An Overview of the Naturopathic Medicine Protocol Used in Inpatient Yoga and Naturopathy Hospitals in India: The Prakriti Shakti Protocol

Abstract

Naturopathic medicine is a popular form of complementary and alternative medicine systems practiced worldwide. This study provides an overview of a typical inpatient yoga and naturopathy protocol followed in India. Naturopathic medicine is commonly used in the management of certain lifestyle-related disorders, such as diabetes mellitus, hypertension, obesity, cancer, musculoskeletal disorders, endocrine disorders, and neurological disorders. Moreover, naturopathic medicine integrates different lifestyle medicine practices, such as yoga, diet, acupuncture, hydrotherapy, and color therapy into its treatment plans. Moreover, India is one of the few countries that offer naturopathy treatments through inpatient hospitals. Although the clinical efficacy of naturopathic medicine practices in various pathological conditions has been confirmed, no studies have yet investigated the effectiveness of naturopathic medicines protocols in naturopathic inpatient settings. Naturopathic physicians use a set of philosophical principles when determining their therapeutic order and all therapies that upregulate physiological homeostasis.

INTRODUCTION

Naturopathic medicine is one among the largely practiced complementary systems of medicine across the globe with more than 108 countries having practicing naturopaths catering to over 5.5 million patients [1]. With the global increase in non-communicable diseases, naturopathy stands as a system of medicine that aligns with public health principles, emphasizing preventative health measures and risk reduction [2]. Naturopathic medicine practice integrates a conglomerate of therapies and practices that are used in various permutations and combinations as per the need of individual patients. Naturopathy treatment plans are curated by the naturopathic physicians after thorough case taking and in alignment with the naturopathic philosophies [3]. India is one among the few other countries which promotes indigenous medical systems with separate health policy. Naturopathic medicine in India is a structured practice where naturopathic physicians are licensed by their respective state governments and their hospitals are recognized under the clinical establishment act and are accredited by the National Accreditation Board for Hospitals & Healthcare Providers [4].

Unlike global scenario where naturopathic medicine is an umbrella term for all complementary and alternative medicine practices, in India yoga and naturopathy are clubbed together as a single system of medicine [4]. Similarly, all the clinical protocols developed by naturopathic physicians shares an intersecting paradigm with yoga philosophies [3]. This concept serves as the cornerstone for both yoga and naturopathic medicine clinical protocols. Besides this, naturopathic medicine protocols include components that are aimed at empowering the patients to take the onus of health as their own responsibility and to position the role of doctor as a teacher [5].

Numerous studies have been published to date substantiating the clinical efficacy of naturopathic medicine practices across diverse disease spectra [6-12]. However, a comprehensive clinical protocol employed in typical yoga and naturopathy settings, particularly in India where these therapies are administered as inpatient services, is lacking. The present paper provides an overview of a clinical protocol used in an inpatient yoga and naturopathy hospital from India. The aim is to assist stakeholders and physicians in elevating the standards of naturopathy settings, simultaneously facilitating the delivery of high-quality care to patients.

THE PRAKRITI SHAKTI PROTOCOL

1. The location

A naturopathy and yoga setting is usually situated in a tranquil and serene environment, providing access to the natural elements of earth, forests, water, and fresh air. This aligns seamlessly with the principle of “return to nature.” The overarching goal is to commence the healing process from the moment the patient arrives at the location.

2. Consultation and treatment planning

Upon admission, patients undergo an initial screening encompassing vital signs assessment, anthropometric measurements, body composition analysis, and evaluation of mental health parameters such as quality of life, stress, anxiety, or depression, utilizing validated instruments. Each patient dedicates a minimum of 30 to 60 minutes daily in consultation with a doctor. This practice encourages patients to express suppressed emotions, habits, and weaknesses, ultimately aiding the physician in identifying the root cause and planning treatments accordingly. Additionally, patients receive detailed information about the nature of the program, anticipated outcomes, and guidance on optimizing their overall experience. This practice is based on standard naturopathy physician manual that recommends understanding each patient’s individual story for developing personalized clinical protocols [13].

3. Morning meditation and yoga practice

The naturopathy program commences at 6:30 am (Indian Standard Time) with panchamaha bhootha upasana, involving meditation on the five great elements. During this session, patients are guided to align their minds and breathing with the elements of earth (prithvi), water (jal), fire (agni), air (vayu), and space (aakash). Rooted in ancient Indian philosophical teachings, this practice is based on the concept that all creations in the world consist of these five elements, interacting harmoniously, the imbalance of which results in disease [14]. By engaging in this practice, patients gain an understanding and appreciation for the holistic nature of the human body and its inherent self-healing capacity.

Subsequently, there is a one-hour session of guided yoga practice, encompassing postures, meditation, and breathing exercises designed to stimulate the parasympathetic nervous system. Combined with panchamaha bhootha upasana, yoga practice helps in developing salutogenic resources in the patients.

4. Naturopathy treatments

Following the morning routine, patients undergo a 20-minute mud pack application to the eyes and abdomen. This practice has demonstrated diverse psychological and metabolic benefits, including stress relief, enhanced mindfulness, and the regulation of blood glucose levels and heart rate variability [15-17]. This is a routine therapy practiced in all yoga and naturopathy hospitals across India.

This is followed by one main treatment for 60 to 90 minutes and one secondary treatment for 30 minutes. These treatments typically encompass therapies such as massage, mud applications, hydrotherapy, chromotherapy, and heliotherapy. The specific combination of main and secondary treatments may vary each day or may be repeated based on the doctor’s assessment of the underlying clinical condition. Philosophically, these treatments are aimed towards rejuvenating vitality, eliminating toxemia, and rectifying the abnormal composition of blood and lymph. From a scientific perspective, these therapies aim to upregulate physiological and psychological functions, ultimately restoring homeostasis [6]. A detailed list of main and secondary treatments is available in the supplementary file (Tables 1, 2).

Table 1.

List of main and secondary treatments

Main treatment	Secondary treatment
Atapa madhusnana (banana leaf honey bath)	Alternate affusion
Banana leaf bath	Arm & foot bath
Earth wrap	Hip bath cold
Eliminative massage	Mud poultice
Deep tissue massage	Mud application
Energising massage	Therapeutic massage
Full body herbal application	Oil pooling
Full body alternate mud poultice	Foot reflexology
Full body hot mud poultice	Sitz bath
Full wet sheet pack	Spinal bath cold
Herbal application	Steam bath
Rejuvenation therapy with steam bath	Sauna bath
Relaxation therapy
Revitalizing therapy with sauna
Additional therapy
Cupping	Gastro hepatic pack
Abdominal pack	Foot immersion bath-hot
Acupuncture	Foot immersion bat-alternate
Alternate hot and cold application	Ice application
Chest pack	Infra-red ray & wintergreen oil application
Cold water affusion	Interferential therapy
Enema	Jaladhaara
Eye and abdominal mud pack	Joint mobilization
Face pack	Kidney pack
Facial steam	Knee pack
Fomentation bag	Leg pack
Moxa	Liver pack
Oil application	Muscle stimulator
Ultra sound	Mustard application
Body walk with salt kizhi	Mustard pack
Oil pooling	Neck pack

Table 2.

Diet therapy protocol of naturopathy hospital

Time	Type	Eliminative culinary	Soothing culinary	Constructive culinary
6:00 am	Water	I glass of neutral water with 1 table spoon basil seeds socked overnight in it	I glass of neutral water with 1 table spoon basil seeds socked overnight in it	I glass of neutral water with 1 table spoon basil seeds socked overnight in it
06:20 am	Juice	Thin alkaline juice that doesn’t provide energy nor demand energy for digestion	Thin alkaline juice that doesn’t provide energy nor demand energy for digestion	Thin alkaline juice that doesn’t provide energy nor demand energy for digestion
08:00 am	Juice	Thin juice that doesn’t provide energy nor demand energy for digestion	Thin juice/thick juice	Thin juice/thick juice
10:00 am	Brunch	Fruit or vegetable based thin juice that doesn’t provide energy nor demand energy for digestion	Fruit or vegetable based progressive thick/semi thick juice	Fruit or vegetable based enriched full course meal
1:00 pm	Tender coconut water	Tender coconut water	Tender coconut water	Tender coconut water
3:15 pm	Hot beverages	Non stimulating non spicy drink (no snacks)	Non stimulating non spicy drink (no snacks)	Non stimulating non spicy drink with snacks
6:00 pm	Dinner	Fruit or vegetable based thin juice that doesn’t provide energy nor demand energy for digestion	Fruit or vegetable based progressive thick/semi thick juice	Fruit or vegetable based enriched full-course meal
8:00 pm	Juice	Thin juice that doesn’t provide energy nor demand energy for digestion	Thin juice that doesn’t provide energy nor demand energy for digestion	Thin juice that doesn’t provide energy nor demand energy for digestion

Ingredients using for preparation: Fruits, vegetables, nuts, seeds and dry fruits, millets, honey, sugarcane and other edible grasses, flowers, sprouts, and green leaves.

Besides this, most of the inpatients engage in one session of Laghu Shankha Prakshalana (LSP), a yogic colon cleansing procedure. This practice involves performing five yoga postures repeated 5-10 times, facilitating natural bowel movements [18]. LSP is known to improve the autonomic function, relieve stress, pain, and upregulate the mental health function [18,19].

5. Diet and fasting

Fasting and diet is an important component of yoga and naturopathy therapeutic protocols [20]. A standard naturopathy diet comprises three key types: i) constructive diet, ii) soothing diet, and iii) eliminative diet. Patients initiate their dietary regimen with a constructive diet, progress to a soothing diet, and then transition to an eliminative diet. This sequence is gradually reversed, returning to a soothing diet and constructive diet. The detailed description of the diet types is tabulated in supplementary file. Each patient participates in a daily 20-minute culinary training session conducted by a trained chef. This training equips patients with knowledge about various naturopathy diet recipes, enabling them to seamlessly integrate these practices at home and sustain the clinical benefits acquired during their inpatient stay.

6. Recreation

Additionally, all the patients participate in an exclusive recreation program that involves games, light music, dance, and trataka (eye exercises) during their stay. This is intended to reduce stress, elate the mood and induce good sleep. Many naturopathy hospitals in India incorporate this practice into their clinical protocols, recognizing the significant healing potential associated with rest and relaxation. The overall treatments are depicted in Fig. 1.

Fig. 1.

Overview of yoga & naturopathy treatments included in the Prakriti Shakti protocol.

7. Discharge and follow up

Following their stay, patients undergo comprehensive post-measurements, including vital signs, anthropometric data, body composition analysis, and mental health assessments using validated tools, along with feedback forms. They receive an explanation of the benefits gained during their stay. Consultations emphasize the importance of adopting a healthy lifestyle, being proactive in health, and reducing disease risks post-discharge. Patients are also provided with a personalized diet chart, yoga plan, and behavior change strategies for sustained long-term health.

CONCLUSION

Naturopathic medicine uses a pragmatic protocol aligned with its guiding philosophies which intends to stimulate the self-healing capacity of the body. The protocol predominantly focuses on the routine detoxification methods administered to patients with the objective of health rejuvenation. However, it is important to note that naturopaths also administer a variety of disease-specific treatments by incorporating physiotherapy, acupuncture, functional medicine, and other integrative medicine therapies which is beyond the scope of the described protocol. However, there are individual differences in the practices or procedures used by naturopathy physicians based on their years of experience, type of training received and regulatory statues. The insights presented in this paper can provide valuable guidance for stakeholders and physicians in the standardization and advancement of naturopathy settings, while concurrently facilitating the delivery of top-notch care to patients.