Ayurveda:Voodoo or real medicine?

1. Ayurveda:Voodoo or real medicine? Amit Pahwa, MS-4 Tinsley Harrison Society University of Alabama School of Medicine October 11, 2005

2. Ayurvedic Medicine • “Ayus” = life, “Veda” = knowledge • Evolved in India among Brahmin sages • Focuses on life energies rather than symptoms • Three doshas • Vata • Pitta • Kapha

3. Vata • “Vaayu” = to move things • Most influential dosha • Cell membrane transport, electrolyte balance, waste elimination, and cell division • Aggravated by dryness • Reduced by foods with building blocks

4. Pitta • “Pinj” = to shine • Metabolism and molecules of energy • Body temperature maintenance, optic nerve impulses, feelings of hunger and thirst • Aggravated by heat • Reduced by “cooling it”

5. Kapha • “Shlish” = that which holds things together • Provides structure and lubrication • Carbohydrates and polysaccharides, mucous, spinal fluid, and synovial fluid • Aggravated by sweet and fatty foods • Reduced by hot, dry, and light things

6. Pathway to Imbalance 1. Accumulation 2. Aggravation 3. Spreading 4. Localization 5. Manifestation 6. Bursting

7. Emblica officinalis Terminalia chebula Terminalia bellerica Triphala

8. Triphala • Kaur et al. examined in vitro cytotoxic and apoptotic activity of triphala • Studies were performed on various cell lines including mouse and human breast cancer as well as human prostrate cancer • NMR studies showed major component of Triphala is gallic acid

9. Triphala toxcitity

10. Apoptotic Effects Triphala concentration Phase Contrast Hoescht DNA

11. Triphala • Sandhya et al compared effects of Triphala on normal versus cancer lines • Also looked at activity in vivo • Showed similar cytotoxic and apoptotic activity on cancer cell lines but insignificant effects on normal cells • Elucidated possible mechanism with quantification of ROS

12. Normal Cancer Triphala Dose dependent cytotoxicity of normal versus cancer cells Apoptosis of normal versus human breast cancer after Triphala

13. Triphala Tumor growth volume of mouse thymic lymphoma after 40 mg/kg of Triphala Apoptosis percentage in control versus treated excised thymic lymphoma

14. Salacia reticulata • Belongs to family of plants used by Ayurvedics for diabetes • Diabetics drank water left overnight in a mug made from the plants root • Studies have shown that S. reticulata has two compounds (salacinol and kotalanol) which both inhibit alpha-glucosidase

15. Salacia reticulata

16. Salacia reticulata RCT • Jayawardena et al conducted cross over double blind RCT • Recruited diabetics using the combination of sulfonylurea/metformin • Study population was split into two groups. Each group received placebo for 3 months and S. reticulata tea for 3 months in addition to normal treatment

17. Salacia reticulta RCT • Mean HgbA1c was lower during three month treatment period compared to the placebo period • Mean dose of sulfonylurea lower in treatment period • Adverse effect rates similar in both groups • No changes in liver enzymes, serum creatinine, or hematological indices

18. WHY SHOULD I CARE?

19. CAM: Economic Impact • 1990: 427 million CAM visits • 1997: 629 million CAM visits • Exceeded visits to U.S. physicians • 1997: $27 billion out-of-pocket expense

21. CAM: Participants • Commonly used therapies • Spiritual healing or prayer (14%) • Herbal medicine (10%) • Chiropractic therapies (8%)

22. CAM: Economic Impact • NCCAM research budget • 1992: $2 million • 1999: $50 million • 2003: $114 million

23. Summary • Ayurvedic herbs have physiological effects • More patients using CAM in addition to traditional Western therapy without their doctors’ knowledge • As future PCP, we need to understand the effects of CAM in combination with Western therapy

24. References • Hankey, Ayurvedic Physiology and Etiology: Ayurvedo Ameritnaam. The Doshas and Their Functioning in Terms of Contemporary Biology and Physical Chemistry. The Journal of Alternative and Complementary Medicine. 2001, 7: 567-574. • History of Traditional Indian Medicine. http://www.mic.ki.se/India.html • The National Institute of Ayurvedic Medicine. http://niam.com/corp-web/index.htm • The Wonders of Triphala:Ayurvedic Formula for Internal Purification. http://www.planetherbs.com/articles/triphala.html • R.K. Mishra Triphala – Renowned Ayurvedic Remed. http://www.naturalhealthweb.com/articles/mishra14.html • S. Kaur, H. Michael. S. Arora, P.L. Harkonen, Subodh Kumar. The in vitro cytotoxic and apoptotic activity of Triphala – an Indian herbal drug. Journal of Ethnopharmacology. 2005 Feb 10;97(1):15-20 • T. Sandya, K.M. Lathika, B.N. Pandey, K.P. Mishra. Potential of traditional ayurvedic formulation, Triphala, as a novel anticancer drug. Cancer Letters. 2005 May 14. • A. Ghavami, B.D. Johnston, and B.M. Pinto. A New Class of Glycosidase Inhibitor: Synthesis of Salacinol and its Stereoisomers. J. Org. Chem. 2001 Apr 6;66(7):2312-7 • M.H.S. Jayawardena. N.M.W. de Alwis, V. Hettigoda, D.J.S. Fernando. A Double Blind Randomized Placebo Controlled Cross Over Study of a Herbal Preparation Containing Salacia reticulata in the Treatment of Type 2 Diabetes. Journal of Ethnopharmacology. 2005 Feb 28;97(2):215-8.

25. Acknowledgements Dr. Sharmila Makhija Dr. Jason Hartig Dr. Akhil Maheshwari