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INDEX – GJRMI - Volume 4, Issue 2, February 2015 INDIGENOUS MEDICINE Ayurveda - Review Article – Dravya Guna CONTRIBUTION OF DHANWANTARI NIGHANTU TOWARDS DRUG SAFETY: A CRITICAL REVIEW Anagha Ranade*, Rabinarayan Acharya
20–29
Ayurveda - Review Article – Moulika Siddhanta CONCEPT OF LIFESTYLE IN AYURVEDA CLASSICS Saylee Deshmukh*, Mahesh Vyas , Hitesh Vyas, Dwivedi R R
30–37
Ayurveda – Kaumarabhritya CLINICAL EVALUATION OF AN AYURVEDIC FORMULATION IN THE MANAGEMENT OF MENTAL RETARDATION Deepa Makhija*, Pratap Makhija, Babasaheb Patil
COVER PAGE PHOTOGRAPHY: DR. HARI VENKATESH K R, PLANT ID – FRUIT OF SHWETHA GUNJA – ABRUS PRECATORIUS L. OF THE FAMILY LEGUMINOSAE PLACE – KOPPA, CHIKKAMAGALUR DISTRICT, KARNATAKA, INDIA
38–45
Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29 ISSN 2277-4289 | www.gjrmi.com | International, Peer reviewed, Open access, Monthly Online Journal
Review article CONTRIBUTION OF DHANWANTARI NIGHANTU TOWARDS DRUG SAFETY: A CRITICAL REVIEW Anagha Ranade1*, Rabinarayan Acharya2 1
PhD scholar, Department of Dravyaguna, IPGT & RA, G.A.U, Jamnagar, Gujarat, India Professor, Department of Dravyaguna, IPGT & RA, G.A.U, Jamnagar, Gujarat, India *Corresponding Author: anagharanade11@gmail.com 2
Received: 02/01/2015; Revised: 25/01/2015; Accepted: 03/02/2015
ABSTRACT The concern about safety of Ayurvedic medicines is augmented with their increased use globally. The concept of Pharmacovigilance in Ayurveda is taking roots in this line. Acharyas have already cautioned about the optimum and careful drug usage in Ayurveda. Pertaining to Dravyaguna, the Nighantus give a vivid drug to drug description along with its pharmacovigilant aspects. Dhanwantari nighantu, one of the oldest among them specifies adverse effects of drugs and even food items. The present paper is an attempt to highlight the pharmacovigilant aspects of certain medicinal plants documented in Dhanwantari nighantu.
KEYWORDS: Pharmacovigilance, Ayurveda, Dhanwantari Nighantu
Cite this article: Anagha Ranade, Rabinarayan Acharya (2015), CONTRIBUTION OF DHANWANTARI NIGHANTU TOWARDS DRUG SAFETY: A CRITICAL REVIEW, Global J Res. Med. Plants & Indigen. Med., Volume 4(2): 20–29
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29
INTRODUCTION: Pharmacovigilance also known as Drug Safety, is the pharmacological science relating to the collection, detection, assessment, monitoring, and prevention of adverse effects with pharmaceutical products (Anonymous, 2002). In this modern era of medicine, this branch is gaining attention and moreover the broad target is the evaluation of safety and efficacy of traditional systems of medicine; Ayurveda being on the top in the list as regards to its manifold usage across the globe. Ayurveda has way back considered the drug to be a double-edged sword and cautioned about its adverse reactions (Yadavji Trikamji, 2011). Ayurvedic literature gives detailed description of drug-drug and drug-food incompatibilities which has been included in various Samhitas (treatise) in proper (Yadavji Trikamji, 2011). The varied modes of prevention of many undesired events have also been highlighted by advocating usage of techniques of Shodhana (detoxification) in some compendias (Indradeo tripathi, 2011). Samhitas have portrayed the vigilance of adverse effects of drug while denoting the treatment module e.g. in case of administration of Bhallataka (Semecarpus anacardium Linn), prior intake or application of ghee internally in the oral cavity is indicated to avoid adverse effects (Yadavji Trikamji, 2011). Other literary sources like Nighantus (lexicons) have entailed a vivid description of pharmacotherapeutic properties of individual drugs which is lacking in Samhitas. The side effects have been reported subtly in these texts. In the recent literature, Pharmacopoeias have specified various tests and permissible limits of toxic material in crude drugs. (Anonymous, 2007) Among the lexicons, Dhanwantari Nighantu is one of the oldest texts which a distinctive categorization of drugs manner in the form of 7 different Vargas based upon their morphology and therapeutic value (P V Sharma, 2008). The author has given an account of poisons and their classification (P V Sharma, 2008). The text has given a lucid explanation of the adverse effects of individual
medicinal drugs. Thus, the pharmacovigilance aspect has been taken into consideration in Ayurveda too. The present review is about the possible adverse effects caused by inappropriate administration of some medicinal plants that have been documented by author of Dhanwantari Nighantu. The observations have been given in a tabular form consisting of the name of the plant, part used, botanical name, its effect on dosha, dhatu, mala and others. RESULT AND DISCUSSION: (Table 1) The observed data in relation to the possible adverse effects of drugs mentioned in Dhanwantari Nighantu have been tabulated in table -1. Drugs: Dhanwantari nighantu comprises of a total of 373 drugs. Out of them, the pharmacovigilant aspects of 140 drugs have been found to be denoted after a thorough review through the text. Among them, 88 drugs are of plant origin, 2 are of kshara (alkali preparation) and 2 are lavana (salts) followed by 11 dravyas of mineral origin, 24 drugs are of animal origin, 9 belong to alcoholic preparations and 4 belong to jala varga. The adverse reactions of the respective useful parts has been mentioned but out of 87 drugs of plant origin, the direct reference of part used is given in case of 65 drugs. The rest is unclear. The botanical identity of certain plant drugs like Kashthapatala, Vaalukam, Shirnavrinta, Satala, Shuklabandi, Rakta apamarga, Renuka, Lamajjak, Shweta kambhoji, Rajakshavak, Sumukh, Shara, Kshudramlika, Mada is not specified clearly. Dosha karma: Among the 140 dravyas, 29 have been reported to vitiate Vatadosha; 31 have been reported to Vitiate Pitta dosha; 13 have been reported to vitiate Shleshma dosha and 9 have been mentioned to cause Tridosha vitiation. Dhatu karma: Among the 140 dravyas, In relation to adverse effect on dhatus (tissue system), only 8 references are available among which 5 are raktadhatu pradushaka, one is sarvadhatupradushak (Ashuddha Tamracopper) and the remaining 2 are shukranashana
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(Nishpav- Dolichos lablab L) & Ashuddha Raupya (crude silver). Mala karma: Data on adverse effects of 7 drugs is available on malas. Among them three are Mutravriddhikara (quantitative increase in urine) (Kshira vidari, Ikshu, Nishpav); one (Dhanyamash) is stated to be bahumala (increasing excretory matter production); one (Aashu vrihi) is stated to be Bahuvinmutra whereas two (Tila & Ashwa dahi) are alpamutrakrit (decreasing urine output). Others: 6 dravyas have been mentioned as Atisheeta (very cold in potency), 4 drugs are Vantikrit (emetic), 14 are specified to possess Vishtambhakari (obstruction of flatus) property; 9 are mentioned to be Durjara; 12 are stated to be Atyushna (increased hot potency) and Tikshna; 4 are Madakrit (stupefying); 5 are virya nashana (causing impotency). Apart from this, many are reported to cause ocular disorders, giddiness and diarrhoea. Guduchyadi Varga: In this varga, the adverse effects of 20 drugs have been specified. Among the 17 plants whose part used are mentioned, 5 are roots, 2 seeds, 2 rhizomes and 8 fruits. Many of the symptoms given on excess consumption of these drugs include Vata vriddhi in particular and other symptoms include vomiting and indigestion pertaining to Gastro-intestinal system. The contra-indication in case of consumption of Haritaki (Terminalia chebula Retz.) fruit is unique and should be made applicable in clinical practice. Shatapushpadi Varga: In this varga, adverse effects of a total of 8 drugs have been mentioned among which 4 belong to lavana and kshara category viz. Audbhida lavana (kind of mineral salt), Yavakshara (impure carbonate of potash), etc. Excess of these lead to serious disorders due to Ushna and tikshna properties. Yavani (Hyoscymus niger L.) is another drug specified which is a known CNS depressant. Chandanadi Varga: The adverse effects of 12 individual drugs have been described in this varga. The drugs list contains aromatic drugs like Karpura (camphor), Puga (areca nut);
drugs of mineral origin include sulphur, Hemamakshik (crude copper pyrite), Samudraphena (cuttle fish bone), etc. The adverse effects of most of them have been given as Atishishira (possess intense cold potency). Karaviradi Varga: The adverse effects of 13 individual drugs have been described in this varga. The botanical sources of some are controversial like Rajakshavak, Shweta kambhoji, Sumukh, Kashthakadali, etc. Two poisonous drugs of herbal origin namely Karveera (Nerium indicum Mill.) and Dhattura (Datura stramonium L) have been mentioned. The untoward effects stated in this Varga are mainly pertaining to CNS dysfunction. A unique effect of Shweta kambhoji is given as Vashikaran (hypnotic) whereas Aasuri (Brassica juncea) is stated to be Nidrakari, Grahakari. Dhattura beeja is known to produce Bhrama (dizziness) (MS Baghel, 2011) Aamradi Varga: The adverse effects of 19 individual drugs have been described in this varga. All of these are fruits which are otherwise considered healthy but still pose problems when consumed recklessly. A keen observation of author is observed when he mentions the adverse effects of the specific parts of fruit viz. Phala majja of Amlika (Tamarindus indicus L), phala tvak of Bijapura (Citrus medica L), pakva phala of Udumbara (Ficus glomerata Roxb.), Apakva phala of Tinduka (Diospyros embryopteris Pers.). All the fruits are durjara (difficult to digest) which suggests optimum consumption. A unique comment about Tilaka (Wendlandia exerta DC) is found that states it to be punstvaghni (rendering sterility). Thus, a cautious diet with a thorough knowledge is necessary for maintenance of health. Suvarnadi Varga: Herein, adverse effects of a total of 70 drugs including food items have been mentioned. Starting with metals, author has given a clear idea about the toxicity caused due to Ashuddha sevana i.e. bhasmas not prepared according to the scientific protocol are prone to cause toxicity. Along with metals, the toxicity caused by precious stones like Hiraka
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29
(diamond), Vaikranta are also specified. The harmful effects of irrational use of cereals and pulses has been described subtly viz. Punstvaghna karma of Chanaka (Cicer arientum L), Shukranashana, rakta vikara janaka karma of Nishpava (Dolichos lablab L), Vata vyadhi utpadak of Masura (Ervum lens L), etc. An account of oil bearing seeds with harmful effects have been mentioned that mainly includes oil derived from Kusumbha (Carthamus tinctorius L) which is Sarvadoshaprakopaka, secondly Sarshapa (Brassica juncea) which is stated to cause ocular disturbances. Later, author has highlighted some harmful effects arising due to improper consumption habits of milk, curd, alcoholic preparations and different types of meat. A contra-indication regarding milk consumption is worth to apply in daily practice because there is a common notion among public that milk is a complete food which has meagre side effects. Perishing time of milk has
also been stated. As regards to alcohol preparations, which are otherwise considered to possess therapeutic value in a optimum dose, if consumed carelessly result into infertility and GIT disorders. Among the mamsa varga, wherein fish in particular are said to be pittaprakopaka and abhishyandi as well if taken in excess quantity or against the code of food consumption given in Ayurveda. Apart from this, author has also portrayed ill-effects of the water consumed from different resources. Among Mutra varga, Gomutra which is gaining popularity in recent eras is also said to be Pittala. Mishraka Varga: Here author describes various categories of poisons along with their properties. Next, among a special therapeutic classification, dvitiya chaturbhadra is reported to be Pittala if consumed inadvertently.
Table 1: The adverse effects of drugs mentioned in Dhanwantari nighantu: Sr. no
Drug
Guduchyadi varga Musta 1) Patola 2)
Part used
Botanical name/ Common name if not plant
Rhizome
Cyperus rotundus L Trichosanthes dioca Willd. Miers Aegle marmelos Corr.
Root
3)
Bilva
Ripe fruit
4)
Kashthapatala
Root
5)
Mudgaparni
Root
6)
Kshiravidari
Rhizome
7)
Shitivara
Seed
Celosia argentia L
8)
Katukalambuni
Fruit
9)
Urvaaru
Fruit
Lageneria vulgaris Ser. Cucumis utilissimus Roxb.
10)
Vaalukam
Fruit
Phaseolus trilobus Ait Ipomoea digitata L
Dosha
Dhatu
Mala
Others
Atishishira Virechak Putimarutam (causing putrid flatulence)
Vidahi (causing heart burns), Vishtambh (obstruction of flatus)
Kinchit marutakaram (vitiating Vata) Kaphakar (vitiating Kapha) Atimutrala
(diuretic) Sangrahi (infrequent bowel movements) Shodhani (cleansing activity) Vitiates vata on excess consumption
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Bhedana (osmotic laxative)
Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29 11) 12)
Shirnavrunta Bimbi
Fruit Fruit
13)
Haritaki
Fruit
Terminalia chebula Retz.
14)
Prachinamalaka
Fruit
Flacourtia cataphracta Roxb.
15) 16) 17)
Satala Shuklabhandi Indravaruni
Root Root
18) 19)
Apamarga Rakta apamarga Jyotishmati
20)
Seed oil
Shatapushpadi Varga 21) Yavakshara
Coccinia indica W&A
Pitta, Kaphakrit
Citrullus colocynthis Schrad. Achyranthes aspera L
Atyushna (hot in potency) Vantikrit (emetic) Vantikrit, Vishtambhi Atyushna, Tikshna
Celastrus panniculatus Willd Impure carbonate of potash
Pittadushaka
Pittadushana
Tankankshara
Borax
23) 24)
Vidlavan Audbhida lavana
Ammonium chloride
25)
Tumburu
26) 27)
Maricha Yaavani yavaani Kapittha
Zanthoxylum alatum Roxb Piper nigrum L. Hyoscymus niger L.
28)
Ahitakara (contraindicated) in case of thirst, dryness of mouth, stiffness of jaw, recent fever , debility and in pregnancy. Durjara, (difficult to digest) guru (prolonging digestion process)
Marutkrit Anilakopini
22)
Fruit Fruit
Pittakrit Vata, Kapha vardhak
Fruit
Feronia elephantum Corr.
Cinnamomum camphora Nees & Ebern. Areca catechu L.
Raktadush aka( causing morbid blood disorder)
Virukshana, Tikshna
Tikshna, virukshana (causing dryness in body) Tikshna Tikshna, Utkledi (increasing sliminess in body fluids) Tikshna
Pittakrit
Vatala
Maadini,(stupefyin g) Grahini Asvarya ( choking voice)
Chandanadi Varga Madakarakam 29)
Karpura
Exudate
30) 31) 32)
Puga Renuka Mura
Fruit Seed Rhizome
Selinum sp.
33)
Elavaalukam
Fruit
Prunus cerasus L.
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Bhedi Atyant shishira Atyant sheeta (excessive cold in potency) Atyant sheeta
Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29 34) 35)
Lamajjaka Dhataki
36) 37) 38)
Gandhaka Siktha Shallaki
39)
Hemamakshika
Woodfordia floribunda Salisb. Sulphur Wax Boswellia serrata Roxb. Copper pyrite
40)
Samudraphena
Os sepiae
Karveeradi Varga 41) Karaveera 42) Dhatura
Flower
Exudate
Root
Atigandhakrit Bhedana Atisheeta Ashuddha: Vishtambh, Mandaanala,(reduc ing digestive fire) producing ocular pain ,dermal disorders. Lekhana (therapeutic scrapping)
Nerium indicum Mill. Datura stramonium L.
44)
Shweta kambhoji Rajakshavak
45) 46)
Sumukh Aasuri
Seed
Brassica juncea Linn.
47) 48)
Rasona Kadali
Fruit
Allium sativum L Musa sapientum Linn.
49) 50)
Kashthakadali Ikshu
Fruit
51) 52)
Shara Padmabeeja
53)
Mrinala
Stalk
Aamradi varga 54) Amra
Fruit
Mangifera indica Linn. Spondias mangifera Willd. Citrus limon L.
43)
Atyant hima Madakrit
Visha (poison) Bhrama utpatti (producing dizziness) Vantikara, vashikaran Drishti, basti pradushini.
Seed Pittala Pittakrit
Atitikshni, Nidrakari, grahakari. Sutikshna. Vatakar, Kaphakar. Durjara
55)
Amrataka
Fruit
56)
Jambira
Fruit
57)
Naranga
Fruit
58)
Bijapura
59) 60)
Madhukarkati Amlika
Fruit skin Fruit Fruit pulp
61)
Kshudramlika
Saccharum officinale L. Nelumbo nucifera Gaertn. Nelumbo nucifera Gaertn.
Kaphakar, vatkara Kinchit Vatkar Marutkrit
Mutrakrit
Vatakopana
Pittakrit, Marutkrit Pittala
Durjar, Vishtambhi.
Raktakrit
Vishtambhi, ajirnakrit (dyspepsia) Guru
Citrus reticulate Blanco. Citrus medica L.
Durjara
Citrus decumana L. Tamarindus indica L.
Durjara Bhedi, Vishtambhi
Durjara
Pittakrit
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29 62)
Tinduka
63) 64) 65)
Pilu Parushaka Mada
66)
Priyala
Fruit
67)
Jambu
Fruit
68)
Udumbara
69)
Shami
Ripe Fruit Fruit
70)
Kareera
Fruit
Capparis aphylla Roth.
71) 72)
Karmarda Tilaka
Fruit Bark
Carissa carandas L. Wendlandia exerta DC.
Suvarnadi varga Svarna 73)
Unripe fruit Fruit Fruit
Diospyros embryopteris Pers. Salvadora persica L. Grewia asiatica Linn.
Buchanania latifolia Roxb. Eugenia jambolana Lam. Ficus glomerata Roxb. Prosopis spicigera L.
Vatakopana Tikshnaka Pittakrit Marutkari Pittanut
Dahanut (producing burning sensation) Durjara
Vatala
Hritkantha kashana Krimikrit(producin g worms) Causing hairfall Adhmanakar (abdominal distension)
Pittakar Punstvaghni(impot ency)
Aurum
74)
Raupya
Argentinum
Shukranas hak (causing oligosper mia)
75)
Tamra
Cuprum
Sarvadhatu
76)
Trapu
Tin
77)
Loha
Ferrum
78)
Parada
Hydrargyrum
79)
Vaikrant
80)
Hirak
pradushak (dysfuncti on at all tissue level)
Sarvadoshaprakopa
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Ashuddha (impure) Balanashan, Viryanashan Rogotpattikar Ashuddha: Dahajanaka, Vibandhakarak, (severe constipation) Viryanashak, Balanashak. Ashuddha: Kantihar, Vantikar, Kusht
Ashuddha: Pandu, Kushtha,Vatvikara, Murccha (fainting) Ashuddha: Hritpida,(cardiac pain) Rogotpattikar Ashuddha: Shariranasha, Kushtha Ashuddha: Pandu (Anaemia) ,Jvara,Hridroga (cardiac disorders), Parshvapida, Kushtha. Ashuddha: Santapjanak
Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29 Kshaya, Kushtha, Pandu, Dussaha pida (excruciating pain) 81) 82)
Vrihi Patal
Seed Seed
Pittakara Tridoshkrit
83)
Aashu vrihi
Seed
Tridoshala
84)
Seed
Setaria italica L.
Vatkrit
85)
Dhanya Priyangu Makushtha
Seed
Vatala
86)
Aadhaki
Seed
87) 88) 89) 90) 91) 92) 93)
Masur Dhanyamash Chanak Kalay Jurnaa Karat Nishpav
Seed Seed Seed Seed Seed Seed Seed
Phaseolus aconitifolius Jac. Cajanus indicus Spreng. Ervum lens L. Phaseolus mungo L. Cicer arientum L. Pisum sativum L. Lathyrus sativus L. Dolichos lablab L.
Ativatala Anila, pittakar
94)
Methika
Seed
Pittaprakopa
95)
Khastila
Seed
96)
Tila
Seed
Trigonella foenumgraecum L. Papaver somniferum L. Sesamum indicum L.
97)
Sarshapa
98)
Eranda
Seed oil Seed oil
99)
Kusumbha
100)
Maahisha dugdha Mrita vatsaa, bala vatsa Pinyak, amla aashi Dharoshna dugdha
101) 102) 103)
104) 105)
Kurchika (milk product ) Dugdha sevan nishedh
Bahuvin mutra (produci ng excess faecal and urine output)
Atyushna, Bahunishyandi Bahushma
Marutkopini Vatamaykar Bahumala
Vatala Vatala
Punstvaghna Vishtambhi Shukranas hana
Mutravri ddhi (diuresis)
Raktavikara.
Raktaprak opa Vishoshana
Kapha pittakrit
Alpamut akrit (oliguric)
Agnisadak Achakshushya Visra
Sarvadoshapra kopak
Seed oil (Buffalo milk) Milk whose calf is dead) The fermented fodder eating cow’s milk
Mahabhishyandi, vanhisadak Doshakarak Abhishyandi Amavatakar (produces rheumatoid arthritis on excessive consumption) Shleshmavardhak
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Navjvara, mandagni,
Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 20–29 amadosh, shula, kushtha. 106)
Dugdha perishing time
107)
Mahisha dadhi
108)
Ashwadadhi
109) 110) 111)
Dadhisar Dadhi anaharya Takra nishedh
Buttermilk
112) 113)
Takrakurchika Madya
Alcoholic preparation
114)
Madhulika
115)
Madhukasidhu
116) 117) 118)
Kohlo jagal Bakkas Kharjuram
119) 120)
Maireya Jambavsidhu
121) 122)
Nav madya Anartava vari
123) 124) 125) 126)
128)
Vapya jala Kedar jala Dhar jala Bhuktottara jalapaan Jirna Narikelodaka Hastimamsa
129)
Ashwa mamsa
130)
Ashwatar
131) 132) 133) 134) 135)
Mesha mamsa Sukar mamsa Matsya mamsa Mukha matsya Irasa matsya
136)
Pulanga
127)
Curd made out of buffalo milk Curd of horse milk
After 5 muhurta – (4 hrs) vikrit; Dviguna kaalVishavat (turns toxic after 8 hrs) Mahabhishyandi Vatala
Mutrapa ham (oliguria)
Vatala
Alcoholic preparation made from barley Alcoholic preparation made from flowers of Madhuca indica
Pittadushana
Raktadush ana
Vishtambhi Raktapitta , kaphajvikara Kshat, Murccha, Bhrama Durjara Vishavad (toxic) Vishtambhini
Tridoshprakop ak
Alcoholic preparation made from dates
Vatala
Alcoholic preparation made from Eugenia jambolana fruit pulp
Vatakopana
Avrishya Vishtambhi alpamadakari Madkrit
Rainfall not according to season Water from wells Water from reservoir
Tridoshakarak Tridoshakarak Pittala Doshakarak
Water consumption after meals Stale coconut water
Pittakar
Meat of elephant
Pittakar
Meat of horse
Kapha pittakrit Kapha pittalam Pittakaphakar Pittala Kaphapittakar Shleshmala Pittashleshma atikopana
Meat of goat Pork Fish
Abhishyandi
Abhishyandi Vishtambhi, Durjar Vishavat (toxic) Vishtambhi Raktaprak opak
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Visra
Vishtambha
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137) 138) 139) 140) 141) 142)
Matsya Shafari matsya Sarovar matsya Uluka mamsa Gomutra Ajamutra Dvitiya chaturbhadra
CONCLUSION: After a critical analysis of the adverse effects of various drugs mentioned in Dhanwantari nighantu, it is found that a vivid idea of pharmacovigilance was present even in the Nighantu period. These aspects do not rest only with medicines but also foodstuffs that are consumed daily. Author has highlighted certain contra-indications regarding milk and milk products which should be applied in by physicians to rule out the etiology of a disorder. The adverse effects caused by inadvertent use of foodstuffs in daily routine have an impact on the basic normal physiology of the body.
Kaphapittala
Pittala, vataprakopak Pittala Marutkopana Pittala
Abhishyandi, ushna Grahini, Drishtinashan Bhrantikar
Hence, this point must be taken into consideration even during prescription and consultation of Pathya. Regarding medicines, Ayurveda is always accused of possessing medications that produce metal toxicity; but the information reported herein along with the contra-indications suggests that pharmacovigilance was a welldeveloped even in traditional medical system, particularly Ayurveda. Thus, it can be concluded that Dhanwantari Nighantu encompasses a well-organised data in the context of pharmacovigilant aspects of various dravyas of Ayurveda.
REFERENCES: Anonymous (2007), Ayurvedic Pharmacopoeia of India (API) Dept. of AYUSH, New Delhi, Part II, Vol 1, Appendix 2, Pg.no.148–179. Anonymous (2002), The importance of Pharmacovigilance, WHO. Available on: http://en.wikipedia.org/wiki/Pharmacov igilance#cite_note-1 Baghel
M.S (2011), Standardization of Ayurvedic Clinical terminologies, IPGT & RA, GAU, Jamnagar, Gujarat.
Source of Support: Nil
Indradeo Tripathi (2011), Editor of Chakradutta of Chakrapani Dutta, Vatavyadhi chikitsa, verse 285-295, Chaukhambha orientalia Bhavan, Varanasi: p.155–156. PV Sharma (2008), Editor of Dhanwantari Nighantu, Chaukhambha orientalia, Varanasi. Yadavji Trikamji Acharya (2011), Editor of Charaka Samhita, Ayurveda Dipika Vyakhya, Sutrasthana, Chap 1, verse 126, Chap 26 verse 82–84,; Chikitsasthana, 1/3/13, Chaukhambha Prakashan, Varanasi. p.23; p150, p 382. Conflict of Interest: None Declared
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 30–37 ISSN 2277-4289 | www.gjrmi.com | International, Peer reviewed, Open access, Monthly Online Journal
Review article CONCEPT OF LIFESTYLE IN AYURVEDA CLASSICS Saylee Deshmukh1*, Mahesh Vyas 2, Hitesh Vyas3, Dwivedi R R4 1
Ph.D.Scholar, Department of Basic Principles, Institute of Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar- India 2 Professor, Department of Basic Principles, Institute of Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar- India. 3 Associate Professor, Department of Basic Principles, Institute of Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar- India. 4 Professor and Head of Department, Department of Basic Principles, Institute of Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar- India. *Corresponding author: Email: dsaylee@ymail.com
Received: 19/01/2015; Revised: 15/02/2015; Accepted: 23/02/2015
ABSTRACT Increased number of deaths due to non-communicable diseases has been proved to be because of lifestyle related factors like physical inactivity etc. It is a responsibility to focus on lifestyle modifications in the 21st century. Ayurveda has great contribution in treatment of diseases as well as prevention of diseases. Conducts like Dinacharya (conducts in daytime), Ratricharya (conducts in night), Ritucharya (seasonal conducts), Ahara Vidhi (diet rules), Sadvritta (good conducts) etc. are described in detail in Ayurveda, can be included under the heading healthy lifestyle. It has a tremendous role in prevention of diseases. Present article aims to elaborate the concept of Lifestyle in Ayurveda classics. KEY WORDS: Lifestyle, Ayurveda, Dinacharya, Ahara Vidhi.
Cite this article: Saylee Deshmukh, Mahesh Vyas, Hitesh Vyas, Dwivedi R R (2015), CONCEPT OF LIFESTYLE IN AYURVEDA CLASSICS, Global J Res. Med. Plants & Indigen. Med., Volume 4(2): 30–37
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INTRODUCTION: According to the health statistics of WHO, among 57 million global deaths in 2008, 36 million or 63% were due to non-communicable diseases (NCD) like cardiovascular diseases (17 million deaths or 48% of all NCD deaths), cancers (7.6 million, or 21% of all NCD deaths), respiratory diseases, including asthma and chronic obstructive pulmonary disease (4.2 million) and 37% were due to communicable diseases. Therefore it can be said that noncommunicable diseases (NCD) are prone to kill more people than communicable diseases worldwide. Amongst them lifestyle disorder is a group of diseases whose occurrence is primarily based on the daily habits of people and are a result of an inappropriate relationship of people with their environment. WHO states the top 10 lifestyle diseases in the world affecting health are Alzheimer's Disease, Arteriosclerosis, Cancer, Chronic Liver Disease/Cirrhosis, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Heart Disease, Nephritis/CRF, Stroke, Obesity. The factors contributing to lifestyle diseases mainly include incompatible food habits, physical inactivity, wrong body posture, and disturbed biological clock. (Mukesh Sharma et al., 2009). It has been proved that in case of noncommunicable diseases, simple lifestyle measures are more effective in preventing or delaying the onset of these diseases. Ayurveda has a great contribution in the treatment of diseases as well as prevention of diseases. In the last few years, According to the ‘seed and soil theory’ in Ayurveda, (Brahmanand Tripathi, 2006) manifestation of disease takes place when there is favorable condition for disease which is being created by wrong conducts like day sleep, being vigil at night, irregular food habits etc. Therefore for maintenance of health and prevention of disease it is very important to follow an ideal lifestyle. A growing body of scientific evidence has demonstrated that lifestyle intervention is an essential component in treatment of chronic disease that can be effective as medication but without risks and unwanted side effects.
Lifestyle medicine (LM) is a branch which includes management of diseases the use of lifestyle interventions like diet, exercise, stress management, de-addiction in the treatment and management of diseases. This field has been growing from last 2 decades. This article is an attempt by the authors to elaborate the concept of lifestyle in Ayurveda classics. MATERIALS AND METHOD: Classical Ayurvedic texts like Charaka Samhita, Sushruta Samhita, Astanga Samgraha, Astanga Hridaya with their commentaries and concerned topics from the texts Kashyapa Samhita, Bhavaprakasha, Bhela Samhita and Kaiyyadeva Nighantu, research articles related to this topic. Concept of Lifestyle: Lifestyle is the way in which a person lives. It is a set of attitudes, habits, or possessions associated with a particular person or group (Lynn R. Kahle, Angeline G. Close, 2011). i.e. how, where and when a person is sleeping, playing, wandering, eating, swimming, walking etc. As quoted by Acharya Sushruta, Vyadhi nigraha hetavah (treatment modalities) are divided as Samshodhana (purificatory), Samshamana (palliative), Ahara (food) and Achara (activities) (Ananta Ram Sharma, 2008). Achara is of 3 types – Kayika karma (physical activities) like Vyayama (exercise), Vachika karma (Verbal behavioral) like Swadhyaya (reading) and Manasika karma (psychological behavior) like Sankalpa (determination). Among them, Achara can be included under the heading lifestyle (Y.T. Acharya, 2012). By the above definition of Lifestyle, it can be said that Vihara, Ahara vidhi and Achara described in Ayurveda classics, can be included under the heading Lifestyle. Arunadatta has classified Vihara as Niyata kala (regular) and Aniyata kala (according to specific condition). Niyata kala vihara includes Dinacharya and Ritucharya. Aniyata kala vihara includes
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Vihara according to avastha (condition); (Y.T. Acharya, 2010) it can be taken as Vyadhi avastha. Ahara Vidhi includes Ahara Vidhi
vidhana (rules of diet) and Bhojanottara Vidhi (conducts after meal); Achara includes Sadvritta (good conducts) (Table.1).
Table.1: List of conducts in Lifestyle Dinacharya Dantadhavana (cleaning teeth) Anjana (collyrium) Nasya (nasal drops) Kavala-Gandusha (mouth gargles) Dhumapana (inhalation of medicated smoke) Tambula Bhakshana (chewing of betel leaves ) Abhyanga (Oil application) Vyayama (exercise) Udvartana (massage) Snana (bathing) Mani-malyadi Dharana (wearing stones etc.) Vastra dharana (wearing clothes) Karnapurana (insertion of oil in ear) Nidra (sleep) Vyavaya (copulation) Padatrana Dharana (footwears)
Ritucharya Abhyanga (Oil application) Udvartana (massage) Dhumapana (inhalation of medicated smoke) Kavala Gandusha (mouth gargles)
Anjana (collyrium) Shayana (sleeping) Vastra Dharana (wearing clothes) Mani-malyadi Dharana (wearing stones etc.) Vyayama (exercise) Vyavaya (copulation) Snana (bath)
Vihara includes the conducts by a person in daily or seasonal routine. This includes Abhyanga (oil application to the body), Vyayama (exercise), Nidra (sleep), Vega dharana (suppression of natural urges), Vyavaya (sexual intercourse), Chankramana (walking), Adhva (brisk walking), Atapa sevana (exposure to sunlight), Asana (sitting), Snana (bathing), Pravatasevana (exposure to
According to Vyadhi As a cause: Vega UdiranaDharana (suppression and forceful production of urges) Pravata (strong wind) Adhva (brisk walking) Chankramana (walking) As a treatment: Abhyanga (oil application) Anjana (collyrium) Kavala-Gandusha (mouth gargles) Nasya (nasal drops) Dhumapana (inhalation of medicated smoke)
As cause and treatment: Vyayama (exercise) Snana (bathing) Vyavaya (copulation) Nidra (sleep) Atapasevana (exposure to sunlight) strong wind) etc. Amongst them Acharyas have quoted their importance and usefulness or harmfulness according to the specific condition e.g. Ardhashaktya Vyayama (exercise upto half of the capacity) with prior Abhyanga (oil application) is useful in Hemanta ritu (winter) and strong individuals but excess Vyayama is harmful in Grishma ritu (summer) and weak individuals (Brahmanand Tripathi, 2007). Also,
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Divaswapna (daytime sleep) is useful in Grishma ritu and emaciated person while harmful in Vasanta ritu (autumn) and obese person (Brahmanand Tripathi, 2006). Also, Acharya Sushruta has given limit of Divaswapna as 1 muhurta i.e. 48 min (Ananta Ram Sharma, 2008). Ratrau jagarana (vigil at night) is contraindicated always by Acharyas for maintenance of health. About Snana (bathing), Acharyas have strictly contraindicated it in the condition of Ajirna (indigestion), Atisara (diarrhea) etc. (Brahmanand Tripathi, 2006). Vegadharana (suppression of natural urges) of mala (faeces), mutra (urination) etc. has always been contraindicated because of their harmful effect in the body. (Brahmanand Tripathi, 2006). In Ayurveda, detailed description about rules of Vyavaya (sexual intercourse) is also available (Ananta Ram Sharma, 2008). About Ahara Vidhi, Acharyas have advised to take Ushna (Luke-warm) and Snigdha (unctuous) food in proper quantity and proper time with full concentration to get easily digested. If one takes cold food it slows down the process of digestion. Unctuous food helps for easy passage of food (Brahmanand Tripathi, 2006). About quantity of food, Acharyas have quoted that it varies according to digestive capacity of person and nature of the food items. To decide the ideal quantity of food, Acharyas have given the symptoms which are produced in the body after taking food in such a quantity which is suitable for him which varies individually (Brahmanand Tripathi, 2006). About the proper time for intake of food, Acharyas have advised to take lunch during 2nd Yama (i.e. between 3–6 hrs after sunrise) and dinner should be taken at the end of first Prahara of night (i.e. within 3 hrs after sunset) (Brahma Shankara Mishra, 2012). It has also been advised to take food as suitable to his prakriti (constitution), age, habitat etc. (Brahmanand Tripathi, 2006). About Ahara sevana krama i.e. sequence of intake of food items, it has been stated by Acharyas that food items having Madhura rasa (sweet) should be consumed first because it is difficult to digest. It gets more in contact with digestive enzymes
when consumed first (Ananta Ram Sharma, 2008). About Bhojanottara Vihara, Acharya sushruta has advised Rajavat asana (sitting in comfortable position), Shatapada gamana (walking about hundred feet i.e. for a while), Vamaparshwa shayana (lying down in left lateral position), manonukula shabda, sparsha, rupa, gandha sevana (to indulge in sound, sight, taste smell and touch which are pleasing to the mind) (Ananta Ram Sharma, 2008). This helps the food to stay more in amashaya (stomach) and get more in contact with the Agni (digestive enzymes) (Brahma Shankara Mishra, 2012). About water drinking habits, it has been stated that water should be taken sip by sip during meal instead of taking it before and after meal in large quantity. It should not be taken more than required quantity. Intake of water on being hungry is also contraindicated. As it leads to harmful effects on body (Ananta Ram Sharma, 2008). Sadvritta includes guidance about the dressing, speaking, social behavior, personal and social hygiene etc. (Brahmanand Tripathi, 2006; Brahmanand Tripathi, 2007). According to different conditions like Rajaswala (menstruating woman), Garbhini (pregnant woman), Sutika (puerperal woman) have been given in Ayurveda. Abhyanga, vyayama, vyavaya etc. has been contraindicated in these conditions (Ananta Ram Sharma, 2008). DISCUSSION: In Ayurveda, it has been quoted that ratrau jagarana is harmful to the body. It leads to Vataprakopa and Agnidushti. In human body, there exists a circadian rhythm in activities of digestive enzymes. Wakefulness in night causes disruption in circadian rhythm and disturbance in activities of digestive enzymes which leads to indigestion (Masayuki Saito et al., 1975). Except in Grishma ritu, it causes vitiation of Kapha-Pitta and also it is a cause for Agnidushti. According to the researchers,
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daytime sleep disrupts the circadian rhythm of digestive enzymes. (Charles W. Atwood, 2008). In 21st century, due to industrialization, there is increase in number of shift workers. Health of shift workers is now becoming a problem. 2007 study led by the IARC (International Agency for Research on Cancer) showed that shift work has been associated with cancer (Kurt, Straif, 2007). Most common disorder in shift workers is Shift work sleep disorder (SWSD). It is a circadian rhythm sleep disorder which requires medications with circadian changes (C C Caruso, 2012). According to the modern researchers, there exists Gut-Brain-Endocrine axis which involves Ghrelin-Leptin hormones, Insulin, Orexins etc. Disturbance in this axis due to disturbed sleep pattern leads to diseases like Diabetes mellitus, Cancer etc. (Annette L. Kirchgessner, 2002; Y Wang, H Yang, 2004) According to Ayurveda, Vyayama leads to increase in bala (strength), agni (digestion). Modern researchers have proved that exercise increases significantly the plasma GH concentration and their combined effect induces a highly synergistic rise in GH (Foued Ftaiti, 2008). Exponential relationships were found between increases in core temperature and plasma growth hormone, prolactin, and catecholamines during exercise, suggesting the existence of a thermal threshold for stimulation of hormonal release during exercise (M W Radomski, 1998). Physical exercise activates hypothalamus-pituitary-adrenal axis and increase number, function and movement of lymphoid cells (Alexander J. Koch, 2010). Mild to moderate exercise stimulates gastric emptying (Campbell J.M.H, 1928) and increases secretions of gastric juice which leads to rapid and healthy digestion (William Beaumont, 1838). Now days, due to growing use of technologies, daily physical activity is decreasing. Lack of exercise/ sedentary lifestyle leads to delayed gastric emptying (Campbell J.M.H, 1928). Exercise has role in treatment of diseases. It has been proved that exercise has role in the treatment of Diabetes mellitus and Obesity (Zinker B A et al., 1993; Epstein LH et al., 1996).
Acharyas have quoted that Abhyanga is essential for maintenance of health. According to modern researchers, skin blood flow increases diverting blood from muscle following 12 minutes of massage which helps in lactate clearance and recovers body from fatigue due to accumulation of lactate in muscles after prolong exercise (Hinds T et al., 2004). Vegadharana has been contraindicated by Acharyas as it is a direct cause of many diseases. Researchers have been proved that voluntary suppression of defecation delays gastric emptying. (Tjeerdsma HC et al., 1993) and retention of urge of micturition causes significant increase in the level of blood pressure, pulse rate, respiratory rate, Plasma Catecholamine, Plasma 5-HT, urinary catecholamine and 5HIAA (5hydroxyindoleacetic acid) in healthy volunteers (Madhu Shukla et al., 1988). According to the modern researchers, voluntary suppression of cough reflex is often associated with lung infection and also it leads to aggravation of symptoms of bronchiectasis (Wells A et al., 1992). As stated in Ayurveda, intercourse has been contraindicated in the period of menstruation and pregnancy. According to the researchers, in the menstruating women it increases the chances of infection (Mayer, 1982) and coitus in the 1st trimester causes disturbance in the process of growth of foetus and results in the malformation of foetus and coitus during 3rd trimester leads to premature labor due to contraction of uterus (Senatur and Kaminer, 1927). Vishamashana means taking food in irregular quantity and at irregular time. Now a days, due to irregular job or business schedule people take meal at irregular time and irregular quantity. Irregular time of food intake disrupts the normal digestive pattern which adhered to a circadian rhythm (Melinda Blackman et al., 2010). Intake of Ushna ahara has been advised by Acharyas. It helps for digestion. It lacks due to intake of cold food items which results in indigestion (William Beaumont, 1838). In Ayurveda, it has been stated to take water
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between the meals which has been proved to stimulate gastric secretions (S Wyard, 1935) and contraindicated to take water before and after meal. Intake of water in large amount before meal dilutes the stomach acid, it also stimulates digestive system to prepare for incoming food from stomach. This stimulation causes a dump of very basic digestive enzymes into the lower gastrointestinal tract (American Academy of Orthopaedic Surgeons, 2013). Excessive intake of water after taking meal can result in prolonged abdominal muscle relaxation which in turn can cause indigestion (Ronald Ross Watson, 2012).
CONCLUSION: Concept of healthy Lifestyle in Ayurveda is wider which includes the conducts like dietary habits under the heading Ahara vidhi vidhana e.g. intake of luke-warm food on proper time in proper quantity with full concentration etc. water drinking habits, general behavioral pattern under the heading Sadvritta, daily and seasonal conducts like exercise, oil application etc. under the heading Dinacharya and Ritucharya, Ratricharya. Healthy lifestyle has great role in prevention of diseases and Lifestyle modification has been proved to be successful treatment in various diseases.
REFERENCES: Alexander J. Koch (2010), Immune response to exercise, Brazilian Journal of Biomotricity: v.4,n.2,p.92–103 American Academy of Orthopaedic Surgeons (AAOS) Rhonda Beck (2013), Advanced Emergency Care and Transportation of the Sick and Injured, p. 393 Ananta Ram Sharma (2008), Sushruta Samhita, edited with Sushruta vimarshini Hindi commentary by Reprint edition, Chaukhamba Sanskrit Pratisthana, Varanasi, Sutrasthana (Chap 1, 46) Sharirasthana (Chap 4), Chikitsasthana (Chap 24) Annette L. Kirchgessner (2002), Orexins in the Brain-Gut Axis, Endocrine reviews, Vol. 23 Issue 1 | February 1, Brahma Shankara Mishra, Rupalalaji Vaishya (2012), Bhavaprakasha, Reprint edition, Chaukhamba Sanskrit Sansthan, Varanasi, Purvakhanda (Chap 5) Brahmanand Tripathi (2007), Ashtang Hridaya, edited with Nirmala Hindi commentary by Reprint edition, Chaukhamba Sanskrit Pratisthana, Varanasi, Sutrasthana (Chap 2, 4)
Brahmanand Tripathi, (2006), Charaka Samhita edited with Charaka-chandrika Hindi commentary by Reprint edition, Chaukhamba Sanskrit Pratisthana, Varanasi, Sutrasthana, (Chapters 5, 7, 8, 21), Nidanasthana (Chap 3), Vimanasthana (Chap 1), Cikitsasthana (Chap 3) C C Caruso (2012), Running on Empty: Fatigue and Healthcare Professionals: The Consequences of Inadequate Sleep. NIOSH: Workplace Safety and Health, Campbell J.M.H, G.O. Mitchell (1928), Influence of exercise on digestion, Guy’s Hosp. Rep. 78:279-293 Charles W. Atwood (2008), Sleep Medicine, p.136 Epstein LH, Coleman KJ, Myers MD (1996), Medicine and Science in Sports and Exercise, 28(4):428–435 Foued Ftaiti (2008), Effect of hyperthermia and physical activity on circulating growth hormoneApplied Physiology, Nutrition, and Metabolism, 33(5): 880– 887, 10.1139/H08-073
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Hinds T, McEwan I, Perkes J (2004), Effects of massage on limb and skin blood flow after quadriceps exercise. Med Sci Sport Exerc, 36(8): 1308–13 32 http://www.medchitchat.com/health/corporatemadness-era-lifestyle-diseases.html https://en.wikipedia.org/wiki/Lifestyle_%28soc iology%29 Kurt,
Straif (2007), "IARC Monographs Programme finds cancer hazards associated with shiftwork, painting and firefighting" International Agency for Research on Cancer
Lynn R. Kahle, Angeline G. Close (2011), Consumer Behavior Knowledge for Effective Sports and Event Marketing, New York: Routledge. ISBN 978-0415-87358-1 M W Radomski (1998), Exercise-induced hyperthermia and hormonal responses to exercise- Canadian Journal of Physiology and Pharmacology, 76(5): 547–552, 10.1139/y98-045 Madhu Shukla, S N Tripaathi (1988), Effect of Vegadharaana (Urine withholding of neurohormones: (An Experimental study) Vol. VIII, Nos. 1. July, Pages 55–59 Masayuki Saito, Eiko Murakami, Teruo Nishida, Yoshiki Fujisawa, Masami Suda (1975), Circadian Rhythms in Digestive Enzymes in the Small Intestine of Rats, Journal of Biochemistry, 78 (3): 475–480 Mayer (1982), "Vaginal physiology during menstruation, Ann Intern Med., 96(6 Pt 2):921–3 Melinda Blackman, Colleen Kvaska (2010), Nutrition Psychology: Improving Dietary Adherence, p.212,
Mukesh Sharma and P. K. Majumdar (2009), Occupational lifestyle diseases: An emerging issue, Indian J Occup Environ Med., 13(3): 109–112. doi: 10.4103/0019-5278.58912 PMCID: PMC2862441 Ronald Ross Watson, Victor R. Preedy (2012), Bioactive Food as Dietary Interventions for Diabetes, p. 467 S Wyard (1935), Diet in Gastric Diseases Postgraduate medical journal, 11(113):103–112 Senatur and Kaminer (1927), Health and Disease in relation to marriage, Vol.I, p.257 Tjeerdsma HC, Smout AJ, Akkermans LM (1993), Voluntary suppression of defecation delays gastric emptying. Dig Dis Sci.;38(5):832–6 WHO Health Statistics (2008) retrieved from http://www.who.int/gho/ncd/mortality_ morbidity/en/index.html WHO Health Statistics (2011) retrieved from http://apps.who.int/gho/data/node.main. 688?lang=en William Beaumont (1838), Experiments and observations on gastric juice and the Physiology of digestion, p.85, 308–310 Wells A, Rehman A, Woodhead M, Wilson R, Cole PJ (1992), Voluntary cough suppression associated with chronic pulmonary suppuration: Respir J, 5(15),141 Y.T. Acharya (2010), Ashtangahrudaya with Sarvangasundara and Ayurveda rasayana commentary by Arunadatta and Hemadri, Reprint edition, Chaukhamba Sanskrit Sansthan, Varanasi, Sutrasthana (Chap 2)
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Y.T. Acharya (2012), Sushrutasamhita with Nibandasamgraha commentary by Dalhana, Reprint edition, Chaukhamba Sanskrit Sansthan, Varanasi, Sutrasthana (Chap 1) Y Wang, H Yang (2004), Neuro-hormonal integration of metabolism: challenges
Source of Support: Nil
and opportunities in the postgenomic era, Metabolic Issues of Clinical Nutrition, Vol 9, p. 227–242 Zinker B A (1993), Role of glucose and insulin load to the exercising limb in increasing glucose uptake and metabolism- J Appl physiol:74: 2915–2921
Conflict of Interest: None Declared
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Research article CLINICAL EVALUATION OF AN AYURVEDIC FORMULATION IN THE MANAGEMENT OF MENTAL RETARDATION Deepa Makhija1*, Pratap Makhija2, Babasaheb Patil3 1,2
Research Officer (AY) scientist-2, Ayurveda Central Research Institute, Punjabi Bagh, New Delhi-26, India Professor, B.S. Ayurveda College, Sawantwadi, (MH), India *Corresponding Author: Mobile No. 09911331074; E-mail: drdeepamakhija@yahoo.co.in 3
Received: 09/01/2015; Revised: 25/02/2015; Accepted: 28/02/2015
ABSTRACT The aim of the study was to assess the efficacy of an Ayurvedic formulation in the management of Mental Retardation. The participants of the study were included 15 Mentally Retarded children between age group of 8 months to 12 years. Combination of Vacha, Rudraksha, Haridra, Hingu was administered twice daily for 90 days. Findings of the study revealed that treatment was highly effective over behavioural disorders, but very minimal response to treatment was noticed over mental age and social age. Also significant improvement was observed over psychological, psychomotor and biological factors. KEYWORDS: mental retardation, behavioural disorders, psychological, intelligent quotient, mental age, social quotient, social age. ABBREVIATIONS: MR SFB V.S.M.S IQ MA SA SQ CA
-
Mental Retardation Seguin Form Board Vineland Social Maturity Scale Intelligent Quotient Mental Age Social Age Social Quotient Chronological Age
Cite this article: Deepa Makhija, Pratap Makhija, Babasaheb Patil (2015), CLINICAL EVALUATION OF AN AYURVEDIC FORMULATION IN THE MANAGEMENT OF MENTAL RETARDATION, Global J Res. Med. Plants & Indigen. Med., Volume 4(2): 38–45
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INTRODUCTION Mental Retardation (MR) refers to significantly sub average general intellectual functioning resulting in or associated with concurrent impairment in adaptive behaviour and manifested during the development period (American Association for Mental Retardation, 1983). It is formally diagnosed by an assessment of Intelligent Quotient (IQ) (below 70) and adaptive behaviour. Adaptive behaviour, or adaptive functioning, refers to the skills needed to live independently. Children with intellectual disability learn more slowly than a typical child. Children may take longer to learn language, develop social skills, communication skills, and take care of their personal needs, such as dressing or eating (Daily DK et al., 2000).There are varying degrees of intellectual disability, from mild to profound. Classification according to DSM IV is designed as mild (IQ 50–55 to approximately 70), moderate (IQ 35–40 to 50–55), severe (IQ level 20–25 to 35–40), profound (IQ level below 20 or 25). Mental retardation affects about 1% to 3% of the population. (Mental retardation, Retrieved 2015 from http://www.psychologytoday.com) Other behavioural traits associated with MR (but not deemed criteria for an MR diagnosis) include aggression, dependency, impulsivity, passivity, self-injury, stubbornness, low selfesteem, and low frustration tolerance. Some may also exhibit mood disorders such as psychotic disorders and attention difficulties (Mental retardation, Retrieved 2015 from http://www.psychologytoday.com). Research work in various aspects of MR has been conducted all over the world with growing awareness in order to solve this complex phenomenon. Currently, there is no "cure" for an established disability, though with appropriate support and teaching, most individuals can learn to do many things. There are four broad areas of intervention. These include psychosocial treatments, behavioural treatments, cognitive-behavioural treatments, and family-oriented strategies. (Mash, E., &
Wolfe, D. 2013). Psychotropic drugs have been used extensively to reduce the symptoms associated with psychiatric disorders, but they too have their own side effects. (R Antochi, 2003) In Ayurveda classics references like Jada (inert), Mudha (dull) etc. are found in different context, meaning intellectually impaired persons (Acharya Jadavaji Trikamji, 1994). But the condition was considered more of a social discrimination rather than as a separate clinical entity. Ayurveda has got a different approach towards diseases which are evasive even to most sophisticated researchers in modern medicine. The acquaintance with the names of diseases is not always necessary to cure diseases. It is thorough knowledge of dosa, dusya, site of manifestation and aetiological factors rather than the names of diseases which count for the purpose of their treatment (Acharya Jadavaji Trikamji, 1994). In MR, treatment should be directed to a) promoting the intellect and correcting the behavioural disorders. b) Improving adaptive behaviour. c) Managing the associated disorders, for example sensory and motor disabilities, incontinence, visual and hearing defect, speech disorder etc. Some drugs explained in our classics are believed to improve intelligence and to cure various mental deficits. Vacha, Rudraksha, Haridra, Hingu is a few among them. The present study was undertaken with an objective to assess efficacy of an Ayurvedic formulation (Vacha, Rudraksha, Haridra, Hingu) in mentally retarded children based on a model explained by Chawla Deepa Nanakram, (2000). MATERIALS AND METHODS For the clinical study, a total of 15 patients approaching to the outpatient department of Basic Principles, Government Ayurveda College Hospital, Trivandrum, Kerala, India were selected for the study. The patients were assigned into a single group taking into consideration inclusion and exclusion criteria. Complete history and clinical examination of all children was carried out and recorded in a specially designed proforma by the post graduate department of Basic Principles,
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 38–45
Government Ayurveda College, Trivandrum, Kerala, India. Social age and social quotient was assessed by using Vineland Social Maturity Scale. Mental age and mental quotient was calculated by using Seguin Form Board Test.
Inclusion Criteria
The Clinical research design was approved by the Research Review Committee of Kerala University. Before administering tests, parents of MR children were made clear about the purpose of this study and were told that the result of tests would be kept strictly confidential and would be used for research purpose only.
Exclusion Criteria
Persons presenting with the clinical features of Mental Retardation Age group between 8 months to 12 years Sex-No sex discrimination.
Persons affected with severe debilitating illnesses Persons below 8 months and above 12 years of age Persons having severe convulsive disorders.
Preparation of the drug Table 1.Ingredients of Ayurvedic formlation with botanical name and part used S.No. 1 2 3 4
Sanskrit name Vacha Haridra Hingu Rudraksha
Botanical name Acorus calamus Linn. Curcuma longa Linn Ferula narthex Boiss Elaeocarpus sphaericus Roxb.
Raw drugs (Table 1) of Vacha (Acorus calamus), Haridra (Curcuma longa), Hingu (Ferula narthex) and Rudraksha (Elaeocarpus sphaericus) were procured from local market, Trivadrum, Kerala, India. The drugs were identified from department of Dravyaguna, Government Ayurveda College Hospital, Trivandrum, Kerala, India. Samples were stored in the department for future reference. These Raw drugs were washed well and dried
Part used Rhizome Fruit Gum resin Rhizome
in shade. Since, Rudraksha was very hard, it was soaked in water for 24 hours and dried in sun for about 15 minutes. Hingu was very sticky to powder hence was sun dried and fried with ghee. Later all the drugs were powdered separately in a pulverizer and then mixed together. Fine powder was weighed out and sealed in polythene packets. Powder was given orally twice a day for 90 days in a dosage given below (Table 2).
Dose and duration Table 2.Dose and duration of treatment S.No. 1 2 3 4
Age (yrs) 8 months –2 years 2 years–5 years 5 years–9 years 9 years–12 years
Dosage 300 mg 500 mg 750 mg 1 gm
Time 7am & 7pm 7am & 7pm 7am & 7pm 7am & 7pm
Instructions were given to rub pieces of Vacha and Rudraksha (2–3 rounds) with water, and the obtained paste mixed with honey was advised to be applied over tongue and inside
Anupana Warm water or Honey Warm water or Honey Warm water or Honey Warm water or Honey
Duration 90 days 90 days 90 days 90 days
the mouth (oral) cavity once a day in the morning for 90 days.
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 38–45
Statistical analysis
Observations
Values obtained were evaluated using paired „t‟ test.
statistically
Parameters for assessment a. Seguin Form Board (SFB) test (Goel, S. K., & Bhargava, M. 1990)→ To assess Mental Age (MA) and Intelligence Quotient (IQ) b. Vineland Social Maturity Scale (V.S.M.S.) test (Indian adaptation by D. A.J. Malin 1965)→ To estimate Social Age (SA) and Social Quotient (SQ) c. Specially designed proforma by post graduate department of Basic Principles, Government Ayurveda College, Trivandrum, Kerala, India for assessing treatment response considering different symptoms or factors (psychological, psychomotor and biological including) including behavioural disorders.
Maximum no. (67%) of the patients were of the age group 5 to 8 years. Male and female were almost in same number (male 7 and female 8). More than half patients (about 67%) were from middle class. Family history of MR was found in 40 % and epilepsy in 20% of patients. In 40% patients perinatal aetiology such as prematurity, delayed birth cry, instrumental delivery was found etc. Prenatal aetiology (chromosomal and genetic disorder) was observed in 20% of cases. 33.33%, 26.67%, 33.33%, 6.67% children were having mild, moderate, severe and profound MR respectively. RESULTS
Social Quotient is computed by using the formula→ (Social Age ÷ Chronological Age) × 100 Intelligence Quotient is computed by using the formula→ (Mental Age † Chronological Age) × 100
Though SA was improved in 3 patients, SQ was found to be increased only in one patient since SA was not increased in accordance to chronological age (CA). In remaining cases no change in SA was seen. As CA of patients was increased SQ came somewhat less after treatment (Table 3).
19.72 1 3.3 23.68 0 9.1 48.86 3 7.2 50 2 0.1 32.73 3 1 52.86 3 0.9 42.10 2 23.81 42.19 1 8.1 28.89 2 2.3 62.07 4 6 29.23 1 11.8 69.05 4 10 45.84 4 7.3 56 3 5.5 48.08 2 0.8 SQ= (SA÷CA) × 100
19.74 21.95 47.25 47.06 32.74 50.68 40 22.99 27.96 60 34.28 65..52 44.71 53.85 45.45
41
Months
Average IQ
After treatment MA IQ Years
Months
Average IQ
Before treatment MA IQ Years
2.1 9.1 7.2 0.1 11.6 0.9 8.1 2.3 6 7.3 10 7.3 5.5 0.8
Months
Months
1 0 3 2 2 3 2 1 2 4 1 4 4 3 2
After treatment SA SQ Years
Years
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Average SQ
Patient No.
Before treatment SA SQ
Average SQ
Table 3.Social age (SA), social quotient (SQ) mental age (MA) and intelligent quotient (IQ) before and after treatment
54.19
4 4
8 3
65.88 42.5
57.53
5 4
IQ=(MA÷CA) ×100
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5 3
73.86 41.2
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Table 4. Mean and standard deviation of individual factors score before treatment and after 90 days of treatment and level of significance
Factors A. Psychological 1.cognition 2. mood B. Psychomotor 1.locomotion a. Activeness b. Performance 2. Drooling of saliva 3. Speech 4. Habits C. Biological 1.Bed wetting 2. Immunity
Score Before After 90 days treatment Mean SD Mean SD 1.76 0.88 2.46 0.64
Mean difference
SD diff.
0.94
0.61
5.87
<0.001
T value P value
1.26 1.8
0.8 0.68
2.33 2.27
0.97 0.59
1.06 0.47
0.95 0.57
4.33 3.61
<0.001 <0.01
1.53
1.24
2.2
1.01
0.67
0.9
2.91
<0.02
2.33
0.9
2.6
0.5
0.267
0.46
2.2
<0.05
2.13
1.64
2.73
1.87
0.6
0.63
3.75
<0.01
0.53
0.84
1.33
0.82
0.8
0.86
3.64
<0.01
1.13
0.91
1.33
0.9
0.2
0.41
1.82
Not sig.
1.07
0.8
1.33
0.49
0.27
0.2
5.4
<0.001
Table 5.Mean and Standard Deviation of scores of behavioural disorders before treatment and after 90 days of treatment and level of significance Time of assessment Before treatment After 90 days of treatment
Mean 6 8.53
SD 1.96 1.68
Among 15 children, only 2 patients could perform SFB test. Out of two, MA and IQ were increased in one patient, while in other MA remained same. Average IQ was increased from 54.19 to 57.73 after treatment. Response to treatment was observed over psychological, psychomotor and biological factors (Table 4). Maximum response was found over psychological factors followed by psychomotor factors. Student t-test was found highly significant for individual psychological factors (cognition and mood). In case of psychomotor factors „t‟ tests were significant for all the factors. Drooling of saliva was present only in 6 children. The „t‟ value for drooling of saliva was found significant at 1 % level when calculated for 6 patients The „t‟ test was highly significant for immunity. No
Mean diff.
SD diff.
t-value
P value
2.53
1.77
5.5
<0.001
statistically significant improvement was found in bed wetting. Under behavioural disorders factors like mood disorders, activeness, drooling of saliva, habits, and sleep disturbance were calculated. The „t‟ test was highly significant over behavioural disorders (Table 5). It means treatment was very effective over behavioural disorders. DISCUSSION Mental retardation is an intellectual and adaptive behaviour disability that begins during the developmental period. Other behavioural traits like aggression, dependency, impulsivity, passivity etc. and mood disorders such as psychotic disorders and attention difficulties may be associated with MR. Various single or
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compound herbo and herbo-mineral preparations which promote intellect are described in Ayurvedic classics under the context of Medhya Rasayana (intellect promoting drugs). While all the Rasayana drugs improve the mental faculties in addition to exerting a beneficial effect on the body, Medhya Rasayana are those drugs that have specific effect on mental performance. They are claimed to promote cognitive functions of the brain and used in various mental disorders. Some examples of scientific validation of Medhya Rasayanas in dementia, depression and memory impairment are mentioned here. Study conducted (Stough et al., 2001) for the chronic effects of an extract of B. monnieri (Keenmind) on cognitive function in healthy human subjects and reported that that B. monnieri may improve higher order cognitive processes that are critically dependent on the input of information from our environment such as learning and memory. Agrawal and Singh (1998) conducted an open trial of Mandukaparni (Centella asiatica) in cases of educable mental retardation indicating significant improvement in performance IQ, Social Quotient, immediate memory span and reaction time. Kapikacchu (Mucuna pruriens) is a Rasayana-Vajikarana plant drug. It is frequently used for the treatment of Parkinsonâ&#x20AC;&#x;s disease and depressive illness in elderly persons. On Phytochemical studies Mucuna pruriens seeds have been shown to contain significant quantity of L-Dopa which could be the basis for its anti-Parkinsonism effect (R.H.Singh 2008). Thus, the Medhya Rasayana drugs such as Vacha, Ashwagandha (Withania somnifera), Brahmi, Mandukaparni, Sankhapuspi, Kapikacchu and several other such herbal and herbo-mineral drugs are very useful in the management of depression, dementia and other mental disorders of elderly. Conceptually it is held that all Rasayana drugs produce their effect by acting through nutrition dynamics (Rasa, Agni, Srotas) at molecular level. They may not possess sharp pharmaceutical activities if used in holistic form and hence as such they may be treated as soft and safe medications which are the popular professional demand in present
times. Medhya drugs can be classified in two broad groups. First group- Madhura rasa (sweet in taste), Guru- snigdhaguna (heavy and unctuous in quality), madhuravipaka (sweet after digestion) and shitavirya (cold in potency). Second group- katu- tikta rasa (pugent and bitter in quality), laghurukshaguna (light and dry in quality), katuvipaka (pungent after digestion) and ushnavirya (hot in potency). The first group drugs provide nourishment to the brain and the second group drugs promote satwa quality of mind and removes rajo and tamodoshas of mind. In other words they stimulate the brain. The combination Vacha, Rudraksha, Haridra, Hingu acts as Medhya Rasayana.. The constituents of the combination (except Rudraksha) predominantly are katu-tikta (Pungent and bitter) in taste, laghu (light) in quality, katu in vipaka (pungent after digestion) and hence pacifies kapha â&#x20AC;&#x201C;vatadosa (functional entities of our body) (Bramhmasankara Sastri, 2007). Rudraksha is amla (sour) in taste, snigdha (unctuous) in quality and madhura (sweet) after digestion (P.V.Sharma, 1990). Vacha is intellect promoting, anticonvulsant. Susruta says it is very good for children to increase their mental abilities. It is useful in epilepsy, delirium, amentia, convulsions, manic conditions, depression and other mental disorders (Bramhmasankara Sastri, 2007). It is indicated in classics from the first day of birth mainly to reduce kapha dosa (functional entities of our body) and promote intellect. Haridra is antimicrobial (Bhawana et al., 2011), immunomodulatory (Tan X et al., 2011), neuroprotective (Dohare P, Garg P et al., 2008) and exhibits synergistic effect (Mansi AP & Gupta SV, 2012). It is among the first 6 drugs which are very frequently indicated in more than 150 different preparations prescribed for mental conditions. Hingu is anticonvulsant and nervine stimulant (Bramhmasankara Sastri, 2007) and antioxidant (Mallikarjuna GU et al., 2003). It promotes the Agni (fire) (Bramhmasankara
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 38–45
Sastri, 2007). Rudraksha possess antioxidant (Kumar ST., 2008) and anxiolytic activities (Shah G., 2010). It is useful in epileptic fits, manic conditions, convulsions, insomnia and other mental disorders. The combination predominantly acts as stimulant to brain, also provides improvement in the nutritional status of the neural tissues (Brain etc.). Like other Ayurvedic drugs Vacha, Rudraksha, Haridra, Hingu is a combination of potentially effective drugs that acts at various levels in a holistic way to improve the mental deficits and promote cognitive functions of the brain.
studies conducted in recent years with this class of drugs have given evidence of neuronutrient effect, neural metabolic modification and improved blood perfusion to the Brain, which is mostly responsible for their clinical effects. The present clinical study revealed that the combination is effective in the management of mental retardation. The Ayurvedic formulation was very effective over Psychological factors like cognition and mood followed by psychomotor factors. Immunity was also found improved with the selected combination. Maximum response was observed over behavioural disorders.
CONCLUSION
ACKNOWLEDGMENT
The tested Ayurvedic formulation posseses Nootropic and cognitive enhancing property. It acts as Medhya rasayana. The scientific
Authors gratefully acknowledge the kind guidance and support given by Dr. K. Sundaran, during the course of the study.
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Chawla Deepa Nanakram (2000), “A study on Mental Retardation and its Principles of Management”, Dept. of Basic Principles, Govt. Ayurveda College, Thiruvanthapuram. Daily DK, Ardinger HH, Holmes GE (2000). Identification and evaluation of mental retardation. Am Fam Physician 61 (4): 1059–67, 1070.PMID 10706158 Dohare P, Garg P, Sharma U, Jagannathan NR, Ray M. (2008). Neuroprotective efficacy and therapeutic window of curcuma oil: in rat embolic stroke model. BMC Complementary and Alternative Medicine, 8:55. doi:10.1186/1472-6882-8-55. Goel, S. K., & Bhargava, M. (1990). Hand Book for Seguin Form Board. Agra: National Psychological Corporation Kumar ST. (2008). Evaluation of Antioxidant Properties of Elaeocarpus ganitrus Roxb. Leaves. Iranian journal of Pharmaceutical Research; 7(3), p211– 215.
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 2 | February 2015 | 38–45
Mallikarjuna GU, Dhanalakshmi S, Raisuddin S, Rao AR. (2003). Chemomodulatory influence of Ferula asafoetida on mammary epithelial differentiation, hepatic drug metabolizing enzymes, antioxidant profiles and N-methyl- Nnitrosourea-induced mammary carcinogenesis in rats. Breast Cancer Research and Treatment, 81(1), p1–10. Mansi AP, Gupta SV. (2012), Synergistic effect of Garcinol and Curcumin on antiproliferative and apoptotic activity in pancreatic cancer cells.Journal of Oncology, Vol. 2012, p 1–8. Mash, E., & Wolfe, D. (2013), Abnormal child psychology, Fifth edition, Wadsworth Cengage Learning, p308–313 Mental retardation (n.d.). Retrieved Jan. 1, 2015, from http://www.psychologytoday.com/condi tions/mental-retardation. P.V.Sharma (1990). Dravyaguna Vijnana, Vol.II, Eleventh Edition, Chawkhambha Bharati Acadamy, Varanasi Pg 219–221
Source of Support: NIL
R Antochi, C Stavrakaki, P C Emery (2003). Psychopharmacological treatments in persons with dual diagnosis of psychiatric disorders and developmental disabilities. Postgrad Med J; 79 (929), p139–146. doi:10.1136/pmj.79.929.139 R.H Singh, K.N.Murthy, G.Singh. (2008). Neuro nutrient impact of Ayurvedic Rasayana therapy in brain aging. Biogerontology; 9:369–374. Shah
G. (2010). Anxiolytic effects of Elaeocarpus sphaericus fruits on the elevated plus-maze model of anxiety in mice. International J of PharmTech Research, 2(3), p1781–1786.
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X, Poulose E, Raveendran W. (2011).Regulation of the expression of cyclooxygenases and production of prostaglandin I(2) and E(2) in human coronary artery endothelial cells by curcumin. J Physiol Pharmacol, 62 (1), p21–28. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed.
Conflict of Interest: None Declared
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