Ayurveda -traditional Indian system of medicine

Achievements and contributions to medicine

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Ayurveda originated as oral tradition in 5000-2000 BC and in written form around 1500 BC. It flourished from 1000 BC – 1000 AD and then declined from 1200 AD to 1800 AD due to Muslim invasion and destruction. Ayurveda, the traditional system of medicine is still used in India by over 70% of its population. Ayurveda is a body/mind /spirit or holistic way to achieve health and its practitioners recommend diet and lifestyles changes along with drug therapy. It tried to put medical knowledge on a rational and scientific basis excluding magic, sacrifices and mysticism unlike the Vedic period. Surgery was a major component of Ayurveda till 600 AD but it is seldom used now. The code of ethics for physicians was well developed. The contributions of Ayurveda to modern system of medicine in surgery, herbal medicine, yoga and meditation will be covered. The reasons for its decline were failure to evolve and take up new ideas, close ties with religion. All animal parts, heavy metals, pesticides, microbes and toxins must be eliminated from Ayurvedic preparations. There is a need to prove the safety and efficacy of Ayurvedic drugs in animal models and double blind placebo controlled trials in adequate number of patients. However its low cost, easy accessibility to poor and uneducated communities make it imperative to modernize Ayurveda in the light of advances in science and medicine and incorporate some of its validated and tested ideas into primary healthcare and modern medical practice. TCM has a much larger share of the global market than Ayurveda.

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Introduction                                                                                                        

 
Neem Tree with its Fruits = Indian Village Pharmacy

In one of the stories in the Hindu epic, Ramayana, the brother of Lord Rama is saved from certain death by a medicinal herb from the Himalayas. This herb is not known today and might have become extinct. Actually between 30-50% of medicines described in Ayurveda are not known or lost forever. The emergence of drug resistance in micro organisms, emergence of new killer micro organisms like Ebola, Lhassa, revival of plague, resurgence of malaria, tuberculosis, cholera, unexpected adverse reactions and subsequent withdrawal of several high profile drugs like benoxaprofen, phen-fen combination, trogltazone, overuse of pesticides and fertilizers is leading to a counter current movement like return to nature or return to the roots. The rising cost of healthcare is driving it out of the reach of the most vulnerable sections of society like the poor, elderly, children and women. The traditional system of Indian medicine is still used by 70% of population, who do not have access to the Western system of medicine or are unable to pay its very high cost.

Ayurveda like the Hindu religion developed in India gradually over several thousands of years. The Indus Valley civilization with its city-states like Harappa and Mohanjodaro is believed to have originated between 5000-3000 BC. These original dark skinned people were called Dravidians, had writing of their own and constructed magnificent public baths. Around 3000-2500 BC, they were overrun by lighter skinned Aryans, who came from Central Asia (Iran). Their language Sanskrit, the language of the elite, evolved in India and is considered as the mother of Indo-European languages.
 Table 1  Period  Historical Milestones
 5000 – 2500 BC Vedic Period  Oral and poetic tradition, divine origin
 2000 – 1500 BC Rigveda written version
 1500 – 1800 BC Agnivesha (Charaka) Samhita  Sushruta Samhita
 800 BC – 800 AD    Golden Period of Ayurveda
 1000 AD – 1945 AD    Dark Period of Decline
 >1950    Revival
With the Aryans starts the Vedic Period. The Vedas (Veda = wisdom) comprise four sacred books in Sanskrit, which originated due to divine inspiration. Originally the four Vedas were transmitted by the word of mouth from teachers to students. The written forms of Vedas appeared probably sometime between 2500-1500 BC. Initial writing was on the birch bark and later on paper. The oldest of these, Rigveda  [1] mentions drugs and diseases.
The fourth Atharva Veda [2] deals with guiding principles for preservation of health and medicinal effects of health. The Hindu priests considered life as an illusion, a very small step to reincarnation and nirvana. Materialistic things like record keeping, history, and biographies were part of human vanity and their destructions happened in total indifference. Transmission of knowledge by word of mouth initially and later writings on birch bark or banana leaves which are easily destroyed by rain/floods, fire and insects, with the indifferent attitude of priests resulted in total loss of any records or evidence for the Indus Valley Civilization, Vedic Period or Post Vedic Ayurvedic Period (Table 1).
The dates of Indian history are quite uncertain. The first definite date in Indian history is 326 BC, when Alexander crossed the river Indus. Ayurvedic physicians treated his army. The edicts of king Ashoka, engraved in stones and pillars, are the earliest examples of preserved relics and can be dated. The invasion by Alexander had no impact on the cultural, scientific or medical practices of Indian civilization. The spreading of Buddhism from India to its neighboring countries must have exposed Indian monks to other civilizations. The Arabic medicine came into contact with Ayurveda through invaders and traders from 6th century AD. The Arab rulers of Baghdad from 753-803 AD had invited several Ayurvedic scholars like Manka, Ibn Dhan and Sali to their court. They were honored and rewarded for translating Ayurvedic texts into Arabic or Persian and setting up hospitals.
The medieval period from 1000-1800AD was a period of great upheavals and destruction and only the Mogul period provided a brief stability and revival of arts and medicine. The invasions from Afghans, Arabs and Turks were crusades or holy wars to establish the supremacy of Islam and focused on destruction of temples and commerce. During this period of invasions, forcible conversions to Islam at knifepoint continued. Artists. Priests, scholars were killed, disabled or maimed permanently. All patronage of Indian arts or ayurveda was withdrawn. Sanskrit became less familiar and was relegated to a classical language. Ayurveda suffered the same fate. Ayurveda went underground, lost contact with its roots, was taken over by quacks and it became a close family secret. It remained mostly in the books and nothing new was added and lost any chance of development until after India’s independence from British rule. Advances in science and medicine have since overtaken it.
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Evolution                                                                                                             

The Atharva Veda [2]  around 2000-1500 BC provided the structural foundation for Ayurveda. The earliest ayurvedic texts were documented in the form of simple sutras in Sanskrit and were beyond the reach of common man. The symptoms of fever, malaria, dysentery, typhoid, cholera, plague, leprosy and smallpox were described. These diseases are still prevalent in India except the last one.
The Atharva Veda gave accurate and detailed description of rheumatoid arthritis, gout, epilepsy, scrofula, blindness, abscess, tumors, bronchitis, delirium, jaundice, neuralgia, migraine, several skin diseases, urine retention and elephantiasis. Water in the abdominal cavity meant Dropsy, but the link between cardiac troubles and edema as well as dropsy did not escape the priests and ayurvedic doctors. Religious prayers, sacrifices, offerings, exorcism, fasting and bloodletting were the standard cures for most of the illness with some 290 herbal preparations. Soma (a kind of wine) and Kushta were used for pain control as anesthetic agents.
Rig Veda [1] mentions that medicine men with pockets full of medicinal herbs, accompanied moving Aryans tribes. They operated on the wounded, took the arrows out of the flesh. They amputated the seriously wounded and infected, treated the stump and made artificial eyes and prosthesis. Soma was used to control pain. Snakebites, a common and frequent occurrence during that period were treated. The opening of the bladder with a sharp instrument is mentioned to overcome blocked urinary canal due to kidney stones.
Brahma   The Creator
Daksha Ashwini
Indra Heaven Indra
Medecine Earth Surgery
Bhardawaja   Dhanwantri
Atreya   Sushutra
Charaka Samhita   Sushutra Samhita


The Himalayas 

                                  • Transfer of ayurvedic knowledge from Heaven to Earth 

                                  • Site of First Ayurvedic Medical Congress 
                                  • Source of several Ayurvedic drugs 

http://upload.wikimedia.org/wikipedia/commons/d/d6/Himalayas-Lhasa9.JPG

The classical treatise of Ayurveda is Charaka Samhita [3][4] which opens with a meeting of the Wise men (sages) in the Himalayas. It was probably the World’s first medical congress. The aim of this congress was to find solutions to human sufferings and diseases. Bhardawaja on behalf of the congress sought the knowledge of Ayurveda from the god Indra somewhere in the Himalayas. He then passed on this knowledge to Atreya, a practicing physician. Atreya founded a medical school in the city state of Taxila. Atreya organized satellite symposia in different parts of India and taught and trained six more disciples, who compiled his teachings in the so-called Charaka Samhitas (Table 2). The treatise by Agnivesa was known as Charaka Samhitas. It was divided in 8 volumes spread into 120 chapters in internal medicine (Table 3).

Table 3: Classification in Ayurveda 
  1. Internal medicine, Therapeutics 
  2. Surgery 
  3. Diseases of Eye, Ear, Nose, Throat 
  4. Pediatrics, Obstetric, Gynecology 
  5. Toxicology 
  6. Psychiatry 
  7. Rejuvenation, Promoting therapy 
  8. Virility 

Internal Medicine


  • General principles and philosophy
  • Cause of disease
  • Nourishment and general pathology
  • Anatomy and embryology
  • Diagnosis and prognosis
  • Pharmacy
  • Treatment
  • Divided into 8 sections covering 120 chapters
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Sushruta Samhita [5][6][7] dealing with surgery was the second treatise to enrich Ayurveda. Dhanwantary purportedly learnt surgery from the god Indra and founded a school of surgery in Banares (Varanasi) and taught it to his student Sushruta. The contents are divided into 6 volumes with a total of 186 chapters dealing with surgery, ENT (Ear, Nose and Throat), and ophthalmology. Nagarjuna around 700 AD wrote his critical monograph on the two Samhitas, another physician of the same name used metals like mercury, sulfur, gold, and silver in therapy and introduced a unique detoxifying process to convert metals for use in his patients.

    



Basic Concepts                                                                                                     

Basic Concepts in AYURVEDA

 

It is a Holistic concept, which treats body, mind and spirit, use medicines from commonly occurring plants and minerals, along with food and life style changes. Yoga and Meditation liberate mind from material bonds through inward concentration. Discovery of the true nature of the self gives better control over the body.
Ayurveda is composed of several hypotheses based on observations, speculations, inferences, generalizations and idealism. It is very rich in concepts, without any rationale for their origin and these have not been proved by rigorous scientific experimentation. The basic concepts of ayurveda are very simple. Charaka divided internal medicine into 7 sections and covered 8 areas of Ayurveda including surgery, causes and symptoms of diseases (Table 3). Scientific methodology and power of reasoning should be applied in the practice of medicine and discovering new drugs [8][9][10][11][12][13][14][15]

The human body like everything else in the Universe is composed of five elements earth, fire, air, water and ether (space). All human beings have mind, body, senses and soul. The five human sense organs ears, nose, eyes, skin and tongue help us in our perceptions. All living matter has the three doshas: vata, pitta and kapha. These doshas arise out of the five elements and regulate all physiological and psychological process in the living organism. A harmonious state of the three doshas creates balance and indicates good health (Table 4) [16][17][18][19][20][21]


Table 4.                                    Basic Concepts

 

5 Elements:                                                     Fire, Earth, Water, Air, Space

5 Senses:                                                        Eyes, Ears, Nose, Skin, and Tongue                                    

7 Tissues:                                                         Blood, Fluids, Adipose, Muscles,                                              

Bone, Nerves, Generative or reproductive

Metabolic End ProductsBone, Nerves,

Tridoshas (Function or Humor) Balance:              

Vita                                                                      Movements

Pitta                                                                      Energy and Metabolism

Kapha                                                                  Synthesis and Growth

Disease:                                                                Tridoshas Imbalance

Doshas                                                                 Change With Age, Diet, Mind Constitution,

                                                                                    Time, Season

Misuse Of Mind Or Body, Influence Of External Factors, Mismatch Between Senses And Perception leads to disease

Restore Balance: Yoga, Meditation, Diet, Massaging, Drugs,

Life Styles Changes, Fasting, Aromatotherapy

Anything that brings sadness and grief to humans is defined as disease. Any imbalance in the three doshas results in diseases, which can be recognized by a variety of signs and symptoms. Vata controls the nervous system, respiration and elimination. Pitta governs digestion, catabolism, metabolism and perception. Kapha is responsible for biological strength, body structure and resistance.
Tridoshas regulate the formation of body constituents and excretion of waste products. These doshas change according to age, diet, constitution, mind, time and climate. Three factors lead to the doshas imbalance like misuse of the mind and body, influence of time, season and mismatch between sense organs and perception of objects. Mind is influenced by external factors and internal body reactions. Mind is for perception and knowledge, interpretation of perceived knowledge in the light of previous experience and intelligence [9][11][14][15][16][19].

According to Charaka, the body ‘Wind’ was responsible for 80 out of 140 disease and had a major role in the diseases. It is mentioned that each day, man breathes (inspire expire) 22636 times at the rate of 16 times per minute, which is close to the modern observations. Charaka was obsessed with classification, subtypes and nomenclature depending on which part of the body was affected. There were 14 types of abdominal tumors, 12 types of infections caused by hookworms, 20 types of ear diseases, 65 different mouth infections, 15 types of sores and 31 diseases of the nose. Requirements for hospital are mentioned in details. Attempts have been made recently to measure tridoshas [22].

In Sushruta Samhita, human dissection is mentioned. However to bypass the religious rituals, it was advised that the dead body be immersed in a river for 7 days and then the decomposed body be dissected. Sushruta also permitted moderate drinking just before the surgical operation to reduce resulting pain to his patients. This was in contrast with total prohibition recommended by the priests. Students were advised to practice experimental surgery on vegetables; meat cuts etc. before moving on to patients. Certification of surgeons and qualifications and qualities of Ayurvedic doctors are given in details (Table 5) [23].


TABLE 5                   SUSHRUTA SAMHITA – SURGERY

 

 

Five Out Of 6 Sections (1,2,4,6) Like Charakas. 186 Chapters

Surgical Operations                            32 Described

Intestinal Obstruction, Bladder Stones, Plastic Surgery (Nose + Ears), Amputation Of Limbs, Abdominal Delivery Of Fetus (Cesarean), Cataract, Vital Points, Snake Bites, Ants As Wound Clamps. Human Dissection

Blunt Instruments                                          101

Sharp Instruments                                          21

Scalpels, Forceps, Pincers, Trocars, Speculums, Syringes, Cannula, Dilators, Bone Levers

Thread, Caustic Coated Thread, Twine, 14 Types Of Splints, Bandages, Gauze.

Steam Bath

Ligature

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Treatment                                                                                                           

Treatment objective is to restore the balance of functions or doshas. Healthy state signifies good appetite, digestive function, proper growth, proper waste product formation and elimination, good sense organs, positive mind and ability to properly adjust to external and internal changes like diet and environment. Good health is favored by regular habits and good food. Dietary overindulgence and irregular or faulty habits are the main causes of disease [24][25][26][27].

The diseases can be due to exogenous (accidents) or endogenous (constitution) factors. The third type of disease is caused by abnormal mental reactions like rage, greed, envy and grief. Drug therapy is not recommended for these diseases. It was mentioned that mental diseases be treated by proper education, counseling and family support. Yoga, Meditation, Aromatotherapy, Naturotherapy, Diet, Massaging, Herbal Drugs, Life styles, and Fasting, could restore balance of the doshas. Drugs were divided into several classes based on their origin from plant, animal or mineral source, physicochemical properties like appearance, color or taste or by the disease. The actions of the drugs were dependent on the patient’s constitution, diet, age, metabolism, mind and resistance; cause, stage and severity of the disease and the strength or dose of the drug, time of administration and its method of preparation. The following routes: topical, oral, inhalation and suppository were used to administer drugs. The intravenous route was not known or used. The following processes for drugs were used: decoction, infusion, fermentation, medicated oils and jams, juice and paste. The solid forms, ointments, liquids and medicated oils were mentioned. There is some reference to testing of drugs on pets and worms. The need for dose adjustments based on patient’s weight, age, diet, digestion, compatibility, constitution, stage and severity of disease and time and season is emphasized [24][25][26][27].
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Decline                                                                                                                 

 

The major reasons for the decline of Ayurveda are that the theoretical basis of general statements and concepts is not explained, there is lack of transparency, mode of action of drugs is not explained at all, treatment is associated with religion and rituals and formulations were kept secret. The original texts of Samhitas are not available and later versions have modifications and additions depending on the editor (Table 6). Some of these additions were not in the original versions like caste-based treatment, different treatment for king, rich and poor or not treating the seriously ill or untouchables.
Ayurveda was not able to free itself from religious controls and that must have been a great barrier to addition of new knowledge and the main cause of its demise. Since Vedas were written by divine inspiration and were the gifts of God, these were the gospel truth and nothing new could be added to this knowledge. Moreover students were asked to blindly follow their teacher and never challenge his teachings. The Hindu Priests caste system did not allow any cross-fertilization with other cultures and addition of new ideas in Ayurvedic medicine. Although palpitation and auscultation are mentioned as diagnostic tools, these were never developed as vital source of investigation due to Priest’s taboo against touching, fear of contamination and inferior castes. Similarly loyalties to teachers, prevented correction of the mistakes made earlier, about the human anatomy or physiology. The later dissection and keen naked eye observation did not add anything worthwhile. Thus scientific methods of observation and deduction were lost. Ayurveda as we know today, is either oversimplified, commercially exploited or misrepresented. It is believed that Ayurveda was at one time a powerful science of health with its own system of diagnosis and rational approach to health with its arsenal of over 6000 natural remedies.
Temples in ancient India were important centers for learning science, medicine, art and culture. The priests had kept the practice of ayurveda to themselves and the patients were given medicine and blessings. The Hindu Priests did not allow for independent growth of Ayurveda or other sciences, which could subsequently challenge the Hindu philosophy. Diseases interfered with the observations of religious rituals, duties and obligations. The priests had a firm grip on applied sciences like Astrology, Meteorology and Ayurveda and preached the concepts and practices of Ayurveda. To an ayurvedic practitioner, religious acts were medicine of the first order. A temple in South India has a mortar and pestle as its main deity, symbolizing the making of medicine. In another temple near Madras, the walls are filled with different prescriptions for various diseases.


TABLE 6                                    DECLINE AND SHORTCOMINGS

 

  • A closed system of learning, did not take up ideas from other systems of medicine due to pride of their race and divine origin. 
  • Original texts written in Pre-Sanskrit grammar style, now forgotten 
  • Lack of anatomical and physiological knowledge 
  • No explanation for origin or proof of concept
  • No objective way to measure doshas or proof of existence.
  • Overkill in sub classification and nomenclature
  • Muslim invasions of India and resulting massacre and wiping out of Indian intellectuals and destructions of universities, temples, libraries etc.
  • Lack of high quality pharmaceutical standards to assure consistent quality of preparations
  • Lack of toxicology and preclinical pharmacology data
  • Lack of data about rigorous proof of safety and efficacy by modern standards of clinical trial
  • Inability to match dramatic outcomes with antibiotics, antiulcer agents etc.

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Contributions to Modern Medicine                                                               

Contributions of AYURVEDA 

 

Some of the concepts first mentioned in Ayurveda have stood the test of time and been incorporated in modern practice (Tables 7-9). The contributions of Sushruta to plastic surgery are well recognized. Plastic surgery arose in India because cutting off nose and ears was a common punishment. The concept of chronomodulation of drugs, mind-body interactions, treatment of mental disease, holistic treatment and slowing of the ageing process are universally accepted. The use of amputation and artificial eyes and limbs must have been a great step forward at that time. The story of a baby saved from its dead mother by opening of her womb must have caught the imagination of mankind 3500-4000 years ago as it does today. This technique, we know today as cesarean, is routinely used when normal delivery of the baby is difficult. 

Similarly opening of the bladder to remove kidney stones was a historic event as was the cataract operation. Lack of sterile or lack of knowledge about anatomy and physiology was made up by keen naked eye observations. Even if very few of these patients survived, there was hope of a cure. No records exist of these early surgeons, about their success or failure rate or their follow up of patients. Medicine progressed by documenting and learning from mistakes. It must have happened during ayurvedic period. 

Besides yoga and meditation, the area of herbal drugs still in use today can be considered as a real contribution. In India, there are 1500 Ayurvedic drugs on the market, sourced from around 800 medicinal plants. There is a separate Ayurvedic pharmacopoeia, standards for Ayurvedic drugs, and the drug controller need not insist on safety and clinical trial data for approval of new or existing Ayurvedic drugs. The ayurvedic system of medicine has been recognized since 1959 and over a hundred ayurvedic colleges were set up. There are over 500,000 registered practitioners of Ayurveda in India today. The total worldwide 2009 market for traditional medicine was around 50 billion US dollars, out of which Ayurveda accounts for 20%. TCM has a dominant position. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] 

Ayurvedic drugs are extensively used in India for hepatoprotection, diabetes, memory enhancement, health promotion, skin diseases, obesity and lipid disorders, ageing, and prostate enlargement. Turmeric in medicated oils or ghee was used at that time for wound healing. Recent studies have shown that semi liquid salted boiled rice (as in Ayurveda) is more effective in cases of severe diarrhea than oral salt mixture. Some of the current uses of these drugs are different from those mentioned in the original text. Like Rauwolfia alkaloids were used in Ayurveda for insanity and insomnia in contrast to their more recent use in cardiovascular diseases.

There is a need to conduct globally acceptable clinical research in ayurvedic therapeutics. The gold standard is a double blind placebo controlled clinical study in hundreds of patients, drug interactions studies and special impaired patients. Selection of appropriate drug, non-drug and/or drug combination, identification of objective outcomes, adequate placebo controls, double blinding, bias, duration of trials, adequate number of patients, dose optimization should be reviewed.. There is  a need to establish reasonable safety and adverse event profile of ayurvedic therapy. A recent survey found wide range of clinical and in vivo studies for many of the plant-based therapies utilized in the Ayurvedic system. Of the 166 plants investigated, 72 (43%) had at least one or more human studies and 103 (62%) had one or more animal studies. Most of these studies in small number of patients and often lack double blinding or a placebo control group. [33]

 

Ayurvedic preparations have been successfully used for the treatment of bronchial asthma, heart disease and hyperlipidaemia. Formulations containing curcumin were reported to reduce inflammation and disability in double blind clinical trials on patients with rheumatoid arthritis. A number of products are reported to be useful in patients with acute viral hepatitis. A multicentric study by the Indian Council of Medical Research showed that a preparation from Pterocarpus marsupium was effective in reducing levels of blood glucose and glycosylated hemoglobin in patients with non-insulin-dependent diabetes mellitus. In another multicentric trial, patients with fistula-in-ano were randomized to surgery or application of medicated seton (Ksharsootra). Surgical treatment led to a faster cure but recurrence rates were lower with medicated Seton.[42][43][44][45][46][47][48][49][50][51] 

The Indian Central Council for Research in Ayurveda & Siddha is an apex body for the formulation, coordination, development and promotion of research on scientific lines in Ayurveda. (Web site, Table 10) The research activities of the Council, for the past three decades, have resulted in the evolution of drugs /formulations like Ayush-64 for malaria, Ayush-56 for epilepsy, Ayush-82 for diabetes mellitus, 777 oil for psoriasis, Pippalyadi yoga as an oral contraceptive and about 18 patents on processes developed in the Council’s laboratories. Drugs like Guggulu for Medoroga, Mandookaparni for mental retardation, Katuki for liver disorders and treatment procedures like Ksarasutra in piles, fistula-in ano, fissure, Amasaya Shodhan in peptic disorders & Pancakarma techniques in Para / hemiplegia, have been successfully demonstrated. Several books and review cover the herbal drugs have appeared.
 

The Central Drug Research Institute CDRI has pioneered new drug discovery in India. 11 drugs mostly herbals have been discovered/developed by CDRI. Six new drugs developed by CDRI have been commercialized and marketed for CVS & CNS disorders (Gugulipid, Memory Plus), malaria (Arteether, Aablaquin). In addition, several new drugs like Consap, Picroliv and 80/574, herbal remedy for diabetes etc, are in development. [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]

The first active drug to come out of India in the early 1960s was Reserpine.

http://101herbs.com/reserpine.html

In India Rauwolfia has been used since centuries for relief of central nervous system disorder including anxiety , excitement etc.

http://101herbs.com/reserpine.html/
The chief use of the drug is as a sedative and hypnotic and for reducing blood pressure. The drug is now largely used in insanity and high blood pressure. The alkaloids stimulate the central nervous system. It is more suitable for cases of mild anxiety or patients of chronic mental illness.

Latin Name : Rauwolfia Serpentina 

Local Name : Reserpine, Rauwolfia, Serpentwood, Sarpagandha 






Gugulip was derived from the resin of the plant Commiphora mukul. It possesses hypolipidemic efficacy comparable to clofibrate[35].  The Institute’s first herbal remedy Memory Plus is derived from the plant Bacopa monnieri. It is comprised of the plant extract duly tested for safety and biological activity in animals’ and has been standardized in terms of active materials. The drug has also undergone clinical trials in children afflicted with Attention Deficit Hyperactivity Disorder (ADHD) and found to improve their performance, as revealed by their ability for sentence repetition, logical memory and paired associate learning. (Web site, Table 10)  Arteether, a blood schizontocidal antimalarial, has been developed from the plant Artemisia annua and is effective in treatment of uncomplicated and complicated cases of malaria caused by Plasmodium falciparum. Isaptent, a cervical dilator for medical termination of pregnancy, was developed from the plant Plantago ovata. It is a simple device for dilatation of cervix required during MTP.  Consap (spermicidal cream) derived from soapnut and Plant based standardized remedy for diabetes. (Web site, Table 10)

Hydroxycitric acid, the active ingredient in the herbal compound Garcinia cambogia, competitively inhibits the extramitochondrial enzyme adenosine triphosphate–citrate (pro-3S)-lyase. As a citrate cleavage enzyme that may play an essential role in de novo lipogenesis inhibition, G cambogia is claimed to lower body weight and reduce fat mass in humans. Heymsfield et al [36] evaluated the efficacy of G cambogia for body weight and fat mass loss in overweight human subjects in a twelve-week randomised, double blind, placebo-controlled trial in overweight men and women subjects (mean body mass index [weight in kilograms divided by the square of height in meters], approximately 32 kg/m2).


Garcinia cambogia for weight loss


A total of 135 subjects were randomised to either active hydroxycitric acid (n=66) or placebo (n=69); 42 (64%) in the active hydroxycitric acid group and 42 (61%) in the placebo group completed 12 weeks of treatment. Patients in both groups lost a significant amount of weight during the 12-week treatment period; however, between-group weight loss differences were not statistically significant. Garcinia cambogia failed to produce significant weight loss and fat mass loss beyond that observed with placebo. In spite of this published study, the HCA and Garcinia Cambogia continue to be marketed for weight loss.

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In India, practitioners of traditional Ayurvedic medicine have long used the herb Coleus forskohlii to treat asthma, heart disease, and a range of other ailments. The active ingredient forskolin, available in supplement form, is commonly recommended for treating hypothyroidism and obesity.. Forskolin is believed to stimulate the release of thyroid hormone, thus relieving such hypothyroidism symptoms as fatigue, depression, weight gain, and dry skin. Forskolin activates an enzyme that raises levels of a key cell-regulating substance called cAMP (cyclic adenosine monophosphate). This compound is considered to be an invaluable tool for proper understanding of cyclic AMP-dependent physiological processes. It has been reported that forskolin reduces preload and after load of the heart due to myocardial contractility arising from its positive inotropic action without affecting myocardial oxygen consumption. Sabinsa Inc. has recently taken out a US patent for its use as a weight loss agent.


 
File:Forskolin.png
 

Coleus Forskolin Reduces the Risk of Blood Clots Formation                

Coleus Forskolin is a plant grown in India and is believed by many alternative medical experts to cure most diseases.

Some benefits may include:

 

Tylophora indica
http://www.flowersofindia.net/catalog/slides/Indian%20Ipecac.jpg

Tylophorine from Tylophora indica has a marked stimulating effect on both the striped and unstriped muscles, and a distinct depressing effect on the musculature of heart. The roots of the plant have a sweetish taste turning acrid, pleasant aromatic odour, and a brittle fracture. They possess stimulant, emetic, cathartic, expectorant, stomachic and diaphoretic properties and are used for the treatment of asthma, bronchitis, whooping cough, dysentery and diarrhoea; they are reported to be given in rheumatic and gouty pains. The roots and leaves are used in hydrophobia, dried leaves are more uniform and certain in their action than the roots. In large doses, the dried leaves may cause fatal poisoning. The dried leaves are used to treat certain forms of allergy.

 

Brahmi
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Brahmi (Bacopa monnieri) has been in use since ancient times as a potent nerve tonic for rejuvenating mental health and promoting intellect and memory and is mentioned in Charak Samhita written in the 1st century A.D., where this brahmi is prescribed as a cure for mental retardation leading to psychosis. Implicit in the pharmacological properties ascribed to brahmi is the cognitive enhancing and anxiolytic effects of this plant. The other classical Ayurvedic treatise Sushruta Samhita precisely describes brahmi as efficacious in loss of intellect and memory. —CDRI’s decided to develop the plant as an herbal remedy. As a result a quality herbal preparation has been developed from B. monnieri, standardized in terms of bacosides contents. (Web site, Table 10)


Preclinical neuropharmacological studies demonstrate that both the standardized extract and bacosides improve short-term and intermediate memories thus improving the long-term memory. The bacosides also significantly enhance protein synthesis in those regions of the brain, which are implicated in the memory formation, a possible explanation for its memory improving effect. Double blind cross over clinical studies have been carried out in children, elderly persons and normal healthy volunteers. Studies carried out in normal healthy volunteers, elderly subjects with age associated memory impairment and children with attention deficit hyperactivity disorder (ADHD) have shown that the drug was safe, well tolerated and efficacious. Study on children with ADHD has shown that the preparation significantly improves sentence repetition, logical memory and paired associate learning 12 weeks after its use.

 

Gugulipid, a hypolipidaemic drug has been developed from the plant Commiphora mukul after obtaining the lead from Ayurveda. 

Gugglu, the gum from the tree Commiphora mukul has been recommended in Ayurveda for the treatment of gout, arthritis, rheumatism and lipid disorders. The establishment of promising hypolipidemic activity in a non-toxic fraction of guggulu led to the identification of the active constituents, gugulsterones. Guggulsterone, the active constituent of gugglelipid, blocks the action of a cell receptor, called FXR, which helps regulate a body’s cholesterol level. 

Gugulipid passed through all the three phases of clinical trials successfully and was found to possess hypolipidemic activity comparable to Clofibrate. The use of Gugulipid led to the average reduction in serum cholesterol and triglycerides by 24% and 22% respectively and there were 80% responders in a group of 330 hyperlipidemic patients. (Web site, Table 10)


           

www.restorativemedicine.com/

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Guggulu

 

 

Latin name: Commiphora mukul
 
Local name: Guggulu
 
Part used: Gum resin
 
Benefits of Guggulu:
 

Hypolipidaemic / hypocholesterolemic:

 

Lowers cholesterol and dangerous low density lipid (LDL) levels in people with high cholesterol.

 
http://www.herbal-supplement-resource.com/images/picrorhiza_kurroa_img.jpg

Picroliv It is a fraction prepared from roots and rhizome of the plant Picrorhiza kurrooa. The major constituents of the fraction are iridoid glycosides (Picroside I and Kutkoside). Picroliv has shown preventive and curative hepatoprotective and anticholestatic activities in animal studies. It also possesses promising activity against Hepatitis B virus and significant immunostimulant activity and is devoid of any adverse pharmacological or toxic effects, as revealed by detailed studies. Advanced clinical trials in cases of acute viral hepatitis have been concluded at and results are encouraging. (Web site, Table 10)

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YouTube VideoPlants described are well-known sources of Ayurvedic drugs used today, for example, emetine, quinine, quinidine, digitoxin, digoxin. The psycllium husk and seeds of Plantago ovatum Forsk. have received wide acceptance as a laxative. The seed oil from the economic plant, Helianthus annus L. is prescribed for patients suffering from hypercholesterolemia. 
Are there any wonder drugs yet to be discovered from Ayurveda? 
Since the original texts mentioned only about 1500 herbal drugs from about 500-1000 medicinal plants, it is unlikely that a wonder drug for AIDS, cancer or other life threatening disease will be found. However automated robotic HTS multireceptor/enzymes or molecular or combinatorial screening of Indian medicinal plants has never been carried out due to lack of resources and funding. If such a screening is carried out it will surely result in several therapeutic leads, will increase chances for finding leads. On the other hand Ayurveda must attract good talent and eliminate quacks and useless and ineffective remedies. There should not be any compromise on standards of quality, efficacy and safety.

TABLE 7                                                  MEDICINAL PLANTS

 

 

Hepatoprotectors

Over 30 Products Marketed In India sourced From About 50 Medicinal Plants.

Andrographis Paniculata And Picrorrhiza Kurroa Have Shown Activity In Animal Models And Clinical Trials.

Picroliv Provides Protection Against Liver Damage/Jaundice.

Liv 50 marketed in Europe for protection against liver damage

 

Health Promoters

              Chywanprash                                                            Anti-Aging

Ocimum Sanctum (Tulsi)                                           Anti-Stress

Withania Somnifera                                                   Anti-Stress

Bacopa Monierri (Brahmi)                                          Memory

Centella Asiatica

(Mandukaparni)                                                         Memory

              Beccosides A+B                                                        Memory Plus

             Ashwangandha                                                            Anti-Cancer             

 

Rauwolfia Alkaloids

Rauwolfia Serpentina (Sarpgandha)                     For Insanity And Insomnia

Reserpine                                                            Hypertension

Ajmaline                                                              Antiarrythmic, Antihypertensive

Ajmalicine                                                            CNS                                                                                                                                                   Vasodilators


TABLE 8                                                   MEDICINAL PLANTS 

 

 

Turmeric for wound healing

 

Psoralens In Vitiligo And Psoriasis

Psoralea Corylifolia (Babchi) Used In Ayurveda For Vitiligo And Skin Diseases. Used Orally And As A Paste / Ointment.

Psoralen UV Radiation (Puva) Is A Standard Treatment For Psoriasis.

 

Holarrhena Alkaloids In Amoebiasis

Holarrhena Antidysenterica (Stem, Root, Bark) Traditional Remedy For Amoebic Dysentery And Intestinal Disorders

Comessine (Major And Most Active Alkaloid) Was Used As A Substitute For Emetine But Is Less Active

 

Azadirachta Indica (Neem)

As A Insecticide, Insect Repellent

Antifertility

Antiviral, Antifungal, Antibacterial

Hypoglycemic, Psoriasis

Forskolin (Coleus forskohlii)

Hypothyroidism and obesity

 

Commiphora Mukul Steroids As Hypolipemics

Guggul for Lipid Disorders And Obesity. Marketed As Gugulipid

Ayush-56 for epilepsy,

Ayush-82 for diabetes mellitus,

TABLE 9                                         CONTRIBUTIONS TO MODERN MEDICINE

 

 

Medicinal plants

Reserpine, hepatoprotective, lipid lowering, memory enhancers, health promoters, psoralens in psoriasis, tylophora alkaloids in allergy, antiamoebiasis, foreskolin neem as antiviral, antifungal, hypoglycemic and skin diseases,

 

Surgery

Dissection, plastic surgery, experimental surgery, Cesarean, steam bath, bladder stones, amputation, cataract, artificial eyes and limbs.

 

Concepts

Mind-body interaction, ageing, hospitals, training and certification, alcoholism, poison, symptoms and etiology of diseases.


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Mount Everest

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Mount Everest  PicApp Image

TABLE 10.  Indian Institutes/Companies involved in Ayurveda Research and Herbal Medicines

 

Council of Scientific and Industrial Research (CSIR) http://www.csir.res.in

§           Central Drug Research Institute (CDRI) http://www.cdriindia.org

§           Central Food Technological Research Institute (CFTRI)

§           Central Institute of Medicinal & Aromatic Plants (CIMAP)

§           Indian Institute of Chemical Biology (IICB)

§           Institute of Himalayan Bioresource Technology (IHBT)

§           Regional Research Laboratory, Bhubaneshwar(RRL-BHU)

§           Regional Research Laboratory, Thiruvananthapuram (RRL-TVM)

 

Central Council for Research in Ayurveda and Siddha http://www.ccras.org/institution.htm

 

Central Research Institute (Ay.), Punjabibagh, New Delhi

 

Central Research Institute (Ay.), Bhubaneshwar, Orissa

 

Central Research Institute (Ay.), Mumbai, Maharashtra

 

Regional Research Institutes (Ay.), Calcutta, Patna, Lucknow, Gwalior, Jaipur, etc

 

Indian Institute of Ayurveda for Drug Research, Tarikhet(Ranikhet).

 

Dabur India Limited  http://www.dabur.com 

Zandu http://www.zanduayurveda.com

Sabinsa Corp. http://www.sabinsa.com

Himalaya Drug http://www.thehimalayadrugco.com/
Pharmacopoeia of India http://www.vedamsbooks.com/pharmaco.htm


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Ethics                                                                                                                                                  

   

Charaka Samhita is full of general statements about qualities of an ideal ayurvedic physician and warns against quacks. Some of these statements are about ethics and conduct expected from Ayurvedic specialists. The ethical code was very similar to Hippocratic Oath (Table 11). [67][68][69][70][71][72]



TABLE 11                                     MEDICAL ETHICS 

 

Ethical Code In Ayurveda

Similar to Hippocratic Oath:  “Do no harm. Cleanliness, respect of patients, training and certification of physicians, tolerance, universal compassion, respect for teachers”

Death and rebirth

              Death:                                           Respiratory Failure

              Life:                                                        Conception                                                                                    Reincarnation:                             Death Denied

 

Procreation and fertility

Pregnancy and abortions, sex selection

High morality, non-violence

Discrimination of patients according to caste, lower status of women

 

Present Day Status

Health Care and Education For All

Flexible Code Of Ethics:              Local, Regional, Folk, Religion, Ethnic, Untouchables, and Tribal

Reproduction and new technology

Surrogate Mothers, Sperm Donation, etc. Ok

Abortion, Sex Selection 

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“The Lord (Atreya) said – The physicians of high descent, well-versed in scripture, having practical knowledge, expert, clean, skilful, self-controlled, well-equipped, having all the sense organs (normal), knower of constitution and course of action be regarded as promoters of vital breath and destroyers of diseases”. “Learning, rationality, specific knowledge, memory, devotion and action – one who possesses these six qualities, nothing remains unachievable for him”. “Learning, wisdom, practical knowledge, experience, accomplishment and popularity – out of these even one quality are sufficient to give significance to the degree of ‘Vaidya’ or physician”. Hence, a physician devoted to these four – scriptures, understanding, application and practical experience is known as one who promotes life. The physician who possesses knowledge of the four aspects – cause, symptoms cure and prevention of diseases is the best one and is fit for a king. Excellence in theoretical knowledge, extensive practical experience, dexterity and cleanliness – these are the four qualities of a physician. Friendliness and compassion towards the diseased, attachment to the remediable and indifference to those who are moving towards end – these are the fourfold attitude of the physician”.

In India, there has been a variable and flexible code of medical ethics based on local, lingual, regional, religious, folk and caste basis. Besides Hindu, there are Muslim, Christians, Buddhists, Jains, Sikhs and untouchables and tribes. Each of these religions has its code of ethics.  The Hindu medical ethical code as mentioned in Ayurvedic books, the four Vedas and scriptures is quite flexible. The Hindu religion is quite heterogeneous, due to the lack of a central supreme authority, which can resolve conflicts or issue guidelines. The early practitioners of Ayurveda were saints or learned scholars and were recognized as well wishers of the society. This tradition still continues in rural communities, where Ayurvedic doctors are sought after for health care and general social problems of the family. [67][68][69][70][71][72] 

The main ethical issue in India today is how to deliver modern healthcare and make it accessible to all. It is a moral dilemma that even 50 years after Independence, India is not able to educate all its children or provide an efficient health care to the poor sections of its population or eliminate misery and poverty. Ayurveda defines death as respiratory failure and mentions that life begins at conception. The belief in reincarnation in a way denies that death has taken place. A Hindu is duty bound (Karma) to have children in particular males. Thus ancient scriptures and Vedas can be used to justify some of the current practices in reproduction like sperm donation, surrogate mothers etc. Similarly abortion in mentioned in ayurvedic texts when the life or honor of the mother is in danger.  

The cost of Ayurveda is much lower, it is closer to the community, and patients get personal attention or the healing touch of the practitioner who speaks the same language. Ayurveda has never been practiced as a commercial service like modern medicine and patients pay according to their ability and financial status. The World Health Organization has recommended for the incorporation of the traditional systems of medicine like Ayurveda, for communities where it is accepted, into the primary health care system. Although Ayurveda did not learn from the rest of the world or incorporate modern ideas from science and medicine, there is no reason for modern medicine to ignore Ayurveda. Ayurveda must be reinterpreted in the light of our new knowledge and it must be incorporated in modern medicine along with other forms of traditional medicine.
Modern Ayurveda must provide clear evidence of clinical safety and efficacy and discard unproven and untested remedies. Ayurvedic drugs quality control and compliance with GMP/GLP/GCP can eliminate contaminants and reduce the incidence of adverse drug reactions. [73][74][75] 


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Monoclonal antibody Books                                                                 


Ayurveda#58 Books and Monographs

 


Sponsorship, Commercial Use and IPR                                                                     

 
 
 


Acknowledgements                                                                                                                        

 

Thanks are due to Mr. Jean-Antoine de Mandato (PDP, Geneva) for providing office facilities and administrative support.
 


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