Rationality of Ayurvedic Prescriptions & Hridroga
Dr. Muralidhara Sharma
based on the lecture available at- Rationality of Ayurvedic Prescriptions & Hridroga
Last time, we had some questions about the rationality of prescribing Ayurvedic medicines. I would like to address that issue as I consider it in my practice.
The evolution of Ayurvedic pharmaceutics consists of two components: Roga and Aushadha. According to Charak, when examining a patient, Roga should be examined first, and later on, Aushadha should be considered. Classical Ayurvedic treatment involves clinically examining the patient and preparing medicine as per the patient’s requirements. Charak followed the same principle. Therefore, in the majority of the prescriptions in Charak Samhita, they would be following some groups of drugs like Dashemani Gana, Pancha Shata Kashaya, etc.
The number of disease-specific Yogas prescribed in Charak Samhita is very few. In all the groups of drugs mentioned in Samhitas, the basic idea is to have plenty of options of drugs which would be selected according to the patient’s condition. Samhitas written after the Charaka period, like Ashtanga Hridaya or Ashtanga Sangraha, show that the number of Yogas specific to disease conditions increased, whereas Ganas containing groups of drugs seemed to be slightly reduced. It’s more about the Yogas, and Yogas have disease-specific indications. When it comes to the next-generation literature like ‘Sahastra Yogas’ and Sharangdhar Samhita, the first one is full of Yoga, where 1000 plus Yogas have been mentioned.As practice evolved further, there was another edition of Rasa Shastra where Rasa Aushadhies were added. There is a sort of general perception related to Rasa Aushadhies, that these drugs are very target-oriented and disease-specific. But my perception is totally different regarding this concept. My perception is that Rasa Aushadhies are potent herbal drugs. Rasa Aushadhies present in Kashta Aushadhi can produce disease-specific or Dosha-specific actions. Hence, Rasa Aushadhies need to be assessed according to Dosha, Dushya, and Kalpna.
Beginners who start practicing Ayurveda would have more confusion issues. Ayurvedic physicians at the beginner’s stage of practice would have plenty of new combinations of drugs like patented drugs, the classical standard book preparations suggested as 277 essential drugs by Ayush ministry, Anubhoot Yoga, Ek Mulika Prayoga, and lastly, everything is medicine. So naturally, these beginners would always have confusion about which medicines to use, and so on. I have referred to the issue in the beginning, like in my practice, I use around 30 to 40 drugs that we have already suggested. So, I limit my prescriptions to those. First of all, the order is not totally alphabetical. Agnitundi is one of the drugs that I very frequently prescribe. The key contents are Kshara, Lavana, Vishamushti. For each of these combinations, I assess the Dosha and Dushya effect of that particular combination, either based on the text and Kashtha Aushadhies present in the formulation or based on our clinical experience as we try the drug on the patient. Most of the time, my idea of the Dosha is based on the textual combinations. Occasionally, it would be slightly different because you have multiple drugs at times, and it may not be possible to decide rationally based on the text; you will have to decide based on what you see in the clinical experience.
Agnitundi Vati, based on its contents, is predominantly effective on Kapha Vataja Vyadhi and Kapha Avritta Vata. The signs of Kaphavritta Vata are Shaitya, Gaurav, Shoola, and the patient prefers warmth and bitter taste in such a condition; Agnitundi Vati is indicated.There is a general perception that Agnitundi is limited to the gastrointestinal tract pathology or Srotas of a specific Dravya. I don’t limit any of the Dravyas to any Srotas. Generally, there is a preference for Annavah Srotas, but it’s not necessary. Any acute colicky pain conditions where the patient would prefer to have some warmth for that.
Without bothering about the location or the status, definitely, Agnitundi can produce some changes in the clinical outcome. Whether I prefer Agnitundi in all painful conditions or not depends on the availability of other choices. For instance, a patient with muscular pain, Agnitundi may not be the first choice. But if a patient presents with muscular pain along with certain gastrointestinal tract pathology, I would prefer Agnitundi, which will be suitable for both. So, that’s an idea that’s how we can limit our prescriptions to a lesser number of drugs. For example, a patient may have gastrointestinal tract pathology like indigestion, and he has pain in the abdomen at the same time, he has some muscular pain also, maybe due to injury or swelling. I would not prescribe two medicines. I would always say I don’t give any specific medicine for the patient’s leg and abdomen. This is the basic issue that we have to maintain as our identity because that’s what we generally criticize on the other side of the practice.
Like, because practices tend to specialize, a patient will have multiple prescriptions. So what usually happens is a patient would have some medicines prescribed as an anti-spasmodic by somebody, and then the patient will go to an orthopaedic, and he would give an analgesic, and so on.And this is what we generally criticize, and I prefer that our prescription should not follow the same lines. In such a condition, it is the same prescription that can solve both problems. So that idea helps us minimize our prescriptions. My idea of prescribing Agnitundi is for any condition where you have these symptoms, irrespective of the other diagnosis. The other diagnoses help you predict the prognosis, possible complications, and the course of the disease. But when it comes to the question of selecting the drug, I keep all that information in the background, like in a gastritis pathology, endoscopic findings, or other investigation reports.”
In the case of a patient with renal colic colicky pain, Agnitundi is my first preference of drug. So the issue is that the suggestion of a drug is not about Annavah Srotas.The same point applies if the patient has a gastrointestinal tract pathology and Kaphavritta Vata Lakshana, in terms of the patient preferring warm food or finding relief after taking some Shunthi or soda. Then Agnitundi is indicated, whereas if you have another patient who feels that taking milk, the Shita is preferable, then choice would be Sootshekhar. So the basic idea while treating is considering the diagnosis as gastritis, and there may be some differences in the endoscopic findings, but there may be very much similar otherwise.
As Ayurvedic physicians, we can make certain findings and distinctions within the same category of diseases. Although these conditions fall within the same category, the prescription may vary, leading to significant differences. This concept underlines the rationality of our prescriptions. So, let’s discuss the group of disease conditions for which I prescribe the choice of Agnitundi. Rare adverse effects that I have observed, but are rarely seen, particularly in Pitta Prakriti patients, include hypersensitive rashes. In Pitta Prakriti individuals, it’s not contraindicated, but I usually administer it for four days. After observing the results, I may continue the treatment. In many Pitta Prakriti patients, it can be administered for an extended duration without causing any harmful effects. Hypersensitive rashes may occur within three to four days, so I typically start with a short duration of Agnitundi. It could be prescribed for one week, depending on the patient’s response, and later, the long-term prescription will be determined with safety in mind.
Key points for Agnitundi Vati:
Include Dosha-Kapha Vata, Dhatu, and Karma-Rasa, Rakta, Deepana, Mal-Vit, Srotas-Annavah. Its general indication is for Kaphavrutta Vata, and it is used in clinical conditions such as chronic gastritis, hepatitis, pancreatitis, and renal calculi with hydronephrosis. A rare adverse effect associated with it is hypersensitive rashes, particularly in Pitta Prakriti patients
Anandbhairav Rasa – Key Contents:
- Tankana ( Rasendra Sara Sanghraha Jwar Adhikar, 103-105)
The textual indications for Anandbhairav are Jwar, Kasa, and Ajeerna. However, I prescribe it in conditions characterized by Kaphavata Dushti and predominant Ama Lakshana. Agnitundi is more oriented towards Deepan karma, while Anandbhairav has a stronger focus on Pachana Karma. When there are Ama Lakshana and more discharges or signs of Sama Vata, Anandbhairav is the appropriate choice. If a patient experiences a feeling of heaviness, reduced motility in the gastrointestinal tract, and sensations of Snighdhata or oiliness, then Anand Bhairav is indicated. Many patients report such symptoms, such as increased oral discharge or a sensation of oiliness. In cases where a patient presents with Shaitya, Arochak, Shopha, including endoscopic findings suggesting proctitis or significant inflammation, and prefers warmth, Anand Bhairav is the suitable choice. Conditions like diarrhea, dysentery with discharge, or excessive salivation also call for the use of Anandbhairav. On the other hand, Agnitundi is prescribed for patients without these symptoms. In cases of overlapping symptoms, both drugs may be prescribed.
Key Points for Anandbhairav Rasa :
Include Dosha-Kapha Vata, Dhatu-Rasa Agnivardhaka, Amapachaka, Mala-Vit, Srotas-Annavah. It has a specific indication for Saam Vata and is used in clinical conditions such as all forms of colitis, malabsorption, and chronic appendicitis. Rare adverse effects associated with it include mouth ulcers.
This is the advantage of Ayurvedic prescriptions. You can prescribe the medicines together and the idea of prescribing at a lower dose, like one tablet twice a day and giving two of the drugs. This would help you target cases where hitting a specific target is difficult. So, you can broaden your approach. This also makes your clinical assessment relatively easier.
In certain areas, if you have some confusion, you also have the choice of reviewing the approach after a short duration because it’s not going to harm you anyway. Occasionally, we may prescribe for one week. After one week, when the patient provides you with feedback, you may review whether you need to change the prescription from Agnitundi to Anandbhairav, and so on. In almost 75% of the cases, we can accurately assess the patients with this approach.
The problem is that we have lost this kind of review; we have either moved away from the contemporary system of medicine or often prefer shortcuts. I’m not saying that we should not use shortcuts. I do use shortcuts in my practice, but the shortcuts we have developed are based on the basic idea of assessing the Dosha Lakshana of the patient. Ultimately, when we prescribe medicines, it’s about the Dosha Lakshana.
One area where we have seen significant success is in reducing the incidence of surgery in appendicitis. The number of patients requiring surgery has significantly decreased in my group of patients. This is due to the use of Anandabhairav and Agnitundi. I often prescribe both of these drugs together in cases of appendicitis because of the presence of both Lakshanas, i.e., Shopha and Adhmaan. It has become a common prescription for appendicitis.
In cases of malabsorption and all varieties of colitis, Anandbhairav can be prescribed. You don’t need to worry about protozoa and bacteria. Anandbhairav will definitely produce results. The only difference may be in terms of the treatment duration and possible complications. So the basic idea of the prescription will be based on Dosha Dushya Lakshana.
The basic key contents are
- Tamra Bhasma
- Abhraka Bhasma
The indications for Arogyavardhini are that I would consider all the Dhatvagnimandya irrespective of the system involved. Arogyavardhini is a kind of combination that is suitable for a wide range of conditions. Therefore, my prescription of Arogyavardhini starts from common cold conditions to very severe conditions like malignancy.
The general perception regarding Arogyvardhini is that it is meant for hepatitis or liver disorders. It’s not limited to liver disorders. If you have any indications of Pittavrita Vata conditions or Dhatvagnimandya, then Arogyavardhini is indicated. For Pittavrtta Vata with Adhamana and Shoola, I would prefer Agnitundi. For Pittavritta Vata with more secretion, I would prefer Gandhak Rasayana. In case of overlapping symptoms, you can prescribe both drugs.
Dosha- Pitta Kapha , Dhatu- Rasa, Rakta , Medas, Dhatwagnivardhak, Mala -Pitta, Srotas-Annavah, Raktavah, Medovah
Genral indication- Pittavritta, Raktavritta Vata, Dhatvgnimandya
Common cold, Hepatitis, Diabetes mellitus, Hypothyroidism, Allergic reactions, Psoriasis, Gall bladder disorders, portal hypertension, Malignancy
Frequent adverse effects – Loose stools (Mild)