Onclolgy -in- Ayurveda

Anti Cancer Treatment in Ayurveda

Onclolgy -in- Ayurveda

January 16, 2015 at 10:21pm

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CANCER IN AYURVEDA.

One of the major reasons for redefining ayurvedic practices is the emergence of new diseases, whichare less amenable to conventional standard treatments. We may openly admit that, cancer, as we knowtoday, is not described in classic ayurvedic works such as Brhatrayi. In ancient times cancer had thestatus of an orphan illness. Orphan illness refers to a disease entity which was not taken up for elaboratestudies in terms of its etio-pathology, therapeutics and prognosis. It may be presumed that the neglectwas for want of large patient population. In the case of cancer the situation has thoroughly changed andit is now the major cause of fatality, second only to cardiac ailments. It is no more considered as anorphan illness as in the past. Naturally ayurveda too has to develop an oncology – both theoretical andapplied.No one can honestly claim to know the cure for cancer. Many of the questions related to etiopathologyof cancer remain unanswered.The therapeutic choices offered to a cancer patient are rather grim. The treatment strategies of cancerare mainly three. - Cut it out (surgery), Burn it out (radiation) and Destroy it (chemotherapy).There is a strong anti-surgery feeling among patients. Cancer patients want to move away from radiationand chemotherapy fearing of physical disfigurations that may result from the therapies. To many, traumaof the treatment is worse than that of the disease. They are therefore, put in a climate of opinion ruled byfear and uncertainty. As a safer option they turn to other systems of medicine. Unfortunately, we havenot so far succeeded in developing an effective ayurvedic methodology to deal with cancer cases.Because of this reason the patients often face agonizing dilemma. In this situation we are bound to takestock of the situation and improve ourselves to come up to the expectations of the ailing fraternity. We just can’t afford to wait to treat cancer patients until we evolve a definite system in oncology.Case StudiesKeeping this in view, our institution has started an exclusive clinic for cancer patients, where primarilywe act as service providers. Meanwhile, we are trying to document the case histories of cancer patientsin a systematic manner so that the data generated thereof can be retrieved for further studies. Our 6years old cancer clinic now has documented clinical case histories of about 2000 cancer patientsbelonging to different categories. The primary analysis of the clinical patient population reveals that fourgroups of patients are seeking ayurvedic treatment.There are patients who want to try ayurvedic treatment along with conventional anti-cancer treatments.They hope that combined therapy will be helpful to nullify the side effects of radiation and chemotherapy.They also hope that ayurvedic therapy would help prevent recurrence in a safer way. Terminally cancerpatients take recourse to ayurvedic treatment for supportive and palliative care. A third group of patientsare those who decide to try ayurvedic treatment on a regular basis for total and permanent cure thoughthey are temporarily released from the clutches of cancer with the help of surgery, radiation orchemotherapy. There is yet another group of patients on whom we are concentrating just because theyare fully dependent on ayurvedic treatment. Admittedly, this category of patients constitute only a minorpercentage of the patient population. Their decision to opt exclusively for ayurvedic treatment is essentially based on their understanding of limitations and risk of other treatment options. Our commitment towardsthis group of patients is relatively more because of the faith they have deposited in ayurveda.As of now we do not have statistically significant number of cancer cases, to establish the efficacy of ayurvedic treatment. But there are medical case histories of cancer patients suggestive of the scope andrelevance of ayurvedic treatment for management of malignant disorders. The guidelines for researchmethodologies designed by WHO include a specific clause which is very pertinent in this context. Itsays single case studies for evaluation of efficacy of herbal medicine should not be ignored because of its potential contribution to traditional medicine.I vividly remember the case of a patient who had adenocarcinoma of stomach. His brother who wasundergoing treatment in our hospital had a discussion with us about the possibilities of ayurvedic treatmentfor stomach cancer in which the western system had nothing much to offer in terms of a medicaltreatment. Based on the reports made available to us we suggested a course of treatment to be tried athis residence. In fact we did not get an occasion to see the patient personally even once before chalkingout the treatment profile. The medicines included Nimbamrithadi Panchathiktham Kashayam, SahadevyadiLeham and a few adjuvants. We too were not very hopeful in the initial stages of treatment. To oursurprise we were getting reports from the patient indicating the progress that he was making towardsrecovery. He made his own arrangement to continue the treatment at Gulf collecting medicines fromKottakkal. He continued the medication without any interruption for a period of more than five years.To him at least ayurveda has a cure for Cancer. Similarly I would now like to refer to another example.In this case the patient is a fifty year-old Keralite lady who was diagnosed as Ca. Lung. She approachedus for medical advice forwarding her full medical case history. In addition to NimbamrithadiPanchathiktham Kashayam, Sahadevyadi Leham, we prescribed Parthadyarishtam andAgasthyarsayanam in view of the specific site of cancerous lesion. One cannot expect a tangibleimprovement in lung cancer cases. But this lady improved rapidly and she attained a near normalcondition. The improvement was not merely symptomatic. Radiological examination revealed theremarkable changes suggestive of the regression of the disease. (I have with me the X-ray films of thispatient).I may now refer to the treatment of one more case. It is about a sixteen year-old patient, diagnosed asAcute Myloid Leukemia M-1. The diagnosis was done at Nizam’s Institute of Medical Sciences,Hyderabad. The presenting symptoms were abdomen pain, low grade fever, dry cough, and generalizedbody ache. On examination there was detectable splenomegaly. Patient was advised to try NimbamrithadiPanchathiktham Kashayam, Chandraprabha vatika, Ayolipta thippali, Rasasindooram and combinationof Nityakalyani extract, Thippali choornam, Rajathabhasmam and Thalakabhasmam. Patient continuedthe treatment on a regular basis and intimated the progress at regular intervals. She was registeringimprovement gradually. Case was personally reviewed after three months. Patient was totally free fromall symptoms recorded initially and there was no splenomegaly. Her blood picture showed tremendousimprovement in every aspect. The patient has now resumed her studies as if she has totally recoveredfrom the ailment. She has been advised to continue the medication and send us the reports without failat regular intervals.These instances cannot be set aside as odd events or miracles. Any way the time is not ripe to make tallclaims about the curative effects of Ayurvedic treatment in cancer cases. I am sure many of you mighthave come across similar incidences. My request is that all of you should as far as possible try topreserve your findings for the future because ‘miracles are also extensions of normal capabilities’.

3Collaborative research activities also bring forth valuable data. I may now refer to a few of such activitiesundertaken by our institution joining hands with Calicut Medical College. Here the attempt was directedto provide terminally ill cancer patients with supportive palliative care. Primarily it was decided to splitthe goals and aim at achievable bits. To cite an example, Opioid induced constipation is a big menaceto the cancer patients who are receiving morphine therapy for pain relief. They cannot do away withopioid preparation because no therapeutically equivalent drug is available to replace it. The standardtreatment adopted to relieve constipation has many inadequacies. It was why doctors were willing totry some herbal preparation. A team of doctors studied the efficacy of well known ayurvedic preparationMisrakasneham to relieve constipation. The study brought out highly encouraging results including betteracceptance by patients. I am happy to say here that an international journal on pain managementpublished an article about this study. Similarly Viswamritham was tried for anorexia, Sathadhouta grithamfor oral mucositis. For various reasons the study could not yield statistically significant data but wecould prove that it is well worth considering ayurvedic medicaments in the treatment profile of cancer.Theoretical OncologyI would now like to touch upon a few hints that could be considered while developing an Ayurvedictheoretical oncology. What should be the starting point? We should have a clear-cut understandingabout contemporary knowledge on cancer. We may look at this information from an ayurvedic perspectiveto form an ayurvedic oncology with theoretical soundness. I have tried to pick up a few points fromclassical ayurvedic works which have relevance in forming an ayurvedic oncology. The booklet amongyou contains a brief account of this information. Kindly subject it for a critical analysisSystematic function of any biological entity requires three fundamental regulatory processes - input/ output (transport), transformation and storage. In other words, we may say -

Tridoshaconcept of ayurveda also has a sound basis of thissystemstheory.To obtain a fair idea about the basic structural and functional concepts of human body we may look intothe derivations of a few words commonly used to denote the human body in Ayurvedic classics.1):As far as our knowledge goes, cell is the basic structural unit of the human body. It may be rationallypresumed that there was some knowledge of the cell boundary and molecular traffic between the extracellular and intracellular fluids even before the advent of electron microscope. Human body is composedof between 50-100 trillion cells. Charaka says It essentially means that the basic body components are structurally atomic, innumerable and microscopicAn individual cell is on one of the two largely exclusive paths: division or differentiation. Cells capableof dividing are undifferentiated (stem cells) whereas terminally differentiated cells are unable to divide.Stem cells produce daughter cells that can either become new stem cells or undergo terminal differentiationdepending on tissue specific programming interacting with environmental signals. Both types of cellshave different patterns of gene expression.Each cell has unique characteristics (either inherited or acquired) to perform certain subset of functions.Integrity of human system is maintained by the synchronization of functions of sub-systems, which areorganically interconnected and biologically regulated by thetridoshas, biophysico chemical energies of the body. Of the three forms of energies,vayuacts as the master force.We may now have a brief overview of how cellular metabolism is governed by the threedoshas.

Vatagoverning input/output is responsible for regulating transport across all membranes including entry of food and other molecules into the cell and elimination of waste materials. Governing motion (kinetics) itwould also be responsible for cell division and differentiation (samyogavibhage karanam vayu).Pittabeing responsible for metabolism (biochemical energy production and regulation) governs thekrebs cycle wherein assimilated food is used to create high energy molecules required for cell growthand sustenance.Pittais also responsible for all processess involving enzyme synthesis needed to bringabout transformation.Kapha,being responsible for storage can be identified with the cell membrane and cell wall, basicreserves for the cell to call upon in hard times. On a molecular levelkahpacan be identified with lipidsand polysaccharides the molecular basis for membrane and cell walls respectively. Mucus ispolysaccharide while other lubrication may use lipids.It may be of interest to note that the strategies, which maintain process of control in single cells possessan underlying continuity throughout their biologic development, starting from the microscopic level of regulation of biochemical processes in single cells, and proceeding to the macroscopic level of controlprocesses regulating whole body and its subsystems. It can be seen that the processes of biologicdevelopment have maintained similar strategies of control to those used in the original cells, adding toand building on them as appropriate, but without fundamental alteration.Cancer is a disorder of cellular behaviour, in which the structural/functional integrity is distorted.What is cancer?We come across descriptions of disease entities in ancient ayurvedic texts that have remarkable similaritieswith modern interpretations of cancer. However, one can hardly find a single comprehensive word inayurveda denoting a disease entity, which is fully comparable with concept of cancer.Etymologically the word ‘Arbuda’ represents an enormously growing mass encroaching and destroyingthe normal structural and functional status of an organ and on a larger scale the entire human body.On conducting a literature survey, we get a fairly good amount of information with regard to theunderstanding and interpretations of our predecessors about cancer. In this context, appropriate referencehas to be made to a variety of diseases which have this particular feature in onset, growth spread or

5manifestation. It includesgranthi,apachi,gulma,udara,vidhradianddustavrana. Benign forms of these diseases are likely to become malignant over a period of time where the standard treatmentsprove ineffective. We may say thatsannipathikastage of doshavitiation of diseases is comparablewith malignant conditions.One of the criteria adopted by the exponents of ayurveda in naming and grouping of diseases was theircommonalities in ethiopathogenesis, disease processes, clinical manifestations and terminal stages of the diseases. 5manifestation. It includesgranthi,apachi,gulma,udara,vidhradianddustavrana. Benign forms of these diseases are likely to become malignant over a period of time where the standard treatmentsprove ineffective. We may say thatsannipathikastage of doshavitiation of diseases is comparablewith malignant conditions.One of the criteria adopted by the exponents of ayurveda in naming and grouping of diseases was theircommonalities in ethiopathogenesis, disease processes, clinical manifestations and terminal stages of the diseases. The following descriptions with its appropriate interpretations provide a sound basis fordevelopment of ayurvedic oncologyBasic ApproachAyurvedic treatment for cancer should be basically holistic in approach and so modulated as to havethe following results.1) eradication of morbid tissues2) protection of healthy cells from toxicity and other unfavourable conditions.3) promotion of regeneration of healthy tissues.Anti cancer treatment has five major categories depending upon the level of medical care required –preventive, prophylactic, curative, palliative and supportive.Based on the current understanding of the biology of carcinogens preventive and prophylactic measurescan be adopted. It includes early identification of disease, avoidance of carcinogens and specificinterference to lower cancer risk. Ayurveda definitely has some important role to play in preventiveoncology because carcinogenesis is not an event but a process evolved over a considerable period of time. Manipulation of genetic, biologic and environmental factors in the causal pathway should beattempted. It could be made easy by adopting and updating the principles and practices laid down insvasthavrtta. It may perhaps be possible to influence the mutations leading to carcinogenesis at embryoniclevel by resorting to well designed prenatal care systems. The methods and materials recommended inayurveda in this regard could be subjected for indepth study. Life style modification in terms of diet,relaxation, exercise, attitude, and motivation can be effectively practiced. Patient education and publicawareness programmes enlightening the need of upkeeping positive health could be contributory.Chemoprevention is a relatively new concept. It involves the use of natural agents (chemical agents arealso considered in western medicine) to reverse, suppress or prevent carcinogenesis before thedevelopment of invasive malignancy. The purificatory treatment regimen of ayurveda followed by theregular use of rasayanas may prove an effective mode of chemoprevention.The inbuilt health potentials of human body could be appropriately channeled to inactivate the carcinogenicproliferation. It may perhaps be possible to influence the mutation leading to carcinogenesis at cellularTable IIThe various stages of development of arbudaDwirarbudam(Distant metastasis)Vidhradhi(abscess)Vrana(Malignant ulcers)Sopha(Oedema)Granthi/Gulma(Glandular swellings)Arbudam(Tumour)Adhyarbudam(Metastasis - Primary site)Dwirarbudam(Distant metastasis)


7level. This appears to be one of the basic axioms of the biologic therapy which is aimed at manipulatingthe host-tumour interaction in favour of the host. The very existence of a cancer in a person is testimonyto the failure of the immune system to deal effectively with the cancer. Tumour cells have inherentcapabilities to escape the attention of the defensive mechanism of the host. This could be comparedwith underground terrorism. In the initial phase tumour cells do not exhibit notable difference fromnormal cells so that they are not identified as possible culprits. Tumour activity at this level is too downregulated to be recognized by the cells so that normal antigen-antibody complex does not develop.Tumour cells can cloak themselves in a protective shell of fibrin to minimize contact with surveillancemechanisms. In short the entire purpose of immune mechanism is thus defeated by the tumour cellsmoving in a hidden path. It is unfortunate that most of the universally accepted anti-caner treatmentsalso suppress the immune mechanism adding to the misery of the individual affected. This may perhapsbe one of the demerits of the cancer therapy.There are guidelines in ayurvedic classics to deal with neoplasia of various types. But therapeuticefficacy of such measures to counteract the process of carcinogenesis remains to be established. Thecentres of advanced studies in ayurveda and allied sciences are equipped with the infrastructure capableof isolating drugs having anti-mutagenic, anti-proliferative activity. There is every reason to believe thatin the near future ayurvea would have an Arbudaharaganam to be incorporated into the chapter of Sodhanadigana sangrahaneeyam..Ayurvedic practitioners have already started using classical formulation such as GulguluthikthamKwatham, Kanchanaragulgulu, Rasasindooram, Gandhira rasayanam etc. of treatment of malignantdisorders. Guided by my experience, I may make an incidental mention about auto-urine therapy too.My personal observation is that urine contains some anti-cancerous ingredients. As scholar of bothwestern medicine and ayurveda, Dr. K. Rajagopalan holds the view that medicaments recommended inArshochikitsa have specific role in the treatment of colon cancer. In a way we are finding clinicallymeaningful anti-tumour and anti-cancerous effect of ancient classical preparations. The observationaland empirical data so obtained would be helpful to form a medical oncology of ayurveda.Palliative care refers to the medical or comfort care that reduces the severity of a disease, slows itsprogress rather than providing a cure. In the case of cancer, palliative care becomes the focus of thetreatment in certain conditions. This helps management of pain and other distressing symptoms 

I.N.T.E.G.R.A.T.I.V.E. M.E.D.I.C.I.N.E.

I.N.T.E.G.R.A.T.I.V.E.  M.E.D.I.C.I.N.E.

Three years ago, Dr Tejinder Kataria, a radiation oncologist at Medanta-The Medicity in Gurgaon, was treating a head and neck cancer patient, who developed painful blisters in his mouth because of the radiation. The patient was in tremendous pain and had stopped taking even fluids orally. Kataria then referred the patient to Dr G. Geeta Krishnan of Medanta's department of integrative medicine and holistic therapies. Krishnan treated him with some ayurvedic concoctions. “The patient responded so well to the ayurvedic treatment that he started taking solid food. I was amazed by his recovery. I then recalled all the effective home remedies my mother used to give me when I was young. Now, I take Dr Krishnan's help in such cases,” she says.

Kataria is not alone. A lot of doctors are reinstating their faith in ayurveda and other alternative medicine systems. Instead of calling it alternative, they now prefer to call it 'integrative' as the idea is to have the best of both allopathic and alternative treatments that will benefit the patient. “Before I take up any patient who requires lung surgery, I send them to our yoga department to learn breathing exercises that help in expansion of lungs. We reduce the lung in such a surgery, and it grows again post surgery. These exercises help them in expansion, and the recovery is faster,” says Dr Ali Zamir Khan, thoracic robotic surgeon at Medanta-The Medicity in Gurgaon.

In fact, these doctors believe that there are some health issues that only ayurveda can tackle effectively. Chronic pelvic pain and inflammatory bowel syndrome, where allopathy offers only symptomatic treatment, have 90 per cent cure rate in ayurveda. Similarly, sleep disturbance, for which one has to pop sleeping pills every day, can be treated for relatively longer time with ayurveda. “One week's ayurvedic therapy brings relief for six months in 40 per cent patients with chronic sleep problem,” says Krishnan.   

Krishnan's 40 per cent patients are referred from various departments¯cardiology, neurology, oncology, gastroenterology, and most from the surgery department. “We are now documenting the results of ayurvedic therapy given to each patient. Scientific mapping would help us establish what is considered an alternative system as a mainstream medicine in coming years,” he says.

Dr Raj Kumar Yadav, assistant professor of physiology at All India Institute of Medical Sciences (AIIMS) in New Delhi, has done research on yoga and modern-day illnesses. “Regular yoga reduces all kinds of inflammation in the body. It helps in cardiac problems, diabetes and obesity,” says Yadav. “We do it scientifically. We measure all the vital parameters and biomarker levels in a patient's body on the first day. We then give them a 10-day therapy under strict supervision and again measure these biomarkers and vital parameters. We have noticed a remarkable improvement in our patients. Most of our research papers are getting accepted by international journals and we are getting queries from international researchers.”

 
Meditation, too, is effective, says Yadav. It activates the right part of the brain, which improves a person's attentiveness. Most people use their right hand and, as a result, the left part of their brain is found to be more active. Regular meditation awakens the Broca area, usually located on the left side, on the right side of the brain, too, he says. Besides, it stimulates the whole brain and improves its functioning. “With the help of PET-CT scan, we have studied how the electrical activity of the brain increases during meditation. The role of yoga in treating Parkinson's and other neurodegenerative diseases is being studied across the world,” says Yadav.

Dr K.P. Kochar, senior professor at AIIMS, is researching the use of basic Indian spices in treating various health problems. “Turmeric, as we all know, is good for infections and healing wounds. But there are many more spices that can be used to treat various health problems,” she says. “There is a lot of scope. We just need to follow the ancient medicine system scientifically as we follow allopathy.”

JOINT EFFORT
* Integrative medicine combines modern medicine with alternative systems like ayurveda, acupuncture and natural wellness.

* The idea is to have the best of both allopathy and alternative medicine to benefit the patient.    

* It supports the body's natural ability to heal, reduces stress and promotes a state of relaxation.

* An increasing number of doctors are adopting the integrative route, be it for treating Parkinson's disease, irritable bowel syndrome or allergies.

Success of ayurveda in neuro degenerative conditions !!!

Got a call from a patient today, the chief doctor ask me to handle the call actually, but nevertheless the patient knew me as I was the one who attended him daily twice, inaddition to the chief, he said was thus , "doctor I fell some stiffness and gripping sensation in my thighs and calf muscles of my leg when I get up and while walking", symptoms resembling arthritis though not of a serious kind, I felt relieved actually ! Three months ago he came in a stretcher (wheel chair was a better option I thought as it give a positive outlook !!!) , with paraplegia for below the umbilical region, with attached catheters. Not able to walk/stand or even sit by himself. He was able to eat, goodness gracious ! he...he..!! As he was a famous entrepreuner, who has caught this disease , "the Kochs disease of D3 vertebrae", he used to speak a lot with me, on most days for an hour or so, for that matter with every one in our hospital ! He seemed too lazy, but not at all depressed or worried about his present condition, which looked astounding for me . The treatments which involved predominantly ayurvedic panchakarma therapies and physio combined ( by physio I mean no expertise treatment, only simple exercises done carefully ), which looked producing slow and steady results. The span of treatments were around a month. At around 15th day he was able to move his legs and foot and then gradually started walking with the help of a walker ! This would not have happened if he had resorted to physiotherapy alone. The sucess of ayurveda once again reitrated in neuro degenerative conditions !

Emerging Ayurveda in the era of genomics and its scope

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 16^th 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 4^th and 5^th lumbar vertebrae and the 5^th lumbar and 1^st 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.

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Medical tourism , the new trend, pros and cons of it .

Abstract

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The concept of medical tourism is almost as old as medicine itself. Kerala has emerged as hub for state-of-the-art Ayurvedic healing. Ayurveda, the Indian system of medicine, is deep- rooted in Kerala from time immemorial. This is an outcome of a study under which the investigator gathered data by visiting Ayurvedic hospitals, patients, healthcare professionals, etc. This study presents the ground realities of medical tourism in Kerala apart from the perceived aspect. This study envisages evaluating the facilities and services provided by the hospitals for medical tourism in Kerala thus trying to foresee the future scenario of medical tourism in Kerala. In this paper, the expectations of  medical tourists and the experience they had is analyzed for giving a clear picture about the success level of  medical tourism in Kerala as of now and that will give the pitfalls in the areas concerned as well.
Key words: Medical tourism, Realm, Bootstrap, IFC,  Sustainability, Healthcare.

Introduction

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Medical Tourism
Medical tourism or medical travel is the act of traveling to other countries to obtain medical, dental, and surgical care. The International Union of Travel Officials first designated medical tourism as a commercial activity only in 1973 (Milica Bookman: 2007). India is contemporary global center for medical tourism, and it offers everything from alternative Ayurvedic therapy to coronary bypasses and cosmetic surgery. Kerala’s strengths in Ayurveda and modern medical technology combined with strong marketing skills have helped the medical tourism industry grow in leaps and bounds. Now the slogan can be:
Medical Treatment in USA = A tour to Kerala + Medical Treatment + Savings.
Many tourists have now realized that Kerala has a pool of trained doctors and nurses and an excellent network of hospitals that offer international standard treatments at very affordable prices. Previously residents of Kerala working abroad, especially in the Persian Gulf countries, would return to India for medical treatment make recommendations as well. Now International patients too have realized the advantages of traveling to Kerala and the medical tourism industry is picking up momentum. Faced with exorbitant fees for procedures such as cardiac surgery, dentistry and cosmetic surgery in their home countries, patients from the West and the Middle East have begun looking at Kerala. Kerala doctors and nurses have established themselves as highly skilled and conscientious caregivers worldwide. Their reputation has led to the growth of the medical tourism industry in Kerala. The excellent hospital facilities, pre and post-treatment care and pleasant climate make medical treatment and recovery in Kerala a positive experience. A holiday coupled with treatment is something, which we would not have thought of in our wildest of dreams before, but today it has become a reality as the total cost, including airfare, hospital expenses, hotel accommodation and the added tourism experience, works out very economic in comparison with the surgery cost in the developed nations.
There has been a trend of healthcare practitioners from other countries such as Japan and South Korea visit Kerala to attend trainings in Ayurveda healthcare practices. Such practitioners set up their hospitals in their home countries after completion of their training. In addition, many entrepreneurial Indians have set-up their Ayurveda hospitals in various countries such as the US, the UK, Canada, and Sweden, Switzerland etc. The trend is expected to continue in the near future and it is estimated that the global Ayurveda healthcare industry would be about USD 5,000 billion in 2050[2]. According to recent estimates, the market size for Ayurveda healthcare in India is about USD 1.4 billion. This includes exports of herbal raw material and medicines worth more than USD 700 million per year. Further, the Ayurveda healthcare market in India is expected to grow at about 20 % per year during the next five years [2]. According to the CII-McKinsy report, medical tourism industry in Kerala is expected to be worth $4 billion by 2017. This sector will bring in as much as $2 billion by 2012 as compared to an estimated $333 million in 2006-07.

Health Care and Kerala

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Kerala possesses the finest health indices in the country. Kerala achieved its health status at par with that of USA spending roughly $ 10 per capita per year while USA spends $ 3500 per capita per year on healthcare (Health and wellness-stark world). Kerala is on par with U.S in longevity and standard of living aspects. With high literacy rates, public distribution system of food, easily available public medical system (three tier system-the primary health and the community centers, taluk and district hospitals, medical colleges) as per in 1995 Government decentralization of healthcare sector, medical pluralism consisting of both formal and informal traditional medical systems, with several unique characteristics, Kerala bags this credit [3]. 
Kerala is known as a land of medicines alternative medical therapies such as Ayurveda for many centuries and has a long history of a well-nurtured health system. The state of Kerala is   the main generating region of ‘medical –paramedical staff of the world. The Confederation of Indian Industry (CII) has declared 2006-2007 as Medical Tourism Year in Kerala. Kerala is being promoted for its cheap health care and medical tourism packages are especially desirable because of the scenic surroundings, including the famous backwaters and houseboats. The Department of Tourism in Kerala in partnership with CII organizes a show and international conference on medical tourism, which is attended by prominent medical tourism hospitals, medical insurance companies, and travel operators. "Kerala has an immense potential to develop the scope of health tourism in the country. It can become the hub and one of the most preferred destinations in the world for potential health tourists," Sri Lankan Minister for minor export crop promotion, Reginald Cooray, opined on an international conference and exhibition on health tourism, Kerala Health Tourism 2011. Low cost is the norm today without compromising on the quality and it is this ‘cost -effectiveness and competency’ bundled and packaged well with amazing tourism products of Kerala. 
Ayurveda, the Indian system of medicine, is deep- rooted in Kerala from time immemorial. Though Ayurveda is practiced all over India, Kerala is perhaps the only State where this science of medicine still follows age-old traditional laws. Because of Kerala’s unique location, its natural wealth, and rich culture, the system of Ayurveda- practiced here has developed certain characteristics different from those observed elsewhere. Kerala has an unparalleled wealth of herbs and natural vegetation. However, similar herbs and plants may be found in the Himalayas, those found in the State have a special potency due to Kerala’s unique geographical position and tropical climate. Even for classical Ayurvedic preparations. The practitioners of Kerala have evolved their own formulations that are superior in effect. Various forms of treatments are offered to patients in Kerala, which are varied in duration. Some of the treatments like massages and rejuvenation therapies are done during monsoon when the atmosphere remains dust free and cool, opening the pores of the body to the maximum, making it most receptive to Ayurveda herbal oils and therapy. The climate in Kerala is tropical and the temperature varies from 180C to 370C. Rejuvenation is the major purpose of Ayurvedic tourist arrivals (78.9%) followed by curative purposes and 89.5% of the visitors like to revisit the Ayurvedic centers again [4].

Ayurveda - A Bootstrapped Realm

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Kerala medical tourism based on Ayurveda is receiving customers from Middle East, Europe and developing countries (low GDP countries) and are motivated by the comparatively cost effectiveness, personal and quality care (Refer Graphs 1and 3). Many tourists are coming from the neighboring countries as the cultural assimilation is easier and easy accessibility. NRIs and other Keralites are there at the forefront for promoting Kerala by giving attractive packages to them. However, the perception-reality analysis indicates that there is a slight difference in these two variables, which calls for conscious and coordinated efforts from the service providers and the competent authorities (Refer Table 1). Leisure component contributes comparatively little to the industry as it is slowly picking up momentum. Now the phenomenon is merely ‘medical travel.' There is an increase in supply of medical tourism products especially in Ayurveda treatments; leading to greater competition and commerialization.There is a chance for Ayurveda and its products to become ‘pseudo products’.

The research shows the absence of an effective follow up care, which makes the potential and actual customers in a dilemma. There should be assured after care system through proper legislation. Quality rather than quantity should be ensured for managing and developing the medical tourism product. They should reconsider their pricing strategies keeping in mind the fact that not all the foreigners are price in elastic. English linguist capabilities of the medical and paramedical staff may be considered as a serious bottleneck of the industry.

The main source of promotion is word of mouth and that should be sustained through the provision of quality of services. The NRIs and Keralites also act as ambassadors of promotion. Medical tourism destinations’ “creative” marketing strategies predominantly use the Internet as an electronic marketing tool to transcend national borders. There should be concentrated and objective oriented promotional efforts, which can make use of other tools of marketing as well. Both the service providers and the governments should actively promote the destination as a medical tourism hub.

Need for Joined Effort
The health and tourism industries should link up to provide medical tourism packages through their websites and brochures, a strategy actively employed by regional competitors like Thailand, Philippines, and Malaysia. There is a lack of co-ordination felt between the key players of medical tourism – airline operators, hotels, hospitals and between Government and private sectors. Transform of Institutes for Collaboration (IFCs) into centers of innovation and competitiveness. The cluster should develop distinctive products, a market niche based on its strengths, e.g. resort- or spa-based cosmetic surgeries and tourism packages incorporating alternative healthcare such as Ayurvedic therapies, and massage. The health industry and the tourism industry should work together and make a concentrated and aggressive effort to market Ayurvedic tourism. Participation in forums and conferences on medical tourism will benefit the state. Develop a market niche and unique value proposition to distinguish itself in the face of strong regional competitors. The cluster should collaborate with major players in the global medical tourism industry to push for global health insurance portability. Both the government and the cluster should proactively and vigorously train skilled workers in medical tourism, insurance staff, and translators, which are vital for sustainability and growth of the cluster. The establishment of an efficient recourse system to deal with complaints would become the Kerala’s comparative advantage competing with countries such as Thailand and Malaysia. Provide readily available package medical services, for example, the Lakeshore Hospital, Cochin provides packages for general medical check-ups and a range of cosmetic surgery procedures, without the long waiting times. Government and hospitals should undertake capacity building programmes to train medical and non-medical staffs to handle the international patients. There should be focused language training for catering to the needs of outbound patients from countries of Middle East which is the major market, particularly Arabic.

Infrastructure Development
The viability and sustained growth of the medical travel industry is dependent upon well-developed transport system (i.e., air, land, and water transport) and well-developed infrastructure (i.e., airports, roads, power, telecommunications, etc.). The study reveals that the patients are much disturbed by the poor infrastructure of Kerala and the inhibiting social activities like hartals and strikes (Refer Graph 2). There should be an effective system to make sure that these disturbances are frustrating them anymore with developmental measures and corrective mechanism.
Role of the Government
There is very little / no government intervention/support in medical tourism industry. Government should make special effort to ensure on-time implementation of current and planned infrastructure projects, especially solid waste disposal system, new airports and roads linking to major tourist sites currently under construction. Attract foreign investment and partnership for medical tourism facilities, incentives, and rules encouraging cluster-based R&D and innovations, initiatives such as tax incentives etc. There are examples of Singapore, Malaysia, and Dubai where government has direct interest in medical tourism. Government can play a role of facilitator and regulator and should determine about the market and product.
Government may initiate efforts to have corporate/ institutional arrangements/tie-ups with an objective to tap the potential of countries /governments who are responsible for medical care of their citizens. Government should also take part in the medical tourism industry with competitive advantages along with the private sector, which would open up the competition and can break up their monopoly, which would automatically result in quality care. The government should bring out a medical tourism policy emphasizing the quality, cost effectiveness, and care.
The government can act as a facilitator for getting hospital accreditations and regulator for hospitals- both public and private and other stakeholders. Public -private partnerships (PPP) in healthcare should be encouraged. Government should institute a uniform grading and accreditation system for hospitals to build consumers’ trust. Primary, secondary, and tertiary medical facilities and services have to be offered to the patients and regulated by a proper mechanism. 
The result of the study reveals that there is a positive perception among the medical tourist that Kerala is a medical tourism destination !

What is the future of Ayurvedic practise ?

Phase-III: Being an Ayurveda disciple and a pioneer of Ayurvedic Biology interface

KJ: After a long and successful career as a cardiac surgeon, assuming the high post of Vice Chancellor in the field of education and several honors as a biomedical scientist, why did you study Ayurveda?

MSV: The “predisposing” factor was my upbringing in an Ayurveda-friendly environment. For any ailment, except obviously surgical, such as a fracture or a tumor, our family consulted a reputed Ayurvedic physician—a scholar who was our neighbor. Once I joined the Medical College and throughout my surgical career of three decades, Ayurveda vanished from my view. It reappeared in the 1990s, when I began to feel that nothing in my cardiac surgical practice, or indeed in the modern medicine, had been contributed by an Indian. That was the “precipitating factor”. It disturbed me that since the advent of modern medicine in India over 200 years ago, there had been no contribution by an Indian—in the causation of a disease, a drug, a surgical technique, a technology, a prophylactic regime in medicine—which had been adopted globally. I refused to accept Shockley's view that originality in science was exclusive to White people! India is much older than 200 years. Was there a time in India's history when we were creative and innovative? That search landed me in the company of Charaka, Susruta, and Vagbhata.

KJ: How did you study Ayurveda?

MSV: I started my study of the Charaka Samhita with a saintly Ayurvedic physician and profound scholar, Sri Raghavan Thirumulpad in Kerala. He was in his 80s but was gracious to me and generous with his time. I would inform him in advance that I would be coming with notes on my understanding of three to five chapters of the Samhita—sometimes only one—so that he too would have looked at the text. I would discuss what I had understood; he would point out my mistakes, the need for greater clarity, for abridgment, or expansion, etc. He would also share with me related ideas and his own experience, which was invaluable. They were highly enlightening discussions.

I used to go to him once in two months and the studies went on for 2½ years. I was honored when he told me that I would not need similar help in the study of Susruta and Vagbhata!

KJ: Please share with us your views on Charaka, Susruta, and Vagbhata.

MSV: Volumes have been written on the Great Trinity. What could I possibly add to what has been said? For me, Charaka represented the synthesis of all that is great in Ayurveda. While excelling as a general physician with an encyclopedic mind, he formulated the Mula Sankhya doctrine—with 24 tathwas—before Iswarakrishna, and modified the gunas of Vaiseshika to suit Ayurveda. He had thoughtful views on destiny and destruction of habitat; and so on. His claim that “what is found here, you may find elsewhere; but what you don't find here, you will find nowhere” was justified. Susruta's text was revised by Nagarjuna a few centuries after Charaka and was better structured, more compact, and conspicuous by emphasis on surgery. He was the surgeon extraordinary. But I felt that several important sections on cadaveric dissection, plastic reconstruction of nose, lips, etc., which won global recognition had perhaps been unduly shortened during the revision of the text! Unlike Charaka and Susruta who cared little for literary style, Vagbhata was a master poet and physician who composed Ashtanga Hridaya in memorable verse for students and practitioners. He drew his inspiration from Charaka and Susruta, and made them more accessible to ordinary people like us.

KJ: How was the process of understanding Ayurveda? Was the language a barrier?

MSV: Learning of Ayurveda was not easy because the basic concepts, the role of causation, pathogenesis, diagnosis, the rationale for doing procedures, the basis for prognosis, and most of all, the preparation of medicinal formulations, were vastly different from what I had learnt and practiced in a lifetime. Language was a barrier, but not insurmountable. Without an inspiring teacher like Sri Thirumulpad, I would have found the learning process too hard if not impossible.

KJ: What is the future of Ayurveda practice?

MSV: Only Ayurvedic physicians can answer this question.

KJ: How can we use newer information (generated through reductionist approach) for understanding Ayurveda (holistic science)?

MSV: New Science (reductionist) cannot help in understanding all aspects of Ayurveda. By definition, “holistic” cannot be fully analyzed by reductionism. Even after the ultimate reduction, there will be a part that would defy understanding. But what is revealed by the reductionist approach even at this early stage—in studies on Prakritis, Rasayana, etc—is important and exciting. That opens a new frontier in knowledge.

KJ: Should Ayurveda be included in medical or basic science courses?

MSV: Yes, it would be desirable to introduce a short, familiarization course of 2 or 3 weeks in Ayurveda for medical students. This is already standard practice in the US, UK, etc. Of course, the course should be prepared carefully and imaginatively.

KJ: What are the important outcomes of the “A Science Initiative in Ayurveda” projects? How are these projects progressing?

MSV: The projects in the first round were concerned with studies on dosha prakritis, panchakarma, rasayna, dosha-neutralizing plants, and rasa-sindur. The investigators were Ayurvedic physicians and scientists from reputed institutions all across India. The studies have been completed and two important papers have been published, with several more on the way. Equally importantly, they have built a bridge between Ayurvedic physicians and basic scientists for joint research, and led to the establishment of a Task Force in Ayurvedic Biology at the Department of Science and Technology. This is a highly significant development.

KJ: You have introduced innovative ideas like “textual epidemiology” in your book Legacy of Charaka. Similar several ideas are reflected in other publications too! Please share your perspectives on these new ideas!

MSV: It would seem that my novel exercise in archeo-epidemiology based on a digitized text of the Charaka Samhita had escaped the serious notice of reviewers except an American scholar! As a matter of fact, textual studies can be as exciting as biological studies. For example, digitized texts could enable one to make probable estimates of common and uncommon diseases, commonly and uncommonly used procedures, evolution of the treatment of a disease from Charaka to Vagbhata, etc., during the period of Brihatrayee; computational linguistics could dissect the different layers of composition and revision of the Charaka and Susruta Samhitas, and so on. Some work on these lines on the Charaka Samhita is being done in Vienna, but none in India.

KJ: What is your future plan?

MSV: I am at a stage when future comes to me in the disguise of today! “Every morning brings a noble chance” and something of interest to do. Future will then take care of itself!

Research in Ayurveda has so far been mainly focused on the utilitarian aspect of drug development. However, Ayurveda offers much more for a student of science. Apart from its central claim to be a holistic system, which prizes wellness, Professor Valiathan believes that unique scientific opportunities would arise from investigating Ayurveda through the perspective of contemporary science. When I asked him how Ayurvedic Biology would help Ayurveda or Biology, his answer was, “I cannot claim that Ayurvedic Biology helps, or will help Ayurveda or Biology. Neither needs help. However, when new science, new techniques are applied to old science, new sprouts of knowledge would appear. Chemistry emerged from new experiments in ancient rasasastra, as P.C. Ray had shown”.

The conversation with Professor Valiathan awakened the scientist as well as philosopher in me. Here I wish to quote Charaka's words from his book: The Legacy of Charaka.

“Ayurveda owes its call not to selfish goals or worldly pleasure, 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”.

JOURNAL OF AYURVEDIC AND INTEGRAL MEDICINE.

Alopecia areata or Indraluptha, its treatments and description in ayurveda and modern.

Alopecia areata or Indrapultha

Alopecia areata or Indraluptha according to Ayurvedic texts is a condition in which hair is lost from some or all areas of the body, usually the scalp. Because it causes bald spots on the scalp, especially in the first stages, it is sometimes called spot baldness. In 1-2% cases the condition can spread to entire scalp (alopecia totalis) or to entire epidermis (alopecia universalis).

Causes

-Not contagious, does not spread from one person to another

-Heredity may be a factor

-Strong evidence of genetic association with increased risk for AA was found by studying families with two or more affected members

-The condition is thought to be a systemic autoimmune disorder in which the body attacks its own anagen hair follicles and supresses or stops hair growth

-For example increase in cell lymphocyte clustre around affected follicles causing inflammation and subsequent hair loss

-Endogenous retinoids (a class of chemical compounds that are chemically related to vitamin A ) metabolic defect is a part of the pathogenesis of AA

Prognosis

-In most cases which begin with a small number of patches of hair loss, hair grows back after a few months to a year

-In cases with greater number of patches, hair can either grow back or progress to AA totalis or in rare cases AA universalis

-Effects of AA are mainly psychological loss of hair also means the scalp burns more easily in the sun. Loss of nasal hair increases severity of hay fever and similar allergic conditions

-Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, however, but rather a natural cycle of growth and shedding from a relatively synchronised starts, such a pattern will fade over time

-Alopecia certainly can be the cause of psychological stress. Because hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety and depression

Things to avoid for Alopecia patients (in Astanga Hrudaya Uttarasthana, Siroroga Pratisheda)

-exposure to smoke which may containn harmful chemicals which may damage the hair follicles

-excessive exposure to cold atmosphere, fog

-excessive sleep

-not sleeping at night, night waking

-over sweating in the head

-avoiding anxiety, depressive moods

-exosure to easterly winds

-willful blocking of tears

-excessive crying

-willful transgression of natural urges

-not using pillows for sleep

-avoiding oil over head for bath

-looking downwards all the time

-exposure to unpleasnt smell

-indigestion

-speaking loudly

Indraluptha lakshana

Due to above said etiological factors vata get vitiated and along with pitta destroy the base of hair follicles. Due to that kapha covers the base of hair follicles like a membrane preventing further growth of new hair follicles, resulting in Indraluptha.

Chikitsa or Treatment in Ayurveda , Astanga Hrudaya

Sira vedha (vene-puncture) over temporal artery

Over pathches prachchanna done ( a procedure where small dots are made with surgical needle over patches in a linear fashion, resulting in mild dotted bleeds)

Then lepana or paste application is to be done with

-Kaasisa+Manahsila+Koshna

-Vanga+Devadaru

-Langali moola

-Gunja+Moola phala

-Karaveera rasa

-Brihati swarasa+Honey

-Dhathoora swarasa

-Bhallathaka paste

-Sesame flower+Gokshura paste+Ghee

Hasti Dantha Mashi

It is a special preparation for alopecia areata and an ever effective drug prepared by burning ivory of elephants tusk and making it to ashes and then mixing with suitable oil and then applying over patches after scrapping the area. Instead of ivory, horns of goat may also be used.

Reference :

1.Astaanga hrudaya uttarasthaana siroroga pratisheda

2.Wikipedia