Scientific Basis for
Ayurvedic Therapies
edited by
Brahmasree Lakshmi Chandra Mishra
TABLE 23.1
Plant Ingredients of Six Polyherbal Formulations
Marketed in India for Memory-Improving Effects
No. Latin Name (Vernacular Name)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Acorus calamus
(
vacha
)
Amomum subulatum
(
badi ilaichi
)
Asparagus racemosus
(
shatawar
)
a
Bacopa monniera
(
brahmi
)
a
Butea frondosa
(
dhak, palash
)
Canscora decussata
(
sankha holi
)
Cinnamomum zeylanicum
(
dalchini
)
Convolvulus pluricaulis
(
shankhpushpi
)
a
Delphinium denudatum
(
jadwar shireen
)
Elettaria cardamomum
(
choti elaichi
)
Emblica officinalis
(
amla
)
Embelia ribes
(
vayu vidang
)
Eugenia caryophyllus
(
laung
)
Foeniculum vulgare
(
bari saunf
)
Ipomea paniculata
(
vidari kand
)
Nardostachys jatamansi
(
jatamansi
)
Operculum tarpethum
(
nishoth
)
Paenia emodi
(
uood saleeb
)
Pandanus odoratissimus
(
keora
)
Pimpinella anisum
(
saunf
)
Piper aurantiacum
(
renuka
)
Piper longum
(
peepal, pippali
)
Prunus amygdalis
(
badam
)
Rosa damascena
(
gulab
)
Sassurea lappa
(
kuth
)
Terminalia belerica
(
bahera
)
Terminalia chebula
(
harar, hareetaki
)
Tinospora card folia
(
giloe
)
Valerian walachia
(
tagar
)
Vetiverica zizinoides (khas)
Withania somnifera (ashwagandha)a
Zingiber officinalis (adrakh)
aTop four most frequently occurring plant ingredients in
commercial polyherbal formulations used in the management
of AD.
23.8 Scientific Basis
23.8.1 Nootropic Plants
This findings of experimental studies on Indian medicinal
plants with nootropic actions
(activating or stimulating mental activity or causing
cerebral or intellectual activity) are
given below.
23.8.1.1 Pharmacological Studies on Single Herbs
23.8.1.1.1 Bacopa monniera Linn. (Herpestis monniera
Linn.) (Brahmi)30–35
This plant has been extensively investigated at the
Central Drug Research Institute, Lucknow,
India, for memory-enhancing effects and is a component of
Mentat (commercially
marketed polyherbal preparation). Ethanolic extract of B. monniera was
demonstrated to
facilitate acquisition, consolidation, and retention of
memory in animal models of the
following cognitive functions: (1) active conditioned
avoidance response, (2) Sidman’s
continuous avoidance response, and (3) foot
shock-motivated brightness discrimination.
Bacosides A and B (Saponins) were identified as active
principles. Administration of
bacosides attenuated the retrograde amnesia produced by
immobilization induced stress,
electroconvulsive shock, and scopolamine. Protein kinase
activity and protein content of
the hippocampus were increased. Improvement was observed
in learning capacity and
correction of epilepsy-associated abnormal behavior to
some extent. Maze learning by
albino rats was facilitated and brain glutamic acid and
gamma-aminobutyric acid (GABA)
concentrations were elevated.
The protective action of B. monniera was
recently demonstrated against phenytoininduced
cognitive deficit. Phenytoin (25 mg/kg orally for 14
days) adversely affected the
passive avoidance task in mice. An extract of this plant
(Memory Plus, 40 mg/kg orally
for 7 days along with phenytoin in the second week of the
2-week regimen) significantly
reversed phenytoin-induced impairment without affecting
its anticonvulsant efficacy. The
observed cognitive effects of phenytoin and the plant
extract were found to be independent
of motor stimulation.
23.8.1.1.2 Centella asiatica (Mandookparni, Brahmi)36
Aqueous extract of this plant was shown to improve
learning and memory in shuttle box,
stepdown paradigm, and elevated plus maze in rats. When
tested on oxidative stress
parameters, it decreased brain levels of malondialdehyde
(MDA) with a simultaneous
increase in the level of glutathione. The drug also
increased catalase levels. As a result,
antioxidant mechanism in the cognition-enhancing effect
of the drug was suggested.
23.8.1.1.3 Convolvulus pluricaulis Chois (Shankhpushpi)37
Ethanolic extract of the drug was made alcohol free and
suspended in water to study the
effect on brain neurotransmitter content in normal and
stressed rats. The drug decreased
the acetylcholine (ACh) content of the whole brain
homogenate, but markedly increased
ACh content in the cortex. The catecholamine and
5-hydroxytryptamine (5-HT) contents
were also raised in treated rats. The histamine content
was lowered in the whole brain
homogenate but raised in the cortex. The changes were
more pronounced in rats subjected
to swimming stress. These changes suggest tranquilizing
action and improvement of
mental function.
23.8.1.1.4 Eugenia caryophyllus spl. (Laung)38
The aqueous extract of E. caryophyllus reduced
hydrolysis of ACh by AChE, indicating the
presence of water-soluble substances with anti-AChE
activity in the plant.
23.8.1.1.5 Glycyrrhiza glabra Linn. (Yastimadhu,
Mulethi)37
The alcoholic extract of G. glabra reduced
ACh content in the whole brain but increased
it in the cortex.
23.8.1.1.6 Hydrocotyl asiatica Linn. (Syn. Centella
asiatica Linn. [Mandookparni])37
The effects of this plant are similar to G. glabra described
above.
23.8.1.1.7 Lawsonia inermis Linn. (Mehndi)39
Significant nootropic effect was observed in acetone
soluble fraction of petroleum ether
extract of leaves on elevated plus maze and passive
avoidance paradigms. It affected
5-HT and noradrenaline-mediated behavior in experimental
animals.
23.8.1.1.8 Nardostachys jatamansi DC (Jatamansi)40–42
This plant has been demonstrated to reduce brain
serotonin content, reaction time of
trained animals for passage through tunnel in a Columbia
obstruction box, and conditioned-
avoidance response. It has also impaired biosynthesis and
metabolism of 5-HT in
rabbit brain. It is a constituent of Mentat, a polyherbal
formulation with cognition facilitatory
effects.
23.8.1.1.9 Paeonia emodi Wall (Uood Saleb)43
This plant is an ingredient of shimotsu-to,
a traditional Chinese medicine shown to improve
spatial-working memory in rats.
23.8.1.1.10 Pongamia pinnata (Karanj)44
Petroleum ether extract was tested in experimental models
of AD (ibotenic-acid induced
lesioning of nuclear basalis magnocellularis). It
reversed both the cognitive deficits and
reduction in cholinergic markers after 2 weeks of
treatment. Reversal of perturbed cholinergic
function was suggested as a possible mechanism of action.
23.8.1.1.11 Tinospora cordifolia F.Vill (Giloe,
Guduchi)37
Ethanolic extract of this plant reduced ACh content in
the whole brain but increased it in
the cortex.
23.8.1.1.12 Withania somnifera Dunal (Ashwagandha)45–47
Active principles (equimolar amounts of sitoindosides
VII-X and withoferin A) of W.
somnifera were
investigated in animal model of AD (ibotenic-acid–induced lesioning of
nucleus basalis magnocellularis) in rats. The lesions
caused marked cognitive deficit as
evidenced by (1) severe reduction in learned task, (2)
significant decrease in ACh levels
in the frontal cortex and hippocampus, (3) reduction in
choline acetyl transferase activity,
and (4) muscarinic cholinergic binding. The drug (50
mg/kg) significantly reversed these
alterations after 2 weeks of treatment.
W. somnifera induced
depletion of ACh and catecholamines and increased serotonin and
histamine concentrations in the whole brain tissue. It
also elicited differential effect on
AChE activity in basal forebrain nuclei by producing a
slight enhancement in the lateral
septum and globus pallidus and a reduction in vertical
diagonal band. The changes were
accompanied by enhanced M1-muscarinic cholinergic
receptor binding in lateral and
medium septum and frontal cortex. GABA and benzodiazepine
receptor binding and nmethyl-
d-aspartate (NMDA) and a-amino 3-hydroxy 5-methyl 4-isoxazole
propionic acid
(AMPA) glutamate receptor subtypes were not affected
after treatment with W.
somnifera
principles, suggesting preferential effect of the drug on
events in the cortical and basal
forebrain cholinergic signal transduction cascade. The
drug induced an increase in cortical
muscarinic ACh-receptor capacity. This finding partly
explains the nootropic action of the
W. somnifera.
23.8.1.2 Clinical Studies on Nootropic Plants
The gist of information on clinical studies on Indian
medicinal plants for nootropic effects
is presented below.
23.8.1.2.1 Bacopa monniera Linn. (Syn.
Herpestis monniera Linn. [Brahmi])48–49
A significant increase in intelligent quotient (IQ)
scores was observed after treatment of
110 males aged 10 to 13 years for 9 months with a suksma (micro)
medicine derived from
B. monniera.
Memory (direct) and arithmatic tests were used. The drug was well tolerated
in single (20 to 300 mg) and multiple (100 and 200 mg for
4 weeks) doses in a doubleblind
placebo-controlled and non-crossover phase I clinical
trial in human volunteers.
23.8.1.2.2 Centella asiatica Linn. (Syn: Hydrocotyle
asiatica Linn. [Mandookparni, Brahm mandooki])
50–52
Double-blind studies with this herb revealed no change of
the height, weight, and intelligence
of mentally normal children but showed favorable action
in mentally retarded
children (free from epilepsy). A significant increase in
general ability and behavioral
pattern was noted even when the drug was administered
only for 12 weeks. Another
double-blind study, carried out on 30 mentally retarded
children (9 to 13 years old) with
an IQ range of 55 to 90, revealed better intelligence
scores and psychological and biochemical
parameters after treatment with the test drug for 9
months. The Binet test and Senguin
Form Board test were used for assessing intelligence and
performance of children.
23.8.1.3 Pharmacological and Clinical Studies on
Nootropic Plant Formulations
23.8.1.3.1 Mentat
The preparation for Mentat (Himalaya) was
developed at the Central Drug Research Institute,
Lucknow, India. The formula (50 to 500 mg/kg) was found
to improve the acquisition
and retention of passive-avoidance task in a stepdown
paradigm in mice. It reversed
scopolamine-induced amnesia and attenuated amnesia
produced by electroconvulsive
shock (ECS) immediately after training. Chronic treatment
with ECS for 6 successive days
at 24-h intervals disrupted memory consolidation on day
7. Daily administration of Mentat
(50 and 100 mg/kg for 6 days) significantly improved
memory consolidation in mice.
Administration of drug on day 7 also attenuated
ECS-induced disruption of memory.
Scopolamine-induced delay in transfer latency was
reversed on day 1. Physostigmine
enhanced the efficacy of Mentat against
scopolamine-induced amnesia. When adminis-
tered in combination with GABA and Aniracetam, the test
drug improved learning and
memory retrieval. The results suggest nootropic action in
naive and amnesic mice and
involvement of cholinergic and GABA-ergic modulation as
possible mechanisms of
action.41,53
The drug was shown to augment acquisition and retention
of learning in normal rats
and in states of cognitive deficits induced by
undernutrition, environmental impoverishment,
sodium nitrite hypoxia, aluminum, aging, and ECS-induced
anterograde and retrograde
amnesia. The parameters included active avoidance
learning, food motivational
behavior (Hebb Willam maze), and avoidance learning
during endurance performance
(Runimex circular runway).54–56
23.8.1.3.2 Trasina (Deys Pharmaceuticals)
Treatment with Trasina for 21 days exhibited significant
nootropic effects in two experimental
models of AD: (1) intracerebroventricular injection of
colchicine (15 mg/rat)
and
(2) lesioning of nucleus basalis magnocellularis by
ibotenic acid (10 mg/rat).
The drug
improved both memory and cholinergic markers (e.g., ACh
concentration, choline acetyl
transferase activity) and muscarinic cholinergic receptor
binding in frontal cortex and
hippocampus of rat brain. Nootropic action was attributed
to correction of cholinergic
dysfunction.57
23.8.1.3.3 Memorin (Phytopharma)
Pretreatment with this drug (200 mg/kg/day) attenuated
ECS-induced retrograde amnesia
in rats. The method used was a passive-avoidance test in
a shuttle box.57
23.8.1.3.4 Syrup Shankhpushpi (Baidyanath)
This drug exhibited nootropic action in various
experimental models of cognitive function
such as active-avoidance learning in young and old rats,
passive-avoidance learning in
normal and scopolamine-amnesic mice, transfer latency
using elevated plus maze in mice,
and food and thirst motivational behavior in rats. It
caused significant reduction in brain
AChE activity but elicited no significant effects on
L-glutamate, L-aspartate, and GABA
content of whole brain tissue. The maximum tolerated dose
was found to be >40 ml/kg
orally, indicating it to be quite safe. Nootropic
activity appears to be mediated through
cholinergic mechanism.30
23.8.1.3.5 Saraswatarisht (Baidyanath)
This formulation (20 ml two times/day for 1 year) showed
good antiepileptic activity in
25 patients; there was a significant reduction in the
frequency and severity of convulsions
and even complete absence of fits in some cases. The drug
was found to be free from side
effects.58,59
The drug showed cognition facilitatary effects against
various experimental models of
learning and memory in rats and mice. The effects were
duly noted in normal animals,
and no activity was discernible against amnesia induced
by scopolamine and ECS. The
activity appeared to be mediated through cholinergic
mechanisms.30
23.8.1.3.6 Vidyarthi Amrit (Maharishi Ayurved)
Vidyarthi amrit exhibited
nootropic activity in active-avoidance learning in aged rats,
passive-avoidance learning in normal mice, and food and
thirst motivational behavior in
rats. No activity was discernible on transfer latency and
against scopolamine- and ECSamnesic
mice. The drug caused a decrease in AChE and L-glutamate
and an increase in
L-aspartate and GABA levels of whole brain tissue. The
nootropic effects appear to be
mediated through cholinergic mechanisms.30
23.8.1.3.7 Dimagh Pushtak Rasayan (Baidyanath)
This drug exhibited nootropic effects in active- and
passive-avoidance paradigms in both
normal and scopolamine-amnesic animals, transfer latency
test, and thirst-motivational
behavior. No effects were observed against food
motivational behavior in the Hebb William
maze, possibly because this test involved a single dose
schedule which may not be
adequate for effective drug concentrations. At least
three of its ingredients, Centella
asiatica,
Convolvulus pluricaulis, and siddh
makardhwaja, are reported to have
nootropic effects. The
memory-enhancing effects of the formulation were
attributed to cholinergic mechanisms.30
23.8.1.3.8 Geriforte (Himalaya)
Clinical psychobiological studies on apparently
normal-aged subjects 45 to 50 years were
treated for 3 months with the test formulation. Results
showed an increasing feeling of
well-being, physical efficiency, and improvement in
mental functions. The therapy reduced
anxiety and helped in better nitrogen retention. The drug
appears to be a rational combination
of herbal components for arresting rapid onset of mental
and physical disability
in aged persons. The effects were attributed to its
constituent drugs (e.g., chyavanprasha
[chief ingredient Emblica officinalis]), Bacopa
monniera, Withania somnifera, etc.).60
23.8.1.3.9 Combination of Four Plants: Convolvulus
pluricaulis, Bacopa monniera, Withania
somnifera, and Acorus calamas
The combination exhibited encouraging effects in patients
of unmada (psychosis).61
23.8.1.4 Herbs with Allied Activities
The following is a summary of studies on Indian medicinal
plants with properties considered
allied to general well-being and nootropic action such as
adaptogenic, immunomodulatory,
anxiolytic, antioxidant, and antiaging effects.
23.8.1.4.1 Asparagus racemosus Wild (Shatawari)
Aqueous extract exhibited adaptogenic activity as evidenced
by protection against a
variety of biological, physical, and chemical stressors
in experimental animals. It also
normalized cisplatin-induced intestinal hypermotility.62
23.8.1.4.2 Bacopa monniera Linn. (Brahmi)
With this herb, significant anxiolytic effects in
experimental animals have been reported.63
23.8.1.4.3 Boerhavia diffusa Linn. (Punarnava)
Milk fortified with this plant extract revealed
growth-promoting and hematinic effects in
children. The plant did not elicit appreciable effect on
body weight, total proteins, and
hematological parameters of normal adults (45 to 50
years).64,65
23.8.1.4.4 Centella asiatica Linn. (Mandookparni)
Aqueous extract of this plant, which is claimed to be a
brain tonic, was given at 25 mg/
kg i.p. Results showed decreased spontaneous motor
activity and delayed pentylenetetrazol-
induced convulsions in mice. The activity was comparable
with diazepam (4 mg/
kg i.p.). The extract potentiated pentobarbitone-induced
sleep but did not affect immobil-
ity time in the swimming test. The results suggest an
anxiolytic effect but no action on
behavioral despair. Another report found antidepressant
activity with 50% of ethanolic
extract as evidenced by the reduction of immobility time
in the forced swimming test.
The effect appears to be mediated through D2
receptor.66,67
Results of a double blind trial in 43 normal adults (45
to 50 years old) after 6 months
revealed that the drug caused an increase in erythrocyte
count, hemoglobin, blood sugar
and serum cholesterol levels, vital capacity, and total
proteins. It decreased mean blood
urea and serum phosphatase concentrations.65
23.8.1.4.5 Syrup Shankhpushpi (Chief Ingredient:
Convolvulus pluricaulis)
One month treatment with syrup Shankhpushpi formulation
(10 ml three times/day) elicited
beneficial action in 30 cases of anxiety neurosis. The
symptoms and levels of plasma
cortisol and urinary catecholamines were reduced.68
23.8.1.4.6 Embelia ribes (Amla)
The protection of E. ribes observed
against a variety of stressors (biological, chemical, and
physical), indicating adaptogenic action. The drug
strengthened the defense against freeradical–
induced damage during stress.62
23.8.1.4.7 Piper longum Linn. (Pippali)
This plant drug exhibited adaptogenic effects similar to E. ribes described
above. 62
23.8.1.4.8 Terminalia Chebula Retz (Harar)
This plant drug exhibited adaptogenic effects similar to E. ribes described
above.62
23.8.1.4.9 Tinospora cordifolia F.Vill (Giloe, Guduchi)
Besides adaptogenic activity against different stressors,
T. cordifolia normalized phagocytic
function irrespective of the direction of change. The
protection against stress-induced
mucosal damage was lost when macrophage activity was
blocked.62
23.8.1.4.10 Withania somnifera Dunal (Ashwagandha)
This reputed nootropic plant has been extensively
investigated by many workers. It
showed antistress, anxiolytic, rejuvenating,
anticonvulsant, free-radical scavenging, adaptogenic,
and antiaging properties in experimental and clinical
studies.43,46,69–74
23.8.2 Nootropic Mineral Preparations
Although the majority of the preparations used in
Ayurveda as a whole and for memoryenhancing
effects are of plant origin, some reports on mineral
prepartions are also available.
The mineral-origin drugs are used mostly in calcined forms.
Ayurvedic physicians
use even those metals for therapeutic purposes, which are
considered toxic and not used
for internal administration in modern medicine (e.g.,
mercury and arsenic). It is believed
that the specialized techniques used during preparation
of the oxides (Bhasmas) (ash)
“purify” the metal and make it therapeutically effective
and safe for internal use. These
techniques involve (1) incorporation of some herbal
juices during the calcination process
and (2) repeated calcination and trituration to fine
powder forms. The mineral preparations,
in contrast to herbal drugs, have not received much
attention by researchers. The
Department of Medical Elementology and Toxicology of
Hamdard University, New Delhi,
India, ventured into this neglected field and found
encouraging results. Some interesting
findings for effects of calcined metal preparations on
animal models of learning and
memory are summarized below.
23.8.2.1 Siddh Makardhwaja (Mercury)
The preparation helped in total development (physical and
mental) of experimental animals.
It revealed growth-promoting, memory-improving, and
carbohydrate-sparing properties
without affecting other central nervous system (CNS)
parameters (e.g.,
pentobarbitone-induced sleeping time, activity index in
traction test, activity counts in
water wheel, rectal temperature, behavioral despair in
forced swimming test, acetic acidinduced
writhing episodes, and amphetamine aggregate toxicity) in
rats and mice. Facilitation
of cognition was shown by marked increase in acquisition,
(control = 81.25%,
treated = 100%), retention (control = 69.23%, treated =
80%), and learning scores (control
= 4.00, treated = 5.26) in the active-avoidance learning
test. The drug restored exercisedepleted
liver and muscle glycogen concentrations, suggesting
antifatigue action. Incorporation
of this mineral in the diet (0.01% w/w) of young rat pups
(45 to 70 g) for 6 weeks
exhibited better growth rate vs. control pups.74
23.8.2.2 Swarna Bhasma (Gold)
The preparation (25 mg/kg orally for 7 to 10 days)
exhibited a nootropic effect in activeand
passive-avoidance learning in rats and mice. It caused
significant increase in acquisition,
retention, and learning scores in treated rats vs. the
control group. The results
compared well with panax ginseng tea (350 mg/kg orally
for 10 days). Significant
reduction in latency to reach shock free-zone and
stepdown errors was observed in
treated mice. Brain acetyl cholinestrase was
significantly decreased in the frontal cortex,
hypothalamus, hippocampus, midbrain, cerebellum, brain
stem, and corpus striatum
after the 10-day treatment in rats. Decreased AChE
activity possibly led to increased
ACh levels in brain with an improvement in cognitive
function. The drug also exhibited
glycogen-sparing, adaptogenic, and immunomodulatory
activities. The drug showed a
wide therapeutic index (effective dose = 25 mg/kg orally,
maximum tolerated dose =
>2 g/kg orally) and lack of gross behavioral effects,
weight loss, or adverse effects on
hematological parameters.75–79
23.9 Summary and Discussion
The revival of Ayurvedic medicine with special emphasis
for research on medicinal
plants has received considerable attention in India
during the past 4 to 5 decades.80
Research effort on medicinal plants and nootropic drugs
that act on CNS gained momentum
during the past 5 to 10 years. This has generated
substantial data, giving a rational
basis to ancient Ayurvedic remedies for deficits in
learning and memory. Experimental
and clinical data presented earlier provide support for
the use of these herbs for the
management of AD. However, further research need to be
conducted to better utilize
these herbs.
In conventional medicine, the drugs currently approved
for the treatment of AD are
cholinomimetics, such as tacrine, which has the pharmacologic
profile of AChE inhibitors.
12,25,26 Modern drugs used for ameliorating intellectual
impairment, confusion,
behavioral disorders of senility, mental retardation, and
learning problems in children
include CNS stimulants and activators such as pyritinol
(Encephabol) and nootropic
agents such as Piracetam (Cerecetam, neurocetam,
Nootropil, Normobarin, and Pirtam).
Some of the adverse effects associated with these drugs
include anorexia, epigastric
distress, nausea, vomiting, headache, fatigue, excitement,
restlessness, sleep disturbances,
and skin rash. In addition, special care is required if
these drugs are used for
patients with hepatic, renal, or cardiac diseases.
Ayurvedic herbal preparations have not
been shown to produce adverse side effects. They offer a
safe alternative in the management
of AD.
In a recent study, leisure activities such as reading,
playing board games, musical
instruments, and dancing are associated with a reduced
risk of dementia. This is consistent
with the Ayurvedic concept of regular physical and mental
exercise, and meditation as a
part of disease prevention and treatment strategy.81
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24
Epilepsy
Heena A. Bhatt, Nithya J. Gogtay, Sudeshna S. Dalvi, and
Nilima A. Kshirsagar
24.1 Introduction
Epilepsy is one of the most common neurological disorders
and afflicts more than 50
million people worldwide.
1
Data from the World Health Organization (WHO) suggest
that as many as 1 in 20 people at some point in their
lives have an epileptic seizure and
that at least 1 in 200 people have epilepsy.
2
Over four fifths of the 50 million people with
epilepsy are thought to be in developing countries, and
90% of these people do not receive
appropriate treatment.
3
In India, it was estimated that by the end of the year
2001, the
number of patients afflicted with epilepsy would be 5.5
million and the number of new
cases each year would be close to half a million.
4
In India, over 70% of the population is
rural, whereas 70% of the medical manpower, and nearly
100% of neurologists, are urban
based.
5
Facilities for neurological investigations such as the
computered tomography (CT) scan,
magnetic resonance imaging (MRI), and
electroencephalogram (EEG), as well as most
first-line and second-line antiepileptic drugs, are
beyond the reach of a vast majority of
patients. Against this backdrop, the Ayurvedic management
of epilepsy, which is sometimes
the only form of treatment available to the rural
population, assumes great importance.
Epilepsy was first documented in the ancient Ayurvedic
literature as
apasmaara
in
Sanskrit. This review provides a comparative study of
modern and Ayurvedic medicine
in hopes of providing the scientific basis for the use of
Ayurvedic therapies in epilepsy.
In addition, our own experiences in the management of
epilepsy with the use of therapeutic
drug monitoring, and the identification of interactions
of allopathic and Ayurvedic
antiepileptic drugs are also discussed.
24.2 Definition
Apasmaara
,
or epilepsy, in Ayurveda has been described as one of the
earliest eight diseases
known (diagnosed) and can be controlled only with medical
therapies that can sometimes
be incurable and remain uncontrolled.
6
The parallels can be found in allopathic medicine
where, despite the best available treatment, 10 to 12% of
the patients still have uncontrolled
seizures.
7
Epilepsy as per Ayurveda is defined as the transient
derangement of memory,
intelligence, and the mind, resulting in a temporary
blackout of vision, loathsome activities,
and unconsciousness.
Vagbhata
defines it as loss or destruction (
apaya
) of memory
(
smriti
).
8
Modern medicine defines a seizure as a transient
alteration of behavior due to
the disordered, synchronous, and rhythmic firing of
populations of neurons. Epilepsy per
se is defined as a disorder of brain function
characterized by the periodic and unpredictable
occurrence of seizures.
7
Whereas the Ayurvedic definition describes the effect,
the modern
definition describes the cause of epilepsy.
24.3 Clinical Description
The clinical description as mentioned in Ayurvedic texts
is classified as prodromal signs
and symptoms (
purvarupa
) and clinical manifestations (
rupa
)
.
The prodromal signs and
symptoms include raising of eyebrows, frequent abnormal
movements of eyes, hearing
of sounds not perceived by others, excessive oozing of
saliva and nasal mucus, aversion
to food, anorexia, indigestion, distension of abdomen,
debility, body ache, transient blackout,
giddiness, profuse sweating, increased thirst, fainting,
hallucinations, delusions, falling,
aura, and insomnia.
6
This description is very similar to the description in
modern
medicine of generalized tonic clonic (GTC) seizures.
These seizures are characterized by
an abrupt onset, sometimes with premonitory symptoms,
loud cry, excessive salivation,
postictal unresponsiveness, headache, muscle ache,
fatigue, and an increase in heart rate
and pupillary size.
9
The loss of memory as described by
Vagbhata
is similar to the description
of absence seizures, which are characterized by loss of
consciousness for a longer
duration and are less abrupt in onset and cessation.
In Ayurveda, epilepsy is divided into four types
according to the dominant
dosa
involved
in the disease pathogenesis: v
ataja, pittaja, kaphaja,
and s
annipataja
;
signs and symptoms
manifest accordingly. The
vataja
type involves
vata
as the dominating
dosa
and is characterized
by having frequent fits; regaining consciousness in the
shortest time interval,
bulging eyes, excessive crying, frothing at the mouth,
irregularly contracted fingers, reddish,
rough, and blackish nails, eyes, face, and skin, hallucinations,
trembling, and visions
of unstable, coarse, and rough objects.
Pitta
is the leading
dosa
in
pittaja
type with distinctive
features of regaining consciousness in shorter periods,
scratching the ground, green-
ish-yellowish and coppery nails, eyes, face, and skin,
and visions of bloody, agitated,
irritated, frightful, and burning objects. The
kaphaja
type denotes
kapha
dosa
as the principal
dosa
including features such as delayed fits, delayed
recovery, increased frothing at mouth,
white nails, eyes, face, and skin, and visions of white,
heavy, unctuous, smooth objects.
Sannipataja
means all the three
dosas
are in conjunction with each other.
Om Tat Sat
(Continued...)
(My
humble salutations to H H Maharshi ji, Brahmasri
Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and
doctors for the collection)
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