Dr. Prasanth Dharmarajan (IND)

Dr. Prasanth Dharmarajan (IND)

Assistant professor Panchakarma at the AIIA
Dr. Prasanth Dharmarajan PhD comes from a family of Ayurvedic doctors in Kerala and was one of the first employees of the All India Institute of Ayurveda (AIIA), the top institute of the AYUSH Ministry of the Indian government. In 2015, he was appointed advisor and assistant professor for Panchakarma. He built up and developed the Panchakarma Department, which now treats hundreds of patients per day. He created the first national standards for training panchakarma therapists in India and trained the Institute's postgraduate students and therapists. Zuvor he worked in the Department of Panchakarma and Integrative Medical Studies at the Mata Amritanandamayi Math and its Ayurvedic School of Kerala. There he led and taught educational programs for international students, including Western doctors and medical personnel.

» Treatment of ankylosing spondylitis with Ayurveda - results of a protocol-based clinical trial

Year: 2021

Ankylosing spondylitis belongs to a group of rheumatic diseases known as spondyloarthropathies (SpA). It shows various skeletal and extra skeletal manifestations. Having strong association with genetic marker HLA-B27, inflammatory back pain and stiffness are prominent early symptoms, whereas chronic aggressive disease may produce pain and marked axial immobility or deformity. Peripheral arthritis, enthesis’s, dactylitis are all commonly associated with ankylosing spondylitis (i). No satisfactory treatment are currently available for this disease, mostly NSAIDs, some biologics are been used to manage health status of patients suffering with Ankylosing spondylitis (AS) (ii). The prevalence of AS is generally believed to be between 0.1% and 1.4% globally (iii). AS is considered as 2nd most chronic disease which affects life style of an individuals after Rheumatoid arthritis (iv).

Considering AS pathophysiology and symptomatology, it can be correlated with different Ayurveda manifestations as per stages of the disease. Early inflammatory symptoms induced by pathogenesis which may be correlated with Amavata (v). Later to inflammation in AS, it has been proposed that the sites of attachment of the ligaments or tendons to the bone called entheses (vi) are the major target of the inflammatory pathological changes this stage can be correlated with Vatarakta (vii) concept of Ayurveda. Later on as the pathology advances, Subchondral tissue adjacent to joint become granulomatous and later affected joints show irregular erosion and sclerosis (viii). Tissue is gradually replaced by fibrocartilage and then become ossified, this last stage can be correlated with the concepts explained in Asthimajjagata Vata (ix).

A clinical study was designed and executed with 21 diagnosed case of ankylosing spondylitis taken into a single group administering a protocol based treatment considering above mentioned pathologies followed by follow up. Total duration of treatment including follow up was 90 days.

Assessment was taken after every Panchakarma procedure, after Shamana Aushadhi (internal Ayurveda medications) and after follow up. Patients were assessed through various scales including disease activity, functional activity/quality of life as well as range of motion of affected joints i.e. BASDAI (Bath ankylosing spondylitis disease activity index), BASFI (Bath ankylosing spondylitis functional index), ASDAS-ESR (ankylosing spondylitis disease activity score including ESR), BAS-G (Bath ankylosing spondylitis patient global scale) and BASMI (Bath ankylosing spondylitis meterological index). Panchakarma procedures were administered as per standard operating procedure (SOP) and Ayurveda assessment of Samyaka Lakshana of every procedure were also analysed.

The Primary objective of the study was to evaluate the effect of protocol based Panchakarma in pain management of ankylosing spondylitis and the secondary objective was to evaluate the effect of treatment protocol in improving quality of life in patients of ankylosing spondylitis.

Observations found during the study showed that all the patients reported Pain and stiffness i.e. 100%. Tenderness was reported in 90.47%. They were also were reporting weight loss and severe reduction in joint movement while 47.61% were having peripheral joint swelling. The results were suitably tabulated and descriptively analysed by statistical tools. The results thus obtained are presented in the detail during the presentation. The reduction in the mean score was statistically highly significant as assessed by the paired‘t’ test. ASDAS-ESR, BAS-G, BASFI and BASMI reduced up to 38.17%, 48.17%, 51.39% and 20.74% respectively. Statistically Significant result (p<0.001) was also observed in every symptom after the completion of management and follow up. These are promising outcomes for the ailing population of AS across the globe to find a better and natural cure through Ayurveda.

References

(i) Wenker KJ, Quint JM. Ankylosing spondylitis. [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173.
(ii) Proft F, Poddubnyy D. Ankylosing spondylitis and axial spondyloarthritis: recent insights and impact of new classification criteria. Ther Adv Musculoskelet Dis. 2018 Jun;10(5-6):129-139.
(iii) Linda E. Dean, Gareth T. Jones, Alan G. MacDonald, Christina Downham, Roger D. Sturrock, Gary J. Macfarlane Rheumatology, Volume 53, Issue 4, April 2014, Pages 650-657, https://doi.org/10.1093/rheumatology/ket387.
(iv)Gupta L, Ahmed S, Choudhury GD, Misra DP, Agarwal V. Poor quality of life in Indian ankylosing spondylitis patients. Indian J Rheumatol 2018;13:101-6.
(v) Yadunandana Upadhyaya, Editor, Sudarsana Shastri, Commentator, Madhava Nidanam of Sri Madhavakara, Amavatanidanam, 25/6, Chaukhambha Prakashan,Varanasi,2018.p.511.
(vi) Mohammad Ghasemi-ras et.al. Ankylosing spondylitis: a state of the art factual backbone. World Journal of Radiology. 2015 SEP 28; 7(9): 236-252.
(vii) Acharya YT, editor, Shri Chakrapanidatta, commentator, Agnivesha, Charka Samhita, Chikitsasthana, Vatashonita Chikitsa Adhyayam,29/21, Chaukhamba Surbharati Prakashan, Varanasi;2016. p.922.
(viii) McGonagle et.al. Advances in the understanding of entheseal inflammation. Curr Rheumatol Rep. 2002;4:500-506.
(ix) Acharya YT, editor, Shri Chakrapanidatta, commentator, Agnivesha, Charka Samhita, Chikitsasthana, Vatavyadhi Chikitsa Adhyayam,28/33, Chaukhamba Surbharati Prakashan, Varanasi;2016. p.792.

» Ayurvedic treatment of psoriasis - Experiences from clinical research

Year: 2021

Age is just a number especially when your skincare is on priority. The best foundation you can wear is a healthy skin, it is a reflection of overall wellness. Skin is the most exposed boundary with the outside world, Skin diseases are frequently noticeable to others. Due to typically connected social stigma to skin diseases, the sufferer has to cope with both their disease and the negative reaction from others. Hence investment in skin is most important as it is going to represent us for a very long time. Psoriasis is a chronic immune mediated (as autoimmune), multisystem inflammatory disease with predominantly skin and joint involvement. It significantly impairs the quality of life of patients and results in great physical, emotional and social burden. Psoriasis has been recognized by the World Health Organization as a serious, disfiguring, disabling, noncommunicable disease that represents a significant public health challenge due to its psychological, social and economic burden (i). According to a scientific study, Psoriasis burden was greatest in countries with high income and high sociodemographic index (ii). Even though, management of Psoriasis in contemporary medicine is advancing with scientific researches there is a high rate of recurrence. That’s where Ayurveda management grounds better.

There are various studies conducted on the efficacy of bio-purification (Shodhana) and oral Ayurvedic drugs in Psoriasis. Such studies reported significant relief in signs and symptoms of psoriasis and better quality of life with no further episodes of recurrence after repeated bio-purification in regular interval of time (iii).

Bio-Purification (Shodhana) along with external therapies probably may have lead to endogenous changes in the body responsible for the alleviation of psoriatic pathology. It would have also resulted in anti-inflammatory action which causes inhibition of cytokines and keratinocyte proliferation (iv). The data collected from the observation of the clinical research are promising with 80-90% improvement at statistical significance of ( P<0.005 ) in sign and symptoms of psoriasis on the basis of PASI and DLQI. During presentation all the outcomes and experience throughout the clinical research will be shared in detail along with relevant evidences.

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References

(i) World Health Organization. Global report on psoriasis. Available at: https://apps.who.int/iris/handle/10665/204417
(ii) Sino Mehrmal, Prabhdeep Uppal, Natalie Nedley, Rachel L. Giesey, Gregory R. Delost, The global, regional, and national burden of psoriasis in 195 countries and territories, 1990 to 2017: a systematic analysis from the Global Burden of Disease Study 2017, Journal of the American Academy of Dermatology, Volume 84, Issue 1,2021, Pages 46-52, ISSN 0190-9622.
(iii) Sneha patil, Prashanth bhat.Importance of repeated Shodhana in Kitibha Kushtha(Psoriasis) Acase study .IJAPR,2021;9:40-44.
(iv) Gunjan Mangal,Gopesh Mangal,Radhey Sham.Clinical efficacy of Shodhana karma and Shamana Karma in Mandala Kushtha(Psoriasis).Ayu.2012;33(2)224-229.

» The role of Shodhana for health strengthening in the context of Svasthavritta

Year: 2020

Human body has been designed to resist an infinite number of changes and attacks brought about by natural environment. The secret of good health lies in successful adaptations to changing realms around the body. But somewhere on the go, we have forgot that we still remain to be one among the creations of nature. Slowly we started drifting away from nature and tried to get identified as a supreme creature who can do anything and everything within nature. From real world we started loving and living more in virtual world. From true nature we moved away, so far away, so that nature itself has to remind us how and where we belong to. We have ample examples to understand same, I guess the present situation can even be related to same.

Ayurveda, the true science of life guided us being healthy happy and content. Being a part of nature makes it obvious for any creature on its surface to get influenced by every change that happens across. Ancient Indian sages very clearly observed these subtle changes that happened in human body. They translated and recorded it in the principle of Dosha and its imbalances. As the seasons vary there can be accumulation of these Doshas by nature and spilling out when exceeded beyond limits. These can be observed as minor or major symptoms of Doshic expressions or even as disorders. One who is aware about these can prevent the accumulation or spilling out even before it happens by seasonal adaptation of specific Shodhana (Purification) indicated. Shodhana or purification has been beautifully elaborated in the context of Panchakarma by the ancient seers.

Scientific Studies have evidenced that the complex intervention of Panchakarma may be effective in assisting one’s expected and reported adherence to new and healthier behaviour patterns.1 Studies even reported PCBs and Beta-HCH levels were reduced by 46 percent and 58 percent respectively in Panchakarma group. Without this intervention, the expected drop in PCBs and Beta-HCH over two months would be only a fraction of one percent. Previously, no method had been scientifically verified to reduce levels of these lipid-soluble toxicants in the human body without causing negative side effects.2 In yet another study, pathway analysis suggests that the Panchakarma intervention results in change of metabolites across many pathways such as phospholipid biosynthesis, choline metabolism, and lipoprotein metabolism. The observed plasma metabolomic alterations may reflect a Panchakarma-induced modulation of metabotypes. Panchakarma promoted statistically significant changes in plasma levels of phosphatidylcholines, sphingomyelins and others.3

It is very clearly evident through scientific literature too that, Panchakarma therapies can not only remove systemic accumulated Doshas from body, but at the same time prevent the forth coming diseases and also significantly improve the health status of an Individual’s perusal of harmony to body mind and spirit – “Swasthya”. In this paper, will try to detail the intricacies and reality behind the relevance of Shodhana in improving health with special reference to “Swastha”.

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1 Conboy L, Edshteyn I, Garivaltis H. Ayurveda and Panchakarma: measuring the effects of a holistic health intervention. ScientificWorldJournal. 2009;9:272-280. published 2009 Apr 27. doi:10.1100/tsw.2009.35
2 Alternative therapies in health and medicine (2002) vol 8 (5) 93-95
3 Peterson, C., Lucas, J., John-Williams, L. et al. Identification of Altered Metabolomic Profiles Following a Panchakarma-based Ayurvedic Intervention in Healthy Subjects: The Self-Directed Biological Transformation Initiative (SBTI). Sci Rep 6, 32609 (2016). https://doi.org/10.1038/srep32609

Ayurveda therapy for hair loss (Alopecia universalis)

Year: 2019

Hair is a protein filament that grows from follicles found in the dermis. A healthy hair plays an important role in making the body externally beautiful Which eventually elevates the enthusiasm and boots the morale of an individual. Alopecia is characterized by few patches of a hair loss, though in some case it can be more extreme. Hair loss (Alopecia) is a common and very challenging and capricious disease that affects approximately 1.7% of the world population and can have a profound effect on physical and emotional state. Nowadays the most common interest in hair is related to hair growth, hairstyles and hair care. In contemporary science the management of hair loss (alopecia) is challenging and treatment is focused mainly on containing disease activity. Corticosteroids are the most widely used drugs for the management of the same which are troublesome.
In Ayurvedic classics Khalitya is a disease in which Pitta Dosha combines with Vata Dosha and lodges into the pores of hairs (hair follicles) causing hair fall, later Kapha along with Rakta obstructs the pores of those hairs and makes it impossible for its regrowth. As it does not destroy the hair follicles, the potential for the regrowth is maintained for many years. Ayurvedic drugs and therapy possessing Keshya, Balya, and Rasayana properties (preserving and promoting body tissues) are very much useful. Hence management based on these principles has a strong potential to breakdown the pathogenesis of this disease and become a ray of light in the darkness. Here we discuss the elixir action of Ayurvedic treatment along with Panchakarma procedures in the management of hair loss (khalitya) with case studies.

Metabolic diseases in Ayurveda practice: stroke and multiple sclerosis

Year: 2019

Stroke means weakness or focal neurological deficit lasting longer than 24 hours. It occurs as a result of obstruction to the blood vessels supplying the brain (ischemic stroke) or due to intracranial haemorrhage (hemorrhagic stroke). Clinical features depend on the site of lesion. Most common clinical features are a weakness on one side of the body (Hemiparesis), Dysarthria (Speech problem), Hemiplegic gait. Stroke is one of the leading causes of death and disability worldwide. The estimated prevalence rate of stroke range, 50 cases per 100 000 persons per year in Germany. Multiple sclerosis (MS), a progressive autoimmune disease, which is characterized by episodes of inflammation and degradation of the fatty myelin sheath surrounding the axons of the brain and spinal cord. The weakness of lower limb, sensory symptoms, blurring vision, Ataxia is commonly seen in cases of MS. Neuro epidemiological studies demonstrate that the prevalence of MS has more than doubled in the past thirty years. In Stroke and MS limited improvement can be obtained through contemporary methods and long treatment have its own side effects through modern medicine.
Ayurveda treatment can help a lot in managing and improving the quality of life in the patients of Stroke and MS. This paper reveals clinical management of stroke and MS on the lines of Ayurveda considering various common stages at which these cases are presented in front of an Ayurveda physician. Results were recorded on the basis of improvement in scales like NIHSS scale, Barthel index for Stroke and Kurtzke Expanded Disability Status Scale (EDSS) for MS. The results of various case studies were found to be really encouraging which will be presented during the full paper.

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