Lecture Note: Rationality of Ayurvedic Prescriptions & Hridroga (Part-2)

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Rationality of Ayurvedic Prescriptions & Hridroga
Part-2

Dr. Muralidhara Sharma

based on the lecture available at- Rationality of Ayurvedic Prescriptions & Hridroga

The Chandraprabha is another very commonly prescribed formulation. I would consider Chandraprabha as Tridoshahara, impacting Vata 3, Pitta 2, and Kapha 1. This is based on my clinical experience. None of the texts would suggest this. So, if somebody differs, I fully have every freedom to differ with that. But this is based on what I have received. So I don’t give very high value to that. Of course, it is specifically or more specifically used in cases involving malas like Mutra or Sweda. It can be used in many other significant groups of drugs where there is Dhatukshayajanya Vata Prakopa. My prescription would start from senility to osteoarthritis. Old senile patients who do not have any other specific disease conditions and seek treatment for vague conditions to very specific indications like in osteoarthritis. I consider osteoarthritis as a Dhatukshayajanaya Vyadhi. I would prescribe Chandraprabha in cases of patients with neuritis with certain deficiency symptoms like calcium deficiency or similarly in patients who have menstrual irregularities, patients with statin complications, diabetes mellitus, spermatogenesis abnormalities, and so on. So the abnormalities are related to those variant conditions where I consider that there is Dhatukshaya janya lakshna, and at times it could be in combination with other drugs. But it could also be prescribed in the course of the management of certain other diseases in between during the course of the treatment. If I find that Dhatukshaya janya lakshna has developed due to any reasons, irrespective of the other previous symptoms, I may prescribe Chandraprabha for these types of conditions.

The fever condition or typhoid-like condition where patients would have some deficiencies, then at that condition, instead of giving Jwarghna Aushadhi like Laxminarayan, etc., I would change to Chandraprabha at that time. So that deficiency complications which can occur as a result of some other disease can also be managed with Chandraprabha. The general indications for Chandraprabha, again, would vary widely, making it challenging to create a complete list. But I have tried to summarize to a great extent. So indications would be changing as such. That’s the basic idea of the rationality of Ayurvedic practice.

Ekangaveer Rasa:

Wherever there is the involvement of Mamsa or Meda Dhatu with Vata Kapha Vyadhi and particularly Kaphavritta Vata lakshana and among them one specific lakshan is that patient would have a symptom of “Piplika eva snachar….”.

हर्षः पिपीलिकानां च सञ्चार इव मांसगे|
चलः स्निग्धो मृदुः शीतः शोफोऽङ्गेष्वरुचिस्तथा||
आढ्यवात इति ज्ञेयः स कृच्छ्रो मेदसाऽऽवृतः|
स्पर्शमस्थ्नाऽऽवृते तूष्णं पीडनं चाभिनन्दति||
सम्भज्यते सीदति च सूचीभिरिव तुद्यते|
मज्जावृते विनामः  स्याज्जृम्भणं परिवेष्टनम्||
शूलं तु पीड्यमाने च पाणिभ्यां लभते सुखम्|
Ch. Chi 28/65,66,67

This is a very common symptom described by the patient. Charaka used these words 5000 years ago, and even today, patients use the same words. I always highlight these issues as an advantage of Ayurveda, where the clinical signs are described in the same language as communicated by the patient. Whereas if you go to contemporary textbooks, you’ll find very complicated words, and you’ll have to open the dictionary to see the meaning of those words and so on. The issues will continue as such. But anyway, not to criticize, but whenever there is a need to highlight, I use these words as well.

Wherever there are Kaphavritta Vata Lakshanas, and the patient’s pain symptoms are not stable at any specific location, or they experience moving sorts of pain, which is also a Lakshana of Chala Guna of the Vata, a feature seen in Kaphavritta Vata Lakshna. When there is an abnormality of sensations, it could be any of the sensations, I would prescribe Ekangaveer again. It could be along with other drugs, like in the case of a patient with neuritis, I would prescribe Chandraprabha along with Ekangveer Rasa. Both can be prescribed together. Chandraprabha takes care of Dhatukshaya, and Ekangveer takes care of Kaphavritta Vata. We have the advantage of tackling both ways. That’s how the medicines are prescribed. The indications are anemia, neuropathy, it could even be advanced neuropathy. Even in cases of mechanical pathology, like spinal compression and spinal canal stenosis conditions, Ekangaveer can also produce a significant change in the outcome. I’m not saying it’s going to cure the condition, but it can produce a significant change in the condition.

A patient who has been suffering for years, if they’re able to work, even with support, that is an advantage. If a patient can maintain bladder function without a catheter, even that is a significant advantage. These are the things we can contribute to by using these medicines. It may not be the final target. Perfectly normal results may not always be possible, but we can produce such significant changes that satisfy the patient and align with our treatment goals. Of course, neurological deficits of all sorts involve a wide range of neurological pathologies. Occasional adverse effects could be a burning sensation over the body or mouth ulcers. These are not significant complications. The administration of Ekangaveer along with Avipattikar can reduce the side effects.

Probably complications could be due to Dosha Sthan or Vibandh. These complications can be reduced by giving Anuloman Dravya. Most of the time, when I prescribe Ekangaveer, Avipattikar is a common co-prescription that helps avoid possible adverse effects. These kinds of tricks, like a combination of these drugs, are based on experience. It’s not something I had at the beginning of my practice, but as we advance and see more patients, that’s the advantage of using a limited number of drugs in a large number of patients. When you use a limited number of drugs in a large number of patients, you develop this kind of extra perception or sixth sense in prescribing, making it somewhat fine-tuned.

I view Gandhak Rasayana as a Tridoshahar Dravya, which means it is beneficial for all three doshas. This is one of the Rasayana substances and is especially useful in Rakta related conditions, specifically those associated with Shonitaja vyadhi. Whenever there are symptoms of skin disorders or Kushtha lakshana, Gandhak Rasayana can be effective. It is also Vyadhipryatyanik, meaning it can be used to treat various diseases.

Whenever a patient presents with itching followed by discharge, Gandhak Rasayana can provide positive results. It can be effective regardless of the cause, whether it’s due to pyoderma, taeniasis, fungus, or bacteria. Some people have incorrectly compared Gandhak Rasayana to an antibiotic because it contains sulfur. I disagree with this perception and criticize it. If you need to use sulfar you should use sulfur directly. Gandhak Rasayana is not the same as sulfur, even though it contains sulfur. This comparison arises from a lack of understanding of biochemistry.

I do not prescribe Gandhak Rasayana as an antibacterial drug. However, I do use it in my post-operative patients to aid in wound healing and reduce the need for antibiotics. It’s not considered an antibiotic in Ayurveda, as it goes against the principles of Ayurveda, which are centered around preserving life. I’m not saying antibiotics should never be used; when necessary, they should be used appropriately.

I use Gandhak Rasayana as a Rasayana, which helps in the prevention of potential complications related to pitta-related discharge, including inflammation in wounds. It can be used in nearly all cases of acute or chronic wounds, whether they are infectious skin lesions caused by pyogenic or other factors. Gandhak Rasayana is a common prescription for these conditions. It’s often my first choice for patients with anorectal disorders like hemorrhoids and fissures, as these are related to Rakta Dushti. I also use Gandhak Rasayana for worm infestations.

The indications for Gandhak Rasayana are varied, and I frequently prescribe it. Occasionally, skin rashes can occur as side effects, but they are not typically severe or persistent. If such side effects occur, the treatment can be discontinued without causing any long-lasting complications.

Tribhuvan Keerthi Rasa

 It’s a predominantly Kaphaghna  dravya particularly Kaphaja Jwara  Lakshna. In case of Kapha Prakopa Lakshnas even minimal Prakopa Lakshnas I would use Tribhuvan Keerthi Rasa. Lakshanas of Kapha  Prakopa are described  in following Shloka.

गौरवं शीतमुत्क्लेशो रोमहर्षोऽतिनिद्रता |
स्रोतोरोधो रुगल्पत्वं प्रसेको मधुरास्यता ||
नात्युष्णगात्रता छर्दिरङ्गसादोऽविपाकता |
प्रतिश्यायोऽरुचिः कासः कफजेऽक्ष्णोश्च शुक्लता ||
(Su Ut 29/33,34)

In cases of Kapha anbandha and Kaphaja Jwara, Tribhuvan Keerthi is more preferred than Mrutunjay Rasa. Many times my prescription changes during the months of November and December. I shift from Mrutunjay Rasa and Arogyavardhini to Mrutunjay Rasa and Arogyavardhini. Particularly in children, when the weather becomes somewhat cold and they exhibit respiratory symptoms. Usually, my first choice for prescription remains Mrutunjay and Arogyavardhini. However, during these seasons, in children, my prescription may change to Tribhuvan Keerthi and Arogyavadhini, based on the clinical presentation of Kapha dhikya Lakshnas. Of course, Tribhuvan Keerthi can also be used in cases of febrile convulsions and gastrointestinal conditions. Occasionally, it may lead to gastrointestinal irritation, such as nausea and vomiting. If the child already has nausea and vomiting, I would not prefer Tribhuvan Keerthi, and in that case, I would opt for Mrutunjay Rasa. That’s the basic idea.

Common indications of Tribhuvan Keerthi Rasa

Common cold, Bronchitis, Exanthematous fever, Periodic fever, Febrile convulsions, Gastroenteritis

Rare adverse effects – Gastrointestinal irritation

Mrutunjaya Rasa

If you review my prescriptions, Mrutunjaya Rasa is probably the most frequently prescribed, followed by Chandraprabha at number two, and Kaishor Guggulu at number three among my prescriptions. I consider this as a Tridoshar drug, and the ratio I use is arbitrary, with Vata 2, Pitta 1, and Kapha 2.

The indications for Mrutunjaya Rasa are whenever there is involvement of Rasapradoshaja Vyadhi, regardless of the doshas; I would prescribe Mrutunjaya Rasa. In every other condition of Ama, I consider this as one of the choices of Amapachana drugs.

When I say Ama, it’s not only about the Annarasa or gastrointestinal tract abnormalities; even abnormal biochemical reactions producing unusual results can be considered as Ama. For example, factors like RA factor, increased Uric acid, or raised ANA are what I consider as Ama. So my perception of Ama is quite broad, and I always say that Ama can be objectively identified through laboratory investigations. It may sound like an over-exaggeration, and if someone sees it that way, I understand. However, it can also be a practical suggestion.

Ama can be identified biochemically in clinical practice. Therefore, the range of indications for Mrutunjaya Rasa is extensive, ranging from common colds to almost every autoimmune disorder. One of the commonly prescribed drugs by me is Mrutunjaya Rasa because I consider it as a choice of Amapachana Dravya. It’s not that it’s the only drug; there may be better options, but it’s my selected drug in my practice. The indications cover various conditions where there are Sama Vyadhi lakshanas.

निद्रानाशो भ्रमः श्वासस्तन्द्रा सुप्ताङ्गताऽरुचिः |
तृष्णा मोहो मदः स्तम्भो दाहः शीतं हृदि व्यथा ||३५||

पक्तिश्चिरेण दोषाणामुन्मादः श्यावदन्तता |
रसना परुषा कृष्णा सन्धिमूर्धास्थिजा रुजः ||३६||

निर्भुग्ने कलुषे नेत्रे कर्णौ शब्दरुगन्वितौ |
प्रलापः स्रोतसां पाकः कूजनं चेतनाच्युतिः ||३७||

स्वेदमूत्रपुरीषाणामल्पशः सुचिरात् स्रुतिः | Su.Ut 39/35 to 38

General indication

  • Vatakaphaja jwara
  • Amapachana
  • Vishama jvara

Clinical indication of Mrutunjay Rasa:
Common cold , Bronchitis,  Exanthematous fever, Periodic fever, Febrile convulsions, Rheumatoid arthritis, Gouts, Reactive arthritis, Autoimmune disorders.

Shvasa kuthara Rasa

Key contents 

  • Mana shila
  • Maricha
  • Trikatu

The symptoms of Kaphavritta Prana  are described in following slhloka.

श्लेष्मणा त्वावृते प्राणे सादस्तन्द्राऽरुचिर्वमिः।
ष्ठीवनं क्षवथुगारनिःश्वासोच्छ्वाससङ्ग्रहः ||
A.H.Ni 16/46

I consider Shwaskuthar as a remedy for balancing Kapha and Vata. In cases of Kapha-avrita Prana, where patients have symptoms like excessive spitting and sneezing, Shwaskuthar can be prescribed. I view Shwaskuthar as a remedy for mitigating dosha imbalances and for treating various diseases. We need to assess the dosha imbalances as well. Indications include even conditions like Cor-Pulmonale. In such cases, I often prescribe Shwaskuthar along with Punarnava Mandur. This combination can help achieve more targeted results. However, there can be occasional complications, particularly skin pigmentation, if Shwaskuthar is not prepared properly, primarily due to the presence of Manshila in its content. Skin pigmentation can be a troublesome complication. Therefore, when I prescribe Shwaskuthar, I limit my sources to very few reliable companies. Many marketed products may still contain Manshila that is not processed properly, and these complications can be quite troublesome. But if you use Shwaskuthar, there is a possibility of these complications, and these complications can be biologically identified. So, it’s important to be careful about the source of Shwaskuthar. Interestingly, even if there is a complication of that deposition, it can be managed and cured with Arogyavardhini. I prefer a combination of Shwas kuthar with Arogyavardhini. Most of the time, Dhatwagni mandya (reduced tissue metabolism) observed in Shwas roga (respiratory disorders) can be managed through the use of Arogyavardhini. Also, the possibility of cumulative toxicity from Manshila can be inhibited by Arogyavardhini. These are simple practice strategies that can positively influence  Ayurveda practice. In general, Shwaskuthar is indicated for conditions related to Kapha and Vata imbalances. Clinical conditions where it’s often prescribed include acute and chronic bronchitis, emphysema, and Cor-Pulmonale. Be aware of potential adverse effects such as skin pigmentation, hair fall, and mouth ulcers.

Soota Shekhara Rasa

Key contents

  • Vatsanabha
  • Tankana
  • Tamrabhasma
  • Chaturjata
  • Bilva

Bhavana – Bhringaraja

लिङ्गं पित्तावृते दाहस्तृष्णा शूलं भ्रमस्तमः ||
कटुकोष्णाम्ललवणैर्विदाहः शीतकामता ।
AH Ni 16/3

In cases of Pittavritta Vata lakshna, Amalpitta, and when dealing with conditions where Pitta predominates in Kapha imbalances, Soota Shekhara is definitely indicated. It’s not limited to just gastritis; even in sinusitis, where there are symptoms of Pitta and Kapha imbalances, I would prescribe Soota Shekhara. In cases of gastritis, I typically prescribe a combination of Agnitundi with Soota Shekhara.

In cases of sinusitis, Soota Shekhara, along with Mrutunjaya, can be prescribed. This combination allows for a more targeted approach to address the dosha imbalances. Ultimately, our guidelines for prescribing drugs are based on how we perceive the dosha imbalances in the patient. Occasionally, constipation can be a side effect, but it can be easily managed with Avipattikar. Therefore, most of the time, my usual prescription involves a combination of Soota Shekhara and Avipattikar. Not every patient requires this combination, but it helps make the treatment more acceptable and reduces the possibility of patient complaints later on, aiming for better feedback.

General indication: Pittavruta Vata, Amlapitta

Clinical conditions: Gastritis, Sinusitis, Food poisoning

Adverse effect – Constipation

Kanchanara Guggulu

 Key contents

Guggulu

Triphala

Trikatu

Ela

Patra

In the case of Kapha Pradhan vyadhi and Meda Mamsahrit Kapha vyadhi, where there is nodular swelling, typically painless or with mild pain, and non-inflammatory swellings, I would prescribe Kanchanar Guggulu. Kanchanar is indicated in both malignant and benign tumors. For specific conditions like Galagand, which is a chronic disorder, and in cases of third-degree osteoarthritis where the joints are unable to support the body, and surgical interventions are usually advised, Kanchanar Guggulu can be prescribed. While it may not lead to structural improvement, functional improvement can be observed. Obesity is another common indication for Kanchanar Guggulu.

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