Eyes closed and ears plugged with cotton, a guest at a health resort lies on a fiber table padded with pillows. Warm, herb-infused buttermilk flows steadily on her forehead from a small hole in a bowl suspended low from the ceiling.
It's one of the treatments used in Ayurveda, or "science of life," the ancient Indian method of healing.
In the West, Ayurveda is perhaps most closely associated with oily spa massages, but a trip to India uncovers Ayurveda's deep roots and diverse techniques. Ayurveda's tools include herbal extractions, a wide range of body treatments, a light vegetarian diet and yoga.
In India's southwestern state of Kerala, Ayurveda is deeply embedded in the culture. It's administered to India's poorest in gritty urban clinics, but also to pampered Westerners in tranquil resorts in tropical settings.
Dr. Balakrishnan Gireesh, a fourth-generation Ayurveda doctor, spans both worlds.
He's an Ayurveda practitioner with a storefront clinic and pharmacy on one of the noisiest corners in Kottayam, a congested town of 60,000 in Kerala. His patients come with a broad range of complaints, from swollen knees to postpartum pain and high cholesterol.
In one of Kottayam's suburbs, Gireesh runs the Athreya Ayurvedic Centre, a resort for tourists and well-to-do Indians. Patients stay for two or three weeks, some seeking relief from the side effects of chemotherapy or anti-depressants, while others try out Ayurveda as a last resort for sometimes hard-to-treat problems like psoriasis and herniated discs. Yet others just come to relax.
Regardless of the setting, the basic principle remains the same — to cleanse the body and, practitioners believe, give it a chance to balance itself.
Sabine Steiger, 28, an anthropology student from Vienna, said she hopes to ease tension headaches and improve her skin.
"I was always interested in Ayurveda and wanted to experience it," said Steiger, who spent two weeks at Athreya. "It might also be useful for my studies."
Dr. S.P. Sreejith, medical director at Athreya, says he tells patients what to expect from Ayurveda, including its limitations. For example, Ayurveda is of no use to someone who just suffered a heart attack, but its emphasis on a healthy lifestyle can help prevent heart disease.
At Athreya, a patient typically has two or three treatments a day in gender-segregated buildings. Here's what to expect in a two-week general cleanse, though the course of treatment is adjusted for specific complaints.
For the first few mornings, you lie on the treatment table as two therapists, synchronizing movements, slowly pour warm herbal water over your body, up and down, back and front, for about an hour. In the afternoon, you get the buttermilk-on-forehead treatment. Called Sirodharda, the practice is meant to calm the mind, but according to Sreejith, it can also ameliorate psoriasis and other ailments.
Patients must also undergo one unpleasant but brief session of induced vomiting. Afterwards, synchronized therapists administer daily massages with medicated oil for several days, each time followed by 10 minutes of sweating in a wooden box filled with medicated herbal steam.
In the second week, you begin at dawn each day, clearing your head with a head massage, nasal drops, facial steam and finally by sniffing smoke from a burning cloth soaked in camphor and other herbs (don't try that at home).
After a break, the therapists, again in synchronized movements, pound and slather your body with rice-stuffed poultices, on the first few days soaked in warm oil and then in a mix of milk and herbs.
Daily yoga sessions and herbal extractions taken before and after meals round out the day.
Sreejith or his wife, G. Jayalakshmi, who is also an Ayurveda doctor, check on you once a day, sometimes coming by your cottage for a chat on the porch. They might adjust the program depending on your body's responses. Each patient fills out a health questionnaire before arrival and Sreejith recommends a preliminary consultation via Skype.
Athreya, with a capacity of 35 patients, is a family business (Jayalakshmi is Gireesh's daughter) and the style is informal.
In the U.S., the National Institutes of Health's National Center for Complementary and Alternative Medicine says "scientific evidence for the effectiveness of Ayurvedic practices varies." The center also cited several studies of over-the-counter Ayurveda remedies found to contain toxins like lead or mercury, though Sreejith says Athreya's pharmaceuticals company operates under strict government supervision.
About 600,000 foreign tourists, many from Europe, visit Kerala, a state with more than 30 million people, every year, said Chandri Nambiar, a Kerala tourism official, and nearly 35 percent are repeat visitors seeking Ayurveda treatments.
'This is God's medicine'
At Athreya, a private cottage with meals and treatment runs $90 to $120 daily (single occupancy). Prices at other resorts vary; some operate in more luxurious beachfront settings, with the feel of a spa rather than a medical retreat. In all, Kerala is home to 92 government-approved Ayurveda resorts, rated either with the top Green Leaf or slightly lesser Olive Leaf rating, based on the level of Ayurveda they practice, Kerala tourism officials say.
Sreejith says visitors can avoid glorified massage parlors posing as Ayurveda centers by checking whether male therapists treat female patients and vice versa (a no-no) and whether there's a doctor on the premises (a must).
Foreigners who come to India for Ayruveda may find it's more affordable here than in the West even counting travel costs. It's not uncommon for U.S. spas to charge $100 an hour for Ayurveda-style treatments.
Other advantages to seeking treatment in India include the availabilty of herbs and other ingredients. Kottayam has a weekly herbs-and-spices market, and if a therapist needs another palm leaf to scrape oil and milk off a patient's body, she can just break one off the nearest coconut tree.
Sreejith says getting away from daily pressures can also contribute to the success of treatment. Kerala's lush green landscape offers a change of scenery, and several day trips are available from Athreya, including to the "backwaters" — a huge network of lakes, lagoons and canals near the Arabian Sea — and to the tea plantations in nearby mountains. In Kottayam, about 15 minutes by car, large fabric stores lure shoppers with a vast array of colorful silks and cottons.
On a recent afternoon at Gireesh's clinic in Kottayam, patients included a pharmaceuticals salesman seeking to lower his cholesterol, an older man with swollen arthritic knees (treatment: hot herb-soaked bandages) and a woman suffering from anxiety after falling off a roof.
Gireesh says his patients' attitude is important. "This is God's medicine," he said. "With faith, it works better."
Sreejith, who works at a government Ayurveda clinic during the day, has started videotaping some of his treatments of Indian patients, such as a medicated water rinse and leech application for a leg abscess.
"We would like the world to see what Ayurveda is capable of, and also what it is not capable of, and to show it as far as possible with evidence," Sreejith said.
Gireesh says Ayurveda is experiencing a renaissance among Kerala locals. He started working in his grandfather's private clinic in Kottayam in 1979. At the time, the rich opted for Western medicine, and Ayurveda was for the poor, he said. Today Kerala's public health care system employs 1,500 Ayurveda doctors and patients can choose between Western medicine, homeopathy and Ayurveda.
"In Kerala, everyone has access to Ayurveda," said Nambiar, "from the simple man to the affluent."