POSSIBILITIES OF INTEGRATING AYURVEDIC CONCEPTS OF TRIDHOSHA AND VYADHIKSHAMATVA WITH CONCEPTS OF CELLULAR COMMUNICATION AND IMMUNITY.
P.K.Garg* and Shakil Ahmed
*14-A, Khurshedbagh, Lucknow.
Abstract
With the emergence of holistic thinking in medicine, fundamentally holistic nature of Ayurved is being recognized. The realization of the need of evolving a holistic system of medicine and health-care has prompted serious attempts towards investigation of the concepts and practices of Ayurved with open mind. The modern scientific medicine has begun to recognize that the traditional Indian system of medicine, Ayurved, is a vast storehouse of knowledge relevant to human health, disease, medicines and general health-care. However, mutual incomprehensibility of the terms and concepts has been a major impediment in meaningful dialogue between modern scientific medicine and Ayurveda. Some attempts in bridging the gap of this incomprehensibility have indicated that the modern concepts of molecular recognition, immunity and immunomodulation are recognizable in Ayurved. The Ayurvedic concept of Tridosha as the basis of disease seems to be similar to the concept of disease as dissonance. The related Ayurvedic concepts of Atiyoga, Ayoga and Mithyayoga appear to be similar to the concepts of excessive interaction, absent interaction and erroneous interaction between receptor molecules and recognition molecules, currently being developed in molecular medicine. Similarly, it is being recognized that the central concept of Rasayana Tantra, one of the eight major branches of Ayurved that deals with the concepts and methodologies of drug designing, is Vyadhikshamatva, which is similar to the concept of immunity. The basic principal of Rasayana-designing seems quite similar to current scientific concept of immunomodulation. These realizations indicate that concerted efforts may be helpful in bridging the gap between the concepts and practices of Ayurveda and modern scientific medicine. Such understanding shall go a long way towards integration of the beneficial aspects of the two systems and development of a truly holistic system of human health.
Introduction
The traditional Indian system of medicine and health-care, Ayurved, was developed painstakingly over many centuries through a vast amount of careful observations, experimentation and building up of a coherent theoretical paradigm. During its golden period of growth, this system influenced many other systems of medicine viz. Unani, Siddha, Chinese, Tibetan etc. due to its underlying rational approach. However, in the last few centuries it was gradually eclipsed by the phenomenal success and growth of scientific medicine. Ayurved also stagnated due to its parochial inward looking approach and a lack of willingness to have dialogue with others, particularly with scientific medicine. Mutual distrust, bordering on hostility, between Ayurved and modern scientific medicine impeded evolution of a mutually complementary interface amongst them. This has, on one hand, weakened Ayurved and on the other hand, failed to transfer the benefits of Ayurved to modern medicine. Only in recent times, Ayurved has started gaining global recognition as a vast storehouse of important and useful medical knowledge. It is now being recognized that there is need to develop an effective interface between the two systems to complement the respective strengths of each other. However, the most exasperating problem in developing meaningful dialogue between Ayurved and modern medicine is that they have basic difference in their perceptions as well as theoretical paradigms towards observing the reality – the healthy individual or the patient.
The Ayurved treats the patients as a whole. Its etiology and pathogenesis of any disease condition is based on the Theory of Tridosha i.e. imbalance of the three body humors (Doshas, viz. Vata, Pitta and Kapha). The imbalance in Doshas and the consequent impact on the body components (Dooshyas, viz. Dhatus and Malas) are supposed to be responsible for disease. This in turn is supposed to influence the pathophysiology (Kriya) of the body. The properties of all the natural and synthetic substances are dealt in terms of their Rasa (taste), Guna (inherent property), Veerya (potency), Vipaka (manifest property) and Prabhava (influence on the body). Management of the patient may require multiplicity of interventions (Poorva karmas, Shodhan and Shaman etc.) but it may not always be possible to point out the exact component of intervention that results in the management of a specific causative factor.
Modern allopathic medicine, with its reductionist approach and mechanistic view of man, tries to identify the cause of any disease at the level of some structural part i.e. organ, cell, cellular organelles, molecules etc. With the same reductionist approach, it also tries to relate the etiology and pathophysiology of any clinical condition to a single cause. Consequently, it believes that an intervention at the specific causative level may result in a pointed attack on the disease and thus, may lead to its cure/management.
Since the beginning of 20th century, the serious limitations of reductionist-mechanistic approach began to be realized in various fields. Attempts began at synthesizing and integrating ideas and observations of different fields into a composite whole. Gradually, a shift from reductionist to holistic approach started influencing every field of knowledge. In the field of medicine, it was realized that human health and its management is a very complex problem. It can only be addressed by evolving a holistic paradigm of medicine and health-care. This realization resulted in reinvestigation of traditional systems of medicine, particularly Ayurved. It is being increasingly realized now that Ayurved fundamentally has a holistic approach to human health. As a result, serious attempts to develop interface between Ayurved and modern scientific medicine are being made. Further, some recent concepts of molecular medicine, immunology etc. have been found to have striking similarities with certain concepts of Ayurved. Therefore, it is being realized that it might be possible to develop a dialogue between modern scientific medicine and Ayurveda. It might be possible to specify the Ayurvedic concepts of Dhatu or Mala in mutually acceptable and yet chemically well definable forms. It might also be possible to better comprehend Ayurvedic concepts like Doshas or Dooshyas along with Rasas, Gunas, Veeryas, Vipakas and Prabhavas of Drayas in physico-chemical terms.
Concept of Tridosh and cellular communication
Molecular recognition is a fundamental feature of all the biological processes encompassing ligand-receptor, enzyme-substrate and antigen-antibody reactions. The scientific attempts at unreveling the molecular basis of the control of metabolism has lead to the development of the concept of cellular communication. The cells comprising body of a living organism are constantly communicating with each other through signaling molecules. All cells have specific receptors that recognize their specific signaling molecules. These receptors are protein molecules to which molecules of natural ligands or the administered drug become bound. The molecules binding to receptors are the specific signaling molecules. The binding of specific signaling molecule to the receptor molecule triggers signal transduction to produce specific response. Such binding, leading to specific response, activates or suppresses a metabolic function. It has been shown that immunocytes have receptors for neurotransmitters and the neurons have receptors for cytokinins produced by immunocytes. The communication between neurons and immunocytes forms the basis of relationship between nervous and immune systems of the body. Use of modern DNA-recombinant technologies and molecular cloning has made possible cloning of most of the important receptor and signaling molecules making them available for research. These developments have led to the development of current concept of molecular medicine – disease as dissonance due to excessive interaction, absent interaction or erroneous interaction between cell receptors and the recognition molecules. This concept of pathophysiology of disease at the molecular level appears quite similar to the Ayurvedic doctrine of Tridoshas, particularly in the concept of Atiyoga, Ayoga and Mithyayoga (Lele, 1997). Further, the use of the techniques of molecular medicine has revealed that the Ayurvedic medicinal herb Ashvagandha is GABA-A receptor agonist. Similarly, Sarpagandha has been shown to inhibit uptake and storage of dopamine, serotonin and nor-epinephrine in pre-synaptic neurons.
Arthritis is one of the most baffling ailments and modern scientific medicine has not been able to do much in its cure or management. Ayurved has extensively dealt with this condition. Charak mentioned various types of arthritis in different headings like Parvastamba (contractures in joints), Paravabheda (pain in joints, Mamsagat vata (deep pain in inside bones), Asthigata avirata vata (overlapping of Vata Dosha) etc. Term Amavata was used in later period to include such diseases. Madhava-Nidan, included in small Samhitas in Ayurvedic literature, gives the latest and most elaborate description of the cause and management this disease. This disease is described in terms of Tridosha in Ayurved. According to Madhava-Nidan, it is curable when caused by a single Dosha. The term Vyapya is used when it is caused by two types of mixed Doshas indicating a more severe condition in which it is difficult to cure. If caused by all the three types of mixed Doshas, the disease is Asadhya i.e. incurable. The cure and management of this disease is made easier by Panchkarma therapeutics if done in a proper way and in proper condition. Oleation and fomentation are pre-operative procedures (Poorva karma). The disease is said to be easy to control and possible to cure according to acute or chronic condition by proper application of oleation, fomentation, climination and basties (medical enimats). In addition, therapeutics includes emesis, purgation and several medicines. About 900 formulations incorporating nearly 190 ingredients are used singly or in combination in Ayurved. Many of the medicines are of plant origin like Guggulu (Commiphora mukul) or Rasna (Pluchea lanceolata), of mineral origin like Gold and Mercurial and of animal origin. Ayurvedic herbal formulation (RA-1) was investigated for treatment of Rheumatoid Arthritis and demonstrated to be safe and effective with slow onset of sustained action (Kasture, 1997; Bhat, 1997; Chopra, Patwardhan, Lavin & Chitre, 1997). Such studies point to the possibility that the detailed investigation of Tridosha theory of Ayurved and relating it with modern scientific concepts may prove helpful in understanding the cause and treatment of this disease.
Rasayana and Immunity
The modern scientific medicine is gradually realizing that mere presence of causative agent in the environment or its entry into the body does not always result in the disease. The most important in relation to health, disease and cure is the immunity of the body. Immunomodulation i.e. modulation of immune response through selective use of immunomodulators is currently being considered the most potent method in the management of health and disease by modern medicine. Recent advances in understanding the neuro-endocrine-immune axis and the influence of nutrition, exercise and circadian rhythms on it, are bringing modern medicine nearer to Ayurved. The concepts of immunity and immunomodulation appear to have been extensively explored and used in Ayurved, particularly in Rasayana Tantra.
Rasayana Tantra is one of eight major specialties of Ayurved. This branch refers to nutrition, natural resistance and geriatrics. Rasayana can be a drug, a food or a life-style (Acara). Acara rasayana forms important part of the Rasayan Tantra. According to Ayurved, a Rasayana helps in strengthening Oja, Bala and Vyadhikshamatva. Bhel Samhita clearly indicates that there are twelve types of Oja. The Oja is essence of all the Dhatus. It also indicates their sites. The Ahara, Vihara, and Manasa Bhava, if properly used, support Ojas but if abused, they have bad effect on it. Three types Bala are recognized. These are Sahaj Bala– that is naturally present, Kalaj Bala– that comes with passage of time i.e. season and changes in age and Yuktikrita Bala– that which is provided through therapeutic measures viz. Rasayan Prayoga etc. The Bala is influenced by a variety of factors. The Tridoshas i.e. Vata, Pitta and Kapha influence the Bala mainly through the Prakriti. The Agni is another factor influencing Bala. The Prana and Bala, both produced by Oja, are synonyms of Kshamatva. The Vyadhikshamatva is capacity of the body to limit virulence of the factors producing disease. It is of two types namely Vyadhi-Utpad-Pratibandhakatva (the capacity to restrict the products of disease) and Vyadhi-Bal-Virodhakatva (the capacity acting against the force of disease). Dhatu-Sarat, especially that of the Shonit (blood), Mamsa (Flesh) and Asthi (bones) result in good Vyadhikshamatva. Samhat-Sharira i.e. a well-nit, compact and well-composed body has good Vyadhikshamatva and is said to resist the ill effects of a disease in efficient manner. This conceptualization of Vyadhikshamatva has striking similarity with the modern concept of immunity. Teja of Dhatu and the living tissues along with normal functioning Shleshma (Kapha), should be comprehended as Oja. This possibly indicates about tissue immunity, as Dhatus of Ayurveda appear nothing but basic tissues of the body. The concept of Jivitashonitatmakam possibly indicates phagocytes. It has been suggested that Ojas has definite bearing on the immunological functioning of the body. (Mihaiskar, 1997; Misra, 1997).
Ayurved describes a very large number of Rasayanas and Ojovardhaka remedies like Ashvagandha, Silajatu, Tulsai, Amalaki, Punarnava etc. Ayurvedic preparations in general and Rasayanas in particular act more on the nutritional dynamics rather than pharmacodynamics. Apparently, Rasayana means an improved state of nourishment that in turn upholds immunity and youth. It might be rewarding to investigate the Ayurvedic concepts of Rasayana Tantra in terms of modern concepts of immunology. Attempts may be made to examine the immunomodulatory effects of Rasayanas. New methodologies should be explored that focus on the nutritional dynamics as the basis of immunomodulatory effect of a Rasayana. (Singh, 1997). Recent studies on opiates have uncovered the structural basis of neuro-hormone-immune axis and added a new dimension to the understanding of the action of adaptogens/tonics that are very close to rasayana drugs of Ayurved. The knowledge of structure and function of chemical constituents of Ayurvedic drugs would give better understanding of the pharmaceutical practices of Ayurved. (Nitya Nand, 1997)
National Institute of Immunology, New Delhi has carried out studies on various plant materials used traditionally in Ayurved with a view to identify immunomodulatory compounds in them having prophylactic/therapeutic effects against infections and tumors. Many traditional Indian medicinal plants have been shown to possess immunomodulatory effects. A glycoside (NII-78) isolated from mango (Mangifera indica) has been shown to enhance intracellular killing of parasites within the macrophages by stimulating the production of nitric oxide. In vivo, It is also effective against Leishmania and Mycobacterial infections and causes regression of P-815 tumor implants in mice. It has been confirmed in studies that the glycoside does not have any direct anti-Leishmanial/Mycobacterial or anti-tumor effect. It acts by enhancing the effector function of the macrophages. Another immuno-suppressive alkaloid (NII-60) isolated from Berberis aristata has been found effective in inhibiting Graft-vs. -Host reactions in experimental model and is more potent and less toxic than the currently used immunosuppressive drug Cyclosporin. (Upadhyay, 1997).
The above examples of some studies, thus, indicate that the investigation of Rasayanas may be quite fruitful in integrating Ayurved with modern medicine. However, if Ayurved is considered as part of a therapeutic approach only, it will restrict the view only to the products that the system has to offer. The attention shall be restricted to the potential of such products to be developed, standardized, evaluated, manufactured and marketed by established approaches of modern scientific medicine. The present approach to Ayurveda is mostly in such a direction. Contrary to this approach, it shall be more useful if basic concepts embodied in the Ayurvedic system are retained while developing a method for validation of their therapeutic usefulness in the context of our current scientific knowledge. (Nair, 1997).
Conclusion
The above brief review indicates that the fundamental Ayurvedic concept of Tridosha, and the related concepts of Atiyoga, Ayoga and Mithyayoga, may be related to currently evolving scientific concepts of cellular communication dealing with molecular basis of metabolic regulation. In the same way, Ayurvedic concept of Vyadhikshamatva appears to be similar to the concept of immunity. Investigation of the concepts pertaining to Ayurvedic Rasayana Tantra in light of the concepts of modern immunology, particularly the immunomodulation might be quite rewarding. Such attempts might bring about much needed integration of traditional Indian Ayurved and modern scientific medicine and help in the development of a holistic approach towards human health.
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