Development of Ayurveda in United States

The Early History of Ayurvedai in the United States
Interest in Ayurveda in the United States began in the 1970's, largely as the result of efforts by the Maharishi Mahesh Yogi organization of Transcendental Meditation. Interest continued to grow as Indian physicians came to the United States in the 1980's. Among these physicians were Dr. Vasant Lad, Dr. Sunil Joshi and Dr. B.D. Triguna. In the late 1980's Dr. Deepak Chopra wrote "Perfect Health", his famous introductory book on Ayurveda for the general public. This opened the door of India 's ancient healing science for many Westerners. Furthermore, several American pioneers helped attract attention to Ayurveda and influence its growth. They include Dr. David Frawley, of the American Institute of Vedic Studies, and Dr. Robert Svoboda, a Westerner who completed India 's BAMS program. As interest and awareness grew, training programs of various degrees emerged. In 1995, the California College of Ayurveda was founded and was the first State-approved practitioner training program in the United States . It is still in operation today.

The State of Ayurvedic Education in America
As of this writing, the quality of educational programs in the United States continues to vary widely. However, in 2004, the National Ayurvedic Medical Association established the first educational standards in the United States . Graduates of schools that meet these minimum standards are able to receive practitioner status in the national association. These standards, while not legal precedents, have motivated schools to uplift the quality of their practitioner training programs.
The focus or vision of schools varies in the United States . The California College of Ayurveda is the leader in clinical practitioner training with the intention of educating its students to be fully qualified practitioners capable of disease management as well as lifestyle training. Almost all other schools focus on training students in lifestyle management and do not address clinical disease management.
Ayurveda training programs in the United States fall into four major categories: (1) correspondence programs, (2) full-time training programs (3) weekend training programs, (4) short-term seminar courses. There is also a division within practitioner training programs, with some of these program offering internship and others not.
(1) Correspondence Programs
Correspondence programs enable the student to study exclusively at home and correspond with questions to the school. Some correspondence courses include internet based study; others include reading the textbook prepared by the instructor. Many require assignments in addition to reading. Testing varies with each program. Today, there are at least half dozen different correspondence courses available in the United States . Credit hours are arbitrarily assigned by the course developer. The National Ayurvedic Medical Association does not recognize correspondence course hours toward national certification.
(2) Full-Time Training Programs
There are only two main institutions for full–time study in the United States . These institutions are the California College of Ayurveda and the Ayurvedic Institute in New Mexico . The course at the California College of Ayurveda is 18 months in duration. The course at the Ayurvedic Institute is 16 months in duration.
(3) Weekend Training Programs
In the United States , there are approximately 10 weekend training programs. Students attend school, most often one weekend per month over a pre-determined period of time. Program lengths vary from 12 weekends on the shorter end to 24 weekends at the California College of Ayurveda.
(4) Short-Term Seminar Courses
Short-term seminar courses are very popular in the United States . These courses vary considerably in quality and content. Many are simple introductory courses, while others focus on a specific modality. These courses are popular for self-healing as well as for training massage and spa therapists in various aspects of Ayurvedic massage and beauty care.
(5) Internship Programs
The California College of Ayurveda was the first school to offer an internship training program in the United States whereby students could practice under supervision in a college clinic or in their own community. Today, several schools offer internship training programs. The nature of internship varies considerably with some schools allowing interns only to observe patient care while others allow students to practice on other students. The California College of Ayurveda is one of the only schools offering a training program that includes seeing patients from the community and providing complete Ayurvedic health care.

State Approval and the Certification of Schools
In most States, schools require State approval to operate. State approval is based primarily upon financial stability and professional operation. Several institutions in the country have successfully by-passed State regulations by declaring themselves religious institutions or churches. While State approval is required for non-religious institutions, there are several programs operating in the United States without proper approval by their State governing body. These schools, operating illegally, are much less professionally run. Because of limited oversight, these schools continue to operate. The National Association has not taken any action against these schools.

Development of Ayurvedic Associations
The National Ayurvedic Medical Association is the major body in the United States representing the Ayurvedic profession. A non-profit association, it was founded in 1998 by four individuals: Dr. Marc Halpern, of the California College of Ayurveda, Wynn Werner, of the Ayurvedic Institute, Kumar Batra, and Cynthia Copple. The National Association represents the interests of Ayurvedic practitioners while trying to advance the Ayurvedic profession. The Association has held annual conferences attracting 150- 250 practitioners each of the past three years. The Association's most important accomplishment to date has been the establishment of minimum practitioner standards.
The California Association of Ayurvedic Medicine is the only established Ayurvedic State Association in the United States . A non-profit association, it was founded by Dr. Marc Halpern along with his graduate students in 1997. Dr. Halpern left the board in 2001. The organization has held several State conferences attracting 75-300 practitioners. The State Association has been minimally active in recent years owing to political infighting. The Association has adopted the National Association's guidelines for practitioner training.

Regulation of Ayurveda in the United States of America
There is no significant regulation of Ayurvedic practice or education in America . Schools in most states must apply for a State license or State approval to provide education. Several states do not have this requirement. The practice of Ayurveda is not formally regulated either. None of the fifty states require a license to practice Ayurvedic health care. Ayurvedic massage is regulated through the massage laws of most states. In two states ( Minnesota and California ) specific laws were passed protecting the practice of alternative medicine and the practitioners who provide those services. The practice of Ayurveda is protected within these laws so long as the practice falls within the limitations of the law and does not impinge on the scope of practice of other licensed health care professions.

Scope of Practice and Other Issues of Practice
Having no formal scope of practice defined through legislation, the practice of Ayurveda is defined more by what can not be done than by what can be legally practiced. While the laws in each State vary, there are many commonalities to these laws that restrict the practice of Ayurveda, the medical practice acts established in each state being the most significant. The following is a list of actions that, in this author's opinion, are generally considered illegal in the United States .
• Practitioners can not call themselves a Doctor even if possessing a doctorate degree from India or a PhD. degree in the United States . The use of the title “Doctor” is restricted to licensed physicians of Medicine, Osteopathy, Chiropractic or Naturopathy. While this is true in a clinical setting, those possessing a doctorate degree of any kind may be referred to as “Doctors” in an academic setting and may also place the title doctor in front of their name on books and published papers.
• Practitioners may not diagnose medical disease. A practitioner can not act in the capacity of a licensed health care physician and provide a diagnosis of a disease using common Western medical terminology. This does not mean, however, that a practitioner can not use their Classical Ayurvedic understanding of disease to come to an understanding of a patient's condition. Hence, a practitioner of Ayurveda may declare that a patient is suffering from a vitiation of pachaka pitta in the rasa dhatu of the annavaha srota but may not declare that the patient is suffering from hyperacidity or an ulcer, or the Sanskrit equivalents: Urdvarga Amlapitta and Grahani.
• Practitioners can not interfere with the prescriptions or recommendations made by a licensed physician. A practitioner who tells a patient not to take their medications is considered practicing medicine without a license.
• Practitioners can not invade the body or perform any other procedure that penetrates the skin or any orifice of the body. This places the practice of nasya and bastii in jeopardy. Even simple surgical procedures may not be performed nor may acupuncture.

The Ability of Indian Trained Ayurvedic Practitioners to Practice in the United States
Indian trained Ayurvedic physicians who come to the United States on a work visa or through immigration may practice Ayurveda within the allowable scope as defined above. However, they may not use the title “Doctor” and the title may not be implied in any clinical setting. Should a physician trained in a foreign country practice as such, they place themselves in jeopardy of legal actions including deportation (if a non-citizen) or imprisonment (if a citizen).

Cultivating an Ayurvedic Profession Within the United States
There are several diverging viewpoints on this subject. One states that Ayurveda should be a subspecialty of allopathic medicine. In this scenario education and the ability to practice would only be available to medical doctors and other licensed health care physicians.
The other view is that the Ayurvedic profession should remain independent and grow on its own, training its own practitioners. Separate schools would train Ayurvedic practitioners who would practice either independently or in a complementary/integrated manner with allopathy. As the director of the California College of Ayurveda, I have supported the independent profession viewpoint. This view is consistent with the models established by the Acupuncture, Chiropractic and Naturopathy professions in the U.S.A.
Divergent points of view also exist as to the long-term scope of practice to be pursued in the United States . There are some with the viewpoint that Ayurveda should be practiced as it is in India and that education should follow a similar model. There are others who believe that, due to certain entrenched restrictions on the practice of Medicine in the United States , it would be impossible to develop Ayurveda in the United States along such integrated lines. Hence, a new model of clinical education is required that better fits the Western environment. Still, there are others who feel that the practice of Ayurveda should be restricted to lifestyle management only and should not enter into the realm of disease management.
It has been the position of the California College of Ayurveda to pursue a Clinical model of training and practice that develops practitioners who can work within the restrictions imposed by US laws but still practice most of the classically recommended natural practices and procedures for the purpose of serving humanity. The California College of Ayurveda has pioneered Western clinical Ayurvedic education since its inception in 1995 and has expanded this model as the school and profession has grown.
Which model of Ayurvedic education becomes established in the United States will depend upon the actions of the National and State Associations, schools and activists within the country and abroad.
While the infrastructure of the Ayurvedic profession in the United States has developed and improved over the past ten years, greater infrastructure is still needed. Absent is a serious body that regulates schools in the United States . The profession is in need of an accreditation agency that regulates and unifies the actions of schools so that graduates of all schools have similar education, training and competency.

The Role of India and the Future of Ayurveda in the United States
While Ayurveda in the United States grows according to its own course, the role of India is crucial in the development of Ayurveda abroad. Actions taken that support, nourish and strengthen (Brimhana Chikitsa) the profession in America are needed. Nourishing actions include teacher and information exchanges.
Unfortunately, the actions of some highly motivated physicians from India have been less than supportive. Rather than providing nourishing support, their actions have attempted to purify Ayurveda (langhana chikitsa) in the United States by attempting to undermine the actions of individuals who are working to build a profession that fits within the Western paradigm. These Indian physicians promote an indo-centric philosophy whereby they can only see or accept Ayurvedic practitioners who are trained and practice exactly as they are and do in India . While the Indian model of Ayurvedic education and practice is the historical standard, it has evolved in India based more on politics and culture than on classical scripture. With a different culture and political landscape in the United States , it is natural that Ayurveda will evolve differently in this country. What is important is that the practice of Ayurveda remain true to its classical body-mind-spirit paradigm. It is the philosophical and spiritual (not religious) constructs that separate Ayurveda from any other system of medicine in the World and it is this that must be preserved above all else.

Conclusion
The Ayurvedic profession is growing steadily in the United States of America . Educational institutions are becoming more established and the Associations are working to give the profession a voice and address regulation issues. Ayurveda is likely to continue to grow in America and take its place among the other licensed health care professions.