Global health challenges are increasing. So are the costs. Despite progress in healthcare, the world is far from achieving health-related sustainable development goals. Is there an answer to this global crisis? Yes, possibly. We propose that the seven shields of Ayurveda can, indeed, help reduce the years lived in morbidity and extend health-span [i.e., a disease-free lifespan].
People today are approaching the age of decay much earlier, particularly in India. For example, non-communicable diseases [NCDs] are normally present in individuals aged 55 years, or older, in many developed countries, yet their onset occurs in India a decade earlier, i.e., >45 years of age. The reason is that a large majority of population has breached the six, out of seven, fortifications, or ramparts, that must exist between health-span and morbidity.
These are 1] ahara [diet]; 2] vihara [lifestyle]; 3] swasthvritta [healthy regimen, or code of personalised health-conduct]; 4] sadvritta [code of personal good conduct]; 5] panchakarma [five procedures for periodic detoxification]; 6] rasayana-vajikara [rejuvenation and restoration of vitality and vigour]; and, 7] aushadhi [medicine].
All these seven shields are concurrently and equally important. Yet, their sequence, as referred to, matters in health management. When we allow the first six walls to rupture, as we often do and as is evident from the discussion that follows, it leaves us with a limited choice — resorting to medicines a little too early. When the shield of medication fails, we die.
Recent studies under the auspices of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 [GBD 2017], as well as assessment of health-related Sustainable Development Goals [SDGs] show that many health-related SDG indicators including non-communicable diseases [NCDs] and NCD-related risks will require a determined effort to shift away from curative interventions, particularly in case of NCDs, towards multi-pronged, prevention-oriented policy action and investments to achieve SDG aims. For example, meeting the SDG targets by 2030 necessitates a pace of progress that no country has been able to achieve until now. Thus, our actions — or, inaction — today will ultimately dictate how close the world can get to leaving no one behind by 2030.
State Of Health In India
The state of health in India, where 18 per cent of the world’s population now lives, is in an even more challenging position. Prevalence of the most leading NCDs, in the country, has increased substantially from 1990 to 2016. The major risk factors for NCDs, including high systolic blood pressure, high fasting plasma glucose, high total cholesterol, and high body-mass index, have all increased between the said period. In 2016, cardiovascular diseases alone contributed 28.1 per cent of the total deaths and 14.1 per cent of the total Disability Adjusted Life Years [DALYs], compared with 15.2 per cent and 6·9 per cent, respectively, in 1990. The increasing burden of diabetes in India is another case in point, where Ayurveda has a large preventive role to play. The prevalence of diabetes in adults aged 20 years, or older, in India, increased from 5.5 per cent in 1990 to 7.7 per cent in 2016. Moreover, for every 100 overweight adults, aged 20 years, or older, there were 38 adults with diabetes, compared with the global average of 19 adults in 2016.
Geriatric problems are another cause for concern. The percentage of people scoring lower Katz index, indicating severe and mild disability, in at least one of the three activities of daily living [ADLs: walking, toileting and dressing] is high in India [17.91 per cent for males and 26.21 per cent for females]. It is crucial to reduce chronic morbidity in a timely way to minimise the enormous associated burden of disability.
Form a large pool of robust scientific studies, these are just a few examples to facilitate an understanding about the necessity of preventative healthcare in India and elsewhere. Since the strategies and principles discussed here have a larger relevance and applicability to public health,we now turn to the seven shields that must form the core of preventive strategies. We hope that the ideas discussed here may also contribute to Translational Medicine in Ayurveda.
Preventative Healthcare
In preventative healthcare, there are sutras in the Charaka Samhita that seem simple and intuitive. Yet, when examined from the perspective of the keywords and related principles embedded in each of the sutras, there are about half-a-million research papers that have been published in the world’s best journals. Although these papers do not specifically mention Ayurveda, yet an overwhelming majority support the conclusions drawn from antiquity — sometimes during 8,000 to 5,000 years ago. The three factors — intellectual error, unbalanced use of senses and the effect of time — are the causes of all disorders. Likewise, the remedy of all disorders lies in the balanced use of intellect, senses and time. The saint-scientist Charaka, while elaborating his terse verse, has noted that if we use wholesome diet, healthy lifestyle, conduct ourselves after analysis, avoid being bonded to sensual pleasures, give people who are in need, observe equality, truthfulness, and forgiveness, and respect the respectable, we can remain free from disease. When our intellect, speech and actions are aimed at happiness, with mindfulness and clear understanding, and promptness in knowledge, self-restraint, and yoga, we do not fall victim to disease.
While the sutras alone are instructive in appreciating the principle of the seven shields, it would be useful to discuss each of these strategies, along with contemporary scientific understanding. Developing this understanding is necessary for common people, but it must now form part of prescription by Ayurvedic physicians in their customised and individualised prescription to extend the health-span of people.
In examining a patient, a large number of factors are taken into consideration. Yet, in contemporary times, it is useful to understand whether or not the patient has breached the seven protective shields, and, if so, to what extent. This data will be helpful in prescribing specific instructions on diet, lifestyle, exercise, sleep, code of personal ethics and health conduct, detoxification, rejuvenation, and medication.
While it is beyond the scope of this piece to deliberate the seven protective walls comprehensively, it would, nevertheless, be useful to discuss the vital importance of some of these, briefly.
Fundamental Strategies
Diet, food and beverages are the fundamental strategies for managing health according to Ayurveda.While scientific studies of health-promoting aspects of food are large, two messages stand out. First, in 2017, the consumption of nearly all healthy foods and nutrients, at the global level, was suboptimal [topped by low intakes of nuts and seeds, milk, and whole grains], whereas that of all unhealthy items exceeded the recommended level [e.g., sugary beverages, processed sugar, sodium, and processed meat]. Second, the burden of disease attributable to dietary factors was huge. Indeed, in 2017, 11 million deaths and 255 million disability-adjusted life-years [DALYs] were attributable to dietary risk factors globally.
Ayurveda places a large emphasis on daily intake of fruits — such as amalaki, Dadim and draksha — by making them nityasevaneeya [part of regular diet]. Risk reductions for total mortality in the order of 35 per cent — and, specifically of 27-39 per cent for cardiovascular and non-cardiovascular death — were found with just three to four servings per day of fruits, vegetables, and legumes, compared with fewer than one serving per day. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at consumption of 375–500gm/day.
Many of the Ayurvedic food items are multifunctional. They are simultaneously food, rejuvenators and medicine. These are super-foods. These include dates, grapefruit, raisins, almonds, sesame seeds, gooseberry, garlic, ginger, black peppers, pippli, turmeric, saffron, cumin, coriander, honey, cow-milk, cow-ghee and triphala. If taken appropriately, they help in free-radical scavenging and oxidative-stress reduction. They also reduce inflammation. Food should, however, be taken only when hungry [i.e., when earlier food is fully digested]. Likewise, on the quality, quantity and timing of diet, although much remains to be understood in contemporary science, yet Ayurvedic and scientific insights are now largely moving towards coherence.
Science Of The Matter
The protective strategy, known as vihara [lifestyle] in Ayurveda, has an overwhelming body of scientific and medical literature. It unequivocally supports the idea that lifestyle is medicine. In particular, vyayama [physical activity] and nidra [sleep] have been the subject of large-scale research. They form the pillars of good health and are as important as diet in extending health-span and delaying age-related pathogenesis. While there is a large body of research on various aspects of sleep, it is necessary to take a minimum of seven hours of sleep during night. Sleep duration should not exceed eight hours though. Sleep during the day, except when fatigued, or ill, is unhealthy.
Physical activity confers large benefits — as noted in Ayurveda — including healthy aging. Physical activity not only enhances healthy aging by 39 per cent, it is also associated with a reduction in obesity, weight gain, coronary heart diseases [CHD], type-2 diabetes mellitus and the age-related diseases, viz., dementia and Alzheimer’s disease. In addition, physical activity has been consistently linked to decreased all-cause mortality rates, probability of long survival, good health and function during older age as well as to cognitive performance. Seen from the perspective of the economic burden of physical inactivity, a global analysis of major non-communicable diseases found that the cost of physical inactivity to healthcare systems was international US$ 53.8 billion worldwide, in 2013, of which US$31.2 billion was paid by the public sector, US$12.9 billion by the private sector, and US$9.7 billion by households.
Investing in vyayama [exercise] daily totalling 150 minutes per week is necessary. Vyayama and other daily routines prescribed in Ayurveda confer healthy longevity, perhaps by way of maintaining the integrity of circadian rhythm, that may, otherwise, trigger fatigue, disorientation, insomnia and increased susceptibility to disease.
Ayurveda recommends sadvritta [ethics], designed to instil conscientiousness, emotional stability, stronger social relationships, reduced loneliness, resilience, persistence, optimism, altruism, compassion and self-restraint. Non-adherence to them strongly increases the risk for engaging in behaviours that deteriorate health-span and shorten the lifespan. Sadvritta confers health and control in sense organs. Science, samhitas and experience are fully coherent in demonstrating that conscientiousness is among the best predictors of longevity and health-span. Even moderately conscientious individuals have 50 per cent lower rates of mortality compared to the those who are non-conscientious.
Extending Health-Span
For extended health-span, Ayurveda recommends a set of daily routines including waking and sleeping, elimination, hygiene, massage, mindfulness practices, diet, work, and travel all during the course of the day and night. The routine calls for optimal times to awake, sleep, oral care, care of eyes, nose, ears and skin. Routines also include cleansing procedures, bowel habits, yoga, breath practices and application of oil all over the body. All these maintain the synchronicity of circadian rhythms, with time of the day, night and seasons [dinacharya, ratricharya, and ritucharya] and to prevent, or delay aging.
Panchakarma, or periodical detoxification, purification, and rasayana and vajikara are highly recommended for strength and nourishment to the deeper tissues, or dhatus, and to delay age-related pathogenesis. Research has some evidence now to support the position of Ayurveda even during an impending societal collapse. Panchakarma can rescue lives and bestow health.
Rasayanas are among the most researched drugs of Ayurveda. They confer longevity, memory, intelligence, freedom from illness, youthfulness, excellent body lustre, complexion and voice, strength of physique and sense organs, perfect speech, respect and brilliance. Rasayanas keep dhatus [body cells and tissues] in healthy condition. They are the best and safest antioxidants known to humanity.
A leading cause of age-related pathogenesis is the inability, impairment, or inefficiency, in the DNA repair mechanisms. This leads to numerous disorders, including cancer, neurodegeneration and a large majority of old-age diseases. Progressive accumulation of DNA damage due to diminished rate of DNA repair is one of the key mechanisms of aging. The ability of the cells to sense and repair the DNA damages deteriorate with age and, thus, accelerates age-related pathogenesis. A pertinent question is: can rasayanas promote DNA repair in aging individuals? While the degree of balance between the rate of DNA damage and rate of repair needs to be maintained, recent research suggests that amalaki rasayana, among others, may contribute to maintenance of such a balance.
Conclusion
The key message emanating from this brief analysis is that Ayurveda has much to offer in both prevention and treatment of diseases, but the potential can only be realised by employing a comprehensive and holistic approach embodied in the philosophy of the seven shields of Ayurveda between health and diseases. Every breach of the seven walls, as discussed here, accumulates personal disease-risks and health debt that may finally result in a faster pace of pathogenesis and aging. These brief, yet evidence-based, insights may be useful to practicing physicians of Ayurveda in enhancing the health-span of citizens in times of health crisis that the world faces today.
