AYURVEDA AND GERIATRIC CARE -A BROAD OUTLINE

1. Demographic context of Geriatrics and limitations of conventional medicine 1.1. Demographic trends The World population of the elderly is increasing and by the year 2050, adults older than 65 years will comprise 1/5th of the global population. In India 3.8% of the population are older than 65 years of age. According to an estimate the likely number of elderly people in India by 2016 will be around 113 million. 1.2. Global health scenario in geriatrics The twenty-first century is witnessing a gradual decline in fertility, and with increase in life expectancy, the society will need to grapple with issues of longevity. The cause of morbidity and mortality world over is shifting from communicable diseases a few decades ago to noncommunicable diseases. The leading causes of mortality among aged people comprise respiratory problems, heart diseases, cancer and stroke. Significant causes of morbidity among this group is chronic inflammatory and degenerative conditions such as Arthritis, Diabetes Osteoporosis, Alzheimers disease, Depression, Psychiatric disorders, Parkinsons disease and age related urinary problems. 1.3. Limitations of conventional medicine in the management of non communicable diseases The stupendous success of conventional medicine in the management of communicable disease especially in the west was owing to the identification of a single cause in the form of a parasite/causative organism for all communicable disease and a systematic plan of action was derived to counter the cause which then cured the disease. However, the biggest challenge with geriatric problem is that in most of the cases the condition cannot be attributed to a single cause or in certain conditions like neuro-psychiatric disorders (Senile dementia, Alzheimers depression), the structural cause is unknown. In such cases the conventional medical therapy fails to come out with effective management plan and hence is severely compromised. Another challenge with conventional medical therapy is that it does not have
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AYURVEDA AND SIDDHA

health promoting agents. Ayurveda on the other hand has interventions those enhance physiological processes that influence metabolic and immunological status (cyavanaprasha, triphala) and such interventions are significant in the context of geriatric care. 2. Ayurvedic clinical experience on geriatrics 2.1. Ayurvedic understanding of geriatrics Ayurveda has a focused branch of medicine called Rasayana (Rejuvenation) which exclusively deals with the problems related to aging and methods to counter the same. Geriatrics or Jara cikitsa or Rasayana in Ayurveda is a method to control / slow down / arrest the aging process in the human being during the degenerative phase of ones life. Rasayana is normally advised during this degenerative phase which starts from around 45 yrs in both male and female. A holistic system like Ayurveda approaches this condition through two-fold methods. One is a radical approach in which it recharges the whole metabolic process of the body by eliminating the toxins from the system by a three to four months rigorous and organized process known as Kutipraveshika Rasayana. However, this process is seldom practiced due to the extreme intricacy of the physiological process involved and the need for utmost care to be taken by the physician and subject including the environment where the treatment is done. Hence this Kutipraveshika remains as a textual marvel of Ayurveda than a practical process of contemporary relevance. The second approach of Ayurveda, which is quite popular today, is called Vataatapika Rasayana which can go along with the normal day to day life. This type of Rasayana is particularly important in the current scenario as it has a relatively easy mode of administration without any restrictive pre-conditions. Apart from this, Rasayana are also classified as: A. B. Medhya Rasayana: Rasayana that act specifically as brain tonics, eg: Shankhapushpi, Mandukaparni, Yashtimadhu and Guduchi. Vardhamana Rasayana: Rasayana given in a gradual step-up dosage from a minimum to a maximum dose followed by a tapering back, eg: Vardhamana Pippali Rasayana. Droni-Praveshika Rasayana: A very spectacular form of Rasayana, where in a person is made to consume stomach full of the juice of

C.
2

8 rare herbs and made to lie down in a wooden casket for a period of 6 months (unconscious). This again has no known history of being performed anywhere in the near past, although finds a mention in the text as being one that will enable an old person to completely regain his youth. 2.2. Core areas of strength in Ayurveda Undoubtedly the strength of Ayurveda in the context of Geriatric care is Rasayana therapy, which is unique because of its ability to promote longevity and influence all aspects of health in a positive way. Describing the effects of Rasayana, the classical texts of Ayurveda say that from Rasayana one attains longevity, improved harmony and intelligence, freedom from disorder, youthful vigor, excellence of luster, complexion and voice, optimum strength of physique and senses, command over language, respectability and brilliance. Ayurveda considers the physical structure to be composed of 7 dhatus starting from Rasa (Rasadi Dhatus) and Rasayana is the tool to create premium dhatus (body tissues). The main utility of Rasayana therapy is in functional and degenerative disorders that have a chronic or long standing nature. In such cases, in fact, Rasayana is the only solution from the point of view of effective management in any system of medicine. Rasayana becomes more fruitful and effective if it is preceded with suitable panchakarma (purificatory therapy). The reason we see mixed results in many cases where Rasayana is employed is because of the fact that either this purification is not done or improperly done. Panchakarma is a bio-cleansing regimen comprising of five main procedures that facilitates better bioavailability of the pharmacological therapies, helps to bring about homeostatsis of body-humors, eliminates disease-causing complexes from the body and checks the recurrence and progression of disease. The five fold measures comprehended in this therapy are Vamana (Therapeutic Emesis), Virechana (Therapeutic Purgation), Astapana Vasti (Therapeutic Decoction Enema), Anuvasana Vasti (Therapeutic oil Enema), Nasya Karma (Nasal administration of medicaments). Panchakarma procedures are preceded by Snehana (Therapeutic Oleation) and Swedana (Sudation) applications to make the body system conducive for elimination of bio-toxins and cleansing of channels. This is effective in managing autoimmune, neurological, psychiatric and musculo-skeletal diseases of chronic and metabolic origin.
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AYURVEDA AND SIDDHA

Single Rasayana drugs for some specific disease conditions Diseases of Eye: Jyotishmati (Celastrus paniculata), Triphala (Three myrobalans), Satavari (Asparagus racemosus), Yastimadhu (Glycyrrhiza glabra) and Amalaki (Emblica officinalis). Diseases of Heart: Salaparni (Desmodium gangaticum), Arjuna (Terminalia arjuna), Guggulu (Commiphora mukul), Pushkaramula (Inula racemosa) Skin diseases: Bhallataka (Semecarpus anacardium), Vidanga (Embelia ribes) and Bakuchi (Psoralia corylifolia). Rasayana for overall Health: Guduchi (Tinospora cordifolia), Amalaki (Emblica officinalis), Aswagandha (Withania somnifera), Cows milk and Takra. Asthma: Sirisha (Albezia lebbeck), Agastya (Sesbania grandiflora), Haridra (Curcuma longa), Haritaki (Terminalia chebula). Arthritis: Rasona (Allium sativum), Guggulu (Commiphora mukul), Aswagandha (Withania somnifera) and Shunthi (Zinziber officinale). Neuropathies: Rasona (Allium sativum), Guggulu (Commiphora mukul), Bala (Sida cordifolia), Aswagandha (Withania somnifera). Diabetes: Silajitu (Black bitumen), Amalaki (Emblica officinalis), Haridra (Curcuma longa), Tejpatra (Cinnamomum tamala), Methika (Trigonella foenum graecum). Lipid disorders: Guggulu (Commiphora mukul), Haritaki (Terminalia chebula), Pushkaramoola (Inula racemosa), Vaca (Acorus calamus). Hypertension: Rasona (Allium sativum), Sarpagandha (Rauwolfia serpentina), Aswagandha (Withania somnifera), Jatamansi (Nardostachys jatamansi). Brain and Memory Disorders: Brahmi (Bacopa monnieri), Mandooka parni (Centella asiatica), Jyotishmati (Celastrus paniculata), Kapikachhu (Mecuna pruriens), Tagara (Valeriana wallichii). Some Compound formulations that are available in the market with a multipronged action are being listed below:
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Chyawanprasha Brahmi Rasayana Aswagandha Lehyam Mahatriphala Ghrita, Triphala Curna

 3.

Aswagandha Curna Narasimha Rasayana Agastya Rasayana Amalaki Rasayana

Challenges for contemporary application of Ayurvedic geriatrics Ayurvedic treatment as such is very individualistic and one medicine found to be useful in a condition in a particular person may not work at all in another. Hence, it is a challenge to come out with generalized management solutions for a condition that would suit all. It is difficult to bring out management plans for a particular disease condition and implement the same in a large scale. It is important that we respect both holism (of traditional medicine) as well as reductionism (of modern bio-medicine) because both are ways of looking at nature and depending on the purpose both the views can be extremely useful. Furthermore the whole and the part are certainly related but it is not a one-to-one relationship. The understanding that it is not one-to-one relationship and learning how to relate the whole perspective (the systemic theories of Ayurveda & Yoga) with part (structural theories of western biomedicine) is the outlook that should underline the implementation of trans-disciplinary research projects. Today, nobody in the academic field has all the answers of how to combine and correlate part and whole perspectives in the context of clinical research design, clinical practice, content of courses on Ayurveda and Yoga, in the context of laboratory research in pharmacognosy and product development, and in assessment of community based local health practices. It is important to understand that drug trials for evaluating efficacy of Ayurvedic interventions is a reductionist approach and is an inappropriate design. Instead, clinical trials should evaluate the efficacy of a whole management package which may consist of drugs, diet, Yoga, Panchakarma including differential diagnosis to identify the specific nature of tridoshic imbalance.

3.1. Contemporary application of Ayurvedic geriatrics

3.2. Developing ambitious projects of trans-disciplinary clinical research on key geriatric problems The biggest challenge in the contemporary application of Ayurvedic
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AYURVEDA AND SIDDHA

geriatrics would be to come up with protocols to document, diagnose in an integrative frame work and manage geriatric problems. This would require critical investment (the current strategies are subcritical) in establishing advanced research, treatment and teaching centers that have a state of the art facility to deal with geriatrics. 4. The policy issues It is important for policy makers to firstly recognize the fact that geriatric health care has to be managed in a pluralistic way because no single system of medicine has the capacity to address the health care needs of the growing size of the aged population. Policy therefore needs to clearly identify the key areas for support in Ayurvedic geriatrics and make plans and proposals for critical investments in such areas. A range of both Govt. and Non-Govt. institutions with either promising or outstanding leadership need to be identified and encouraged to prepare ambitious proposals commensurate with the magnitude of the social problem of old-age care. Unless generous funding is invoked, it will be like trying to plough a huge field with a stick instead of modern tractors. It is essential that a multi-dimensional intervention be conceived that will involve a) trans-disciplinary research b) advanced treatment centers and c) specialized post graduate education. There is a very urgent need to establish centers in the country that would engage in the kind of transdisciplinary research that we are envisaging in order to take Ayurveda globally and also to bring the clinical services of Ayurveda into the mainstream. This would require a generous funding for undertaking such research and also establishing centers that would provide effective clinical services. There is also a need to support specialized transdisciplinary PG researches in centres where PG in geriatrics is offered. The areas for policy interventions are outlined below: 4.1. The need for generous funding for Ayurvedic Geriatric research and clinical services 4.2. Building treatment capacities in reputed Govt. and Non-Govt. institutes for geriatrics 4.3. Support advanced clinical centers for Geriatric care in reputed institutions in the Govt. and Non-Govt. sectors 4.4. Support specialized trans-disciplinary PG education courses in geriatric care
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RASAYANA - HEALTHY AGING

BACKGROUND Aging is a process of physical, psychological and social change in multidimensional aspects. Some dimensions of aging grow & develop with time while others decline. The world population of the elderly is increasing significantly, and by the year 2050, adults older than 65 years will comprise 1 th /5 of the global population. In India 3.8% population are older than 65 years age. According to an estimate the likely number of elderly people in India by 2016 will be around 113 millions. The aged population in India is mostly in rural than the urban. The other significant feature in the aged population is that number of females is more than males and are residing in pitiable situation in rural India. The Indian traditional culture respects the aged, but the shift to the nuclear family pattern the aged individuals are neglected. The important issues in aged population are many like social, economical etc. but more than these is health. The Ayurveda & Siddha traditional holistic health sciences are very much potential in prevention of diseases by promotion of health & management of metabolic syndromes occurring in old age. Twentieth century has seen gradual decline in fertility, the growth rate of population but with increase in life expectancy. As a result society is grappling with longevity issues. Though worldwide demographic revolution is a social achievement, yet the consequences of longevity inter alia are larger number and proportions of older people that influence financing of health care. The growing number and proportion of elderly persons is placing the increasing demands on Public Health System and on medical and social services. Most of the older people are suffering from at least one chronic disorder and they may be suffering from multiple of disorders. Their quality of life as a result is suffering and also poses a burden on their family and caregivers. The leading causes of illness and death among aged peoples comprise respiratory problems, heart diseases, cancer and stroke. Chronic inflammatory and degenerative conditions such as Arthritis, Diabetes, Osteoporosis, Alzheimers disease, Depression, Psychiatric disorders, Parkinsons disease and Urinary incontinence diminish the quality of life.
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AYURVEDA AND SIDDHA

Although the risks of developing diseases rises with advancing age, but it is not an inevitable consequence of aging. Prevention and management of health problems could help the elderly to improve quality of life and remain independent for their daily activities to certain extent. Ayurveda literatures record vivid information about the concept of aging process and loss or impairment of tissue system/ functions during various decades of life and their management. Ayurveda has broad spectrum of preventing measures for combating the aging process which is in practice in large number of people in our country. National Policy for aged under the Ministry of Social Justice and Empowerment seeks health security of older people and it recognizes special health needs of the older persons to be met through strengthening and reorienting of public health services at Primary Health Care level and creation of health facilities. Some of the well known centers of Ayurveda & Siddha viz Central Research Institute (Ayurveda) (CCRAS) ,Cheruthuruthy Kerala, National Institute of Ayurveda, Jaipur, Rajasthan, Institute of Post Graduate Teaching & Research in Ayurveda (IPGT&RA), Gujarat Ayurveda University, Jamnagar, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Govt. Ayurveda College, Thiruvananthapuram, Central Research Institute Siddha (CCRAS), as well as National Institute of Siddha, Chennai are catering significant health care services in the field of Geriatrics. A few Societies and NGOs viz. Association of Gerontology, Geriatric Society of India, Parkinsons & Ageing Research Foundation, Helpage India, Age well Foundation etc. are engaged in support activities related to Geriatric Care. Geriatric clinics and M.D. course in Geriatric are functioning at BHU, Varanasi, AIIMS, New Delhi, MGIMS, Wardha and Maulana Azad Medical College, New Delhi and so on. POTENTIAL AND STRENGTH Ayurveda attributes primary importance to preventive and promotive health care and the maintenance of positive health. The major preventive approaches for maintaining and improving the quality of life include individualized specific daily regimen (Dinacharya), seasonal regimen (Ritucharya), behavioral and ethical considerations (Sadvritta). Healthy lifestyle is emphasized as the determinant of longevity of life, which by and large depends on the Prakriti (bio-identity i.e. body-mind constitution) of an
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individual. Proper understanding of Prakriti leads the physician in making right diagnosis, prognosis and treatment plan and in guiding patients as well as healthy individuals, what dos and donts they need to follow for restoration and maintenance of health. Rasayana therapy is a specialized branch of clinical medicine in Ayurveda aimed at preventing the effects of aging and to improve intelligence, memory, complexion and sensory and motor functions. Numerous single and compound Rasayana medicines possessing diversified actions like immuno-enhancement, free-radical scavenging, adaptogenic or anti-stress and nutritive effects are described in Ayurveda literature for their use in health promotion and management of diseases with improvement in the quality of life. Rasayana Therapy can be advocated at out door level (Vatatapika Rasayana) and with hospitalization also (Kutipraveshika Rasayana) depending upon the need of patients. Panchakarma is a bio-cleansing regimen comprising of five main procedures that facilitates better bioavailability of the pharmacological therapies, helps to bring about homeostasis of body-humors, eliminates disease-causing complexes from the body and checks the recurrence and progression of disease. The five fold measures comprehended in this therapy are Vamana (Therapeutic Emesis), Virechana (Therapeutic Purgation), Astapana Vasti (Therapeutic Decoction Enema), Anuvasana Vasti (Therapeutic oil Enema), Nasya Karma (Nasal administration of medicaments). Panchakarma procedures are preceded by Snehana (Therapeutic Oleation) and Swedana (Sudation) applications to make the body system conducive for elimination of bio-toxins and cleansing of channels. This is effective in managing autoimmune, neurological, psychiatric and musculo-skeletal diseases of chronic and metabolic origin. Ayurveda and Siddha Literatures record numerous single and compound plant based medicines (majority) and herbo-mineral, herbo-metalic (a few) formulations for general good health and disease specific indications relating to Geriatrics. Single Rasayana drugs for some specific Disease conditions Diseases of Eye: Jyotishmati (Celastrus paniculata), Triphala (Three myrobalans), Satavari (Asparagus racemosus), Yastimadhu (Glycyrrhiza glabra) and Amalaki (Emblica officinalis).

AYURVEDA AND SIDDHA

Diseases of Heart: Salaparni (Desmodium gangaticum), Arjuna (Terminalia arjuna), Guggulu (Commiphora mukul), Pushkaramula (Inula racemosa). Skin diseases: Bhallataka (Semecarpus anacardium), Vidanga (Embelia ribes) and Bakuchi (Psoralia corylifolia) Rasayana for overall Health: Guduchi (Tinospora cordifolia), Amalak (Emblica officinalis), Aswagandha (Withania somnifera), Cows milk and Takra. Asthma: Sirisha (Albezia lebbeck), Agastya (Sesbania grandiflora), Haridra (Curcuma longa), Haritaki (Terminelia chebula). Arthritis: Rasona (Allium sativum), Sallaki (Boswellia serrata), Guggulu (Commiphora mukul), Aswagandha (Withania somnifera) and Sunthi (Zinziber officinale). Neuropathies: Rasona (Allium sativum), Guggulu (Commiphora mukul), Bala (Sida cordifolia), Aswagandha (Withania somnifera). Diabetes: Silajitu (Black bitumen), Amalaki (Emblica officinalis), Haridra (Curcuma longa), Tejpatra (Cinnamomum tamala), Methika (Trigonella foenum graecum). Lipid disorders: Guggulu (Commiphora mukul), Haritaki (Terminalia chebula), Pushkaramoola (Inula racemosa), Vacha (Acorus calamus). Hypertension: Rasona (Allium sativum), Sarpagandha (Rauwolfia serpentina), Aswagandha (Withania somnifera), Jatamansi (Nardostachys jatamansi). Brain and Memory Disorders:- Brahmi (Becopa monnieri), Mandooka parani (Centela asiatica), Jyotishmati (Celastrus paniculata), Kapikachhu (Mecuna pruriens), Tagara (Valeriana wallichii). SOME COMPOUND FORMULATIONS
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Cyawanprasa Brahmi Rasayana Aswagandha Lehyam Mahatriphala Ghrita, Karisalai Legiyam Triphala Curna

Aswagandha Curna Pranada Gutika Narasimha Rasayana Agastya Rasayana Amalaki Rasayana Ayajambeera Karpam Bavana Kadukkai Ayabringaraja Karpam

AT A GLANCE Multiple actions of Rasayana therapy includes immuno-modulation, antioxidant action (prevents bio-oxidation thereby checking age related disorders, auto immune disorders, degenerative disorders), adaptogenic (anti-stress) affects and so on. Time-tested holistic and comprehensive remedies for on Natures Laws can address the gaps in health care of old people. Lifestyle modulation (Swathavritta and Sadvritta) remains integral to the treatment. Most cost effective; affordable by all sections of People Well tolerated; no Adverse Drug Reactions AYUSH systems have specialized therapeutic procedures for rejuvenation, health promotion and prevention & management of degenerative health problems. Panchakarma & Yoga are proven to be efficacious in neuro-muscular, musculo-skeletal, psychosomatic, metabolic and many chronic health problems of elderly people.

EVIDENCE BASED RESEARCH 1. Brahmi (Bacopa monnieri) in the management of Senile Dementia. Brahmi Vs Placebo: Administration of 1gm. of powdered extract of Brahmi twice a day for 5 years has shown significant reduction in the progression of memory loss in persons suffering from senile dementia.
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AYURVEDA AND SIDDHA

Reference: Role of the Ayurvedic Drug Brahmi (Bacopa monnieri) in the management of Senile Dementia. Pharmacopsychologia (1990),3,47-52. 2. Butea monosperma root distillate in the management of age related immature Cataract The root distillate drops of Butea monosperma developed as per I.P Standards has shown significant improvement in visual acuity and quality of vision (disturbance in vision viz. haziness, diplopia etc.) in the subjects of age related immature cataract (n=52). Reference: Srikanth N. et al., Butea Monosperma Root distillate eye drops (Palasa Moola Arka) in age related immature cataract: A clinical observation, Journal of Research in Ayurveda and Siddha, Vol.XXVII. No.1-2, (2006) pp 12-23. 3. Aswagandha (Withania somnifera) on the process of aging Aswagandha Vs Placebo: 3 gm. of root powder of Aswagandha (Withania somnifera) was administered in the dosage of two tablets three times daily with milk for one year showed statistically significant increase in Haemoglobin, RBC count, hair melanin & seated stature and decrease in serum cholesterol and ESR. Reference: Kuppurajan etal, Effect of Aswagandha (Withania somnifera) on the process of ageing in Human volunteers . Journal of Research in Ayurveda and Siddha. 4. Guggulu (Commiphora wightii) in Hyperlipidaemia Guggulu (Commiphora wightii) Vs Placebo: Cardinal clinical manifestations of disease like precordial pain and dyspnoea were relieved in in most of the cases in a clinical study tried with Guggulu in the dose of 8 gm/day. Substantial fall in lipid fractions like cholesterol 27%, triglycerides 36%, phospholipids 20% and free fatty acids 37% indicated the possibility of regression of atherosclerosis. The reversal of ECG changes substantiated the anti-ischaemic effect of the drug in the treatment of ischemic heart diseases. Reference: Clinical and Experimental trial of Guggulu (Medoroga). 1989 Central Council for Research in Ayurveda and Siddha, Janakpuri, New Delhi.
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5.

Sallaki (Boswelia serrata) in Rheumatoid arthritis Sallaki Vs Diclofenac sodium: 600 mg of Sallaki 3 times in a day and 50 mg. of Diclofenac Sodium 3 times in a day was given in treated and control groups respectively for 4 weeks. Efficacy of Sallaki was found to be comparable to that of Diclofenac Sodium in the patients of RA, who demonstrated predisposition for gastric intolerance with antiinflammatory medication. Reference: Bichile, LS et al., Double blind randomized controlled trial of Sallaki Vs Diclofenac in treatment of Rheumatoid arthritis, Select Research Papers on Evidence Based drugs in Ayurveda, Dept of ISM&H, Ministry of Health, Government of India, New Delhi-2000.

6.

Management of Hemiplegia by Panchakarma therapy Panchakarma Vs Palliative therapy: In a comparative study on 744 hemiplegics revealed that 552 subjects who received Panchakarma therapy showed significant recovery from illness, besides improvement in motor functions and quality of life in comparison to subjects who received shamana therapy (Palliative therapy) alone. Reference: Management of Hemiplegia by Panchakarma therapy, Central Council for Research in Ayurveda and Siddha, Janakpuri, New Delhi-1990.

7.

Multi-facetted protective role of Cyawanprasa Cyawanprasa showed significant Immunomodulatory activity (Decrease in Ig G, C3 and C4 levels in patients of recurrent cough and cold), Cytoprotective action (Cancer patients receiving radiation therapy showed a protective role against radiation induced tissue damage)and Genoprotective action (significant reduction in Mitotic Index (MI) and Chromosomal aberrations (CA)). Reference: NB Brindavanam, N.Bhattacharya, C.K.Katiyar and DBA Narayana Multi-facetted protective Role of Rasayana Therapy: A review of investigations on CyawanprasaAyurvedic Conference on Rasayana 2002, Rashtriya Ayurveda Vidyapeeth

8.

Anti-anxiety effect of an Ayurvedic compound drug A double blind sequential cross over clinical trial with an Ayurvedic compound containing Mandukaparni (Centella asiatica),Yastimadhu
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AYURVEDA AND SIDDHA

(Glycyrrhiza glabra) and Jatamansi (Nordostachys jatamansi) as trial drug, diazepam as control and placebo carried out on 12 patients of anxiety neurosis. It was found that Ayurvedic compound formulation is more effective in enhancing the perceptual discrimination and psychomotor performance over placebo and control drug. Reference: K.Kuppurajan et al - Anti-anxiety effect of an Ayurvedic compound drug A cross over trial, Journal of Reserch in Ayurveda & Siddha Vol. XIII No. 3-4, PP 107-116. 9. Guduchi (Tinospora cordifolia) as immunomodulatory agent Clinical studies of Guduchi (Tinospora cordifolia) have shown significant efficacy in the cases of obstructive jaundice. Dahanukar et al., Immunotherapy with Tinospora cordifolia: A new lead in the management of obstructive jaundice by Tinospora cordifolia, Indian J Gastroenterol, 12 (1993) 5. READING MATERIAL 1. 2. Clinical & Experimental Studies on Rasayana Drugs & Panchakarma Therapy, CCRAS, New Delhi, 1993. Management of Hemiplegia by Panchakarma therapy, Central Council for Research in Ayurveda and Siddha, Janakpuri, New Delhi-1990.

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NEUROLOGICAL DISORDERS
(Nadisansthanagata Roga)
BACKGROUND Neurological disorders need greater attention as the age advances. Many neurological disorders (gait disorders), neurodegenerative disorders (Dementia) and neuromuscular disorders (Paralysis) affect the geriatric population. Atrophy, peripheral sensory neuronal loss are also seen in old age. Marked vascular changes occur with aging. At age 80, brain blood flow decreases by 20-28% and this parallels a decline in a cerebral metabolic rate. In addition, increase in cerebrovascular resistance with cerebral arteriosclerosis, vessel fibrosis and endothelial involution is seen with aging. Decrease in nerve conduction velocity, muscular functions are also seen in elderly individuals due to aging. The functional impairments such as with devastating stroke are threatening to an individuals independence. Stroke is a disease of middle aged and elderly individuals. In U.S.A annual stroke cases are 7, 50,000 and there is occurrence of one stroke in every 53 seconds and one stroke death in every 3.3 minutes. In India exact data is not known, 30% people die in first few days of acute attack and among survivals 25% are suffering with disabilities. Atherosclerosis and uncontrolled HTN are the common causes of Cerebrovascular diseases and the associated risk factors like diabetes, heart disease, hypercholesterolemia, smoking and excessive alcohol intake also play an importance role in the pathogenesis of cerebrovascular diseases. The effect of stroke on the individual can be devastating. The sudden loss of neurological function is unanticipated. Most young and all older patients experience drastic lifestyle changes may never return to employment and may become dependent for even the simplest activity of daily living. Depression is common (up to 5%) following a stroke and interferes with rehabilitation, Insomnia, diminished appetite, poor attention and concentration and a withdrawn feeling are frequently associated with stroke. Pakshaghata (Hemiplegia) is mainly caused by vitiation of Vata causing dryness of sira and snayu and loss of function of one half of body. Ayurveda provides both preventive, curative and rehabilitative
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AYURVEDA AND SIDDHA

measures for the management of stroke. Prevention is the best cure. Identification of risk factors and their treatment can prevent the occurrence of stroke. Ayurveda offers various antihypertensive drugs, anticholesterolemic, antistress drugs, practicing of yoga and meditation, lifestyles and dietary regime for the prevention of disease. For curative purpose or to rehabilitate the patients and to treat disability after stroke Ayurveda has Panchakarma treatment and Massage therapy. Various nervine tonics and bulk promoting drugs are available for providing strength. POTENTIAL AND STRENGTH Preventive aspects - Ayurveda offers various herbal formulations to treat the risk factors for stroke. Life style regime as advocated in Ayurvedic literature can help in attaining mental peace. Yoga and meditation are both curative and preventive measures. 1. 2. 3. Antihypertensive drugs Arjuna, Pushkarmoola, Prabhakaravati, Hridyarnava Rasa, Arjunarista, Arjunakshirapaka, Sarpagandhadi Vati Antihypercholesterolemic drugs Arogyavardhini vati, Navakagugglu, Kaisor guggulu, Triphala Curna, Trikatu Curna. Drugs for the management of stress and depression Aswagandha Curna, Brahmi vati, Medhya rasayana, Saraswata Curna etc.

Panchakarma Mainly Vasti therapy, Niruha Vasti with Dasamula Kwatha and Anuvasana Vasti with Mahanarayana taila or Bala taila provide strength to neuromuscular system. Massage (Abhyanga) with strengthening oils to provide nutrition to muscles and to prevent atrophy of muscles. Shashtikashali pindasweda.

Nervine tonics in Ayurveda Dasamula Kwatha Shilajatu Aswagandha Curna Saraswata Curna Brahmi Ghrita
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Oils for massage Mahanarayan Taila Bala Taila Prasarini Taila Mahamasha Taila Nirgundi Taila Panchaguna Taila

EVIDENCE BASED RESEARCH 1. An Ayurvedic combination therapy in Hemiplegia In a clinical trial, a combination of Ekangaveera rasa 250 mg twice daily, Masha taila for massage and Shastikashali pinda sweda for 45 days were given to the patients of Hemiplegia which showed good response in subjective and objective parameters as power and tone of the muscles in 42% cases. Reference: L.K.sharma et al., A clinical study on pakshaghata (Hemiplegia) with a combination of Ekangaveera rasa, Masha taila and Shashtikashali panda sweda, Journal of Reserch in Ayurveda & Siddha Vol. XXV No. 1-2 pp 53-66. 2. Hingutriguna taila-role in Hemiplegia In a clinical trial on 35 patients of Pakshaghata, Hingutriguna taila 5ml orally 2-3 times a day with Abhyanga and Pindasweda twice a day is found to be effective within 2 weeks and definite relief has been observed after 4-6 weeks of treatment. Reference: Prem Kishore and M.M.Padhi, Role of Hingutrigunataila in the treatment of Pakshaghata (Hemiplegia). Journal of Reserch in Ayurveda & Siddha Vol. IX No. 1-2 pp 18-28. 3. Panchakarma treatment in Pakshvadha In a controlled clinical study, 56 patients of hemiplegia were treated with Panchakarma treatment (snehana, sweda, mriduvireka and vasti) with taila and kasaya of Mashadi Yoga (Masha, Atmagupta, Eranda and Bala) and in control group colored taila and Kasaya (of Manjistha) for
17

AYURVEDA AND SIDDHA

panchakarma treatment had been used. The trial has shown that the treatment sneha, sveda, mriduvireka and vasti are effective but Mashadi compound has only slight effect on this disease. Reference: S.Madhavan Pillai et al., Effect of Panchakarma treatment with Mashadi Yoga on Pakshavadha , Journal of Reserch in Ayurveda & Siddha Vol.I No.2 (1930) pp 301-328. 4. Sodhana therapy vs Samana therapy in Khanja and Pangu In a control clinical trial Prabhanjanavimardanam taila for internal and external use as samana therapy, for external application only as placebo and for virecana and vastikarma as sodhana therapy were randomly given to patients of Khanja (Monoplegia) and Pangu (Paraplegia). Results were highly encouraging and statistically significant with samana and sodhana therapy and not significant with placebo. Further results in sodhana group was found better in comparison to samana group Reference: P. Ramachandran Nair et.al., Clinical evaluation of Prabhanjanavimardanam taila and Sodhana therapy in the management of Khanja (Monoplegia) and Pangu (Paraplegia), Journal of Reserch in Ayurveda & Siddha Vol. XIII No.1-2 pp 14-26. READING MATERIAL: 1. 2. CCRAS Research an over view, CCRAS, New Delhi, 2002 Clinical & Experimental Studies on Rasayana Drugs & Panchakarma Therapy, CCRAS, New Delhi, 1993

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MUSCULOSKELETAL DISORDERS
(Mamsa-Asthi-Sandhigata Roga)
BACKGROUND Musculoskeletal Disorders predominate in the older adults and are major cause for chronic disability and health care utilization in the geriatric age group. Disorders of Musculoskeletal system impair mobility, interfering with activities of daily living and function. These disorders are chronic in nature, not life threatening but affect the quality of life. Due to ageing process, there is a decrease in hydration of cartilage secondary to changes in proteoglycan structure, affecting water binding. There is an increase in crystallization and calcification, decrease in cellularity and probable decrease in the response to growth factor stimulation. All these change in the tissue results into less able to handle the mechanical stress. Fragility fractures have doubled in the last decade. 40% of all women over 50yrs. will suffer an osteoporotic fracture. The number of the hip fractures will rise from about 1.7 million in 1990 to 6.3 million by 2050. Common musculoskeletal disorders found in Geriatric group are Osteoarthritis (Sandhivata), Rheumatoid arthritis (Amavata), Spondylosis and Osteoporosis (Asthi soushirya), Back pain (Katisoola), etc. It is found that nearly 20% to 30% of Rheumatoid arthritis patients present after age 60. It is a chronic multi-system disease, which affects mainly the joints. Remissions are less likely in the elderly with established disease, resulting in much discomfort and disability in patients with Rheumatoid arthritis. Osteoporosis is common in older adults and is associated with enormous morbidity from complications. Ayurvedic classics have comprehensive description on the pathophysiology and management of Musculoskeletal disorders like Sandhigata vata, Amavata, Vataroga, etc. Ayurveda also considers these musculoskeletal disorders to be prevalent in elderly persons as the domination of Vata is predominant in old age and it is mentioned that Vata rogas generally occurs in elderly persons. Different procedures like Snehana (oleation), Swedana (sudation), Vasti (medicated enema), Kativasti, Januvasti and a number of single and compound formulations are practised in Ayurveda for the management of these disorders.
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AYURVEDA AND SIDDHA

In addition, preventive measures like Rasayana (Rejuvenation), Panchakarma (Bio-cleansing) therapy, dietary regimen and lifestyle practices are also equally practiced for these disorders. POTENTIAL AND STRENGTH Preventive aspects: Specific dos and donts for the prevention of musculoskeletal disorders are advisable. Use of Rasayana drugs and Panchakarma procedure can prevent the physiological changes in bones and joints occurring due to aging. Special Oleation (Snehana) and Sudation procedures (Swedana) like Kativasti, Januvasti, Grivavasti, Valuka swedana, Nadi swedana and Patrapinda pottali swedana are very effective in the management of these disorders. Some single herbal drugs in musculoskeletal disorders In single drugs following are giving promising results in the musculoskeletal disorders. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Bala (Sida cordifolia) Guggulu (Commiphora mukul) Rasna (Pluchea lanceolata) Eranda (Ricinus communis) Bhallataka (Semecarpus anacardium) Laksha (Laccifer lacca) Kupilu (Strychnos nux-vomica) Sunthi (Zinziber officinalis) Aswagandha (Withania somnifera) Nirgundi (Vitex negundo) Guduchi (Tinospora cordifolia)

Some compound formulations in musculoskeletal disorders 1. 2.

20

Vaiswanara Curna Aswagandha Curna

3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Rasna Panchaka Kwatha Maharasnadi Kwatha Dashmoola Kwatha Rasna saptaka Kwatha Yogaraj Guggulu Mahayoga Raja Guggulu Sinhnada Guggulu Sunthi Guggulu Saptavinsati Guggulu Panchatikta Guggulu Ghrita

Some medicated oils for massage Narayana Taila Mahanarayana Taila Nirgundi Taila Panchaguna Taila Mahamasha Taila Pinda Taila Kshirabala Taila Dhanwantari Taila

EVIDENCE BASED RESEARCH 1. Shunthi & Guggulu in Rheumatoid arthritis A combination of equal parts of powder of Shunthi (Zingiber officinale) and Guggulu (Commiphora mukul) resin at a dose of 2 gm thrice daily with Valuka Sweda (dry fomentation) was studied on 497 patients and very good effect was found in 67% of patients after a course of 6 weeks treatment. Reference: CCRAS Research An Overview, 2002.
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AYURVEDA AND SIDDHA

2.

Ayurvedic combination in Rheumatoid arthritis A combination of Mahayogaraja Guggulu (1 gm), Vaiswanara Curna (3 gm) twice daily and Simhanada guggulu (1/2 gm) at bedtime has been given in 518 patients and was found that, about 60% of the patients have shown improvement. Reference: CCRAS Research An Overview, 2002.

3.

Ayurvedic combination in Rheumatoid arthritis A combination of Aswagandha curna 3gm thrice daily, Eranda taila 15 ml at bedtime have been administered along with dry fomentation for a total duration of 6 weeks. It was observed that, 57% of the patients have shown improvement with the above therapy. Reference: CCRAS Research An Overview, 2002.

4.

Sunthi Guggulu and Godanti in Amavata (Rheumatoid arthritis) In a Clinical study of Sunthi Guggulu and Godanti on 80 cases of Rheumatoid arthritis encouraging results are found. Reference: M. Mruthyumjaya Rao et al., Clinical evaluation of efficacy of Sunthi, Guggulu and Godomti in the management of Amavata (RA). Journal of Reserch in Ayurveda & Siddha, Vol. XXVI. No. 3-4 (2005) Page: 80-94

5.

Shallaki as an Add-on therapy along with NSAID in the management of Osteoarthritis In a clinical trail on patients of Osteoarthritis, Sallaki 400 mg thrice daily for a period of 4 weeks in addition to routinely prescribed NSAID were given. After a period of 4 weeks NSAID was withdrawn and only Sallaki administered for an additional two weeks period. It was observed that the improvement in signs and symptoms was sustained until the sixth week i.e. even after discontinuation of the NSAID therapy. Supplementation of the NSAID with Sallaki resulted in a significant reduction in pain, tenderness, swelling, morning stiffness and functional impairment of the affected joints. Reference: Rajadhyaksha A.Chauhan et.al. Open study to evaluate the efficacy of Sallaki as an Add-on therapy along with NSAID in the management of patients with Osteoarthritis, Selected papers on evidence based Ayurvedic drugs, CCRAS, 2001.

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6.

Vaitaranavasti, Patrapinda Sweda in Inter vertebral disc prolapse Vaitarana Vasti (medicated enema) with prior Patrapinda Sweda (medicated fomentation) has been tried on 72 patients suffering from inter-vertebral disc prolapse with sciatica and other related problems. The overall treatment was found encouraging and good relief is seen in 47% of cases and fair relief in 26% of cases. Reference: P.K.S. Nair et. al. Journal of Reserch in Ayurveda & Siddha, Vol. XXII, 3-4 (2001) Page: 120-130.

7.

Guggulu (Commiphora mukul) in Osteoarthritis In a clinical study on 30 male and female patients each Commiphora mukul in capsule form (500 mg concentrated extract) thrice daily along with food showed significant improvement in both the subjective and objective parameters used for assessment purpose and no side effect was noticed during the trial. Reference : Singh B.B.et.al. The effectiveness of Commiphora mukul for Osteoarthritis of the knee- an outcome study, Altern Ther Health Med. 2003 May-June 9 (3):74-9

READING MATERIAL: CCRAS Research an over view, CCRAS, NewDelhi 2002.

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AYURVEDA AND SIDDHA

CARDIOVASCULAR DISORDERS (Hridroga)

BACKGROUND Cardiovascular diseases are the most frequent causes of death in the geriatric age group. Significant physiological changes in the heart and blood vessels occur due to aging (Cardiac mass increases, vascular fibrosis and calcification occurs). Increased collagen deposition, calcification, smooth muscle cell proliferation and elastin breakdown lead to vascular thickness and stiffening. There is also diminished capacity of heart to work. The incidence of congestive heart failure, coronary artery disease, cardiac arrhythmias, valvular abnormalities and hypertension increases with age. Heart failure remains the leading cause of death in geriatric age. The causes of heart failure in the elderly are many. CHD remains the predominant cause. Prevalence of coronary heart disease (CHD) increases in older subjects, 80% of total myocardial infarctions (MI) occur in those more than 65 yrs. Angina pectoris is common presentation. Hypertension is also one of the risk factor and there is a steady rise in average systolic and diastolic blood pressure with advancing age upto 70 years age. Treatment of cardiovascular disorders in elderly is difficult and need prolonged treatment and there is a need for the safer drugs to use them for longer period. Ayurveda offers satisfactory management strategies for cardiovascular disorders through preventive and curative approaches. It provides clinically effective and safe single and compound formulations to control the risk factors like obesity, hyperlipidaemia, hypertension, and diabetes. In addition, these drugs are also helpful as an adjuvant and supportive therapy along with the conventional treatment. The adjuvant effect of Ayurvedic drugs has been established through various studies. POTENTIAL AND STRENGTH Preventive potentials Concept of well-balanced dietary regimen (fresh foods, seasonal fruits, salt restriction, etc.) and advocating exercise, Pranayam, yoga, sufficient sleep, avoiding anxiety, worry and emotional upset, regularly attend natural urges, mantra chanting, positive attitude etc. in regard to heart diseases is elaborately available in the Ayurveda literature.
24

Curative aspects Different effective and proven single and compound formulations to control the risk factors like obesity, hyperlipidaemia, hypertension, diabetes are available in the Ayurveda classics. Some drugs (e.g. Terminalia arjuna) even reduce the hypertrophy of the cardiac muscle. Some single and compound drugs Churna (Powders): (i) Arjuna Curna (Terminalia arjuna), (ii) Pushkaramula Curna (Inula recemosa), (iii) Trivritadi Curna, (iv) Haritakyadi Curna. Vati (Tablets) and Guggulu: (i) Prabhakara Vati, (ii) Nagarjunabhraka ras, (iii) Hridayarnava Rasa, (iv)Navaka Guggulu, (v) Puskara Guggulu. Asava & Arishta (Fermented liquids): (i) Arjunarishta, (ii) Punarnavasav, (iii) Dasamularishta, (iv) Chitrakadyarishta. Ksheera paka (Processed milk with herbs): Lasuna Kshirapaka, Arjuna kshirapaka. EVIDENCE BASED RESEARCH 1. Pushkara guggulu as an Antianginal and Hypolipidaemic drug In a clinical trial on 150 patients of Coronary Heart Disease, Pushkarguggulu 6-8 g per day showed highly significant reduction in cholesterol, triglycerides and total lipids. Significant improvement in the symptoms and in ECG changes was observed with remarkable reduction in body weight. Reference: Tripathi S. N. et al., Pushkaraguggulu an antianginal and Hypolipidaemic agent in Coronary Heart Disease, Journal of Reserch in Ayurveda & Siddha, Vol. XII No. 1-2, pp 1-18 2. Lekhana Vasti (medicated enema) in Ischemic Heart Disease A clinical trial on 35 cases of essential HTN (mild-moderate) and IHD, Lekhana Vasti with Vaca (Acorus calamus) revealed significant reduction in mean systolic blood pressure, body weight and lipid profile. Reference: P.K.Gupta et al., A study on the effect of Lekhana Vasti in cases of Essential Hypertension and Ischemic Heart Disease, Journal of Reserch in Ayurveda & Siddha, Vol. XVI. No. 3-4 (1995) PP. 93-101 3. Terminalia Arjuna as an adjuvant in Hypertensives with LVH In a controlled clinical study, with Arjuna Kwatha (25ml twice daily) along with atenolol (50mg daily) in treatment group and atenolol (50mg daily) alone as control was studied on hypertensive LVH patients. Significant
25

AYURVEDA AND SIDDHA

decrease in LV mass which was seen after 3 months and maintained even for a period of 6 months in treatment group. Whereas in control group, regression in LV mass was insignificant. Reference: B.Chandrashekhar Rao et al., Effect of Terminalia Arjuna W & A on regression of LVH in Hypertensives A clinical study, Journal of Reserch in Ayurveda & Siddha, Vol. XXII No. 3-4 (2001) PP 216-227). 4. Arjunavacadi yoga in Hypertension (HTN) Arjunavacadi yoga a combination of Arjuna (Terminalia arjuna), Brahmi (Centella asiatica), Vaca (Acorus calamus) and Jatamansi (Nordostachys jatamansi) in the form of Ghana (aqueous extract) at the dose of 250-500mg thrice daily was given on 182 patients of Vyanbala Vaishamya (HTN) for 3 months. A considerable fall in Blood pressure and improvement in symptoms was observed in this study. Reference: Bharti et.al Evaluation of efficacy of Arjuna Vacadi Yoga in Vyanabala vaisamya (Hypertension) A clinical study Journal of Reserch in Ayurveda & Siddha, Vol. XXVII No. 1-2 (2006) PP 57-66. 5. Guggulu (Commiphora wightii) in Hyperlipidaemia Guggulu 8gm daily Vs placebo: In a study with Guggulu 8gm/day, cardinal clinical manifestations of disease like precardial pain and dyspnoea were relieved in most of the cases; substantial fall in lipid fractions like cholesterol 27%, triglycerides 36%, phospholipids 20% and free fatty acids 37% indicated the possibility of regression of atherosclerosis. The reversal of ECG changes substantiated the antiischemic effect of the drug in treatment of ischemic heart disease. Reference: Clinical and experimental trial of Guggulu (Medoroga), 1989, CCRAS 6. Guggulu (Commiphora wightii) as Hyper-cholesterolemic agent The clinical studies with crude gum guggulu (Commiphora wightii) showed reduction in serum cholesterol levels in patients with obesity and hypercholesterolemia. Reference: Satyavati G.V. Effect of an indigenous drug on disorders of lipid metabolism w.r.t. to atherosclerosis & obesity, M.D. Thesis BHU, 1966, READING MATERIAL: Clinical and experimental trial of Guggulu (Medoroga), CCRAS, New Delhi, 1989,
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RESPIRATORY DISORDERS
(Swasansansthanagata Roga)
BACKGROUND Respiratory disorders are among the most common cause of morbidity and mortality in elderly. Pulmonary function progressively decline after 25 years of age. The major changes with aging in lungs include decreased elastic recoil, stiffening of the chest wall and deteriorating respiratory muscle strength. Total lung capacity decreases with age, residual volume increases, due to small airway closure during exhalation resulting in air trapping. Common respiratory disorders like COPD (chronic bronchitis and emphysema), Asthma, Pneumonia and Lung cancer are more likely to develop as the age advances. Chronic Obstructive Pulmonary Disease (COPD) is defined as a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema. COPD is the fourth leading cause of death in USA and a growing health problem. The prevalence of chronic bronchitis in rural India may be high as 30% in the over 40 years age group where as in urban India the incidence around 10%. Asthma is a chronic inflammatory disorder of the airways. The prevalence rate of asthma in elderly people indicate that it varies from 6.5 to 10% approximately. Asthma manifests itself differently in children, adults and elderly people. In older people, it is not early to differentiate whether it is certainly a case of asthma as cough & breathlessness in this age group is a symptom of other disease also because of poor respiratory function. Treatment of COPD and asthma in older people needs much more attention and care. Corticosteroids can cause softening of bone results in to fracture of fragile bone. Incidence of acquiring Tuberculosis also increases in patients on therapy with of corticosteroids. Injection of adrenaline in status asthmaticus endangers the heart and blood vessels of those who have hypertension and Ischemic Heart Disease. Elderly people are more likely to get pneumonia. Elderly people tend to have diminished cough and gag reflexes and weaker immune system. In elderly people pneumonia can be fatal. It is the common cause of hospitalization and prolonged hospital stay in the elderly.
27

AYURVEDA AND SIDDHA

Thus the conventional therapy for respiratory disorders in the elderly has many side effects & limitations. In this juncture, there is need to search for herbal medicines in this field. Ayurveda has immense knowledge regarding disorders of Pranavaha srotus (Respiratory system) like Kasa (Cough), Swasa (Dyspnoea), Kshaya (T.B.) and Kshata ksheena (Pleurisy) etc. the main dosa involved in respiratory disorder are Kapha and Vata which causes constriction of channels of respiration and obstruction in the respiration process at micro and macro level. This leads to Pranavaha Srotas Dushti. Thus the principle of treatment for pranavaha srotus is to bring normalcy in these dosas by Samana (palliative) medical treatment as well as Sodhana (bio-cleansing) Procedures. Ayurveda also offers dietary and lifestyle regimes for prevention of respiratory disorders. Nidana Parivarjana (Avoidance of causative factor) is the principle of treatment for all diseases in Ayurveda. Satwavajaya (Psycho therapy) like listening music, meditation helps in quality of mental and physical health. Rasayana therapy (use of rejuvenative drugs acting on lungs), Yoga and Pranayama are advocated classical methods for the prevention and cure of respiratory disorders. POTENTIAL AND STRENGTH 1. Panchakarma Therapy Panchakarma therapy to be performed after preparatory procedures like Snehana (Oleation) and Swedana (Fomentation). Panchakarma procedures i.e. Vamana (therapeutic emesis) Virechana (therapeutic purgation), Niruha Vasti (decoction based enema), Anuvasana vasti (oil based enema) and Nasya (nasal administration of medicaments) expel out the excessively accumulated doshas from the body and restores health. Vamana and virechana procedures are very effective in chronic respiratory disorders. Medicinal Treatment Number of herbal and herbomineral preparations are in practice which strengthen the respiratory system and have curative effect in respiratory disorders.

2.

Some of the commonly used Ayurvedic Siddha formulations: Churna (i) Sitopaladi Curna, (ii) Talisadi Curna, (iii) Haridra Khanda, (iv) Sringyadi Curna, (v) Sathyadi Curna, (vi) Trikatu Curna, (vii) Somalata Curna Asava & arishta (i) Kanakasava, (ii) Vasarista, (iii) Drakshasava, (v) Sirishasava.
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Vati (i) Kasturyadi Vati, (ii) Gorochana Vati, (iii) Lavangadi vati, (iv) Vyosadi Vati. Avaleha (i) Kantakari Avaleha, (ii) Thoothuvallai legiyam, (iii) Vyagraharitaki, (iv) Vasa avaleha. Rasa (i) Swasa kuthara rasa, (ii) Nagarjunabhra rasa, (iii) Kapha Ketu Rasa, (iv) Swas Kasa Chintamani Ras, (v) Laxamivilas Rasa. Parpam Muthuchippi parpam Kwatha - (i) Sirishadi Kwatha, (ii) Gojihwadi Kwatha. 3. Diet and life style Avoidance of exposure to dust, smoke and pollution Avoid sleep in day time Old wheat, Kulatha (horse gram), Sathi Rice, Parval, Misri, Jaggery, Lasuna, Tulasi, Gomutra, Honey, Raisins, Sunthi, Elaichi, and other hot pungent diet and hot water. Yoga Some Rasayana medicines to strengthen Respiratory system and to combat infections and allergies Cyavanaprasha Agastya Haritaki Rasayana Kantakaryavaleha Vasaveleha Vardhamana Pippali Rasayana Nagabala Rasayan Muthuchippi parpam Drakshavaleha. Brahmi Rasayana Madhu (Honey)
29

4.

AYURVEDA AND SIDDHA

Some single Herbs acting on Respiratory System 1. Yastimadhu (Glycyrrhiza glabra), Kantakari (Solanum xanthocarpum) Tulsi (Ocimum sanctum) Pippali (Piper longum) Pushkrarmula (Inula racemosa) Vasa (Adhatoda vasica) Haridra (Curcuma longa) Draksha (Vitis vinifera) Banafsha (Viola odorata) Shati (Hedychium spicatum) Sirisha (Albizia lebbeck) Kantakari (Solanum xanthocarpum) in Tamaka Swasa (Bronchial asthma) In a clinical trial on 44 patients of Bronchial asthma, decoction of Kantakari in doses of 60-200ml daily with honey was given for a period of 15-20 days on an average. Out of 21 cases of Sleshma pradhana Tamaka swasa, 70-75% shown complete or significant response and out of 23 cases of Vata pradhana Tamakswasa 30% showed complete response and in more than 50% cases significant reduction in intensity of dyspnoea and cough was observed. Reference : J.P.Jain, A clinical trial of Kantakari (Solanum xanthocarpum) in cases of Tamaka Swasa, Journal of Reserch in Ayurveda & Siddha, Vol. I No. 3 (1980) PP 447-460. 2. Shirisa (Albezia lebbeck) twak kwatha in Tamaka Swasa (Bronchial asthma) In a clinical trial on 19 patients of Tamaka swasa, Sirisa twak kwatha was given 30 ml thrice daily for 6 weeks. It was found that, a considerable fall of total WBC count (P<0.01), eosinophil count (P<0.01), ESR and increase the PEFR (P<0.001) were observed which was statistically significant. Effect on subjective and objective parameters was also highly significant. Reference : G.K.Swamy et al., Clinical Evaluation of Sirisa twak kwatha
30

EVIDENCE BASED RESEARCH

in the management of Tamaka Swasa (Bronchial asthma) Journal of Reserch in Ayurveda & Siddha, Vol. XVIII No. 1-2 (1997) 21-27. 3. Picrorhiza kurroa in Chronic Obstructive Airway Disease A clinical trial on 45 patients of obstructive airway disease including bronchial asthma, chronic bronchitis and allergic bronchitis was carried out with Picrorhiza kurroa 2 caps (500mg each) thrice daily for 4 weeks. A significant reduction in the global score of respiratory signs and symptoms and eosinophils count was observed. There was significant improvement in the respiratory function test and with one week of treatment viscosity of sputum was markedly decreased. Reference : T.Bikshapathi et al., A clinical evaluation of Picrorhiza kurroa (Katuki) in the management of chronic obstructive airway disease, Journal of Reserch in Ayurveda & Siddha, Vol. XVII No. 3-4 (1996) PP 126-148 4. Vibheetaki (Terminalia chebula) phala Curna in Kasa (Cough) and Swasa A clinical trial was carried out on 93 patients i.e., 61 cases of Kasa, 12 cases of Swasa and 20 cases of Kasa & Swasa mixed type with Vibheetaki phala churna. Vibhitaka was found to possess broncho-dilatory, antispasmodic and anti-asthmatic effects. Reference : V.P.Trivedi et al., A clinical study of the Antitussive and Antiasthmatic effects of Vibhatakiphala Curna in cases of Kasa-Swasa, Journal of Reserch in Ayurveda & Siddha, Vol.III, No. 1-2, PP 1-8. 5. Brihati (Solanum indicum) and Kantakari (Solanum xanthocarpum) in Swasa (Bronchial asthma) and Kasa (Cough) The decoctions of Brihati and Kantakari were studied to evaluate the efficacy on the patients with Swasa (Bronchial Asthma) and Kasa (Cough). It was found that the effect of Kantakari decoction was better than Brihati decoction on different clinical parameters like dyspnoea, cough, frequency of asthma attacks per week and severity of asthmatic attack. Reference : P.P.Gupta et al., A comparative study on Brihati and Kantakari in Swasa and Kasa, Vol. XX, No.3-4 (1999) Pg. 191-194. READING MATERIAL: Monograph on effect of Shirishadi Kwatha and Sweta parpati in Bronchial Asthma.CCRAS, New Delhi.
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AYURVEDA AND SIDDHA

DIABETES MELLITUS
(Madhumeha)
BACKGROUND The prevalence of various metabolic diseases, such as hypothyroidism and diabetes mellitus is increasing in the elderly population. These diseases may be present with non-specific symptoms in the elderly rather than the classic signs & symptoms of the disease. They may present with fatigue, anorexia, obesity, failure to thrive, loss of motivation and difficulty in concentration. In India, about 10% elderly people aged 65 or more have Diabetes. At age the of 40, glucose tolerance begins to decline and at 65-70 years of age 23% have impaired glucose tolerance and by the age 80 it may reach to 40% people. The risk of death among people with diabetes is about twice that of people without diabetes of similar age. The Health care cost of Diabetes in the United States is 132 billion dollars, thus posing a big economic burden in the country. Diabetes Mellitus is a group of diseases marked by high level of blood glucose resulting from defects in insulin production, insulin action or both. Glucose intolerance and insulin resistance increases with age. Diabetes may leads to serious complications. Diabetes Mellitus poses a wide range of problems for elderly people and their families also. These problems include pain, physical disabilities, financial burden, change in life style and threatened survival. The history of diabetes (Madhumeha) can be traced back in 1000 BC (Caraka Samhita). Descriptions concerning the disease and its management are available in Ayurvedic literature. Caraka Samhita (1000 BC) and Susruta Samhita 1000-600 BC) defined madhumeha as the disease in which the patient passes frequent urine characterized as astringent, sweet. Ayurveda attributes multifactorial etiology to madhumeha and it has been described as advanced urinary condition which is difficult to cure. POTENTIAL AND STRENGTH Maharshi Caraka classified subjects of madhumeha into two groups according to their vitality, constitution and disease etiology. Patients are either obese and strong or lean and weak. Treatment for obese and strong patients begins with Biocleansing procedures (Panchakarma) is aimed at reducing
32

the obesity of the patient (Apatarpana Cikitsa) and lean and weak diabetic patients can undergo milder cleansing procedures followed by the treatment to build his body with specific management (Santarpana Cikitsa). Both types of patients are then treated with specific distinct therapy and diet. Exercise and diet are important adjuncts to the primary diabetes treatment. Vigorous exercise, however, is contra-indicated in lean and weak patients. Instead, diabetic patients are advised to perform specific yoga practices that are believed to benefit them at the mind and body level. Yoga is believed to stimulate the endocrine pancreas and improve its function. Stress is also a very important cause of diabetes and yoga, meditation and Ayurvedic medicines have an important therapeutic value. Diet is prescribed according to age, body constitution, season, and environment as well as the socioeconomic status of the patient. Various preparations of Yava (barley) Mudga, (Green gram), Old rice, Karela (Bitter gourd), Drumstick, Methi, Snake gourd, Pumpkin, Cucumber, Bimbi (Coccinia grandis), Watermelon, Buttermilk, Triphala, etc. are beneficial items for diabetic patients. AYURVEDIC MEDICINES Single drugs (Appropriate drug should be selected for two groups.) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Amalaki (Phyllanthus emblica), Meshasringi (Gymnema sylvestre) Karavellaka (Momordica charantia) Methika (Trigonella foenum-graecum) Shilajit (Black bitumen), Vijaysar (Pterocarpus marsupium) Jambu (Syzygium cumini) Tejpattra (Cinnamomum tamala) Twak (Cinnamomum zeylanica) Guduci (Tinospora cordifolia) Bimbi (Coccinia grandis) Khadirasara (Acacia catechu) Katphala (Myrica nagi) Kakamaci (Solanum nigrum) Devadaru (Cedrus deodara)
33

AYURVEDA AND SIDDHA

AYURVEDIC FORMULATIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Candraprabha Vati, Silajitwadi Vati Vasanta Kusumakara Rasa Trivanga Bhasma Phalatrikadi Kwatha Vangabhasma, Nisamalaki Curna Kathakakhadiradi Kwatha Mehari Vati Saptacakra Ghana Vati

EVIDENCE BASED RESEARCH 1. Vijayasara (Pterocarpus marsupium) in NIDDM A flexible dose open trial was conducted in four centres in India to evaluate the efficacy of Vijayasara in the treatment of newly diagnosed or untreated NIDDM. By the 12 weeks, control of blood glucose had been attained in 69% patients studied. The mean Hb Ac was decreased significantly (P<0.001) to 9.4 % at 12 week from the initial mean of 9.8%. Other laboratory parameters remained stable and no side effects were reported. Reference: Flexible dose open trial of Vijayasara in cases of newly diagnosed non-insulin dependent Diabetes mellitus ICMR collaborating centres, Central Biostatistical Monitoring Unit, Chennai & Central technical coordinating unit, ICMR, New Delhi. 2. Ayush-82 and Shuddha Shilajit in NIDDM In a clinical trial on 80 cases of NIDDM, an Ayurvedic formulation named Ayush-82, 5gm thrice daily and Shuddha Shilajit, 500mg twice daily was given for 24 weeks. Fasting and postprandial blood sugar levels were estimated at 6 th weekly intervals. There was statistically significant reduction in both fasting and postprandial blood sugar. Reference: V.N.Pandey, et.al., An effective Ayurvedic Hypoglycaemic formulation , Journal of Research in Ayurveda and Siddha. Vol. XVI No. 1-2, 1995 PP 1-14
34

3.

Coccinia indica in Diabetes Mellitus In a controlled clinical trial on 30 patients of NIDDM, tablets made from aqueous extract of Coccinia indica twice daily were given before meal for 3 months. The drug was found to be significantly attenuated the lipid fraction almost to normal range with the control of hyperglycemia. Reference: S. M. Kamble et al., Efficacy of Coccinia indica W & A in Diabetes mellitus, Journal of Research in Ayurveda and Siddha, Vol. XVII, No. 1-2 (1996) PP. 77-84

4.

Ayurvedic Therapy in Diabetic Retinopathy A combination therapy of tarpana with Patoladi ghrita and internal administration of Dhanvantara kwatha 20ml, Punarnavasava 25ml, Candraprabhavati 250 mg and Nisamalakai 5 gm twice a day in the subjects of Diabetic retinopathy showed remarkable improvement in visual acuity. There was no further visual loss, no further focal haemorrhages and no neovascularisation was observed. Reference: N.Srikanth, An appraisal of clinical trails in Diabetic Retinopathy, Ayurvedic Management of Diabetes Mellitus, Rashtriya Ayurveda Vidyapeeeth, 2005.

5.

Ayush-82- An Ayurvedic Hypoglycemic formulation Ayush-82 consisting of Amra bija (seeds of Mangifera indica), Karavellaka bija (Seeds of Momordica charantia), Jambu beeja (seeds of Syzygium cumini), Gudmara (leaves of Gymnema sylvestre) was tried on a fairly large sample size (350 patients) in a control clinical study revealed statistically significant reduction in fasting and postprandial blood sugar in Non Insulin Dependent Diabetes Mellitus. Reference: CCRAS Research An Overview, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi- 2002.

READING MATERIAL: CCRAS Research An Overview, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi- 2002.

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AYURVEDA AND SIDDHA

DIGESTIVE DISORDERS
(Pacanasamsthanagata Roga)
BACKGROUND Older adults frequently present with gastrointestinal disorders due to significant changes in the gastrointestinal functions with aging. These include a variable diminution in the secretion of hydrochloric acid and digestive enzymes of stomach, intestine, liver and pancreas. Poor olfactory sensation, impaired taste detection and discrimination and increase of satiety hormone (Cholecystokinin) leads to poor appetitie in old age. Relaxation of lower esophageal sphincter, decreased mucosal prostaglandin synthesis in the stomach and atrophy of small intestine with decrease in number of follicles and payers patches occurs with aging process, which are responsible for digestive disorders. Many of the digestive complaints of the elderly may be due to altered motility and secretion and are usually considered functional in origin. They are often difficult to measure and to identify clearly. Most patients with cirrhosis of liver present between 40 and 70 years of age. Symptoms of digestive disorders become a matter of increasing concern to an older patient. Poor appetite, heartburn, dyspepsia, flatulence, diarrhoea or constipation may also be associated with emotional factors in the elderly patients. Flatulence and intestinal gas occurs in almost every elderly individual. It is often associated with constipation. Approximately 30% healthy elderly people use laxatives regularly. If this problem is not addressed properly may lead to anal fissures, hemorrhoids and fistula-in-ano. The diseases of the digestive system result in poor nutrition and weight loss. The multiplicity of the diseases in aging population often need multi drug medication which may lead to poor appetite, loss of appetite, heartburn and many other related problems. Ayurveda believes that digestive disorders occur due to altered lifestyle &faulty food habbits. Inappropriate food includes insufficient food, and even starvation, excessive amounts of both food and water, wrong food combination which results in poor appetite, indigestion, diarrhoea and other digestive disorders. Overeating of high fat foods, which can result in obesity. Ama-producing food (certain food combinations lead to toxemia) causes
36

digestive disorders. The factors such as time of eating, manner of eating, eating when mind is burdened with worries etc., also precipitate digestive disorders. Food not compatible to body, mind, constitution (Prakriti) may cause digestive disordersimmunity and cause diseases. According to Ayurveda, every food has its own taste (rasa), a heating or cooling energy (virya) and post-digestive effect (vipaka). When two or three different food substances of different taste, energy and post-digestive effect are combined together, agni can become disturbed and inhibiting the enzyme system and resulting in production of toxins in the system. Combining food improperly can result in digestive disorders like indigestion, diarrhoea, and gas formation. Lack of proper and systematic lifestyle also leads to the chain of reactions to cause digestive disorders. Ayurveda manages these digestive disorders by managing Jatharagni (Digestive fire and liver function) and balancing the doshas with the help of food, lifestyle and medicines. Ayurveda offers a rational and scientific approach for determining correct diet, which is, based upon an individuals constitution i.e. Vata, Pitta and Kapha. This constitution is the basis of determining which foods are best for maintaining physiological balance for a given individual. Panchakarma treatment along with various Ayurvedic preparations is effective in treating the gastro intestinal disorders. POTENTIAL AND STRENGTH OF AYURVEDA Diet and lifestyle changes Food and diet are important component of management of digestive disorders. Ayurveda relies primarily on the adoption of lifestyle and food habits maintain the Jatharagni that reduces the fat, accumulation of dosha in the body and keep the dosas in normal state. Adoption of food habits mentioned in Ayurveda as one should not eat too fast, too slow, not talking or laughing while eating. One should eat warm, unctuous food, in proper quantity and only after the digestion of previous meal etc can prevent the occurrence of such disorders. Irregular, untimely and excessive eating are important causes to disturb the digestion, which lead to the gastro intestinal disorders. Panchakarma- Panchakarma is Ayurvedas primary purification and detoxification treatment. Panchakarma means the five therapies. These 5 therapeutic means of eliminating toxins from the body are Vamana,
37

AYURVEDA AND SIDDHA

Virechana, Niruha and Anuvasana Vasti and Nasya. This series of five therapies help to remove vitiated dosas and illness causing toxins from the body and balancing the dosas. In elderly people selective one or two procedures may be required to manage the digestive disorders. Medicinal treatment: Ayurveda has a wide range of medicines for digestive disorders described under Deepaniya, Pacaniya, Stambhana, Grahi, Anulomana, Rechana, and Bhedana class of drugs. For Poor appetite and Dyspepsia: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Lavana bhaskara Curna Hingvastaka Curna Saindhavadi Curna Sunthyadi Curna Vaiswanara Curna Narayana Curna Shivakshara pachan Curna Hingvadi Vati Citrakadi Vati Ajirnakantaka Rasa Agni kumara Rasa Vishatinduka Vati Drakshasava Kuberaksha Vati Kankayana Vati

For Diarrhoea: 1. 2. 3. 4.
38

Siddha praneshwara Rasa Dadimastaka Curna Bilwadi Curna Gangadhara Curna

5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Kapithashtaka Curna Lasunadi Vati Sankha Vati Sanjeevani Vati Anandabhairavi Ras Kutaja Ghana Vati Siddha Praneswara Ras Karpura Ras Pathyadi Curna Jatiphaladi Curna Cangeryadi Gutika

For vomiting: 1. 2. 3. 4. 5. 6. Bilwadi Avaleha Eladi Vati, Dadimashtaka Curna Chardiripu Vati Dadimavaleha Mayurapinccha Bhasma

For IBS: 1. 2. 3. 4. 5. 6. 7. 8. Citrakadi Vati Hingwastaka Curna Sankha Vati Maha gandaka Rasa Agnitundi Vati Panchamrita Parpati Kravyadi Rasa Kaidaryadi Kvatha Curna
39

AYURVEDA AND SIDDHA

9. 10. 11. 12.

Pippalyasava Takrarista Shatapushpadi Curna Jeerakadyarishta

For Hyperacidity: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Avipattikara Curna Amalaki Curna Yastimadhu Curna Sutasekhara Rasa Kamadudha Rasa Pravala Panchamrita Pravala Pisti Dhatri Lauha Indukantha Ghrita Misreya Curna

For Constipation: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

40

Triphala Curna Panchasakara Curna Shatsakara Curna Eranda Taila Dantiharitaki Hingu triguna Erandam Isabgol Husk Draksharishta Abhayarishta Kumaryasava

For liver disorders: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Arogyavardhini Vati Phalatrikadi Kwatha Katuki Curna Bhunimbhadi Kwatha Rohitakarista Avipattikara Curna Bhumyamalaki Swarasa Eranda Pallava Swarasa Vasaguducyadi Kvatha Kumaryasava Rohitakarishta

EVIDENCE BASED RESEARCH 1. Ayurvedic combination in Kamala (Jaundice) A combination of Punarnava mandura 500 mg along with Arogyavardhini Vati 1 gm thrice daily for 21 days was tried in a clinical trial on 37 patients of Kamala (Jaundice). The combination showed antiviral, antiinflammatory and purgative effect in Kamala. Reference: S.K.Singh et al., Study of herbomineral therapy - effect in the case of kamala (Jaundice), Journal of Reserch in Ayurveda & Siddha, Vol. XXVI No. 1-2 (2005) PP 45-51 2. Ayurvedic combination in Parinama Soola In a placebo controlled clinical trial, a combination of Narikela Lavana in a dose of 1g of twice daily and Tiktaka ghrita 10 gm once daily in early morning with hot water in the treatment group and starch tablets as placebo was given for 4 weeks. It was found that, in the trial drug group 80% patients were cured and 20% were improved while with placebo no significant response was noted. Reference: Sulochana Muddepal et al., Clinical study on the efficacy of Narikala Lavana and Tiktaka Grita in Parinama Soola, Journal of Reserch in Ayurveda & Siddha, Vol XXVII, No. 3-4 (2006) PP 1-9
41

AYURVEDA AND SIDDHA

3.

Panchamrita Parpati in Grahani Roga (Ulcerative colitis) In a control clinical trail, the administration of a combination of allopathic medicine (Sulphasalazine and Prednisolone) and Panchmrita parpati kalpa in the management of 30 cases of Grahani roga (Ulcerative Colitis) produced highly significant improvement in various symptoms of the patients, without producing any side effects in comparison to the other two groups i.e. allopathic medicine or Panchamritaparpati alone. Reference: Ajay Kumar Sharma et al., Evaluation of the efficacy55 of Panchamrita parpati in the management of Grahani roga vis--vis Ulcerative colitis. Journal of Reserch in Ayurveda & Siddha, Vol. XXVII, No. 1-2 (2006), PP- 24-40

4.

Bhumyamalki (Phyllanthus amarus)- a promising Hepatoprotective agent A clinical trail of Bhumyamalki (Phyllanthus amarus) in chronic viral hepatitis for a period of three months revealed remarkable recovery of liver function and inhibition of HBV replication. Xin Hua, W. et al., A comparative study of Phyllanthus amarus compound and interferon in the treatment of chronic Viral Hepatitis B, B.J. Trop. Med. Public health, 31, 140, 2001.

5.

Comparision of different drug schedules in Grahani Roga In a clinical trail, a comparative study was done with a herbomineral combination of Kutaja Ghana vati 1gm thrice daily with 2 drops of Sankha drava in one group and Herbal combination of bark of Kutaja (Holarrhena antidysenterica), beans of Babula(Acacia arabica), fruit pulp of Bilva (Aegle marmelos) and seeds of Sveta Jirka (Cuminum cyminum) 1gm thrice daily in another group. It was found that all the patients respond to both the therapies and the second therapy was more effective than first therapy. Reference: Naresh kumar et al., A comparision of Different drug Schedules under different groups of Grahani Roga, Journal of Reserch in Ayurveda & Siddha, Vol. XVIII, No. 3-4 (1997), pp 79-88.

READING MATERIAL: Monograph on Parinama sula ( Peptic Ulcer), CCRAS, New Delhi.
42

PSYCHO NEUROLOGICAL DISORDERS

(Mano evam Nadi tantrika roga)
BACKGROUND Psychosomatic disorders are increasing in number and leading to the large number of health problems and complications. Incidence of Psychosomatic disorders is increasing because of many factors but the most important factor is urbanization and fast so called modern lifestyle of today. Prevalence of all the psychiatric disorders observed to be 65.4 per 1000 population. Prevalence of Schizophrenia is 2.3/1000; depression is 31.2/1000 and anxiety neurosis is 18.5/1000. There are several neuropsychiatric medical conditions that are frequently seen in elderly like Dementia, Alzheimers disease, Parkinsons disease and psychosomatic disorders like depression, anxiety, hypertension, insomnia, etc.. Advanced age among the elderly has been hypothesized to be a risk factor for depression. Depression contributes to significant psychological and physical distress, physical disability and higher mortality. Acetyl choline, dopamine and norepinephrine decrease in the CNS in the advancing age, elevated levels of MAO & decrease in no. of neuro-receptors contribute to the vulnerability to depression in older adults. Depression presents most often as anxiety in older peoples. The presence of co-morbid anxiety disorder is associated with poor social functioning and a higher level of somatic symptoms and even suicidal tendency. All statistics show a sharp rise in the prevalence of dementia with age. Between 1990 and 2010 the number of dementia cases in the developed countries will project to increase from 7.4 million to 10.2 million. This predicted data shows that it affects the individual as well as the economy of the country. Parkinsons disease is a hereditary degenerative disorder. It is one of most common crippling diseases. It strikes 2/1000 people in USA. Because of increased longevity, roughly 60,000 new cases are diagnosed annually. Parkinsons disease is the most common extrapyramidal disease affecting the elderly. Tremor is the common presenting symptom. Conventional medical therapy to treat psychosomatic diseases includes use of antidepressants, psychostimulants and electroconvulsive therapy.
43

AYURVEDA AND SIDDHA

Neuropsychiatric complications like delirium, dry mouth, blurred vision, urinary retention and insomnia are the common side effects leading to non compliance. Thus there is no effective therapy without side effects in conventional system of medicine for psychosomatic disorders. Ayurvedic classics describe psychosomatic illness under different headings. Much description is available in the disease Unmada. Description of other conditions like chittodwega (Anxiety), Avsada/Vishada (Depression), Anidra (Insomnia), Smritinasa (Loss of memory) and Kampavata (Tremors) are available in Ayurvedic texts. POTENTIAL AND STRENGTH OF AYURVEDA Ayurveda has various therapeutic modalities to improve the psychological, neurological, intellectual, physical and social functioning of elder people to make them adjustable in the society in a better way, thereby improving the quality of life and making him socially useful. Concept of Satvavajaya Cikitsa (Psychological therapy) is uniquely mentioned in Ayurveda. By following Sadvritta (Good social conducts), one can prevent the occurrence of Psychiatric illness. Panchakarma therapy to clean the channels of body, mind and various Medhya Rasayana formulations which act on manovaha srotas are the hallmark of Ayurvedic treatment. Number of Ayurvedic formulations are used in Ayurveda for the management of these disorders. Concept of Satvavajaya Cikitsa (Psychological therapy)- This therapy aims at restrainment of mind from the unwholesome objects. Treatment with a advice from the knowledgeable people to prevent negative thinking, promotes positive approach. Various Mani, Mantra, Oushadhi and Panchakarma procedures with medicines are advocated in Ayurveda. Panchakarma Therapy Vamana, Virechana and Vasti etc., should be advocated according to the preponderence of dosha involved. This therapy cleanses the channels of body and mind so that nutrition can be provided to the body. The patient attains mental peace, good memory and mental health Nasyakarma (Nasal administration of medicaments) is the root of choice in the diseases of head and supraclavicular region. Sodhana Nasya can be given for cleansing the channels of head & Brimhana Nasya provides nutrition to check the process of degeneration. The external therapeutic applications like sirovasti, Takradhara, Siro pichu etc, are also useful in tranquilizing the agitated mind.

44

Medhya Rasayanas in Psychiatric disorders - Rasayana drugs have quality of enhancing memory, intelligence and strength of body, mind and sense organs. Medhya rasayanas viz., Juice of Mandukaparni, Guduchi, powder of Yastimadhu and paste of Sankhapushpi are intellect promoters. Brahmi rasayana Aswagandha Ghrita

Single Drugs for Psychoneurological disorders 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Brahmi Bacopa monnieri Sankhpushpi - Convolvulus pleuricaulis Mandukparni - Centella asiatica Aswagandha -Withania somnifera Kapikacchu - Mucuna pruriens Vaca - Acorus calamus Jatamansi - Nordostachys jatamansi Guduci - Tinospora cordifolia Bala - Sida cordifolia Badam - Prunus amygdalus Goghrita - Cow ghee Godugdha - Cow milk

Ayurvedic Formulations Curna 1. 2. Vati 1. 2. 3. Brahmi Vati, Sarpagandhadi Vati Manasamitra Vati
45

Saraswata Curna, Aswagandha Curna

AYURVEDA AND SIDDHA

Asava 1. 2. Taila 1. 2. 3. 4. Ghrita 1. 2. 3. 4. 1. 2. 3. 4. 5. 6. 1. Maha Pancagavya Ghrita Kalyanaka Ghrita Saraswata Ghrita Bramhi Ghrita Manasamitra Vataka Smriti Sagara Ras Yogendra Ras Caturbhuj Ras Pracand Bhairav Ras Brihatvata Cintamani Ras Jyotishmati Taila, Brahmi Taila Himasagara Taila Tungadrumadi Taila Aswagandharista, Saraswatarista

Rasoushadhis -

EVIDENCE BASED RESEARCH Brahma Rasayana an Antianxiety formulation. In a double blind cross over trail, 15 cases of anxiety neurosis were randomly divided into 3 groups receiving placebo or diazepam or brahma Rasayana. The overall result showed that. Brahma Rasayana is more effective in enhancing perceptual discrimination and psychomotor performance than the other two groups. Reference: Ajay K. Sharma. Antianxiety effect of classical Ayurvedic compound, Brahma Rasayana, Journal of Reserch in Ayurveda & Siddha, Vol.XXIII, No.3-4 (2002), pp. 33-48.
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2.

Ashwagandha and Kapikacchu in psychiatric disorders Aswagandha and Kapikacchu were studied for anxiety and depressive disorders respectively in 60 Psychogeriatric patients for 3 months. Aswagandha and Kapikacchu were found to promote positive health to retard biological and psychological aging factors and to control the psychological symptoms. Reference: K.K.Dwivedi et al., A study of Psychiatric symptoms of geriatric patients and the response to Ayurvedic therapy, Journal of Reserch in Ayurveda & Siddha, Vol.XXII No.3-4 (2001), Pg 198-207.

3.

An Ayurvedic formulation- in the management of depressive disorders An Ayurvedic compound containing organic extract of Guduchi (Tinospora cordifolia), Mandukparni (Centella asiatica) and Basant (Hypericum perforatum) in a dose of 1200 mg/50 kg body wt were studied in a control clinical trial, which revealed considerable reduction in the depression score and mental fatigue level in depressive patients. Reference: Gayatri Juneja et al. Depressive disorders among elderlyits prevention and management by an Ayurvedic formulation. Ayurvedic conference on Rasayana, Rashtriya Ayurveda Vidyapeeth, 2002.

4.

Brahmi (Bacopa monnieri) in the management of Senile Dementia. Brahmi vs Placebo: Administration of 1 gm. of powdered extract of Brahmi twice a day for 5 years has shown significant reduction in the progression of memory loss in persons suffering from senile dementia. Reference: Role of the Ayurvedic drug Brahmi (Bacopa monnieri) in the management of Senile Dementia. Pharmacopsychoecologia (1990),3,47-52.

5.

Ashwagandha a potent anti-stressor agent. Anti-stress property of Withania somnifera has been experimentally studied in adult Wistar strain albino rats. In this study, the drug treated animals showed better stress tolerance. Reference : R. Archana et al., Antistressor effect of Withania somnifera, Journal of Ethnopharmacology, 64 (1999), 91-93.

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AYURVEDA AND SIDDHA

SURGICAL PROBLEMS IN ELDERLY

BACKGROUND There are vast number of surgical problems that occur in elderly population eg. Gall Bladder stones, BPH, renal/vesical calculus, Coronary artery disease, Hernia, Piles, Fistula-in-ano etc., and Prolapse of rectum. As the population grows, older patients will present for the treatment of surgical disease. When treating older patients main focus shift from maximizing longevity to maximizing the quality of life, maintaining dignity and minimizing sufferings. Age related changes as decrease the vital capacity, cardiac complications associated with general anesthesia and a gradual loss of reserve capacity decreases the patients ability to tolerate surgery. The surgeon identifies those at risk for complications and considers alternative modalities of surgical treatment. Out of above mentioned surgical problems in the elderly Ayurveda offers alternative management for BPH, renal disorders (eg. calculus, chronic renal failure etc.), piles, fistula-in-ano and anal prolpase. Benign Prostatic Hyperplasia (BPH) is a progressively worsening condition associated with aging. Onset of this disease is seen after forties due to the enlargement of prostatic gland. Due to its location, the enlarged prostate bulk may subsequently increases the resistance of the proximal urethra to the outflow of urine. This results in higher pressures generated by the bladder to overcome the obstruction. Progressively, the bladder musculature decompensate, resulting in a weak and flabby bladder with diverticuli. Stasis of urine harbors infection and bladder stone formation. This high bladder pressures may be transmitted to kidneys resulting in Hydronephrosis and Hydroureters and gradual loss of renal function. Maharshi Susruta (1000 BC), a great surgeon advised surgical treatment for many diseases and the procedure advocated by him is being practiced even today. But Surgery in geriatric patients should be avoided if possible. Ayurveda has many treatment options, which can manage/can reduce the sufferings due to such disorders. Ayurveda provide minimum invasive
48

parasurgical techniques like Kshara sutra therapy for the management of some surgical disorders like Piles, fistulain-ano etc., POTENTIAL AND STRENGTH OF AYURVEDA Ksharasutra Therapy- Ksharasutra is a unique minimal invasive parasurgical measure successfully practiced as promising therapy for the management of ano rectal disorders. The prolonged internal pile masses and external piles can be treated successfully by ligation of the Ksharasutra around pile masses. The Ksharasutra is tied in the fistulous tract and is changed every week till the whole tract is excised and healed symultaneously. It is a very successive method of the treatment. The recurrence rate after Ksharasutra therapy is very low (3-5%) and the patient need not to be hospitalized. Need of Anaesthesia and antibiotics are negligible. 1. Piles (Haemorroids) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Arsakuthar Rasa Arsoghna Vati Kankayana Vati Pranada Vati Sigru Guggulu Rasanjana Vati Abhayarista Prabhakar taila (for external use) Surana Avaleha Dantiharitaki

Beningn Prostatic Hypertrophy (BPH) 1. 2. 3. 4. 5. Varunadi Guggulu Shigru Gugulu Kanchanara Guggulu Chandraprabha Vati Shilajitvadi Vati
49

AYURVEDA AND SIDDHA

6. 7. 8. 9. 10. 11. Calculus: 1. 2. 3. 4. 5.

Punarnavasava Gokshuradi Guggulu Brihatyadi Kwatha Varun Sigru Kwatha Dasamoola Kwatha Narayana Taila (for Vasti)

Pashanabhedadi Curna Gokshuradi Guggulu Varuna Sigru Kwatha Sweta Parpati Kulutha Kwath

Anti-inflammatory Drugs 1. 2. 3. 4. 5. 6. Guggulu Varuna Sigru Gokshura Punarnava Silajitu

EVIDENCE BASED RESEARCH 1. Kravyadi Rasa, Kaseesadi Taila Vasti and Triphala Churna in Hemorrhoids In a single blind clinical trail Kravyadi Rasa 500mg thrice daily, Kaseesadi Taila 10 ml per rectal and Triphala Churna 5 gm at bed time on 50 patients of bleeding piles showed complete relief in 28 cases and marked relief in 13 cases. Reference: A clinical study on the effect of Kravyadi Rasa, Kaseesadi Taila Vasti and Triphala Churna in the management of Arsas
50

(Haemorrhoids), Journal of Reserch in Ayurveda & Siddha, Vol. XXV, No.1-2 (2004), PP 1-10. 2. A Compound Ayurvedic Formulation For Haemorrhoids A single blind clinical trial was conducted on 182 patients of Arsa (Haemorrhoids) to evaluate the efficacy of Kaseesadi taila vasti 10 ml, Kankayanavati 500mg thrice daily, Kravyadi rasa 500mg thrice daily, Abhayarista 25 ml thrice daily and Triphala curna 5gm at bed time. It was found that 31.31% cases got complete relief and 29.12% got marked relief. Reference: Therapeutic Evaluation of compound Ayurvedic formulation in the management of Arsas (Hemorrhoids) A Clinical Study, Journal of Reserch in Ayurveda & Siddha, Vol. XXII, No.3-4 (2006), PP-81-91 3. Ksharasutra in the management of Fistula-in-Ano In multicentric randomized controlled trial, the efficacy of Ksharasutra in the management of Fistula-in-ano is compared with conventional surgery, which concluded that long term outcome with Ksharasutra is better than surgery although initial healing time is longer. Ksharasutra thus offers an effective, ambulatory and safe alternative treatment for patients with Fistula-in-ano. Reference: ICMR collaborating centres and other units. Multicentric randomized controlled clinical trial of Ksharasutra (Ayurvedic medicated thread) in the management of Fistula-in-ano, Indian J. Med. Res. (V) 94, June 1991, PP 177-185. 4. Teekshna Ksharasutra in Fistula-in-ano A clinical study has been conducted on 100 patients of Fistula-in-ano, divided into 2 groups; in control group standard Ksharasutra (Apamarga kshara + Snuhi ksheera and Haridra) was applied and in treatment group the Teekshna ksharasutra containing Apamarga, Palasa, Kutaja etc. was applied. The average unit cutting time in control group was found to be 6.6 days/cm, while in treated group the average U.C.T was just 5 days/cms. Reference: Role of Teekshna kshara Bhavitasutra in the management of Bhagandara (Fistula-in-ano), Journal of Reserch in Ayurveda & Siddha, Vol. XX, No.3-4, (1999), PP-130-140.
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AYURVEDA AND SIDDHA

6.

Sweta Parpati with Pashanabheda and Goksura in Mutrasmari Effect of Ayruvedic drugs Sveta Parpati with Pashanabheda and Goksuru in the management of Mutrasmari (Urolithiasis) was evaluated in 30 radiologically established cases of renal and ureteric calculi were included. One gm. of Sveta parpati with 50 ml. of Pasanabheda goksuru kwatha was given thrice daily. The assessment of the response of the therapy was made on the basis of relief in presenting symptoms and the radiological findings. The results have shown that Urolithiasis could be well managed with Ayurvedic therapy. The radiological findings also support the elimination of stone and reduction of their size. Reference: CCRAS Research an overview ,CCRAS 2002 , pp55

7.

Palasa ksara in the management of Mutrasmari (Urolithiasis) The effect of Palalsa ksara in the management of Mutrasmari (Urolithiasis) was evaluated on 50 radiologically established cases. Out of 50 cases, 24 were having Renal calculus (Vrikkasmari) and 26 were having Ureteric calculus (Gavini asmari). Palasa ksara was given in the dose of 1 gm. thrice daily with water. The clinical and radiological findings reveal the elimination of stone and reduction of their size. Reference: CCRAS Research an overview, CCRAS 2002, pp55

READING MATERIAL: 1. 2. 3. 4. 5. Monograph on clinical studies on Bhagandara (Fisstulo-in-ano) CCRAS, New Delhi. Monograph on Delhi. "Clinical studies on Arsha (Hemorrhoids)" CCRAS, New

Book "Kshara sutra therapy for Ano rectal disorders", Dr. S.K. Sharma, RAV Publication, New Delhi. Monograph on "effect of Varuna, Kuluthha& Gokshura in the management of Urinary calculus", CCRAS, New Delhi. Monograph on "Management of BPH", CCRAS, New Delhi.

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APPENDIX - 1

SOME CENTERS OF EXCELLENCE (Ayurveda & Siddha) FOR GERIATRIC CARE

1. Institute of Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University Administrative Bhavan, JAMNAGAR- 361 008. (Gujarat) India. Phone (O) : 0288-2676854, Fax : 0288-2555585 Email :info@ayurveduniversity.com http://www.ayurveduniversity.com National Institute of Ayurveda, Madhav Vilas Palace, Amer Road, Jaipur-302002, Phone No:- 091-141-2635709,2635816, Fax: 91-141-2635709, Website: http://nia.nic.in, Email: nia@raj.nic.in Institute of Medical Sciences, Banaras Hindu University Varanasi, India -221005 Phone 0542 - 2307500, 2367568, Fax 91-542-2367568 http://www.bhu.ac.in/ims/index.html R. A. Podar Medical College (Ay) Dr. Annie Besant Road, Worli, Mumbai 400 018 Telephone: 022 4936881/ 4934214 Hospital: 022 4931846/ 4933533 Website: www.ayurvedinstitute.com Govt. Ayurveda College Hospital Trivandrum, Kerala Hospital Ph: 0471 - 2460823 College Ph: 0471 2474190
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2.

3.

4.

5.

AYURVEDA AND SIDDHA

6.

Arya Vaidya Sala, Kottakkal-676503, Malappuram Distt, Kerala Tel: 0483/2742216-19, 2742561-64, 2742571, 2744506-08 Fax: 0483-2742572 E-mail: koz_kottakkal@sancharnet.in Website: www.aryavaidyasala.com Central Research Institute (Ayurveda) Cheruthuruthy, Via Shoranur Trichur Distt.Kerala-679531 Fax: 04884-262366, Phone: 04884-262543 M: 09446501746 E-mail: trc_criachy@sancharnet.in National Institute of Siddha Thambaram Sanatorium Chennai-47 Reference: 044-22411611(Telefax) 098447211057 email. ambairuna@rediffmail.com crisiddha@gmail.com Central Research Institute (Siddha), A.A. Govt. Hospital Campus, Arumbakkam, Chennai-600106 Phone No: 044/26214809(O) Regional Research Institute (Siddha) Chellaperumal Street, Kuyavarpalayam Pondicherry-605006 0413/2245072 (Telefax) E-mail: rrisiddha@yahoo.co.in Govt Siddha Medical College & Hospital, Palayamkottai Tirunelvelli-2 Govt Siddha Medical College & Hospital, Aringar Anna Hospital, Campus, Arumbakkam, Chennai-106 Phone: (044) 26281563, 26214844

7.

8.

9.

10.

11.

12.

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APPENDIX - 2

SOME NGOs ENGAGED IN GERIATRIC CARE AND OTHER HEALTH PROGRAMMES

Agewell India, M-8A, Lajpat Nagar, Part-2, New Delhi Help Age India C-14, Qutub Institutional Area, New Delhi 110 016 Rajasthan Voluntary Health Association, A-12 (B), Maheveer Udyan Path, Bajaj Nagar, Jaipur-302 015 Voluntary Health Services Technical Teachers Training Institute- Post, Chennai-113, Tamilnadu Healthy Services Society, 406 & 501, 14th Street, Himayat Naagar Hyderabad-29 Missionary of Charity,(Mother Teressa Centre), 54A/AJC Bose Road, Kolkata-700016 Ramakrishna Math & Mission P.O. Box Belur Math, District- Howrah, West Bengal-711 202 Phone: 011-91-33-6541144, 011-91-33-6541180, Fax: 011-91-33-6544346 Email: rkmhqbm@cal.vsnl.net.in Help Age India , No.34-A/44,Guruchhalya Manish Nagar, P.O. Azad Nagar, Andheri (West), Mumbai 400 053 West Bengal Voluntary Health Association 19 A, Dr. Sundari Mohan Avenue, Kolkata Dist. Kolkata 700 014 Sambandh Plot No.2926/5198, Jaydev Nagar Lewis Road, Bhubaneshwar- 751002

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