Adravyabhuta Chikitsa Non-pharmacological Treatments In Ayurveda

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Adravyabhuta Chikitsa includes all those treatments wherein no drug or pharmacological approach is involved. A = no, Dravyabhuta = drug / pharmacological dependent, Chikitsa = treatment. So, adravyabhuta chikitsa means ‘non-drug or non-pharmacological treatments / therapy’. These treatments may be in different forms –

• Physical activities
• Mental / psychological activities
• Spiritual activities
• Religious activities etc

Adravyabhuta Chikitsa is complementing therapy in some diseases but can also be a mainstay approach or a part of it in some conditions. Example – Apart from medicines and dietetic regimens, ancient treatises have advocated and also emphasized constant indulgence in physical activities and exercises, as in santarpanottha rogas i.e. diseases caused due to over-nutrition like in prameha (diabetes), sthaulya (obesity) etc.
Read – Chikitsa: Treatment Types, Ayurvedic classification

Can we treat the diseases without medicines?

Absolutely yes. It is said that anything – a material or non-material is skillfully chosen, can be used to treat the diseases and anything which can do so would fall under the purview of an effective therapy / treatment.

It is not that all that is ‘non pharmacological’ can treat ‘all diseases’. It is selective and includes skill and experience to implement the same in therapy. Some ‘non-drugs’ can cure some diseases for which they are designed and they may not be suitable to treat the other diseases or to treat the same disease in some other person. So, adravyabhuta chikitsa is also a ‘personalized medicine’, like ‘what suits you doesn’t suit me!’.

How does it work?

How does something which is a non-drug would be considered as a therapy?

As per the definition of medicine, anything which brings about the balance (samyavastha) of the dhatus should be considered as chikitsa i.e. treatment or therapy. If something which is not a medicine can achieve this objective, we can definitely call it a medicine.

Ingredients of comprehensive treatment – In each and every disease, when the treatment procedures are explained, Ayurveda has always comprehensively focused on right type of aushadha i.e. medicines, ahara (diet) and viharas (lifestyle/conduct). Viharas are non-pharmacological interventions. Amongst synonyms of medicine – Pathya (that which is wholesome for the channels of transportation in the body), Prayaschitta (atonement) and Hita (beneficial) are the synonyms of bheshaja (medicine). All these are non-drug forms which define treatment. These synonyms highlight the importance of non-pharmacological therapy. Pathya also includes diet regulations which are in the form of substance, but those which are formless and serve the purpose of pathya shall be included in this discussion.
Read – Importance Of Diet (Pathya) For Specific Diseases

The physicians should explore this method of treatment since it is also cost-effective and very significant many times. Adravyabhoota and Dravyabhuta Chikitsa shall be skillfully combined so as to procure maximum benefits in curative and preventive aspects of the treatment. It can be used alone or in combination in treatment of both physical and mental disorders and thus would cover a broad spectrum. Meditation, Yoga and Marma therapies also fall under the umbrella of adravyabhuta chikitsa.
Read – Health Benefits Of Yoga: Mind And Body

Likewise the energies derived from Sun, Water and Air and other elements of nature were used for healing purposes in the ancient days. The forces of nature were also considered as Gods and were worshipped. Rituals like fire sacrifices, oblations etc were also done for creating healing impact. They are followed even today. They can also be included in daivavyapashraya chikitsa i.e. divine therapies but being non-medicinal are included in adravyabhuta chikitsa. Adravyabhuta Chikitsa in Nija Rogas (somatic diseases) – As already said, these therapies are also included in the treatment of somatic disorders, as in mental disorders. These therapies are mentioned in both yuktivyapashraya chikitsa (rational therapy) and also daivavyapashraya chikitsa (divine therapies)
Read – Daiva Vyapashraya Chikitsa – Divine Therapies of Ayurveda

For mental disorders

Adravyabhuta Chikitsa in Manasika Rogas (mental disorders) – Master Charaka has advised the below mentioned to be followed in the treatment of psychological therapy –

1. Gyana – spiritual knowledge
2. Vijyana – scriptural knowledge
3. Dhairya – nurturing patience
4. Smriti – evoking memory
5. Samadhi – meditation

All these fall in the territory of adravyabhuta chikitsa. It is administered using measures (upaya) which are formless (amurta) which includes the below mentioned methods –

• creating terror or fear (bhaya darshana)
• surprising / shocking (vismapana)
• making one to forget (vismarana)
• causing agitation (kshobhana) or exhilaration (harshana)
• threatening to kill (vadha)
• tying up a person (bandhana)
• inducing sleep (swapna)
• gentle massage / touching (samvahana) etc

These measures are explained in the context of chapter dealing with treatment of unmada (psychoses) and apasmara (memory disorders).

Adravyabhuta Chikitsa and Trividha Chikitsa

Trividha chikitsa i.e. threefold treatments are popular strategies used in Ayurveda to comprehensively treat many physical, mental or psychosomatic disorders. They are –

1. Daivavyapashraya Chikitsa – spiritual therapies
2. Yuktivyapashraya Chikitsa – rational therapies (including treatments, medicines, dietetic regime)
3. Sattvavajaya Chikitsa – psychotherapy

Among these three formats of treatment, divine therapies and psychotherapy are formless treatments and do not use any substance for the purpose of treatment. Therefore most measures included in daivavyapashraya and sattvavajaya chikitsa fall under adravyabhuta chikitsa.
Read – Mental And Spiritual Benefits Of Fasting

Adravyabhuta Chikitsa and Chaturvidha Chikitsa

Master Sushruta has mentioned 4 kinds of treatments, adopted to comprehensively treat the diseases. They are samshodhana – cleansing therapies, samshamana – palliative treatments, ahara –diet and achara – conduct and lifestyle modifications. Among these, achara shall be included in adravyabhuta chikitsa. Alternatively we can tell that many measures of adravyabhuta chikitsa fall under the umbrella of achara.
Read – Achara Rasayana – Behavioral Therapy For Calm Mind And Long Life

Adravyabhuta Chikitsa and some forms of Shamana

Shamana means palliative treatments treatments. The below mentioned shamana measures shall be considered as adravyabhoota chikitsa since no substance is used in these forms of treatment –

• Kshudha (nigraha) – controlling or pacifying the hunger (fasting)
• Trshna (nigraha) – controlling or pacifying thirst
• Vyayama – getting indulged in exercise
• Atapa – exposure to heat of the sun
• Maruta – exposure to the wind
  Read – How To Do Fasting? A Step By Step Guide For You

Adravyabhuta Chikitsa and Upashaya

Upashaya is like shamana. It is administered with a hope of pacifying a disease, if it does, it is continued and the same upashaya becomes chikitsa i.e. treatment for that disease. If it doesn’t, the physician would look for an alternative approach. If it aggravates the disease, it is considered as anupashaya and the measure is discontinued. Upashaya is thought of when a disease is not properly diagnosed or when there are many diseases and it is difficult to make an accurate diagnosis. In a way upashaya works on the logics of ‘trial and error method’. It is one among the five diagnostic tools nidana panchaka.

18 types of upashaya have been explained in Ayurveda treatises. Three types of methods are used in the context of upashaya i.e. aushadha – medicine, ahara – foods and vihara – activities. They may be either similar to or antagonistic to the cause of the disease, disease or both. The permutations and combinations make up for 18 types of upashaya.

Among these viharaja upashayas related to activities shall be considered under adravyabhuta chikitsa. They are –

• Hetu viparita vihara – activities antagonistic to the causative factors
• Vyadhi viparita vihara – activities antagonistic to the disease
• Hetu-Vyadhi viparita vihara – activities antagonistic to both cause and the disease
• Hetu viparitarthakari vihara – activities similar to the causative factors
• Vyadhi viparitarthakaria vihara – activities similar to the disease
• Hetu-Vyadhi viparitarthakari vihara – activities similar to both cause and the disease

Read – Upashaya Anupashaya – Pacifying And Non-Pacifying Factors Of Disease

Gist of Non-pharmacological Therapies extracted from Ayurveda classics

Adharaniya Vegas – Ayurveda enlists 13 body reflexes which should not be forcibly withheld when the body is trying to express them. If they are suppressed they will lead to many diseases. If they are not suppressed they would contribute towards comprehensive health. Below mentioned are those urges which should not be suppressed forcibly –

• Vata – fart and belch
• Vit – feces
• Mutra – urine
• Kshavathu – sneeze
• Trt – thirst
• Kshudha – hunger
• Nidra – sleep
• Kasa – cough
• Shrama shvasa – exertion dyspnea
• Jrmbha – yawning
• Ashru – tears
• Chardi – vomiting
• Retas – ejaculation

Here no medicine or substance is used for maintenance of health. But it is advised not to withhold these naturally manifesting urges.
Read – Do Not Suppress Body Urges: Charak Samhita Sutrasthana 7th chapter

Dharaniya Vegas

Similarly there are some urges which should be controlled and withheld. They are mainly the mental expressions / emotions. They are –

• Kama – lust
• Krodha – anger
• Bhaya – fear
• Lobha – greed
• Matsara – envy
  Read – Vega Dharana: Suppression of urges, types, symptoms, and management

Dinacharya / Rtucharyokta Vihara

Physical activities advised to be practiced on daily basis in the context of dinacharya i.e. daily regimen like walking, exercise, waking up early in the morning etc shall be considered as non-pharmacological therapies. Likewise the activities advised to be done or practiced during each and every season in the context of rtucharya i.e. seasonal regimen also need to be considered.

Other inclusions

Nidana Parivarjana – keeping away from the etiological factors (causative factors of a disease) Sadvrtta – observance of good conducts and noble deeds
Achara Rasayana – all those acts and deeds which would bestow the benefits of rasayana (rejuvenators, immune modulators, anti-ageing medicines)
Langhana – all types of lightening therapies except shodhana – cleansing therapies,  deepana – digestive fire kindling medicines and therapies, and pachana – ama digesting medicines / therapies
Niragni sweda – all 10 kinds of sudation therapies wherein the contact of fire or heat generated from the fire are not used
Vyyama – exercise – helps in making the body firm, stable and strong, increases endurance – apart from many other benefits
Nidra – sleep – is said to be one of the upastambha i.e. supporting pillar for maintenance of health in a comprehensive way, is therapeutic in emaciation patients
Brahmacharya – celibacy – is yet another upastambha i.e. supporting pillar for maintenance of health in a comprehensive way, helps in having balance of healthy semen and sperms in men, it bestows longevity and is also considered as an important pathway for salvation
Sankalpa – determination or decision to get indulged in sex is said to be the best aphrodisiac Vajikarana Viharas – some activities, regimens and conducts are mentioned to have aphrodisiac effect in the chapter of Vajikarana
Vidya – knowledge / wisdom is said to be the best among the brmhana – bulk promoter / promotes physical and mental nourishment
Vata, Pitta, Kapha hara Viharas – regimens / activities to balance / pacify vata, pitta and kapha Harsha – exhilaration is the root of cheer or delight
Prashama – tranquility is said to be the best among the pathyas i.e. wholesome regimes – those beneficial and conducive for the channels of the body
Tattva Avabodha – understanding the basics, truth and reality is said to be the best among the Harshana – those which promote happiness / bliss
Indriyajaya – control over one’s senses / self control is the best among those which promote delightfulness
Nivrutti – means freedom (from liabilities), this is considered to be the best among those which induce / bestow nourishment of the body
Vayu – fresh air is said to be the best among those which give vital strength – prana
Dhee, Dhairya, Atmadi Vijnanam – These are the threefold treatments preferred and highly advocated as the first line of approach towards handling mental disorders. This is the basis of psychotherapy in Ayurveda. Dhee means promoting the intellect of the person, dhairya means installing courage in the minds of the patient and atmadi vijnana includes making the person to understand the concept of self-worth and providing counseling. These measures are used in the modern psychiatry also.
Read – Counselling – Types, Benefits, Myths And Facts

Examples of Adravyabhuta Chikitsa

Also,

The below mentioned measures (non-pharmocological) are considered to be upayantras i.e. accessory instruments and hence useful in the treatment of diseases –

• Harsha – exhilaration
• Pravahana – straining for evacuation
• Kala – time factor
• Bhaya – fear

The below mentioned non-drug therapies shall also be included in adravyabhuta chikitsa –

• Yoga
• Meditation
• Marma Chikitsa
  Read – Health Benefits Of Yoga: Mind And Body

Summary

Adravyabhuta Chikitsa do not comprise of any herbs, medicines, foods or substances to treat the diseases. Being non-pharmacological therapies they do have an impact (positive impact) on the body parts and their functions. Some of them have their therapeutic impact on the body and mind. Some of these non-drug therapies help in preventing diseases, some in maintenance and balance of health and many others in curing the diseases – at physical, mental or both levels.

At physical level they help in maintenance of physical health and also to maintain dhatu samya i.e. balance of body tissues. They help in balancing the body doshas and thus keep all the functions in a state of balance. Example – exercise, sleep, and fasting, not withholding body’s natural urges etc. Those non-drug therapies which are mainly implemented for maintenance of mental health helps in enhancing the sattva attribute of the mind and balance imbalanced rajas and tamas attributes at the same time. This helps in prevention and cure of various psychological problems and diseases. Example – psychotherapy, counseling, exhilaration, encouragement, meditation, delightful companies etc.

The imbalance of physical doshas and mental doshas may impact each other in due course of time. Therefore the non-pharmacological measures used at physical level would help in mental balance and treating mental disorders and vice versa. The non-pharmacological therapies including religious activities and divine therapies mainly act on the basis of prabhava – special effect which cannot be explained logically. These activities also enhance and promote sattva attribute of the person. It is also believed that these therapies have an impact on the cosmic rays of different planets (graha) and thus is believed to please the exogenous forces.

From disease and their treatment perspective – Even according to the modern research, exercise helps in controlling the blood glucose levels and also improves insulin sensitivity. It helps in preventing the associated complications such as cardiovascular damage. Ayurveda too has given importance to the inclusion of exercise in many metabolic diseases including prameha / madhumeha vis-à-vis diabetes mellitus. In a study it was found that various types of exercises viz aerobic, resistance, Yoga, endurance type etc showed beneficial effect in T2DM (Srijit Das et al).

By all these we can see that adravyabhuta chikitsa are important part of the Ayurveda treatment protocol, be it in case of mental disorders or physical disorders or psychosomatic disorders. Most of these measures are also followed in the modern era, some owing to the practices which have descended through the timeline of evolution and some after having been proved through scientific tests and research works (though many of these haven’t gone under the hammer of scientific tests and have been discarded as absurd and useless). In most of them the faith or trust is the working factor and many are said to work on the basis of special effect for which no scientific principle or basis has been explored. But what is important is that any treatment with or without form should provide cure or help in preventing the diseases or in maintenance of health. An ideal and skillful combination of dravyabhuta (treatments wherein materials like medicines, diet etc are used) and adravyabhuta (non-drug) chikitsa is the best way towards comprehensively dealing with many diseases in clinical practice. When done so, the main objective of treatment i.e. dhatusamya can be definitely achieved to a great extent.