Naturopathic medicine in India

O R I G I N A L A R T I C L E

Focus on Alternative andComplementary Therapies

Volume 19(3) September 2014 140–147© 2014 Royal Pharmaceutical Society

DOI 10.1111/fct.12125ISSN 1465-3753

Naturopathic medicine in India

Pradeep MK Nair, Awantika Nanda

AbstractBackground Naturopathy is a traditional system of medicine that believes in the body’s innate capacity to heal itself. InIndia, the philosophy and practice of naturopathy differs from that of other countries. Yet little is known about the practiceand regulatory affairs of naturopathy in India.Objectives To explore the Indian perspective of naturopathy in terms of philosophy, practice, regulatory issues, chal-lenges and future directions.Methods An online literature search was carried out in PubMed and Google Scholar using the keywords ‘naturopathicmedicine’, ‘AYUSH systems’, ‘naturopathy’ and ‘CAM in India’. Websites of universities and government bodies were alsosearched for details regarding regulation and registration. Unstructured interviews were conducted with eminent experts andlocal physicians via telephone and in person to understand the challenges in practice and their views on the standardisationof naturopathy.Results Naturopathic medicine in India is a purely drugless approach. Naturopathic physicians use diet therapy, mud,hydrotherapy, massage, acupuncture, chromotherapy, magnet therapy, acupressure and yoga therapy as their maininterventions. Lack of appropriate regulatory bodies, research, uniformity in practice and adequate support from thegovernment are the main issues facing the naturopathic community in India.Conclusion Naturopathy, as practised in India, is a drugless system that believes in the body’s self-healing capability. Thelack of solid evidence for many of its modalities indicates the need to offer adequate research training to professionals toassist them in building an evidence-based practice. The standardisation of naturopathy can only happen by forming a centralregulatory council and by calibrating its educational standards with respect to traditional philosophies.

KeywordsAlternative medicine • Department of AYUSH • Bachelor Degree in Naturopathy and Yogic Sciences (BNYS) • naturopathicmedicine • naturopathy

Background

Indian systems of medicine are traditional systems ofIndian origin (other than homoeopathy), whichcame to India in the 18th century and became assimi-lated into Indian traditional practice.1 Indian systemsof medicine such as ayurveda, yoga, naturopathy,unani, siddha, homeopathy and sowa-rigpa comeunder the auspices of the Ministry of Health andFamily Welfare within the Government of India. Ofthese Indian systems of medicine, yoga and natur-opathy are the only drugless systems practised in

India. This paper is an attempt to explore the Indianperspective of naturopathy in terms of philosophy,practice, regulatory issues, challenges and futuredirections.

Methods

PubMed and Google Scholar were searched using thekeywords ‘naturopathic medicine’, ‘AYUSH systems’,‘naturopathy’ and ‘CAM in India’ to understand thepractice of naturopathic medicine in India. Websites

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of universities offering degrees in naturopathic medi-cine were explored for details about courses offered innaturopathy, the curriculum and the colleges regis-tered under them. The websites of Indian Govern-ment bodies like the Department of Ayurveda, Yoga& Naturopathy, Unani, Siddha and Homoeopathy(AYUSH), the Central Council of Research in Yogaand Naturopathy and the National Institute of Natur-opathy were also searched for data regarding the reg-istration and regulation of naturopathic medicine inIndia.

Unstructured interviews were conducted among100 naturopathy graduates across India, which werecomprised of naturopathic physicians, leaders of pro-fessional bodies, directors of national institutes,research scholars and spa professionals. Interviewswere conducted by phone and in person in order tointerpret each participant’s views on the practice,philosophy and challenges of naturopathic medicine.The questions asked at the interview were:

• What are the challenges faced by you in your dailypractice?

• Are you getting adequate support from thegovernment in the process of developingnaturopathy?

• What are the interventions used by you in yourpractice?

• What is your approach towards a disease?• What is the scope of research in naturopathy?• What do you anticipate will be the position of

naturopathy in medical systems in coming years?• What do you think about the standardisation of

naturopathy?• What is deficient in naturopathy?

These questions were framed just to guide the inter-view, and the participants were encouraged to shapethe discussion in line with their own perspective,focus and concerns. The phrases and contentionsused by the naturopaths were marked and theirmeanings had been elucidated during the process ofthe interview.

Results

The data obtained illustrated a clear picture about theconcerns of naturopathic physicians towards thevarious aspects of naturopathy in India. The datahave been extensively examined and have beendivided into the following subsections:

Historical highlightsNaturopathy is an ancient system of science thatemphasises healthy living without drugs, which iswell depicted in ancient Vedas and texts. The termnaturopathy is derived from Greek and Latin and

means ‘nature’s disease’. The term naturopathy wasfirst coined in 1895 by John Scheel2 and adapted byBenedict Lust, who is regarded as the father of natur-opathy in the USA.3 The modern practice of naturopa-thy has its roots in the Nature Cure movementof Europe during the 19th century.4 The‘Ordnungstherapie’, a term coined by Bircher-Bennerin 1937, is a concept of naturopathy in Europeancountries, which is now regarded as one of the fiveconcepts of naturopathy in Europe.5 Internationally,the naturopathy movement started in Germany andother Western countries under the name of ‘watercure’, which was propagated by the work of VincentPriessnitz and other personalities like Louis Kuhne,who propounded the unity between disease and treat-ment. Henry Lindlahr, JH Kellogg, Arnold Ehrit, DDPalmer, Rolier, ED Babbit, Bernarr Macfadden, ArnoldRickley, JH Tilden, Father Kneipp, Stainley Lief andHerry Benjamin, as well as Benedict Lust, may also bementioned among others who contributed in someway to the development of naturopathy.

The wisdom of naturopathy in India revived afterLouis Kuhne’s New Science of Healing (in German,1883; English translation, 1892) was translated intodifferent regional languages of India. Shri D VenkatChelapati Sharma translated this book into Telugu in1894 and it was translated into Hindi and Urdu byShri Shroti Kishan Swaroop in 1904. These transla-tions triggered the propagation of naturopathy acrossthe nation of India.

The system became more popular when MKGandhi, who is regarded as the Father of the IndianNation, was inspired by the book Return to Nature byAdolf Just (in German, 1896; English translation,1903). Gandhi started following naturopathy for hisown health and later turned out to be a strongbeliever in naturopathic practice. He even carried outseveral naturopathic experiments on himself and hisdisciples. He used to stay in the Nature Cure Clinicrun by Dr Dinshaw Mehta from which the All IndiaNature Cure Foundation Trust was established. ThisTrust was later taken over by the Government ofIndia in 1986 and the National Institute of Naturopa-thy came into existence.

Influenced by Gandhi, many other popular leadersalso joined the naturopathy movement, which laterextended to different states of India, includingAndhra Pradesh, Uttar Pradesh, Bengal, Maharashtraand Gujarat. The naturopaths who did this founda-tional work, and who were involved in the revival ofnaturopathy in these different States, were DrMahavir Prasad Poddar, Dr Janaki Sharan Varma, ShriSharan Prasad, Dr Khushi Ram Dilkash, Dr SJ Singh,Dr Hiralal, Dr Vitthal Das Modi, Dr KulranjanMukherjee, Dr Sukhram Das, Dr JM Jussawala, Dr MMBhamgara, Dr Vegi Raju Krishnam Raju, Dr B VenkatRao, Dr B VijayaLaxmi, Dr Ganga Prasad Gaur Nahar,Shri Dharam Chanda Saravagi, Dr Sukhbir Singh

Original Article 141

Rawat and Acharya K Laxman Sharma.6 This estab-lishes the presence of a long history of naturopathyin India.

Philosophy and practice of naturopathyWestern dimensionNaturopathy is a system of medicine based on thefundamental principles of nature’s cure; these prin-ciples radically differ from other systems of medicine.It is a system of humans building in harmony withconstructive principles, which is the principle innature that builds up, improves and repairs thehuman being on the physical, mental and moralplane.7 The human body has its own vitality or lifeforce, which is the primary force of being that givesthe body recuperative power to restore itself. Accord-ing to naturopathy, the primary cause of disease inhumans is lowered vitality, abnormal composition ofblood and lymph and the accumulation of morbidmatter and poisons, all of which are due to violationsof nature’s law. This concept was formulated byHenry Lindlahr and is considered a fundamentalprinciple of naturopathic medicine. According toLindlahr, every acute disease is the result of thehealing effort of nature.7

The basic principles of naturopathic medicine,according to Western philosophy, are as follows:8

1 The healing power of nature (vis medicatrixnaturae): naturopathic medicine recognises thebody’s natural healing ability and trusts that thebody has the innate wisdom and intelligence toheal itself, if given the proper guidance and tools.

2 Identify and treat the causes (tolle causam):naturopathic doctors (NDs) attempt to identifyand treat the underlying cause of illness,rather than focusing on individual presentingsymptoms.

3 First do no harm (primum non nocere): NDs beginwith minimal interventions and proceed tohigher level interventions only as determinednecessary.

4 Doctor as teacher (docere): NDs educate patients,involve them in the healing process, andemphasise the importance of the doctor-patientrelationship.

5 Prevention: naturopathic medicine emphasisesoptimal wellness and the prevention of disease.

Indian dimensionIndia is a domain of spiritual wisdom. Nature’s curein India is based on the transcendent truths of phil-osophies as depicted in ancient vedantic lore such asKatho Upanishad and Bhagavad Gita. Naturopathycan be defined as a drugless, non-invasive, rationaland evidence-based system of medicine impartingtreatments with natural elements based on the theo-ries of vitality, toxaemia and the self-healing capacity

of the body, as well as the principles of healthyliving.9 The basic principles of naturopathy recog-nised by practitioners in India are as follows:10

1 All disease, their cause and their treatment areone.

2 The primary cause of disease is not bacteria. Bac-teria develop only after the accumulation ofmorbid matter when a favourable atmosphere fortheir growth develops in the body. Hence, theprimary cause of disease is morbid matter not thebacteria.

3 Acute diseases are self-healing efforts of the body.Hence, they are our friends, not the enemy.Chronic diseases are the outcome of wrong treat-ment and the suppression of acute disease.

4 Nature is the greatest healer; the body has thecapacity to prevent disease and regain health, ifunhealthy.

5 The patient is treated not the disease.6 Naturopathy treats the four aspects of physical,

mental, social (moral) and spiritual together.7 Naturopathy treats the body as a whole instead of

giving treatment to each organ separately.8 Naturopathy does not use medicines; according to

naturopathy, ‘food is medicine.’9 According to Gandhiji, ‘Ramanama is the best

natural treatment’, which means doing prayeraccording to one’s spiritual faith; this is an impor-tant part of treatment.

Naturopathy treats the human as a complete unit.The ultimate aim of naturopathic medicine is topromote the inherent power within the human bodyand to accelerate self-healing capacity.

Diagnosis in naturopathic medicineTraditional diagnosis, like iris diagnosis11 and facialdiagnosis,12 were used by the ancient naturopaths.But the authenticity of iris diagnosis is under ques-tion;13 hence, it is mostly avoided by naturopathicphysicians in India. Currently, most naturopathicphysicians in India use modern diagnostic tech-niques, although a few of them still use facial diag-nosis alongside modern diagnostic techniques.

Treatment modalities in naturopathyNaturopathic medicine is not defined by the sub-stances used but rather by the principles that underlieand determine its practice, which include the follow-ing: supporting the healing power of nature, findingthe root cause of ill health, first doing no harm,treating the whole person, prevention, and doctor asteacher.8,14 Naturopathic treatments are mainly basedon the five great elements or panchamahaboothas,15

namely air, water, earth, fire and ether, which are thefundamental constituents of every human. The main

Focus on Alternative and Complementary Therapies September 2014 19(3)142

treatment modalities commonly used by Indiannaturopathic practitioners are described below.

Diet therapyDiet therapy may be defined as the use of food sub-stances for therapeutic purposes. Good diet andnutrition are always appreciated when it comes todisease and its treatment. Naturopathy mainly advo-cates the intake of food in its natural form, such asseasonal fruits and sprouts, which are alkaline innature. Naturopathic diets can be classified into threetypes:10

• Eliminative diet: liquids such as lemon water,citric juices, tender coconut water, vegetablesoups, butter milk and wheat grass juice.

• Soothing diet: fruits, salads, boiled or steamedvegetables, sprouts and vegetables.

• Constructive diet: wholesome flour, unpolishedrice, little pulses and sprouts.

Diet works as a medicine in naturopathy, which inturn improves the health and vitality of an individ-ual. So it is always important to choose the right foodfor better health.

Fasting therapyFasting can be defined as ‘total rest’ – physical,physiological, sensory and mental rest – whichincludes voluntary abstinence from the intake of anykind of food, solid or liquid that demands digestion(except water) for a definite purpose and period oftime.9 Fasting is considered to be a first-line treat-ment in naturopathy. It helps in effective detoxifica-tion by directing the vital energy towards theelimination10 of toxins in the body, which are con-sidered to be the cause of many diseases.

Mud therapyMud is a mixture of inorganic and organic matterwith water, which has undergone geological and bio-logical processes under the influence of variousphysicochemical factors.16 Mud therapy can bedefined as the application of processed mud eitherdirectly or in the form of packs to elicit therapeuticbenefits. It is a common intervention in Indiannaturopathic medicine. Mud therapy has proved tobe successful in the management of skin pathologies,rheumatic disorders, musculoskeletal disorders,gynaecological conditions, neurological complaintsand cardiovascular conditions.16,17 The mud acts bydiluting and absorbing the toxic substances of thebody and ultimately eliminating them from thebody.10 The effects of mud-application include: anincrease in membrane electrical conductance,absorption phenomena, hyperaemia and activationof the hidropoietic glands, enzymes and hormones.16

HydrotherapyHydrotherapy is one of the most important interven-tions in naturopathy, which has been used sinceancient times. It can be defined as a naturopathicmodality that involves the use of water at differenttemperatures, pressures, states and modes of applica-tion for the treatment of various disorders. Thephysiological effects and therapeutic applications ofhydrotherapy are diverse. Water used at various tem-peratures enhances blood flow, which is thought tohelp dissipate algogenic chemicals and facilitatemuscle relaxation.18 In addition, the hydrostaticeffect may relieve pain by reducing peripheraloedema19 and by dampening sympathetic nervoussystem activity.20 Hip baths, enemas, hot and coldfomentation, hot foot baths, spinal baths, steambaths, immersion baths, application of hot and coldpacks as well as advanced modalities like whirlpoolbaths, sprays and jets are some of the various forms ofhydrotherapy. Hydrotherapy stimulates the body’snatural healing mechanisms, which increases the cir-culation of blood and lymph.8 Studies have beenconducted extensively in hydrotherapy and it hasevolved as a promising intervention in treatingvarious systemic disorders.

Massage therapyMassage therapy is one of the most popular therapiesin naturopathic medicine. It is the systematicmanipulation of body parts for the purpose ofimproving circulation, mobility and various diseasestates. In India, Swedish massage is prescribed andadministered by naturopathic doctors. Swedishmassage is considered to be one of the first scientificapproaches to massage, which specifically affects thecirculatory, lymphatic and nervous systems.21 It sys-temically manipulates the soft tissues of the bodythrough effleurage, petrissage, friction, tapotementand vibration.22 Mustard oil, sesame oil and coconutoil are generally used in massage for lubrication, butcan also be used to generate therapeutic effects.10

AcupressureAcupressure is rapidly gaining acceptance as asafe, cost-effective, non-invasive and non-pharmacological form of therapy. Acupressureinvolves using the fingers, thumbs, palms, heels ofthe hand and elbows to apply pressure and stimulatespecific points along the energy channels of thebody.23 Acupressure can be effective in treating mus-culoskeletal pain, digestive disorders, anxiety andinsomnia.6

AcupunctureAcupuncture is an important part of TCM and hasbeen used for millennia to treat various clinical dis-orders based on ancient Chinese medicine theory.Acupuncture is a family of procedures involving the


penetration of specific superficial anatomic locationson the skin called acupuncture points by thin, solid,generally metallic needles.24 In the last 100 years,acupuncture has become one of the most popularcomplementary and alternative therapies in theworld.25 It is widely used in the treatment of paralysis,painful conditions, motor neurone lesions andneurological conditions. Acupuncture would appearalso to be beneficial for the symptomatic manage-ment of Parkinson’s disease.26

ChromotherapyChromotherapy can be defined as the use of theseven colours of the sun’s rays to treat disease. Thesecolours include violet, indigo, blue, green, yellow,orange and red. Water and oil exposed to the sun fora specified number of hours in coloured bottles andcoloured glass are used as devices to treat differentdisorders.6 Chromotherapy provides colours to theelectromagnetic body or the aura (energy field)around the body, which in turn transfers energy tothe physical body.27 The colours used inchromotherapy have their own properties; differentsources of colour, like clothing and food, are alsoconsidered to have beneficial effects on the body.

Magnet therapyMagnet therapy can be defined as the application ofmagnetic materials on or very close to the skin, usingdifferent strengths and different modes of adminis-tration over a prolonged period of time.28 Magnettherapy responds positively when used in conditionssuch as oedema, pain and inflammation.29 Studieshave shown obtrusive changes in haemodynamicswhen it is applied in combination with other thera-pies in patients with ischaemic heart disease andosteochondrosis.30 Magnetic treatment is applieddirectly to the body parts and are available in theforms of belts, necklaces and bracelets.6

Yoga therapyYoga therapy is a mind–body discipline that offersboth physical and mental health benefits. The com-ponents of yoga include physical postures, controlledbreathing techniques, meditation and other relaxa-tion techniques. It is an established intervention foralmost all chronic anomalies of the human mind andbody.

Naturopathic therapeutic order1 Diagnosing the underlying malady.2 Identifying the root cause and removing the

underlying aetiology.3 Advocating a healthy regimen for:

(a) ameliorating the vital power;(b) initiating the body’s self-healing capacity.

4 Promoting healing crisis by:(a) boosting the inflammatory response;(b) encouraging the immune system;(c) reviving the body’s metabolism.

5 Assisting the body in the removal of toxins orpathogens by:(a) naturopathic interventions like fasting,

hydrotherapy and mud therapy.6 Educating the patient towards prevention and

self-healing.

Naturopathy regulation and education in IndiaIn India, yoga and naturopathy are grouped togetheras a system of medicine31 under the Department ofAYUSH within the Ministry of Health and FamilyWelfare. The regulation of naturopathy in India is acomplicated issue when compared with othersystems of medicine practised in India. India has along history of traditional medicine that is well-established and integrated within the overall medicalstructure of the country. The Indian Governmentestablished the Department of Indian Systems ofMedicine and Homeopathy in 1995 and laterrenamed it as the Department of AYUSH. The IndianGovernment also established a Central Council forResearch in each of these core areas, as well as sepa-rate Directorates of AYUSH in 18 Indian States.32

The Central Council of Indian Medicine was ini-tially constituted under Section 3 of the IndianMedical Council Act in 1970.33 There are well-established national councils for all other systemsthat come under the Department of AYUSH (exceptyoga and naturopathy), which deal with themedical education, professional conduct and recog-nition of medical schools. Naturopathic practition-ers in India are registered medical practitioners withan ‘A’ class medical registration under their respec-tive state government’s Board of Medical Registra-tion, as per Government Order, G.O (MS) No.133dated 2.3.1996, Indian Medicine and HomeopathyDepartment – Registration of Naturopathy QualifiedPersons in Tamil Nadu, Health & Family WelfareDepartment.

There are 17 colleges34 across India offering aBachelor degree in Naturopathy and Yogic Sciences(BNYS), with one college offering post-graduate edu-cation (MD)35 in these two disciplines. The durationof the BNYS course in India is 5.5 years, except inthe State of Karnataka where it is 5 years. There arealso a number of diploma and certificate coursesconducted across the country by various privatebodies. The Government of India, through itsautonomous bodies [i.e. Central Council forResearch in Yoga and Naturopathy (CCRYN),Morarji Desai National Institute of Yoga (MDNIY),New Delhi and National Institute of Naturopathy(NIN)], is taking action to promote yoga and natur-opathy across the country.


Professional bodiesThere are two major professional associations thatrepresent naturopathic physicians in India: theIndian Naturopathy and Yoga Graduate MedicalAssociation, which is the major association in India,and the Tamil Nadu Naturopathy Doctors Associa-tion, which functions only in the State of TamilNadu. There are also other bodies like the Interna-tional Naturopathy Organization, of which tradi-tional practitioners and other holistic practitionersmake up the membership. These associations are dif-ferent in terms of their approach and representa-tional nature. Most of these associations are notactive in pursuing recognition due to internal con-flicts, poor representation and lack of support fromthe members.

Scope for naturopathic doctors in IndiaNaturopathic doctors in India work as clinicians, acu-puncturists, wellness consultants, research scholarsand spa managers. The scope of work fornaturopathic doctors in the government sector islower that in the private sector. Most naturopathyhospitals and clinics in India are run by privatebodies. The number of permanent employees in thegovernment sector is less than 40; around 30 BNYSdoctors work on a contractual basis with governmentbodies like NIN, CCRYN and MDNIY.

Research and developmentAlthough scope of research is large for naturopathyand yoga, it is not actively pursued in India becauseof a lack of trained personnel10 and active insightsinto research. The Government of India establishedthe CCRYN in order to conduct research in naturopa-thy and yoga, but this area remains unexplored.Some modern medicine institutes and naturopathichospitals in India are currently making small effortsto investigate the potential of this system ofmedicine.10

Standardisation of naturopathic medicineMost of the professionals who were interviewedexpressed the term ‘standardisation’. When theywere asked to clarify what they implied by standardi-sation they explained that traditional philosophieshave to be strictly adhered to by all professionals inorder to maintain the uniqueness of naturopathicmedicine. Regulatory issues were a major concernamong respondents; they also felt they were laggingfar behind in evidence-based practice when com-pared with other systems of medicine. Most of themevinced a lack of uniqueness in naturopathic prac-tice. This is a major obstacle preventing naturopathyfrom being considered as a standardised system ofmedicine.

Discussion

The results point out the distinguishing characteris-tics of naturopathic medicine in India. One areawhere it differs in a major way from Westernnaturopathic practice is its drugless approach.Excerpts from our interviews and the literaturesuggest that, although the treatment modalities haveproven to be potentially beneficial to consumers,there is a lack of solid evidence. This is not only dueto the poor documentation of clinical results, but alsoto an unawareness of appropriate documentationprocedures. The respondents also foregrounded theirdifficulty in enabling the public to make a distinctionbetween naturopathic practice and other CAMsystems. The inadequate evidence-base of naturopa-thy, and the challenges in creating evidence, makesnaturopathic practice in India an effortful task; it alsomakes it difficult for naturopaths to earn recognitionfrom practitioners in other medical streams.However, respondents believed they were prominenthealthcare providers in an era where lifestyle diseasesare taking the lead run across the globe. This pointhas to be explored further. Extensive studies in thearea are also needed to make naturopathy more of anevidence-based system rather than a belief-basedsystem. The future directions for naturopathy inIndia should be to strengthen the body of research inthe area, and to work towards solving regulatoryissues.

Conclusions

Naturopathy is a drugless system that believes in thebody’s self-healing capacity. Though manynaturopathic modalities have been shown to be ben-eficial, the evidence for its capability is still missing.The training of professionals in these areas ofresearch is required to make naturopathy moreevidence-based. The regulation of naturopathy is alsoneeded so as to standardise the system; this includespractice and training that values the traditional prin-ciples and philosophies of naturopathy. Measuresalso should be taken to reduce the differences inpractice across the country.

Conflict of interest None declared.

Acknowledgements

We are thankful to Dr Dhananjay Arankalle, Facultyfor Health and Social Care, University of Chester, UK,for his guidance in completing this study.

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Pradeep MK Nair, BNYS, MSc, Physician, Department ofIntramural Research, Office of Research and Development,National Institute of Naturopathy (Department of AYUSH,Ministry of Health and Family Welfare, Government ofIndia), Bapu Bhawan, Road No. 6, Tadiwala Road,Sangamvadi, Pune, Maharashtra 411001, India.E-mail: [email protected]

Awantika Nanda, BNYS, MSc, Physician, Department ofIntramural Research, Office of Research and DevelopmentNational Institute of Naturopathy (Department of AYUSH,Ministry of Health and Family Welfare, Government ofIndia), Bapu Bhawan, Road No. 6, Tadiwala Road,Sangamvadi, Pune, Maharashtra 411001, India.E-mail: [email protected]


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Naturopathic medicine in India