Thursday, February 27, 2014

Understanding of Pandemics according to Ayurveda



Understanding of Pandemics

Dr Gururaja derebail,M.S(Ayu)PhD scholar(Japan)

 
Introduction
World has become very small due to technological developments. We can reach any part of the earth within few hours. Diseases appeared at one part can also reach our country within few days. But even before its arrival we can see statements in newspapers “Ayurveda has medicine”.
It is really surprising for me how and why they make such statements. Are we not degrading our self? We should think before giving such statements.
Ayurveda mentions about औपसर्गिक व्याधि. जनपदोध्वंस is also a wonderful concept. There are also references about diseases came from foriengners.eg phiranga .Over the period of time from charaka till today many new diseases has been added. Ayurveda always welcomes new thoughts. Whenever such new disease arises we should discuss before coming to any conclusion.  
Pandemics-  Pan-all   Demos –people.
Spreading through human population across a large region.
WHO criteria-
Emergence of the disease new to population
Agents infect humans causing serious illness.
Agents spread easily and substantially among humans
H1N1(H-Hemaglutinin,N-Neuraminidase)
Started in Mexico  - America- Worldwide
Host –Swine.
Animal to Human transmission.
Now human to human transmission.
WHO has pandemics alert grading.According to this
Phase 6-Human to Human , substantial number ,more than one country.[ see WHO guidelines ]
Ayurveda
Even though there are explanations regarding
जनपदोध्वंस-अधर्म-साधारण हेतु. [ विप्रकर्ष निदान ]
दूषित वायु
औपसर्गिक व्याधि-निश्वासात् [ सन्निकर्ष ]
संसर्गजव्याधि
आगन्तु व्याधि [ लक्षणतः ]
अभिष‌‍ङ्ग  and  सन्निपात ज्वर concept
Here every theory holds good to some extent
 To get a comprehensive picture of the disease is not so easy.
Discussion
Modern science says this is due to a virus .
But we don’t accept infection theory
If we follow dosha dushya vighatana in some cases we get good result but we find difficult to generalize it.
We say it is our greatness, that we treat patients not disease.
I accept we have many positive points.
Are we capable of treating pandemic outbursts??????
            OR
Is there any need to accept infection theory?
Lacuna
1 Difficulty in explaining औपसर्गिक सम्प्राप्ति.
2 दूषित जल ,वात-related vyadhis Where acute dosha vitiation occurs we say it is due to achaya prakopa…or…pradhanika hetu…….there is missing link between the nidhana to Vyadhi pradurbhava. We find it difficult to understand in terms of kriya kala.
3 In many vyadhi if we fail to get result from sneha sweda etc vidhi, then we should consider it as raktaja vyadhi.this shows again our limitation.
4 In Jwara explanation, we can get the references about fever in Elephants and Horses.Charaka`s period Human and Elephant relation was more common, But presently Human and Pig,Birds are more so we find Swine Flue.In Charaka We fail to get the references regarding animal to human transmission. We may apply Aupasargika reference here to understand this.  
5 रक्तज कृमि - invisible. krimi management prakrutivighata treatment is explained which is similar to the concept of antibiotic theory.
Even in Veda we can find the references like “yatudhana” “Sarpa”.
6 Explanation about राक्षस, पिशाच is available in ulcer management where secondary infections are more common. Without antibiotics we find it difficult to manage post operative cases. Dhupana is mainly a disinfection procedure.
7 Many विष concepts like mushaka visha convey some diseases rather than simple bite.
8 Drugs ,which act on vyadhi ,not on dosha dushya ,are mainly to the diseases of infectious origin and even Rasa drugs.
9Now all ayurvedic doctors know about infections and many prefer antibiotics.
10 Modern investigation-प्रत्यक्षप्रमाण (they are making alpam apratyaskyam)
11 Take H1N1 virus we can see the same virus everywhere.
We should take this in to consideration.
12Symptoms of vishama jwara depending on dhatu, when the infection is on particular dhatu fever appears.eg Malaria,Rakta and Organisms in Blood.
13Ama pachana is nothing but removal of the infection eg Kala is also one in that -Time require to develop immunity against that oraganism.
14Vyadhi kshamatva is nothing but Immunity and resistence .Vaccination is a Yukti kruta bala.Sucess of vaccination on many diseases cannot be rejected.
15 In modern success rate will not vary much depending on the doctors.But In Ayurveda success rate mainly depends on the doctors. (About 60% not get good results) 
16 If we observe the health system in developed countries and their way of managing epidemics, is really appreciable. There are some limitations but we cannot discard.
17 Modern people say many complications of the disease which are rare or 5%but they will try to prevent even that but in our case, if our treatement succeeds then we say ayurveda is great, but we just escape or say ayurveda has limitations when the case becomes serious later shift to modern, it is not good. I feel ,we could have prevented those cases if we had started modern medicine from the beginning.
Our approach:-
1Dosha dushya and Samprapti.
2Change in season resulting in dosha vitiation and roga
3 Importance to Agni and Bala.
4Concept of Ama ,If we correct the agni and remove ama then the disease cures.
5 Even modern medicine has many lacunas like In many people even though the organism is present person will not show any symptoms or carrier stage so It means organism is not the main cause for the disease. We can’t vaccinate for each disease. Viruses also change their structure .Organisms develop resistance against the antibiotics so later more powerful drugs are needed ,In future somewhere it should stop Eg is Tuberculosis –new resistance stains are coming.
Relation to seasons and Body – this is the point where we have credits. Every species on this earth react to seasonal changes even micro-organisms. Many infectious diseases also rise during seasonal changes.  
What happens if we accept?
Our approach differs-           One as dosha dushya
                              Other specific to organism.
                              Preventive aspect.
If a Patient who belongs to one desha ,gets disease in other place, then moves to some other country. Then our theory like-
1यस्य देशस्य यो जन्तुः……
2Seasons are different at different places.
3Even simple disease becomes असाध्य.
We escape by saying viral diseases do not have treatment. [ tamiflu].
What we should do
Welcome new concepts
Know our limitation
Don’t go away from our basics.
Convey right message to the society.
Don’t always say same that our drugs improve resistance power.To develop resistence takes sometime,so if we find few drugs which act on oraganisms then I think we can control the disease better. We should target those wicked organisms also. [Not by extracting principle chemical]
For example I think drugs like Kirathatikta,Parpata these are effective against some organisms.or Sudharshana khada are good but not up to the mark, we cannot say confidently that it works.  
Pandemic- Ayurvedic Plan of management
Iteology and Pathogenesis -Prajnaparadha- Main cause
Viprakrusta nidana- Pig to Pig
Sannikrusta- Pig to Man  and Man to Man
Vyabhichari- weak Virus stains due to change in season or place.
Pradhanika- Potent stains due to improper drug management resulting in fatal acute complications.
                          Cause                                                    Treatment
Origin-  Adharma- Janapadodwamsa  Daivavyapasraya and Shudda Vayu etc
                                                                  SwasthaVruttha-Personal    
                                                                   Society – Need government help.
Spread-  Aupasargika-Niswaasaath    Mask ,Dhupana, Improve the bala

Vyadhi-    Aganthu- Vyatha purva            Improve Bala,Lakshanatah treatment.
                           Achaya prakopa             Treat  Dosha and lakshana
Lakshana-    Jwara (Sannipata)               Jwara management  Doshaja and Abhishangaja
Infection –     Krimi Management-          Apakarshana- Bheshajena Apakarshana
                                         Prakritivighata- Change the environment unwholesome environment for organism.
                                                                   Nidana Parivarjana- Quarantine.
         Pishacha etc supernatural powers   Daiva vyapasraya.
         Sadhyaasaadhyata – Kastasaadhya Vyaadhi
Note Asaadhya symptoms according to Ayurveda.

Ayurvedic Preventive Measures
Swasthavrutta-Food-Rasa-Tikta Rasa good for Jwara and infections
                  Promote Seasonal Customs – Saptaparna kashaya,Amalaki etc
                   Vegetables – Karavella,Kusmaanda,Phalandu,Lasuna.Shatavari.
                               Avoid-Cabbage,Cauliflower
                   Fruits – Orange,Jambo , Amalaki ,Dadima
                             Avoid – Grapes.
                   Preparations-Shadanga Paniya –Drink enough water.
                   Drinks – Green tea ,Lemon tea,Kuthanbhari kashaya.
Preparations Tambuli–Mandukaparni,Kakamachi,Shunti,Methika,Kasamarda,Parnayavani,Bhrungaraja etc which are good for respiratory system and to maintain Agni.
Avoid –  Oily and Spicy items,Chats,Junk foods,Cold water,Tender coconut.
Fasting,Heavy exercise,Irregular food habits, Jagarana
Dinacharya-Usually infection spread by droplet infection so We should improve the bala of nasal and pharyngeal mucosa.
    Improve the Bala of nasal mucosa by-Anutaila Nasya, Jala Neti.
               Give strength to pharynx – By Irimedadi taila kavala
                               Gandusa of Pancha valkala kashaya.
                               Salt water gargle etc
            Improve the strength of Respiratory system – Pranayama.
  Improve general strength by – Abhyanga,Yoga,Meditation.
Rutucharya- Encourage the Shodana in respective Rutus
Government and Insurance companies should consider this.
Hygiene Of the hands- Promote awareness about regular washing of the hands.
Drugs –Improve the General Bala
       Swarnayoga – Navaratna yoga,Swarna Malini vasanta,Makaradwaja.
         Children-Kumarakalyana rasa
         Diabetic patient-Vasanta Kusumakara rasa
        Old age and other degenerative patients- Yogaraja guggulu ,Shiva Gutika.
        Swasa patients- Swarna malini vasanta,Agatsya rasayana,Arogyavardhini.
        Females - Chandraprabha
        General drugs- Arogya vardhini rasa, Muktayukta Kamadugha rasa.
        Leha – Chyavanaprasa,Narasimha rasayana.
        Arista- Kumaryasava ,Draksharista , Pippalyasava.
Specific to Disease-Fever is the main symptom in these infectious conditions so the drugs told in Jwara chikitsa can be used- Mrtyunjaya rasa,Amrutarista,Pippalyasava.
Folklore preparations like-Kashaya of Amruta,Shunti,Kirata tikta,Majjige soppu etc
Specific to organisms- Study of the effect of Kashaya or drugs on those specific organisms
 Depending upon symptoms etc these drugs may vary. That is left to physician’s choice.
Disinfection Method- Maintain the Hygiene in city.
Provide clean drinking water
Dhupana in every house and in public places.
               Grow Neem ,Aswatha trees in the city.
               Public Daivavyapasraya treatment.
               Treat pets as pets not as your brother or partner.
Control of Vectors- mosquitoes or Hosts –pigs
[Direct relation is not established in Ayurveda.]
Don’t oppose vaccination.[ should have the knowledge about company lobby]
Use of Mask is not proved But don’t oppose, nor support by saying wear Neem oil masks.Further research is needed.
Scope for research- Need to get clear knowledge about these preventive measures.
Like For how long we should take, what might be the mode of action etc.

Treatment-1 According to Samprapti
          2 Target the organism
          3 Treat the symptom
          4 Manage the complications
If you have any doubt or you are not confident about yourself refer the patient. But discuss your problem with others.
Scope for research-I feel many drugs in our science are good against infections or organisms .There is a need to identify and record it so that we can improve our treatment.


Alert scale - accept WHO guidelines.


Implication of WHO grading for Ayurvedic Management-
WHO Grade
Monitoring - Assessment
Action plan
Phase1-Only animal infection
Observe the symptoms in animals, complication etc
Their reaction, Plants they eat etc.
Plan the treatment in animals
Observe the people who come in contact with infected animals
Phase2-Potential pandemic treat-Animal virus caused infection in humans
Monitor the symptoms, severity, and epidemic threat.
Inform all doctors about possible outburst ,its nature,Gather information from Old Vaidya about their experience.
Treat the patient accordingly.
Cosider the seasonal dosha vitiation,Protect others by following Swasthavruttha and Drugs which improve the bala ,Disinfection measures like dhupana etc
Phase 3 –Sporadic incidents but no human to human transmission.
Assess the symptoms at different Desa,Kaala
Effect of different drugs.
Good communication between Doctors.
Form a committee to assess and monitor the situation.
Educate the people about preventive measures.
Special care to pregnant,Child Old age, DM etc diseased .
Phase4 Human to Human transmission
Increase surveillance.

Limit the movement of affect population
Gather-monitory,Drug,etc resources .
Form many local working bodies to collect the information.Exchange the views and findings.

Phase5 and Phase6
More countries
No need to discuss

Post pandemic period
Share the experience.
Review the lessons learnt
Evaluate the pandemic characteristics etc
Evaluate the total operation.
Replenish the Resources
Fill the lacuana

    
Conclusion-
1 Sometimes I feel there is a need to evaluate our self. शास्त्रमेवादितः परीक्षेत
( refer Charaka Samhita,Vimana sthana for Shaastra pariksha.)
2 We should not lose our identity and also dignity. Someone has to take ATREYAs role it may be an institute or committee to make conclusive remarks on any subjects.
3To improve Surgery, Ulcer and Fever management we need to accept infection.
4Truth has many faces and Infection is also a truth and result is in front of us it is left for us to accept it or reject. I think Present need is “accept.”
5 Know the limitations not to limit you but to grow yourself.
6 Only by proper study we can develop our science not by statements or by misguiding the public.
7 Government should consider and support Ayurveda whenever such pandemic threat appears. Ayurveda should be included in National Pandemic Management. Then only Reporting system, Monitoring etc in Ayurveda will develop.


 

             
                       



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