Comparative Assessment Of Ayurvedic And Allopathic Methods

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Comparative Assessment Of Ayurvedic And Allopathic Methods
Ananya S. Gope
Abstract
This research paper will explore the methods of Allopathic and Ayurvedic medicine. Allopathic
medicine has a strong focus on symptomatic components, basing diagnostic and treatment
decisions on presented patient conditions. Contrastingly, Ayurvedic medicine, a traditional
approach native to the Indian subcontinent, is an all-encompassing wellness system that
emphasizes root cause and preventative medicine. The goal of this paper is to synthesize the
ideologies behind Allopathic and Ayurvedic approaches, compare varied responses to
hypothetical patient scenarios spanning mental and physical health, and review potential
integrative techniques to optimize patient health. The responses to all three patient scenarios
show a large overlap between the diagnostic rationale used by Allopathic and Ayurvedic medical
professionals. Treatment plans, however, tend to vary much more between the two due to the
difference between ideologies. All three Allopathic responses focused on the short-term while
Ayurvedic responses tended to favor a gradual treatment approach and placed a heavy
emphasis on prevention. The successful integration of underutilized herbal remedies and
modern surgical technology will result in a more effective healthcare system. This ideal can be
achieved through in-depth research that focuses on the compatibility of Allopathic and Ayurvedic
approaches.
Introduction
Throughout human history, many therapeutic practices have treated a range of medical
conditions. Some of these historical practices, including Ayurveda, Oriental medicine,
Osteopathy, and Reiki, are still being utilized to treat modern-day patients. This research
compares a modern Allopathic approach to a traditional Ayurvedic approach. By conducting
diagnostic cases grounded in each specialty’s framework, this research explores the tenets of
these two medical disciplines.
History of Allopathic Medicine
Coined in 1810, “Allopathy” has become a general term for the use of modern, Westernized
diagnostics, technologies, and approaches within the healthcare system. Its prefix “allos” means
“opposite” and “pathos” refers to suffering (What to know about allopathic medicine, 2021).
Upon creation, the practice of Allopathy was centered around treating a symptom with its
opposite. The term was initially used in a derogatory sense due to its undeveloped, radical
ideas, but it has since evolved into the mainstream medicine of today. Allopathic medicine is
currently the most widely accepted and practiced global medical approach. (Eldridge, L., MD,
2022).
Allopathic medicine was initially founded upon the principle of symptomatic treatment. The goal
of Allopathic medicine is to use opposites to counteract each other and restore balance after
infliction/disease. This brings us to the main difference between Allopathy and Ayurveda:
Allopathy promotes the patient's ease and quick return to normalcy while Ayurveda emphasizes
long-term cureability.
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Allopathic Ideologies
Allopathy is organized into specialty units that narrow down the required scope of knowledge for
practitioners. This also allows for a more standard procedure to be set in place. More general
roles such as general practitioners and hospitalists tend to be diversified and employ
cross-specialty knowledge. These individuals then utilize referrals and collaborative treatment
plans that optimize the abilities of field specialists who can provide more niche care and
treatment. (Allopathic and Osteopathic Medicine, n.d.)
Allopathic medicine accounts for patient symptoms and signs before treatment. After general
symptoms have been used to narrow the scope of the issue, diagnostic methods include
imaging, blood testing, direct pathologic sampling to confirm the presence and severity of
certain conditions. Patient feedback is also acknowledged and incorporated into the treatment
plan. Within Allopathy, a large importance is placed on patient and family history because of the
role of genetics in many medical conditions.
When physicians are developing a treatment plan, the patient's need is also considered with the
overall goal being to assist the patient in everyday life. The treatment plan is used to address all
aspects of a condition and therefore usually involves multiple healthcare specialists based on
severity and need. Allopathic treatments also tend to be more solution-based rather than
curative to help the patient quickly return to their daily life. Alternatively, Ayurvedic treatments
may take longer to accomplish this.
History of Ayurveda
The Sanskritic title “Ayurveda” roughly translates to knowledge of life and is used to describe the
practice’s overarching governing principles (Johns Hopkins Medicine, 2019). Ayurveda is a
natural system of medicine that originated in the Indian subcontinent at the time of the Indus
Valley civilization. During the Samhita period (between the 6th century B.C. and the 7th century
A.D), Ayurveda underwent a developmental interval that featured the introduction of various
guiding texts including the Charak Samhita, Sushurta Samhita, and Ashtanga Hridaya. This
literature is now utilized as the modern foundation for Ayurvedic reasoning and treatment.
Because the human body has not hugely evolved during this period, these teachings are still
considered applicable to modern patients (Narayanaswamy, 1981).
Although there has been a significant increase in global interest in Ayurvedic teachings, the
practice is still mostly limited to the Indian subcontinent through nearly 250,000 registered
Ayurvedic practitioners (Pandey, M. M. et al., A. K. S. 2013). Ayurveda has also not been widely
supported by allopathic sources due to a lack of evidence-based research, standardization, and
publication awareness.
Ayurvedic Ideologies
Ayurveda is a comprehensive, complete medical system with uniquely defined anatomy,
physiology, pathology, pharmaceuticals, treatments, and surgical techniques. The approach is
based on the five elements of space, air, fire, water, and earth. The idea is that the body’s
internal functions replicate the interactions between these elements that occur on an earthly
scale. For example, the bones within the human body represent the earth while water is
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represented by plasma fluid and lymph within the body. Metabolic and digestive processes are
indicative of the element fire. Space is present between all organs within the body while Air is
present in the abdomen. Similarly, these five elements are present within medicinal plants at
varying degrees. By ingesting such plants, ayurveda can adjust the level of each element within
the body. These concepts of human-cosmos interrelation are referred to as Panchamahabhuta.
These elements are further categorized into the three doshas, which are fundamental energies.
The three doshas are labeled kapha (water content), pitta (fire content), and vata (air content).
The guiding principle of Ayurveda is that by upholding a balance between these three doshas,
optimal health is achieved. It is also said that individuals are inclined to one of these elemental
dispositions. All diseases within Ayurveda can also be grouped under these three doshas. For
example, digestive/GI diseases are considered under pitta dosha because they are associated
with an increased level of the fire element. These doshas can also be combined based on
affected systems. The following figure labels the interactions between the doshas.
(Ayurveda Test | Euroved, 2018)
Based on the patient’s elemental disposition and how a disease will disrupt inner balances, an
Ayurvedic practitioner will recommend treatment avenues. There are also five main treatments
in the realm of Panchakarma: vaman (emesis), virechan (therapeutic purgation), basti (enemas),
nasya (nasal rinsing), and raktamokshana (phlebotomy). (Panchakarma Therapy – Treatment
Steps and Benefits, 2022)
Methods
For this study, perspectives from each discipline were synthesized and compared. Professionals
chosen for this study had previous knowledge of both Allopathic and Ayurvedic medicine with a
certified specialization in one field. This allowed for discussion of cross-discipline topics, such as
integrative techniques and infrastructure necessities. Due to the range of patient issues
discussed, an Allopathic professional with an extensive role in the healthcare system was
chosen for their expertise in a multitude of fields. Interviews were completed either through
conversation or a questionnaire accompanied by follow-up questioning.
During questioning, the allopathic-oriented participant was first asked basic profiling questions,
such as asking them to state their occupation, education and background, and any prior
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knowledge of Ayurveda. The Ayurvedic-oriented participant was similarly asked to state their
occupation, education and background, and alternatively asked for their perspective and
understanding of allopathic methodology. Both participants were then introduced to three case
scenarios and asked to walk through their diagnostic process and create a brief treatment plan
for each patient. Finally, participants were asked if they saw any benefit to integrating both
approaches and what changes to the current healthcare system were necessary to fit their
vision. For each response, similarities within approaches were condensed, while differences
between professional opinions were highlighted and discussed.
Scenario 1: Mental Health
To provide a full scope of each approach’s ability, patient scenarios in different specialty areas
were chosen. The following subsection describes the scenario presented to participants about
mental health. This scenario is a textbook case of clinical depression and was sourced from
Chafey et al. (2009).
Scenario Description
The patient was a 15-year-old adolescent female living with both her parents and a younger
sibling. Her parents presented with significant marital problems, had been separated several
times, and were discussing divorce. Her mother reported having a history of psychiatric
treatment for depression and anxiety and indicated that the patient's father suffered from bipolar
disorder and had been receiving psychiatric treatment. He was hospitalized on multiple
occasions during previous years for serious psychiatric symptoms.
After further questioning, participants were presented with the following details:
Recent Events: failed several classes in school, and her family was in the process of
looking for a new school due to her failing grades and difficulties getting along with her
classmates. She presented the following symptoms: frequent sadness and crying,
increased appetite and overeating, guilt, low self-concept, anxiety, irritability, insomnia,
hopelessness, and difficulty concentrating. In addition, she presented difficulties in her
interpersonal relationships, persistent negative thoughts about her appearance and
academic abilities, as well as guilt regarding her parents' marital problems.
Medical History: revealed that she suffered from asthma, used eyeglasses, and was
overweight. Her mother reported that she had been previously diagnosed with major
depressive disorder (MDD) 3 years ago and was treated intermittently for 2 years with
supportive psychotherapy and antidepressants (fluoxetine and sertraline; no dosage
information available). This first episode was triggered by rejection by a boy for whom
she had romantic feelings. Her most recent episode appeared to be related to her
parents' marital problems and academic and social difficulties at school.
Responses
Allopathy
Ayurveda
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Approach
Asked for further clarification of the
family’s situation with a focus on her
parents' current medication and
treatment; Assessed home safety
The patient is first characterized by
ailment. In this scenario, the ailment
is psychological. The patient's dosha
will then be identified by an
ayurvedic practitioner either through
a questionnaire or a discussion of
sleep and diet habits.
Diagnosis
Diagnosed with depression; the
patient may have underlying
anxiety; these psychological
patterns most likely developed as a
reflection of parental behavior
All psychological issues within
Ayurveda fall under the label
Manasika Vyadhi which
encompasses disorders that
allopathy refers to as anxiety,
depression, schizophrenia,
insomnia, psychosis, etc.
Treatment/Referrals
This patient's condition was most
likely identified through school or a
general physician. The first step
would be to complete a risk and
severity assessment through a
screening questionnaire. From the
patient's initial description, the next
step would be to reach out to a
psychologist and psychiatrist.
Generally, based on the patient's
age, pharmacological treatment
would not be the initial
recommendation. Instead, lifestyle
changes and counseling would be
the first mode of intervention.
Counseling sessions could consist
of parental counseling, patient
counseling, or combined
patient-parent counseling.
Anti-depressants would be used as
a last resort in case of extreme
behavior, such as manic or
depressive episodes, or suicidal
thoughts. If these are prescribed,
side effects would be carefully
monitored and the dosage would be
gradually increased until a benefit is
seen.
The patient would begin with initial
questionnaires to characterize the
imbalance and identify their
constitution. Advice would include a
change of environment to reduce
external stressors and the addition
or increase of prayer or meditation
to add to mental positivity and
calmness. Medicinal therapies such
as purgation may be used to
decrease the pitta and kapha dosha.
The patient should also schedule
shirodhara therapy in which warm oil
is dripped onto the forehead to
generate vibrations. These
vibrations convert from kinetic
energy into neural impulses which
then influence the secretion of
neurohormones. Shirodhara can be
used to create calmness or reduce
anxiety. Herbal medications may
also be used to adjust pitta and
kapha levels, although this would
not be used as a first response due
to the patient's age.
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Timeline/Effectivenes
s
Some notable aspects of this
approach include the 3-6 month
time period required to experience
the effects of the antidepressants. If
a benefit is not seen, psychiatrists
may need to increase the dosage,
decrease the dosage, or change
the medication type. Additionally,
because of the temporary quality of
psychological drugs,
antidepressants would not be a
long-term fix for this patient, rather,
the goal would be to fix underlying
issues.
Shirodhara is a non-invasive, weekly
repeated treatment for several
weeks, and can then be adjusted
based on the patient's preferences.
Ayurvedic herbal medications are
taken for an approximate span of
3-6 months until treatment is
considered complete.
Current
Progress/Events
Many hospitals across the country
have begun implementing
adolescent behavioral units to
address the increase in mental
illness cases.
Findings
Both disciplines accounted for the effect of environmental factors during their diagnostic
process. Ayurveda also discusses the patient’s dosha characterization. Where Allopathy has a
specific name for clinical depression, Ayurveda uses the broader label “Manasika Vyadhi” to
accommodate this condition. Both treatment recommendations contained a significant overlap;
however, the ideology behind each was different. Allopathy focused on creating situational
changes and counseling while Ayurveda promoted mental clarity and balance. On the
pharmaceutical side, Ayurvedic herbal remedies are typically used for a shorter period of 3-6
months and then the treatment is considered complete. In contrast, the prescription of modern
antidepressants must be more closely monitored and adjusted over a longer period. The
treatment of shirodhara (oil therapy) has also been shown in multiple case studies to show a
significant improvement in stress and depression levels. Overall, this patient would be
diagnosed and treated by both approaches.
Scenario 2: Physical Health
This second scenario was geared toward physical health and the description was from the
Osteoarthritis Action Alliance (2023). This scenario presents an osteoarthritis case as it relates
to obesity. The following subsection describes the scenario presented to participants.
Scenario Description
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Emma is a 35-year-old woman who injured the ACL and meniscus in her right knee playing
NCAA collegiate soccer at age 20. Her ACL was surgically reconstructed, and she returned to
play after completing a full physical rehabilitation program. During her annual physical, she
commented that her right knee feels achy some mornings when she wakes up. She also notes
that while kicking the soccer ball with her children over the last couple of months, she has felt
twinges of pain and weakness in her right knee. Emma is 5’11” and 215 pounds (BMI 30 kg/m2).
On her pre-visit worksheet, Emma reported that she engages in moderate exercise about once
per week for 30 minutes but is otherwise fairly sedentary. She also reported eating fast food for
lunch 5 days a week.
Responses
Allopathy
Ayurveda
Approach
Assess factors including current
physical symptoms and reported
severity, as well as patient medical
history. Taking into account the
patient's pain in the knee, a knee
arthroscopy would be completed to
check for arthritis.
Based on the patient's symptoms,
an Ayurvedic practitioner can
characterize the affected doshas to
assist in finalizing a diagnosis. In
this case, because the patient feels
pain, an imbalance in vata must be
involved. The patient's weight
indicates an imbalance of kapha.
Diagnosis
Diagnosed as overweight; knee
pain in the right knee due to
osteoarthritis
Knee Pain corresponds to an
increased vata level, while weight
gain corresponds to an increased
kapha level in Ayurveda.
Treatment/Referrals
To address weight issues, the
patient should implement a weight
reduction/management plan that
features a gradual increase in
exercise durations. It is also
important to note during the
development of this plan, the
patient's pain tolerance and to
utilize exercises that avoid stress on
the leg. Concerning the patient's
osteoarthritis, they should schedule
physical therapy sessions to
address mobility issues. The patient
may have a scheduled
Tylenol/Motrin/ibuprofen intake for
pain management. If mobility issues
persist, the patient should consider
surgical options through an
orthopedic doctor, such as a
Oil therapies, such as Janudhara, in
which oil is poured over the joint,
can be used to decrease vata levels.
This, accompanied by light
massaging of the joint will reduce
pain and stiffness. Herbal
fermentation and steam therapies
can also be used to decrease vata
levels and reduce joint pain. Kapha
levels can be reduced with dietary
inclusion of honey, vaman (emesis),
udvartana (powder massage),
virechan (therapeutic purgation), or
basti (enemas). If these treatments
do not have the desired effect, the
use of herbal medications can also
adjust vata and kapha levels.
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complete or partial knee
replacement.
Timeline/Effectivenes
s
Partial knee replacement surgery
can temporarily relieve pain from
osteoarthritis, but does not act as a
cure. Complete knee replacement
surgery can provide a joint that lasts
up to 20 years.
Jhanudhara would continue weekly
for 3-6 months and can then be
adjusted to accommodate any
further pain. Kapha-reducing
therapies would conclude in 3
weeks and then herbal medications
may be utilized.
Current
Progress/Events
Some orthopedic professionals
have made use of repeated
viscosupplementation, referred to
as Hylan Synvisc injections, to
provide joint lubrication and relieve
knee pain.
Findings
Both disciplines separated the patient’s treatment to focus on two main concerns: the patient’s
weight and knee pain. On the Allopathic side, exercise and dieting were the basis for weight
reduction and management. Ayurveda similarly offered dietary changes, but provided herbal
supplements and physical treatments rather than exercise. Both disciplines offer a gradual
approach to modification of the patient's weight. To respond to the patient’s knee pain, Allopathic
professionals provided instant pain relief along with a diagnostic plan to test for osteoarthritis. If
osteoarthritis was confirmed, a partial or complete knee replacement surgery would be
recommended.
Allopathic professionals also would refer the patient to a physical and orthopedic therapist for
long-term care to provide a more holistic treatment. To reduce the patient’s knee pain, Ayurveda
offered a more long-term treatment that has been shown to have semi-permanent results
(Centre for Reviews and Dissemination (UK), 2014). Another point that emerged during the
Ayurvedic discussion of this scenario was the importance of Allopathic techniques. Upon
introduction, professionals explicitly stated that if the ACL (Anterior cruciate ligament) was
affected in any way, Allopathic surgical methods should be used because of the instant
effectiveness provided.
Scenario 3: Melanoma
The last scenario presented concerned a patient showing signs of early-stage melanoma. This
scenario was sourced from A Case of Melanoma (n.d.). The goal of this section is to compare
the responses of each discipline when faced with a long-lasting, difficult-to-treat, globally
prevalent condition.
Scenario Description
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Demographics: A 38-year-old white man presented to a dermatologist for evaluation of a
suspicious lesion on the right side of his nose.
History: The patient reported that he had been at a cookout when a family member had
asked about the mole on his nose. The patient stated that he thought that the lesion had
always been there but could not say for certain. The patient stated that he had not
noticed a change in the lesion; however, he had not been monitoring it for change. He
denied pruritus, bleeding, or erythema of the lesion. He reported no family history of skin
cancer or other skin disease. The patient’s occupation required him to work outdoors at
times. He denied consistent sunscreen use while outdoors.
Physical examination: Upon evaluation, the patient was noted to have a singular,
irregularly shaped lesion on the right dorsum nasi, brown and black, and approximately 4
mm in size at the largest diameter.
Professionals were also presented with the following image from A Case of Melanoma (n.d.):
Fig 1. Lesion on side of patient's nose
Responses
Allopathy
Ayurveda
Approach
First, the patient's age and medical
history were considered. Then, the
permanence of the lesion's
presence was questioned.
Long-lasting periods of unchanged
behavior can increase the likelihood
that the lesion is benign. Next,
when evaluating the image, the
ABCDE method was used to search
Ayurvedic standards indicate that
any skin pigmentation is related to
an imbalance of pitta. The factors
that would be considered for
diagnosis would be appetite, diet,
digestion, bowel habits, and
temperament.
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for asymmetry, border irregularities,
color discrepancies, and larger
diameters, and evolution of
size/shape/color which are
associated with malignancy. The
height of the lesion was also taken
into account. A malignancy
diagnosis would be confirmed
through a biopsy.
Diagnosis
Based on the initial screening, the
lesion was determined to be a
nevus that could develop into
melanoma. The patient would be
referred to a dermatologist who
would confirm the diagnosis through
a biopsy and establish a treatment
plan.
This patient would be classified
under the ayurvedic title of Arbuda,
a term used as an equivalent to all
types of cancer.
Treatment/Referrals
After melanoma is confirmed
through test results, treatment of
any stage of melanoma would be
composed of surgical removal of
the lesion.
The first step would be to reduce the
patient's pitta by avoiding alcohol
and hot, spicy foods made with
chilies, raw onion, raw garlic,
mustard, and cayenne. Purgation
treatments can be used to reduce
pitta as well. Certain herbal
medications can be used to change
the appearance of the skin. Some
applied examples include
sandalwood, neem oil, ghee
medicines, etc, while ingested
medications can include
ashwagandha (Indian ginseng),
kanchar (blooms from bauhinia
tree), turmeric, ginger, amla (Indian
gooseberry), and tulsi (basil).
Ayurvedic remedies have also been
shown to have positive results in
melanoma prevention.
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Timeline/Effectivenes
s
Surgical removal of melanoma has
shown to be a highly effective
treatment option for earlier stages.
These treatments can be used to
reduce symptoms gradually, but
may not show a highly effective
outcome in the short-term. For that
reason, these are not viable
solutions to melanoma conditions
and should instead be used in
combination with other disciplines as
prevention or symptom
management.
Current
Progress/Events
With the rise of AI technology,
online dermatology applications
have been trained to diagnose skin
conditions by image with a relatively
high accuracy. Although this is still
under development and requires a
medical professional to confirm the
diagnosis, it does introduce a
primary diagnostic platform for
patients.
Findings
It is interesting to note the similarities between diagnostic methods that were established
centuries apart. Ayurvedic practices also use a process similar to the allopathic ABCDE method
to evaluate skin lesions. This method looks for the following features to differentiate whether it is
a malignancy or benign lesion: Vrittam (round), the Sthiram (immovable), the Manda Ruja
(slightly painful), the Mahant (big size), the Alpamoolam (deep-seated) (C.P et al., 2020). When
faced with this scenario, professionals of both disciplines showed some difficulty with diagnosis,
most likely due to the presentation of a very early-stage case of melanoma. In terms of
treatment and effectiveness, each has its benefits. According to further research, "if cancer cells
are found in the lymph nodes, further treatment will become necessary, such as a lymph node
dissection.., chemotherapy, immunotherapy, or targeted therapies'' (Mount Sinai Health System,
n.d.). Skin grafting can also be used to cover any wounds left from surgical treatment. The
following effectiveness statistics are taken from Melanoma Survival Rates - Melanoma
Research Alliance (n.d.):
Stage I, and Stage II: 98.4%
Regional melanoma- Stage III: 63.6%
Metastatic melanoma- Stage IV: 22.5%
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Allopathy offers an immediate solution through surgical removal however allows the possibility
of relapse. Adversely, Ayurveda offers long-standing preventative measures against melanoma
symptoms. In this way, the application of Ayurveda preceding or following surgical removal could
be a highly effective option against melanoma.
Discussion
When reviewing possible integration strategies, Allopathic professionals saw a benefit in
incorporating herbal remedies to lessen chemical side effects. However, they explicitly cited the
need for expansive research into the effects of herbal remedies and their compatibility when
used alongside Allopathic drugs. It is currently recommended that patients using natural
medications disclose all information to their healthcare professional and, in most cases, stop
taking them together. For a successful combination of these two disciplines, in-depth research
and education is required to increase practitioner and patient confidence.
From an Ayurvedic standpoint, Allopathic surgical methods have evolved to address medical
needs far beyond the scope that Ayurveda can provide. In this area, Allopathic treatments are
better for patient health and more reliable. It has been made clear by Ayurvedic professionals
that specific conditions that deal with internal function or extreme blood loss should only be dealt
with through modern technology. However, although Allopathic technologies have improved
rapidly, Ayurvedic professionals point out the negative effects that tend to accompany modern
drugs and pharmaceuticals.
By combining certain herbal pharmaceuticals from Ayurveda with the abilities of precision
surgical technology, patients may experience decreased side effects while still receiving benefits
from reliable modern interventions.
Conclusion
This paper sought to contrast Ayurvedic and Allopathic medicine. After interviewing practitioners
in their specialized fields this paper determined that meaningful similarities exist across
Ayurvedic and Allopathic approaches. Both take a systematic approach when understanding the
patient’s diagnosis, but they differ in their approach to treatment. Ayurvedic medicine lacks the
precision technology to combat more serious illnesses and conditions and relies on traditional
herbal treatments, while Allopathic medicine has a greater interplay with pharmaceuticals and
technology. Both practices benefit patient health and well-being which can be retained by further
research into a combined approach that optimizes the strengths of both disciplines.
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Acknowledgments
I would like to extend my thanks to Jyothi B. Kudakandira, M.D. and Dr. Praveen Kumar
Madikonda for their participation, theoretical explanations, and contributions from their broad
expertise in their respective fields which added an increased level of complexity and
understanding to the research presented. Without their thoughtful additions and suggestions,
this paper would not be possible. Their credentials can be found below:
Dr. Jyothi B. Kudakandira, St. Luke's Hospitalist Medicine, St. Luke's University Health
Network, Bethlehem, Pennsylvania, USA
Medical School
JSS Medical College, 2001
Residency
Bronx-Lebanon Hospital Center, 2006 - 2009
Residency
Government Medical College, 2002 - 2004
Dr. Praveen Kumar Madikonda, Ayurvedic General Physician, Uma Ayurvedic Speciality
Center, Hyderabad, Telangana, India
MD (Ayurveda Medicine)
Institute Of Medical Sciences, Banaras Hindu University (IMS-BHU) - 1999
BAMS (Ayurveda)
Dr. NTR University Of Health Sciences Andhra Pradesh - 1994
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