Scientific Basis for
Ayurvedic Therapies
edited by
Brahmasree Lakshmi Chandra Mishra
It is their simultaneous
vitiation that gives rise to the combination of signs and
symptoms.
Vataja
and
kaphaja
types match the description of GTC seizures,
pittaja
matches complex
partial seizures, and
sannipataja
matches the characteristics of a mixed-seizure profile.
24.4 Etiology (
Vyaadhi hetu
)
As per the classical texts, the basic etiology is
threefold for epilepsy. Endogenous factors
(
nija
) include genetic, congenital, constitutional (
prakriti
), enzymatic disturbance (
agni
vikruti
), and idiopathic. Exogenous factors (
agantuka
) include habitual intake of unwholesome
and unhygienic foods and drinks that have mutually
contradictory properties (
apathya
aahar
), especially those with properties similar to
vata dosa
causing its aggravation
and trauma; this aggravation is due to worms (
krimijanya
) and environmental and idiopathic
factors. Psychological trigger factors (
manasika
) include excessive worry, grief, fear,
passion, anger, anxiety, attachment, and excitement.
Modern medicine describes the etiology
of epilepsy in a similar manner while giving an agewise
classification of the causes.
In neonates, genetic disorders, metabolic disturbances,
and acute central nervous system
(CNS) infection are the common causes. Infants and
children have genetic disorders, febrile
seizures, traumas, and CNS infections as common causes.
Etiology for adults includes
trauma, infection, tumor, and metabolic disorders in the
case of older adults.
9
The relationship
between the mind and the somatic response is well
established.
10
24.5 Pathogenesis
Of the three
dosas
,
vata
is the rudimentary element responsible for all the
beneficial and
harmful effects in the body in its normal and abnormal
states, respectively, as mentioned
in the authentic text,
Charak Samhita
. In epilepsy,
vata
is predominately vitiated and is the
fundamental cause in the pathology of the disease.
Neurological disorders, as understood
in Ayurveda, are considered to be due to imbalance of
vata
.
11
All the three etiological factors contribute in the
accumulation and vitiation of the
psychosomatic
dosa
, specifically
vata
affecting consciousness and all the sense organs. After
it is aggravated, the
dosa
spreads throughout the body and through the nerves (
dhamanis
),
leading to a manifestation of the epileptic episode. The
agitated
vata dosa
abruptly proceeds
through the nerves of the body, shaking it in a quick
succession (shaking jerks) called
“a
kshepaka,
” which means convulsion.
12
Another term for this condition is
apatanaka
where
the patient falls on the ground without spasm at
intervals that could be correlated with
absence-seizure type of epilepsy.
According to modern medicine, epilepsy results from a
focus of hyperexcitable neurons
in the cortex. During seizures, the permeability of the
cytoplasmic membrane of the
neurons changes. This results in increased levels of
intracellular calcium and extracellular
potassium, which contributes to overall excitability of
the epileptic neuronal aggregate.
The neurons become susceptible to hypoglycemia,
hyponatremia, hypocalcemia, sleep
deprivation, and photic stimulation.
7,9
An epileptic seizure has two phases: initiation phase
and seizure propagation phase. The initiation phase is
characterized by two concurrent
events: high frequency bursts of action potentials and
hypersynchronization. In epileptogenesis,
a normal neuronal network transforms into one that is
chronically hyperexcitable.
Ayurveda also has the concept of seizure propagation
where the
vata
dosa
spreads rapidly
throughout the body.
24.6 Clinical Examination and Diagnosis
Following the principles of an Ayurvedic diagnosis, a
comprehensive examination of the
patient (
rogi pariksha
) precedes the disease diagnosis (
roga pariksha
). As in the modern
approach of history taking, Ayurveda also emphasizes on
the detailed history of the patient
as well as features of the case definition of the
disease. The type of epilepsy is diagnosed
as explained under clinical description. Today, even
Ayurvedic physicians establish their
diagnosis utilizing modern techniques such as the EEG, CT
scan, and MRI. As per Brodie,
13
the choice of treatment in newly diagnosed epilepsy
should take into consideration the
patient’s age, general health, coexisting disabilities,
concomitant medication, and lifestyle
that is consistent with the Ayurvedic principles of
treatment.
24.7 Clinical Course and Prognosis
According to Ayurveda, because epilepsy arises from the
aggravation of the
dosas
of
the body and mind together and is localized in an
important vital organ (
mahamarma
),
the brain (
shiromarma
), it is difficult to treat and cure. Sannipatika-type
epilepsy, where
all three
dosas
are vitiated, is incurable. Chronic epilepsy and the presence
of concomitant
diseases compound the problem. The case is worsened if
the underlying
dosa
and
the constitution (
prakriti
)
of the patient are similar. For example, if the patient
is of
vata
pitta
constitution, his or her epilepsy is more difficult to
treat than that patient with a
different constitution.
6
Modern medicine determines the prognosis of epilepsy by
the
epilepsy syndrome type; these are classified into four
groups: excellent, good, uncertain,
and poor prognosis.
14
Interestingly, the terms are strikingly similar to the
Ayurvedic
concept of prognosis terms of
sukhsadhya, kashtasadhya, yapya,
and
pratyakheya,
respectively.
24.8 Management
All the three streams of Ayurvedic therapy are used in
treatment of epilepsy: divine
therapy (
deva vyapashraya
), rational therapy (
yukti vyapashraya
), and psychotherapy
(
satvavajaya
). Divine therapy is often practiced with the principles
of astrology, stones,
religious scriptures, and auspicious rites. Rational
therapy mainly includes purification
and evacuatory (
samshodhana and panchakarma
) and curative and pacificatory (
samshamana
) with diet, drug, and lifestyle modification followed by
restorative therapy (
rasayana
). Psychotherapy is practiced by incorporating the
philosophy of assurance therapy
(
aashvasana
) and the substitute of passions from negative to
positive. Psychoneuroimmunology
is a well-known concept in modern medicine where
interaction between the
brain and immune system is studied and used to treat
patients. Consulting to produce
positive emotions is an important aspect of the therapy.
15
The potential for behavioral
interventions to affect psychological adaptations and the
course of immune-related
diseases should be investigated. Physicians should first
restore the activities of the heart,
mind, and channels (
srotas
) occluded by the
dosa
by using
samshodhana chikitsa
.
Vataja
should be treated with enema therapy (
basti
),
pittaja
with purgation therapy (
virechana
),
and
kaphaja
with emesis therapy (
vamana
). This is followed by medicinal recipes.
Samshamana
therapy does not work well if purification is not made a
priority.
6
A study by
Nagashayana et al.
16
establishes the necessity of
panchakarma
therapy in Ayurveda medication
before palliative therapy.
Primary therapy described in epileps
y
is oleation (
snehana) where narayan tail is
commonly
used followed by fomentation (swedana). These
are also the preparatory measures
physician may use emesis therapy in epilepsy where drugs
are suitably prepared; a
common vehicle is honey and rock salt followed by a
postemesis regimen. Nasal insufflation
(nasya) is also an important treatment wherein herbal powders
and medicated oils
are administered in the nostrils as per the case; vacha powder
and oil, anu tail, panchendriya
vardhan tail, and
fresh juice of nirgundi are commonly used formulations.17 Shirodhara is
another part of the treatment (shiro = head
and dhara = slow uniform dripping of a liquid
substance). This is basically the pacificatory therapy
wherein liquid medicaments like
medicated oil, ghrita (clarified butter made out of
cow’s milk), decoctions of various
suitable herbs, and buttermilk are allowed to trickle
slowly on the forehead of the patient
in a supine posture.
Formulations used in the treatment are as follows:
1. Brahmi
ghruta containing vacha, brahmi, kushtha, shankhpushpi, and ghruta
2. Kushmanda
ghruta made by cooking ghruta with 18
times its quantity of kushmanda
juice and paste of yashtimadhu
3. Kalyanaka
churna containing 17 herbs
4. Sarasvata
churna containing 12 ingredients
having vacha as the main constituent
The treatment of chronic epilepsy includes garlic with
oil, brahmi juice with honey or
vacha powder
with honey, and shatavari with milk.
Strong emetics cannot be given in an acute attack of
epilepsy but could be beneficial
after the patient is stable and suitable to receive the
therapy following the guidelines of
authentic texts. In the current practice, Ayurvedic
physicians use conventional medicines
in the acute phase and subsequently panchakarma therapy
followed by rasayana therapy
to get the optimum benefit for the patient. It is shown
that the blood histamine level
decreased from 0.9 to 0.37 mg/ml by vamana, and the
same is emitted in vomitus. This
indicates elimination of toxic materials (sukshma malas)
from the cellular level.18
The management of elderly patients is also an important
issue.19 The elderly may have
many disorders, take multiple concomitant medications,
and have different metabolic
features; they are also more sensitive to the adverse effects
of drugs. The incidence of
epilepsy in the elderly is rising; an ideal
anticonvulsant for use in an elderly patient in
modern medicine is not currently available.20
Furthermore, febrile seizures are the most
for the panchakarma
described in Chapter 4. Keeping in mind the
particular patient, a
common convulsive events in childhood, occurring in 2 to
5% of children. Approximately
20 to 30% of these children may have recurrence during a
subsequent febrile infection.
These could be nonepileptic. Because the side effects of
the antiepileptic drugs outweigh
their benefits, their continuous use is no longer
recommended.21 In both these circumstances,
Ayurveda as an individualized therapy could be of great
value.
The dos and don’ts (pathyapathya)
for an epileptic patient have been mentioned in
classical texts. The beneficial regime (pathya)
includes a hot-water shower, consuming an
ample amount of clarified butter (ghruta) as per
the digestive capacity, massaging the soles
in the evenings with narayan tail followed
by hot water, fomentation, and living in a
pleasant atmosphere. Furthermore, the patient should
never go out alone and never be
around a lake or fireplace or ride a horse. Patients
should not be told any good or bad
news suddenly so that they get emotionally disturbed.
Products and regimes causing
aggravation of vata dosa should be strictly avoided.
The parallels in allopathy can be seen
in the use of prophylactic therapy, a ketogenic diet, and
mono- and polytherapy based on
an individual patient’s response.
24.9 Cost of Epilepsy Management
The costs of Ayurvedic medicines and conventional therapy
for epilepsy are more or
less similar in India contrary to the West.22 However, in
epilepsy treatment due to milder
and fewer adverse effects and toxicities than modern
medicine, the ultimate expenses
would be certainly less than the conventional therapy. In
many countries the vast
majority of sufferers remain untreated.23 The use of
Ayurvedic therapies could help solve
this problem worldwide. The Ayurvedic formulations used
in the treatment of epilepsy
24 and the conventional medicines
25
24.10 Scientific Basis
Conventional drugs for epilepsy should be further
investigated for a safe and effective
drug because none is available at this time.
Carbamazepine treatment has potential risks
that should be weighed against its benefits before
initiating the therapy.26 Weight gain in
patients on antiepileptic drugs disturbs the general
health. It causes cosmetic adverse
effects and can have serious psychological effects that
may lead to withdrawal of the
drug.27 Hepatotoxicity and teratogenecity of
antiepileptic drugs like valproate are rare,
but severe adverse effects have been reported.28
Hepatoprotective Ayurvedic therapies
may be used as an adjuvant to protect from hepatotoxicity
of conventional drugs. All
conventional antiepileptic drugs may provoke positive or
negative psychiatric reactions
in individual patients, and these reactions depend on the
strength of the drugs and genetic
and biographic psychiatric predisposition of the
patient.29 These adverse side effects can
be prevented using Ayurvedic therapies where the concept
of prakriti plays a vital role in
the treatment.
Although they provide a scientific basis with modern
parameters for Ayurvedic antiepileptic
drugs, the majority of the herbs are investigated only in
animal models. Rats and
available in the Indian market are given in Table 24.1
are given in Table 24.2.
mice are subjected to kindling, which involves periodic
administration of low-intensity
electrical stimuli. Systemic administration of convulsant
chemical agents, such as pentylenetetrazole
and pilocarpine, are also used for animal models to study
the antiepileptic
activity of the drugs.
In one study, the first ultrastructural evidence of
neuroprotective properties in Semecarpus
anacardium and
Withania somnifera has been reported.30 Today’s molecular pharmacology
has made it possible to understand the mechanism of the
action of Ayurvedic drugs.
Ashwagandha (W. somnifera)
is gamma-aminobutyric acid-A (GABA-A) receptor agonist,
and katuka (P.
kurroa) has antioxidant action equal
to alfa-tocopherol, which has an effect
on glutathion metabolism in the liver and brain.31 It is
believed to maintain the levels of
cellular endogenous antioxidants in liver and brain.
Subacute toxicity studies of drugs
like W.
somnifera did not reveal any toxicity.32
A methanolic extract of W.
somnifera root
contains an ingredient that has a GABA-mimetic
activity.33
A clinical trial of rejuvenating drugs for the nervous
system (medhya rasayana) on
epilepsy suggested that these medicines reduce the
frequency, duration, and severity of
TABLE 24.1
Ayurvedic Medicines for Epilepsy Available in the Indian
Market
Formulation Dose Manufacturersa Ref.b
Asvagandhadyarishta 12–24 ml twice/day 2–6, 8–10, 13 BR
Bala tail For
snehana and
abhyanga (local
application)
4, 9, 10 AH
Brahmi ghruta 12
g/day 3, 6, 7, 9, 10, 12, 13 AH
Chandanadi tail For
snehana and
abhyanga (local
application)
3, 4, 9–11, 13 YR
Chaturmukha rasa 125 mg twice/day 2, 6, 13 BR
Haratala bhasma 125–250
mg/day 2, 6 AP
Kalyanaka ghruta 12 g/day 4, 9–11 AH
Kumaryasava 12–24
ml twice/day 2, 4–6, 8–10, 13 YR
Mahakalyanaka ghruta 12 g /day 9, 10 AH
Mahamrutyunjaya rasa 125 mg twice/day 2, 3, 6, 9 ASS
Rajata bhasma 125
mg twice/day 2, 7, 8, 11, 13 Rasamrita
Saarasvatarishta 12–24 ml twice/day 2–6, 8–11, 13 BR
Sarpagandha vati 2–3 pills twice/day 2, 6, 11, 13 ASS
Svarna bhasma 15.5–62.5
mg/day 6, 7, 9, 11, 13 Rasamrita
Svarnamakshika bhasma 125–250 mg/day 2, 6–8 RSS
Vaatakulantaka rasa 125–250 mg/day 3, 6, 8, 12 BR
Yogendra rasa 125–250
mg/day 6–8, 11 BR
a Numbers denote the manufacturer in the Table. (1) Arya
Vaidya Sala, Kottakkal, 676 503, Kerala;
(2) Dabur Research Foundation, Ghaziabad, 201 010, Uttar
Pradesh; (3) IMIS Pharmaceuticals
Pvt. Ltd., Dubagunta nivas, Kari Marx Road, Vijayawada,
520 002; (4) Kerala Ayurveda Pharmacy
Ltd., Athani Post Office, 683 585, Aluva, Kerala; (5)
Sandu Brothers Pvt. Itd., Sandu Nagar, DK
Sandu Marg, Chembur, Mumbai, 400 071; (6) Shree Baidyanath
Ayurveda Bhawan Pvt. Ltd.,
Bamgani, Gopalgunj, M.P.; (7) Shree Bhuvaneshwari,
Aushadhashhram, Gondal, 360 311, Gujarat;
(8) Shree Dhootapapeshwar Ltd., 135, Nanubhai Deasai
Road, Khetwadi, Mumbai, 400 004; (9)
The Arya Vaidya Pharmacy (Coimbatore) Ltd., 326, Perumal
Koli Street, Ramanathapuram,
Coimbatore, 641 045; (10) Vaidyaratnam Oushadhasala,
Ollur, Thaikkattussery, Thrissur, 680 322;
(11) Venkateswara Ayurveda Nilayam Pvt. Ltd., Chintalru,
533 232 A.P.; (12) Vyas Pharmaceuticals,
98-C, Sanver Road, Sector-E, Indore; (13) Zandu
Pharmaceutical Works Ltd., 70 Gokhale
Road (South), Dadar, Mumbai, 400 025.
b BR = Bhaishajya
ratnavali; AH = Ashtang hridiya;
YR = Yoga ratnakar; RSS = Rasendra
sara sangraha;
AP = Ayurveda prakash; ASS = Ayurveda sara sangraha.
© 2004 by CRC Press LLC
434 Scientific
Basis for Ayurvedic Therapies
seizures and have not shown any side effects.34 Brahmi rasayan,
an Ayurvedic preparation,
was studied in mice and rats for its effects on the CNS
at oral doses ranging between 1
and 30 g/kg. The study suggests an involvement of the
GABA-ergic system in the mediation
of the CNS effects of brahmi rasayan.35
Piperine, an active alkaloid of Piper
longum
and Piper
nigrum, exerted a significant
protection against tertbutyl hydroperoxide and
carbon tetrachloride hepatotoxicity by reducing both in vitro and in vivo lipid
peroxidation,
reducing enzymatic leakage of glutamate pyruvate
transaminase (GPT) and alkaline phosphatase
(AP), and preventing the depletion of reduced glutathione
(GSH) and total thiols
in the intoxicated mice.36 Piperine and its derivatives
are effective anticonvulsant drugs
that antagonize convulsions induced by physical and
chemical methods. They also have
sedative, tranquilizing, and muscle-relaxing effects.37
The effects of piperine on convulsions induced in mice by
agonists at different excitatory
amino acid receptor subtypes were studied. Piperine
significantly blocked convulsions
induced by intracerebroventricular injection of threshold
doses of kinate.38 Toxicity evaluation
of potassium embelate from Embelia ribes Burm.
did not indicate adverse effects.39
Vohora et al.40 screened the ethanol extract of Acorus calamus rhizomes
for CNS effects and
found that it exhibited a large number of actions similar
to alpha-asarone (an active
principle of A. calamus). The effect of acute and
subchronic administration of an alcoholic
extract of Nardostachys jatamansi roots on
norepinephrine (NE), dopamine (DA), serotonin
(5-HT), and GABA were studied in male albino Wistar rats.
A 15-day treatment resulted
in a significant increase in the levels of NE, DA, 5-HT,
and GABA, which indicates that
the extract causes an overall increase in the levels of
central monoamines and inhibitory
amino acids.41
The anticonvulsant activity of Myristica fragrance was studied against seizures induced
by maximum electric shock (MES), pentylene tetrazole
(PTZ), lithium sulphate-pilocarpine
nitrate (Li-pilo), and picrotoxin. Results showed that M. fragrans inhibited
seizures induced
by MES, PTZ, and Li-pilo, but not by picrotoxin.42 An
animal study with Sesbania grandiflora
(Agastya) showed a wide spectrum of anticonvulsant profile and
anxiolytic activity.43
Brahmi rasayan offered
a graded protection against audiogenic seizures in mice and antagonized
the mescaline-scratch response in mice, indicating its
tranquilizing properties.44
The therapeutic efficacy of an Ayurvedic formulation is
due to actions of various components
of the plant and their interactions. Studies on the
efficacy of the whole plant
cannot be confirmed by fragmented research using the
plant extracts or isolated phytochemicals.
TABLE 24.2
Allopathic Antiepileptic Drugs
Generic Name Dose (mg/day)
Phenytoin sodium (100 mg) 100–600
Carbamazepine (200 mg) 200–1200
Phenobarbitone (30 mg) 30–210
Sodium valproate (200 mg) 600–2500
Lamotrigine (25 mg) 25–150
Primidone (250 mg) 125–500
Oxcarbazepine (300 mg) 600–1200
Topiramate (25 mg) 25–800
24.11 Drug Interactions in Epilepsy Management
In India, Ayurvedic medicines have been used for
thousands of years, and adverse drug
reactions are also fewer in frequency and severity.45,46
These facts lead to the concomitant
use of both Ayurvedic and modern medicine by the patient
without the physician’s
knowledge. This can ultimately lead to drug interactions,
which could be useful or harmful
for the patient. At our therapeutic drug-monitoring
clinic, we observed two patients who
had well-controlled seizures who presented with sudden
loss of seizure control. A detailed
history taking revealed that they had started taking shankhapushpi,
a purported memory
enhancer. Animal studies with rats were carried out with
single and multiple doses of the
two drugs given alone and in combination. It was seen
that on chronic administration,
both the antiepileptic effect and plasma levels of
phenytoin were reduced by shankhapushpi.
Single-dose administration of the drugs did not lead to
any change in phenytoin
levels but decreased its antiepileptic effect. The
interaction was found to be pharmacokinetic
and pharmacodynamic.47,48
Another marketed memory enhancer, Mentat, has been shown
to increase phenytoin
levels in rabbits.49 Likewise, studies on the possible
interactions between traditional Chinese
medicines and antiepileptic drugs are in progress.50
Honey, a substance widely used
as a good vehicle for a given Ayurvedic medicine, has
shown to decrease the bioavailability
of carbamazepine.51
24.12 The Future
Instead of using single-drug or various formulations
mentioned in the authentic texts, the
principle of threefold therapy should be validated where
yoga can be practiced under
divine therapy. Several parameters have been proposed to
monitor the level of tridosa,
where vata can be monitored in terms of membrane-bound signal
transduction.52 With
reference to epilepsy, a vata-dominant
disease, such a hypothesis should be validated.
Allopathic and Ayurvedic practitioners and researchers
should also plan effective healthcare
delivery systems for epilepsy to improve the overall
quality of life. Traditional systems
of medicine like Ayurveda in India are here to stay. It
is also inevitable that they will be
used concomitantly with the allopathic system of medicine
in the years to come. The
worldwide herbal medicine market has grown by leaps and
bounds. In the light of this,
an understanding of the scientific basis of Ayurvedic
therapies based on systematic studies
of principles and practices and using current scientific
principles and technology would
certainly help contribute toward better patient care.
References
1. Porter, R.J., Therapy of epilepsy, Curr. Opinions Neurol. Neurosurg., 1, 206, 1988.
2. Shorvon, S.D., Epidemiology, classification, natural
history and genetics of epilepsy, Lancet,
366, 93, 1990.
3. Scott, R.A., Lhatoo, S.D., and Sander, J.W.A.S., The
treatment of epilepsy in developing countries:
where do we go from here?, Bull. World Health Org., 79, 344, 2001.
4. Sridharan, R. and Murthy, B.N., Prevalence and pattern
of epilepsy in India, Epilepsia, 40, 631,
1999.
5. Mani, K.S. et al., Epilepsy control with Phenobarbital
or phenytoin in rural south India — the
Yelandur study, Lancet, 357, 1316, 2001.
6. Sharma, R.K. and Dash, B., Charaka Samhita,
6th ed., Chaukhamba Sanskrit studies, Varanasi,
India, 1999.
7. McNamara, J.O., Drugs effective in the therapy of the
Epilepsies, in Goodman & Gilman’s The
Pharmacological Basis of Therapeutics, 10th ed., McGraw-Hill Medical Publishing Division, New
York, 2001, p. 521.
8. Shrikanthamurthy, K.R., Ashtanga Samgraha of Vagbhata, 5th ed., Vol. 1, Chaukhambha Orientalia,
Varanasi, India, 2002.
9. Lowenstein, D.H., Seizures and epilepsy, in Harrison’s Principles of Internal Medicine, 15th
ed.,Vol. 2, McGraw-Hill Medical Publishing Division, New
York, 2001, p. 2354.
10. Singh, N.B. and Singh, R.K.L., Mental health: the
journey ahead, J. Med. Sci., 16, 1, 2002.
11. Gourie-Devi, M. and Venkataram, B.S., Concept of
disorders of muscles in Indian medical
treatise — relevance to modern mycology, Neurol. India,
31, 13, 1983.
12. Bhishagaratna, K.K., Sushruta Samhita, 1st ed., Vol. 1, Chowkhamba Sanskrit series Office,
Varanasi, India, 1998.
13. Brodie, M.J., Monostars: an aid to choosing an
antiepileptic drug as monotherapy, Epilepsia,
40, S17, 1999.
14. Mukherjee, A. and Chakravarty, A., Prognosis of
Epilepsy, Neurosci. Today, 5, 82, 2001.
15. Reilly, D. and Harrison, T., Creative consulting:
psychoneuroimmunology, the mind body,
Student Br. Med. J., 18, 312, 2002.
16. Nagashayana, N. et al., Association of L-DOPA with
recovery following Ayurveda medication
in Parkinson’s disease, J. Neurosci.,
176, 124, 2000.
17. Srikanthamurthy, K.R., Bhavprakash of Bhavmishra, 1st ed., Krishnadas Academy, Varanasi,
India, 1998.
18. Sachdev, K. et al., Recent advancement in snehana, svedana and vamana therapy with special
reference to experimental study, in The Holistic Principles of Ayurvedic Medicine, 1st ed.,
Chaukhamba Sanskrit Pratishthan, Varanasi, India, 1998.
19. Rowan, J., Management of seizures in the elderly, Pharmacotherapy, 20, 178S, 2000.
20. Arroyo, S. and Kramer, G., Treating epilepsy in the
elderly: safety consideration, Drug
Safety,
24, 991, 2001.
21. Rantala, H., Tarkka, R., and Uhari, M., Preventive
treatment for recurrent febrile seizures, Ann.
Med., 32,
177, 2000.
22. Chandrashekara, S., Anilkumar, T., and Jamuna, S.,
Complementary and alternative drug
therapy in arthritis, J. Assn. Physicians India, 50, 225, 2002.
23. Mental and neurological disorders WHO fact sheet No.
265, Dec. 2001, Indian J. Med. Sci., 56,
26, 2002.
24. Nayak, B., Ayurmedline, Ayurmedline, Bangalore,
India, Jan–June 2001.
25. Malik, S., Indian Drug Review,
Mediworld Publication Pvt. Ltd., New Delhi, India, May–June
2002.
26. Ramadasan, P., Chaudhary, S., Vaishampayne, S., and
John, T.R., Stevens-Jhonson Syndrome
due to Carbamazepine, J. Assoc. Physicians India, 48, 742, 2000.
27. Jallon, P. and Picard, F., Bodywight gain and
anticonvulsants: a comparitive review, Drug
Safety, 24,
969, 2001.
28. Bialer, M., Pharmacokinetic considerations in the
design of better and safer new antiepileptic
drugs, J.
Controlled Release, 62, 187,
1999.
29. Schmitz, B., Psychiatric syndromes related to
antiepileptic drugs, Epilepsia, 40, S65, 1999.
30. Shukla, S.D., Jain, S., Sharma, K., and Bhatnagar,
M., Stress induced neuron degeneration and
protective effects of Semecarpus anacardium Linn. and Withania
somnifera Dunn. in hippocampus
of albino rats: an ultrastructural study, Indian J. Exp. Biol., 38, 1007, 2000.
31. Lele, R.D., Ayurveda (Ancient Indian system of
medicine) and modern molecular medicine,
J. Assn. Physicians India, 47, 625, 1999.
32. Aphale, A.A. et al., Subaute toxicity study of the
combination of ginseng (Panax ginseng) and
Ashwagandha (Withania somnifera) in rats: a safety
assessment, Indian J. Physiol. Pharmacol.,
42, 299, 1998.
33. Mehta, A.K. et al., Pharmacological effects of Withania somnifera root extract on GABAA
receptor complex, Indian J. Med. Res., 94, 312, 1991.
34. Dwivedi, K.K. and Singh, R.H., Clinical trial of medhya rasayana drugs
in apasmaara, in The
Holistic Principles of Ayurvedic Medicine, 1st ed., Chaukhamba Sanskrit Pratishthan, Varanasi,
India, 1998.
35. Shukia, B., Khanna, N.K., and Godhwani, J.L., Effect
of Brahmi rasayan on the central nervous
system, J.
Ethnopharmacol., 21, 65, 1987.
36. Koul, I.B. and Kapil, A., Evaluation of the liver
protective potential of piperine, an active
principle of black and long peppers, Planta Medica, 59,
413, 1993.
37. Pei, Y.Q., A review of pharmacology and clinical use
of piperine and its derivatives, Epilepsia,
24, 177, 1983.
38. Hooge, R.D. et al., Anticonvulsant activity of
piperine on seizures induced by excitatory amino
acid receptor agonists, Arzneim.-Forsch./Drug Res., 46, 557, 1996.
39. Johri, R.K. et al., Toxicity studies with potassium
embelate, a new analgesic compound, Indian
J. Exp. Biol., 28,
213, 1990.
40. Vohora, S.B., Shah, S.A., and Dandiya, P.C., Central
nervous system studies on an ethanol
extract of Acorus calamus rhizomes,
J. Ethnopharmacol., 28, 53, 1990.
41. Prabhu, V., Karanth, K.S., and Rao, A., Effects of Nardostachys jatamansi on biogenic amines
and inhibitory aminoacids in the rat brain, Planta Medica,
60, 114, 1994.
42. Sonavane, G.S., Palekar, R.C., Kasture, V.S., and
Kasture, S.B., Anticonvulsant and behavioral
actions of Myristica fragrans seeds, Indian J. Pharmacol., 34, 332, 2002
43. Kasture, V.S., Deshmukh, V.K., and Chopde, C.T.,
Anxiolytic and anticonvulsive activity of
Sesbania grandiflora leaves in experimental animals, Phytother. Res.,
16, 455, 2002.
44. Ganguly, D.K. and Malhotra, C.L., Some behavioral
effects of an active fraction from Herpestis
monniera Linn. (Brahmi), Indian J. Med. Res., 55, 473, 1967.
45. Chopra, A. and Doiphode, V., Ayurvedic medicine, Med. Clin. North Am., 86, 75, 2002.
46. Okamato, T. and Hino, O., Drug development with hints
from traditional Indian Ayurveda
medicine: hepatitis and rheumatoid arthritis as an
example, Int. J. Mol. Med., 6, 613, 2000.
47. Dandekar, U.P. et al., Analysis of a clinical
important interaction between phenytoin and
shankhapushpi,
an ayurvedic preparation, J.
Ethnopharmacol., 35, 285, 1992.
48. Kshirsagar, N.A. et al., Phenytoin and Ayurvedic
preparation-clinically important interaction
in epileptic patients, J. Assn. Physicians India, 40, 354, 1992.
49. Garg, S.K. et al., Effect of Mentat on the
pharmacokinetics of single and multiple doses of
phenytoin in rabbits, Neurol. India,
47, 104, 1999.
50. Chen, L.C. et al., Drug utilization pattern of
antiepileptic drugs and traditional Chinese
medicines in a general hospital in Taiwan: a
pharmaco-epidemiological study, J. Clin.
Pharm.
Ther., 25,
125, 2000.
51. Koumaravelour, K. et al., Efffect of honey on
Carbamazepine kinetics in rabbits, Indian J. Exp.
Biol., 40,
560, 2002.
52. Tripathi, Y.B., Molecular approach to Ayurveda, Indian J. Exp. Biol., 38, 409, 2000.
25
Psychiatric Disorders
R.H. Singh
and Lakshmi Chandra Mishra
25.1 Introduction
The discipline of psychiatry according to Ayurveda has
its roots in the four ancient books
of knowledge called
Vedas of India,
where science and knowledge of an evil spirit
(
bhutavidya
) is mentioned vividly. As a matter of fact, the word
bhutavidya
of
Vedas
refers
to Ayurveda as a whole. There is no direct mention of
tridosa
doctrine (
vata, pitta,
and
kapha
) of Ayurveda in
Vedas
. As such,
bhutavidya
may be considered the mother of medicine
as a whole in ancient India.
1
Psychiatric disorders are very prevalent diseases. They
accounted for 10 to 15% of the
prescriptions written in 1996 in the U.S.
2
The diagnostic criteria for psychiatric disorders
in the U.S. are described in the American Psychiatric
Association’s
2000-941 DSM IV TR
publication,
Diagnostic
and Statistical Manual of Mental Disorders
.
3
Since the mid-1950s,
research and development efforts in drug therapies for
psychiatric disorders have led to
the discovery of many useful drugs.
2
These drugs, however, are known to have significant
adverse side effects. Because Ayurvedic dietary herbal
supplements are relatively safe,
their use in managing various psychiatric disorders is
explored here.
25.2 Basic Ayurvedic Concept of Psychiatry
The contemporary Ayurvedic psychiatry in terms of
concepts consists of two components,
namely:
1. Ayurvedic science of psychiatric disorders (
Ayurvediya manas roga vijnana
) or rational
Ayurvedic psychiatry — This deals with clinical
conditions where the disease
and its treatment are based on fundamental principles of
Ayurveda (i.e., theories
of five elements [
pancamahabhuta
]
, tridosa, triguna,
etc.). The diseases such as psychosis
(
unmada
)
and others are well characterized.
2. Demonology (science and knowledge of evil spirits) (
bhutavidya
) — This deals
with psychiatric problems like psychosis (
bhutonmada, grahavesa
) in a nonconventional
manner.
Psychiatry emerged to the present scientific shape from
demonology,
where the disease and its treatment is not based on
classical principles of
Ayurveda and science (
vijnana
).
Rather, it is based on paranormal factors like the
doctrine of deeds (
karma
)
,
planets
(
graham
)
,
evil spirits (
bhuta
), and others. The
latter appears to be based more on astrology
than on psychiatry. Sometimes this
aspect of the psychiatric disorders, such as
bhutavidya,
is equated with demonology.
It seems that different kinds of psychosis
and effects of planets described in
ancient texts are nothing but different forms of psychiatric
syndromes or sets of
behavioral alterations named symbolically after the name
of different planets
because of the similarity with their mythological
descriptions. The element of
demonology exists in Ayurveda but only symbolically.
In Ayurveda, the entire concept of life, health, and
disease revolves around the classical
theory (
loka-purusa samya
) that proclaims that the individual living being is a
miniature
replica of the universe; the universe
(
loka
) and individuals (
purusa
) exist as a continuum
of each other. The individual life entity is called
ayu,
which is four dimensia composed
of physical, sensorial, mental, and spiritual attributes.
The human being is provided not
only with sensorial apparatus (
jnanendriyas
), but also with a highly dynamic psyche and
mind (
manas
). According to Ayurveda, the mind is highly active but
is unconscious (
acetana
). It derives its consciousness from the soul (
atma
) — an extension of the cosmic or
divine consciousness.
The mind (
manas
) is further considered to have three dimensions in terms
of the three
properties or attributes (
gunas
):
sattva, rajas,
and
tamas
. The
rajas
represent activity and
dynamism, whereas the
tamas
denotes inertia and darkness.
Sattva
is the state of pure
mind with absolute balance when both the extreme
qualities of mind, namely,
raja
and
tamas
, cease or merge into each other. It is believed that all
mental illnesses are because
© 2004 by CRC Press LLC
Psychiatric Disorders
441
of the
rajas
and
tamas
. These properties are also called mental (
manasa
)
dosas
in the same
way as
vata
,
pitta,
and
kapha
are called body (
sarira
)
dosas
and all kinds of physical diseases
are attributed to them.
In consideration of the
trigunas
,
4
Ayurveda postulates the idea that there can be three
broad categories of mental personalities (
prakritis
):
sattvika prakrti, rajasa prakrti,
and
tamasa
prakrt
.
5
These categories are further divided on the basis of
finer considerations into 16
mental (
manasa
) personalities or mental traits. These 16 personality
traits are characterized
with unique features that may also predispose specific
mental diseases simulating 16
personality factors (16 PF) of modern psychology.
The entire concept of the mind (
manas
)
is psychological. Its neurophysiological attributes
have not been described vividly in Ayurveda. However, the
text
Bhela Samhita
states that
the mind (
manas
) is located in the skull (
sirstalvantrgatam manah
). There are also references
describing heart (
hrdaya
) as the seat of consciousness (
cetana
). Ayurvedic texts consider
mental health a state of sensorial mental, intellectual,
and spiritual well-being. Ill mental
health is brought about essentially as a result of
unwholesome interaction between the
individual and his environment. This interaction operates
through three fundamental
factors: time rhythm (
kala
), intellect (
buddhi
), and sensorial inputs
(
indriyartha
).
25.3 Etiology
Ayurveda believes in the theory of rebirth (
punarjanma
) and actions of past life
(
karma
).
Accordingly, clusters of mental illnesses primarily fall
into two etiological areas: the
hereditary and the environment.
Etiological factors in the diagnosis of psychiatric
disorders are not clearly defined.
Categorical relationships between disorders and the
symptom constellation provide an
important key in understanding how heterogeneous symptoms
may descend upon a final
common pathway. Consequently, a number of disorders exist
as discrete mental disorders
but rely on an aggregate of behavior that may be common
among other families of mental
disorders.
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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