Approach to Ayurveda Treatment
(Part-6)
Prof. Muralidhar Sharma
based on the lecture available at–Approach to Ayurvedic Practice
A clinical condition associated with postural changes:
In the majority of patients with lower back pain, the major clinical sign would be muscle spasms than the other way and may not have a gross structural pathology. In such conditions, Kati Basti or Sthanik Snehan would be suggested and it helps in the resolution of spasms. One of the general principles which I adopt would be that contemporary investigations may help me to select the choice of an Ayurvedic approach to treatment.
Spondylitis – Kevala Vata
Treatment:
Gokshuradi guggulu
Vishamushti Vati
Godanti bhasma
Avipathikara
Kati Basti
Dashamoola niruha basti
रूक्षाय बहुवाताय स्नेहबस्तिं दिने दिने |
दद्याद्वैद्यस्ततोऽन्येषामग्न्याबाधभयात्त्र्यहात् ||
Su.Chi 37/79
स्नेहोऽल्पमात्रो रूक्षाणां दीर्घकालमनत्ययः |
तथा निरूहः स्निग्धानामल्पमात्रः प्रशस्यते ||
Su.Chi 37/80
Certain experiences with the prescription of Rasoushadhis based on Dosha :
Why consider Dosha while prescribing Rasoushadhis? There is a general notion that Rasoushadhis when prescribed, there is no need to bother about the Doshas but I don’t agree with it. I say Rasoushadhis also have to be selected based upon the Dosha principle that is present in the contents. I can explain it with three formulations like Tribhuvan Kirti, Mrutunjay Rasa, and Anand Bhairav Rasa. All these formulations contain Rasoushadhis like Hingula, Kajjali, and some Kashtha Aushadhis( herbs). Kashtha Aushadhis(Herbs) present within Tribhuvan Kirti possesses Jwarghana property while it carries Pachana property with Anand Bhairav Rasa. These specific properties like Jwarghana and Pachana are based on the herbal contents of that particular formulation. Doshghanta of this kind of formulation can be decided after knowing the exact constitution. One of my students beautifully complied with all my prescriptions along with their contents and Doshghanta used it practically. I would like to clarify that the prescription of Rasoushadhis based upon Doshghanta is my perception.
Rasoushadhis can be prescribed safely for prolonged durations
One of the general notions is that Rasoushadhis are harmful and cannot be prescribed for a longer duration. Rasoushadhis being harmful is a myth or ghost. Well-prepared Rasoushadhis with their proper use can be used for a long duration. I have had a patient using Rasoushadhis for more than 35 years. Still, she is my patient. When I joined the institution in 1983 she came with septic arthritis complications and we have managed her. From that day onwards till now she has not taken any medicine from any other doctor. In my absence, if someone else prescribe medicine she didn’t take the medicines. She is taking Rasoushadhis for more than 35 years and she has not developed any complications. Many so-called complications produced with the use of Rasoushadhis can be managed with Rasoushadhis. I observed that contemporary physicians mention the history of intake of Ayurvedic medicine like once in a lifetime or throughout life in the case sheet of renal pathology patients. I have also seen one of the urologists prescribing the drug K4 which is an Ayurvedic medicine that contains Rasoushadhi. So the myth about Rasoushadhis being harmful is not true. But safety about the preparation and techniques followed during preparation is crucial and needs to be followed strictly. There is no need to be get educated by others as methods to prevent harmful effects associated with Rasoushadhis have been already mentioned in Ayurveda texts. Also, methods of converting harmful drugs into safe drugs have been mentioned in the texts and the necessary one is to follow them.
Key points:
- Quality of preparation is to be ensured.
- Chemically pure and Shuddha Dravya are not the same.
आयुर्वेदोपदेशेषु विधेयः परमादरः||
A.H.Su ½
It has been mentioned by Vagbhat to keep trust over the guidelines described in Samhitas. Because you have come to the Ayurveda stream, you have to develop faith in it. If you do not develop the h and have doubt mongered personality then don’t continue with this profession. It is safe to use Rasaushadhi. So absolutely there is no need of questioning it. Most of the time the questions are indeed raised by Ayurvedic doctors than the others. When questions are raised by Ayurvedic doctors naturally others will magnify them.
Therefore we need to have that kind of confidence of having safe medicine and the adverse effects of the drugs are known to us. So when you know about the adverse effects and known complications, why should you bother about that? As far as safety aspects related to Rasaushadhis I have a definite answer in the form of my clinical experience. So I’m quite confident about the safety of Rasaushadhis
The clinical decision of deciding about withdrawal of existing treatment is the key
When a patient comes with existing contemporary medical treatment, whether to withdraw that, which of the drugs to be withdrawn is another crucial part. This is possible only when you have proper knowledge of contemporary pharmacology and the limitations of the contemporary system. Unless you have that contemporary knowledge, withdrawal from certain drugs can be harmful and certain drugs would be mandatory. But one of the advantages Ayurvedic practitioners would get in the present situation is patients may go to more than one specialist. When the patient goes to each of the doctors, there is a common prescription given by the modern doctors like one is a multivitamin, another one H2 receptor blockers, or so on to reduce that gastric irritation. Most of the time when patient comes to Ayurvedic doctors usually they would be taking two or three analgesics, two or three H2 receptor blockers, or proton pump inhibitors, two or three vitamins, one calcium, and at times it could be some sedatives. In such a condition I would cut off all that nonessential drugs. So once you have cut off that nonessential drugs, the patient will be relieved of much of the distress, 50% relief is gained by blocking or releasing those drugs. This is one of the advantages we have. But the only thing is we should be very selective and should have that command.
Essential drugs are a very sensitive issue and usually, the drugs like anti-hypertensive, anti-diabetics, hormones, hormone supplements, and certain psychoactive drugs cannot be withdrawn suddenly. You have to assess the patient based on the patient’s response, either it could be tapered or withdrawn is a complex issue. But vitamin supplements, antidepressants, and analgesics can be stopped. Patients would get relief after stopping such kinds of medicines.
You need not prescribe any other medicine still the patient would be happy with your assessment. The only thing is we should have the patience to look at all the prescriptions. There would be certain kinds of patients demanding to treat me only for my headache, not for the others, then I say no. In such a condition, I say the patient to go to some other doctor and I don’t treat that patient at all.
I don’t have any hesitation to refuse to consult such patients, I have not lost any of the patients. My number of patients is increasing because I have that rejection. So don’t think that rejecting such patients would be affecting the practice. It is one of the areas where we can make a change from others if we have that sufficient skill and that sufficient perception. It needs some skill and it cannot be gained all of a sudden. It needs more exposure to the patients, exposure to the contemporary system of medicines, and so on. This is one of the principles which I adopted in my practice.
Key points
- Anti Hypertensive, anti-Diabetics, hormone supplements, and psychoactive therapies should not be withdrawn suddenly.
- Withdrawal or tapering the doses of these drugs is a very critical issue requiring thorough and regular clinical follow-up.
- Vitamin supplements, antidepressants, and analgesics can be stopped unless there is a real indication.
- Most of the time tweaking the medication itself can produce huge relief.
A higher dose does not mean more relief
Certain practitioners say that if you give more drugs in higher doses, you will have a benefit. But that ‘अधिकस्य अधिक फलं’is misquoted in the context of Mardana of Dravya indicating that more Mardana results in more benefit. It’s not about the prescription rather it is the other way a lesser dose of the drug would always benefit. In my clinic, I always give two tablets per day. Whereas in my hospital distribution I give three tablets per day and I have maintained this difference to be very confident. Now, after long years of having that kind of a differential approach, I feel my patients in my clinic are more comfortable than my patients in the hospital where we give three tablets per day. But still, I’m continuing with that practice because I wanted to still have a more solid background or information that I can demonstrate. A perfect practitioner would be prescribed only one drug. Prescription of more drugs that suggest our imperfections. So usually my prescription is limited to three drugs, so I say I am better than those who prescribe 5, 10, or more drugs. This is my approach and my purpose is not to criticize anyone. I’m not perfect because still, I use two or three drugs, maybe perfect would be one drug for one patient at one stage would be a perfect treatment. This is one of the issues where we need to progress and it can be developed with clinical experience.
Key points
- The clinical utility of medicine is not dependent on quantity.
- The right prescription in the right context makes a real impact.
- Ghrita and Tailas used for prolonged duration fail to produce clinical benefits.
Basic perceptions
All the principles that have been said are summarized into 10 basic principles. I have tried to summarize all the principles discussed before into the basic 10 principles. One thing I have added further is that patients who are conditioned to Ayurvedic medicines, always respond better. I have seen many patients who are committed to Ayurvedic treatment and at the beginning of their visit to me, they needed four days of medicine or two days of medication for certain conditions and so on. But now such patients who do not take any other contemporary system medicine for any of the problems, a single dose of medication would be enough. In case of common cold and fever-like conditions, my prescription would be Mritunjay, Arogyavardhini, and Amrutarishta for four days. After getting relief with a single dose, patients keep that remaining medicine for the next six months. If a patient would have a similar complaint again they use a single dose of the remaining drug and get relief. Such kind of patient revisits me once all 12 doses get finished.
This is one of the important advantages of Ayurvedic medicine and it’s not necessary that we have to highlight, patients will recognize it. It is one of the areas where we can develop significantly. Another controversial area that I do not use in practice is Anupana and I don’t give much stress on it in my practice. That doesn’t mean Anupana doesn’t have any role. Dut to make the therapy more convenient for the patients, I have not focused on it. In my practice that doesn’t make a very huge change in terms of outcomes. It doesn’t mean that Anupana is not useful and it would be useful, but in the usual conventional urban patients to have Anupana would be difficult.
- A thorough clinical examination and diagnosis is the first step.
- Investigations are done only to confirm the clinical diagnosis or decide about the Ayurvedic course of treatment.
- Dosha assessment is the key to prescription.
- Rasoushadhis are prescribed based on the Dosha
- Rasoushadhis can be prescribed safely for prolonged durations.
- Asadhya Lakshana is the limitationisLakshmanarekha) for Ayurvedic management.
- The clinical decision of deciding about withdrawal of existing treatment is the key.
- A higher dose does not mean more relief.
- Patients conditioned to Ayurvedic medicines respond better.
- Anupana is useful but not mandatory.