Ayurveda

Origin and History

Ayurveda originated in India long back in pre-vedic period. Rigveda and Atharva-veda (5000 years B.C), the earliest documented ancient Indian knowledge have references on health and diseases. Ayurveda texts like Charak Samhita and Sushruta Samhita were documented about 1000 years B.C. The term Ayurveda means ‘Science of Life’. It deals elaborately with measures for healthful living during the entire span of life and its various phases. Besides, dealing with principles for maintenance of health, it has also developed a wide range of therapeutic measures to combat illness. These principles of positive health and therapeutic measures relate to physical, mental, social and spiritual welfare of human beings. Thus Ayurveda becomes one of the oldest systems of health care dealing with both the preventive and curative aspects of life in a most comprehensive way and presents a close similarity to the WHO’s concept of health propounded in the modern era.

A perusal of its several classical treatises indicates presence of two schools of Physicians and Surgeons and eight specialities. These eight disciplines are generally called "Ashtanga Ayurveda" and are:

  • Internal Medicine (Kaya Chikitsa)
  • Paediatrics (Kaumar Bhritya)
  • Psychiatry (Bhoot Vidya)
  • Otorhinolaryngology and Ophthalmology (Shalakya)
  • Surgery (Shalya)
  • Toxicology (Agad Tantra)
  • Geriatrics (Rasayana)
  • Eugenics and aphrodisiacs (Vajikarana)

Compendia on these subjects like Charak Samihta, Sushruta Samhita, etc, were written by the ancient scholars during B.C period. These were used for teaching of Ayurveda in the ancient universities of Takshashila and Nalanda.

The Early Beginning

During its early period, it was perhaps the only system of overall healthcare and medicine, which served well the people in such crucial areas as health, sickness, life, and death. It enjoyed the unquestioned patronage and support of the people and their rulers. This situation promoted maximally the growth of this system. Practically all the systematic ground work of laying down its basic concepts, principles and medicaments took place during this period of Indian history.

The Medieval Period

Then followed a long period of medieval history marked by unsettled political conditions, several invasions from outside the country and finally subjugation of the country first by the Moughals and later by the Britishers. Each of them had their own system of medicine, which they patronized, and Ayurveda faced utter neglect. Its growth was stunted its teaching and training were stopped from being spread and its monopoly in practice or utilization was eroded greatly by the officially supported systems. Ayurveda barely survived because of its native roots and also because the official systems of medicine could not reach everywhere particularly in widely scattered and difficult rural areas.

The Present Era

The political situation of the country was destined to change in favour of freedom from foreign rule. With the awakening of nationalism and movement for freedom, the Indian cultural values and way of life (including health care and sickness cure systems) surfaced again. The patriotic attitude and zeal of the people, their leaders and benevolence of the rulers of princely states initiated the revival of Ayurvedic system of medicine even before the country got its freedom.

In 1916, the Members of Imperial Legislative Councils pressed the Government to accept this ancient and indigenous system of Ayurveda for developing it on scientific basis and for increasing its usefulness. In 1920, the Indian National Congress demanded Government patronage for Ayurveda and Provincial Governments began to grant assistance. The State and Central Governments appointed several committees to suggest ways and means of rehabilitating this time tested system in the service of the people and promote its further growth following modern scientific parameters and methods. As a result, several States started schools and colleges for training of competent Ayurvedic practitioners with working knowledge of modern medicine.

After, the country became free in 1947, the movement for revival gained additional momentum. The first Health Ministers’ Conference resolved that Ayurveda should be developed and put to use for providing Medicare to the people. In due course of time, this system got official recognition and became a part of the National Health network of the country. In several ways, the official health policies, national plans, and programmes accorded to it the same status as enjoyed by the dominant Allopathic system. At present, the system is well set to re-orient itself to modern scientific parameters. Simultaneously, it is well poised for much greater, effective utilization so as to enable the country to reach its goals of Health for all and regulate population growth. In the present situation, Medical Scientists are researching for remedies in Ayurveda for lifestyle related diseases, degenerative and psychosomatic disorders.

Concepts and Principles

The Body Matrix

Life in Ayurveda is conceived as the union of body, senses, mind and soul. The living man is a conglomeration of three humours (Vata, Pitta & Kapha), seven basic tissues (Rasa, Rakta, Mansa, Meda, Asthi, Majja & Shukra) and the waste products of the body such as faeces, urine and sweat. Thus, the total body matrix comprises of the humours, the tissues, and the waste products of the body. The growth and decay of this body matrix and its constituents revolve around food, which gets processed into tissues, and wastes. Ingestion, digestion, absorption, assimilation, and metabolism of food have an interplay in health and disease which are significantly affected by psychological mechanisms as well as by bio-fire (Agni).

Panchamahabhutas

According to Ayurveda, all objects in the universe including human body are composed of five basic elements (Panchamahabhutas) namely, earth, water, fire, air, and vacuum (ether). There is a balanced condensation of these elements in different proportions to suit the needs and requirements of different structures and functions of the body matrix and its parts. The growth and development of the body matrix depends on its nutrition, i.e., on food. The food, in turn, is composed of the above five elements, which replenish or nourish the like elements of the body after the action of bio-fire (Agni). The tissues of the body are the structural whereas humours are physiological entities, derived from different combinations and permutations of Panchamahabhutas.

Health and Sickness

Health or sickness depends on the presence or absence of a balanced state of the total body matrix including the balance between its different constituents. Both the intrinsic and extrinsic factors can cause disturbance in the natural equilibrium giving rise to disease. This loss of equilibrium can happen by dietary indiscrimination, undesirable habits, and non-observance of rules of healthy living. Seasonal abnormalities, improper exercise, or erratic application of sense organs and incompatible actions of the body and mind can also result in creating disturbance of the existing normal balance. The treatment consists of restoring the balance of disturbed body-mind matrix through regulating diet, correcting life-routine and behaviour, administration of drugs and resorting to preventive Panchkarma and Rasayana therapy.

Diagnosis

In Ayurveda, diagnosis is always done of the patient as a whole. The physician takes a careful note of the patient’s internal physiological characteristics and mental disposition. He also studies such other factors as the affected bodily tissues, humours, the site at which the disease is located, patient’s resistance and vitality, his daily routine, dietary habits, the gravity of clinical conditions, condition of digestion and details of personal, social, economic and environmental situation of the patient. The diagnosis also involves the following examinations:

  • General physical examination
  • Pulse examination
  • Urine examination
  • Examination of the faeces
  • Examination of tongue and eyes
  • Examination of skin and ear including tactile and auditory functions
  • Treatment

The basic therapeutic approach is, ‘that alone is the right treatment which makes for health and he alone is the best doctor who frees one from disease’. This sums up the principal objectives of Ayurveda, i.e. maintenance and promotion of health, prevention of disease and cure of sickness.

Treatment of the disease consists in avoiding causative factors responsible for disequilibrium of the body matrix or of any of its constituent parts through the use of Panchkarma procedures, medicines, suitable diet, activity and regimen for restoring the balance and strengthening the body mechanisms to prevent or minimize future occurrence of the disease.

Normally treatment measures involve use of medicines, specific diet, and prescribed activity routine. Use of these three measures is done in two ways. In one approach of treatment, the three measures antagonize the disease by counteracting the etiological factors and various manifestations of the disease. In the second approach, the same three measures of medicine diet and activity are targeted to exert effects similar to the etiological factors and manifestations of the disease process. These two types of therapeutic approaches are respectively known as Vipreeta and Vipreetarthkari treatments.

For successful administration of a treatment, four things are essential. These are the physician, the medicaments, the nursing personnel and the patient.

The physician comes first in order of importance. He must possess technical skill, scientific knowledge, purity, and human understanding. The physician should use his knowledge with humility, wisdom and in the service of humanity. Next in importance comes food and drugs. These are supposed to be of high quality, wide application, grown, and prepared following approved procedures and should be available adequately. The third component of every successful treatment is the role of nursing personnel who should have good knowledge of nursing, must know the skills of their art, and be affectionate, sympathetic, intelligent, neat & clean and resourceful. The fourth component is the patient himself who should be cooperative and obedient to follow instructions of the physician, able to describe ailments and ready to provide all that may be needed for treatment.

Preventive Treatment & the concepts of Aetio-Pathogenesis

Ayurveda has developed a very vivid analytical description of the stages and events that take place since the causative factors commence to operate till the final manifestation of disease. This gives this system an additional advantage of knowing that possible onset of disease much before the latent symptoms become apparent. This very much enhances the preventive role of this system of medicine by making it possible to take proper and effective steps in advance, to arrest further progress in pathogenesis or to take suitable therapeutic measures to curb the disease in its earliest stage of onset.

Types of Treatment

The treatment of disease can broadly be classified as:

  • Shodhana therapy (Purification Treatment)
  • Shamana therapy (Palliative Treatment)
  • Pathya Vyavastha (Prescription of diet and activity)
  • Nidan Parivarjan (Avoidance of disease causing and aggravating factors)
  • Satvavajaya (Psychotherapy)
  • Rasayana therapy (use of immunomodulators and rejuvenation medicines)

Shodhana treatment aims at removal of the causative factors of somatic and psychosomatic diseases. The process involves internal and external purification. The usual practices involved are Panchkarma (medically induced Emesis, Purgation, Oil Enema, Decoction enema and Nasal administration of medicines), Pre-panchkarma procedures (external and internal oleation and induced sweating). Panchkarma treatment focuses on metabolic management. It provides needed purificatory effect, besides conferring therapeutic benefits. This treatment is especially helpful in neurological disorders, musculo-skeletal disease conditions, certain vascular or neuro-vascular states, respiratory diseases, metabolic, and degenerative disorders.

Shamana therapy involves suppression of vitiated humours (doshas). The process by which disturbed humour subsides or returns to normal without creating imbalance of other humours is known as shamana. This treatment is achieved by use of appetisers, digestives, exercise, and exposure to sun, fresh air etc. In this form of treatment, palliatives and sedatives are used.

Pathya Vyavastha comprises indications and contraindications in respect of diet, activity, habits, and emotional status. This is done with a view to enhance the effects of therapeutic measures and to impede the pathogenetic processes. Emphasis on do’s and don’ts of diet, etc. is laid with the aim to stimulate Agni and optimise digestion and assimilation of food in order to ensure strength of tissues.

Nidan Parivarjan is to avoid the known disease causing factors in diet and lifestyle of the patient. It also encompasses the idea to refrain from precipitating or aggravating factors of the disease.

Satvavajaya concerns mainly with the area of mental disturbances. This includes restraining the mind from desires for unwholesome objects and cultivation of courage, memory, and concentration. The studies of psychology and psychiatry have been developed extensively in Ayurveda and have wide range of approaches in the treatment of mental disorders.

Rasayana therapy deals with promotion of strength and vitality. The integrity of body matrix, promotion of memory, intelligence, immunity against the disease, the preservation of youth, lustre, and complexion and maintenance of optimum strength of the body and senses are some of the positive benefits credited to this treatment. Prevention of premature bear and tear of body tissues and promotion of total health content of an individual are the roles that Rasayana therapy plays.

Diet and Ayurvedic Treatment

In Ayurveda, regulation of diet as therapy has great importance. This is because it considers human body as the product of food. An individual’s mental and spiritual development as well as his temperament is influenced by the quality of food consumed by him. Food in human body is transformed first into chyle or Rasa and then successive processes involve its conversion into blood, muscle, fat, bone, bone-marrow, reproductive elements and ojas. Thus, food is basic to all the metabolic transformations and life activities. Lack of nutrients in food or improper transformation of food leads to a variety of disease conditions.

Development and its Status

Human life and knowledge of preserving it as a going concern, in the face of overpowering and brute physical and biological environment, must have come into being almost simultaneously. It has to be so. There cannot be any other plausible explanation, other than this, to account for the continuity of human race and survival of its several highly developed cultures and civilisations. All known cultures of the past - Egyptian, Babylonian, Jewish, Greek, Indus Valley, etc, - had their own equally glorious and useful systems of medicine and health care.

In India, development and growth of such a body of knowledge known as Ayurveda, meaning science of life, was coeval with the growth and evolution of Indian civilization and culture. Vedas, which are considered to be the repositories of recorded Indian culture, have mention of this knowledge both in theoretical and practical form. There is discussion of theories about the composition of living and non-living matter, the physical, biochemical, biological, psychological and spiritual components of man and the vital motive forces working both inside and outside the body. In other ancient works, there is mention of such current medical subject like anatomy, physiology, aetiology, pathology, treatment, and environmental factors. This medical knowledge has been the work of ages. It is the outcome of the great power of observation, generalisation and analysis combined with patient labour of hundred of investigators spread over thousand of years. This knowledge has played so important a part in the development of Indian culture that it has been documented in an integrated form in the Vedas, which are considered to have been originated from Gods. Most of this mythological and medico-religious genesis of Ayurveda is even today shrouded in the mist of antiquity.

Ayurveda means the Science of life. Around 1500 BC Ayurveda’s fundamental and applied principles got organised and enunciated. Aatharvaveda (one of the four most ancient books of Indian knowledge, wisdom and culture) contains 114 hymns or formulations for the treatment of diseases. Ayurveda or the Indian Science of life originated and developed from these hymns. In this sense, Ayurveda is considered to have divine origin representing one of the oldest organised system of medicine for positive health and cure of human sickness. Making use of systematic careful observation and documenting detailed experiences over the past several thousand of years, it has grown into a very comprehensive health care system with two major schools and eight specialisations. It has a school of physicians and a school of surgeons referred in literature as ‘Atreya Sampradaya’ and ‘Dhanvantri Sampradaya’ respectively.

The most important and massive ancient compilation of the School of Medicine is known as Charka Samhita. It contains several chapters dealing at length with therapeutic or internal medicine. About 600 drugs of plant, animal, and mineral origin are described in it. Besides, this compendium also deals with other branches of Ayurveda like anatomy, physiology, aetiology, prognosis, pathology, treatment, and medicine etc.

An equally exhaustive ancient compilation, Sushruta Samhita exists relating to school of surgery. It deals primarily with various fundamental principles and theory of surgery. More than 100 kinds of surgical instruments including scalpels, scissors, forceps, specula etc. are described along with their use in this valuable document. Dissection and operative procedures are explained making use of vegetables and dead animals. Descriptions of how to go about doing incision, excision, extraction and bandaging etc. are detailed in this compendium. In addition, this document also mentions of such other topics as anatomy, embryology, toxicology, and therapeutics. It also has a mention of about 650 drugs.

In course of time Ayurveda, which started as a magical-religious practice, matured into a fully developed medical science with eight branches, which have parallels in the modern western system of medicine. The growth of these eight specialties gave Ayurveda another name of Astanga Ayurveda. In the last 50 years of development in the teaching and training, it has developed into following sixteen specialties.

  1. Ayurveda Siddhanta (Fundamental Principals of Ayurveda).
  2. Ayurveda Samhita.
  3. Rachna Sharira (Anatomy).
  4. Kriya Sharira (Physiology).
  5. Dravya Guna Vigian (Materia Medica & Pharmacology).
  6. Ras-shastra.
  7. Bhaishajya Kalpana (Pharmaceuticals).
  8. Kaumar Bharitya (Peduatrics).
  9. Prasuti Tantra (Obstetrics & Gynaecology).
  10. Swasth-Vritla (Social & Preventive Medicine).
  11. Kayachikitsa (Internal Medicine).
  12. Rog Nidan (Pathology).
  13. Shalya Tantra (Surgery).
  14. Shalkya Tantra (Eye & ENT).
  15. Mano-Roga (Psychiatry)
  16. Panchkarma.

Some milestones in the Development of Ayurveda

  • Divine origin of Ayurveda from Lord Brahma - Dates back to origin of human race
  • Mention of various references on Health, Diseases and Medicinal Plants in Rigveda and Atharvveda – 5000 BC
  • Origin of Attreya and Dhanwantari School of Ayurveda – 1000 BC
  • Documentation of Charaka Samhita - 600 BC
  • Documentation of Sushruta Samhita - 500 BC
  • Advent of Muslim Rulers and start of the Decline of Ayurveda –1100 to 1800
  • Resurrection of Ayurvedic system of Medicine under the rule of Peshwas-1800 AD
  • Classes in Ayurvedic medicine opened in Government Sanskrit College, Calcutta – 1827
  • Discontinuation of classes in Government Sanskrit College by British -1833
  • Dr. Komar Commission (one-man commission) to make investigation in indigenous system of medicine - 1917
  • Indian National Congress Convention at Nagpur recommended acceptance of Ayurvedic system of medicine as India’s National Health Care System -1920
  • Mahatma Gandhi inaugurated Ayurvedic and Unani Tibbia College in Delhi -1921
  • Mahamana Madan Mohan Malviya established Ayurveda college in BHU, Varanasi - 1927
  • Enforcement of Drugs and Cosmetics Act for Ayurvedic/ Siddha/ Unani medicines - 1940
  • Bhora Committee or Health Survey and Development Committee recognised past services of indigenous medicines but failed to recommend for its further development - 1943
  • Chopra Committee recommended systems of old and modern systems of medicines to evolve a common system of medicine - 1946
  • Pharmaceutical Enquiry Committee headed by Dr. Bhatia, for intensive research in indigenous drugs of Ayurveda - 1953
  • Recommendation of Dave Committee for uniform standards of Ayurveda education - 1955
  • Establishment of Institute of Post-Graduate Training and Research in Gujarat Ayurvedic University, Jamnagar, Gujarat - 1956-57
  • Udupa Committee set up. It recommended that there is a need for integrated system of medicine and a training course in Siddha and Ayurveda - 1958
  • Establishment of Post Graduate Institute of Ayurveda at Banaras Hindu University, Varanasi, Uttar Pradesh - 1963-64
  • Amendment of Drugs and Cosmetics Act, 1940 for Indian systems of medicines/drugs - 1964
  • Establishment of Central Board of Siddha and Ayurvedic Education - 1964-65
  • Setting up of an apex Research Body for Indian medicine & Homoeopathy, Central Council for Research in Indian Medicine and Homoeopathy (CCRIMH) - 1969
  • Establishment of Pharmacopoeia Laboratory for Indian medicine, Ghaziabad, UP - 1970 Constitution of Central Council of Indian Medicine (CCIM) under IMCC Act- 1970 for regulation of education and practice –1971
  • Establishment of National Institute of Ayurveda, Jaipur, Rajasthan-1972-73
  • Publication of Part-I of Ayurvedic formulary containing 444 preparations-1976
  • Establishment of Central Council of Research in Ayurveda and Siddha (CCRAS)-1978
  • Passing of Amended Drugs and Cosmetics Act regulating import/export of Indian Systems of Medicine-1982
  • Setting up of Indian Medicine Pharmaceutical Corporation Ltd. in Mohan, Almora Distt., Uttaranchal.-1983
  • Silver Jubilee function of Jawaharlal Nehru Ayurvedic Medicinal Plants Garden and Harbarium, Pune. Inaugurated by Shri R. Venkataraman, Vice-president of India - 1986
  • Second World Conference on Yoga & Ayurveda held at Banaras Hindu University, Varanasi, Uttar Pradesh -1986
  • Foundation stone of Jawaharlal Nehru Anusandhan Bhawan, Institutional Area, Janakpuri, New Delhi by Hon’ble Vice President of India, Dr. Shankar Dayal Sharma - 1988
  • Establishment of National Academy of Ayurveda (Rashtriya Ayurveda Vidyapeeth) -1989
  • Creation of separate Department of Indian Systems of Medicine & Homoeopathy in Ministry of Health & Family Welfare, Govt. of India - 1995
  • Introduction of Extra mural Research Programme for accredited organizations with central assistance - 1996
  • Implementation of Central Scheme in 33 organizations for development of agro-techniques of important medicinal plants - 1997
  • Maiden participation of Ayurveda along with other systems in India International Trade Fair - 1998
  • Implementation of Central Scheme in 32 laboratories for developing pharmacopoeial standards of Medicinal Plants/ ISM Formualations-1998
  • Establishment of specialty clinic of Ayurveda in Central Govt. Hospital (Safdarjung Hospital) New Delhi - 1998
  • Implementation of IEC (Information, Education & Communication) Scheme for NGOs for propagation and popularisation of Ayurveda & other systems-1998-1999
  • Participation in Mystique India (Exhibition cum fair on Indian Traditions) - 1997 to 1999
  • Introduction of Vanaspati Van Scheme for large scale cultivation of Medicinal Plants - 1999
  • Inauguration of Ayurveda conference at New York, USA by Hon’ble Prime Minister of India Atal Bihari Vajpayee – 2000
  • Gazette Notification for constitution of Medicinal Plant Board under the Dept. of Indian Systems of Medicine & Homoeopathy – 2000
  • Publication of 2nd volume of Ayurvedic Pharmacopoeia - 2000
  • Introduction 7 of Ayurvedic Medicines in RCH Programme - 2000
  • Constitution of Advisory group for research in Ayurveda – 2000
  • Policy Decision on mainstreaming of Ayurveda in RCH programme as per National Population Policy-2000
  • Implementation of Central Scheme of assistance for strengthening of State Drug Testing Laboratories and Pharmacies - 2000-2001
  • Publication of 3rd volume of Ayurvedic Pharmacopoeia - 2001
  • Publication of English edition of 2nd volume of Ayurvedic Formulary of India - 2001
  • Maiden participation of ISM tableau on Republic Day - 2001
  • Exhibition and presentation of Ayurveda during World Health Assembly, Geneva - 2001
  • Presentation on evidence based support by Dept. of ISM&H before House of Lords, U.K. against Sir Walton Committee’s Report on status and nomenclature of Ayurveda among Complementary and Alternative systems of Medicine – 2001
  • Participation of Dept. in "Made in India" exhibition organized by CII in South Africa - 2001

Definition

The classical works on Ayurveda describe it as under:

It is that knowledge of life, which deals elaborately and at length with conditions beneficial or otherwise to the humanity, and, to factors conducive to the happiness, or responsible for misery or sorrow besides indicating measures for healthful living for full span of life.

Ayurveda is also considered as ‘Science of life’. This probably makes it the earliest medical science having a positive concept of health to be achieved through a blending of physical, mental, social moral and spiritual welfare.

According to the ancient books of knowledge, health is considered as a prerequisite for achieving the supreme ends of life consisting of righteousness, wealth, artistic values, and spiritual freedom. Preventive and curative aspects of diseases are considered as important components of the concept of positive health.

Ayurveda deals elaborately with measures of healthful living during the entire span of life and its various phases. Besides dealing with principles for maintenance of health, it has also developed a wide range of therapeutic measures to combat illness. These principles of positive health and therapeutic measures related to physical, mental, social and spiritual welfare of human beings. Thus, Ayurveda became one of the oldest system of medicine dealing with both the preventive and curative aspects of life in a most comprehensive way.

Diagnosis

Ayurveda postulates that the human organism exists in a balance of elements, imbalance causing disease. Poor nutrition, excess of body wastes, or disturbance of the circulating fluid and vital organs are the primary causes to which therapy must be applied, both in prevention and cure.

As already mentioned the diagnosis involves consideration of the whole man. For this a comprehensive knowledge about the physical, physiological, and mental state of the patient is gathered and systematically recorded. This includes details about the persons temperament, his habits, diet, external living conditions and details about the disease itself. In other words, the diagnosis process largely involves two types of examination: examination of the patient and examination of the disease.

Examination of the patient generally involves one or more of the following:

  • Pulse examination to find out which of the three ‘Dosha or Doshas’ have lost equilibrium or balance causing the person to become sick.
  • Urine examination.
  • Examination of the stool.
  • Examination of the tongue.
  • Eye examination.
  • Examination through auscultation.
  • Examination of tactile stimulation.
  • Examination of part or parts of the body.

The above examinations help to further confirm and sharpen the diagnosis.

The second examination relating to disease concerns with determination of the causative factors, and details of the pathological as well as clinical conditions for determining treatment.

Treatment in Ayurveda

Traditional Ayurvedic Medicine is one of the important parts of the splendid cultural heritage from our ancient civilization. It is the summation of the Nation’s experience in struggling against illness through centuries. It has played an important role in the prosperity in our nation and is still of incalculable value. With its unique and complete theoretical system, it stands firmly among the medical sciences of the World.

Treatment of the disease generally consists in avoiding factors responsible for causing disequilibrium of the body matrix or of any of its constituents parts, through the use of medicines, suitable diet, activity and regimen for restoring the balance and strengthening the body mechanism to prevent or minimise future occurrence of the disease, while treating the whole man is considered including the disease in question.

Treatment in Ayurveda has to be individualised and in addition to medicine, it has to consider other factors such as diet, sleep, work and rest pattern environment, age, sex, appetite strength, and vitality. Treatment is directed for correcting the causative factors through prescription of medicine, suitable diet, and activity regime with the ultimate goal of restoring the balance or equilibrium state of the body.

In Ayurveda, there are two approaches to treatment. In one of these the recommended therapeutic measures consisting of medicine, diet and activity antagonise the disease, while in the other approach, the prescribed measures create effects similar to the etiological factors of the disease process.