Scope of Practice for the Ayurvedic Profession

 

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The following listing of professional categories for the practice of Āyurveda in the United States represents the current state of the profession and also the potential for the growth of the profession moving forward. These three categories are distinguished by their focus on health and disease as well as the educational and experiential background needed to be competent as a professional in each category.

 

Ayurvedic Health Counselor

This category includes Ayurvedic professionals trained to focus on preventive healthcare as well as health promotion with a specific focus on diet and lifestyle.

 

>>The recommended hour range of training is 600-­1000 hours for this category.

 

Ayurvedic Practitioner

This category includes Ayurvedic professionals with additional training in pathology and disease management beyond that of the Ayurvedic Health Counselor. These professionals also practice preventive healthcare and health promotion, using diet and lifestyle.

 

>>The recommended hourly range of training for this category is 1500-­2500 hours.

 

Ayurvedic Doctor

This category includes Ayurvedic professionals who have specific specialized training in Ayurveda with overview training in conventional medicine that enables them to interface with western medical practitioners and provide comprehensive Ayurvedic healthcare to their patients.

 

>>The recommended hourly range of training for this category is 3000-­4500 hours.

 

 

NOTE: The use of the term “doctor” may be limited by individual state licensure regulations.

 

 

This document is broken into four divisions clarifying the scope of practice in each category:

  1. Description
  2. Skills and Competencies
  3. Recommendations
  4. Treatment and Intervention Skills

 

 

Three Professional Categories
General Description of the Scope of Practice

Category

Category I

Ayurvedic Health Counselor

Category II

Ayurvedic Practitioner

Category III

Doctor of Ayurveda

General Description

Āyurvedic Health Counselors are competent in health promotion and disease prevention (svasthavṛtta). They utilize the principles of Āyurvedic medicine to create diet and lifestyle (āhāra and vihāra) recommendations according to their assessment of the patient’s Āyurvedic constitution and imbalances  (prakṛti and vikṛti), state of the doṣas, agni, dhātus, malas, and manas (mind).

 

After the completion of academic study they have Āyurvedic clinical experience (supervised clinical practice) including a minimum of 50 patient encounters(1). They educate, motivate and counsel patients in order to  support them to be successful in implementing the principles of Āyurveda into their lives. Āyurvedic Counselors refer patients whose disease state (samprāpti) is beyond the third stage to Āyurvedic Practitioners or Doctors of Āyurveda for diagnosis (nidāna) and treatment (cikitsā) of disease.

Āyurvedic Practitioners are competent in managing and treating disease from the Āyurvedic perspective, using Āyurvedic etiology,  (nidāna), pathology (samprāpti), diagnosis and management of diseases (kāya cikitsā), in addition to being in the prevention of disease and promotion of health (svasthavṛtta).  

 

After the completion of academic study, they have Āyurvedic clinical experience equivalent to a minimum of six months of supervised clinical practice (including a minimum of 100 patient encounters during this level of training(1) in order to acquire and internalize a broad database of clinical experience enabling them to make clinical decisions based on experience.  In addition to diet and lifestyle (āhāra vihāra), Āyurvedic Practitioners are competent in the use of herbs as medicine (dravyaguṇa vijñāna) and Āyurvedic purification (śodhana  cikitsā)and rejuvenative  therapies (rasāyana). They also understand the basics of Western anatomy, physiology and pathology. They should be able to contribute to the profession such as by writing articles, contributing to research, teaching at professional conferences or presenting case studies.  

The general scope of practice of the Āyurvedic Doctor is similar to the Āyurvedic Practitioner, but they have more extensive, in-­depth education and relevant clinical experience in Aṣṭāṅga Āyurveda (all eight branches of Āyurvedic medicine(3)). They also have additional experience in teaching(5), demonstrations, practical pañcakarma training, and research methods.

 

After the completion of academic study they have extensive Āyurvedic clinical experience equivalent to a minimum of one year of supervised clinical practice, including a minimum of 250 documented patient encounters(1) in order to acquire and internalize a broad database of clinical experience enabling them to make clinical decisions based on experience. Doctors of Āyurveda are competent at understanding disease from an Āyurvedic perspective, while possessing a working knowledge of Western medical diagnostic and treatment terminology and practices, sufficient to enable them to correlate those terms and diagnoses into Āyurvedic (janapadoddhvamsa) from the Western and Āyurvedic perspectives. They are informed consumers of research pertaining to the Āyurvedic field, and are able to evaluate, discuss, and apply contemporary research within the context of Āyurvedic knowledge. They are able to make significant contributions to the profession such as contributing to or participating in research, review articles, conference teaching, or presentation of case studies,(4) understanding and practice.

 

Doctors of Āyurveda therefore have a working knowledge of  Western medical pathology, pharmacology, diagnostic reports, and treatments, in order to interface with the Western medical community and modify the Āyurvedic management of cases accordingly, as needed. But they are not required to order Western diagnostic tests and do not prescribe Western medicines. Āyurvedic Doctors have an informed awareness of public health and epidemiology

 

Notations

1. A patient encounter is defined as a combination of the following, a substantial percentage of which should involve direct hands on contact:

 

a) Experience history and/or outcomes of patients in order to build an internal database of clinical knowledge and experience. This internal database can be built by a variety of experiences whether it is observation, internship, externship, small group work or apprenticeship (working under and alongside the practitioner in a graduated responsibility model.

 

b) Carry out procedures such as history taking, prakṛti assessment, vikṛti assessment, pulse, tongue and nail diagnosis in order to gain clinical skill and fluency. This cannot be accomplished by passive observation but can be attained in a variety of settings including intern, small group work or apprenticeship (working under and alongside the practitioner in a graduated responsibility model).

 

c) Create treatment plans and experience outcomes through follow up in order to develop clinical proficiency. Accomplished in intern or supervised extern setting.

 

2. Required prerequisite study of Western sciences to be determined.

 

3. Aṣṭāṅga Āyurveda: Internal Medicine (Kāya Cikitsā) ENT (Śālākya Tantra) Pediatrics(Kaumārabhṛtya) Psychology (Bhūtavidyā / Manovijñāna) Rejuvenation (Rasāyana) Fertility (Vājīkaraṇa) Toxicology / Epidemiology (Agada Tantra) Surgery (Śalya Tantra) - confined to theoretical knowledge of contemporary practice and historical overview and understanding of Āyurvedic surgery

 

4. The intention behind creating this separate category is to set the bar high for the development of the Āyurvedic profession. While many schools may not feel ready to offer this level of training, it carves out the direction for on-­going development, while also identifying a category for existing highly trained and experienced practitioners.

 

5. Teaching includes: Public speaking One-on-one skills Ability to communicate the truths of Āyurveda in a clear way

 

6. Recommended minimum hours or duration of study for: Category I – 600 to 1000 Category II – 1500 to 2500 Category III – 3000 to 4500

 

 

General Notes:

 

1. Throughout this document each proceeding category has all of the knowledge and can provide all of the therapies of the preceding categories.

 

2. The total patient encounters for each category is in addition to earlier experience (i.e. it is not cumulative as it pertains to experience at the level of the category for which it is credited).

 

3. Hours are cumulative from Category II to Category III (i.e. the 100 patient encounters of Category II are included in the up-classification to Category III, thus an additional 150 patient encounters are required). Patient encounters from Category I are not sufficiently akin to the hours for Category II or III, and are therefore not cumulative to the qualification to those higher categories.

 

4.Throughout this document, “disease” refers to disease according to Ayurvedic diagnosis and treatment refers to disease management according to the Ayurvedic perspective.


 

 

Skills and Competencies

The practitioner should be able to show skill and competency in each of the following categories.

Category


Category I

Ayurvedic Health Counselor

Category II
Ayurvedic Practitioner

Category III
Doctor of Ayurveda

Communication

Counseling skills, "bedside manner" and cultural competency to their patient base.

Personal & Family Health History

Taking a detailed current and past personal and family health history.

Basic Vital Signs

Taking basic vital signs such as blood pressure (raktacāpa).

Etiology(Nidana)

Determining the etiological factors (nidāna) responsible for the doṣic imbalance.

Determining the etiological factors (nidāna) responsible for the doṣic imbalance and the disease.

Prakṛti & Vikṛti

Assessing physical and mental prakṛti and doṣa imbalance using Ayurvedic diagnostic methodology (trividha, aṣṭavidha and daśavidha parīkṣā).

20 Gunas

Determining which guṇas are predominant in prakṛti and vikṛti.

Doṣas/Sub-doṣas

Identifying which sub-doṣas are involved in a presenting imbalance.

Identifying which sub-doṣas are involved in a presenting disease.

Dhātus/Srotāṁsi

Determining dhātu, upadhātu, and srotāṁsi involvement (sāmyata, vṛddhi/kṣaya, duṣṭi) in a presenting imbalance.

Malas and Dhātumalas

Assessing the state of the malas through questioning (praśna).

Assessing the state of the malas through questioning (praśna) and special tests, including tailabindu parīkṣā, mūtra and purīṣa darśana.

Agnis: Jāṭhara, Dhātu, Bhūta

Determining the clinical state of agnis by questioning (praśna) and observation (darśana).

Āma

Determining the clinical state of āma by questioning (praśna) and observation (darśana).

Prāa, Ojas & Tejas

Determining the state of prāṇa, ojas and tejas.

Samprāpti

Determining the stage of samprāpti by observations (darśana), touch (sparśana) and questioning (praśna).

Determining the full samprāpti of disease conditions.

Western Diagnostic Reports

N/A

Understand basic Western diagnostic and medical reports.

Patient Strengths/Assets

Assessing and determining patients strengths and willingness to follow recommendations.

Research Skills

Able to create and collect case studies to contribute to research on health promotions and disease prevention (svasthavrtta).

They are informed consumers of Ayurvedic medical research. They may be capable of writing articles, contributing to professional conferences and presenting case studies.

They are informed consumers of research pertaining to the Ayurvedic field, and are able to evaluate, discuss and integrate contemporary research within the context of Ayurvedic knowledge. They may make significant contributions to the profession such as contributing to or participating in original research, review articles, conference teaching, or presentation of case studies.

 

 

Recommendations

The practitioner should have the knowledge within their prescribed scope of practice as noted
under the General Description to be able to recommend/prescribe the following approaches to restore balance and support the healing process.

Category

Category I
Ayurvedic Health Counselor

Category II
Ayurvedic Practitioner

Category III
Doctor of Ayurveda

Food (Āhāra

Recommending appropriate food choices according to prakṛti, vikṛti, guṇas, rasa, season (ṛtu), digestive strength (agnibala) and age (vaya), and proper eating behaviors (āhāravidhi).

Lifestyle (Vihāra)

Recommending appropriate daily routines (dinacaryā), seasonal routines (ṛtucaryā) and life cycle routines according to prakṛti, vikṛti, guṇas. Recommending and educating patients about at-­‐ home preventive and promotive measures (svasthavṛtta), and positive conduct measures (sadvṛtta).

Senses (Indriyārthasaṁyoga)

Recommending appropriate use of sight, smell, touch taste and hearing (sātmyendriyārthasaṁyoga).

Herbs (Dravya)

Recommending pre-designed or creating custom herbal formulas, herbal medicines, minerals, or other natural substances for internal or external use with consideration of dose (mātra), vehicle (anupāna), timing (auśadha kāla) and their safe use for the purpose of balancing agni, eliminating āma while supporting the malas and protecting and building ojas.

Recommending pre-designed or creating custom herbal formulas, herbal medicines, minerals, or other natural substances for internal or external use with consideration of dose (mātra), vehicle (anupāna), timing (auśadha kāla) and their safe use for the purpose of balancing agni, eliminating āma while supporting the malas, protecting and building ojas, and treating disease.

Yoga

Referring patients to an Āyurveda Yoga Therapist for further assessment and possible treatment related to Āyurvedic Yoga therapies. Able to educate patients on general scope and value of Āyurvedic Yoga Therapies and the value of practicing yoga for promotion of health and the prevention of disease (svastha).

Pacification
(Śamana)

Recommending pacification (śamana) therapies to balance the doṣas and eliminate āma.

Laṅghana:Pañcakarma (Śodhana)

N/A

Recommending pañcakarma programs as well as individual treatments (śodhana cikitsā), including: classical pañcakarma, and treatments for individual conditions, including use of specialized traditional body treatments. Includes pūrva karma, pradhāna karma, (diet, lifestyle & herbs).

Rejuvenation (Rasāyana)
Reproductive Vitality /Tonification (Vājīkaraṇa)

N/A (See below)

Recommending post pañcakarma rejuventation (paścāt karma).

Building/Tonification Therapies
(B
ṁhaṇa Cikitsā)

Recommending tonification (bṛṁhaṇa) for the body and mind.

Recommending tonification (bṛṁhaṇa) therapies for the body and mind.

Prenatal, Natal and Post-natal Care for Mother & Baby
(Kaumārabhṛtya)

Recommending basic diet (āhāra) and lifestyle (vihāra) guidelines for prenatal and post-natal women.

Recommending diet (āhāra), lifestyle (vihār), herbs (dravya) and treatments (cikitsā) to manage prenatal, natal, post-natal health and pathologies and care of newborns.

Children's  Health
(Bālāvastha)

Application of appropriate recommendations  for children over the age of five.

Application of appropriate recommendations for children of all ages.

Internal Medicine
(Kāya Cikitsā)

Recommending a plan to pacify the doṣas that affect the digestive system (annavahasrotas).

Recommending a plan for the elimination of presenting pathologies and the restoration of health in all systems of the body.

Head& Neck Region
(Śālākya Tantra)

Recommending preventative care for the head and neck region, including ears, eyes, nose and throat.

Recommending preventative care and treatment for conditions of the head and neck region, including ears, eyes, nose and throat.

Psychiatry
(Manovijñāna / Bhūtavidyā)

Recommending diet (āhāra), lifestyle (vihāra) and positive conduct (ācāra) to maintain a healthy mind.

Recommending diet (āhāra), lifestyle (vihāra) and positive conduct (ācāra), herbs (dravya) and treatments (cikitsā) to treat pathologies in the mind.

Jyotiṣa

Referring patients to a Jyotiṣi for assessment and educating patients on general scope and value of Jyotiṣa.

Vāstu

Referring patients to a Vāstu practitioner for assessment and educating patients on general scope and value of Vāstu.

Western medical approaches (drugs, surgery, diagnostic procedures)

Referring patients to a practitioner of Western medical approaches for assessment and possible treatment (presumes a general understanding of the scopes of practice of various Western medical disciplines).


 

 

Treatment and Intervention Skills (Cikitsā

The practitioner should have the knowledge and skill to be able to utilize
the following treatment approaches and/or intervention skills to support the healing process(1).

Category

Category I
Ayurvedic Health Counselor

Category II
Ayurvedic Practitioner

Category III
Doctor of Ayurveda

Food (Āhāra

Demonstrate the selection and preparation of appropriate foods and spices according to prakṛti, vikṛti, guṇas, rasa, season (ṛtu), digestive strength (agnibala) and age, and demonstrating proper eating behaviors (āhāravidhi).

Lifestyle (Vihāra)

Demonstrate the appropriate daily routine (dinacaryā) seasonal routine (ṛtucaryā) and life cycle routines according to prakṛti, vikṛti, guṇas. Demonstrating at-­home preventive and promotive (svasthavṛtta) measures, and positive conduct (sadvṛtta) measures.

Demonstrate the appropriate daily routine (dinacaryā), seasonal routine (ṛtucaryā) and life cycle routine components for the treatment of the underlying conditions. Demonstrating at-­home preventive and promotive (svasthavṛtta) measures, and positive conduct (sadvṛtta) measures.


Senses (Indriyārthasaṁyoga)

Demonstrate appropriate use of sight, smell, touch, taste and hearing.

Demonstrate appropriate use of sight, smell, touch, taste and hearing, and administer appropriate treatments.

Herbs (Dravya)

Administer, combine, provide, compound, and dispense herbal medicines,  minerals, or other natural substances. Herbs are to be used for internal or external use for the purpose of balancing agni and eliminating āma while supporting the malas and protecting and building ojas.

Administer, combine, provide, compound, and dispense herbal medicines, minerals, or other natural substances.  Herbs may be used for internal or external use for the purpose of balancing agni and eliminating āma while supporting the malas and protecting and building ojas, as well as for treating specific diseases affecting any dhātu, upadhātu, malas or srotas in any stage of the disease pathology.


Laṅghana:   Pacification (Śamana)

Designing, implementing and managing pacification (śamana) therapies directed to balance the doṣas and elimination of āma of a patient.


Laṅghana:
Pañcakarma
(Śodhana)

N/A

Designing, implementing and managing pañcakarma programs as well as individual treatments (śodhana cikitsā), including: classical pañcakarma and treatments for individual conditions, including use of specialized traditional body treatments. Includes pūrva karma, pradhāna karma, (diet, lifestyle & herbs).

Rejuvenation (Rasāyana)
Reproductive Vitality /Tonification (Vājīkaraṇa)

N/A (See below)

Designing, implementing and managing post-pañcakarma rejuvenation (paścāt karma).

Building/Tonification Therapies
(B
ṁhaṇa Cikitsā)

Designing, implementing and managing tonification (bṛṁhaṇa) for sustaining the health of the body and mind.

Designing, implementing and managing tonification (bṛṁhaṇa) for sustaining health and correcting imbalances of the body and mind.


Prenatal, Natal and Post-natal Care for Mother & Baby
(Kaumārabhṛtya)

Designing, implementing and managing basic diet (āhāra) and lifestyle (vihāra) guidelines for prenatal and post-natal women.

Designing, implementing and managing diet (āhār), lifestyle (vihāra), herbs (dravya) and treatments (cikitsā) to manage prenatal, natal, post-natal health and pathologies and care of newborns.

Children's  Health
(Bālāvastha)

Designing, implementing and managing diet (āhāra), lifestyle (vihāra), herbs (dravya) and treatments  (cikitsā) in children over the age of five, and diet (āhāra) and lifestyle (vihāra) for children under five.

Designing, implementing and managing diet (āhāra), lifestyle (vihāra), herbs (dravya) and treatments (cikitsā) to treat pathologies in babies and children.


Internal Medicine
(Kāya Cikitsā)

Designing, implementing and managing a plan to pacify the doṣas within the digestive system (annavahasrotas).

Designing, implementing and managing a plan for the elimination of presenting pathologies and the restoration of health.

Head& Neck Region
(Śālākya Tantra)

Teach  preventative care for the head and neck region, including eyes, ears, nose and throat.

Teach preventative care and provide treatment (cikitsā) for the head and neck region, including eyes, ears, nose and throat.


Psychiatry
(Manovijñāna / Bhūtavidyā)

Designing, implementing and managing a plan to pacify the doṣas within the mind.

Designing, implementing and managing a plan to pacify the doṣas within the mind and providing treatments (cikitsā) to treat pathologies in the mind.

Yoga

All categories should be informed on yoga therapies but its practice requires a separate certification.

Jyotiṣa

All categories should be informed on Jyotiṣa but its practice requires a separate certification.

Vāstu

All categories should be informed on Vāstu but its practice requires a separate certification.

 

Notations

  1. All treatment and intervention skills for each category are based on the scope of practice of that category. Thus, treatment modalities for the Āyurvedic Health Counselor are limited to the management of the first three stages of the pathological process.
 
Note on Saṁskṛta for All Sections: The final document will use the international transliteration font that is more universal and accurate for each term.

 

 

 

 




 

 

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