Ayurveda in India: Regional Traditions and Schools

Kerala is a narrow strip of tropical coast in southwest India, and it is the place most often called the capital of Ayurveda. That reputation owes much to the physicians of the old Kerala school.

The Ashtanga Hridaya — a treatise by the physician Vagbhata, dated by historians to the 6th–7th centuries — reached Kerala, and local healers literate in Sanskrit made it their main book. Yet they did not abandon local experience: folk medicine, the treatment of poisoning and snakebite, techniques linked to kalaripayattu, Kerala’s martial art.

This is how the school of the Ashtavaidyas took shape. The word means “physicians of the eight branches”: the Ashtanga Hridaya divides Ayurveda into eight sections, from general medicine and pediatrics to toxicology and rejuvenation. According to tradition, the Ashtavaidyas were originally eighteen Brahmin families. Each guarded its own methods but also took outside students, so the knowledge spread more widely. Today only a handful of practicing physicians from these lineages remain.

The Ashtavaidyas trained for a long time. Training began with the student memorizing the Ashtanga Hridaya — about 7,120 verses. The ideal length of study was described by a saying in Malayalam (Kerala’s main language): five years over the texts, five years in the forest learning plants and five years as an apprentice in the teacher’s house. The student wrote out prescriptions for the master: the master spoke the first words of a verse, and the student completed the formula from memory.

Kerala physicians also wrote their own books — commentaries on the Ashtanga Hridaya in Sanskrit and collections of formulas in Malayalam. The best known is the Sahasrayogam, “a thousand formulas”. Hence a feature of the Kerala pharmacy: it is rich in herbal decoctions — kashayams — and in medicated oils and ghees prepared to local recipes.

The northern schools grew up around the two senior treatises. The Charaka Samhita is a book on internal medicine: the causes of disease, diet, routine and medicines. The Sushruta Samhita is a book centered on surgery; tradition links its teaching with Kashi, today’s Varanasi.

If the Kerala school is recognized by its treatments, the northern one is more often recognized by its pharmacy. Rasa shastra is strong here — the branch of Ayurvedic pharmaceutics that works with metals and minerals such as sulfur, gold, iron, copper and others. They are purified and calcined at length, mixed with herbs and turned into powders called bhasmas (“ash”). In Ayurvedic thinking this processing removes the harmful properties of a substance and enhances its healing ones.

An important caveat: calling rasa shastra “northern” would be a simplification. The first known medical text with recipes for processing metals, the 9th-century Kalyanakaraka, was written in southern India, and rasa shastra preparations are known throughout the country. It is more accurate to say that they hold a prominent place in northern practice, while the Kerala school is better known for decoctions and oils.

Preparations with metals and minerals are potent remedies and call for care. The rules are simple. Rasa shastra preparations are taken only on the prescription of a doctor who knows what they are prescribing and sees the person. They are bought from reputable manufacturers, not at random online. And you always tell your own doctor at home what you are taking. More on the safety of Ayurvedic medicines in What is Ayurveda, in plain words.

Classical panchakarma is practiced all over India, Kerala included. Its core is therapeutic vomiting, purgation, medicated enemas and nasal administration; Sushruta adds bloodletting to the list. The classical texts also give the idea of ritu shodhana — cleansing according to the seasons. Therapeutic vomiting is considered suitable in spring, when kapha accumulates; purgation in autumn, when pitta is aggravated; medicated enemas in the rainy season, when vata rises.

Ayurveda is studied and practiced almost everywhere in India. Hundreds of colleges across the country teach to a single national standard, and a graduate from Pune receives the same Bachelor of Ayurvedic Medicine and Surgery (BAMS) degree as a graduate from Kerala. Regional character shows more in practice than in the curriculum.

• Maharashtra. Pune has a long-standing school of Ayurvedic education: Tilak Ayurveda Mahavidyalaya has been operating since 1933.
• Karnataka. Kerala’s coastal neighbor, with major Ayurvedic colleges — for example, SDM College of Ayurveda in Udupi, opened in 1958.
• Gujarat. Besides Jamnagar, a state with a strong tradition of Ayurvedic pharmaceutics: the Indian Institute of Ayurvedic Pharmaceutical Sciences became part of ITRA.

For all their differences, India’s schools have more in common than not. They are united by a few simple ideas.

• The person, not the diagnosis. The doctor looks at constitution, age, digestion, lifestyle, season and the place where the person lives — and treats the person, not the name of the disease. The Ashtanga Hridaya, on which the Ashtavaidyas trained, says so directly, as does Siddha with its eight methods of examination.
• The season matters. Karkidaka chikitsa in Kerala, ritu shodhana in the classical texts, seasonal rules of diet and routine — everywhere treatment is adjusted to the weather and the time of year.
• Food and routine are treatment too. In every tradition diet and the daily routine stand alongside medicines and treatments, not after them.
• A doctor leads the treatment. No school expects a person to prescribe themselves cleansing, a medicine or a course of treatments.

In India you see an “Ayurveda” sign at every turn — from the hospital of a government college to a massage parlor by the beach. A few questions help you understand what you are looking at.

• Is there a doctor? A serious place starts with a consultation with a qualified Ayurvedic doctor, an examination and a plan, and only then treatments. If you choose treatments from a menu as in a café, it is more of a spa. On the difference, see Spa vs Ayurveda: what’s the difference.
• Do they ask about your health? A good clinic wants to know your diagnoses, medications and contraindications before starting. What that list can look like is covered in Who panchakarma suits and who should avoid it.
• How much time? A full program takes weeks, not a couple of days. A single treatment “to try” can be pleasant, but it is not therapy.
• Where do the medicines come from? If you are prescribed medicines, ask who makes them, and don’t hesitate to ask whether they contain metals. A good doctor will answer without taking offense.
• Which climate suits you? Kerala is the tropics, heat and humidity, especially in the monsoon. The north has a hot summer with a monsoon and a cool winter, mountains and the Ganges. The season and how you feel on the road matter as much as the name of the place.
• Are the promises realistic? A place that promises a miraculous result in a week is best avoided. Ayurveda is long-term work, and it complements conventional treatment rather than replacing it.

No tradition is better than another in itself. A good place is one where you are examined carefully, told honestly what to expect, and looked after throughout the course.