This article is part of Public Spirit series on Faith and wellbeing.
The ancient South Asian medical tradition of Ayurveda has become increasingly popular in the West in recent years, with practitioners of holistic health incorporating it into the complementary and alternative medicine sector. Since its introduction, it has been reshaped and linked with self-help literatures, while practitioner groups have pushed for increased regulation and government recognition. In the last ten years, even the Indian government has been involved in lobbying, though so far the results of the push for recognition have been mixed.
Ayurveda, the ancient health tradition originating from South Asia, has gained increasing popularity in the holistic health sector of North America and Western Europe over the last three decades. It is often described as a ‘sister tradition’ to yoga, though in terms of their pre-modern histories, the two traditions would seem to have had very little to do with each other. Given the vast popularity of meditational and postural yoga as a health tradition in the West, however, it is perhaps inevitable that Ayurveda, a relatively unknown phenomenon even as recently as the early 1980s, should ride on the back of yoga’s meanings and networks, even as its promoters and practitioners seek to enhance its public visibility.
Ayurveda is based on an understanding of health and disease in terms of the three humours – vata (wind), pitta (bile) and kapha (phlegm). Balance between the humours is conceptualized as a state of health, while their imbalance, caused by the over-production or under-production of one or more dosa, is understood to result in disease. Ayurveda has both preventative and remedial aspects. It offers a great deal of practical advice on day-to-day living and emphasizes moderation in all one’s activities. Ayurvedic medicines are mostly herbal, and its therapies cover a wide range including massage, enema, purgation, emesis, douching, sudation and minor surgery.
“In the West, the more popular forms of Ayurvedic practice have assimilated the values of the holistic health sector with its networks of unchurched spirituality.”
Ayurveda has many faces, both in its South Asian context and in its more recent transnational manifestation. In South Asia it encompasses a wide range of ‘folk’ traditions as well as more formalized, institutionalized forms of practice. Since the early 20th century, mainstream Ayurveda in India and Sri Lanka has undergone processes of professionalization and standardization. Its practitioners have embraced the organizational structures of biomedicine, and formal training in Ayurveda incorporates significant elements of instruction in biomedicine. Ayurvedic practice in South Asia often combines, to different degrees and in different ways, biomedical frameworks of diagnosis and treatment with humoural ones.
In the West, the more popular forms of Ayurvedic practice have assimilated the values of the holistic health sector with its networks of unchurched spirituality. Health here is understood not purely in somatic terms but in terms of the mind-body-spirit triad. The focus is not on curing disease but on healing the person. Crucial to achieving health, in this understanding, is the development of deep self-understanding, which in turn is understood to lead to self-empowerment. A particularly noteworthy feature of this form of Ayurveda is its reinterpretation of the three dosas or humours. Whereas traditionally the humours are understood as indices of states of health or disease, in the new understanding they provide a framework for classifying all persons into humoural types. One’s humoural constitution is understood to determine everything from one’s personality, one’s moods, likes and dislikes, to one’s looks, and one’s propensity towards particular forms of disease.
A number of self-help publications available in print and online explain the different humoural types, inviting the reader to identify his/her constitution by means of a questionnaire, and offering dietary and lifestyle advice for each category. Ayurvedic food supplements, teas, oils and cosmetics are all often classified in dosa terms – so that there are pitta oils meant for ‘pitta types’ and vata teas intended for persons diagnosed with a vata-predominant constitution. Such categorization enables a new understanding of the self, and holds out the promise of health through adherence to a systematic programme of self-care and self-nurture. The actual practice of Ayurveda takes a variety of forms, and range from forms of counselling about lifestyle and diet, to massage and other treatments in clinics and therapy centres.
Ayurveda entered the UK’s public arena in the 1980s, at a time when there was growing public interest in alternatives to biomedicine. One of the first to bring Ayurveda to the attention of the Western public was Maharishi Mahesh Yogi. His ‘Maharishi Ayurveda’ was quite unique in its close interconnections with Transcendental Meditation or TM. In the UK, the central institution promoting Maharishi Ayurveda is what is known as the ‘Maharishi European Sidhaland’ in Skelmersdale. The Maharishi Ayurveda Health Centre here sells a range of Maharishi Ayurveda products and services, and its small number of practitioners offer Ayurvedic diagnosis and treatment at Skelmersdale and at various locations across the UK. Maharishi Ayurveda practitioners were previously members of the Maharishi Ayurvedic Practitioners Association (MAPA).
“Government sought the opinions of Ayurvedic practitioner groups on statutory regulation, but it soon became clear that the different groups were in complete disagreement.”
Another Ayurvedic organization in the UK prominent in the 1990s and early 2000s was the Ayurvedic Company of Great Britain, founded in 1989 by an Indian claiming to be an expert in Ayurvedic medicine, partnered with an English entrepreneur. Apart from running Ayurveda clinics in London, this company established a number of allied organizations including the British Ayurvedic Medical Council, and the British Association of Accredited Ayurvedic Practitioners (BAAAP). The founding members of BAAAP were primarily qualified practitioners of Indian origin. The ACGB and many of its allied organizations were declared insolvent and forced to close down in 2008. BAAAP however continues to operate with a very small membership.
For five years, ACGB ran an undergraduate degree programme in Ayurveda validated by London’s Thames Valley University. In 2004 it began to offer a new degree programme in place of the old in association with the Manipal Academy of Higher Education, an establishment based in Mangalore in south India. The resulting set-up, called the Mayur Ayurvedic University of Europe, offered, for a time, BSc programmes in Ayurveda and Yoga, and shorter courses in Ayurvedic massage and Sanskrit.
ACGB’s major competitor emerged in 1996 when the Ayurvedic Medical Association (AMA) came into being. This was a professional association of qualified Indian and Sri Lankan Ayurvedic practitioners. For a time this group offered Ayurvedic training at the College of Ayurveda UK in Milton Keynes. In 2005, the tutors sought formal university accreditation for their course and have, since then, run degree programmes at Middlesex University in London.
The regulatory initiative
The year 2000 was significant for practitioners of all Complementary and Alternative therapies in Britain. In this year, the House of Lords Select Committee produced a report on ‘Complementary and Alternative Medicine’. This report surveyed various aspects relating to the use of Complementary and Alternative Medicine (henceforth CAM) in Britain, and in doing so, divided CAM therapies into three groups. It was supportive of practices grouped under the first division, which included therapies like Western herbal medicine and acupuncture, and for which there was some scientific evidence of real and potential benefits. These traditions were to be statutorily regulated. Ayurveda was not included in this category. This caused a great deal of consternation among Ayurvedic practitioners, and their lobbying resulted in the Indian government sending a delegation to the UK to persuade the authorities to review this classificatory system.
When the British government responded to this report, it proposed a reclassification whereby Ayurveda was to be included under Group 1 within the larger category of ‘herbal medicine’. Practitioners welcomed the reclassification and the regulatory initiative since this now meant greater respectability for Ayurveda (as a credible and safe practice), greater visibility, and greater access to resources. The government sought the opinions of Ayurvedic practitioner groups on matters to do with statutory regulation, but it soon became clear that the different groups were in complete disagreement with each other about standards of education and practice. The consultative process ground to a halt.
“Fourteen years after the government first announced its regulatory initiative, statutory regulation is yet to be implemented.”
In 2005, concerned individuals came together to try and break the impasse by constituting a new professional group, the Ayurvedic Practitioners Association (APA). While initially comprising a small number of Ayurveda practitioners graduated from Thames Valley University, and a few Maharishi Ayurveda practitioners, the APA soon grew into the leading professional association for Ayurvedic practitioners in the UK. Both MAPA and AMA merged their registers with that of APA. ACGB, and its allied practitioners’ association, BAAAP, remained openly antagonistic to this group, accusing them of ‘hijacking’ a uniquely Indian tradition which, they claimed, the Indian practitioners registered with BAAAP alone had the authority to represent.
In contrast to the somewhat nationalistic and exclusivistic outlook of BAAAP, the Ayurvedic Practitioners Association promoted an inclusive and humanitarian vision of Ayurveda. Today it is the single largest and most influential Ayurveda practitioners’ group in the UK, run along highly professionalized lines. Among its key aspirations, as set out in its constitution, is that this organization and its members should be recognized by the government, the public, and the health industry as ‘synonymous with excellence and professionalism’. It is allied to, and works closely with, the European Herbal and Traditional Medicine Practitioners Association, the main umbrella body negotiating with the government to try and secure the interests of practitioners of traditional and herbal medicine in the UK.
The current situation
Fourteen years after the government first announced its regulatory initiative, statutory regulation is yet to be implemented. The frameworks proposed for regulation have been revised and reworked by successive governments. For bodies like APA, who have worked intensively trying to gear up for regulation, the goalposts have changed more than once. They have lobbied the government demanding speedy implementation of regulation, but to no avail. Delays in implementing regulation have been detrimental to the sector, particularly since 2011, when the highly restrictive European Traditional and Herbal Medicines Directive came into effect, curtailing individuals’ rights to access (and prescribe) unlicensed medicines from suppliers and manufacturers. The necessary access is allowed only to ‘authorized health professionals’ but the delay in implementing regulation has meant that qualified professionals are not officially recognized as such.
Government proposals in 2011 suggested that a centralized body, the Health Professions Council (since renamed the Health and Care Professions Council – HCPC), would be charged with maintaining a statutory register of practitioners of traditional and herbal medicines. Three years on, the HCPC is still not authorized to register Ayurvedic practitioners and practitioners of the other ‘CAM’ systems to be regulated. The delays have in large measure to do with the legal and other problems emerging from the need to harmonize UK laws with EU ones. The UK government now appears to have gone back to the drawing board, questioning afresh the feasibility and the necessity of statutory regulation. It has convened a Working Group to look into these issues, which is to submit its report in 2015.
Practitioners of Ayurveda and of other ‘Group 1’ traditions like Western herbal medicine, traditional Chinese medicine, and acupuncture, thus remain in a protracted state of limbo. The government’s stated priority in initially introducing statutory regulation was to minimize any risk to the public posed by unqualified practitioners. In their zeal to safeguard the interests of potential clients, government bodies have (in the absence of regulation) significantly undermined the interests of the practitioners. This perhaps reflects the orthodoxy of the establishment, which has traditionally regarded these systems with deep suspicion and distrust, and made allowances for them only because of the persistent public demand for alternatives to biomedicine.
Maya Warrier is Associate Professor in Religious Studies at the University of Wales, Trinity Saint David (Lampeter campus). She is author of Hindu Selves in a Modern World: Guru Faith in the Mata Amritanandamayi Mission (London, New York, Delhi: Routledge-Curzon, 2005). Her research interests centre on modern manifestations of Indic traditions in India and overseas. Her publications include book chapters and journal articles on aspects of spiritual seekership in modern guru organisations, questions of identity in the Hindu diaspora in the UK, and the transformations undergone by Ayurveda in the Western holistic health milieu. Her current research focuses on questions of ‘authenticity’ and ‘hybridity’ in the development of modern transnational Anglophone Ayurveda in South Asia and beyond.
 For an overview of Ayurveda in its traditional forms, see D. Wujastyk (2003) ‘The Science of Medicine’ in G. Flood (ed.) The Blackwell Companion to Hinduism (Oxford: Blackwell), pp. 393-409.
 For a discussion of Ayurveda in late colonial and post colonial India, see for instance, J. Langford (2002). Fluent Bodies: Ayurvedic Remedies for Postcolonial Imbalance. Durham, London: Duke University Press.
 A fuller discussion of Ayurveda’s assimilation of the values central to the Western milieu of holistic health and spiritual seekership is available in M. Warrier (2009). ‘Seekership, Spirituality and Self-Discovery: Ayurveda Trainees in Britain’, Asian Medicine: Tradition and Modernity, 4(2), pp. 423–51.
 http://www.maharishiayurveda.co.uk/about/ (accessed on 30/3/14).
 Among ACGB’s various initiatives were an Ayurvedic charitable hospital in London which was forced to close down soon after its establishment due to inadequate funds, an Ayurvedic restaurant, and a spa in Heythrop Park in Oxfordshire.
 http://www.britayurpractitioners.com/ (accessed on 30/3/14).
 On the regulatory initiative, see D. Wujastyk (2005) ‘Regulation of Ayurveda in Great Britain in the Twenty-First Century’, Asian Medicine: Tradition and Modernity, 1(1), pp. 162–84.
 http://apa.uk.com/ (accessed on 30/3/14).
 http://apa.uk.com/wp-content/uploads/2013/04/APA-Constitution.pdf (accessed on 30/3/14).
 http://www.hpc-uk.org/aboutus/ (accessed on 30/3/14).
The image of Maharishi Mahesh Yogi is included courtesy of Wikimedia Commons and is licensed under the GNU Free Documentation License. The image of the pharmacy in India is included courtesy of Ken Wieland and is licensed under the Creative Commons Attribution-Share Alike 2.0 Generic license.