Emerging Ayurveda in the era of
genomics and its scope
By Dr.Prasanth, Kerala Ayurveda Hospital, Trichy.
Ayurveda said to have been in practise since 2000 B.C. , is
known to have flourished under the era of Buddhism and Ashoka, who spread it to
adjacent countries. The science of life as the etymology of the word denotes
has been in practise for thousands of years. Well before it was found out by
sir Robert Hooke in the 16th century
that cell was the basis of all life forms, that cell is the basic unit
of life. It has been passed on from generations to generations through the
gurukula system. But a setback that was received in the Buddhist era was that
all sorts of treatments that inflict pain upon the treated were banned from
usage, resulting in a near complete vanishing of a branch of Ayurveda dealing
with surgeries called “Salyatantra”.Dont forget the fact that Susrutha the
author of Susrutha Samhita , is considered the father of modern surgery !
Ayurveda is a philosophical science and is based upon the Sankhya stream of
reasoning. Accordingly three dosas namely Vata, Pitta and Kapha are responsible
for causing health and diseases. There are studies proving certain links
between the three dosas and their role in expressing certain traits under the
name called “ayurgenomics”. The pancakarma therapies form the basis of all
ayurvedic treatments which are in reality a collection of five therapies namely, Vasti, Vireka, Vamana, Nasya and
Raktamoksha
Unlike other streams of medicine , Ayurveda views the
individual as a whole and thus is in every sense a holistic medicine. As a part
of this holistic approach Ayurveda gives importance to the aetiology or the
cause of disease termed the “nidana”. Ayurveda has dedicated an entire volume
in its text for explaining the causative factors of diseases called the “nidana
sthana”. Ayurveda elicits three causes
or nidanas that are responsible for causing diseases, they are
insufficient union(hinayoga), perverted union(mithyayoga) and excessive union
(atiyoga) of seasons(kala), objects(artha) or actions(karma). On the other hand
to the modern world disease is viewed as a particular abnormal pathological
condition that affects part or all of the organism. The modern medicene views
microbes, genes, external factors like trauma etc as the causative factors in
disease causing. The problem with this view point is that it considers human as
a one separate from his environment or ecosystem. Thus the Ayurvedic view point in its own sense is whole and
complete.
Ayurvedic tradition mentions dietary regimen or “pathya”
while treating. That which is optimum for the body and mind is termed as
pathya. Based on criterias such as quantity, time of administartion,
processing, nature of land, physique of the person, the physiologic status and nature
of the individual what is pathya for one individual may become apathya for
another. The concept of using food as a medicine itself is gaining popularity
worldwide due to the proven fact that certain foods, especially plant food,
contain phytochemicals , which help in preventing diseases. There are many
compelling evidences showing preventive as well as curative role of diet in
obesity and type 2 diabetes. Many dietary ingredients to the Indian
conventional diet have been identified for their beneficial roles in various
diseases. Mimordia charantia(bitter guard) and Piper nigrum(pepper) are two
such drugs. Kasyapa one of the luminaries of ayurveda in his text says that
diet is responsible for the maintenance of life on this planet. Without food no
living being in this world can survive. So there is no medicene in this world
that equals food. One can maintain proper health only by resorting to proper
foods alone. The effects of the medication become nullified without food. So
one must consider food as the mega medicene or “mahoushadha” as it is expressed
in Sanskrit. The common dietary regimen that are to be followed , may be taken
as a universal rule for intake of ayurvedic medicines, is that , all the spicy
, oily foods are to be avoided. Salt is to be taken in moderation.Curd, meat,
egg yolk, fried foods, brinjal, potato, unripe bananas, citric fruits such as
grapes and oranges and dhal are to be
avoided. General rule is that, all those foods causing abdominal flatulence and
acidity, are aviced as non beneficial while taking ayurvedic treatments for the
patients health.
Whatever allopathic medicenes you may take may it be an
antibiotic or a pain killer or a steroid, it is basically a chemical that
inhibits certain metabolic pathways responsible for causing pain or
inflammation. As such the chemicals when they diffuse into blood , react only
with the target cells which due to their specific chemical nature interact with
the drug producing an immediate effect. The basic fault with such an approach
towards treating a disease is that the body metabolism has been altered by an
external chemical substance to produce a temporary favourable effect. These
medicines may give you a drastic pain relief or recovery and in short bouts are
beneficial, but when taken for a long time say a year or more, the metabolisms
of the body may become altered permanently, resulting in the ineffectiveness of
any other medicines that may be available below the sun. Instead of using pain
killers or anti inflammatory drugs , ayurveda introduces the concept of “ama”
which in its simplest sense denotes metabolic stagnation. Every disease in its
initial stages is said to be in its amavastha, so inorder to invigourate the
bodily metabolism, all sorts of dry fomentation methods are resorted to. The
application of oil and other oleation therapies are contra indicated. Only
after the ama has been removed, the treatment progresses to the next level.
This consideration of the body to be got removed of the ama is responsible for
the so called delay or lateness of all ayurvedic therapies. But considering the
fate of all those progressive diseases like Ankylosing Spondylitis, Rheumatoid
Arthritis, Psoriais, Scleroderma, Multiple Sclerosis, Guillain Barre Syndrome,
Demyelinating Neuropathies, where one has to take steroids like prednisolones,
hydrochloroquinones etc for a life time without any significant changes in
symptoms, just adding to the burden of hepatic and renal systems, 14 to 90 days
of continuous Ayurvedic medication (which produce results and relief ) is not
at all a delay.
Low back pain is the
single leading cause of disability worldwide.According to the reports an
estimated 500
Crore Rupees has been
spent on pain relief treatments.About 40
to 60 % of all the complaints that a
patient come to a doctor includes on or other sort of back pain symptoms
.Due
to the erect nature of the human vertebrae , he is prone to a special type of
disease that is absent in other mammals called the back pain. Back pain or low
back pain is the pain that is experienced in the low back which is caused due
to a disc bulge that compresses the nerve roots. The discs or intervertebral
discs as they are called are the cushion like substance that reduce friction
between two vertebrae and thus enable flexion and extension movements of the
spine. The most common site of a disc bulge or proplapse is between the 4th
and 5th lumbar vertebrae and the 5th lumbar and 1st
sacral vertebrae represented in reports as L4L5 and L5S1 disc prolapse
respectively. The patients taking admission in an Ayurvedic Hospital with the complaints of back pain show
a past history of the use of pain killers or steroids. Questioning with the
patients revealed excessive physical strain as the single largest reason for
all back pain. Everybody forgets the fact that only hands and legs are fit for
lifting weight and using spine for doing such activities results in damage to
the vertebral system . Lack of proper exercise or sedentary professions have
been the other cause. The Ayurvedic approach in treating cases of back pain
have been a mixture of oil&heat therapies, oil bandages and application of
pastes. Choorna Kizhi ( Dry
fomentation) are given in the initial stage with two heated bolus prepared by
powder of herbs like medhika, sarshapa, shatapushpa, jatamansi and atasi. The
dry fomentation is followed by oleated fomentation . Pizhichil (which is the squeezing of heated oil over the patients
by the use of a cloth) is the main treatment that is effective in bringing out
a positive result .The oils bring about an effect via the trans dermal
delivery. Little has been known to the
world or has been questioned as to how these oils which are given through the
skin bring about a positive result as we all know skin is impermeable and water
proof ! There is a mode of transport of drugs called the transdermal delivery,
which is the movement of compounds across the skin into the systemic
circulation. Epidermis is the outer epithelial portion of the skin. The outer
most layer of epidermis is called the stratum corneum poses the major
resistance to transdermal transport. Blood and lymphatic vessels, nerve
endings, hair follicles and sebaceous glands are embedded within the dermis,
lying beneath the epidermis. Regardless of skin dosage forms eg., creams, gels,
ointments, suspensions, emulsions, and patches, drug molecules that are in
contact with the skin may penetrate it through three possible ways. One is
through the appendageal shunt route, which includes the sweat ducts, hair
follicles and sebaceous glands. Since these occupy only 0.1 % of the skin’s
surface area, drug penetration through this mode is not effective. The
intracellular and transcellular mode of transport are the other two ways which
pave the way for the majority of the drugs to be absorbed through the skin. The
barrier called stratum corneum of the epidermis is composed of a “brick and
mortar” kind of structure made out of hydrophilic corneocytes containing
keratin pigments and hydrophobic lipid layer. The water passes through the
intracellular route by diffusing through several layers of corneocytes, while
fats pass through the lipid layer by following a rather tortuous route.
For enhancing the bioabilability of ayurvedic drugs via the
trandermal delivery , oils are given at an increased temperature by heating it
(~38 -40 degree celcius) inducing sudation which causes increased hydration
through sweating resulting in better absorption and by massage for effecting a
manual type of iontophoresis. Even the external use of oils increases body
temperature which inturn favours production of sweat by sweat glands. Though this
is not excreted at that moment due to partial closure of sweat pores by fat ,
subsequent application of heat releases the barricade of fat to effect full
oleation used in conjunction with sudation in ayurveda, it provides both
hydration and temperature increase. Thus Ayurveda has its own concept of a rich
tradition of transdermal therapeutical system, it is convinient, effective,
eliminates variables that influence gut absorption, it enters the systemic
circulation directly, it provides a controlled constant drug administration,
displaying a single pharmacological effect, it is patient friendly as it
eliminates the effect of taste or gastric irritation. Little wonder that when
the world is still in its experimental stages by introducing topically acting counter
irritants, NSAIDS, steroids, & transdermal clinical patches of oestradiol,
clonidine, nitroglycerine, testosterone etc, Ayurveda has addressed transdermal
use of medicenes in versatile conditions from neurological affections to
rheumatological conditions and also for skin ailments in various modes and
methods around 2500 years ago, oleation done externally through skin is only
one example.
. Vasti forms the mainstay of all in
patient treatments, and is a procedure similar to enema, but unlike enema,
medicated oils and decoctions are given via the anal route. Many controversies
exist as to how this procedure acts, but according to the study conducted by
P.K.Gupta and R.H.Singh, vasti acts by producing a pharmacological effect
through the drugs present in the oil and by volume or amount of the liquids
given exciting the pressure receptors thus enchancing further drug absorption.
Vasti is known to enhance gut flora, Vitamin B12 synthesis needed for better
integration of nerve signals, increase serum protein levels, Hb % and reduce
ESR thus resulting in better health.
Other sub treatments
that are done are application of medicated pastes over swellings called lepam, oil bandages and use of rice pastes for strengthening the nerves called
as Njavara Kizhi . The pateints are
adviced complete bed rest for 10 days, where the duration of In- Patient
treatment is 14 days. Only mild flexion and extension exer cises are adviced
after discharge. On the whole it takes about 3 months of continuous medication
after the discharge form hospital through OPs to bring about a complete cure.
The recurrence rates are very low and there is an absolute relief for 2 years
atleast that can be guaranteed. Even though after hours of education about the
factors responsible for back pain , the patients commit the same mistakes again
and again. They resort to all sorts of physical strain, travelling in two
wheelers for kilometers for days and months, ignore sleep, lift weight that are
the reason for 99% of back pain relapses. But once taken ayurvedic treatment at
the earliest the possibility for another severe attack of back pain is very
low. The pain relief is brought about within five days of admmission that too
with zero pain killers, which may sound llike a sort of miracle. For better
results following an ayurvedic treatment patients are adviced compulsary bed
rest for 2 weeks immediately following the treatment. Acute cases of fall
involving fractures of spine have been dealt with very successfully. The relief
given to the young patient who suffers from the crippling Ankylosing
Spondylitis (arthritis of the spine) is worth mentioning. The treatment enables
him to return to his normal life ! Considering the fact that India is the home
to Ayurveda, it is a bit of a surprise when you hear form the patients that
such an effective treatment exists in ayurveda for back pain, all else(the
foreigners) are well aware of it, coming to the hospitals by searching the net.
The cost of the ayurvedic treatments are one of the prime factors responsible
for the patients avoiding IN-PATIENT treatments in hospitals, but considering
the fact that for a severe or chronic back pain, when you consult an
orthopaedician or a neurologist, you have to go through a series of diagnostic
procedures as adviced by him starting from simple AP/LATERAL X RAYS of the
lumbar spine to costly MRIs and CT scans and Nerve conduction studies,, not to
forget the regular dosage of pain killing medications that you are gonna take
which in any case is not going to help the patients in the long run. So when
you evaluate the pros and cons of ayurvedic and allopathic medications , the
balance is definitely going to tilt in favour of the former. Don’t forget about
the side effects of these pain killers which start from simple gastric ulcers
to liver failures in long term users, as is signified by their abnormal values
in the Liver Function Tests (LFT’s). Time is going to tell wether the Ayurvedic
physicians would be able to capitalise on this major draw back of the
allopathic system ( to interfere with bodys metabolism), and for any system to
survive, the support of the soceity becomes inevitable. Ayurveda hence has
survived through milleniums only with such support and the big question mark as
to how the drugs act is only one among various other curiosities of the human
being ( it is this very nature that is responsible for all inventions). The
goal to achieve for all ayurvedic practitioners and researchers and scholars
would be to make this system as the sole and complete treatment in the
management of back pain, suffered by everybody atleast once in their life time
!
While considering the fact that 98% of all back pain cases can
be treated using conservative method avoiding surgical intervention, kudos must
be given to the modern surgical
developments , it has added yet one more disease to the long list of diseases
it has classified ! It is called as the “FAILED BACK SYNDROME”, or the “POST
LAMINECTOMY SYNDROME” , which is the recurrence of back pain following
laminectomy, a surgical procedure that removes a portion of the vertebral bone
called the lamina. No treatments can give relief to a disease caused by a
surgery which involved removal of an important anatomical portion of the lumbar
vertebra which is intended to protect the spine ! That portion of the spine
where laminectomy has been performed is left unguarded exposed to muscles and
soft tissues. The logic behind this surgery seems too weird to be successful as
the failure rates for this particular treatment called laminectomy are as high
as 74 % while other surgeries invoving the spine show revision rates of about 65 %. In numbers approximately 30,000 to
40,000 patients obtain no relief per year following the surgery or the symptoms reoccur
(according to wikipaedia) . The patient upon ayurvedic treatment after
performing laminectomy makes increasing demands for pain relief. The pateint
grows angry at failures and may become litiguos. The use of narcotic pain
medication adds to the pressure of the treating ayurvedic doctor in the sense
that it may have become addictive or habituative in addition to the major
psychological problem of depression. The probability of returning to a gainful
employment decreases with increasing length of disability, so considering these
hindrances in mind , the results produced, that too a near complete sort of
relief , which can be maintained throughout life time with careful management
of ones own spine, is an effort that needs world wide accredition, recognition
and propogation ! The word of appraisal from the mouth of patients after
completing 2 weeks of ayurvedic in patient treatment is in its sense rewarding.
The contibution of ayurveda in reducing the panic regarding
the edemic viral disease popularly known as the chikun gunya and dengue
haemorrhagic fever is no less . The extracts from the leaves of pappaya have
shown miraculous results in thwarting a condition called thrombocytopenia characterised
by reduction in the number of platelets as a result of the virus affecting bone
marrow (resulting in haemorrhages and thus the name), by a drastic elevation of
platelet counts. The efforts taken by the Tamil Nadu Govt. in making the
extracts available to every affected area needs special mention so that dengue
and chickun gunya are less feared now ! Wrightia tinctoria is another wonder
drug that produces miraculous effects in psoriais (a skin disease). Ayurveda as
an indigenous medical system needs a new direction, while considering the
efforts of the Chinese government in bringing acupuncture, its indigenous
medical system to the fore front, India is the only country that ignores its
precious traditions and heredity in the passage of time. We need to inculcate
the culture of ayurveda and create more and more awareness regarding its
efficacy. Unlike the modern medicine which is in tune with the marketing rules
and principles of profit gaining, Ayurveda owes its call not to selfish goals
or worldly pleasures, but to compassion for fellow beings. In seeking to know
my legacy you have but seen the leaves of a universal tree , too vast for your
eyes. May your sight grow and your quest never end ! The author being an
Ayurvedic physician has written this article based on his experiences in
ayurvedic therapies and this does not mean other systems of medicine are
secondary to ayurvedic treatments. May it be the allopathic system or
homeopathy or siddha or naturopathy or physiotherapy , all has got its own significance
and role to play in disease curing.
