INTRODUCTION:

Nursing professionals have been holding a unique place in health care system. They are working in diverse settings and fields and are front line health care providers, therefore skill and expertise development of nurses is prime importance of an organisation for effective health care delivery¹. Nurses are delivered services in primary health care settings, health care education, schools, emergency services, health advises and counselling, and Alternative health care system². Ayurveda is coming up as best Alternative System in India and other developing and developed countries on the globe.

Many trained allopathic Nurses are well placed in Ayurvedic medical centres and Government/Private Ayurvedic Hospital. Although a few Institutes have started certificate courses and Diploma of Ayurvedic Nursing, they do not have a uniform study curriculum and the students coming from these institutes are unable to meet the requirements and norms as laid down by Ministry of AYUSH of State and Central Government. Therefore, Ayurvedic Hospitals are forced to depend on the Nurses trained in Allopathic Medical System. Nurses of Allopathic medical system in other countries often come across the patients who have considered Ayurvedic Therapies and have consulted Ayurvedic Medical Professionals some of whom may be undergoing Ayurvedic Treatment also. Ayurveda being specific in its concepts, philosophy, diagnosis, principle and techniques of treatment and Ayurvedic terminology, The Nurses of allopathic system are not accustomed to Ayurvedic Terminology, Ayurvedic diagnosis, Ayurvedic Assessment, Principles and Techniques of Ayurvedic treatment^3-4.

It was observed that the sisters (Nurses) are unable to be comfortable and professionally competent to work with Ayurvedic Principle, Treatment Procedure even after ten year’s services. The induction training for newly appointed Nurses is limited at the Institute level⁵. Therefore, this review is planned to reduce the knowledge gap and provide various learning outcomes for development of nursing skill for better management in Ayurvedic Hospitals.

Nursing as secular profession was stated in 19^th century but about 1000BCE Charaka Samhita considered Upasthata(Nurse/supporting hospital staff/attendant) is one of the key component of Chikitsachatuspada(four fold of Hospital management)⁶ The qualities of good Nurse are also described in that text. A good nurse should provide prescribed medicine in proper time, affectionate to the patients, provide good diet as prescribed and offer selflessness services to patients⁷. Holistic nursing care defined as nursing practice to develop interpersonal relation to assess prakriti to deliver personalised health care in life style management, diet, yoga, meditation that provide health and overall well being⁸. It is an enumeration of the Ayurveda concept, physiology, pathology, pharmacology and therapies.

Enumeration:

AYURVEDA- THE SCIENCE OF LIFE:

Ayurveda is a Sanskrit word derived from Ayush (life) and Veda (Knowledge), so Ayurveda is the knowledge repository of life. Again, Ayu is two types Sukhayu(happiness) or health and Dukkhayu (Sorrow) or diseases. Ayurveda is a documentation of experiences and observations of human civilisation and developed in written form as Vedic medicine during 2000-1000 BC in India. Ayurveda enumerated the beneficial, non-beneficial, happy and unhappy aspects of life. Health is defined as the complete equilibrium of dosa (humours), agni (digestive juices, enzymes and hormones), dhatu (tissues) and the normal excretion of mala (waste materials), along with a happy state of indriya (sensory and motor organs), manas (mind) and atma (soul)

CONCEPT AND PHYSIOLOGY:

The fundamental theories and principles of Ayurveda practice are derived from experience and are known as Ayurvedic Concepts. These are ascertained by the methods of aptopadesha (authoritative statement), pratyaksha (perception), anumana (inference) and yukti (rationale) as stated in the Charaka Samhita. The elemental composition of the body is explained in the theory of dosha, dhatu and mala, which is the tridosaconcept of Ayurveda. The aim of Ayurveda is to achieve equilibrium between dosas and dhatus, which is believed to bring health and longevity which is verified with clinical research⁹.

The Ayurvedic concepts of physiology, pathology, examination, diagnosis, clinical assessment and therapeutics are based on the doctrine of tri-focals (vata, pitta and kapha). They are designated as dosas because of their capacity to vitiate other dhatus. Dhatu support the body and can be compared as tissues. The dosas are present in every cell and move through every channel of the body. These dosas in their normal state are the main supports of the body. The activities of the nervous system are governed by vata, thermogenic and endocrine/exocrine glandular activities by pitta and the musculoskeletal, immune response and anabolic systems by kapha. The seven dhatus, the basic tissues of the body, also act as supports when they are in a normal state. They are rasa (nutritive elements constituting the end product of gastrointestinal digestion - chyle, lymph, tissue fluid etc.), rakta (blood), mamsa (muscle tissue), medas (adipose tissue), asthi (cartilage and osseous tissue), majja (red bone marrow) and shukra (reproductive elements). When normally disposed, the dhatus are in their “prasada” state, i.e. fit for building substances of the body; when abnormal, they are in a state that is believed to cause disease. The term mala means waste products, and the main excretory wastes of the body are mutra (urine), purisha (faeces) and sveda (sweat). The agni (bio active energy) corresponds to various digestive juices, enzymes, hormones etc, involved in digestion and metabolism. Ayurveda aims to maintain or resume and restore equilibrium of dosha, dhatu and mala, patency of srotas (channels), and a healthy state of the agni. The description of tridosa and its normal character, normal character of dhatu and mala are described under Ayurveda physiology¹⁰.

AYURVEDIC PATHOLOGY:

Ayurveda postulated three main causes of disease, namely asatmyendriyarthasamyoga (indiscriminate use of senses and their objects), prajnaparadha (misuse of intellect resulting in a loss of discrimination between wholesome and unwholesome diets and behaviour) and parinama (seasonal variation, cosmic effects and the effects of time). The five components of the pathology of a disease (Panchalakshananidana) to assist in diagnosis. Panchanidan components are nidana (causative factors), purvarupa (prodromal symptoms), rupa (signs and symptoms), samprapti (pathogenesis) and upashaya (elements antagonistic to disease and causes). The concept of shat kriyakala (six stages of pathogenesis) is vital for an understanding of the pathological states (samprapti) of the dosas that can resulted in disease. These kriyakala are chaya (accumulation), prakopa(aggravation), prasara (overflowing), sthanasamsraya (localization), vyakta (manifestation) and bheda (classification or dissolution) of dosas.

CLINICAL EXAMINATION METHODS:

The clinical examination consists of Rogaparikshya (examination of Diseases) and Rogiparikshya (examination of Patients). The examination of diseases by nidan(etiology), Purbarupa (prodromal sign and symptom), rupa (signs and symptoms), samprapti (pathogenesis) and upashaya (elements antagonistic to disease and causes).

The examination of patient and its assessment is vital part for physician and nursing staff. The ten fold of examination (dasabidhaparikshya) and Astavidhaparikshya (eight fold of examination) are mostly adopted by Ayurveda physician and reflected in Case Record form.

The tenfold of examination tools are 1. Prakriti (physical and mental constitution) 2. Vikruti (vitiation stage of dosa) 3. Satva (Emotional Balance), 4. Sara (Tissue Vitality) 5. Samhanana (Body compactness), 6. Pramana (physical structure) 7. Satmya (Adaptibility to environment and changing circumstances) 8. Vyayama Shakti (physical strength)9. Ahara Shakti (digestive capacity) 10. Vaya (Rate of aging).

Again eight fold of examination where the stage of vitiation of dosa can be evaluated are 1. Nadi (Pulse) 2. Mutra(urine) 3. Mala(stool) 4. Jivha(tongue) 5.Sabda (Voice) 6. Sparasa (skin or body temperature) 7. Druk (eye) 8. Akriti (facial expression)

AYURVEDAIC PHARMACOLOGY:

The substances of natural origin, including whole plants or their parts, animal parts and minerals are used as drug either alone or in combination. In addition, various other measures are used in an attempt to maintain health in a healthy person and alleviate disorders of the body and mind. These Ayurvedic drugs act on the principles of samanya (homologous) and visesha (antagonistic) action. Substances possessing homologous properties and actions increase the relevant elemental properties or constituents of the body while those having antagonistic properties or actions decrease those properties or constituents. In cases of disease or imbalance of dosa, dhatu and mala, the rational use of naturally available substances aims to equilibrium to its quality and quantity. The composition of elements in medicines and the diet are studied in terms of various properties, referred to as rasa, guna, virya, vipaka andprabhava.

Ras (taste): This property of a drug detected by the tongue. There are six different tastes, each with a predominance of two mohabhuta(elements) and showing the characteristics of these elements. Administration of a medicine consisting of a particular ras enhances that property in the body and decreases its opposite. According to Ayurveda the six tastes are sweet (madhur), sour (aml), salty (lavan), pungent (katu), bitter (tikta) and astringent (kashaya).

• Guna: This property of a drug detected by sense organs other than the tongue. They are 20 in number and represent the characteristics of the elements. There are 10 pairs of opposite characteristics – heavy (guru)/ light (laghu), dull (manda)/ sharp (tikshna), cold (sita)/hot (ushna), unctuous (snigdha)/ non-unctuous (ruksha), smooth (slakshna)/ rough (khara), immobile (sthira)/ mobile (sara), soft (mridu)/hard (kathina), clear (visada)/ slimy (picchila), solid (sandra)/ fluid (drava), bulky (sthula)/ fine (sukshma).

• Virya denotes the potency of the drug. There are eight viryas, representing the active gunas. These can be put into two broad categories – sita (cooling) and ushna (heating).

• Vipaka: It denotes the state of transformation of rasas after digestion as demonstrated by their action. There are three vipakas. A sweet taste becomes madhuravipaka; sour and salty tastes become amlavipaka and pungent, bitter and astringent tastes become katuvipaka. The action is same like rasa as elements predominate.

Prabhava is special property of some medicines, which cannot be explained by their elemental composition. It may due to bio active component of body.

AYURVEDAIC MEDICATION PROCEDURES:

Disease can be treated in one of three main ways, namely nidanaparivarjana (avoidance of causative agents and provocative factors), shodhana and panchakarma (purifying therapies) and shamana (palliative therapies). The panchakarma procedures are grouped under three stages purba karma (preparatory procedures), Pradhan karma (main five procedures) and paschat karma (post-operative procedures). Snehana (Oleation and Message) and Swedana (fomentation are preparatory procedures. The pancha karma are 1. Vamana(emesis), Virechana (Purgation), Asthapanavasti (decoction enema), Anuvasanvasti (oil enema) and Raktamakshona(bloodletting). Leech therapy is a very common bloodletting procedures of practice in Ayurveda hospitals^11`.

In Ayurveda, the equilibrium of the dhatus in healthy individuals is preserved so that disease can be prevented. In diseased people, treatment eliminates the disequilibrium between the doshas, and the body is restored to normality. Thus equilibrium is the determining factor in all individuals. From this point of view, a wholesome substance is said to be one of two types, either one that maintains health or one that corrects the abnormal doshas thereby alleviating the disorders. The former is useful for healthy people and the latter for the diseased. Vajikarana (aphrodisiac) and rasayana (rejuvenative/promotive) measures are also prescribed for maintaining equilibrium and preventing senility and related disorders¹².

The nurses can use the checklist to assess the state of dosas and report to the physician (Table no-1). Ayurveda medication and modern drug may lead to enhanced or diminished effect that may be useful or harmful. The action of one drug is affected by the other drug either quantitatively i.e. increased or decreased intensity of action or qualitatively, i.e. an abnormal or a different type of response is produced. Some of the herbs used in Ayurveda formulation or functional foods or anupana (Adjuvants) may interact with modern drugs (Table no-2). The Ayurveda medications have direct relationship with Anupana (Adjuvents), Ousadhi sebana kala (medication time), pathya (diet), so nurses should have common idea of all these things (Table no-3)

Some of the therapeutic terminologies as prescribed in Ayurvedaa are as follows: Brimhana (promoting body weight; bulk-promoting). langhana (producing lightness in the body), svedana (diaphoretic), stambhana (refrigeration; holding back; checking), rukshna (roughening), snehana (uncting/anointing) • rasayana (promotive therapy), Vajikarana (aphrodisiac) • samsodhana (proper purification by elimination of impurities) • ahara (food) • achara (behaviour; conduct) etc.

Table no-1. Check list for clinical symptoms and Ayurveda markers

S. No	Clinical symptom	Ayurveda markers
1.	Motion	State of Vata
2.	Appetite	State of Pitta
3	Sleep	State of Kapha
4	Pulse	State of Vata, Pitta , Kapha
4.	Coated tongue	Amalipta
5.	Facial expression	Akruti
6	Stool	Ama/nirama state
7.	Emotion, state of mind	Satva state
8.	BMD	Samhanana

Table no-2: Ayurveda herb and Modern Drug Interaction^13-14

S.N	Ayurvda herb	Modern Drug	Interaction
1.	Kumari Aleo vera	Cardiac glycosides Thiazide diuretics	Electrolyte imbalance
2	Arogbadha Casia Angusthifolia	Cardiac glycosides Thiazide diuretics	Sodium and other electrolyte loss Hypotension
3	Sunthi Zinger	Anticoagulant	Thrombocytopenia
4.	Haldi Curcuma longa	Antiplatelet agent	Thrombocytopenia
5.	Karabellaka Bitter melon	Hypoglycemic agent	Hypoglycemia
6	Asava & Arista	NSAID	Gastric damage and ulcer
7	Yastimadhu	Prednisolone	Hypertension, oedema feet, hypokalaemia
8.	Aswagandha	Diazepam	Increase sedative action
9	Guggulu	Beta blocker	Decrease bio availability
10	Tulasi	Paracetamol	Hepatotoxic

Table -3. Ayurveda Medication Relationships

Medication related attribute	Name	Remark
Anupana¹⁵	Luke warm water in all times Honey in Kapha Pitta in ghee, Vata taila	Anupan varies in diseases condition and prakriti
Bhaisajya Kala¹⁶	Always before food, but depends on Dina(parts of day), Rogi(patient), vyadhi(diseases), Jeerna linga(digestion of food), Ritu(nature of season)	Ten time of administration as per Ayurveda.
Pathya (diet) ¹⁷	Manda, peya, vilepi, yabagu, yusa, Mamsa rasa	Warm food, butter milk, mudga are always pathya

DISCUSSION:

It is very difficult to understand Ayurvedic terminologies by those who are not trained in Indian science and philosophy. Ayurveda has its own developed physiology, pathology, pharmacology, clinical diagnostic tool, non-invasive procedure of management. More emphasis has given to positive and preventive health care. The dose is depending upon the dosa, prakriti and environmental condition¹². Ayurveda scientists have been creating evidences in clinical medicine, nanotechnologies, psychiatric, gynaecology etc^18-24but awareness is less ²⁵. The treatment protocol is individualised, The Nurses should have the knowledge so holistic nursing care is very important. The check list for the assessment of dosa, Ayurveda herb and modern drug interaction and Ayurveda medication relationships are very important in Ayurveda hospital.

CONCLUSION:

Ayurvedic medicine can be truly complementary to conventional medical practices or vice versa depending on the case history and other relevant medical information related to the patient necessary for total clarity on the ailment of the Patient as this will be the deciding factor in Holistic System to select the main treatment system and complimentary system with clarity on the role of each system as part of a holistic approach to diversify and synergise the existing health care. It is a learning tools for Nurses working in Ayurvedic Hospitals. An awareness of Ayurvedic medicine might help nurses to be cognisant of patients who take such remedies and to be able keep the treating Doctors informed. Potential complications arising from combinations of both modern and traditional treatment may be averted through such awareness. It is hoped that this article has raised readers’ awareness of the principles of Ayurveda care.

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Received on 01.04.2021 Modified on 11.09.2021

Asian J. Nursing Education and Research. 2022; 12(2):165-169.

DOI: 10.52711/2349-2996.2022.00033