Ayurveda doctor and pharmacologist
Ram Manohar MD (Ayu) is a doctor for Ayurvedic medicine and pharmacologist. He is currently working as Research Director at the Amrita Centre for Advanced Research in Ayurveda, Amrita Vishwa Vidyapeetham University, Kollam, Kerala. He also serves as a research consultant for the National Institute of Ayurveda and for History of Science at the Indian National Science Academy. He is an expert member of the World Health Organization Committee for the International Standardization of Ayurvedic Terminology. He has worked in the Kerala State Government Task Force on the AYUSH response to COVID-19 and is a member of the Interdisciplinary Research and Development Working Group on COVID-19 at the AYUSH Ministry of the Government of India. His special interest is psychology and spirituality from an Ayurvedic perspective.
Epidemics were described in classical Ayurvedic literature dating back to centuries before the common era. In Sanskrit, Epidemics were called Janapadodhvamsa - Janapada - large human settlements, Udhvaṃsa - to be affected, to be destroyed. The third chapter in the Vimanasthana of the Carakasaṃhita deals exclusively with this topic raising the important question as to why people of different body constitutions, lifestyle, diet and genetic inhertiance become afflicted with the same disease. The text replies with the answer that Climate, Air, Water and Land can become a common medium through which the same disease can affect a large human settlement.
Today the whole world has come to a standstill due to the outbreak of the COVID-19 pandemic. A glance at classical Ayurvedic texts reveal that Susruta was perhaps the first whistle blower warning us about the possibility of epidemic outbreaks like COVID-19 which primarily affects the respiratory system. Susrutasaṃhita, an ancient text book of surgery in Ayurveda describes illnesses manifesting as epidemics affecting the respiratory system time and again, presenting with the symptoms of fever, cough, breathing difficulty, rhinorrhoea, headache and even anosmia The clinical presentation of such diseases described in the Susrutasaṃhita are strikingly similar to epidemics like SARS, Ebola, MERS, Swine Flu and even COVID-19 exhibiting severe respiratory symptoms. Dalhaṇa, the commentator of this text specifies that causative agent of such diseases enters the human body through the nasal passages. When Dalhaṇa comments on the passage in Susruasaṃhita referring to symptoms of the epidemic manifesting respiratory illnesses that is seen to be caused by airborne transmission, he lists a very interesting symptom - gandhajnana or anosmia Anosmia has been reported in COVID-19 patients. Writes Prof. Claire Hopkins, President of British Rhinological Society, "There is potential that if any adult with anosmia but no other symptoms was asked to self-isolate for seven days, in addition to the current symptom criteria used to trigger quarantine, we might be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors, not realising the need to self-isolate". Post-viral anosmia is one of the leading causes of loss of sense of smell in adults, accounting for up to 40% cases of anosmia. Viruses that give rise to the common cold are well known to cause post-infectious loss, and over 200 different viruses are known to cause upper respiratory tract infections. Previously described coronaviruses are thought to account for 10-15% cases. It is therefore perhaps no surprise that the novel COVID-19 virus would also cause anosmia in infected patients. There is already good evidence from South Korea, China and Italy that significant numbers of patients with proven COVID-19 infection have developed anosmia/hyposmia. In South Korea, where testing has been more widespread, 30% of patients testing positive have had anosmia as their major presenting symptom in otherwise mild cases. This lends strong support to the assumption that Susrutasaṃhita was referring to viral infections in this context.
The Susrutasaṃhita also describes the modes of contagion - by repeated physical contact (gatrasaṃsparsat), by inhalation (nihsvasat), by eating together (sahabhojanat), by sitting and sleeping together (sahasayyasanat), by contact with clothes, garlands and so on (vastramalyanulepanat) - The importance of social distancing to prevent the spread of epidemic diseases is hinted at in this ancient medical text. Sthanaparityaga or abandoning the places of human activity is mentioned by Susruta as the first and foremost measure in mitigating an epidemic. This reminds us of the stringent measures like lockdown that we have been forced to enforce in the wake of the COVID-19 pandemic. The word quarantine means fourty days in Italian and refers to the practice of isolation to prevent contagion in the middle ages. This practice is said to have been discovered by Avicenna, the Arab Physician. However, such principles in the mitigation of epidemics are found mentioned in classical Ayurvedic texts composed centuries before the common era. Quarantine was also practice in the ancient civilisation of Nepal. nearly a thousand years ago. To contain and prevent the transmission of infectious diseases it was a standard cultural practice for people to self-isolate themselves after travelling to distant places. The Newars of ancient Nepal travelled long distances for trade. As they moved about in far off places and mingled with different types of people, most of them would come back sick with some disease. In order to prevent such diseases from spreading to the community, it was a custom to isolate themselves before returning to their homes. Once they show signs of health, the chief priest would examine them and subject them to a purificatory ritual before sending them to their homes. The self-quarantine routine was an important part of Nepali Culture during the Malla Dynasty and was practiced until the last century.
The word kṛmi in Sanskrit means that which migrates from one location to the other. This term covers pathogenic organisms in general, but also includes microbes. One category of kṛmi is minute, without feet and invisible to the naked eye. The existence of microbes was clearly documented in classical Ayurvedic texts. It is even more interesting to note that these organisms were classified into the natural (sahaja) and pathogenic (vaikarika) . Cakrapaṇi, the commentator of Carakasaṃhita says that the natural organisms and microbes living in the human body have not been counted and this is perhaps a very early allusion to the human microbiome. Modern studies have confirmed that many herbs used in Ayurveda against kṛmis (kṛmighna) have anti viral and anti bacterial activity.
It would be pertinent to ask what medical measures Ayurveda has advised to deal with such epidemic diseases. Interestingly, the Carakasaṃhita says that we will need highly potent medicines to deal with an epidemic and that effort has to be taken to collect and process such medicines before the epidemic scales up. The text advises that as soon as an outbreak is anticipated, people should be administered medicines that enhance their immunity (rasayana) The importance of bolstering one's immune system to survive an epidemic was emphasised in ancient times in Ayurveda.
However, Ayurveda informs us that epidemics are not merely diseases that can be handled just by medical interventions. The texts emphasize that the root cause of an epidemic outbreak is adharma or unsustainable ways of human thought and action that damage the plant and animal life around us, the environment around us and the natural resources available on our planet - From the Ayurvedic point of view, an epidemic comes with a deep message. The message is that we have to mend our ways and find sustainable ways of living and a deeper connection with the Universe. As well as practice compassion to other living forms and even to other human beings and mother earth itself. For this reason, many spiritual practices and compensatory actions are recommended in the Ayurvedic texts for mitigation of the epidemic apart from medical measures. In the aftermath of an epidemic, humans can reflect and introspect and find ways to restore the lost harmony within their own selves, the people and living forms around them and the Universe itself. Caraka also mentions that one should protect onself (guptiratmanah) and relocate to places that are not affected by the disease.
The Structure of Classic Ayurvedic Writings - A Hidden Story
Dr Ram Manohar
The Classical texts of Ayurveda are variously called as Tantra, Sāstra, Lakṣaṇam, Śākhā and Vidyā. A tantra is a highly structured technical writing which employs many complex techniques of writing to coherently and concisely link sentences (vākya) and meanings (artha). These techniques are called as the Tantra Guṇas which are a measure of the quality of the writing.
In ancient days, it was a challenge to write and preserve knowledge in the absence of printing technology. Therefore the texts were composed in a neither too concise nor elaborate manner. Since it was a challenge to make copies of the manuscripts, the texts were designed for memorisation Oral transmission was the method of transferring the knowledge from one generation to another. Therefore, the texts served as a supplement material to the oral teaching. In other words, without the initiation of a teacher trained in the tradition, the written texts by themselves are difficult to read and understand.
The classical Ayurvedic writings are extremely codified and have preserved the information in an encrypted form. The key to decoding and decrypting the writings is safeguarded by the oral tradition. The teacher or the Guru holds the key to unlocking the knowledge preserved in the texts.
For this reason, a literal translation of classical texts will not yield deep insights. Without these deep insights, we cannot grasp the fundamental concepts and theories of Ayurveda. The deeper knowledge of Ayurveda arises in altered stated of consciousness. With the help of the teacher and the book, the consciousness of the student is also elevated, enabling him/her to comprehend the subtle aspects of Ayurvedic knowledge.
Modern aspirants of Ayurveda have limited access to the original writings of Ayurveda. Even when there is access, the right methodologies are often not applied to study and understand them.
In this discussion, an attempt will be made to unravel some aspects of the methods used in ancient times to study and understand the classical texts.
Systematic study of original Sanskrit words give better insights than translations. For example, the word Sukha is often translated as happiness. But the word Sukha in Sanskrit means good space. Su means good and Kha means space. So sukha means being in the good or proper space. At the mental plane it means the harmonious and coherent movement of thoughts. At the physical plane, it means that there is no obstruction in the micro and macro spaces of the human body. It means that all substances and fluids in the body are moving without any blockage. That is why Sukha is a synonym of health. To be healthy means that there is no stress in the mind as well as the body. There is no block in the flow of thoughts in the mind or the flow of substances in the body. The translation happiness cannot give such an insight. Sukha also means that we are positioned in the right time and space. Once we get to the root of the Sanskrit words, multiple meanings of the word give a deep illumination and insight, which is lost in the crude translation.
The method of exposition of the knowledge of Ayurveda adopted in the classical texts is to first summarise everything in a nutshell and then to elaborate in greater detail. Therefore, the first section of the main classical texts is called the Sutrasthanam. Sutra means thread. It is like the thread that connects everything together. The essence of Ayurvedic knowledge is first given in a seed form. Then it is elaborated just like a plant is grown from the seed. This is different from the modern method of breaking the subject into different topics and studying them one by one.
For example, in the Sutrasthana of Astangahridayam, the entire concept of treatment and the structure of an Ayurvedic prescription is explained. Chapter One introduces the basic terminologies of Ayurveda but also emphasises that the foundation of all treatment is psychological counselling. Without proper psychological counselling results of other methods of treatment cannot be optimised. Chapters 2 to 4 deal with lifestyle. This means that to change lifestyle, psychological counselling is needed. Chapters 5 to 8 deal with Food, Nutrition and Diet. The message is that Food is properly transformed and will nourish the body only if lifestyle is optimised. Diet control without lifestyle changes will not yield results. Next comes the application of medicines, therapies and surgery. With the support of psychological counselling, lifestyle adjustments and diet regulation, medicines, therapies and surgery can be applied to cure and manage diseases. Chapters 9 and 10 deal with the study of the properties of substances used as medicine. Chapters 11 to 14 deal with the physiology and pathology of the body giving an insight of how medicines can reestablish normalcy. Chapter 15 gives the knowledge of formulating different drugs into medicines that can be administered internally. Chapters 16 to 24 deals with the external therapies and cleansing procedures. Internal medications prepare the body for external therapies and cleansing procedures. That is why internal medications are mentioned first and then the external therapies and cleansing procedures. Chapters 25 to 29 deal with minor and major surgical procedures. Surgery is an option only when other approaches fail. So it is mentioned last. Even more invasive and destructive treatments are described in the end. Chapter 30 deals with thermal cautery and alkaline cautery, which are the final options when even surgery fails. Thus, the 30 chapters of Sutra Sthana engineers the mind. of the Ayurvedic aspirant to structure a comprehensive prescription that begins with psychological counselling and ends with thermal and alkaline cautery. All these methods need not be always employed in all patients. We can thus see that a lot of information is conveyed even by the sequence and subject of the chapters in a particular section of the text.
In Carakasamhita, the Nidana Sthana which deals with Diagnosis of diseases is surprisingly short and concise. It contains only 8 chapters. We may wonder why this important section is very brief. Once again, the answer to this question is in the sequencing of chapters. The diseases dealt with in the Nidanasthana of Carakasamhita are Jvara (Fever), Raktapitta (Hemothermia), Gulma (Intestinal distention and tumours), Prameha (Diabetes), Kustha (Skin Diseases), Sosha (Consumption), Unmada (Psychosis) and Apasmara (Epilepsy). If we look at these diseases carefully, we can understand that they describe the substratum for manifestation of all diseases. The first six diseases originate in the body and the last two in the mind. Therefore, this list of diseases point out that the body and the mind are the substratum of diseases. The first three diseases manifest in the alimentary tract or Kostha of the body, which is the first disease pathway. The next two diseases manifest in the Sakha or peripheral pathway of the diseases. And the next disease, sosha manifests in the Marma or the central pathway of the disease. Jvara represents affliction in the Rasadhatu, Raktapitta in the Raktadhatu and Gulma in the Mamsadhatu. Prameha affects the Medodhatu and Kushta the Asthi and Majja Dhatus. Sosha affects the Sukradhatu. With the help of these six diseases, the involvement of the seven dhatus in diseases are explained. Unmada represents Rajoguna imbalance of the mind, whereas Apasmara denotes the Tamoguna imbalance of the mind. Thus, the Nidanasthana of the Caraka Samhita explains the platform and pattern for the manifestation of all diseases, which are further elaborated in the section on treatments. We can say that the Nidanasthana maps the evolution of diseases in a comprehensive manner and all other diseases come within the gambit of this classification.
Even the structuring and sequencing of chapters convey profound meanings and give interesting insights. We can then imagine what a more systematic study of the texts can yield.
Why does the chapters of Rasayana and Vajikarana in Caraka Samhita have four subchapters each? Why is Rasayana mentioned before Vajikarana. Why are both mentioned before discussion of treatments? What is the meaning of Sarira in Ayurveda? Is it just the study of Anatomy or something more? These are some of the questions regarding the structure of the texts that will be discussed in the talk.
We will also discuss about the methods of studying classical texts - Sentence by sentence (Vakyasah), Meaning of the Sentence (Vakyarthasah), Deeper meaning of the sentence (Vakyarthavayavasah). This is coming within the scope of Patha (Reading) and Avabodha (Contemplating). Once the text is carefully read and contemplated, then it has to be applied in practice (Anusthana).
To sum up, the discussion will be focused on the keys that can unlock the hidden meanings of the classical Ayurvedic texts, an exercise that can bring about a deep transformation in our perception and understanding of Ayurveda and of life itself.
Traditional veterinary medicine
Dr P Ram Manohar
The history of biological sciences in ancient India is ill understood. Not to speak of its relevance and scope in contemporary times. The word Ayurveda can be aptly translated as Life Science and its scope is more than the health care of human beings. It extends to other forms of life including plant and animal life. Indeed, the ancient disciplines of Vṛkṣāyurveda and Mṛgāyurveda dealt with plant and animal life.
The branch of veterinary medicine was well developed in ancient India and was devoted to the well-being of domesticated animals like cows, horses and elephants. Earliest references can be seen in Vedic literature. Animal husbandry was prevalent in ancient India and cows, horses and elephants were the most common domesticated animals. For this reason, we find text books on Animal Husbandry and Veterinary Medicine exclusively devoted to cows, horses and elephants.
The first ever text book on Zoology seems to be Hamsadeva's Mṛgapakṣi Śāstra - The Science of Animals and Birds. Most of the available texts on animals deal with veterinary medicine and are utilitarian in nature. In medical textbooks, animals are described as sources of meat. However, the Mṛgapakṣiśāstra was composed out of compassion for animals. In the first few verses of this text, the change of mind that happened to King Shaudadeva is described. When the King approached the forest with great zeal for hunting, he was suddenly overwhelmed by the diversity and beauty of the animal kingdom that he beheld. He exclaimed, "What a wonderful creation of God!... How cruel of me to desire to kill these living beings?" It was as desired by the King on his return to the palace, that Hamsadeva composed this text describing the different species that populate the animal kingdom on earth.
Hamsadeva uses a structured format to describe a particular species of animal or bird. It covers the entire life cycle starting with mating behavior and then goes on to describe pregnancy, delivery, behaviour of offspring, variations within the species, the life span and death. He describes the behavior of female species separately as well as the psychological inclinations of the animals and birds. This is a unique text that attempts to determine species and characteristics of various animals and birds in India. Hamsadeva recognizes different types of animals within a species. For example, he identifies six subtypes of lions - the killer, the majestic, wide-jawed, red-eyed and yellow.
The diversity of animal life has been well captured in the ancient literature of India. The canons of Caraka and Suśruta classify animals on the basis of their habitat and predatory behaviour. Animals are classified on the basis of habitat into terrestrial, underground, aquatic, aerial and marshy types. Animals are prey snatchers (prasaha), peckers (viṣkira) or attackers (pratuda). In different texts, animals have been classified on the basis of varied criteria. Animals are reproduced sexually (yonija) or asexually (ayonija). Sexual reproduction is either through eggs (oviparous) or placenta (viviparous). The texts also speak of life emerging from moisture and heat as well as from dead vegetation. One classification distinguishes animals by number of feet and another by the presence or absence of hoofs. The Matsyapurān classifies animals on the basis of their activity into diurnal, nocturnal or both. A number of animals have been described in the context of food and dietetics. The medicinal and nutritional properties of meat from a variety of animal sources have been documented in the classical texts of Ayurveda. The food web and food chain have been described highlighting the principle that one form of life is food for another (jīvasya jīvo jīvasya). The snatchers are animals that snatch and eat their prey (1). Burrowing animals are those that live in pits under the ground. Wetland animals are those that live in marshy places. The aquatic animals live in water and the floating animals float on water. Terrestrial animals are those that live on land. The peckers are those that peck on the ground to pick their food. The piercers are animals that pierce and tear their prey before eating (2). These are the eight type of animals from which edible meat is obtained (3). Caraka Sūtrastha, ̄na, 27.53-56
Śa of Hayāyurveda is an ancient textbook of veterinary medicine that classifies horses and describes treatments for horses apart from providing accounts of anatomy. ̄lihotra composed many treatises on horses, which were translated into Arabic, Persian and Tibetan. A treatise on Pālaka devoted to elephants was composed by Gajāyurveda, which deals with treatment of diseases afflicting elephants.
Gajāyurveda is still practised by traditional experts in states like Kerala. Veterinary herbal medicines are manufactured and marketed by pharmaceutical firms in India.
People of ancient India lived in close proximity with nature and were keen observers of animal life. It has been mentioned in some texts that the first clues regarding medicinal properties of plants can be discovered from animal behaviour. Thus, ancient Indian literature has one of the earliest documented evidence of the practice of zoo-pharmacognosy, that is, the discovery of medicinal uses of plants by observing how animals eat specific plants when they suffer from a disease, have worms or have been bitten by a snake.
We can thus see that Zoology, Animal Husbandry and Veterinary Science were developed in ancient India. In modern times, Veterinary medicines are being developed from Ayurveda and there are still live traditions of Ayurvedic veterinary science like Gajayurveda.
This paper will discuss the historical evolution of animal sciences in ancient India and explore the potential applications and scope of this ancient knowledge in contemporary times.
Ojas, Prana and the psyche
Dr P Ram Manohar
In the chapter dealing with alcoholism (madātyaya), the Carakasamhita points out the relationship between Ojas and Manas. Alcohol or Madya affects Ojas with exactly opposite qualities. When the Ojas is affected, Satva or Manas which is dependent on Ojas gets disturbed. A major function of Ojas is to invigorate and stabilise the mind.
Elsewhere, the decline in Ojas has been linked with major mental disturbances. Emotional instabilities like fear, worry, lack of enthusiasm have all been associated with debilitation of Ojas. Manas and Ojas influence each other profoundly. Just like disturbances in Ojas can affect the mind, disturbances in the mind can also affect the Ojas. Anger, anxiety and sorrow can deplete Ojas instantaneously.
Prāṇa is the link between Ojas and Manas. In other words, we can say that Manas, Prāṇa and Ojas represent one single continuum connecting the Mind, Nervous System and the Immune System of the body. In medical science, this is nowadays recognised as PNI or Psycho-Neuro-Immunological Axis.
PNI researchers have revealed how emotions and thoughts impact our brain, hormones, and nervous system and also our immune system's ability to protect us. It can also work the other way - changes in the immune and endocrine systems create changes in our nervous system which lead to changes in our emotions also.
Here is what new research on PsychoNeuroImmunology has revealed.
"People who were abused or neglected as children can have permanent changes in their brain chemistry and immune response as a result. Trauma survivors, like military veterans, natural disaster and assault victims, and those who work in first responder roles, have higher than expected incidences of both infectious illnesses (because their immune response to viruses is reduced) and cancer.
Even loneliness can be the cause of immune system suppression that can lead to illness. PNI also studies how positive emotions can bolster both immune and endocrine system responses. The interactions work in the other direction as well, with many disease sufferers prone to developing clinical depression in response to lowered hormone levels and chronic inflammation. Studies of cancer victims and other disease-sufferers who receive psychotherapy and group support show that these interventions in emotional health can have an impact on physical health.
The link between stressful emotions and our immune system has also been well studied.
"Stressful emotions also reduce the numbers and effectiveness of immune system cells, including the inflammation response which is part of our non-specific protection, the t cells that directly attack invaders and the Natural Killer (NK) t-cells that rid us of cancers, the macrophages that also attack directly, and the cells and processes, including cytokines, that fuel chronic inflammation - a risk factor for cardiovascular disease and cancer".
The new findings in modern medical science seems to echo the observations in classical Ayurvedic texts about emotions and immune system.
ojaḥ kṣīyeta kopakṣuddhyānaśokaśramādibhiḥ - Ojas will decline by anger, hunger, thinking too much, sorrow, exertion and such other activities. When Ojas declines, immunity is compromised.
A person whose Ojas is affected has been graphically described thus -
bibheti durbalo/bhīkṣṇam dhyayate vyathitendriyaḥ, duśchāyo durmanā rūkṣo bhavet kṣāmaśca tatkṣaye - When there is a decline in Ojas, one loses strength and immunity, one begins to worry too much, the senses are under stress, the natural complexion is afflicted and the mind takes on a negative disposition and the person becomes dry and debilitated.
While the superficial correlations are striking, we cannot straight away equate Manas, Prāṇa and Ojas with the Mind, Nervous System and the Immune System. The observations in the classical Ayurvedic texts and the findings in modern medical science converge in the understanding of the deep interconnection between the mind and the body.
The Carakasamhita itself has pointed out that the mind can exert a powerful healing effect on the body. When the mind is influenced favourably, there is satisfaction, enhancement of energy and immunity. There is significant reduction in overall physical and mental strength leading to the reduction in the severity of the disease.
manaso/rthānukūlyāddhi tuṣṭirūrjābalodayaḥ, sukhopabhogatā ca syād vyādheścāto balakṣayaḥ.
We will explore how the pyschosomatic pathways of the human body have been depicted and mapped in the concept of Manas, Prāṇa and Ojas in the human body.
Ojas itself is said to be the Tejas of the Dhātus. Which means it is the refined essence of the physical food that we eat - ojastu tejo dhātūnām.
At the physical level Ojas is said to be responsible for the ability of the organism to act - tannibaddham hi ceṣṭitaṃ. Thus, we can understand that Ojas is linked to Prāṇa because Prāṇa is the impulse that enables us to act. Prāṇa is the master controller of all the sensory and motor activities of the body. And Prāṇa is also that which links the physical body with the mind.
It woud be an interesting exercise to explore how the connections between Manas, Prāṇa and Ojas have been elaborated in the classical Ayurvedic texts and how these are applied in clinical situations to kindle the healing mechanisms in the human body in a holistic manner.
Parkinson's disease (PD) is a neurodegenerative disorder that affects predominantly dopamine-producing ("dopaminergic") neurons in a specific area of the brain called the substantia nigra. Symptoms generally develop slowly over the years. The classical features of Parkinson's disease are a) Bradykinesia - slowness of movement, b) Tremor - Shaking of limbs, hand or fingers, c) Rigidity, d) Imparied posture and balance, e) Loss of automatic movements, f) Changes in speech, g) Difficulty in writing.
All these symptoms may not be seen in all the patients. A combination of slowness of movement, tremors and rigidity can make one to strongly suspect Parkinson's disease.
The current understanding of Parkinson's disease has a primary focus on the changes that happen in the brain, specifically in the area called the substantia nigra that leads to a deficiency of dopamine in the body.
Unfortunately, effective treatment for Parkinson's disease (PD) is not yet available. Treatment for each person with Parkinson's Disease is customised considering his or her symptoms.
Treatments can include both medication and surgery. Lifestyle modifications are also recommended for the management of Parkinson's Disease like getting more rest and exercise. Although there are many medications available for PD, none of them can bring about a cure, though these medications can manage the symptoms to a certain extent. Patients with PD take a variety of these medications - all at different doses and at different times of day - to manage symptoms.
The most commonly used medicine for Parkinson's is levodopa (also called L-dopa) is. L-dopa is recognised as the best mediation at controlling the symptoms of PD, particularly slow movements and stiff, rigid body parts.
Levodopa works when brain cells convert it into dopamine, which is a chemical the brain uses to send signals that helps to move the body. People with Parkinson's don't have enough dopamine in their brains to control their movements.
Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better so that its dose can be reduced to prevent side effects.
Safinamide (Xadago) is an add-on medicine that is prescribed when individuals taking levdopoa and carbidopa have a relapse of Parkinson's symptoms that were previously under control.
There are other drugs called Dopamine agonists which simulate the action of dopamine. There are also other medicines that influence the activity of dopamine in the brain and can help in control of the symptoms of Parkinson's Disease.
All these medications have the risk of side effects on long term use and can only mask symptoms. Studies have indicated that these medications cannot even prevent the progress of the disease.
The renowned neuroscientists of the world, Dr. V.S. Ramachandran recently recommended Ayurveda to treat Parkinson's disease over. He has also expressed interest to collaborate with Indian doctors to study Ayurveda drugs as they have lesser side effects and could be more effective in treating Parkinson's disease than allopathic drugs.
Dr. V.S.Ramachandran, is currently director, Centre for Brain and Cognition and distinguished professor with the neuroscience program and department of psychology, University of California, San Diego. He has been hailed as one of the most eminent neuroscientists in the world and was selected as one among the 100 most influential persons in the world in 2011 in a survey conducted by the Time magazine. He is very well known for his best selling books like Phantoms in the Brain and Tell-tale Brain.
In an interview during a visit to India, he explained that the Ayurveda drug Mucuna pruriensis (a variety of bean, rich in L-dopa and known in Sanskrit as Kapikacchu) was tested and proven in clinical trials to be more effective than allopathic drug placebo and synthetic L-dopa used to treat Parkinson's disease, especially exhibiting fewer side effects.
Well, in this discussion, I do not intend to discuss about Mucuna pruriens, which as discussed above is being seriously considered as a safer and more effective alternative for the management of Parkinson's even by modern scientists. The use of L-Dopa as well as Mucuna pruriens is based on the perception of Parkinson's disease as a pathological process that is exclusively happening in the brain of the patients. The excessive presence of an abnormal protein called alpha-synuclein has been found in the brain regions of patients affected by Parkinson's disease.
Parkinson's disease is characterized by the buildup of a misfolded protein, called alpha-synuclein, in the cells of the brain. As more of these proteins begin to clump together, they cause nerve tissues to die off, leaving behind large swaths of dead brain matter known as Lewy bodies. As brain cells die, they impair a person's ability to move, think or regulate emotions.
And it is here that a completely new way of looking at Parkinson's Disease emerges. The possibility that Parkinson's Disease may actually have origins in the gut rather than the brain. And a number of studies in recent times have lend substance to this hypothesis. It all began with observations made in 2003 by German neuroanatomist Heiko Braak who demonstrated that people with Parkinson's disease also had accumulations of the misfolded alpha-synuclein protein in the parts of the central nervous system that control the gut. Hanseok Ko, Johns Hopkins, observed that the appearance of these neuron-damaging proteins is consistent with some early symptoms of Parkinson's disease, which include constipation. He went on to hypothesize that Parkinson's disease originates in the gut and then moves up to the brain.
Studies have pointed out to the possibility that the misfolded alpha-synuclein protein may travel from the gut to the brain through the vagus nerve. The vagus nerve runs like an electrical cable from the stomach and small intestine into the base of the brain. This possibility was experimentally proven when researchers injected guts of mice with misfolded alpha-synuclein in two groups, one with vagus nerve intact and the other with vagus nerve removed. They found that the misfolded alpha-synuclein traveled to the brain in the group of rats with intact vagus nerve.
A correlation has also been made between good microbiota and Parkinson's disease. A number of studies have reported that individuals with Parkinson's disease have a unique composition of gut microbes. Transplanting fecal microbes from patients into rodents predisposed to develop Parkinson's can worsen motor symptoms of the disease and increase alpha-synuclein aggregation in the brain.
It is also suspected that inflammation in the well triggered by microbes may have a role to play in the development of Parkinson's Disease.
This is the most interesting part of our discussion. For centuries, Ayurveda has considered the gut, especially the lower intestine to be the primary seat of Vāta. The upward movement of Vāta known as Udāvarta is considered to be an underlying pathology in many diseases. It has been a fascinating experience to see clinical improvement in patients with Parkinson's disease when treated with Ayurvedic medications and treatments that target the gut, especially to re-establish the natural functions of Apāna Vāta. In fact, this approach seems to give results more quickly in the clinical settings than the administration of Mucuna pruriens alone.
Three patients in different stages of the development of Parkinson's Disease are followed up closely to see the improvements in clinical presentation with Ayurvedic treatment that focuses on correcting the functions of Vāta in the lower well. In all three patients, constipation was found to be a cardinal symptom and the clinical improvement has been seen to be directly proportional to the improvement observed in constipation.
The Ayurvedic approach to the management of Parkinson's Disease is clearly a bottom up approach starting from the good and gradually moving towards the brain region, the head. Internal medications for Dipana and Pachana, followed by Snehapana and Virechana, the administration of Vasti and then treatments like Nasya and Sirovasti are found to bring remarkable clinical improvements in patients presenting in different stages of progression of Parkinson's Disease.
It would be an interesting exercise to study about the effect of Ayurvedic treatment in influencing the misfolding of alpha synuclein protien as well as its migration from the gut to the brain. It would also be interesting to see if Ayurvedic treatments can restore the balance of the microbiome in the gut of patients afflicted with Parkinson's Disease.
Careful documentation of cases of Parkinson's Disease treated with Ayurvedic interventions highlighting and correlating the treatment protocol with clinical improvements will be a very important first step in this direction.