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					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,
Alzheimer‟s disease, Depression, Psychiatric disorders, Parkinson‟s 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,
Alzheimer‟s 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
AYURVEDA AND GERIATRIC CARE
-A BROAD OUTLINE
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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
one‟s 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. Medhya Rasayana: Rasayana that act specifically as brain tonics,
eg: Shankhapushpi, Mandukaparni, Yashtimadhu and Guduchi.
B. 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.
C. Droni-Praveshika Rasayana: A very spectacular form of Rasayana,
where in a person is made to consume stomach full of the juice of
3
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.
4
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), Cow‟s 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:
Chyawanprasha
Brahmi Rasayana
Aswagandha Lehyam
Mahatriphala Ghrita,
Triphala Curna
5
Aswagandha Curna
Narasimha Rasayana
Agastya Rasayana
Amalaki Rasayana
3. Challenges for contemporary application of Ayurvedic geriatrics
3.1. 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.
3.2. 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
7
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
1/5
th 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,
Alzheimer‟s disease, Depression, Psychiatric disorders, Parkinson‟s disease and
Urinary incontinence diminish the quality of life.
RASAYANA - HEALTHY AGING
8
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, Parkinson‟s & 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
9
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 do‟s and don‟ts 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).
10
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), Cow‟s 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
Cyawanprasa
Brahmi Rasayana
Aswagandha Lehyam
Mahatriphala Ghrita,
Karisalai Legiyam
Triphala Curna
11
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 Nature’s 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.
13
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 Cyawanprasa–Ayurvedic 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. Clinical & Experimental Studies on Rasayana Drugs & Panchakarma
Therapy, CCRAS, New Delhi, 1993.
2. Management of Hemiplegia by Panchakarma therapy, Central Council
for Research in Ayurveda and Siddha, Janakpuri, New Delhi-1990.
15
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 individual‟s 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
NEUROLOGICAL DISORDERS
(Nadisansthanagata Roga)
16
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. Antihypertensive drugs – Arjuna, Pushkarmoola, Prabhakaravati,
Hridyarnava Rasa, Arjunarista, Arjunakshirapaka, Sarpagandhadi Vati
2. Antihypercholesterolemic drugs – Arogyavardhini vati, Navakagugglu,
Kaisor guggulu, Triphala Curna, Trikatu Curna.
3. 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
17
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
18
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. CCRAS Research an over view, CCRAS, New Delhi, 2002
2. Clinical & Experimental Studies on Rasayana Drugs & Panchakarma
Therapy, CCRAS, New Delhi, 1993
19
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.
MUSCULOSKELETAL DISORDERS
(Mamsa-Asthi-Sandhigata Roga)
20
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 do‟s and don‟ts 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. Bala (Sida cordifolia)
2. Guggulu (Commiphora mukul)
3. Rasna (Pluchea lanceolata)
4. Eranda (Ricinus communis)
5. Bhallataka (Semecarpus anacardium)
6. Laksha (Laccifer lacca)
7. Kupilu (Strychnos nux-vomica)
8. Sunthi (Zinziber officinalis)
9. Aswagandha (Withania somnifera)
10. Nirgundi (Vitex negundo)
11. Guduchi (Tinospora cordifolia)
Some compound formulations in musculoskeletal disorders
1. Vaiswanara Curna
2. Aswagandha Curna
21
3. Rasna Panchaka Kwatha
4. Maharasnadi Kwatha
5. Dashmoola Kwatha
6. Rasna saptaka Kwatha
7. Yogaraj Guggulu
8. Mahayoga Raja Guggulu
9. Sinhnada Guggulu
10. Sunthi Guggulu
11. Saptavinsati Guggulu
12. 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.
22
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.
23
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.
24
AYURVEDA AND SIDDHA
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.
CARDIOVASCULAR DISORDERS
(Hridroga)
25
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
26
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,
27
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.
RESPIRATORY DISORDERS
(Swasansansthanagata Roga)
28
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.
2. Medicinal Treatment – Number of herbal and herbomineral preparations
are in practice which strengthen the respiratory system and have
curative effect in respiratory disorders.
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.
29
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
4. 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)
30
AYURVEDA AND SIDDHA
Some single Herbs acting on Respiratory System
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)
EVIDENCE BASED RESEARCH
1. 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
31
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.
32
AYURVEDA AND SIDDHA
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

DIABETES MELLITUS
(Madhumeha)
33
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. Amalaki (Phyllanthus emblica),
2. Meshasringi (Gymnema sylvestre)
3. Karavellaka (Momordica charantia)
4. Methika (Trigonella foenum-graecum)
5. Shilajit (Black bitumen),
6. Vijaysar (Pterocarpus marsupium)
7. Jambu (Syzygium cumini)
8. Tejpattra (Cinnamomum tamala)
9. Twak (Cinnamomum zeylanica)
10. Guduci (Tinospora cordifolia)
11. Bimbi (Coccinia grandis)
12. Khadirasara (Acacia catechu)
13. Katphala (Myrica nagi)
14. Kakamaci (Solanum nigrum)
15. Devadaru (Cedrus deodara)
34
AYURVEDA AND SIDDHA
AYURVEDIC FORMULATIONS
1. Candraprabha Vati,
2. Silajitwadi Vati
3. Vasanta Kusumakara Rasa
4. Trivanga Bhasma
5. Phalatrikadi Kwatha
6. Vangabhasma,
7. Nisamalaki Curna
8. Kathakakhadiradi Kwatha
9. Mehari Vati
10. 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 6th 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
35
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.
36
AYURVEDA AND SIDDHA
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 payer‟s 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

DIGESTIVE DISORDERS
(Pacanasamsthanagata Roga)
37
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 individual‟s
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 Ayurveda‟s primary purification and
detoxification treatment. Panchakarma means the “five therapies”. These
5 therapeutic means of eliminating toxins from the body are Vamana,
38
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. Lavana bhaskara Curna
2. Hingvastaka Curna
3. Saindhavadi Curna
4. Sunthyadi Curna
5. Vaiswanara Curna
6. Narayana Curna
7. Shivakshara pachan Curna
8. Hingvadi Vati
9. Citrakadi Vati
10. Ajirnakantaka Rasa
11. Agni kumara Rasa
12. Vishatinduka Vati
13. Drakshasava
14. Kuberaksha Vati
15. Kankayana Vati
For Diarrhoea:
1. Siddha praneshwara Rasa
2. Dadimastaka Curna
3. Bilwadi Curna
4. Gangadhara Curna
39
5. Kapithashtaka Curna
6. Lasunadi Vati
7. Sankha Vati
8. Sanjeevani Vati
9. Anandabhairavi Ras
10. Kutaja Ghana Vati
11. Siddha Praneswara Ras
12. Karpura Ras
13. Pathyadi Curna
14. Jatiphaladi Curna
15. Cangeryadi Gutika
For vomiting:
1. Bilwadi Avaleha
2. Eladi Vati,
3. Dadimashtaka Curna
4. Chardiripu Vati
5. Dadimavaleha
6. Mayurapinccha Bhasma
For IBS:
1. Citrakadi Vati
2. Hingwastaka Curna
3. Sankha Vati
4. Maha gandaka Rasa
5. Agnitundi Vati
6. Panchamrita Parpati
7. Kravyadi Rasa
8. Kaidaryadi Kvatha Curna
40
AYURVEDA AND SIDDHA
9. Pippalyasava
10. Takrarista
11. Shatapushpadi Curna
12. Jeerakadyarishta
For Hyperacidity:
1. Avipattikara Curna
2. Amalaki Curna
3. Yastimadhu Curna
4. Sutasekhara Rasa
5. Kamadudha Rasa
6. Pravala Panchamrita
7. Pravala Pisti
8. Dhatri Lauha
9. Indukantha Ghrita
10. Misreya Curna
For Constipation:
1. Triphala Curna
2. Panchasakara Curna
3. Shatsakara Curna
4. Eranda Taila
5. Dantiharitaki
6. Hingu triguna Erandam
7. Isabgol Husk
8. Draksharishta
9. Abhayarishta
10. Kumaryasava
41
For liver disorders:
1. Arogyavardhini Vati
2. Phalatrikadi Kwatha
3. Katuki Curna
4. Bhunimbhadi Kwatha
5. Rohitakarista
6. Avipattikara Curna
7. Bhumyamalaki Swarasa
8. Eranda Pallava Swarasa
9. Vasaguducyadi Kvatha
10. Kumaryasava
11. 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
42
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-à-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.
43
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, Alzheimer‟s disease,
Parkinson‟s 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.
Parkinson‟s 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.
Parkinson‟s 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.

PSYCHO NEUROLOGICAL DISORDERS
(Mano evam Nadi tantrika roga)
44
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.
45
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. Brahmi – Bacopa monnieri
2. Sankhpushpi - Convolvulus pleuricaulis
3. Mandukparni - Centella asiatica
4. Aswagandha -Withania somnifera
5. Kapikacchu - Mucuna pruriens
6. Vaca - Acorus calamus
7. Jatamansi - Nordostachys jatamansi
8. Guduci - Tinospora cordifolia
9. Bala - Sida cordifolia
10. Badam - Prunus amygdalus
11. Goghrita - Cow ghee
12. Godugdha - Cow milk
Ayurvedic Formulations
Curna -
1. Saraswata Curna,
2. Aswagandha Curna
Vati -
1. Brahmi Vati,
2. Sarpagandhadi Vati
3. Manasamitra Vati
46
AYURVEDA AND SIDDHA
Asava -
1. Aswagandharista,
2. Saraswatarista
Taila -
1. Jyotishmati Taila,
2. Brahmi Taila
3. Himasagara Taila
4. Tungadrumadi Taila
Ghrita -
1. Maha Pancagavya Ghrita
2. Kalyanaka Ghrita
3. Saraswata Ghrita
4. Bramhi Ghrita
Rasoushadhis -
1. Manasamitra Vataka
2. Smriti Sagara Ras
3. Yogendra Ras
4. Caturbhuj Ras
5. Pracand Bhairav Ras
6. Brihatvata Cintamani Ras
EVIDENCE BASED RESEARCH
1. 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.
47
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.
48
AYURVEDA AND SIDDHA
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 patient‟s 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

SURGICAL PROBLEMS IN ELDERLY
49
parasurgical techniques like Kshara sutra therapy for the management of some
surgical disorders like Piles, fistula–in-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. Arsakuthar Rasa
2. Arsoghna Vati
3. Kankayana Vati
4. Pranada Vati
5. Sigru Guggulu
6. Rasanjana Vati
7. Abhayarista
8. Prabhakar taila (for external use)
9. Surana Avaleha
10. Dantiharitaki
Beningn Prostatic Hypertrophy (BPH)
1. Varunadi Guggulu
2. Shigru Gugulu
3. Kanchanara Guggulu
4. Chandraprabha Vati
5. Shilajitvadi Vati
50
AYURVEDA AND SIDDHA
6. Punarnavasava
7. Gokshuradi Guggulu
8. Brihatyadi Kwatha
9. Varun Sigru Kwatha
10. Dasamoola Kwatha
11. Narayana Taila (for Vasti)
Calculus:
1. Pashanabhedadi Curna
2. Gokshuradi Guggulu
3. Varuna Sigru Kwatha
4. Sweta Parpati
5. Kulutha Kwath
Anti-inflammatory Drugs
1. Guggulu
2. Varuna
3. Sigru
4. Gokshura
5. Punarnava
6. 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
51
(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.
52
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. Monograph on clinical studies on Bhagandara (Fisstulo-in-ano) CCRAS,
New Delhi.
2. Monograph on "Clinical studies on Arsha (Hemorrhoids)" CCRAS, New
Delhi.
3. Book "Kshara sutra therapy for Ano rectal disorders", Dr. S.K. Sharma,
RAV Publication, New Delhi.
4. Monograph on "effect of Varuna, Kuluthha& Gokshura in the
management of Urinary calculus", CCRAS, New Delhi.
5. Monograph on "Management of BPH", CCRAS, New Delhi.
53
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
2. 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
3. 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
4. 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
5. Govt. Ayurveda College Hospital
Trivandrum, Kerala
Hospital Ph: 0471 - 2460823
College Ph: 0471 – 2474190
SOME CENTERS OF EXCELLENCE
(Ayurveda & Siddha) FOR GERIATRIC CARE
APPENDIX - 1
54
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
7. 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
8. National Institute of Siddha
Thambaram Sanatorium
Chennai-47 Reference:
044-22411611(Telefax)
098447211057
email. ambairuna@rediffmail.com
crisiddha@gmail.com
9. Central Research Institute (Siddha),
A.A. Govt. Hospital Campus,
Arumbakkam, Chennai-600106
Phone No: 044/26214809(O)
10. Regional Research Institute (Siddha)
Chellaperumal Street, Kuyavarpalayam
Pondicherry-605006
0413/2245072 (Telefax)
E-mail: rrisiddha@yahoo.co.in
11. Govt Siddha Medical College & Hospital,
Palayamkottai
Tirunelvelli-2
12. Govt Siddha Medical College & Hospital,
Aringar Anna Hospital, Campus, Arumbakkam, Chennai-106
Phone: (044) 26281563, 26214844
55
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
SOME NGOs ENGAGED IN GERIATRIC CARE AND
OTHER HEALTH PROGRAMMES
APPENDIX - 2

				
DOCUMENT INFO