Exploring Evidence for Contemporary Ayurveda

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1 Exploring Evidence for Contemporary Ayurveda Prof. R. H. Singh Professor Emeritus Faculty of Ayurveda Banaras Hindu University Varanasi, India

2 Ancient Concept of Evidence for Truth The Four - Fold Testing for Evidence: 1. Pratyaksa Direct Observation 2. Anumana Inferential Evidence 3. Aptopadesa Scriptural Evidence 4. Yukti Experimental Evidence

3 The Contemporary Concept Evidence is largely expressed in terms of the science of today. But it also implicates scriptural and experience-based evidence. Evidence for safety & efficacy of medications seems to be the focus. But it also implicates the validity of principles of Ayurveda.

4 Dimensions of Evidence Available: 1. Scriptural Evidence. 2. Experience-based Evidence. 3. Current Professional Evidence. 4. Mass Acceptability. 5. New Scientific Evidence.

5 The Historicity and the Available Ancient Literature Ayurveda is the most ancient system of medicine, its antiquity going back to the Vedas, surviving today through two sets of classic texts: Name of Texts Author Historicity Subject Brihattrayī The Three Major Texts : 1. Caraka Samhita Caraka B.C. Philosophy & Medicine 2. Susruta Samhita Susruta B.C. Practice of Surgery 3. Vagbhatta Samhitas Vagbhatta A.D. Medicine & Therapeutics Laghuttrayī - The Three Minor Texts : 1. Madhav Nidana Madhavkara 900 A.D. Diagnostics 2. Sarangadher Samhita Sarangdhara 1300 A.D. Medicine 3. Bhava Prakasa Bhava Misra 1600 A.D. Drugs and Herbs

6 EIGHT CLINICAL SPECIALITIES OF AYURVEDA KĀYACIKITSĀ ŚALYA TANTRA ŚĀLĀKYA TANTRA KAUMĀRABHRITYA AGAD TANTRA BHUTA VIDYĀ RASĀYANA VĀJIKARANA INTERNAL MEDICINE SURGERY EYE & ENT DISEASES PAEDIATRICS & GYNAEC TOXICOLOGY PSYCHIATRY NUTRITION & GERIATRICS SEXOLOGY, REPRODUCTION

7 Definition of Health in Ayurveda lenks"k% lekfxuüp le/kkrq eyfø;% A izlékresfunz;euk% LoLFk br;fhk/kh;rs AA & lqñ lwñ 15%41 Health is the state of equilibrium of Dosas, Agnis, Dhatus, Malas and body functions along with spiritual, sensorial and mental well-being.

8 Sun Pitta Teja Energy Oja Biology Prana Water Kapha Ecology Vata Air Tritriangular Eco-genomic Holism, the circle signifying inherent harmonising equilibrium

9 WHO Perspective of Global Evidence 1. Key issues in assessment of therapeutic effect : Clinical Epidemiology for clinical research. Standardization of diagnostic criteria. Clinical Trials to assess safety & efficacy. Systematic review on literature & clinical research 2. Cross - national evaluations using common Protocols. 3. Weighting the evidence using systematic reviews. 4. Conduct of research in practice - setting. 5. Evaluating information from completed studies.

10 Local Perspective : HMPC Regulation for Registration of Herbal Products in Europe The rationale behind the actual registration procedure is to enable products which have been in long standing traditional use to be registered because their safety and efficacy can be deduced from their long standing use. The long tradition of the medicinal product enables to waive requirement for clinical trials, insofar as the efficacy of the medicinal product is plausible on the basis of longterm use and experience. The preclinical tests do not seem necessary either, where the medicinal product on the basis of the information on its traditional use proves not to be harmful in specified conditions of use.

11 Priorities in Ayurvedic Drug Research Standardization and quality control of in-use Ayurvedic medicines with necessary GMP. New drug / formulation development through a Reverse Pharmacology approach.

12 Lead Areas in Drug Research 1. Antistress, adoptogens and memory enhancers. 2. Immuno-enhancers and Anti-Aging remedies. 3. Hypolipidemics and Cardioprotectives. 4. Hepatoprotectives. 5. Antidiabetics and Anti-arthritics. 6. Cytostatic and Anticancer Drugs. 7. Nutraceuticals and Antioxidents. 8. Cosmetics and Cosmetic base materials.

13 Plants with New Evidence for Specific Effect Bhumyamalaki Sakhotaka Vijaisar Sirish Haridra Nimba Rasona Guduchi Guggulu Ashwagandha Kpikachu Brahmi P. amarus S. asper P. marsupium A. lebek C. longa A. indica A. sativum T. cardifolia C. wighti W. somnifera M. pruriens B. monniera Antiviral/HBV Antifilarrial Antidiabetic Antihistaminic Anti-inflammatory Antiseptic, Antifungal Hypolipidemic Immunomodulater Hypolipidemic Antistress Antiparkinsonism Memory enhancer

14 Some Leading Phytochemicals & Their Uses Reserpine Phytoche micals Medicinal Plants Rauwolfia serpentina Therapeutic Use Hypertension Piperine Digoxine Levo Dopa Curcumine Vincristicine Kutakin Ephedrine Strychnine Atropine Punarnavine Bacosides Withanolides Allinin Glycyrrhizin Piper longam Digitalis Mucuna pruriense Curcuma longa Vinca rosia Picrorhiza kurroa Ephedra Nuxvomica Atropa bellodona Boerhaavia diffusa Bacopa monniera Withania somnifera Allium sativum Glycyrhiza glabra Bio- enhancer Cardiotonic Parkinsons Disease Anti-diabetic, Anti Cancer Anti-inflammatory Anti cancer Hepatoprotection Anti-asthmatic Neuro stimulnt Anti-spasmodic Diuretic Nootropic Adaptogen Hypolipidemic Anti inflammatory

15 Cytostatic Anti Cancer Activity of the Extracts of Some Plant Drugs against COLO 320 Tumor Cells Sl.No. Ayurvedic Name (Botanical Name) Part Used IC 50 µg/ml 1. VACA (A. calamus) Rhizome > ARKA (C. procera) Flowers < KAMPILLAKA (M. philippinensis) Glandula MAHANIMBA (Melia azadarach) Fruits SIGRU (Moringa oleifera lam.) Cortex > CHITRAK (Plumbago zeylanica) Branches > BHALLATAKA (S. anacardium) Fruits < KANTAKARI (S. xanthocarpum) Fruits NIRGUNDI (Vitex nigundo) Leaves > CISPLATIN - <10

16 Anti-stress effect of some Ayurvedic drugs in terms of Ed 50 and Antistress Unit Activity Plant Drug Screened Swimming Performance Test Prevention of Increase of Adrenal Wt. Prevention of Adrenal Ascorbic Acid Prevention of Increase of Adrenal Cortisol Prevention of Restraint Induced Ulcer Antistress Unit Activity 1. Tulsi (O.sanctum) 13.3 ± ± ± ± ± ± Ashwagandha (W.somnifera) 15.0 ± ± ± ± ± ± Aralu 27.4 ± ± ± ± ± ± 1.9 (A. excelsa) 4. Tinduka (D.perigrina) 40.3 ± ± ± ± ± ± Kutaki (P. kurroa) 41.5 ± ± ± ± ± ± Nilotpala (N. stellata) 48.8 ± ± ± ± ± ± Bimbi 46.3 ± ± ± ± ± ± 2.5 (C.indica) 8. E. centicosus 22.2 ± ± ± ± ± ± P. Ginseng 44.0 ± ± ± ± ± ± 2.3

18 Jyotismati (Celastrus paniculatus)

19 Effect of Jyotismati in cases of Depressive illness in terms of HDRS Trial Group BT Mean±SD AT Mean±SD d Mean±SD Unpaired t test Jyotismati alone n = 18 ± 3.54 ± 3.71 ± 1.69 p<0.02 Jyotismati added on n = 14 ± 2.49 ± 2.19 ± 1.75 Placebo n = 9 ± 3.72 ± 2.45 ± 2.47

20 Kapikacchu (Mucuna pruriens)

21 Changes in HDRS Scores in Cases of Depression Treated with Kapikacchu Total Cases No. 44 React. Depression No. 23 2nd Follow up 1st Follow up Initial Values Endo. Depression No

22 Pancakarma Therapy Samsodhana or Biopurification of the body using five-fold therapeutic technology of Pancakarma is an important component of classical Ayurveda. Some of these practices have shown notable effect in clinical settings viz., Vamana in treatment of bronchial asthma and allergies, Vasti in the treatment of neurological diseases, Snehana-Swedan in treatment of arthritis, Sirodhara in treatment of headaches, anxiety and insomnias etc.

23 Kshara Sutra Treatment Application of standardised medicated thread in treatment of fistulla-in-ano has shown notable success and acceptability. Gradual cutting and simultaneous healing of fistullar tract by Kshara Sutra has overwhelming advantage over conventional surgery for this purpose. There are convincing published data as evidence-base for this technique.

24 Conclusion Ayurveda is one of the most ancient systems of medicine and has enjoyed an unbroken tradition of practice in India for thousands of years till now. Because of its growing popularity and spreading global usage, a need has been felt to explore evidence-base for Ayurveda and its medications. The concept of evidence in this context is still vague. WHO while recognizing its scriptural and experiential evidence has suggested to gather also new scientific evidence. The last five decades have made commendable efforts in this direction which needs to be documented to identify leads for further research. Besides, there is a greater interim need to standardize the in-use medications for quality assurance through due GMP in order to strengthen the ongoing practice of Ayurveda in the hands of over 5,00,000 registered Ayurvedic practitioners who could play a significant role in National Health Care Program specially for rural masses.

25 Inspite of the fact that the ancient Hindu Medicine practised in India in the earliest times was an equally developed scientific discipline as any other contemporary system in the world, Its influence on the western society was small. Hence, most of the current writings in history of medicine do not have an appropriate mention of the contributions of ancient Indian medicine. Welch, C.S. 1968

26 Thank You

Evidence based Ayurveda

Evidence based Ayurveda in Hungary since 1991 Mr. Istvan Riesz Dr.(Ayu)Hon. Chairman of the Hungarian Ayurveda Medical Foundation PUO (1996, Budapest) www.ayurveda.hu, www.garuda.hu In frame of the First