Mainstreaming traditional systems of medicine and integrating them with the established health delivery mechanisms is an important step in accelerating advancement of health sciences to achieve current global health care goals. This paper proposes the “axial-model” of Integrative Medicine (IM). A replicable model, viable across multiple IM possibilities, which are clinically beneficial, supports evidence-based evolution and is socially acceptable. Axial model may be implemented to integrate two or more systems of medicines, provided they are legally regulated and approved for clinical administration. It proposes three consecutively phased clinical processes, named parallel, complementary and protocol, respectively. The model supports translational medicine by mainstreaming beneficial practices of traditional medicine as a part of its process of execution.
Integrative medicine; mainstreaming traditional medicine; translational medicine
Saraswatarishta (SA) is a herbo-mineral formulation consisting of 18 plants some of which are Medhyarasayanas. It has been claimed to be useful in treating central nervous system disorders.
To evaluate antidepressant effect of ‘Saraswatarishta’(SA) alone and in combination with imipramine and fluoxetine in animal models of depression.
Materials and Methods:
After obtaining IAEC permission, 144 rats (n = 36/part) were randomized into 6 groups- Group 1: Distilled water (1 mL), Group 2: Imipramine (30 mg/kg), Group 3: Fluoxetine (10 mg/kg), Group 4: SA (1.8 mL/kg), Group 5: Imipramine + SA, Group 6: Fluoxetine + SA. Effects of study drugs were evaluated in forced swim test (FST) with single exposure to FST (Part 1) and repeated exposure for 14 days (Part 2). In Part 3, reserpine was used with FST and effects of study drugs were evaluated against single exposure to FST. Same model was used with repeated exposures to FST (Part 4). In each part, rats were subjected to open field test (OFT) for 5 min prior to final FST. The variables measured: Immobility time in FST; line crossing, rearing and defecation in the OFT.
In all four parts, individual drugs and combinations thereof produced significant decrease in immobility time as compared to control, and extent of decrease was comparable amongst these groups. However, values for combination of fluoxetine with SA group were found to be lesser than that for individual agents in Parts 2 and 3. Combination of SA with imipramine did not enhance its anti-depressant effect in any of the parts. OFT findings did not vary significantly amongst the study groups.
Decreased immobility in FST and absence of generalized stimulation or depression of motor activity in OFT point towards potential antidepressant effect of Saraswatarishta. Its co-administration with fluoxetine showed more promising effects.
Depression; forced swimming test; reserpine; saraswatarishta
Kushta is an important solid dosage form of Unani system of medicine used to treat various ailments. Very small particle size of kushta is responsible for its rapid absorption in body leading to instant therapeutic actions. Kushta tutia (KT) is one such renowned formulation used by hakims for successful management of various disorders. However, there is lack of scientific work on KT.
The present study was performed to evaluate KT physicochemically by testifying it on classical tests along with modern scientific techniques.
Materials and Methods:
Tutia was first detoxified as per classical literature. It was triturated with water and dried, afterwards subjected to calcination in furnace rather than cow dung cakes due to isolation of material being heated and better temperature control. Finished product was evaluated for physicochemical characteristics including preliminary tests mentioned in classical literature.
Floating and finger test were positive. Curd test showed no discoloration after 48 h. These findings indicate correct preparation of KT according to classical literature. Bulk density (0.96 ± 0.00 g/ml); tapped density (1.53 ± 0.00 g/ml); Hausner ratio (0.62 ± 0.00), compressibility index (37.52 ± 0.19%); loss of weight on drying (0.08 ± 0.00%); pH of 1 and 10% (5.20 ± 0.00) and 5.62 ± 0.00, respectively); total ash, acid insoluble ash, and water soluble ash values 95.75 ± 0.09, 6.57 ± 0.02, and 45.02 ± 0.20%, respectively; and extractive values 0.85 ± 0.02% were reported in KT.
Since this work has not been reported earlier, the results obtained could be considered as the standard for KT for future studies.
Kushta; standardization; tutia; Unani
Abrus precatorius seeds traditionally used for the treatment of sciatica and alopecia contains the toxic protein, abrin, a Type II Ribosome Inactivating Protein. Ayurveda recommends the use of Abrus seeds after the Shodhana process (detoxification).
The current study was aimed at performing the Shodhana process, swedana (boiling) of Abrus precatorius seeds using water as a medium and to evaluate the anti-inflammatory potential of seed extract post detoxification.
Materials and Methods:
Non-detoxified and detoxified extracts were prepared and subsequently subjected to various in vitro and in vivo assays. In hemagglutination assay, the non-detoxified extract shows higher agglutination of RBCs than detoxified extract indicating riddance of toxic hemagglutinating proteins by Shodhana. This was confirmed by the SDSPAGE analysis of detoxified extract revealing the absence of abrin band in detoxified extract when compared to non-detoxified extract.
The cytotoxicity assay in HeLa cell line expresses a higher reduction in growth percentage of the cells with non-detoxified extract as compared to detoxified extract indicating successful detoxification. Brine shrimp lethality test indicated the reduction in toxicity index of detoxified extract as compared to non-detoxified extract. Further, the whole body apoptosis assay in zebrafish revealed that percentage of viable cells were greater for detoxified extract than non-detoxified extract. The anti-inflammatory studies using carrageenan induced paw edema model in rats was carried out on the extracts with doses of 100 mg/kg and 200 mg/kg, per oral, where the detoxified extract exhibited significant inhibition of rat paw edema at both the doses comparable to that of Diclofenac sodium.
Absence of toxicity and the retention of the anti-inflammatory activity of detoxified Abrus seed extract confirmed that the Swedana process is effective in carrying out the detoxification without affecting its therapeutic potential.
Abrin; Abrus precatorius; anti-inflammatory; detoxification; Gunja seeds; shodhana
Nowadays, owing to medicinal plants as a candidate to obtain promising new medicinal agents, there is a renewed interest in the use of these natural sources for drug development.
In the present study, we aimed to assess the anticholinesterase, antioxidant, and neuropotective effects of Tripleurospermum disciforme and Dracocephalum multicaule extracts.
Materials and Methods:
Methanolic extract of the plants was prepared by maceration method. Anticholinesterase effect of different concentrations of the plants was studied by colorimetric method and antioxidant activity was evaluated using diphenypicrylhydrazil (DPPH) assay. Protective effect of the extracts against amyloid β (Aβ)-induced toxicity in PC12 cells was determined by MTT (3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide) method.
Both T. disciforme and D. multicaule extracts could inhibit acetylcholinesterase (AChE) in a dose-dependent manner. The highest inhibition occurred at 5 μg/ml (71.18 ± 4.9 and 79.06 ± 3.1% inhibition respectively by T. disciforme and D. multicaule) in comparison to tacrine (86.37 ± 3.24%). The greatest DPPH inhibition of T. disciforme and D. multicaule was shown at 800 μg/ml (89.04 ± 3.9 and 78.5 ± 3.7%, respectively). None of tested extracts induced protection against βA toxicity in PC12 cell.
Although the results indicated anticholinesterase and antioxidant of the T. disciforme and D. multicaule, further specific studies and scientific validity are needed.
Anticholinesterase; antioxidant; Dracocephalum multicaule; Tripleurospermum disciforme
Constitutional type of an individual or prakriti is the basic clinical denominator in Ayurveda, which defines physical, physiological, and psychological traits of an individual and is the template for individualized diet, lifestyle counseling, and treatment. The large number of phenotype description by prakriti determination is based on the knowledge and experience of the assessor, and hence subject to inherent variations and interpretations.
In this study we have attempted to relate dominant prakriti attribute to body mass index (BMI) of individuals by assessing an acceptable tool to provide the quantitative measure to the currently qualitative ayurvedic prakriti determination.
Materials and Methods:
The study is cross sectional, multicentered, and prakriti assessment of a total of 3416 subjects was undertaken. Healthy male, nonsmoking, nonalcoholic volunteers between the age group of 20-30 were screened for their prakriti after obtaining written consent to participate in the study. The prakriti was determined on the phenotype description of ayurvedic texts and simultaneously by the use of a computer-aided prakriti assessment tool. Kappa statistical analysis was employed to validate the prakriti assessment and Chi-square, Cramer's V test to determine the relatedness in the dominant prakriti to various attributes.
We found 80% concordance between ayurvedic physician and software in predicting the prakriti of an individual. The kappa value of 0.77 showed moderate agreement in prakriti assessment. We observed a significant correlations of dominant prakriti to place of birth and BMI with Chi-square, P < 0.01 (Cramer's V-value of 0.156 and 0.368, respectively).
The present study attempts to integrate knowledge of traditional ayurvedic concepts with the contemporary science. We have demonstrated analysis of prakriti classification and its association with BMI and place of birth with the implications to one of the ways for human classification.
Ayusoft; body mass index; place of birth; Prakriti
Recent studies have shown the association of disproportionate body size measurements with noncommunicable diseases like diabetes. This concept is described in Ayurveda (1500 BC), which uses Anguli Parimana (the breadth of one's own finger as 1 unit) to measure the body proportions. Excessive tallness or shortness (deviation from the reference value of Anguli Parimana) indicated deranged meda dhaatu (mainly adipose tissue). Deranged meda dhatu was associated with Prameha (diabetes).
To find association of Anguli Parimana with modern parameters of adiposity and diabetes.
Materials and Methods:
We studied 192 village residents representing the whole population (94 men and 98 women) to measure height, arm span, facial structures and limbs and expressed them in Anguli pariman (ratio of each measure as: Length or height of the body part [cm]/anguli, i.e. average finger breadth [cm]). The Anguli measurements were associated with body mass index, body fat percentage by DEXA, glucose and fasting insulin levels.
The volunteers were adults between 20 and 40 years age. Their mean fasting and 2 h plasma glucose concentrations were 91.6 mg% and 102.8 mg%, respectively. Of all, only 6 subjects had impaired glucose tolerance, while 3 were diabetic (WHO 1999). When compared with reference Anguli measurements mentioned by Charaka Samhita and Sushruta Samhita, the participants had smaller height, facial structures, and lower limbs. Those, who had proportionately smaller facial, neck and limb structures, had higher obesity, adiposity, plasma glucose, insulin and insulin resistance (homeostatic model assessment [HOMA]-R) indicating higher metabolic risk. In contrast, those who had proportionately larger forehead and face had higher beta cell function measured as HOMA-B indicating lower risk for diabetes (r = 0.20 both P < 0.05 all, adjusted for age and gender).
Compared with ancient Indian Anguli reference, our subjects were proportionately smaller in most of the measurements except fingers and upper arm. Relative smallness of body parts was predictive of increased risk of type 2 diabetes.
Adiposity; Anguli Pariman; Ayurved; body proportion; insulin resistance in Indians
A 41-years-old woman diagnosed of Systemic Lupus Erythematosus (SLE) in 2006 came to our hospital - outpatient department with the complaint of severe pain and swelling over multiple joints associated with disturbed sleep/sleeplessness and poor quality of life since seven years. She received acupuncture (20 minutes) and massage (20 minutes) daily for the period of 30 days with 7 days of rest period in between after first 15 days. After intervention we observed reduction of pain in Visual Analog Scale score; improvement in day time sleepiness, and quality of sleep in Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index, respectively; improvement in health related quality of life in Short Form-36 version 2 (SF-36v2) Health Survey. These results showed that acupuncture and massage can be considered as an integrative approach for symptomatic management of SLE.
Acupuncture; massage; systemic lupus erythematosus
The process by which the world outside is seen is termed as visual process or physiology of vision. There are three phases in this visual process: phase of refraction of light, phase of conversion of light energy into electrical impulse and finally peripheral and central neurophysiology. With the advent of modern instruments step by step biochemical changes occurring at each level of the visual process has been deciphered. Many investigations have emerged to track these changes and helping to diagnose the exact nature of the disease. Ayurveda has described this physiology of vision based on the functions of vata and pitta. Philosophical textbook of ayurveda, Tarka Sangraha, gives certain basics facts of visual process. This article discusses the second and third phase of visual process. Step by step analysis of the visual process through the spectacles of ayurveda amalgamated with the basics of philosophy from Tarka Sangraha has been analyzed critically to generate a concrete idea regarding the physiology and hence thereby interpret the pathology on the grounds of ayurveda based on the investigative reports.
Ayurveda; physiology of vision; visual process
Pashanbhed is a commercially available diuretic and lithotropic drug, used to treat renal problems. It is a controversial name as it is assigned to various plants such as Bergenia ligulata, Kalanchoe pinnata, Coleus aromaticus and Rotula aquatica.
To perform the comparative preliminary phytochemical screening, diuretic activity, and thin layer chromatography (TLC) finger printing profile of three plants (B. ligulata, C. aromaticus, and K. pinnata), most commonly used as Pashanbhed.
Materials and Methods:
Diuretic potential of methanolic extract (ME) of three plants were evaluated at two dose levels (500 and 1,000 mg/kg p.o.), using normal Wistar rats (Lipschitz method). Furosemide (20 mg/kg p.o.) was used as a standard drug. The effect on urine output and electrolyte changes were measured for 24 h and compared. All MEs were screened preliminarily for their constituents and their TLC finger printing profiles were prepared. One-way analysis of variance (ANOVA) followed by Bonferroni's multiple comparison test. P < 0.05 was considered statistically significant.
The MEs of all three plants have shown diuresis in normal rats. However, in intercomparison of the ME C. aromaticus (1,000 mg/kg p.o.) produced more significant diuresis (P < 0.05) and electrolyte excretion compared to other test groups, the effect was at par with furosemide. The ME of these plants showed presence of alkaloids, glycosides, steroids, terpenoids, saponins, flavonoids, etc.
The ME of C. aromaticus (1,000 mg/kg p.o.) has showed highest diuretic action (4.2) among the tested extracts. This suggests the use of C. aromaticus leaves as “Pashanbhed”; the most effective diuretic drug.
Bergenia ligulata; coleus aromaticus; diuretic; kalanchoe pinnata; pashanbhed
Periodontal diseases are ubiquitous, affecting all dentate animals. Regular methods for controlling it have been found to be ineffective, which have paved the way for the use of herbal products as an adjunctive to mechanical therapy as they are free to untoward effects and hence can be used for a long period of time. Ocimum sanctum is a plant which has the greater medicinal value and enormous properties for curing and preventing disease.
In the present study we assessed the effectiveness of Ocimum sanctum on dental plaque, gingival inflammation and comparison with gold standard chlorhexidine and normal saline (placebo).
Materials and Methods:
A triple blind randomized control trial was conducted among volunteered medical students. They were randomly allocated into three study groups: (1) Ocimum sanctum mouthwash (n = 36); (2) Chlorhexidine (active control) (n = 36); (3) normal saline (negative control) (n = 36). Assessment was carried out according to plaque score and gingival score. Statistical analysis was carried out later to compare the effect of both mouthwash. ANOVA (Analysis of variance) and post-hoc LSD tests were performed using software package used for statistical analysis (SPSS) version 17. P ≤0.05 was considered as statistically significant.
Our result showed that Ocimum sanctum mouthrinse is equally effective in reducing plaque and gingivitis as Chlorhexidine. The results demonstrated a significant reduction in gingival bleeding and plaque indices in both groups over a period of 15 and 30 days as compared to control group.
The results of the present study indicate that Ocimum sanctum mouthrinse may prove to be an effective mouthwash owing to its ability in decreasing periodontal indices by reducing plaque accumulation, gingival inflammation and bleeding. It has no side effect as compared to chlorhexidine.
Chlorhexidine; gingival index; Ocimum sanctum; plaque index
Catechins and epicatechins are monomers of naturally occurring proanthocyanidins, which have been reported with free radical scavenging, antioxidant, antiinflammatory, antiallergic, and vasodilatory properties. Plant parts rich in proanthocyanidins have been used for years in treatment of various ano-rectal diseases. This study compares the efficacy of two herbal preparations, Daflon® 500 mg and Roidosanal®, in ameliorating the signs and symptoms associated with hemorrhoids.
To evaluate the safety and to compare the efficacy of a herbal preparation, Roidosanal® versus Daflon® 500 mg, on signs and symptoms of hemorrhoidal disease.
Materials and Methods:
In this pilot, active controlled, open-labeled multicentre study, 73 patients with proctoscopy proven hemorrhoids (Grade I to III) were randomly assigned to receive either Roidosanal® (Gr R; n = 37) or Daflon® 500 mg (Gr D; n = 36), for 15 days, at three centers in India. Assessment of hemorrhoidal symptoms was carried out in all patients at different time points. Intent-to-treat analysis was performed for both primary and secondary endpoints.
Baseline characteristics were comparable between the two groups. Both products were found to be equally effective in improving the ano-rectal conditions in Grade I and Grade II hemorrhoids; however, Roidosanal® demonstrated better efficacy in patients with Grade III hemorrhoids. Hemorrhoids associated symptoms like bleeding, pain, etc., improved in both groups, although intergroup comparisons were comparable.
Both Roidosanal® and Daflon® 500 mg were equally effective in resolving signs and symptoms of hemorrhoids. Roidosanal® can be tried as a safe and effective treatment option for treatment of hemorrhoids. Further randomized, double-blind and large multicentre studies are recommended.
Bleeding; catechins; flavonoids; hemorrhoids; proctoscopy
Nevus of Ota is a congenital blue-gray color nevus afflicting unilaterally, the area near the eyes. It poses a huge cosmetic concern besides being a potential threat for developing melanoma sometime in the course of the disease. The treatment options are neither many nor promising besides they are too expensive. We have treated a case of nevus of Ota with leech therapy where leech was applied upon the lesion for five times spanned in a period of 2 months. The results in terms of change in the color of lesion were evaluated with the help of serial photographs following every treatment session to mark the level of color changes in the lesion. A substantial reduction in color of the nevus was reported following the completion of the therapy. The results were demonstrated with the photographs. Although, recommended as the classical Ayurvedic management for skin diseases, leech therapy is not reported earlier in such conditions. It proposes a novel approach to deal with such congenital pigment lesions where other options are not promising.
Ayurveda; hyperpigmentation; leech therapy