Indian – Detoxification and Rejuvenation

Prof. Dr. Gangadharan GG, Ayurvedacharya, FAIP (USA), PhD, MoM (McGill, Canada) Director, Ramaiah Indic Specialty Ayurveda – Restoration Hospital, A unit of Gokula Education Foundation (Medical) New BEL Road, MSR Nagar, Mathikere PO, Bengaluru - 54 Tel: +91-80-22183456, +91-9632128544, Mob: +91-9448278900 e-mail: [email protected] Website: http://www.msricaim.com/

Introduction

• Indian knowledge systems (IKS) – foundational unity despite diverse nature • Contiguous, interconnected and epistemologically common identity • Same thread runs through gamut of activities including medicine, farming, cooking, grammar, dance, arts etc. • Currently, IKS are in a state of transition owing to external influence • Distorted promotion and popularization of IKS will be detrimental to its growth • WHO defines Traditional medicine as the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness • These include Ayurveda, medicine, Unani, , Iranian (Persian), Islamic medicine, traditional Chinese medicine, (drawn largely from TCM, in Japan), traditional Korean medicine, , , Ifá, and traditional African medicine and many many more newer practices • Very few of such practices are complete knowledge systems • Ayurveda – a comprehensive system, with holistic approach; attends to body, mind and spirit

Subjectivity and objectivity

Contemporary science systems • Testability • Four-fold approach • verifiability • Aptopadesha (Scriptures and • Reproducibility peers) • Quantitative • Pratyaksha (direct cognition) • Evidence based • Anumana (Inference) • Structural • Yukti (Rationale) • Generalised • Qualitative • Word of mouth • Functional Medical pluralism • Health behavior is a type of social behavior mainly influenced by the various socio-cultural issues. • Understanding a disease/illness is not a medical subject rather it is mainly reliant on the common information of the concerned community. • This has led to prevalence of more than one system of medicine existing • Medical Pluralism is an adaptation of more than one medical system or simultaneous integration of orthodox medicine with complementary and (CAM) Different traditional medical systems • Traditional include Ayurveda, , Unani, ancient Iranian medicine, Iranian (Persian), Islamic medicine, traditional Chinese medicine, Kampo (drawn largely from TCM, in Japan), traditional Korean medicine, acupuncture, Muti, Ifá, and traditional African medicine and many many more newer practices • Very few of such practices are complete knowledge systems • Ayurveda – a comprehensive system, with holistic approach; attends to body, mind and spirit

Challenges to traditional medicine

• Major threat is • trend to negate philosophical moorings • Discard their interconnectedness • Promote them as fragmented systems • Concept of holism, ethics in application and responsibility to the philosophy is diluted and disregarded • Need is • Explore and adopt ethical modes to adapt to changing times Advantage of Ayurveda

A functional framework that can accommodate any medical condition one may encounter.

A practical inventory of physical universe and their effect on the living system which, when understood makes everything Vikaro nama akushalo na jihriyat kadaachana around us a potential medicine Indicative correlates of theory with biomedical science Vata Pitta Kapha

Movement Transformation Anabolism

Governs nervous Actions of enzymes, Maintains body and musculoskeletal growth factors, mass, shape, and systems hormones flexibility

Signaling pathways Processes such as Biosynthesis of regulating cell growth, digestion, macromolecule. differentiation, and cell metabolism, coordination of death production gene and protein function

Sumantran and Tillu, 2012 Elemental tissues (dhatu) – factors affected in disease pathogenesis

• Rasa • Rakta • Mamsa • Meda • Fluid component • Intravascular • Muscular tissue • Adipose tissue (intra-extra component cellular)

Nourishes Gives life Covers Lubricates

• Asthi • Majja • Shukra • Structural • Intraosseous • Reproductive component material material (skeletal)

Supports Completes Reproduces

Image courtesy: ancientsciencesofhealing.blogspot.com • 52 single nucleotide polymorphisms (p ≤ × −5) were significantly different between Prakritis, without any confounding effect of stratification, after 106 permutations • PGM1 correlated with phenotype of Pitta as described in Caraka Samhita, suggesting that the pheotypic classificatio of Idia’s traditional medicine has a genetic basis; and its Prakriti-based practice in vogue for many centuries resonates with personalized medicine (Govindaraj et al, 2015) Triphala: An Intelligent Formulation Cause of disease in ayurveda (AMA)

Aberrant metabolism

Ama - Toxic, pro-inflammatory, waste-product

Blocks micro-channels (Srotas)

Disease Ayurveda theory of pathogenesis

Six stages of progression

2017 - 09 - 20

Dushya Nidana Dosha (Dhatu, Agni, Disease (Cause) (V,P,K) Ama)

Factors involved in disease production Therapeutics is designed to correct Nidana, Dosha and Dushya Variables in Ayurveda disease management

Causes

Pathogenesis Disease

Symptoms Diet No Symptoms 2017 - 09

Affecting factors Lifestyle -

Homeostasis 20 Medicines Good QoL Precise Customized Relief Health Constitution Diagnosis Treatment Therapies Systems & organs Tranquil mind

Age Counselling Well Being

Season Others

Strength Patient

Metabolic status Rogi Pariksha Tolerance

Surroundings

Diet Image Courtesy: Tillu G Holistic therapeutics

• Focus is on

• Host factors rather than disease factors

• Whole system rather than target tissue

• Multidrug/therapy rather than single molecule

• Preventive and promotive in addition to curative

Inherent strengths of Ayurveda 1. Customised intervention that varies according to individual constitutional frame work (prakriti) and the stage & phase of disease. 2. Multi-component intervention involving drug, diet, lifestyle, 2017 - 09 panchakarma (detox) and . - 3. A systemic cleansing of body ( chikitsa) using 20 techniques of Panchakarma that is unique to Ayurveda 4. A treatment approach that has homeostasis or restoration of balance as its end point. In this approach, stress is laid on two things: a. Apunarbhavatva: Achieving a stable state of homeostasis that does not relapse to the prior diseased stage (non-recurring). b. Yonyamanyamudeerayet: Achieving homeostasis without causing any disturbance to any other systems (without side- effects).

Ayurveda principles for healthy life

Dinacharya (Daily regimen)

Ritucharya (Seasonal regimen)

Panchakarma (5 purificatory procedure)

Rasayana (rejuventaion)

Aachara – Sadvritta (Behavioral therapeutics)

Ashtanga Yoga (8 steps of Yoga)

Nityam hitaharaviharasevi sameekshakari vishayeshvebhaktah I Dhata samah satyaparah kshamavanaptopasevi ca bhavatyarogah II (A.H.Su.4/36)

Aahara - SHADRASA PRADHANATA

Let thy food e thy ediie ad thy ediie e thy food Hippocrates Shadrasa-(Six tastes) - and alleviation of by tastes; Svadu /Madhura – sweet, Amla – Sour ,Lavana – Salt ,Tikta – Bitter ,Ushna – Katu – Pungent, Kashaya – Astringent are the six types of Rasa(tastes);they are present in the substances, each one is more strengthening (to the body)in their order of precedence. Rasaha swadvamlalavantiktoshnakashayakah || Shad dravyamashritaste ca yathapoorvam balavaha | tatraadyaa maarutam ghnanti trayastiktaadaya: kapham | kashaayatiktamadhuraa: pittamanye tu kurvate || (As.H.su1/14,15)

Diurnal and seasonal clocks

DINACHARYA

Healthy habits should be included in life-style even in the busy schedule , if a person want to be healthy forever. Includes- • Early go to bed and early wake-up. • Daily physical exercise. • Daily oil massage including scalp, ear and feet as well as bathing. • Daily use of oily nasal drops. • Maintenance of body hygiene. • Daily prayer and meditation. • Take nutritious and balanced diet. • Proper dressing. • Use of gems and jewellery. • Use deodorants and perfumes. • Wear good quality of shoes and sandals. • Select a job with morals and ethics

RITUCHARYA (SEASONAL REGIMEN)

• Environment influences the resting state of Doshas—Vata, Pitta, and Kapha • Good understanding of it is very much essential for early diagnosis and prognosis of any disease & for adopting preventive and curative measures. • Dosha accumulation in cold season - expelled in vasanta/spring • Dosha accumulation in summer / grishma - expelled in varsha / rainy season • Dosha accumulation in varsha - expelled in sarat / autumn • Key to preetio of ost NCDs – a gift of Ayurveda shiitotdbhavam doshacayam vasante vishodhayan griismajam abhrakaale I ghanaatyaye vaarsikamaa su samyak praapnoti rogaan rtujaanna jaatu

Main categories of therapeutics

Purification (shodhana) Palliation (shamana) Emesis (Kapha) Enhancing digestion Purgation (Pitta) Withstanding thirst Decoction (Vata) Withstanding hunger Nasal medication Exposure to sun Blood letting Exposure to wind Physical exercise shodhaaṃ shaaaṃ ceti samaasaat aushadham dvidhaa| shareerajaanaam doṣaaṇaa kramena paraauṣadha || basti: vireko vaaaṃ tathaa taila ghrutam madhu: | (A.H.Su.1/25) Homeostasis with Panchakarma – few reports

• Twice weekly Panchakarma treatment consisting of snehana (external oleation), swedana (passive heat therapy), hrudaydhara (concoction dripping treatment) and basti (enema) in patients of chronic heart failure significantly improved metabolic equivalents of task and peak oxygen uptake (Sane R, et al, 2017) • Quality of life assessment (Skindex-29) among patients of skin diseases, showed improvement quality of life domains- emotions, functioning, and symptoms before and after Ayurvedic purification therapy (Deshpande H, et al, 2016) • Ayurveda panchakarma intervention resulted in changes in metabolites across many pathways such as phospholipid biosynthesis, choline metabolism, and lipoprotein metabolism (Peterson CT et al, 2016)

• A combination of Panchakarma purificatory measure Virechana and multiherbal oral medication has been demonstrated to be effective in management of Hepatic Cirrhosis Complicated by Ascites (Patel MV et al, 2015) • Panchakarma therapy – Vamana showed significant relief in parameters of psoriasis such as scaling, itching, candle grease sign and psoriasis area and severity index score (Bhattacharya N, 2016). • A therapeutic course of Basti in obese individuals modulated immune responses by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells. These changes are associated with a reduction in the body weight which is maintained even after three months of treatment (Thatte U, 2015) Salutogenesis – Svasthya rakshana

• The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease – Aaron Antonovsky • Health is a positive state and it is the outcome of the adaptive feedback that each being establishes with the environment • Health is not merely a biological process, it is also a cultural one involving knowledge as well as the interaction with the environment in order to modify it Rasayana chikitsa

• Jara - Sequential biological human aging in terms of sequential loss of certain biological qualities of life specific to different decades of life • If these bio-losses are compensated in respective decades by appropriate life-style, nutrition and Ayurvedic rejuvenative Rasayana remedies described for this purpose, the rate of biological aging may be retarded • Rasayana are age-specific as they promote nutrition relevant to the natural bio-losses occurring at different phases of life span • Rasayana – Ensure excellence of tissue elements by • Deepana, pachana (enhanced metabolism) • Srotoshodhana (detoxification) • Poshana (nourishment) • All these three events singly or jointly lead to improved nutritional status in the body leading further to the formation of the best qualities of cells and tissues which sustain aging and stress Tridosha and biological clock • Predominance of Dosha changes with age • So also propensity for disease caused by a specific dosha differs across ages; eg. Disease of vata – degenerative illnesses in old age • Prophylactic measures to keep the dosha fluctuations in control helps avoid undue effects • Age appropriate Rasayana therapy Decade-wise ageing and prevention

2017 - 09 - 20 Rasayana chikitsa – an elixir – evidence

• Abundant evidence for anti-ageing/healthy ageing/reversal of process benefits of Rasayana • Few examples • Amalaki Rasayana (herbal formulation) and Rasa-Sindoor (a mercury-based organo-metallic formulation) suppressed cell death and pathology in fly models of neurodegeneration; contribute to 'healthy ageing (Dwivedi V, etal, 2015, 2016) • Curcumin reduces oxidative stress and apoptosis, and increase in the life span of PD model flies (Siddique YH etal, 2014) • Brahma Rasayana and Chyavanaprash reduce cardiotoxicity (Alsuhailbani etal ,2016) • Amalaki rasayana in aged individuals showed stable maintenance of DNA strand break repair without toxic effects (Viswanath U etal ,2016) Genomic Variation Analysis and Gene Expression Profiling of Human Dosha Prakriti based on Principals of Ayurveda

• Determination of Dosha prakriti of the subjects with Ayusoft software and senior ayurvedic physician (Vaidya) • Analyis of Genetic variation after isolating DNA from selected subjects. Results • Kapha prakriti specific CDH22 5′-UTR CpG methylation was also found to be associated with higher body mass index (BMI) (Nizamuddin S et al, 2015) • Significant difference in the expression of CD14, CD25 and CD56 markers between three different prakriti is demonstrated. The increased level of CD25 and CD56 in kapha prakriti may indicate ability to elicit better immune response, which is in conformity with textual references in Ayurveda (Rotti H et al, 2014). • Prakriti may govern functions at cellular, tissue and at system levels maintaining equilibrium determined by genes which in turn are regulated by epigenetic cross talk especially through DNA methylation. • These may provide basis to explore whether the DNA methylation programmed at the time of birth of an individual that will mimic the prakriti constitutions (Rotti H et al, 2015)

• Approaches to identify the influence of food and utritio i idiiduals groth, deelopet and disease causation • आहारस륍भवं वतु रगा�चाहारस륍भवा賈| हहताहहतववशेषा楍च ववशेष賈 सुखद賈खय賈ु ||४५|| C.S.Su.28 • Grow local, eat local • यय देशय य जनतु賈 त煍जं त煍जषधं हहतं ।B.N.5/8 • Scope for Ayurveda based food and beverages

The siee of life shall eer attai fiality. Therefore, humility and relentless industry should characterize your endeavour and approach to knowledge. The entire world consists of teachers for the wise. Knowledge conducive to health, longevity, fame, and excellence, coming even from an unfamiliar source, should be received, assimilated and utilized ith earestess. Acharya Charaka

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