Standards Committee
Scope of Practice Recommendations
Introduction
The practice of Ayurveda in America has grown and matured in recent years and includes a spectrum from health counseling to advanced clinical management of disease. In order to support the practice and recognition of Ayurveda in the US, NAMA's Standards Committee has proposed the development of three primary types of practitioner: Ayurvedic Health Counselor, Ayurvedic Practitioner, and Ayurvedic Doctor, each category building on the previous one. A subsequent proposal will articulate the scope of practice for Ayurveda/Panchakarma Therapists, Ayurveda Yoga Therapists, and Ayurvedic Pharmacists.
These standards are intended to serve both as a foundation for future certification and licensing of Ayurveda in the US, and to support education that produces competent and confident practitioners of Ayurveda.
What follows is a working draft of the recommended scope of practice for these three primary types of Ayurvedic practitioner. NAMA's Standards Committee is currently reviewing input from our early round of input, though their comments have not yet been incorporated.
We are now seeking input on this draft from the NAMA community and beyond, including practitioners, educators, students, deans of schools and other professionals in the field of Ayurveda and health care. We will subsequently be working on a grandfathering policy, national exam, continuing education, and other ways to support the dynamic integration of these new standards.
In reading this, please note that since licensure to practice healthcare professions is regulated by each state in the U.S, and states have different requirements and acceptable terminology, terms used in these descriptions are not intended to correspond to terms used in such regulations.
We are keen to hear your comment and suggestions. Please take some time to study this proposal. We will be discussing it at length at the Practitioners Forum preceding the NAMA conference in mid April. You can bring your input to the conference, where we will also have a designated table manned by Standards Committee members who can answer questions and discuss your input. If you will not be attending the conference, you can take the online survey.
NOTE: Below is a Working Document
Three Main Practitioner Categories
General Description of the Scope of Practice
Category I: Ayurvedic Health Counselor
Ayurvedic Health Counselors are experts in health promotion and disease prevention (swasthavritta). They utilize the principles of Ayurvedic medicine to create diet and lifestyle (ahaar-vihara) recommendations according to their assessment of the client?s Ayurvedic constitution and imbalances (prakriti & vikriti), state of the doshas, agni, dhatus, malas, and the mind. After the completion of academic study they have Ayurvedic clinical experience (supervised clinical practice) including a minimum of 35 patient visits1
They educate, motivate and counsel clients in order to support them to be successful implementing the principles of Ayurveda into their lives. Ayurvedic Counselors refer clients whose samprapti is beyond the third stage (disease state) to Ayurvedic Practitioners or Ayurvedic Doctors.
Category II: Ayurvedic Practitioner
Ayurvedic Practitioners are experts in managing and treating disease from the Ayurvedic perspective, using Ayurvedic etiology (nidan), pathology (samprapti), diagnosis and management of diseases (kaya chikitsa), in addition to being experts in the prevention of disease and promotion of health (swasthavritta).
After the completion of academic study they have Ayurvedic clinical experience equivalent to a minimum of six months of supervised clinical practice (including a minimum of 50 patient visits 1 in order to acquire and internalize a broad database of clinical experience and make clinical decisions. In addition to diet and lifestyle (ahara-vihara), Ayurvedic Practitioners are experts in the use of herbs as medicine (dravyagunavijnana) and Ayurvedic purification (shodhanachikitsa) and rejuvenative therapies (rasayana). They also understand the basics of conventional pathology.
Category III: Ayurvedic Doctor
Ayurvedic Doctors are experts at understanding disease from both an Ayurvedic and Western perspective and utilizing Ayurvedic methods of treatment. They have the highest level of education, training and competency.
After the completion of academic study they have extensive Ayurvedic clinical experience equivalent to a minimum of one year of supervised clinical practice (including a minimum of 100 patient visits 1 in order to acquire and internalize a broad database of clinical experience in order to make clinical decisions based on experience.
The Ayurvedic Doctor understands pathogenesis and disease prevention and health promotion (swasthavritta) and disease treatment from both an Ayurvedic as well as a Western perspective but only practices from the Ayurvedic perspective using Ayurvedic principles.
Ayurvedic Doctors have a working knowledge of conventional medical pathology, pharmacology and laboratory reports, in order to interface with the conventional medical community and modify the Ayurvedic treatment program accordingly.
Ayurvedic Doctors have a basic knowledge of public health and epidemiology and are informed consumers of medical research. They are able to make significant original contributions to the profession 2
Requires prerequisite study of Western sciences to be determined.
Notations
1 a “patient visit” means a private one on one patient encounter between the intern and the patient with supervisor oversight.
2Original research or review articles, discussions of controversy, conference teaching, presentation of case studies.
Skills and Competencies
| Category | Category I: Ayurvedic Health Counselor | Category II: Ayurvedic Practitioner | Category III: Ayurvedic Doctor |
|---|---|---|---|
| Communication | Counseling skills | ||
| 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 (Raktadab) | ||
| Etiology (nidan) | Determining the etiological factors (nidan) responsible for the doshic imbalance | Determining the etiological factors (nidan) responsible for the doshic imbalance and the disease | |
| Prakruti & vikruti | Assessing physical and mental prakriti and dosha imbalance using Ayurvedic methodology (trividha, ashtavidha and dashavidhapariksha) | ||
| 20 gunas | Determining which gunas are predominant in prakriti and vikriti | ||
| Doshas/subdoshas | Identifying which subdoshas are involved in a presenting imbalance | Identifying which subdoshas are involved in a presenting disease | |
| Dhatus/srotamsi | Determining dhatu and upadhatu involvement (samyata, vriddhi, and kshaya, and srotamsi) in a presenting imbalance | ||
| Malas and dhatu malas | Assessing the state of the malas through questioning (prashna) | Assessing the state of the malas through questioning (prashna) and special tests. Including tailabindupariksha, mutra and parishadarshana. | |
| Agni: jathara, dhatu, bhuta | Determining the clinical state of agnis by questioning (prashna) and observation (darshan) | ||
| Ama | Determining the clinical state of ama by questioning (prashna) and observation (darshan) | ||
| Prana, Ojas & Tejas | Determining the state of prana, ojas and tejas | ||
| Samprapti | Determining the stage of samprapti by observation (darshana), touch (sparshana) and questioning (prashna) | ||
| Conventional laboratory reports | n/a | Interpreting basic conventional laboratory medical reports | |
| Conventional laboratory reports | n/a | Interpreting basic conventional laboratory medical reports | |
| Client strengths/assets | Assessing and determining clients strengths and willingness to follow recommendations | ||
Recommendations
| Category | Category I: Ayurvedic Health Counselor | Category II: Ayurvedic Practitioner | Category III: Ayurvedic Doctor |
|---|---|---|---|
| Food (ahara) | Recommending appropriate food choices according to prakriti, vikriti, gunas, rasa, season (ritu), digestive strength (agnibala) and age (vaya), and proper eating behaviors (aharaviddhi) | ||
| Lifestyle (vihara) | Recommending appropriate daily (dinacharya), seasonal (ritucharya) and life cycle routines according to prakriti, vikriti, gunas. Recommending and educating clients about at-home preventive and promotive (swasthavritta) measures, and positive conduct (sadvritta) measures. | ||
| Senses (indriya-arthasamyoga) | Recommending appropriate use of sight, smell, touch, taste and hearing (satmyaindriya-arthasamyoga) | ||
| Herbs (dravya) | Recommending predesigned or creating custom herbal formulas, herbal medicines, minerals, or other natural substances for internal or external use with consideration of dose (matra), vehicle (anupan), timing (bhaishajyakala) and their safe use for the purpose of balancing agni, eliminating ama while supporting the malas and protecting and building ojas. | ||
| yoga | Referring clients to an Ayurveda Yoga Therapist for further assessment and possible treatment related to Ayurvedic Yoga therapies. Able to educate clients on general scope and value of Ayurvedic Yoga Therapies and the value of practicing yoga for promotion of health and prevention of disease (swastha). | ||
| Langhana: pacification (shamana) | Recommending pacification (shamana) therapies to balance the doshas and eliminate ama. | ||
| Langhana: Panchakarma (shodhana) | n/a | Recommending panchakarma programs as well as individual treatments (shodhanachikitsa), including: classical panchakarma, treatments for individual conditions, including use of specialized traditional body treatments. Includes purva karma, pradhana karma, (diet, lifestyle & herbs) | |
| Rejuvenation (rasayana) & reproductive vitality / tonification (vajikarana) | n/a | Recommending post panchakarma rejuventation (pashchatkarma) | |
| Building / tonification therapies (brimhanachikitsa) | Recommending tonification (brimhana) for the body and mind. | Recommending tonification (brimhana) therapies for the body and mind. | |
| Pre-natal, natal and post natal care for mother and baby (kaumarabhritya) | n/a | Recommending diet (ahara), lifestyle (vihara), herbs (dravya) and treatments (chikitsa) to manage pre-natal, natal, post natal conditions and care of the newborns | |
| Children's health (balasvasta) | Application of appropriate recommendations for children over the age of 5 | Application of appropriate recommendations for children of all ages | |
| Internal medicine (kayachikitsa) | Recommend a plan to pacify the doshas that affect the digestive system (annavaha srota) | Recommend a plan for the elimination of presenting pathologies and the restoration of health in all systems of the body. | |
| Head & neck region (shalakya) “ENT” | Recommend preventative care for the head and neck | Recommend preventative care and treatment for the head and neck | |
| Psychiatry (mano vijnana / bhutavidya) | Recommend diet (ahara), lifestyle (vihara) and positive conduct (achara) to maintain a healthy mind. | Recommend diet (ahara), lifestyle (vihara), positive conduct (achara), herbs (dravya) and treatments (chikitsa) to treat pathologies in the mind. | |
| Jyotish | Referring clients to a Jyotishi for assessment (Presumes a general knowledge of the scope of practice of a practitioner of jyotish) | ||
| Vastu | Referring clients to a Vastu practitioner for assessment (Presumes a general knowledge of the scope of practice of a practitioner of vastu) | ||
| Western medical approaches, (drugs, surgery, diagnostic procedures) | Referring clients 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
| Category | Category I: Ayurvedic Health Counselor | Category II: Ayurvedic Practitioner | Category III: Ayurvedic Doctor |
|---|---|---|---|
| Food & eating (ahara) | Demonstrate the selection and preparation of appropriate foods and spices according to prakriti, vikriti, gunas, rasa, season (ritu), digestive strength (agnibala) and age, and demonstrating proper eating behaviors (aharaviddhi) | ||
| Lifestyle (vihara) |
Demonstrate the appropriate daily (dinacharya), seasonal (ritucharya) and life cycle routines according to prakriti, vikriti, gunas. Demonstrating at-home preventive and promotive (swasthavritta) measures, and positive conduct (sadvritta) measures. |
Demonstrate the appropriate daily (dinacharya), seasonal (ritucharya) and life cycle routine components for the treatment of the underlying conditions.
Demonstrating at-home preventive and promotive (swasthavritta) measures, and positive conduct (sadvritta) measures. |
|
| Senses / sensory therapies (satmyaindriya-arthasamyoga) | Demonstrate appropriate use of sight, smell, touch, taste and hearing | Demonstrate and administer the appropriate use of sight, smell, touch, taste and hearing. | |
| 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 ama 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 ama while supporting the malas and protecting and building ojas as well as for treating specific diseases affecting any dhatu, upadhatu, malas or srota in any stage of the disease pathology. | |
| Langhana: pacification (shamana) | Designing, implementing and managing pacification (shamana) therapies directed to balance the doshas and elimination of ama of a patient. | ||
| Langhana: Panchakarma (shodhana) | n/a | Designing, implementing and managing panchakarma programs as well as individual treatments (shodhanachikitsa), including: classical panchakarmatreatments for individual conditions, including use of specialized traditional body treatments. Includes purva karma, pradhana karma, (diet, lifestyle & herbs) | |
| Rejuvenation (rasayana) & reproductive vitality / tonification (vajikarana) | n/a | Designing, implementing and managing post panchakarma rejuvenation (paschatkarma) | |
| Building / Tonification Therapies (brimhanachikitsa) | Designing, implementing and managing tonification (brimhana) for sustaining the health of the body and mind. | Designing, implementing and managing tonification (brimhana) for sustaining the health and correcting imbalances of the body and mind. | |
| Pre-natal, natal and post natal care for mother and baby (kaumarabhritya) | n/a | Designing, implementing and managing diet (ahara), lifestyle (vihara), herbs (dravya) and treatments (chikitsa) to manage pre-natal, natal, post natal conditions and care of the newborns | |
| Children's health (balasvasthya). | Designing, implementing and managing diet (ahara), lifestyle (vihara), herbs (dravya) and treatments (chikitsa) in children over the age of 5 | Designing, implementing and managing diet (ahara), lifestyle (vihara), herbs (dravya) and treatments (chikitsa) to treat pathologies in babies and children | |
| Internal medicine (kayachikitsa) | Designing, implementing and managing a plan to pacify the doshas 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 (shalakya) “ENT” | Teach preventative care for the head and neck | Teach preventative care and provide treatment for the head and neck | |
| Psychiatry (mano vijnana / bhutavidya) | Designing, implementing and managing a plan to pacify the doshas within the mind. | ||
| Yoga | All categories should be informed on yoga therapies to be able to refer clients to an Ayurvedic Yoga Therapist for further assessment and possible treatment. Practice of yoga therapy requires a separate certification. | ||
| Jyotish | All categories should be informed on jyotish to be able to refer clients to a Jyotishi practitioner. | ||
| Vastu | All categories should be informed on vastu to be able to refer clients to a Vastu practitioner for assessment. | ||
| Research Skills | Ayurvedic Practitioners are informed consumers of Ayurvedic medical research. They should be well capable of writing review articles, contributing to professional conferences and presenting case studies. | Ayurvedic Doctors are informed consumers of medical research. They are able to make significant original contributions to the profession. Original research or review articles, discussions of controversy, conference teaching, presentation of case studies. | |
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 Ayurvedic health councilor are limited to the management the first three stages of the pathological process.
2Note on Sanskrit For All Sections: The final document will use the international transliteration font that is more universal and accurate for each term.
