In Ayurveda, it is thought that the first cause of disease is a sense of loss or hunger at the spiritual level; when a person does not feel at one with the divine (in whatever form or concepts are meaningful to each person), suffering begins. Other influences that cause disease are internal (diet, digestion, mental), and external (lifestyle, seasons of the year, environment). Body types are often spoken of according to which of the doshas predominates in a particular person: Vata types tend to be thin, Pitta muscular, and Kapha overweight. Knowing one's basic type can assist in developing a diet and lifestyle that are suited to keeping life energies properly balanced.

Once a diagnosis is made, treatments are prescribed from a broad array of choices: dietary changes, herbs, exercise, bodywork (massage, yoga), meditation, chanting, even certain smells (aromatherapy) or colors. Eventually, very significant changes from a patient's established lifestyle may be required. However, Ayurveda suggests implementing changes gradually, as even healthy changes made quickly can be as damaging and as unnatural as unhealthy lifestyles. In this way, clients are advised to start their healing journey from where they are. Even a little change brings good results. As the symptoms diminish or disappear and the changes are integrated into one's lifestyle, then they are encouraged to entertain more lifestyle changes on the basis of their newly found faith in Ayurvedic therapies. Ayurveda may not adapt very well to the kind of fragmented treatment approach Americans are accustomed to (e.g., trying this or that single herb, exercise or food, to see if it works). Because it is a unified and integrated healing system, all the pieces of the whole are thought to be interrelated and, when implemented together, will enhance and strengthen the desired effects.

Scope of practice
The word "Ayurveda" is usually defined as the science or knowledge (veda) of life (ayu), reflecting an exceedingly comprehensive approach to health from this ancient Indian system of healing. There are no laws in the United States today regulating the practice of Ayurvedic Medicine so it is difficult to describe a "standard" scope of practice. The training in India creates what could be called a doctor of natural medicine (see Philosophy below). The Ayurvedic doctor or practitioner looks at all aspects of the patient's life - body, mind, spirit, environment (physical and social) - seeking for imbalances among the basic life energies. Severe or prolonged imbalances may create disease; milder imbalances may result in disruption of health (a stage before overt disease symptoms are apparent). Approaches to restoring balance involve the use of herbs, dietary interventions, lifestyle changes, cleansing, body work and spirituality.

In the absence of state or national standards, the scope of practice may vary considerably with such factors as the regulatory climate in various states, other health care training or credentials of the provider, and the degree to which the system is being practiced in its full integrated model (or only parts thereof). If the practitioner has a license in another field (e.g., chiropractic, naturopathic medicine, medical doctor, osteopath), he or she may be able to provide full Ayurvedic diagnostic and treatment services. If not otherwise licensed, the practitioner may serve more as a health advisor, educating the client about the Ayurvedic approach to improved general health status (diet, exercise, meditation, yoga, etc.).

Regulatory scope
There is no regulation of Ayurveda in any state at this time. The ability of a given practitioner to practice Ayurveda in its broadest scope may be extremely limited by the lack of regulation, even if the practitioner is well trained. Generally speaking, a practice act that allows the use of herbs, nutrition and lifestyle counseling would encompass the scope of Ayurvedic Medicine; for this reason, you may see naturopathic doctors, medical doctors and osteopaths, or (depending on the state laws) chiropractors or acupuncturists, who practice Ayurveda. However, these credentials do not provide assurance to the patient that the provider is competent in this ancient and complex discipline, leaving considerable responsibility on the consumer's shoulders to exercise due diligence in selecting a provider. Ask lots of questions about education and clinical training; look carefully at any other health care credentials; look for membership in reputable professional organizations; ask for professional references; talk to friends and family; search the Internet to gain a better idea of what's available. Be as diligent on your own behalf as you would be if you were researching the practitioner for a beloved friend or family member.

Education and credentialing The United States has no Ayurvedic colleges or universities. There is training available in a few private clinics, small private schools and institutes, and through distance learning and clinical mentoring. Some of it is available to anyone, and some only to those who already have a health care credential. Generally, a 2-year or 3-year program will result in a certificate showing completion of the hours and the field of study. There does not yet appear to be anything in the U.S. that is comparable to the in-depth, integrated training experienced in an Ayurvedic college or university in India, but some of the programs have ties with India-based colleges and may offer the option of some training with their affiliate schools.

There are practitioners with extensive training in India who have come to the U.S. to live, practice and teach; some have earned other health care degrees with a scope broad enough to encompass full Ayurveda. There are also U.S.-born practitioners who first earned a different health care degree and then obtained additional training in Ayurveda through workshops and seminars, or by apprenticing with an Ayurvedic doctor. Consumers may also find practitioners of Ayurveda who have no recognized health care degree or license; they may be foreign born and trained, self-taught, or have attended one of the on-site or correspondence training programs. Since the discipline is unregulated, it is difficult for the consumer to know how to select a provider who has been competently trained. There is no standardized system by which to evaluate either training in India or training here in the U.S. There are no recognized credentials here (such as a national board examination, a license or certification), and no national organization upon which to rely for guidance. Although consumers can gain an extra measure of safety by consulting an Ayurvedic doctor or practitioner who has a recognized health care credential, there are still a lot of unknowns. Consumers should gather as much information about a provider's education as possible (an Internet key word search will turn up several dozen sites from around the world), and then must rely on their own judgment.

Typical first office call or visit
The first visit to an Ayurvedic doctor or practitioner may vary according to the scope of practice allowed by an existing health care credential (or the absence of one), and by the extent of the provider's training. However, you should always expect to be educated about Ayurveda as a health care practice. You should learn what the diagnostic process consists of, what the diagnosis itself will address, what kinds of treatments may be recommended, and what outcomes can be expected and in what time frame. You can expect a fairly lengthy interview, as information is elicited about your physical, mental and spiritual well being.

Limitations to be aware of
Many of the limitations discussed above relate to the lack of regulatory models and standards for Ayurvedic Medicine. If your Ayurvedic practitioner holds another health care credential, he or she will be limited by the scope of that credential. Because of the lack of nationally recognized standards, your primary care provider should not be an Ayurvedic doctor (unless otherwise licensed as a primary care provider). Be sure communications flow both directions between your regular health care provider and your Ayurvedic doctor, so that if acute care needs arise, they can be appropriately handled.

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