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Patients with chronic rheumatic diseases are frequent users of alternative and complementary medicine.1–5 In a previous study we found that more than 50% of patients with ankylosing spondylitis (AS) had experience with such treatments.6
Ayurveda, the traditional Indian medical system, is receiving increasing attention from patients and medical doctors in Western nations. Western medicine and Ayurveda have, however, severe difficulties in understanding each other, which impairs the use of Ayurveda as a reasonable “complementary” treatment for patients.
According to the Ayurvedic tridosha teachings rheumatic symptoms result from an inequality and disharmony among the three doshas (humours), in particular from a predominance and dysfunction of the vata dosha.7 If this view is applicable to Western patients, one would expect patients with rheumatic disease to show a surplus and overflow of vata constitutional factors (predisposing for rheumatic disease) and patients who are vata types to have more severe symptoms.
The present investigation evaluates the predominant dosha in patients with AS in comparison with patients with (non-inflammatory) low back pain and healthy controls, and the degree of functional impairment in the groups of patients with AS with predominating vata, pitta, or kapha features.
Patients with AS (n=141, 114 male, 27 female, mean age 52 years) and non-inflammatory low back pain (n=63, 35 male, 28 female, mean age 60 years) presenting for treatment at the Gasteiner Heilstollen Hospital and healthy controls (visitors, staff, n=55, 32 male, 23 female, mean age 43 years) were asked to complete a questionnaire deciding which group of features listed in table 1 would, in their own view, best reflect their own personal characteristics. These features are typical symptoms and signs of vata, pitta, or kapha as proposed by Rudolph in 1997.8 The questionnaire did not give the Ayurvedic denotations to the patients, but named the groups A, B or C. Patients had to decide on one group, which was taken as the individual’s predominating vata, pitta or kapha dosha. For quantification of functional impairment of the patients with AS a German version9 of the Bath Ankylosing Spondylitis Functional Index (BASFI10) was used (with Likert formatted scales).
No predominance of the vata dosha was found in patients with AS or low back pain. The distribution of predominating vata, pitta, or kapha features did not differ (no significant difference in χ2 test) between patients with AS (vata n=46 (33%); pitta 64 (45%), kapha 31 (22%)), patients with low back pain (vata 18 (29%), pitta 28 (44%), kapha 17 (27%)), or healthy controls (vata 18 (33%), pitta 25 (45%), kapha 12 (22%)). Also, patients with AS had the same degree (no significant difference in analysis of variance) of functional impairment whether they showed predominating vata (BASFI, mean (SEM) 3.6 (0.3)), pitta (3.9 (0.29)), or kapha features (3.2 (0.39)).
Evidently, the present evaluation failed to show an association between a certain dosha and the manifestation or severity of AS or low back pain. The results do not advocate that Ayurvedic treatments should be employed for AS on the grounds that disharmony in the tridosha system and overflow of vata need correction.
Traditional Indian doctors may maintain that the present form of defining the predominating dosha is an illicit simplification and that extensive diagnostic procedures are needed to establish a proper diagnosis in the sense of Ayurveda. This may be true, but it is up to them to disprove the present conclusion by more sophisticated methods. Here, with our simplified methods we could not find a reasonable foundation for recommending Ayurvedic treatments for patients with the Western diagnosis of ankylosing spondylitis.