modes of transmission of ayurveda to Europe and the kinds of practitioners and concepts, beliefs, practices and the drugs used in the European ayurveda. The ultimate goal is to open up the discussion on how the idea of ‘universality’ of medicine can be thought about in alternative ways.

Ayurveda and the Hindu Gurus in Europe

A remarkable thing is that unlike other aspects of Asian culture such as cuisines, costumes and music, which were brought into the West by the Asian diaspora, ayurveda was absorbed directly by European natives. In other words, the transmission was not brought about by the Indian migrants in the West as was the case of other Asian cultural products but followed another trajectory of transfer, that is, from charismatic religious figures to zealous European seekers, and hence presents a distinct case of global flows in the postmodern period.

I could discern three phases in the trajectory of ayurvedic practices in Europe since the 1980s, which are also three different paths of transmission. Ayurveda was first introduced in the West in the early 1980s by Maharishi Mahesh Yogi, a Hindu guru, and has earned the brand name Maharishi Ayurveda (MA). Mahesh Yogi inspired allopathic doctors among his disciples to learn ayurveda. He got vaidyas² from India to teach them; by 1985, the first Maharishi ayurvedic clinic was opened in Lucerne, Switzerland. Maharishi had a dedicated following for his TM, and some allopaths who enrolled in the TM programme got interested in ayurveda. One such pioneering biomedical cum ayurveda doctors in Germany who has been practising ayurveda for more than 25 years narrated thus:

When I was a medical student in Munich, about 20 years old then, I learnt TM of Maharishi Mahesh Yogi. We were a handful of students interested in TM. I was already interested in herbal medicine. We joined Maharishi when he came to Europe and started ayurveda. He brought Indian doctors like Raju to Europe and gave courses and we learnt from them.… When I finished my medical studies, I attended more courses of Raju and learnt the herbs of Europe. I am from the countryside and I was born in small village and knew how they cured diseases with herbs. Ayurveda is so beautiful and holistic; we see the whole patient as a man. Do not see only the disease. Allopath sees one part if there is knee pain; ayurveda says it is vata and treats the root cause like apana vata that includes mental problems by which the patient cannot let go of the block. It is fascinating.

Another senior biomedical ayurveda doctor said:

Many plants used in traditional pharmacopeia in India are same as our phytotherapy. But the beauty of ayurveda is that the theory behind it is a lot more systematic than our European ideas.

MA seems to be the largest coherent group of allopaths who have taken to ayurveda. Many of his disciples were allopathic physicians from small towns like the one cited above and were practising in and around their town.

The second phase of spread of ayurveda was in the early 1990s through European yoga teachers who were influenced by something they read about India or what they experienced during a visit to India when they were very young. Some others got deeply interested in the ayurvedic theory of food that gave a comprehensive framework to understand food, digestion, metabolism in organisms in relation to their environment. They added ayurvedic nutritional advice to their clients in yoga classes who were increasingly seeking dietary alterations for everyday ailments. Gradually, some yoga teachers drifted towards ayurveda courses and practices. Ayurveda came to be the focus of interest among yoga zealots and the first ayurveda academy in Germany started in 1993 in a small town.

The academy in the Netherlands also started in the mid-1990s. The founder studied Latin and Greek at the university and got interested in ayurveda when he came across an ancient Indian text. As he could not get trained in ayurveda in India despite many visits, he participated in a workshop and seminar with Dr Vasant Lad in Great Britain and the USA. On his return, he taught in a school in the east of Netherlands for some time. It was early 1990s and there were 10 students for ayurveda. As the school was about to close for some reason, he was urged to start a school for ayurveda in Amsterdam.

At that time, I connected with bigger ayurveda school in France of Atreya Smith and he gave the full backup for our school to start here.

So the Yoga path to ayurveda fostered academies outside the Maharishi fold. Although fewer Europeans take to ayurveda than yoga, ayurvedic massages became popular in the yoga circles and yoga teachers started arranging group trips of European clients to Indian locations for massage and well-being treatments. The entrants to ayurveda from the yoga route are not qualified physicians but acquire intermittent training through short workshops and visits. The yoga teachers had a religious bent of mind and keen inclination for Hindu forms of worship and sacrificial rituals.

The third wave of the European ayurveda has been brought about by the spurt of interest in herbal medicines and natural substances in the global health market and has since been accommodated into the practice of European herbalists and massage therapists who addressed a variety of syndromes not found in the biomedical canon. A male massage therapist in a German town explained:

I was working in Australia and was interested in natural remedies. There was also a school for ayurveda there. I came to Germany did a three-year course in naturopathy for a couple of remedies. Ayurveda interested me because it is simple, has a lot of depth and the spiritual aspect is important. It has lot of manual treatment—massage, shirodhara, abhyanga—many things you can do with your hand.… Mostly we do massage—abhyanga, that is what we mainly do. Then we give consultations on food, herbal remedies and advise on daily activities. For me, I treat pains and chronic aches. Different kinds of massage—Western methods with a kind of a machine—a wave—ultra.… I put it on the skin plus ayurvedic treatment plus herbs like salaki that reduce inflammation and pain.³

Ayurveda in Europe was thus introduced by Hindu gurus in the 1980s, developed by Yoga teachers in the 1990s and received a boost through the booming market for natural therapies that followed in the next couple of years.

How was ayurvedic knowledge transmitted to the first few generations of European practitioners? The training in ayurveda received by the pioneering European enthusiasts was quite diverse and solely guided by the intensity of their search to find their feet in holism and spiritualism. It ranged from 6 months one-year full time training in India or two years of intermittent training in India. It is important to note that the training taken by the pioneers was through personal apprenticeship with individual ayurveda vaidyas, as they could not be admitted to Indian university departments of ayurveda. Another typical trajectory was by approaching different vaidyas to learn different things and integrating them into their own practice back home suitably. When I enquired about his years of training in ayurveda, one of biomedical physicians from the Maharishi group said:

When you include the studies, it is 35 years of ayurveda; took about 10 visits to India. Trained some time with Vaidya Triguna from Delhi for pulse, another teacher for panchakarma. I saw the video tapes and got the training from his system and then another dermatologist from India. They come to Europe and then we go to India. There is constant learning and exchanging because we were also trained doctors and also practice natural medicine already, so it was easy to practice ayurveda.

Another German biomedical doctor outside the MA group arrived at ayurveda through Indology and Sanskrit; he said:

During my training in Trivandrum, I spoke mostly in English to my teachers. One year in Trivandrum clinic was practical. Many young doctors were there and they learnt a lot of theory from me and I learnt practicals from them.… The text I translated to German for my thesis was Balatantra Kalyana. Charaka Samhita and Susruta Samhita are available in English. There is a good German translation of Astanga hrdaya.

In the past decade or so, these first generation ayurveda enthusiasts have set up an informal, yet regular mechanism for ayurvedic education in Europe such that the current generation could get their training in Europe through workshops and certificate courses. Ayurveda academies are doing good business in the recent years.

Classification of the European Ayurveda Practitioners

Based on their training and role in health care delivery, I could identify about four categories of European ayurvedic practitioners, though they are not mutually exclusive. Some of them combine several roles in one:

•

Qualified biomedical doctors practising ayurveda along with homeopathy, whom I refer to as ayurveda doctors.

•

Yoga teachers or persons with various non-medical backgrounds practising ayurveda that I refer to as ayurvedic service providers.

•

Massage therapists who offer a medley of remedies such as phytotherapy, naturopathy and what they call ayurvedic massage.⁴

•

Ayurvedic educationists who run academies for certificate courses and produce manuals and pharmaceutical catalogues for ayurvedic drugs in German, Dutch and French.

Let us take a closer look at the training, practice and use of drugs in the European ayurveda.

Ayurvedic Learning

Entry-level courses were taught by the first generation European ayurvedic doctors. Typically, full courses in ayurveda for two years are run in the workshop mode with a package of two weeks’ contact hours per year or at times twice a year. The quality of the learning derived in self-study was quite uneven, as one may expect. The two-year course at times included about three–four weeks of interning in an Indian ayurvedic hospital, but that was optional.

Several European learners said that they could not accept the noise and delays in found Indian settings. A biomedical doctor who had come to the Maharishi Convention and was learning the basics of ayurveda narrated his nightmares in India:

I was not very comfortable in India—first week in Delhi was in the hospital with the ayurveda vaidya to learn treatments—then we want to go to Himalaya by plane, but the doctor was not ready and we were late. Then there was an accident near the airport and the plane was gone. We had to organise a bus and then trek—I was nearly dead when we arrived. The trek to Himalaya after 18 hours by road—it was cold—we wanted to see the plants and learn about them. Nothing was possible—I had severe diarrhoea—mental diarrhoea due to severe anxiety and stress. I wanted to fly back—we could have only discussion.

Another yoga teacher who was learning ayurveda at a Kerala clinic said that though he has been visiting the ashram for about 10 years, he never goes out anywhere because he cannot tolerate the noise and pollution of Indian towns. Clearly they were comfortable relating to ‘Vedic’ India rather than contemporary India.

Seven-day Ayurveda Convention: New Age Gurukula?

Until recently, ayurveda was taught to small groups of learners by visiting vaidyas from India invoking the gurukula⁵ system. Even today, the conventions organised by the German Ayurveda Association are conducted around the idea of pupilage, though they also at times participate in larger congresses. In 2010, the German Ayurveda Association that practices MA had 150 members of which 125 were medical doctors. Here, a vaidya visits for a week or two and the learners spend the entire period with him by the way of residential workshops. The workshops have several themes ranging from examination of the naadi,⁶ clinical discussions, education on herbal products and nutritional discussions.

The most conspicuous element in the discussions was that biomedical terminologies were avoided and ayurvedic terminology was used during the sessions in order to retain the authenticity and integrity of classical ayurveda. Diagnosis by naadi reading was emphasised and considerable importance was given to individual cases of patients brought to the discussion by participant ayurvedic doctors. The visiting vaidya reviewed and commented on the diagnosis and treatment provided. They ‘translated’ biomedical aetiology and nomenclatures into the ayurvedic format before they discussed the plausible treatment protocols. The vaidya was familiar with European diet and habits because he has been their teacher for about 25 years now and was able to analyse the metabolic effects of European food items such as cheese, pasta and raw vegetable salads in terms of the ayurvedic padarthavignan.⁷

There were exclusive sessions in the ayurveda conventions on how to use the medicinal catalogue published by the MA Company. Such sessions facilitate the novice to undertake clinical practice of ayurveda based on the indications and drugs listed in the catalogue and learn from client feedbacks. Most of the participants in the MA convention were practicing ayurveda for anything between one to eight years, and three pioneers who were the organisers had about 25–28 years of experience of ayurvedic practice. The convention which lasted for a total of five days costed 880 euro fees, inclusive of ayurvedic food⁸ and accommodation.

Ayurveda Certificate Courses

There are other academies outside MA and they do run numerous certificate courses in ayurvedic massage, ayurvedic cookery, ayurvedic nutrition and so on. There were also part time ayurveda cookery courses for chefs and working people in the evening and they consisted of 20–25 people per course. The courses include yoga, meditation and chanting sessions; they serve vegetarian food in rustic surroundings. The fees for the one-week course was 1,200 euro inclusive of food and accommodation in 2010 and the vacancies were generally full through the year.

But the investment made in attending the ayurvedic certificate courses is not without purpose; it yields good returns and is part of the growing economy around ayurvedic learning in the same way as yoga teachers have rapidly proliferated in the West. The participants in these workshops and certificate courses mentioned that they would start practise immediately after attending a few courses and recover the expenditure incurred in attending these workshops. Humes (2008) refers to the commercialisation around ayurveda, spirituality and holism in the West as ‘enlightened marketing’.

In terms of content and substantive learning, many of the ayurveda certificate courses in Europe are ambiguous and lacking in coherence. They are based on working arrangements of European organisers with different kinds of visiting physicians from India. Wujastyk and Smith (2008) observe that this lack of standardization one of the most formidable problems of ayurvedic training in the West which is often run by individuals who are not accredited or have clinical experience. These training programmes often combine practices like astrology, tantra, herbalism and meditation into a medley of therapies to cater to popular demand. They often combine different kinds of practices tantra, herbalism and mediation into a medley of therapies.

Clinical Practice

Ayurvedic clinics in Germany are positioned as spa or well-being centres and often located in places that have natural hot springs known as bad.⁹ The Maharishi clinic in one of the bad towns is a well-established clinic run by a couple, both of whom were allopathic doctors with a diploma in ayurveda. The resident ayurvedic doctor at the clinic was an Indian who was from a family of vaidyas and also had formal training from ayurvedic college in India. This reputed clinic had been visited by the then Delhi CM, Sheila Dixit and certified by the Indian government officials from the AYUSH department, whose pictures are displayed in the lobby.

They get patients from other European countries apart from a significant inflow from Russia and Dubai for well-being and rejuvenation therapies. The common ailments treated in this ayurvedic clinic are pains, psychosomatic ailments, arthritis, gastro-intestinal disorders, gynaecological ailments and skin problems. The clinic professes ayurvedic approach with the study of pulse and elaborate clinical history taking for diagnosis. Medication is only with Maharishi catalogue products and the medicated oils used for massage are imported from outside and tested for safety and purity before use. The internal medicaments given in this clinic do include neutraceuticals and rasayanas (rejuvenators). The ‘ayurvedic’ food served in the clinic for inpatients is the North Indian vegetarian food.

Panchakarma, literally referring to five actions, is the most popular ayurveda therapy in Germany, especially so in MA, where it has been found to be effective for the treatment of asthma, hypertension, stress disorders and gastro-intestinal disorders. In some places, panchakarma is also presented as a ‘salvific’ healing experience as noted by Wujastyk and Smith (2008). It is a highly paid therapy costing anything about 5,000 euro per patient. Panchakarma is an intensive 21-day therapeutic process of interventions that aims at cleansing the innards of the body and restoring balance by removing undigested food juice and accumulated wastes in the interiors of the body. It involves five actions to be performed in designated sequence and time gap under medical supervision—emesis, purgation and enema, nasal cleansing and blood-letting punctuated by application of oil and diaphoretic massages.

It requires inpatient admission because the interventions as well as the diet are to be carefully monitored during this period. Zimmerman (1992) showed how panchakarma was part of larger therapeutic arsenal of classical ayurveda in which strong methods of evacuating the accumulated wastes inside the body channels and trails by purgation and emesis are followed by methods of soothing and calming the body, and how panchakarma in the modern period has eschewed some of these interventions presenting itself as a gentle and soft process of purification to suit the clients today.

A Maharishi doctor explained that panchakarma cannot be fully adopted in Europe because,

Emetics are not common in Europe; our people are more vata type. Emetics are not suitable to bring kapha out from a vata type. You have to see what the pulse says.

Even the softer version was seen as very effective by some of the European ayurveda doctors:

I treat many, many cases of hypertension and cholesterol. This is one thing that we can treat well with panchakarma and can really root it out. I cannot imagine taking chemical medicine for the rest of my life for hypertension; it can be completely cured by ayurveda.

A non-medical Dutch ayurveda practitioner exclaimed:

… give me all the people in Holland; everybody each in two years one panchakarma, then measure it; measure the health!

He argued that the Dutch government is spending much money on chemotherapy and palliation to cancer patients.

If you give them panchakarma, you are saving money on total health care.

Another doctor said that the main problem is to persuade European patients to take time off work to take such treatments:

When I get patients, I find it difficult to get them out of their business life for certain time of the treatment.… Most treatments need that they stop working for two–three weeks—and have only treatment. But people do not want to take their holidays for health.

An ophthalmologist practising ayurveda observed:

If we need to get quicker results, we need allopathy; if we need to feel better and live better—then widen your sight you do ayurveda. Sometimes people learn only by suffering from disease. Disease teach us a lot; we only wait.

When I asked about whether biomedical and ayurvedic approaches conflict with each other in their practice, an Austrian ayurvedic doctor responded:

For us, it is not a conflict; only for allopaths it is a conflict. Allopathy is useful and necessary in some places, but we try to use ayurveda more. I decide which treatment to give. Patients know I practice natural medicine. Every second doctor who is not from the university practices some form of natural medicine.

Individual Ayurveda Practitioners

There are a few individual ayurvedic doctors who are not attached to the Maharishi group though they may prescribe Maharishi products. One such informant was a German allopath and Indophile from a southern town who visited India during his late teens and developed an attachment to the ancient Indian traditions. He obtained his biomedical degree in Germany and instead of interning in a hospital, he did a project on the history of ayurvedic medicine in the history faculty and also learnt Sanskrit. Subsequently, he made a trip to India completing an internship in ayurveda at a hospital in Kerala and has since been practising ayurveda for about a decade now. As he cannot practice allopathy in Germany without completing residency in biomedicine, he works for the Red Cross certifying people who are fit for blood donation. His patients come to him through personal reference and word of mouth. In his own words:

… [T]here is no official way for ayurveda in Germany. Homeopathy, you can write it on your door or advertise it. Ayurveda works on an individual level by word of mouth.… I get about two patients a week. Normally they come with chronic ailments they have a long time, they tried many doctors before then they come to me. Chronic ailments like pain, psoriases, skin diseases, neurological ailments like facial paralysis and diseases that you do not find in a book.… If there are case sheets of other doctors, I am interested in looking at it. I am also allopathic doctor. But here I do ayurvedic diagnosis. The most important thing for me is that I get time to speak to the people, but no pulse diagnosis. When I saw in India pulse diagnosis is one small thing in the big picture you need a lifetime to learn it. You are expert in pulse or you are a good physician. I do pulse diagnosis, but I spend more time with the patient. I talk to them for an hour. I try to explain to them about ayurveda because it is necessary to change the diet and way of life.

Individual massage therapists have a bigger clientele as it is much a sought after treatment and they also have a reason why bodily massage relieves mental stress:

Reduce the stress in the tissues in the mind, this is a most Western problem than Indian countries because Europeans are more mental than Indians¹⁰—there is advantage but also more anxiety stuck there and going on in the mind. Help people reduce mental affectivity through ayurvedic treatments, use your hands calm them down—it is quiet—this is the spiritual aspect of it—not just oil. Mind calming techniques to help people find peace—through consultation. They have been to many doctors; the first thing is you have time and listen—it is important for them to trust—then you treat them. With mantras like Om chanting on low volume, ask them to close their eyes and move inwards and experiencing consciousness helps as well.

One could also discern different degrees of involvement among European practitioners towards ayurveda. A handful of biomedical doctors with avid interest in holism were deeply involved. They translate ayurvedic material to German and Dutch, visit India regularly and update their knowledge.

Main problem is with the medical community in Europe. Many people do not take ayurveda as medicine—we have to establish ayurveda as the mother of all medicine—that modern medicine comes from ayurveda—it can contribute a lot to the European health system. Our health systems are in crisis. They are disease coordinating systems and we are heading to financial crisis in medicine—ayurveda can help our health system to be health oriented, not disease oriented.

When asked about the many ayurvedic rules of diet and eating that are not possible to follow in Europe, a physician responded by saying that they have to be modified and given ‘different weightage in different places’:

I think digestion is weaker in the Indian climate; you need to do more to keep healthy. In colder weather, digestion is better.… In the time, I was in Trivandrum, I took German cheese and bread with me. Nobody was able to eat it there, even I found it too heavy to digest it there. I can eat it here, I like it. The basic principles are the same for the taste you have to look for. In India, you have to be much more careful about food. There are so many people with weak agni¹¹ in India, not so many here. Here, if you make mistakes on the diet, it is not so bad because digestion in colder climate is better.

There is then a large section of practitioners that adopts CAM practices like ayurveda only to attract patients and expand their client base. Casual acquaintances were not interested in the ayurvedic pharmacological principles or the Sanskrit terminology. The ‘Indian’ culture is recreated in these centres with figurines of Hindu gods, incense sticks, brass pans and other such effects. But they spend lot of time with their clients as part of consultations that ranged from 45 minutes to a maximum of 2 hours and a large part of consultation was counselling with minor dietary advice for which they charge about 200 euro.

In the past few years, one can talk about the fourth wave of globalisation of ayurveda. It is being brought about by Indian ayurveda practitioners in Europe. The UK, especially, has a long history of difference between the Sri Lankan/Indian ayurveda, on the one hand and, the more multicultural ayurveda of white practitioners (Warrier 2014) with the South Asian ayurveda practitioners focusing more on scientific credibility than spirituality (Wujastyk and Smith 2008) and seen as less authentic.

Gendered Clientele

The overwhelming presence of women as practitioners in the CAM sector in the West (about 98%) is very well documented. But as one can see, my data on the European ayurvedic practitioners shows that men are found and in significant proportion, more in the first category of ayurveda doctors, that is, medical doctors of the Maharishi group and outside, those who obtain ayurvedic diploma in addition to the biomedical degree. Male doctors have been foremost playing a pioneering role in setting up networks of ayurvedic training, supply of drugs and political lobbying in Europe. There are several active women biomedical doctors in the ayurveda associations; but the point is that in this category of practitioners, we do see the men in the forefront. Male yoga teachers have set up their academies with spousal support, but men can be found at the forefront where new institutions have been set up. I did not find practitioners among my respondents who were single women; they were mostly housewives. The women practitioners are found in substantial and overwhelming numbers only in category two and three, namely the non-biomedical practitioners and massage therapists.^¹²

The clientele for ayurveda consisted of, is predominantly women patients seeking holistic care and spiritual fulfilment. Cant and Watts (2012) find this to be true of CAM in general and all over the West. When I asked about this, a veteran, male ayurvedic doctor in the Maharishi group replied:

Ya, ya. absolutely. The women listen, decide and practice, men have to be convinced. Women go by feeling, but men check on the internet and it may be wrong.

Ayurveda and Vegetarianism

It was also interesting to see that European upper-middle class participants in the massage workshops were keenly engaged in Hindu rituals such as puja and yagna (forms of prayer and ritual sacrifice). While India has moved toward secular college-based ayurvedic education, in Europe by contrast, ayurveda has inseparable connections with Hindu religiosity. It is evident that the European ayurveda espouses a Brahmanical form of Hinduism tracing its origins to ancient Vedic wisdom with no reference to the strong Buddhist and regional moorings of ayurveda which has been so widely written about in the history of medicine in India. The association of ayurveda with vegetarianism is a case to point. ‘Pure’ ayurvedic world view in my informant’s narratives consisted of the following principles: Holism of mind and body, focus on individual body types (prakriti), vegetarianism, meditation and transfer of positive energy to patients through massage.

Vegetarianism was never a part of ayurveda. The prescription of meat of all kinds including that of cow, pig, earthworm and snail both as medicine and food is very well documented in the ayurvedic classics (Zimmerman 1987). The medical and nutritional prescription of meat and meat-based soups is commonly found in traditional ayurvedic practice. For example, physicians administering herbal medicines for night blindness with goat liver and prescribing pork for piles, apart from recommending mutton soup as the most nutritious food for weak patients (Sujatha 2002, 2011). Vegetarianism becoming intrinsic to ayurveda is a particularly post-modern Western formulation that has appeal among the upper echelons of the Hindu society.

The transfer of positive energy achieved through TM from therapist to the patient is another instance of a specific formulation of the mind-matter dualism which is more homeopathic than ayurvedic in nature. It comes from a vitalism that underplays the soma over the psyche. Ayurveda is renowned for somatisation of psychic problems; this is a well-known theme in the study of mind and body discourses in Asian healing traditions, which I have discussed elsewhere (Sujatha 2015) and will not enter into here. The issue here is not authenticity of ayurveda, rather what is that of great interest to us here is which aspects get selectively modified in cultural transmission.

Drugs

As for the drugs and medicaments used in the European ayurveda, concerns of safety, taste and appeal are foremost to Western clients. Any adverse report could destroy the prospects of ayurveda in the West.

Ayurvedic drugs for internal consumption are classified into shastric and proprietary drugs. The drugs and medicaments mentioned in the classical ayurvedic texts and those that are prepared according to the textual prescriptions for the ingredients and the methods of processing are referred to as shastric drugs and they are exempt from clinical trials in India. Shastric drugs are in the form of powders, ghee, oils, paste, and liquors that are strong smelling and bitter-tasting; they are often to be taken with other combinatory substances. Until few years ago, they were produced in smaller quantities by the ayurvedic physicians themself even as bulk production of shastric drugs already started a century ago.

Proprietary drugs, on the other hand, are patented modern ayurvedic drugs that are developed by the R&D of biopharmaceuticals and they are industrially manufactured with machines. Unlike the polyherbal formulae of shastric drugs, proprietary drugs consist of the active principle of a single herb. The manufacture of proprietary drugs requires mining the classical ayurvedic texts for pharmacological formula, whose active ingredient could be made in the easily consumable form of tablets. The pharmacological principles of ayurveda will have to be abandoned while the therapeutic ingredients are isolated and mass produced. The manufacture of proprietary drugs calls for a battery of cognitive processes by which ayurvedic knowledge is converted to biochemical and technologically pliant knowledge suitable for product development. This is mostly the arena of ethnobotany and biotechnology which are fast growing professional fields in India (Sujatha 2011).

Although the European ayurvedic practitioners were keen about the authenticity of their diagnostic methods categories and Sanskrit vocabulary, they cannot use shastric ayurvedic drugs in their practice. Shastric preparations are considered unsafe for use in Europe. Only the use of proprietary drugs are permitted apart from the imported oils used for external treatment. MA Company produces proprietary drugs and another category called veda herbs which are single herb powders, and a whole range of caffeine free teas tailored to ayurvedic body types. Regulations for import of drugs are stringent in Europe and only those drugs that have demonstrated 15 years of safe use in Europe will be allowed.

European ayurvedic doctors try to recreate the practice of what they think is ancient ayurveda in the clinical encounter. All my informants did not fail to point out how the European ayurveda was purer and more authentic than Indian ayurveda which they found to be polluted by biomedical methods and terminology. But they were happy with the proprietary drugs, which in their view, was safe for the European clientele. But as we just saw, the production of ‘authentic’ ayurveda in Europe is made possible by modern ayurveda at home, working through biotechnology, though it is not immediately visible in the European clinical encounter.

The Universal and the Global in Ayurveda

Ayurvedic concepts could globalise and spread spatially as spiritual and cultural elements, but this not true of the material substratum of ayurveda, namely the drugs. They have to follow the ‘universal’ and replicable parameters of the laboratory and acquire commodity form through capital investment. This model of universalisation is environmentally unsound and markedly different from the way in which ayurveda spread throughout South Asia.^¹³

Biomedical pharmacology at some point in history freed itself from locally available substances and shifted to industrially manufactured chemicals that could be mass produced and circulated as commodities and this has been a crucial factor in its universalisation. But the same logic will not work for a medical system based on herbs. Not just ayurvedic drugs but raw herbs are also commodities in neo-liberal South Asia as they are used in several biotechnology projects. India is the world’s second largest exporter of herbs after China, but China cultivates 80 per cent of its herbs, whereas almost 80 per cent of herbs in India are sourced from the wild (Ved and Goraya 2007).

The Power of Associational Groups

Small networks and associations of ayurveda practitioners, now crystallised into associations, have managed to accumulate critical mass for whom the international ayurveda congress is organised by the Indian Ministry of AYUSH every year.

An important development in the globalisation of ayurveda is the demand for clinical trials of ayurvedic treatments on European subjects even when they are not required in India. The German government will not accept the import or sale of ayurvedic drugs as medicines unless they have been clinically tested in the German soil. Although many European ayurvedic doctors personally did not feel the need for clinical trials on classical formulations during the interviews, as interest groups invested in the growth of ayurvedic enterprise in the West, they were part of the lobby that got government of India to sponsor the clinical trial in Germany at a huge cost. Moreover, the Central Council for Research in Ayurvedic Sciences (CCRAS) of the government of India sponsored a clinical trial on ayurvedic treatment for Osteoarthritis of the knee on German patients for a four year period.¹² The Indian Ministry of Health that has one of the lowest budgets in the world for health research has sponsored a trial costing 1 million euro in Europe for a treatment that is already well established in India, in order to give ayurveda a global facelift. A German lady ayurvedic doctor remarked:

We need big scale research to show that ayurveda for chronic diseases can be cheaper than biomedicine. For ayurveda we need more publicity. Ayurveda is poorer than Chinese medicine. China is spending much money to push traditional Chinese medicine (TCM) in Germany. I am trying to get more money for ayurveda. The government close their eyes. You can only hope that the people in the government fall so ill that they need ayurveda; then you get a little look at it. We are too cheap; China government is giving them money. TCM association has 50,000 members and we are 150 members—this is the difference and we are still very small in the market.

Most of the European ayurvedic practitioners I spoke to were also comfortable with the regime of importing herbal medicines and had not envisaged the path of developing their own botanical reserve. The domestic market for raw herbs and AYUSH products in India is bigger than the export market¹³ and proprietary drugs are also used widely in India. The domestic demand for herbs and ayurvedic products in South Asia is met with supplies from within the region and even here concerns about depletion of several botanical species due to mindless harvesting has repeatedly been raised (Ved and Goraya 2007).

Our argument is that ayurveda can steer in a different direction by drawing upon regional and local botanical resources around common principles as it historically spread in South Asia. As discussed in the introduction, this would be another model for universalisation without scaling up the production of ayurvedic drugs into a global industry for herbal commodities. Surprisingly, one of my zealous European ayurveda friends, probably the only one, also suggested this:

The most important thing for ayurveda in Europe is to do translation. Translate the herbs. We have all the herbs but no one taught us to use our herbs in ayurvedic way. If you test the herbs here by taste by rasa, guna here—then you need not be dependent on Indian herbs and Indian oils. To make the system suitable for to this place. If we buy cookbooks of ayurveda, they are only Indian cooking. We can do ayurvedic cooking with European herbs and things.

This could then be the basis for redefining universalism in medicine not as the replicability of a constant but the re-workability of the common.

Acknowledgement

I wish to place on record the support and cooperation I received from ayurveda practitioners, their associations and the heads of ayurveda academies during my fieldwork in Germany, Switzerland and the Netherlands. I also thank Maarten Bode for facilitating my research in the Netherlands.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: A part of the fieldwork on which this paper is based was made possible by the grant from UGC-DAAD Joint Research Programme (2009-10).

Footnotes

UGC–DAAD Joint Research Programme 2009–10 and IIAS, Amsterdam Affiliation 2010.

Vaidya is a physician and it is here used to denote ayurvedic physician trained in the traditional system of apprenticeship under a master physician.

For a detailed treatment of such practices, see Naraindas (2011).

In Germany, this category could include the Heilpraktiker.

Gurukula system is a traditional pupilage system of learning where the pupil resides with the master and acquires learning of knowledge and skills.

Naadi refers to the channels of movement of life-giving breath or prana in the body; reading the naadi in the wrist of the hand is a skilled method of diagnosis in several South Asian medical systems.

Padarthavignan is the ayurvedic science of substances and their transformation based on the panchabhuta theory or the theory of five elements of nature found in the macrocosm and microcosm (body).

Ayurvedic food in the clinic referred to the vegetarian Indian meal with salads and fruits.

‘Bad’ towns in the German culture are associated with healing or convalescing, a process that consisted of sessions of bath in the hot springs.

The idea that Europeans possess vata and pitta body constitution and are thereby were satvic (contemplative) and rajasic (action oriented) in their mental make-up, in contrast to Indians who are kapha prone and also thereby tamasic (prone to inertia) in nature, emerged repeatedly in the narratives of the European ayurveda practitioners, and this interpretation is specific to European ayurveda and Maharishi group. In the classical texts, the tridoshas and trigunas are non-absolute properties applied only to individual prakritis and not to entire populations or nations.

Agni, in this context, refers to digestive fire.

See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733211/ (accessed on 31 March 2019).

See http://ficci.in/ficci-in-news-page.asp?nid=13586 (accessed on 31 August 2019).

References

Cant Sarah, Watts Peter 2012. ‘Complementary and Alternative Medicine: Gender and Marginality,’ in Kuhlmann E., Annadale E. (eds.), The Palgrave Handbook of Gender and Health Care. London: Palgrave Macmillan, 488–504.

Mar	APR	May
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2022	2023	2024

Abstract

Universality of Medical Science

From ‘Standalone’ Biomedicine to CAM

Ayurveda and the Hindu Gurus in Europe

Classification of the European Ayurveda Practitioners

Ayurvedic Learning

Seven-day Ayurveda Convention: New Age Gurukula?

Ayurveda Certificate Courses

Clinical Practice

Individual Ayurveda Practitioners

Gendered Clientele

Ayurveda and Vegetarianism

Drugs

The Universal and the Global in Ayurveda

The Power of Associational Groups

Acknowledgement

Declaration of Conflicting Interests

Funding

Footnotes

References

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