Scientific Basis for
Ayurvedic Therapies
edited by
Brahmasree Lakshmi Chandra Mishra
The role of environmental factors has not
been adequately ruled out. In fact, socioeconomic,
environmental, and dietary factors are
currently considered causal, based on epidemiological
studies for many diseases previously thought
to be related to genetics (e.g.,
cancer).
6
The same may be true for psychiatric
disorders.
25.4 Psychopathology
Sthana
), in a very systematic manner in terms of
eight essential psychological factors
considered to be centrally affected in all
psychiatric disorders in varying degrees
7
:
1. Emotion, mood, affect
(
mana
)
2. Thought and decision (
buddhi
)
3. Orientation (
sajna-jnana
)
The psychopathology in Ayurveda is described
by Charaka Samhita, Chapter 7 (Nidana
4. Memory and learning
(
Smrti
)
5. Desire (
bhakti
)
6. Habits (
sila
)
7. Psychomotor function
(
cesta
)
8. Conduct and behavior
(
acara
)
25.5 Clinical Description of Psychiatric
Disorders
A wide range of psychiatric conditions and
affective behaviors have been described in
Ayurveda. Besides their aetiopathogenesis,
the texts describe briefly but vividly the
signs, symptoms, and behavioral alterations
in different psychiatric diseases and their
classifications. The psychiatric conditions
described in original texts may be classified
as follows:
1. Primary psychological conditions caused
purely by
manasa
dosas
(i.e.,
rajas
and
tamas
)
.
An example is the set of
manas dosas vikaras
7
: lust (
kama
), anger (krodha),
greed (lobha),
delusion (moha), jealousy (irsya), pride (mana), eurphoria (mada),
sorrow (dukha),
grief (soka), anxiety (cinta),
neurosis (udvega), fear (bhaya),
and
happiness (harsa).
2. Psychiatric conditions, neurological
problems, and symptoms caused by the
mixed pathology (samprapti) including both the body dosas (vata, pitta,
kapha) and
mental dosas (raja, tama). Examples include psychosis (unmada), convulsive diseases
(apasmara), hysteria (apatantraka), obsession (atattvabhinivesa), vertigo
(bhrama), drowsiness (tandra), neuresthenia (klama), comas (mada-murccha-sanyas),
alcoholism (madatyaya), and hypochondriasis (gadodvega).
3. Personality (prakrti) disorders: There are 16 mental disorders (manasa prakriti)
representing 16 types of behavior traits.
When such personality behavior becomes
overt and overrides the range of normalcy,
the patient may have a psychiatric
disorder.
4. Mental retardation (buddhimandya).
5. Neurological and behavioral problems of
the elderly (jara-janya
manasa vikara).
6. Psychosomatic diseases, where the cause of
disease is mental and manifestation
is somatic (manodaihika vyadhis,[ e.g., sokatisara]).
The psychiatric syndromes named symbolically
after the name of planets (e.g., bhutonmada
and grahavesa) warrant prayers (daivavyapasraya cikitsa).
This is because herbal and
purification treatments (yuktivyapasraya cikitsa) based on fundamental doctrines of
Ayurveda are not possible.
In conventional medicine, mental diseases in
general are characterized by altered behavior.
The clinical diagnosis is done on the basis
of the pattern of alteration of the behavior
and certain associated signs and symptoms.
Common psychiatric diseases described in
the conventional medicine8 and Ayurveda7 are
(1) psychosis (unmada), (2) depressive
illness (cittavasada), (3) anxiety disorders (cittodvega), and (4) somatoform disorders, alcoholism,
and drug abuse (mada). These diseases are briefly discussed here.
25.5.1 Psychosis
Psychosis is described in Ayurveda as a major
psychiatric disease. There are several types
identified in terms of the set of signs,
symptoms, and the pattern of behavior alterations
referable to the three dosas and their combinations.
A separate category of psychosis, described
as agantuja unmada by Charaka and as
bhutonmada by Susruta, forms an interesting dimension of Ayurvedic
psychiatry. In this
context about a dozen psychiatric syndromes
are described and named after different
planets or divinities (grahas). Thus, bhutonmada
is a specialized aspect of
Ayurvedic psychiatry
using symbolic terms and need not be pushed
into the realm of demonology.
In the conventional medicine, schizophrenia
is a major psychotic (presence of hallucinations
or delusions) illness. The major feature of
schizophrenia is a decline in psychosocial
functioning, with a tendency to move down in
a person’s social circle. Some patients may
have acute full-blown symptoms, whereas
others may have chronic and less severe symptoms.
Characteristic symptoms are delusions,
hallucinations, disorganized speech, grossly
disorganized behavior, and hallucinations
consisting of a voice or two voices that converse
with each other and affect the behavior or
thought of the patient. Prevalence of the disease
is about 1% for lifetime risk. Schizophrenia
affects both sexes equally. It affects all ages,
although most cases are known to occur
between the age of 15 and 35 years.8
25.5.2 Depressive Illness (Cittavasada)
Major clinical features of depressive
disorders include persistent depressed mood, markedly
diminished interest or pleasure, insomnia or
too much sleep, psychomotor agitation,
fatigue, loss of energy, diminished ability
to think, and suicidal tendencies. An examination
of the patient history does not reveal any organic
factor or pathology or any family disaster
to explain symptoms, nor does it reveal
delusions, hallucinations in the past 2 weeks, or
schizophrenia. In some cases, however, the
family history may show biological or genetic
propensity.
The mechanism responsible for depression is
believed to be the decrease of catecholamine.
This is based on the observations in 1950s
that reserpine, a catecholamine and
indolamine depleter, causes depression and
drugs that replenish these amines are therapeutic;
it was suggested that a reduction in the
levels of these amines in the brain are
related to depression. A specific cause
responsible for the reduction in amine levels is not
clear. It is possible that a thinking process
in the cortex responding to an adverse physical
or psychosocial environment may trigger the
reduction in amine levels. Thus, the reduction
in amine levels may be a manifestation of the
disease and not the cause. Almost all
antidepressant drugs are known to increase
the availability of catecholamine and indolamine
at the synapse in the central nervous
system.8
25.5.3 Anxiety Disorders (cittodvega)
Major features of anxiety disorders include
nervousness, sleeplessness, hypochondriasis,
and somatic complaints. No age is immune to
these disorders. Clinical symptoms may
occur as an episode, such as paniclike
anxiety, or may show chronic generalized anxiety.
A panic anxiety episode may consist of
following symptoms: shortness of breath, dizziness,
unsteady feeling, fainting, accelerated heart
rate, trembling, sweating, choking, nausea,
depersonalization, paresthesia, hot flashes,
chills, chest pain, fear of dying, and fear
© 2004 by CRC Press LLC
444 Scientific Basis for Ayurvedic Therapies
of going crazy. No clear etiology is known,
but a cluster of cases in families indicates some
genetic component similar to depression.
However, physical and sociopsychological environmental
factors must be considered. Neurophysiology
and neurobiochemistry of anxiety
disorders suggests the involvement of the
noradrenergic system.8
25.5.4 Somatoform Disorders, Alcoholism, and
Drug Abuse (Mada)
Somatoform disorders basically have one
common characteristics: mimicry of medical
diseases involving exaggeration of severity
or disability accompanying actual medical
illness. There is still no credible
neurobiological basis for these disorders. Some examples
of these diseases are listed below8:
1. Somatization disorder — This is a
multisystem disorder characterized by complaints
of pain, gastrointestinal, sexual problems,
and pseudoneurologic problems.
It begins early in life.
2. Hypochondriasis — Patients believe that
they are going to contract some serious
illness.
3. Conversion disorder — Patients mimic
symptoms of neurological or medical
illness and show dominant psychological factors
as the cause.
4. Body dysmorphic disorder — Patients are
concerned with an imagined defect in
physical appearance.
5. Pain disorder — Patients complain of pain
and indicate some dominant psychological
factor as the cause.
Examples of somatiformlike disorders include
the following:
1. Dissociative disorder — Patients show
disrupted consciousness, memory, identity,
or perception judged to be attributed to
psychological factors.
2. Factitious disorder — Patients
intentionally create physical and psychological
signs of illness when no cause (financial
gain, avoidance of responsibility, etc.)
can be identified.
3. Malingering — Patients intentionally
create false physical and psychological signs
of illness and an identifiable cause
(financial gain, avoidance of responsibility, and
others).
4. Chronic fatigue syndrome — The syndrome
has the basis in reports appeared in
1980s in the U.S. of pathologic
fatiguability. Unconscious psychological factors are
believed to be involved as important
contributors.
25.6 Diagnosis of Psychiatric Disorders
The clinical examination in Ayurveda has two
objectives: (1) to examine and assess the
primary nature of the patient as an
individual as opposed to a disease and his or her
health (rogi pariksha) and (2) to examine and assess the nature and severity of the disease
(rog-parikhsa). The examination of the patient is done by a 10-point interrogation (dasavidha
pariksa):
1. Constitution (prakriti)
2. Morbidity (vikrti)
3. Quality of tissues (sara)
4. Body stucture (samhanana)
5. Anthropometry (pramana)
6. Adaptability (satmya)
7. Mental stamina (sattva)
8. Digestive power (ahara sakti)
9. Physical strength (vyayama sakti)
10. Age and aging (vaya)
The clinical examination includes an interview
(prasna pariksa) with the patient, a reliable
attendant, or relative. The physical
examination of the patients (pancendriya pariksa)
includes the following:
1. A general survey by eight-point
examination (astavidha
pariksa): pulse (nadi), urine
(mutra),
stool (mala), tongue (jihva), voice (sabda), skin (sparsa), eyes (netra), facies
(akrti).
2. Systemic examination (sadanga pariksa) of the six parts of the body: head-neck,
trunk, and the four limbs along with 13
channels (srotamsi) distributed over the
entire body (sadangas). The examination of channels (srotas) with psychiatric
patients must include the examination of
mental channels (manovaha
srtoas).
The clinical data available through the above
methods are critically examined and
evaluated in the light of the doctrine of
Ayurvedic knowledge of clinical description,
signs and symptoms, pathology, and diagnostic
criteria (pramana
vijnana and nidana
pancake, nidana, purvariipa, rupa, samprapti,
upasaya-anupasaya). The
diagnosis is made not
merely by name of a disease or syndrome, but
in a descriptive way identifying the
constitution, etiology, and abnormal
personality (prakrti,
hetu, vikrti); this
includes dosa
tissues (dusya)
and seat of the vitiated dosa (adhisthana). The Ayurvedic physician pays
special attention to the patient’s
environment, hereditary and genetic background, and
original personality makeup in terms of tridosa and three personality properties (triguna).
25.7 Treatment
The Ayurvedic management of a psychiatric
patient is carried out through three broad
streams of therapy: (1) divine therapy (Daivavyapasraya cikitsa), (2) biological therapy
(Yuktivyapasraya cikitsa), and (3) psychotherapy (Sattvavajaya). The divine therapy includes
the use of religious activities (mantra, japa) and wearing of precious stones. Ayurvedic
psychotherapy is practiced incorporating the
principles of assurance therapy (asviisana),
replacement of negative emotions with
positive emotions, and psychological shock therapy.
In addition, it includes encouraging the
patient to find or develop a specific goal,
purpose, or meaning in life; find a job that
gives better job satisfaction; improve relationships
with family members; contribute own share of
responsibilities to the household;
maintain a healthy lifestyle with respect to
daily routine (sleeping schedule and exercise);
and join some sports activity, fitness club,
and volunteer groups to help the community.
In biological therapy, the patient is
subjected to biopurification by pancakarma in order
to cleanse the channels of the body. This is
followed by salisamana
therapy or palliative
treatment with the help of ausadhi (medicinal herbs and herbal formulas), anna (dietetics),
and vihara (lifestyle). The drugs used in the treatment are mostly nootropic (medhya)
herbs or herbomineral formulas or nootropic rasayanas, which are believed to act as
brain tonics and adaptogens. The nootropic
herbs are considered as specific molecular
nutrients for the brain, affording a better
mental health and leading to alleviation of
behavioral alterations.9 The vajikarana drugs such as kapikacchu and others are used in
the treatment of depression. The entire
Ayurvedic management is more health oriented
than disease oriented. As such, there is a
big scope of utilizing Ayurvedic approach and
therapeutics as an adjunct to the
disease-oriented therapy of modem psychiatry to afford
a full treatment.
25.7.1 Ayurvedic Herbs and Herbal Formulas
Besides the nondrug approach to prevention
and treatment of mental disorders, the
Ayurvedic texts describe a large number of
herbal and herbomineral formulas for treating
mental diseases. Many of these formulas are
still in popular use in the hands of a large
number of Ayurvedic practitioners. The
scientific validity of many of these herbs and
herbal formulas drugs has been tested on
scientific parameters, and several of these have
been found effective.
Ayurveda describes a class of herbs termed as
medhya herbs and medhya rasayana. All
medhya and medhya rasayana drugs are
claimed to be nutraceutical agents specific to neuronutrition.
They are called medhya because they are beneficial for medha (i.e., intellect). All
such herbs have been found to possess
nootropic effect besides varying degrees of anxiolytic
activity. In addition to other aspects of the
rasayana effect, they bring about antistress
effect and improve the memory and cognitive
power. The popularly used Medhya herbs
and commercially available herbal compound
formulas are listed below:
All these plants are tropical and grow in
India and other tropical countries profusely.
The recent clinical and laboratory studies
conducted on these herbs have shown mild to
moderate nootropic and antistress effects
with high safety profile.10–17
In addition to the medhya herbs as mentioned above, it is pertinent to mention that
the
herbs of vrisya and vajikarana categories are also used in psychiatric care.
Vrisya and
vajikarana herbs are essentially aphrodisiacs and are commonly used
for promotion of
sexual stamina and virility. Some Ayurvedic
physicians use this category of herbs for
treating depression. The most popular herbal
drug of this category is kapikacchu (Mucuna
Single Herbs Herbal Formulas
1. Sankhapuspi (Convolvulus pluricaulis)
2. Mandukaparni (Centella asiatica)
3. Brahami (Bacopa monnieri)
4. Vaca (Acorus calamus)
5. Jatamansi (N. jatamansi)
6. Ashwagandha (Withania somnifera)
7. Sarpagandha (Rauwolfia serpentina)
8. Jyotismati (Celestrus panniculatus)
9. Yasti madhu (Glycyrrhiza glabra)
10. Guduchi (Tinospora cardifolia)
1. Saraswatarista
2. Aswagandharist
3. Smriti sagar rasa
4. Krisna chaturmukha rasa
5. Unmada gajankusa rasa
6. Unmada gajakeshri rasa
© 2004 by CRC Press LLC
Psychiatric Disorders 447
pruriens). The seeds of this plant, which are also edible as a
vegetable, are used in the
treatment of depression and also for
treatment of Parkinsonism because of high levadopa
(L-DOPA) content.
25.7.2 Nonherbal Therapies
The Ayurvedic classics describe sattvavajaya as one of the three major therapeutic streams
of Ayurveda. Sattvavajaya is a special form of psychotherapy where the
therapist attempts
to divert the thought process of the patient
from unwanted targets (ahit bhawas) to
beneficial
targets (hita bhawas). This is done through supportive therapy, assurance, and replacement
of negative emotions by positive emotions.
In addition to this classic Ayurvedic
psychotherapy, the role of yoga and meditation can
not be over emphasized. Scientific evidence
has already accumulated to suggest that
several yogic practices have great
psychorehabilitative and antistress effect.
Similarly, certain traditional practices of keraliya panchakarma (i.e., sirodhara and sirobasti)
are used for treatment of chronic mental
diseases and have good results. However, their
mode of action has not yet been validated
scientifically.
In conventional medicine, treating
psychiatric disorders essentially consists of identifying
and eliminating socioenvironmental factors
and administration of antipsychotic drugs
(neuroleptic drugs) similar to that in
Ayurveda. The drugs used for the treatment of
psychosis include phenothiazines,
structurally similar thiozanthenes, and heterocyclic
dibenzazepines; butyrophenones and
diphenylbutylpiperdines; and indolones and other
heterocyclic compounds. These drugs act via
blocking the mesolimbic dopamine receptors.
The adverse side effects of the drugs are as
follows:
1. Acute spasm of the tongue, face, neck, or
back may mimic seizures, not hysteria
2. Motor restlessness
3. Bradykinesia, rigidity, variable tremor,
mask facies, and shuffling gait
4. Catatonia, stupor, fever, unstable blood
pressure, and myoglobinemia can be fatal
5. Perioral tremor
6. Oral facial dyskinesia, widespread
choreoathetosis, or dystonia
7. Agranulocytosis8
The pharmacologic agents available to treat
depression disorders exert their antidepressant
effect by inhibiting the reuptake of
serotonin at presynaptic membrane selectively
(fluoxetine) and the reuptake of both
serotonin and norepinephrine or (imipramine),
directly inhibiting monoaminao oxidase enzyme
(phenelzine) or causing dopamine blockage
(trazodone). These drugs provide symptomatic
relief and remissions but do not cure
the disease. The side effects of these drugs
include dry mouth, constipation, postural
hypotension, tachyarrhythmia, nervousness,
insomnia, tremor, agitation, headache,
weight loss, hypertensive crisis, and
priapism.2
The drugs used for the treatment of anxiety
disorders are primarily antihistamines and
benzodiazepines. The adverse side effects of
these drugs include dry mouth, mental confusion,
addiction, ataxia, drowsiness, sedation,
nervousness, headache, and bradycardia.8
No drug treatment should be given to patients
suffering from somatoform disorders,
alcoholism, or drug abuse (mada) unless there are secondary signs that require drug
treatments. Attempts should be made to
identify and eliminate sociopsychological factors
and other environmental factors associated
with the diseases. The psychiatrist and family
members need to take care of the patient with
assurances, spiritual guidance, and prayers.8
25.8 Prevention
Ayurveda places great emphasis on preventing
diseases; psychiatric disorders are no
exception. As a matter of fact, a healthy
lifestyle, a healthy diet, balanced physical activities,
living up to social and family
responsibilities, enjoying work, regularly exercising, practicing
a proper daily routine (dincharya), and keeping personal living spaces (such as
bedrooms and cars) presentable and pleasing
may prevent many psychiatric disorders,
particularly if children are also raised with
this lifestyle. According to Ayurveda, the
human body is like a vehicle driven by the
soul (spirit, atma). When the vehicle takes
control of the travel, a disaster is bound to
occur. One must not surrender his or her life
to the body; the soul must drive the body.
25.9 Scientific Basis of Ayurvedic Therapies
Although the therapies mentioned above have
been in traditional use for thousands of
years, with the recent demand of
evidence-based Ayurveda, modest efforts have been
made to generate scientific evidence for the
safety and efficacy of the traditional medications.
Reports on such studies are accumulating in
scientific journals. Some such studies
are highlighted below.
25.9.1 Antistress Agents
A large number of Ayurvedic herbs have been
described to possess the medhya effect.
All
such herbs are believed to have
neuronutraceutical effect with varying degree of anxiolytic
and antistress effect. The potentiation of
barbiturate hypnosis by sankhapuspi (C. pluricaulis)
in rats and the evidence of anxiolytic and
adaptogenic effect of this drug in patients of
anxiety and neurosis has been demonstrated.18
In another study, similar effects for
mandukaparni (C. asiatica) and aswagandha
(W. somnifera) have been reported in animal
models and in clinical settings,
respectively.19 The effect of brahmi (B. monnieri) in similar
clinical and laboratory models was also
investigated and was found to lower the level of
anxiety and promote memory and adaptation.11
Singh and associates screened a series of
herbal therapies in albino rats for
antistress effect by measuring swimming performance,
changes in adrenal weight, and ascorbic acid
and cortisol content of adrenal glands during
stress; they also measured the incidence of
stress ulcers in stomachs that were under the
influence of herbs in stressed rats. The
investigators found highly significant antistress
effect in ashwagandha (W. somnifera) and tulasi (O. sanctum). These two drugs were found
to be twice more effective than P. ginseng in terms of ED50.16,17
25.9.2 Memory-Enhancing Agents
All medhya rasayana of Ayurveda are conceptually nootropic agents. Recent studies
conducted on these herbs have shown evidence
for this conceptual claim. Singh and
Singh reported a memory-enhancing effect in brahmi (B. monnieri)
followed by several
studies conducted at the Central Drug
Research Institute, Lucknow, India, by Dhawan
and Associates in recent years characterizing
active constituents of this plant responsible
for the memory enhancing effect.10,20
25.9.3 Treatment of Residual Psychosis
With the advent of strong antipsychotic drugs
in modern medicine, it is no longer difficult
to control the acute episodes of psychotic
disease. It is becoming more and more difficult,
however, to take care of the long-term
chronic residual phase of these diseases and their
negative symptoms. Modern medicines are not
suitable for such long-term use because
of drug dependence and adverse side effects.
In such cases, Ayurvedic medications are
the only logical answer. Certain Ayurvedic
herbs, particularly the polyherbomineral compounds
like smrti sagar rasa21,22 and unmada
gaja kesari rasa, have
shown encouraging
results.23
25.9.4 Antidepressants and Mood Elevators
A number of Ayurvedic herbs, particularly the
vajikarana formulas (Ayurvedic aphrodisiacs),
have been evaluated for their possible role
in the management of depressive illness.
Aswagandha (Withania somnifera),
kapikacchu (Mucuna pruriens), jyotismati (Celeastrus panniculatus),
and vaca (Acorus calamus) have shown good results in pilot studies.
In one study,
aswagandha and kapikacchu used
alone in patients of depressive illness exhibited an antidepressant
effect when measured on the Hamilton
Depression Rating Scale.20 The potentiation
of hypothermia effect of the agonist in aswagandha-treated animals suggests that
aswagandha sensitizes serotonin (5-HTIA) autoreceptors. A similar
effect was also found
for sankhapuspi (C. pluricaulis).20
25.9.5 Geriatric Mental Health
Aging is generally associated with a range of
psychological symptoms. The rasayana
formulas of Ayurveda are the logical remedy.
The antiaging effects of selected rasayana
formulas like aswagandha (W. somnifera) and tulasi (O. sanctum) were
evaluated by using
a standardized biological age scale and brief
psychiatric rating scale, memory span test,
and mental fatigue rate.24 It was observed
that use of aswagandha
and tulasi singly for a
sample test period of 3 to 6 months exhibited
notable beneficial effect in elderly individuals.
Such an effect is attributed to the drugs’
antistress and adaptogenic activities.
25.9.6 Medhya Rasayana and Mental Retardation
A varying degree of mental retardation is a
major health hazard in children prevalent
throughout the world and belong to divergent
etiology. Besides self-recovery and compensation,
there is no definite treatment for this
condition in conventional Western medicine.
But the Ayurvedic texts describe a range of
restorative remedies (i.e., rasayana),
especially for the promotion of mental health
and cognitive functions. Such rasayanas are
called medhya rasayana. It is claimed that such rasayanas, because of their nutritive impact
on the brain, may help mentally retarded
children. Mandukaparni
(C. asiatica) is one of the
four medhya rasayanas described by Charaka Samhita.7 This drug is in traditional use and
was studied preliminarily for its utility in
mental retardation.15 More recently, a clinical
study on mandukparni in 30 mentally retarded children (6 to 18 years old), fulfilling the
selection criteria for mental retardation and
excluding any other major organic cause, was
conducted.14 These children received the mandukparni (whole plant granules) at a dose of
5 g twice/day for 6 months. The observations
showed significant improvement in performance
intelligence quotient, social quotient
(measured by Vineland social maturity scale
for behavior and social adoptability),
immediate memory span, and reaction time. The
authors concluded that such an effect of mandukaparni could be due to the rasayana effect
of the drug both in terms of its
microneuronutrient effect and its srotas (microvascular)
effect by promoting the blood supply to the
brain.
25.10 Summary and Conclusions
Mental health and ailments of psyche have
been important considerations in the field of
medicine from the very beginning. Ayurveda
has a well-developed branch of psychiatry,
and the principles and practices of mental
health care which developed thousands of years
ago are again drawing attention because of
their unique holistic approaches. There is a
need to integrate this novel wisdom into the
mainstream of the health care delivery system
of today.
References
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Varanasi,
India, 1985.
2. Baldessarini, R.J., Drugs and the
treatment of psychiatric disorders, in Goodman and Gillman's
The Pharmacological Basis of Therapeutics, Hardman, J.G., Limbird, L.E., et al., Eds.,
McGraw-
Hill, New York, 1996, chaps. 18 and 19.
3. American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, 4th
ed.,
text revision, Washington, D.C., 2000.
4. Singh, R.H., Singh, M.B., and Udupa, K.N.,
A study of tridosa as neurohumours, J. Res.
Ayurveda Siddha, 1(1), 1–20, 1979.
5. Udupa, K.N., Singh, R.H., Dubey, G.P.,
Rai, V., and Singh, M.B., Biochemical basis of psychosomatic
constitution (prakriti), Indian J. Med. Res., 63(7), 923, 1975.
6. Cotran, R.S., Kumar, V., and Collins, T.,
Neoplasia, in Robins
Pathological Basis of Disease, Cotran,
R.S., Kumar, V., and Collins, T., Eds., W.B.
Saunders, New York, 1999, chap. 8.
7. Charaka Smhita (700 B.C.), translated by Sharma, P.V., Choukhamba Orientalia Varanasi,
U.P.,
India.
8. Schiffer, R.B., Psychiatric disorders in
medical practice, in Cecil
Text Book of Medicine,
Goldman,
L. and Bennett, J.C., Eds., W.B. Saunders,
Philadelphia, 2000, chap. 450.
9. Singh, R.H., Sinha, B.N., Sarkar, F.H.,
and Udupa, K.N., Comparative biochemical studies on
the effect of medhya rasayana drugs on brain in rats, J. Res. Indian Med., 14(3), 7–14, 1979.
10. Singh, H.K. and Dhawan, B.N.,
Neuropsychopharmacological study of B. monieri Linn. (brahmi),
Indian J. Pharmacol., 29, 5359–5365, 1997.
11. Singh, L. and Singh, R.H. (Sup), (1978):
Studies on Psychotropic Effect of the Medhya Rasayan
Drug, Brahmi (Bacopa Monieria), M.D. thesis
(Kayachikitsa), Banaras Hindu University, Varanasi,
India, 1978.
12. Singh, N., Study of anti-stress effect of
plant drugs, Ann.
Natl. Acad. Indian Med.,
1(1), 1987.
13. Singh, R.H., Singh, L., and Sen, S.P.,
Studies on medhya rasayan drug brahmi (Bacopa monnieri
Linn.). II. Experimental studies, J. Res. Indian Med., 14(3)1–6, 1979.
14. Agrawal, S.C. and Singh, R.H., Effect of medhya rasayana drug mandukaparni on cognitive
functions and social adaptability of mentally
retarded children, J. Res.
Ayurveda Siddha,
18(3–4),
97–107, 1998.
15. Apparao, M.V.R., Srivastava, K., and Rao,
K., The effect of mandukaparni (Centella asiation)
on general mental ability of mentally
retarded children, J. Res.
Indian Med., 8(4),
9–16, 1973.
16. Archana, R. and Namasivayam, A.,
Anti-stressor effect of Withania somnifera, J. Ethnopharmacol.,
64, 91–93, 1999.
17. Bhattacharya, S.K., Satyan, K.S., and
Ghosal, S., Anxiolytic activity of glycowithanolides from
Withania somnifera, Indian J. Exp. Biol., 35, 236, 1997.
18. Mehta, A.K. and Singh, R.H. (Sup),
Studies on the Psychotropic Effect of the Medhya Rasayana
Drug: Shankhapuspi (Convolvulus Pluricaulis),
M.D. thesis (Kayachikitsa), Banaras Hindu
University, Varanasi, India, 1976
19. Mishra, B.K. and Singh, R.H. (Sup),
Clinical and Experimental Evaluation of Medhya Rasayan
Effect of Mandukaparni (Hydrocotyle
Asiatica), M.D. thesis (Kayachikitsa), Banaras Hindu
University, Varanasi, India, 1980.
20. Koirala, R.R. and Singh, R.H. (Sup),
Clinical and Behavioural Study of Medhya Drugs on
Brain Functions, M.D. thesis (Kayachikitsa),
Banaras Hindu University, Varanasi, India, 1992.
21. Tripathi, J.S. and Singh, R.H. (Sup), A
Clinical Study on Personality Factors in Cases of Residual
Schizophrenia and Its Ayurvedic Management,
M.D. thesis (Kayachikitsa), Banaras Hindu
University, Varanasi, India, 1992.
22. Tripathi, K.M. and Singh, R.H. (Sup), A
Study on Stress Profile and Personality Factors in
Some Psychosomatic Disorders, Ph.D. thesis
(Kayachikitsa), Banaras Hindu University, Varanasi,
India, 1982.
23. Choudhuri, O. and Singh, R.H. (Sup),
Development of an Ayurvedic Regimen for the Management
of Residual Schizophrenia, M.D. thesis
(Kayachikitsa), Banaras Hindu University,
Varanasi, India, 2001.
24. Dwivedi, K.K. and Singh, R.H. (Sup), A
Study on Psychiatric Symptoms of Geriatric Patients
and Response to Ayurvedic Therapy, Ph.D.
thesis (Kayachikitsa), Banaras Hindu University,
Varanasi, India, 1997.
26
Parkinson’s Disease (Kampa Vata)
Lakshmi Chandra Mishra and R.H. Singh
26.1 Introduction
According to Ayurveda, most of the diseases
of the
vata
system are essentially the conditions
of degenerative diseases of the nervous
system. As many as 80 kinds of
vata
diseases
are described in Charak Samhita.
1
The syndrome of parkinsonism is commonly
compared
with
kampa vata
(
kampa
literally means tremors). The syndrome was
comprehensively
described by James Parkinson in 1817, but the
review of much early literature would show
that syndromes strikingly similar to
parkinsonism were already known and were categorized
among the
vata
diseases in Ayurveda.
Parkinson’s disease (PD) is prevalent all
over the world and has no definitive treatment
in conventional medicine except for the
palliative prescription of anticholinergics together
with levodopa and dopadecarboxylase
inhibitor. The Ayurvedic treatment strategy is to
combat
vata dosa
and to sustain neuronutrition by
rasayana
remedies. This chapter discusses
vata
diseases (neurological diseases) as a class
with emphasis on Ayurvedic therapies of
PD and a possible scientific basis for the
therapeutic effect.
26.2 Etiology
whole body physiology by explaining the body
functions in terms of three biofactors called
tridosa
(
vata
,
pitta
,
and
kapha
). In all applied considerations, the
vata
system of the
tridosa
doctrine represents neuroscience in Ayurveda.
The
vata
dosa
is responsible for the entire
neurophysiological phenomena operating in the
body.
1
There are five major components
of
vata
systems:
prana, udana, vyana, samana,
and
apana
. These components are responsible
for five different aspects of neural
functions at five different levels in the body. When the
vata
dosa
looses its equilibrium due to a wide range of
aetiological factors, including tissue
degeneration and damage (
dhatu ksaya
) and neuro-obstructive diathesis (
margavarana
), it
leads to the development of 80 types of
vata
diseases or neurological diseases.
The etiopathogenesis of PD is not precisely
known in conventional medicine, but it is
understood to be caused by lesions in the
basal ganglia and is especially associated with
the damage to the interconnecting system
between substantia nigra and corpus stratum.
Specific etiology of PD is related to aging,
and it develops in people over 50 years old.
There is no specific genetic component
involved in most cases, but mutation in the gene
for alpha synuclein has been linked to PD in
some cases.
2
Exposure to environmental
chemicals may cause damage to basal ganglia
and brain stem resulting in parkinsonism.
For example, exposure to 1-methyl 4-phenyl-1,
2, 3, 6-tetrahydropyridine, a contaminant
present in a psychoactive meperidine analog,
can cause an acute onset of parkinsonism
symptoms and the associated destruction of
substantia nigra.
26.3 Pathology
In Ayurveda, no specific structural pathology
of PD is described other than its identification
as a
vata
dosa
disease.
In conventional medicine, PD is described as
a chronic progressive disease of extra
pyramidal system of the brain where voluntary
movement is disturbed with the appearance
of involuntary movements and altered muscle
tone. The pathology of PD essentially
involves a loss of pigmented dopaminergic
neurons in the substantia nigra pars compacta
(SNPC) of the brain with the appearance of
intracellular inclusions known as Lewy
bodies.
3,4
SNPC provides dopaminergic innervation to the
dopamine content (caudate and
putamen). Early studies have shown 80%
reduction in the dopamine content of the striatum.
This reduction parallels a loss of neurons in
the SNPC, indicating that dopamine
loss may be the cause of PD symptoms and that
replacement of dopamine could be
helpful.
5,6
The major symptoms of PD are related to the
deficiency of dopamine. Cholinergic
nucleus basilis degeneration is believed to
be related to dementia that affects many
patients. Noradrenergic locus nucleus
degeneration is believed to be associated with the
facial expression of freezing and with
depression.
7
26.4 Classification of
Vata
Disorders
The
vata
diseases as described in Ayurvedic classics
include a wide range of neurological
morbidities, including inflammatory,
degenerative, obstructive, and functional. The
vata
diseases may manifest as neural
hyperfunctioning (
vata vriddhi
), neural hypofunctioning
(
vata ksaya
), or masked functioning (
avarana
). It is not possible to innumerate and
classify
all 80 types of
vata
diseases here. However, Ayurvedic texts
describe the etiology, symptomatology,
and treatment of a variety of paralytic
conditions, painful neuropathies, conditions
with tremors, and involuntary movements and
convulsions in detail. PD is one of
those diseases. The descriptions of these
conditions in Ayurveda are very similar to those
described in conventional medicine. Some of
these conditions are listed here as examples.
1. Paralysis and paresis — Facial paralysis (
ardita
), hemiplegias (
pakavadha
), paraplegias
(
adharanga vata
), quadruplegi (
sarvauga vata
), and others
2. Painful neuropathies — Sciatica (
gridhrasi
), limb cramp (
khalli
), brachial neuritis
(avavahuka
and
viswachi
), trigeminal neuralgia (
siragrah
), lumbago (
kati-sula/pristhasula
), cervical neuropathy (
manyastambh
), peripheral neuritis (
rasagata vata
), and
others
3. Coordination disorders and convulsive
diseases: parkinsonism, tremors, choreas
(
kampa vata
), convulsive neuropathies (
aksepa
), epilepsies (
apasmara
), pseudo seizure
disorders (
apatantraka
), and others
4. Visceral neuropathies — A large number of
diseases and syndromes related to
the neuropathy of different visceral organs
of the digestive system, urogenital
system, and sensory organs as described in
Ayurveda
26.5 Clinical Features and Diagnosis of
Parkinson’s Disease
Clinical features of
kampa vata
in Ayurveda are similar to those described
for parkinsonism
and Huntington chorea in conventional
medicine. These are the two most important
neurodegenerative diseases of the basal
ganglia and brain stem.
8
These diseases are frequently
associated with movement disorders, rigidity,
abnormal posturing, and involuntary
movements marked by fine disorganized and
random movements of the extremities
(usually the hands and to a lesser extent
proximal limb and muscles). The four main
features of parkinsonism are (1) bradykinesia
(abnormal slowness of voluntary movements,
often associated with diminution of the range
of movements), (2) muscular rigidity,
(3) resting tremor, and (4) postural
imbalance (leading to disturbance of gait and falling).
9
These features are also seen in other conditions,
such as idiopathic PD, progressive supranuclear
palsy, and corticobasal degeneration, with
common damage to the nigro-striatal
dopaminergic system.
Other symptoms of PD are related to mood,
intellect, and the autonomic nervous system.
These symptoms are hypophonic disarthria,
monotonous speech pattern, difficulty in
getting in and out of a chair or a bed,
shuffling gait with short steps, decreased automatic
movements, and arm swing. The resting tremors
are slow, regular oscillations (3 to 6/sec)
that usually cease during voluntary movements
of the affected part, though occasionally
the tremors may be of action type. Tremors
are exacerbated by fatigue and cold; they can
also affect the lips, lower jaw, and tongue.
Tremors may be a dominant feature in some
patients, whereas postural instability may be
dominant in others.
7
Other PD-like conditions can be
differentiated from PD on the basis of a low to no degree
of tremor and poor response to levodopa. The
good response to levodopa in PD is because
dopamine receptors are preserved in PD, but
they are decreased in other PD-like conditions.
26.6 Prognosis
In Ayurveda, the prognosis of PD is not
specifically given. Most
vata
diseases are not
curable, but the patient may be able to live
with the disease with certain degree of
inconvenience and difficulties. As the
disease progresses, patients develop rigidity and
cannot take care of themselves. In extreme
cases, death may occur from the patient’s
inability to breath, resulting in aspiration
pneumonia or pulmonary embolism. Ayurvedic
therapies available can make life much easier
and increase life expectancy. Treatment with
pharmacologic agents or direct electrical
stimulation of target areas (thalamus, subthalamic
nucleus, or globus pallidus) can provide
relief in symptoms, good functional mobility for
many years, and a substantial increase in
life expectancy.
9
26.7 Treatment
Ayurveda takes a unique approach to the
management of the above-mentioned neuropathies
with a special emphasis on eliminating their
causes by
panchakarma
, physiotherapy,
and medicinal treatment with the help of a
wide range of herbal and herbomineral drugs.
Ayurveda describes a large number of
nootropic drugs (stimulating to mental activity,
causing cerebral or intellectual activity)
and nervous system tonics (i.e., rasayanas in the
treatment of
vata
diseases).
Panchakarma
therapy is especially advocated in the
treatment
of neurological diseases. Using different
kinds of oil massage (
snehana–abhyanga
) and
medicated heat treatment (hot room) (
swedana
) is very efficacious. Besides special
treatments
like
sirovasti
and
sirodhara, vasti
therapy is indicated in such diseases and
administered
in the form of a specially planned
therapeutic enema. With all this, contemporary
Ayurvedic medicine claims good success in the
practice of neuromedicine.
Being a neurodegenerative disease,
parkinsonism is essentially treated by
rasayana
or a
rejuvenative approach in Ayurveda.
10,11
The
rasayana
drugs of Ayurveda are essentially
nutraceutical agents, and the
medhya rasayana
are specific neuronutrients or nervine tonics
with nootropic effect.
Aswagandha
(
Withania somnifera
),
brahmi
(
Bocopa monnieri
),
mandukaparni
(
Centella asiatica
), and
bala
(
Cida cordifolia
) are the common classical drugs advocated
for this purpose. This is because Ayurveda
considers such movement disorders under
vata
vyadhi
, and in common practice the term
kampa vata
is used to describe the syndrome. The
strategy is to combat
vata
dosa
and to sustain neuronutrition by
rasayana
remedies.
Kapikacchu
(
Mucuna pruriens
), an edible legume and popular Ayurvedic
aphrodisiac, has also been
used in the hands of Ayurvedic practitioners
for treating
kampa
vata
. With the recent
discovery that
Mucuna pruriens
seeds are a highly rich source of levodopa,
the use of
kapikacchu
in
kampa
vata
has tremendously increased.
Kapikacchu
(
Atmagupta
) has been
traditionally used for treating tremor
disorders in Ayurveda.
12
In conventional medicine, the treatment of PD
is primarily based on increasing the levels
of dopamine in SNPC. Carbidopa and levodopa,
dopamine receptor agonists (pergolide
and bromocriptine), and monoamino oxidase
inhibitor (selegiline) are used to maintain
the levels of dopamine. The other less-used
drugs are muscarinic receptor antagonists and
amentidine, an antiviral agent. The common
side effects of levodopa are psychiatric
problems, dyskinesis, and the
wearing-off-effect (loss of effectiveness). The pharmacological
treatments are only symptomatic; they do not
change the progression of the disease.
If used skillfully, these drugs may
dramatically improve the quality of daily life and
functional ability. Another treatment option
is surgery. The main surgical approach commonly
used is pallidotomy (incision or partial
destruction of globus pallidus) and highfrequency
deep-brain stimulation with an electrode
implanted in one of these target areas:
thalamus, subthalamic nucleus, or globus
pallidus. These procedures are effective in
providing relief from major symptoms and
improving the quality of daily life but do not
alter the course of the disease.
7,13
26.8 Scientific Basis
The levodopa content of
M. pruriens
appears to be the basis for the therapeutic
effect. MP
endogenously accumulates
L-dihydroxyphenylalanine in the range between 0.2 and 2.0%
on a dry-weight basis in tissue culture.
14
In a clinical trial, HP-200 made from MP was
found to be an effective treatment for
patients with PD.
15
A concoction of powdered
M. pruriens
seeds,
Hyoscyamus reticulatus
seeds,
W. somnifera
roots, and
C. cordifolia
roots in cow’s milk was clinically tried in
18 diagnosed patients
with PD.
16
Of these 18 patients, 13 cases underwent
biopurificatory (
panchakarma
) procedures
for 28 days and palliative therapy for 56
days, whereas the remaining 5 patients
underwent palliative therapy alone for 84
days. The former group showed significant
improvement in daily activities. Symptomatically,
they showed a better response in tremor,
bradykinesia, stiffness, and cramps as
compared with the latter group. Salivation increased
in both groups. Chemical analysis of the
concoction revealed about 200 mg of levodopa
per dose. The study shows the importance of
cleansing therapy in Ayurveda medication
before palliative therapy. It also confirms
the usefulness of some Ayurvedic herbal preparations
in PD.
17
In an interesting study, PD was treated with
the compound Parkino at 20 ml twice/day
for 8 weeks.
18 The response was assessed symptomatically
in terms of the subjective
feelings of the patient, degree of
involuntary movements, and facial expressions. All the
patients exhibited highly significant
improvement in symptoms during the first 2 to 4
weeks of treatment. However, during
subsequent intervals, no further improvement was
noted.
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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