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EVIDENCE BASED AYURVEDA




              N.SRIKANTH
           ASST.DIRECTOR (AY)
              G.S.LAVEKAR
                DIRECTOR
 CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA
                  AND SIDDHA
             Department of AYUSH
      Ministry of Health & Family Welfare
                  Govt. of India
                                            1
CODIFIED SYSTEM OF HEALTH CARE
•Ayurveda- the science of life is a comprehensive system of
health care of great antiquity, based on experiential
knowledge and grown with perpetual additions
•Original dimensions of Ayurveda are inbuilt in the ancient
compendia of Indian wisdom called Vedas, which are
believed to be documented around 6000 years back.
Rigveda and Atharvaveda are replete with information on
health and maladies and their management with natural
modes and modalities.
• The knowledge expanded further with laying down of
fundamentals      and    concepts     of  Ayurveda     and
systematization in classical texts like Charak Samhita,
Sushruta Samhita and Astang Sangrah.
• Present form of Ayurveda is the outcome of continued
scientific inputs that has gone in to the evolution of its
principles, theories and guidelines of healthy living and
disease management.

                                                          2
EVALUATION OF PHARMACOPOEIA OF INDIGENOUS DRUGS
      Period         Approx. no.       Remarks on changes               Literature
                      of plants
                        used
3000 BC to 1000 BC   289           Building a Pharmacopoea.        Vedic texts
                                   (Atharvaveda)
1500 BC to 500 AD    650           1. Incorporation of new drugs   - Charaka
                                   2. Discharging old drugs        - Sushruta
                                                                   -Ashtanga
                                                                    Samgraha
                                                                   - Astanga Hridaya
500 AD to 1900 AD    Approx 2000   I)Incorporation of new          16 major Nighantus
                                    drugs                          (like Dhanvantari
                                   I)Discharging old drugs         Bhavprakasha, Raja
                                   II)Varieties identified         upto Shaligram)
                                   III)Substitutes identified
                                   IV)Expansion in
                                      applications

   •India is having the world’s richest flora, comprising of about 120 families of
   plants, comprising 1.30,000 species.
   •Ayurvedic texts cover about 2400 species of plants with their medicinal uses
   as described by ancient Indian medical scholars.
                                                                                     3
   •10,000 herbs are used worldwide for medicinal purposes regularly.
REVERENCE AND STRENGTH
•Considering health of an individual as dynamic integration of
environment, body, mind and spirit, Ayurveda lays great
emphasis on preservation and promotion of health and
preventing the occurrence of disease.
• Besides, it advocates employing holistic approach to
understand all aspects of human life including diagnosis and
management of diseases.
• Ayurveda attributes primary importance to preventive
medicine and the maintenance of positive health.

•The major preventive approaches for maintaining and
improving the quality of life include individualized specific daily
regimen (Dinacharya), seasonal regimen (Ritucharya),
behavioral and ethical considerations (Sadvritta).

•Healthy lifestyle is emphasized as the determinant of longevity
of life, which by and large depends on the Prakriti (bio-identity
i.e. body-mind constitution) of an individual.

                                                                  4
THERAPEUTIC STREAMS

•Proper understanding of Prakriti leads the physician in
making right diagnosis, prognosis and treatment plan and in
guiding patients as well as disease-free individuals what dos
and don’ts they need to follow for restoration and
maintenance of health.

•The therapeutic streams advocated in Ayurveda comprise

 -Daivavyapasraya chikitsa (Spiritual measures)
 -Yuktivyapasraya chikitsa (Pharmacological therapies)
 -Satvavajaya (Non-pharmacological Psychotherapies)

• The treatment plan is worked out on the basis of underlying
morbidity keeping in mind the strength of the disease and the
tolerability of the patient.

                                                           5
SOURCE OF DRUGS

•   Ayurveda considers all the substances in the world as
    drugs if used appropriately according to status and
    severity of disease as well as patient.

•   There are three main sources of drugs

    -Plant sources
    -Animal sources
    -Metals/Mineral, marine sources




                                                            6
IDEAL DRUG/THERAPY


•An ideal drug or therapy should cure the disease alone, but not
to create any adverse/toxic effects and must restore the
homeostatis of somatic/psychic environment of human body
(Dhatu-Samyatwva).


•Safety of a drug also depends upon its dosage.

•Dose of a drug plays a pivotal role in clinical practice as
Ayurveda says “Poison in proper dose acts a wonder drug while
an effective drug in higher dose acts as Poison ”.




                                                               7
FOUR-PRONGED TREATMENT PLAN
1.   Avoidance of causative and precipitating factors of
     disease (Nidan parivarjan )
2.   Bio-purification (samshodhan)
3.   Use of palliative remedies (samshamana)
4.   Health-promoting regimen (pathya Vyavastha)

      is the hall mark of Ayurvedic therapeutics
     recommended for physicians to prescribe.

•     Specific diet and lifestyle guidelines are always
     prescribed along with the drugs and therapies so as to
     facilitate restoration of bio-humoral balance and
     health status.




                                                              8
CREDIBLE THERAPEUTIC MODALITIES OF AYURVEDA

 - Bio-purification therapy – Panchakarma

 - Minimal invasive para surgical measure for management of
   fistula-in-ano and piles -Ksharsutra

  - Specialized health promotive & rejuvenative approach for
    geriatric health care - Rasayana.

• These modalities are proven to have an edge over conventional
  medical approach in dealing with chronic and refractory
  disease conditions.




                                                               9
MERITS

• Culturally competent & sensitive

• Holistic approach

• Cost-effective

• Natural/ eco-friendly

• Minimal adverse effects

• Easily accessible

• Emphasis on prevention

• Health promotion and Quality of life concerns especially in

     Chronic illness

     Refractory conditions
                                                          10
GLOBAL SCENARIO


 •During last decade, use of Ayurveda      and traditional
 systems of medicine (TM) has expanded globally and has
 gained popularity.
 • It has not only continued to be used for primary health
 care of the poor in developing countries, but has also
 been used in countries where conventional (Allopathic)
 medicine is predominant in the national health care
 system.




                                                             11
•The most prevalent users of    Ayurveda /TM are
individuals who have incurable, non–life-threatening
conditions that may be chronic viz. neurological
disorders, arthritis etc.
•The second largest group of users are those struggling
with chronic, potentially life-threatening diseases, such
as cancer and HIV/AIDS etc.
• Both groups turn to Ayurveda /TM for a variety of
reasons, such as to improve immune functioning, to
improve overall functioning, to increase quality of life, to
cope with side effects from conventional therapies, and
to relieve symptoms related to their illness.
•Most therapies are for chronic diseases such as
Neuromuscular disorders, Life style disorders, allergies,
arthritis and insomnia HIV/AIDS cancer and so on.
                                                               12
POTENTIAL ROLE OF TM/CAM IN REFRECTORY ILLNESS
            USE OF CAM BY PEOPLE LIVING WITH HIV/AIDS IN USA




   non-- CAM users -- 60 % regular CAM users -- 40 %      non-- CAM users --22 % regular CAM users -- 78 %


GENERAL ADULT POPULATION                               PEOPLE LIVING WITH HIV/AIDS



                                                                                                        13
GLOBAL SITUATION OF USE OF TRADITIONAL MEDICINE

      CHINA                           40%
      CHILE                           71%

      COLUMBIA                        40%

      INDIA ( use of Ayurveda)        65%

      AUSTRALIA                       48%
      BELGIUM                         70%
      CANADA                          70%
      FRANCE                          49%
      USA                             42%
      UK                              70%
      NORTH IRELAND                   90%

SOURCE : WHO traditional medicine strategy 2002-2005. Document WHO/EDM/TRM/2002.
                                                                           14
SAFETY AND EFFICACY

• The health care services of Ayurveda are being successfully
  catered to the masses in India through a huge network of
  443634    registered   practitioners,   13887   government
  dispensaries, 2394 hospitals with 42087 beds, 225 colleges
  conducting degree course, 61 post graduate centres, 7786
  manufacturing units and 39 research institutes functioning
  under the Central Council for Research in Ayurveda and
  Siddha (CCRAS).

• Manufacturing of medicines is regulated under Drugs &
  Cosmetics Act and licensing of manufacturing premises and
  products within GMP requirements is mandatory legally.

                                                           15
SAFETY AND EFFICACY

• About 65% of population in India is reported to use Ayurveda
  and medicinal plants to help meet their primary health care
  needs and the safety of this vibrant tradition is attributed to
  time-tested use and textual reference.

• Besides,   synergy   of   ingredients    in   conjunction   with
  individualized Prakriti-based treatment plan forms the basis
  of efficacy and safety of Ayurvedic formulations.

• Specific guidelines are prescribed for the use of apparently
  toxic medicinal plants with certain detoxification processing
  that also enhance the bioavailability and efficacy of the
  final product.

                                                                16
EVIDENCE BASED RESEARCH


•In Ayurveda the process of learning, research and
clinical practice are scientific and evidence based.

•The   knowledge    is   scientifically   validated   through
evidence based approaches; the Pramanas,

  Pratyaksa (Direct perception),

  Anumana (Logical inference),

  Aptopadesa (authentic documentary testimony),

  Yukti (Experimental evidence)




                                                            17
APEX BODY FOR RESEARCH
   The Government of India set up Central Council for
   Research in Ayurveda and Siddha (CCRAS) as an apex
   body in the country for the :
   • Formulation
   • Co-ordination
   • Development
   • Promotion
    of research in Ayurveda and Siddha Systems of Medicine
   on scientific lines.

 THE MISSION
 • To prioritize research needs of the country and constantly
   strive for excellence and global leadership .

 • To develop quality assured and cost effective research
   products for health promotion, prevention, management
   /cure of the disease to meet the needs of the country through
   establishing the state of art research facilities for
   comprehensive research with a focus on public health needs
   for masses.
                                                               18
THE VISION

• To develop CCRAS into a dynamic vibrant and model state
  of art research organization for achieving global
  leadership
• To focus research on the needs of India with a view to
  emerging health requirement of the country.

THE AREAS OF FOCUS

     -AYUSH Literature Research and Research on Basic concepts
      -Drug research
      -Clinical Research
      -RCH Research
      -Neutracautical Research
      -Cosmeceutical Research
      -Bio Medical Instrumentation Research.



                                                           19
SOME SIGNIFICANT LEADS

DRUG DEVELOPMENT                            PROJECTS OF NATIONAL
                                            IMPORTANCE
•Ayush -64 for Malaria
• 777oil for Psoriasis                          1.Feasibility of introducing
•Ayush-56 for Epilepsy                          Indian systems of medicine
•kshara sutra -minimal invasive para-surgical   (Ayurveda & Siddha) In the
 procedure for Anal Fistula                     “National RCH at the
                                                primary health care (PHC)
•Nutraceutical supplements-Ayush poshaka
                                                Level- CCRAS-ICMR
  peya & Ayush Poshaka Yoga
• Ayush Face pack for Melasma                   2.Safety/Toxicity Evaluation
•Ayabringaraja karpam in leucoderma             of Metal Based
•Brahmyadiyoga for acute schizophrenia          Bhasmas/Rasa Kalpas
•Ayushman-8 for (Mental retardation)
•Shunthi Guggulu for Rheumatoid Arthritis       3.Evaluation for Heavy
•Ayush-82 for Diabetes mellitus                 Metals and safety profiles of
                                                Ayurvedic
•Guggulu in Obesity and Lipid disorders
                                                formulations (Published in
•Pippalyadi yoga - An Ayurvedic Oral            JAMA
• contraceptive for females                      4.Bio-medical/Therapeutic
                                                instrumentation research
                                                                        20
Identification of priority area


                         Literature Survey


      Hypothetical Basis (single components/compound formulations )


             Drugs for identified conditions
SOP ,Standardization, Pre-clinical safety , Biological activity


                        Specific Protocols


                     Approval by Task Force


                            Clinical Trial                            21
AYUSH 64– AN AYURVEDIC
             ANTI-MALARIAL DRUG

Drug :          Ayush-64 Vs Chloroquine
                [Picrorhiza kurroa, Alstonia scholaris,
                 Swertia chirata&Caesalpinia bonducella]


Findings     : * Temperature tends to normalcy.
               * Maintenance of Thymol turbidity[P<0.05]
               * Significant decrease in lymphocytes, total
                 disappearance of parasite & clinical improvement
                 were seen in 72.4 -95.4 % in comparison with
                   100 % in control group in various level of studies .
SIDE EFFECTS: No side/toxic effects in prescribed doses

                                           (Double blind)
                    IPR Status -Patent No. 152863 dated 28.7.198
   Ref ;M.V.Chary et al., Double-blind Clinical Trail with Ayush-64 an Ayurvedic drug
 in P.Vivax Malaria, Journal of Rersearch in Ayurveda and Siddha Vol.VI No.1, 3&4:105-
                                                                               22
 116,1985.
777 OIL FOR PSORIASIS

DRUG          :       777 OIL
                      [Wrightia tinctoria]

FINDINGS       : Significant response was observed in 80% patients .
            The recurrence is postponed and the Intensity of the
             lesions is very much minimized .The efficacy of the drug
             is also supported by histopathological studies.

                                                          (open study)




 Before treatment                            After treatment
                                                                        23
    IPR Status - Patent No. 166740 dated 11.9.1987
KSHARA SUTRA -MINIMAL INVASIVE PARA-SURGICAL
      PROCEDURE FOR ANAL FISTULA(BHAGANDARA)
             Ingredients
            •     Snuhi Ksheera-latex of Euphorbia neriifolia
                        Ksheera-
            •     Apamarga Kshara (Achyrantus aspera)
                                                  aspera)
            •     Fine powder of haridra-(Curcuma longa)
                                  haridra-          longa)
            •     Barbour’s surgical thread No. 20
                  Barbour’


  Ksharasutra offers effective
  ambulatory     and      safe
  alternative to surgery in
  fistula in ano. Recurrence
  rate was 4% in Ksharsutra
  group when compared 11
  %with surgery.

Findings : The study revealed 98.7% cure rate. In this OPD procedure
Cutting and Healing took place simultaneously so that no raw area was left
besides Minimal tissue damage and less pain. No recurrence has been
reported.                             (Randomized controlled study )
      IPR Status - Patent No.186243 dated 15.2.2002                  24
AYURVEDIC NUTRACEUTICAL SUPPLEMENTS
  -AYUSH POSHAKA PEYA & AYUSH POSHAKA YOGA
 FINDINGS

 Clinical trial was conducted on Antarctic Expedition
 members (n=20, trial group) for a period of 6 weeks.

     The     study    revealed,   Potential     adaptogenic
     properties. Immuno-stimulant and anti oxidant
     effects besides significant anti stress effect against a
     series of stress like extreme cold, mental stress.
     (isolation and some        psychological factors),and
     nutritional stress .

     No clinical toxicity was noticed and lipid profile as
     well as body weight, body mass Index / lean body
     mass were not effected.



IPR Status - Patent Application No. 961/DEL/2004                25
AYUSH FACE PACK FOR MELASMA

Findings
-The result was assessed using Melasma. Area & Severity
  Index (MASI score) (n=20).
-The response was statistically significant with P< . 05. the
 average score was 7.32 compared with 19.25
 pretreatment score. No side effect was recorded in all
  the treated patients.




                                            After treatment     26
   Before treatment
SHUNTHI GUGGULU FOR RHEUMATOID ARTHRITIS

   DRUG                        :         SHUNTHI GUGGULU
                                         [Zingiber officinale &
                                          Commiphora mukul]


   FINDINGS                    :         Significant response was observed
                                         in 72% cases. There was marked
                                         improvement of signs and symptoms
                                         besides significant changes in lab.
                                         parameters like,ESR etc.




                                                                  (open study )



Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and Siddha.
Janakpuri, New Delhi-2002                                                        27
AYUSH-82 FOR DIABETES MELLITUS


DRUG                       :        AYUSH-82 [Mangifera indica,
                                    Syzygium cumini, Gymnema
                                    sylvestris, Momordia charantia]

FINDINGS                   :        Fall in FBS, PPBS after treatment
                                    was significant (0.001) besides 75%
                                    good response on subjective
                                    assessment.

                                                              (open study )

 Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and
 Siddha. Janakpuri, New Delhi-2002



                                                                                 28
A CONTROLLED CLINICAL TRIAL OF GUGGULU AND P.E.
EXT. OF GUGGULU IN OBESITY AND LIPID DISORDERS



Drugs       : Guggulu , P.E. Ext. of Guggulu Vs Placebo

Findings:    - Reduction in serum cholesterol was observed in
             all cases.
            - Significant weight reduction was found in P.E. extract
               treated    group [2 kg/month] when compared with
               Guggulu group [1 kg/month].




                                                      (Double blind)

 Ref;Clinical and Experimental Trial of Guggulu (Medo-Roga). 1989Central Council
                                                                           29
 for Research in Ayurveda and Siddha. Janakpuri, New Delhi.
AYUSHMAN-8 IN MENTAL RETARDATION

DRUGS            : AYUSHMAN-8 VS PLACEBO[STARCH]
                   [Centella asiatica & Bacopa monierri]


Age Group        : 5-16 years

Findings         : * Binet-Kamat Test-Numerical increase in mental age
                     was greater in drugs group [p=0.05<P<0.1].
                   * SEGUIN- Form board Test: Increase in mental age
                     shown was significant when compared to Placebo
                      group [P>0.01]
                   * Clinical improvement.

 Ref V. Rajagopalan et al Effect of Ayushman-8 in Mental retardation, Journal of
 Research in Ayurveda and Siddha, Vol.XIX-No.3-4 (1998), p. 89-97.


                                                                         30
                                                              (Double blind)
ADOUBLE BLIND CONTROLLED STUDY ON THE
  ROLE OF BRAHMYADIYOGA AND TAGARA IN
           ACUTE SCHIZOPHRENIA

   Drugs          : 1. Brahmyadi Yoga
    1NGREDIENTS
    i.   Manduk parni (Centella asiatica)
    ii. Jatamansi Root ( Nardostachys jatamansi)
    iii. Kustha (Sausurea lappa)
    iv. Sarpagandha ( Rauwolfia serpentina)
    v. Vacha (Acorus calamus))
                 2.Tagara.
                 3.Standard control : Chlorpromazine Vs Placebo[Starch]
 Findings :
         1. The mean difference effectiveness of Brahmyadi Yoga is
             better than that of Tagara[P<0.005] and Placebo[P<0.001]
             besides clinical improvement.
          2. The mean effectiveness of Brahmyadi Yoga and
             chlorpromazine is not significant [P>0.05].
         3. The Anti-psychotic effect of Brahmayadi Yoga is better than
             Tagara and Placebo and comparable to standard control.
Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and 31
Siddha. Janakpuri, New Delhi-2002                                   (Double blind)
ANTI ANXIETY EFFECT OF AN AYURVEDIC
       COMPOUND DRUG – A CROSS OVER TRIAL

•Double blind study with sequential crossover design
comparing the efficacy of Ayurvedic preparation with
modern control.
•
•Ayurvedic preparation- Mandukaparni (Centella asiatica),
Yasti (Glycyrrhiza glabra), Jatamansi (Nardostachys
Jatamansi) in the ration of 1:1:2. Vs. Diazepam and Placebo

Results :Psychological parameters show that Ayurvedic drug
is more effective in enhancing the perceptual discrimination
and Psychomotor performance than the other two control
drugs.

Ref .K. Kuppurajan, C. Seshadri, V Rajagopalan, Kanchan Srinivasan, R.
Sitaraman, Janak indurathi & S Venkatraghavan – Dr. A Lakshmipathi
Research Center for Ayurveda (CCRAS) VHS Campus, Chennai



                                                                         32
ROLE OF THE AYURVEDIC DRUG BRAHMI (BACOPA
    MONNIERI) IN THE MANAGEMENT OF SENILE
                   DEMENTIA.

Drug & Dosage:          Brahmi Vs Placebo
                        Brahmi extract 1 gm. BD .
Duration :              5 years

Results :          The drug not only arrests further
                   memory loss but slows the process
                    of subsequent acetylcholine
                   reduction in person suffering
                   from senile dementia.
Ref ;Pharmacopsychoecologia (1990), 3, 47-52.




                                                       33
AYUSH -56 AN AYURVEDIC ANTI-EPILEPTIC DRUG


 DRUG              :     AYUSH -56
                 [Nardostachys jatamansi & Marseliaminuta]
                          (N=273)
 Adult 2 tablets of 50mg. TDS for 6 months Children – 1 tablet TDS
                                               (<11 years)
 FINDINGS          :    SIGNIFICANT DECREASE IN FREQUENCY
                        OF ATTACKS & DURATION OF SIEZURE .
 •Post seizure symptoms like headache, confusion, excitement,sleeplessness,
 excessive sleep, anorexia, lethargy, amnesia, irritability and mood changes etc.
 also decreased considerably in epileptics after treatment with Ayush –56.

 •No Drug interaction or toxic effects were observed even after prolonged used
  up to 10 years.


Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and
Siddha. Janakpuri, New Delhi-2002

                                                                    (Double blind)
KATUKI (Picrorhiza kurroa )FOR LIVER DISORDERS

  • Hepatoprotective activities of Katuki which is a common
    ingredient in many of Ayurvedic formulations have been
    demonstrated through experimental studies.

  • Alcoholic extracts of Picrorhiza kurroa has been tested against
    CCl4 induced hepatotoxic studies on experimental rats
    revealed hepatoprotective effect viz. improvement of bio
    chemical parameters - SGOT, SGPT, and liver glycogen.
  • Powdered rhizome of Katuki 4 gm. Per day in four divided
    doses for 6 weeks has shown remarkable recovery of liver
    function and inhibition of HBV replication.



Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and
Siddha. Janakpuri, New Delhi-2002
                                                                                35
DEVELOPMENT OF AYUSH QOL-2A ;
   A CODED DRUG FOR IMPROVING QUALITY OF LIFE
                 IN HIV/AIDS
-Keeping the global prevalence of HIV/AIDS and
potentials of Ayurveda in view, the council has
formulated and developed          AYUSH QOL-2         for
symptom management, Improvement of quality of Life
through extensive pre clinical standardization /safety
/targeted                                        activity
studies.
 -AYUSH QOL-2 has been formulated and standardized           Section of kidney showing
adopting the WHO/Global norms (including microbial          normal glomeruli (Ayush QOL
                                                                   2(TD), Female).
growth, estimation of pesticides, presence of
adulterants,         heavy           metals         etc).
 -The preclinical safety and toxicity studies have been
conducted adopting WHO/International norms and
revealed                     its                  safety.
- The Biological activity study revealed significant
immunomodulator, adaptogenic activities(antagonized
the effect of      Cyclophosphamide and confirmed             Section of Liver showing
                                                              normal portal areas and
immunomodulatory        effect * P<0.001 ) which are         hepatocytes. (VC, Female).
essential for improvement quality of life and symptoms
management in HIV/AIDS.
                                                                              36
STANDARDIZATION AYUSH – QOL-2

 Ayush –       Description: Dark brown moderately fine powder with                Microbiological
 QOL-2                         characteristic smell.                              analysis                    3.3 x 103 col/g
                                                                                  Total viable aerobic              Nil
                                       Parameters
                                                                                  count                             Nil
                     Ash %                       11.63         11.60      11.62   Total
                                                                                  Enterobacteriaceae
              Acid-insoluble ash %               0.79              0.30   0.63
                                                                                  Total fungal count
           Water-soluble extractive %            51.39         53.61      52.50
                                                                                  Test for specific
           Alcohol-soluble extractive %          21.75         22.33      22.04   Pathogen                          Nil
                                                                                  E. coli                           Nil
           Loss on drying at 105°C %
                                °                14.10         14.80      14.45
                                                                                  Salmonella sp.                    Nil
              pH (5% aq. solution)                           4.60                 S. aureus                         Nil
                                                                                  Pseudomonas
                Bulk density g/cc                            0.55
                                                                                  aeruginosa
                 Tap density g/cc                            0.63
                                                                                  Lethal dose            No mortality and toxic
                   Calcium %                     0.30          0.295      0.30                           symptoms upto a dose
                                                                                                         level of 5 g/kg body wt.
                  Total sugar %                  12.37         12.44      12.41
                                                                                  TLC                              Done
               Reducing sugar %                  5.65              5.69   5.67
              Non reducing sugar %               6.72              6.75   6.74
                   Sulphur %                     1.65              1.72   1.69
                   Calcium %                     0.30          0.295      0.30




                                                                                       Toluene : Ethyl      Chloroform :
                                                                                       Acetate 93 : 7       methanol90 : 10
                                     Solvent system: n-Butanol :                    TLC profiles of ingredients
                                                                                                             37
TLC of Ayush QOL - 2                Acetic acid : Water 63:27:10
IN F L U E N C E O F A Y U S H Q O L -2 O N
                                                    INFLUENCE OF AYUSH QOL-2                                                                                                                                           T A IL S U S P E N S IO N T E S T
                                                ON FORCED SWIM TEST IN ALBINO MICE                                                                                                                                                                                                 1 1 th   1 2 th          1 3 th
                           250.00
                                                                                                                                                                                       2 5 0 .0 0
                                                                                                              11th       12th   13th
                           200.00
IMMOBILITY PERIOD




                                                                                                                                                                                       2 0 0 .0 0                                                  *            *          *
                                                                                                * * *




                                                                                                                                                       IMMOBILITY PERIOD
    (Seconds)




                           150.00




                                                                                                                                                                           (Seconds)
                                                                                                                                                                                       1 5 0 .0 0

                           100.00                                                                                         *                                                            1 0 0 .0 0
                                                                                                                                * *                                                                                                                                                           *
                             50.00                                                                                                                                                                                                                                                                      *         *
                                                                                                                                                                                        5 0 .0 0

                              0.00
                                          CONTROL               AYUSH QOL-2               AYUSH QOL-2                  CYCLOPHOSPHAMIDE                                                   0 .0 0    C ON TR OL                A Y U S H Q O L- 2        A Y U S H Q O L- 2                  C Y C LO P H O S P H A M ID E
                                                                                                                                                                                                                                                   + C Y C LO P H S P H A M ID E
                                                                                       +CYCLOPHSPHAMIDE                                                                                 GR OU P
                             GROUP




INFERENCE                                                                                                                                                                                                                    TARGETED ACTIVITIES
1. Cyclophosphamide has significantly                                                                                                     decreased the                                                              1.the effect of Aush QOL-2 on body
immobility period when compared                                                                                                            to control *                                                              weight and hematological parameters
P<0.001                                                                                                                                                                                                              such as TLC, DLC & Hb.
2. Ayush QOL-2 has antagonized
           QOL-                                                                                                                           the effect of                                                              2. preliminary effect of Ayush QOL-2
Cyclophosphamide            and                                                                                                               confirmed                                                              on stem cell proliferation.
                                                                                                                                                                                                                     3. the effect on the T Cell subjsets
immunomodulatory effect * P<0.001
                                                                                                                                                                                                                     CD4+ & CD8+ cells.
                                                                                                                                                                                                                     4.effect on macrophage mediated
                                                                                                                                                                                                                     Phagocytosis.
                                                                                                                                       Inference:                                                                    5.To study the effect on the
                                            BLOOD NEUTROPHIL COUNT AFTER                                                               1.Cyclophosphamide has                                                        proliferation of lymphocytes.
                                        14 DAYS ADMINISTRATION OF AYUSH QOL-2
                                                                                                                                       significantly decreased the                                                   6. effect of Ayush QOL-2 on the level
                          12.00

                          10.00
                                                                                                                                       neutrophils counts *P<0.001                                                   of cytokines liberated by TH1 (IL-2, IFN-
                                                                                                                                                                                                                     7), TH2 (IL-4, EL-6, IL-10) and
  NEUTROPHIL PERCENTAGE




                           8.00
                                                                                                                                        2. Ayush QOL-2 has
                                                                                                                                                       QOL-
                           6.00                                                                                                        antagonized the effect of                                                     macrophages (IL-12, ILN-8)
                                                                                                        *                                                                                                            8. effect of Ayush-QOL2 on the
                           4.00
                                                                                                                                       Cyclophosphamide        and                                                   expression of TH1 and TH2, Cytokines.
                           2.00
                                                                                                                                       neutrophil      count     is                                                  8. In vitro anti retro viral activity on cell
                           0.00
                                                                                                                                       comparable with central
                                     CONTROL        AYU SH QOL- 2            AY US H QOL-         CYCLOPHOS PHAM IDE


                                                                                                                                                                                                                     lines.                          38
                                                                        2 +CYC LOPHS PHAM IDE


                          GROUP
                                                                                                                                       group
EVIDENCE BASED OPERATIONAL STUDIES
 The study was executed in 13 states through CCRAS field units
         Objective               Subjects /population covered   OBJECTIVES
1.Prakriti and its relation to              56,600              • study the role of Prakriti in relation to
disease causation and                                           the        socio-economic              and
susceptibility                                                  demographic aspects,
2. Disease Prevalence                       49,992              •the relation between the food habits
studies                                                         and the incidence of diseases
3. Clinical observational                   21,348              • the nature and          frequency       of
studies on efficacy of                                          prevalent diseases
certain Ayurvedic drugs in
various common clinical                                         • ways and means of prevention of
conditions in rural areas                                       diseases and maintenance of positive
                                                                health.
  OUTCOME
  1.      The majority of the population covered during the study was found of Dvandaja Prakriti -
         Personality with combination of two humors, i.e. 64.53%.
  2.     Of these, the highest rate was observed in Vatakapha Prakriti (25.58%).


  3.     The over all incidence rate of illness in the whole of the population 49,992covered during the
         study period remained at 735.10 per thousand.

  4.     Among the specific diseases, the highest incidence rate was observed in Jwara (Fevers)
         106.66 per thousand followed by Kasa (respiratory problems ) 63.65 per thousand. Other
         ailments found prevalent were Atisara (diarrhoea), Pratishyaya (rhinitis), Vata Vyadhi
         (neurological diseases),) and Pandu(anaemia )                                    39
INTEGRATION AND MAIN STREAMING
 Feasibility of introducing Indian systems of medicine
 (Ayurveda & Siddha) In the “National RCH at the primary
 health care (PHC) Level”: (CCRAS-ICMR Collaborative venture)

 OBJECTIVE
 -Main streaming of practices of Indian Systems of Medicine
 (Ayurveda and Siddha ) by integrating them with the Reproductive
 and Child Health (RCH) Programme at Primary Health Centre
 (PHC) level in five states of the country
 -Focus on prevention & management of on common conditions
 that lead to morbidity & mortality during Ante-natal to post- natal
 periods.

 -Evolved Special Modules and Imparted Training -Developed
 Pharmacopoeal standards/Q.A parameters for 17 Ayurveda and
 16 Siddha formulations .

 -Acute/sub chronic and chronic toxicity studies reveled safety

 -The project will be launched shortly
                                                                   40
EVIDENCES ON SAFETY ISSUES
SAFETYEVALUATION OF METAL BASED BHASMAS/RASA KALPAS
  OBJECTIVES

  1.   Preparation of selected Ayurvedic Bhasmas and Rasakalpas
  2.   Formulation of SOPs for preparation.
  3.   Physio-Chemical analysis of prepared Bhasmas.
  4.   Evaluation of safety & toxicity profiles
  5.   Formulation of Pharmacopoeial standards of identified
       Bhasmas.

  OUT COME (two samples at two labs )

       -Physio-Chemical analysis of prepared Bhasmas reveled
       heavy metal contents with in permissible limits .

       -The acure /sub chronic and chronic toxicity study profiles
       of Bhasmas and Rasakalpas reveled safety .


                                                                 41
Evaluation for Heavy Metals and safety profiles of
 Ayurvedic formulationsPublished in JAMA, December
15, 2004-/Vol. 292 No. 23
•It has been reported in JAMA, December 15 2004-/Vol. 292
No. 23 for having heavy metal contents in some Ayurvedic
medicines .

•This has created fear and misconception among Physicians,
Scientists and consumers as well.

•In view of this the dept of AYUSH has taken up chemical
analysis for heavy metal contents and evaluation of safety
profiles of these drugs biologically through sub-chronic and
chronic toxicity studies

OUT COME
• The outcome of the study has reassured the chemical and
biological safety .
                                                          42
S.N.    Drug                  Chemical Analysis   Acute toxicity       Sub-acute   Chronic
                              (CCRAS) (ppm)                            toxicity    Toxicity 90
                                                                                   days


 1.     Swaran Mahayogaraj    Hg-0.04             Non toxic upto 10       NA       Histopathol
        Guggulu(Baidyanath)   As-4.79             times more dose                    ogicaly
                                                  even the sample
                              Pb-46                                                 Shows no
                                                  exceed permissible
                              Cd-0.42             limit                            toxic effect



 2.     Navaratna             Hg-0.05             Non toxic upto 10       NA       Histopathol
        Rasa(Unjha            As-4.18             times more dose                    ogicaly
                                                  even the sample
        Pharmacy)`            Pb-47.05                                              Shows no
                                                  exceed permissible
                              Cd-0.48             limit                            toxic effect



 3.     Mahayogaraj           Hg-0.07             Non toxic upto 10       NA       Histopathol
        Guggulu(Baidyanath)   As-5.19             times more dose                    ogicaly
                                                  even the sample
                              Pb-25.8                                               Shows no
                                                  exceed permissible
                              Cd-0.94             limit                            toxic effect



 4.     Mahalaxmibilas Rasa   Hg-0.06             Non toxic upto 10       NA       Histopathol
        with Gold             As-5.39             times more dose                    ogicaly
                                                  even the sample
        (Baidyanath)          Pb-164.04                                             Shows no
                                                  exceed permissible
                              Cd-0.54             limit                            toxic effect

                                                                                      43
      Permissible limit (ppm) Hg- 1, As-10 (FDA), Pb-10, Cd-0.3 (WHO)
5.   Mahasudarshan Ghan   Hg-0.07                Non toxic up to 10         NA              Completed
     Vati (Zandu)         As-6.96                times more dose
                          Pb-9.96
                          Cd-0.27


6.   Karela Capsules      Hg-below det. limit    Non toxic upto 10    Histopathological         NA
     (Himalaya)           As-2.01                times more dose      y Shows no toxic
                          Pb-4.58                                           effect
                          Cd-0.08




7.   Mahasudarshan        Hg-below det. limit    Non toxic upto 10    Histopathological         NA
     Churna (Zandu)       As-1.08                times more dose      y Shows no toxic
                          Pb-3.8                                            effect
                          Cd-0.16

8.   Gesari Pills         Hg-0.40                Non toxic upto 10    Histopathological         NA
     (Harinarayana        As-0.20                times more dose      y Shows no toxic
     Pharmacy)            Pb- below det. limit                              effect
                          Cd-below det. limit


9.   Balghutti Kesaria    Hg-below det. limit    Non toxic upto 10          NA            Histopathologica
     (Kesari Ayurved      As-26.60               times more                               ly Shows no toxic
     Pharmacy)            Pb- 11.56              doseeven the                                   effect
                          Cd-below det. Limit    sample exceed
                                                 permissible limit




                                                                 44
     Permissible limit (ppm) Hg- 1, As-10 (FDA), Pb-10, Cd-0.3 (WHO)
•Rasakalpas and Bhasmas are safe, if they are prepared
and used as per the specifications mentioned in the
Literature (Ayurvedic Pharmaceutical practices strongly
recommend various aspects like GAP, GFCP and GMPs )
•Drug Design: Bhasmas and Rasa Kalpas are prepared with
metals as basic ingredients and they naturally possess
certain amount of original ingredients in native form.
•Natural biological form: Besides this certain plants used for
processing these preparations also possess metals in natural
biological form e.g. Vitis Vinifera L. ( Draksha) - 0.02-9 ppm
lead Glycyrrhiza glabra (Liconci/Yastimadhu)-24 ppm Tin
(http.//www.levity.com/alchemy/metals.html).
•These factors may sometimes appear in the finished
products if not properly observed, the manufacturing
procedure.



                                                             45
BIO-MEDICAL / THERAPEUTIC INSTRUMENTATION RESEARCH
(Development of Automated instruments in collaboration with IIT Delhi)

•   Automated Sarvngadhara yantra (Commercialization is in
    pipe line)
•   Automated Bhaspasweda yantra (Lab. Prototype is
    developed)
•   Automated Kasharasutra preparing machine (Lab. Prototype is
    developed)
                      ADVANTAGES OF THE AUTOMATED SYSTEM

                      Standardization: Entire X-Y locus motion suiting body profile
                      can be online set, stored and replayed and unaffected by
                      operator’s fatigue. Temperature and flow can be preset and
                      clean oil used to dispense standardized treatment.

                      Minimal fluid & energy: The pumping, filtering and
                      temperature control utilizes small medicated fluid volumes
                      and hence less of the costly fluid is required per patient. It
                      also saves electrical energy. Only one trained operator is
                      needed.
                      Programmability : The therapy time is programmable suiting
                      the different needs of the patients and treatments.

                      Easy setting:       Digital camera with a Flat Screen display
                                                                              46
                      and joystick help quick setting of dispensation locus.
GOLDEN TRIANGLE” PARTNERSHIP (GTP) SCHEME FOR
VALIDATION OF TRADITIONAL ASHU DRUGS
   (AYURVEDA, SIDDHA, HOMOEOPATHY & UNANI)
        AND DEVELOPMENT OF NEW DRUGS

            AYUSH –RESEARCH COUNCILS




               ICMR                    CSIR
Department of AYUSH/ CCRAS,CSIR and ICMR decided to work
together to achieve safe, effective and standardized classical
ASHU products for the identified disease conditions and to
develop new Drugs        effective in disease conditions of
national/global importance.
                                                           47
OBJECTIVES
•To bring safe, effective and standardized ASHU (Ayurveda, Siddha,
Homoeopathy & Unani) products for the identified disease conditions;

•To develop new Ayurvedic / Siddha / Unani / Homeopathic products
effective in the disease conditions of national/global importance.
Products should be better than the available products in the market for
such disease conditions;

•The criteria will be to have best quality, safe and effective products.
Mechanism will be evolved to make products affordable for the
domestic market;

•To utilize appropriate technologies for development of single and
poly-herbal products to make it globally acceptable;

•To promote collaborative research         on   AYUSH    with   modern
medicine/modern science institutions.


                                                                     48
DISEASES/AREAS OF PRIORITY
1. Rasayana (Rejuvenators / Immunomodulators) for healthy ageing.
2. Joint disorders
3. Memory disorders
4. Menopausal syndrome
5. Bronchial allergy
6. Infertility
7. Cardiac disorders (cardio-protective & anti-atherosclerosis)
8. Sleep disorders
9. Irritable Bowel Syndrome (IBS)
10. Vision disorders
11. Urolithiasis & Benign Prostrate Hypertrophy (BPH)
12. Malaria/Filariasis / Lieshmaniasis
13. Diabetes
14. Obesity
15. Cancer
16. Bhasmas/ Rasa Kalpas (Herbomineral Preparations)
17.Development of Pharmacopoeial software
18. Development of Research Council Labs as per NABL / GLP
19. Fundamental and Basic Research in ASHU disciplines


                                                                    49
KEY ELEMENTS FOR RESEARCH &DEVELOPMENT


   Standardization and Quality Control of traditional

   drugs

   Creation of scientific evidences on Safety and Efficacy

   Refractory and Chronic disease Management

   Mainstreaming of strengths of Ayurveda through

   integration




                                                         50
SUGGESTED APPROACHES FOR CREATION OF BETTER
SCIENTIFIC EVIDENCE IN TM/CAM

 EVOLVING OBJECTIVE PARAMETERS OF BASIC CLASICAL METHIODS
 (STANDARDIZATION/ DIAGNOSTIC/THERAPEUTIC ASSESSMENT) FOR
  VALIDATION OF TSM/CAM


 EVOLVING CRITERIA FOR PRIORITIZING RESEARCH OPPORTUNITIES IN
 TSM/CAM


 EMPHASIS ON INTEGRATION – A KEY SOLUTION FOR RESEARCH IN
  TSM/CAM




                                                            51
EVOLVING CRITERIA FOR PRIORITIZING RESEARCH
OPPORTUNITIES

•Quantity and quality of available preliminary data to help
determine the most appropriate type of research (basic
versus clinical research; phase I or II clinical trial versus
phase III trial).
•Extent of use by the public (greatest weight given to
interventions in wide use).
•Public health importance of diseases being treated
(greatest weight to diseases associated with highest
mortality or morbidity or for which conventional medicine
has not proved optimal).
•Feasibility of conducting the research.
                                                           52
PRIORITY AREAS FOR RESEARCH

   Effects of each individual therapy: efficacy, safety and cost-
  effectiveness.
   Research into mechanisms of action of individual therapies,
  including patterns of response to treatment.
   Research into new research strategies which are sensitive to the
  TM/CAM paradigm.
   Research into efficacy of diagnostic methods used.




                                                                    53
RESEARCH FOCUS ON                   CHRONIC       AND
  REFRECTORY DISEASE

  It would be worth to direct our research efforts to
   those traditional drugs which may be of use ….

(a) in combating the so-called ‘Refractory Diseases’ for
   which modern medicine has not been able to offer any
   lasting remedies so far; and

(b) as supplementary remedies to well-established modern
   chemotherapy.




                                                      54
AMONG THE REFRACTORY DISEASES, THE FOLLOWING
MAY PRIOTORISED FOR DEVELOPMENT OF SAFE,
EFFECTIVE TM/CAM REMEDIES
(i) Cancer/HIV/AIDS (ii) Rheumatoid arthritis and Allied conditions;
(iii) Conditions with an allergic component in their etiology (e.g.
bronchial asthma, skin allergies, eczema, psoriasis etc.); (iv) Liver
disorders (including viral diseases like poliomyelitis, herpes, zoster;
(v) Urolithiasis; (vi) Obesity, Hyperlipidaemia and Atherosclerosis;
(vii) Metabolic disorders like diabetes mellitus; (viii) Peptic ulcer; (ix)
Cerebrovascular disorders like Hemiplegia and Paraplegia; (x)
Malabsorption syndromes included Ulcerative colitis; (xi) Ischemic
Heart Disease; (xii) Epilepsy; (xiii) Mental disorders including
psychosis, anxiety neurosis, stress disorders, drug dependence etc.


                                                                        55
AMONG THE REFRACTORY DISEASES, THE FOLLOWING
MAY PRIOTORISED FOR DEVELOPMENT OF SAFE,
EFFECTIVE TM/CAM REMEDIES
(i) Cancer/HIV/AIDS (ii) Rheumatoid arthritis and Allied conditions;
(iii) Conditions with an allergic component in their etiology (e.g.
bronchial asthma, skin allergies, eczema, psoriasis etc.); (iv) Liver
disorders (including viral diseases like poliomyelitis, herpes, zoster;
(v) Urolithiasis; (vi) Obesity, Hyperlipidaemia and Atherosclerosis;
(vii) Metabolic disorders like diabetes mellitus; (viii) Peptic ulcer; (ix)
Cerebrovascular disorders like Hemiplegia and Paraplegia; (x)
Malabsorption syndromes included Ulcerative colitis; (xi) Ischemic
Heart Disease; (xii) Epilepsy; (xiii) Mental disorders including
psychosis, anxiety neurosis, stress disorders, drug dependence etc.


                                                                        56
Thank You



            48



                 57

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Evidence based ayurveda

  • 1. EVIDENCE BASED AYURVEDA N.SRIKANTH ASST.DIRECTOR (AY) G.S.LAVEKAR DIRECTOR CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA Department of AYUSH Ministry of Health & Family Welfare Govt. of India 1
  • 2. CODIFIED SYSTEM OF HEALTH CARE •Ayurveda- the science of life is a comprehensive system of health care of great antiquity, based on experiential knowledge and grown with perpetual additions •Original dimensions of Ayurveda are inbuilt in the ancient compendia of Indian wisdom called Vedas, which are believed to be documented around 6000 years back. Rigveda and Atharvaveda are replete with information on health and maladies and their management with natural modes and modalities. • The knowledge expanded further with laying down of fundamentals and concepts of Ayurveda and systematization in classical texts like Charak Samhita, Sushruta Samhita and Astang Sangrah. • Present form of Ayurveda is the outcome of continued scientific inputs that has gone in to the evolution of its principles, theories and guidelines of healthy living and disease management. 2
  • 3. EVALUATION OF PHARMACOPOEIA OF INDIGENOUS DRUGS Period Approx. no. Remarks on changes Literature of plants used 3000 BC to 1000 BC 289 Building a Pharmacopoea. Vedic texts (Atharvaveda) 1500 BC to 500 AD 650 1. Incorporation of new drugs - Charaka 2. Discharging old drugs - Sushruta -Ashtanga Samgraha - Astanga Hridaya 500 AD to 1900 AD Approx 2000 I)Incorporation of new 16 major Nighantus drugs (like Dhanvantari I)Discharging old drugs Bhavprakasha, Raja II)Varieties identified upto Shaligram) III)Substitutes identified IV)Expansion in applications •India is having the world’s richest flora, comprising of about 120 families of plants, comprising 1.30,000 species. •Ayurvedic texts cover about 2400 species of plants with their medicinal uses as described by ancient Indian medical scholars. 3 •10,000 herbs are used worldwide for medicinal purposes regularly.
  • 4. REVERENCE AND STRENGTH •Considering health of an individual as dynamic integration of environment, body, mind and spirit, Ayurveda lays great emphasis on preservation and promotion of health and preventing the occurrence of disease. • Besides, it advocates employing holistic approach to understand all aspects of human life including diagnosis and management of diseases. • Ayurveda attributes primary importance to preventive medicine and the maintenance of positive health. •The major preventive approaches for maintaining and improving the quality of life include individualized specific daily regimen (Dinacharya), seasonal regimen (Ritucharya), behavioral and ethical considerations (Sadvritta). •Healthy lifestyle is emphasized as the determinant of longevity of life, which by and large depends on the Prakriti (bio-identity i.e. body-mind constitution) of an individual. 4
  • 5. THERAPEUTIC STREAMS •Proper understanding of Prakriti leads the physician in making right diagnosis, prognosis and treatment plan and in guiding patients as well as disease-free individuals what dos and don’ts they need to follow for restoration and maintenance of health. •The therapeutic streams advocated in Ayurveda comprise -Daivavyapasraya chikitsa (Spiritual measures) -Yuktivyapasraya chikitsa (Pharmacological therapies) -Satvavajaya (Non-pharmacological Psychotherapies) • The treatment plan is worked out on the basis of underlying morbidity keeping in mind the strength of the disease and the tolerability of the patient. 5
  • 6. SOURCE OF DRUGS • Ayurveda considers all the substances in the world as drugs if used appropriately according to status and severity of disease as well as patient. • There are three main sources of drugs -Plant sources -Animal sources -Metals/Mineral, marine sources 6
  • 7. IDEAL DRUG/THERAPY •An ideal drug or therapy should cure the disease alone, but not to create any adverse/toxic effects and must restore the homeostatis of somatic/psychic environment of human body (Dhatu-Samyatwva). •Safety of a drug also depends upon its dosage. •Dose of a drug plays a pivotal role in clinical practice as Ayurveda says “Poison in proper dose acts a wonder drug while an effective drug in higher dose acts as Poison ”. 7
  • 8. FOUR-PRONGED TREATMENT PLAN 1. Avoidance of causative and precipitating factors of disease (Nidan parivarjan ) 2. Bio-purification (samshodhan) 3. Use of palliative remedies (samshamana) 4. Health-promoting regimen (pathya Vyavastha) is the hall mark of Ayurvedic therapeutics recommended for physicians to prescribe. • Specific diet and lifestyle guidelines are always prescribed along with the drugs and therapies so as to facilitate restoration of bio-humoral balance and health status. 8
  • 9. CREDIBLE THERAPEUTIC MODALITIES OF AYURVEDA - Bio-purification therapy – Panchakarma - Minimal invasive para surgical measure for management of fistula-in-ano and piles -Ksharsutra - Specialized health promotive & rejuvenative approach for geriatric health care - Rasayana. • These modalities are proven to have an edge over conventional medical approach in dealing with chronic and refractory disease conditions. 9
  • 10. MERITS • Culturally competent & sensitive • Holistic approach • Cost-effective • Natural/ eco-friendly • Minimal adverse effects • Easily accessible • Emphasis on prevention • Health promotion and Quality of life concerns especially in Chronic illness Refractory conditions 10
  • 11. GLOBAL SCENARIO •During last decade, use of Ayurveda and traditional systems of medicine (TM) has expanded globally and has gained popularity. • It has not only continued to be used for primary health care of the poor in developing countries, but has also been used in countries where conventional (Allopathic) medicine is predominant in the national health care system. 11
  • 12. •The most prevalent users of Ayurveda /TM are individuals who have incurable, non–life-threatening conditions that may be chronic viz. neurological disorders, arthritis etc. •The second largest group of users are those struggling with chronic, potentially life-threatening diseases, such as cancer and HIV/AIDS etc. • Both groups turn to Ayurveda /TM for a variety of reasons, such as to improve immune functioning, to improve overall functioning, to increase quality of life, to cope with side effects from conventional therapies, and to relieve symptoms related to their illness. •Most therapies are for chronic diseases such as Neuromuscular disorders, Life style disorders, allergies, arthritis and insomnia HIV/AIDS cancer and so on. 12
  • 13. POTENTIAL ROLE OF TM/CAM IN REFRECTORY ILLNESS USE OF CAM BY PEOPLE LIVING WITH HIV/AIDS IN USA non-- CAM users -- 60 % regular CAM users -- 40 % non-- CAM users --22 % regular CAM users -- 78 % GENERAL ADULT POPULATION PEOPLE LIVING WITH HIV/AIDS 13
  • 14. GLOBAL SITUATION OF USE OF TRADITIONAL MEDICINE CHINA 40% CHILE 71% COLUMBIA 40% INDIA ( use of Ayurveda) 65% AUSTRALIA 48% BELGIUM 70% CANADA 70% FRANCE 49% USA 42% UK 70% NORTH IRELAND 90% SOURCE : WHO traditional medicine strategy 2002-2005. Document WHO/EDM/TRM/2002. 14
  • 15. SAFETY AND EFFICACY • The health care services of Ayurveda are being successfully catered to the masses in India through a huge network of 443634 registered practitioners, 13887 government dispensaries, 2394 hospitals with 42087 beds, 225 colleges conducting degree course, 61 post graduate centres, 7786 manufacturing units and 39 research institutes functioning under the Central Council for Research in Ayurveda and Siddha (CCRAS). • Manufacturing of medicines is regulated under Drugs & Cosmetics Act and licensing of manufacturing premises and products within GMP requirements is mandatory legally. 15
  • 16. SAFETY AND EFFICACY • About 65% of population in India is reported to use Ayurveda and medicinal plants to help meet their primary health care needs and the safety of this vibrant tradition is attributed to time-tested use and textual reference. • Besides, synergy of ingredients in conjunction with individualized Prakriti-based treatment plan forms the basis of efficacy and safety of Ayurvedic formulations. • Specific guidelines are prescribed for the use of apparently toxic medicinal plants with certain detoxification processing that also enhance the bioavailability and efficacy of the final product. 16
  • 17. EVIDENCE BASED RESEARCH •In Ayurveda the process of learning, research and clinical practice are scientific and evidence based. •The knowledge is scientifically validated through evidence based approaches; the Pramanas, Pratyaksa (Direct perception), Anumana (Logical inference), Aptopadesa (authentic documentary testimony), Yukti (Experimental evidence) 17
  • 18. APEX BODY FOR RESEARCH The Government of India set up Central Council for Research in Ayurveda and Siddha (CCRAS) as an apex body in the country for the : • Formulation • Co-ordination • Development • Promotion of research in Ayurveda and Siddha Systems of Medicine on scientific lines. THE MISSION • To prioritize research needs of the country and constantly strive for excellence and global leadership . • To develop quality assured and cost effective research products for health promotion, prevention, management /cure of the disease to meet the needs of the country through establishing the state of art research facilities for comprehensive research with a focus on public health needs for masses. 18
  • 19. THE VISION • To develop CCRAS into a dynamic vibrant and model state of art research organization for achieving global leadership • To focus research on the needs of India with a view to emerging health requirement of the country. THE AREAS OF FOCUS -AYUSH Literature Research and Research on Basic concepts -Drug research -Clinical Research -RCH Research -Neutracautical Research -Cosmeceutical Research -Bio Medical Instrumentation Research. 19
  • 20. SOME SIGNIFICANT LEADS DRUG DEVELOPMENT PROJECTS OF NATIONAL IMPORTANCE •Ayush -64 for Malaria • 777oil for Psoriasis 1.Feasibility of introducing •Ayush-56 for Epilepsy Indian systems of medicine •kshara sutra -minimal invasive para-surgical (Ayurveda & Siddha) In the procedure for Anal Fistula “National RCH at the primary health care (PHC) •Nutraceutical supplements-Ayush poshaka Level- CCRAS-ICMR peya & Ayush Poshaka Yoga • Ayush Face pack for Melasma 2.Safety/Toxicity Evaluation •Ayabringaraja karpam in leucoderma of Metal Based •Brahmyadiyoga for acute schizophrenia Bhasmas/Rasa Kalpas •Ayushman-8 for (Mental retardation) •Shunthi Guggulu for Rheumatoid Arthritis 3.Evaluation for Heavy •Ayush-82 for Diabetes mellitus Metals and safety profiles of Ayurvedic •Guggulu in Obesity and Lipid disorders formulations (Published in •Pippalyadi yoga - An Ayurvedic Oral JAMA • contraceptive for females 4.Bio-medical/Therapeutic instrumentation research 20
  • 21. Identification of priority area Literature Survey Hypothetical Basis (single components/compound formulations ) Drugs for identified conditions SOP ,Standardization, Pre-clinical safety , Biological activity Specific Protocols Approval by Task Force Clinical Trial 21
  • 22. AYUSH 64– AN AYURVEDIC ANTI-MALARIAL DRUG Drug : Ayush-64 Vs Chloroquine [Picrorhiza kurroa, Alstonia scholaris, Swertia chirata&Caesalpinia bonducella] Findings : * Temperature tends to normalcy. * Maintenance of Thymol turbidity[P<0.05] * Significant decrease in lymphocytes, total disappearance of parasite & clinical improvement were seen in 72.4 -95.4 % in comparison with 100 % in control group in various level of studies . SIDE EFFECTS: No side/toxic effects in prescribed doses (Double blind) IPR Status -Patent No. 152863 dated 28.7.198 Ref ;M.V.Chary et al., Double-blind Clinical Trail with Ayush-64 an Ayurvedic drug in P.Vivax Malaria, Journal of Rersearch in Ayurveda and Siddha Vol.VI No.1, 3&4:105- 22 116,1985.
  • 23. 777 OIL FOR PSORIASIS DRUG : 777 OIL [Wrightia tinctoria] FINDINGS : Significant response was observed in 80% patients . The recurrence is postponed and the Intensity of the lesions is very much minimized .The efficacy of the drug is also supported by histopathological studies. (open study) Before treatment After treatment 23 IPR Status - Patent No. 166740 dated 11.9.1987
  • 24. KSHARA SUTRA -MINIMAL INVASIVE PARA-SURGICAL PROCEDURE FOR ANAL FISTULA(BHAGANDARA) Ingredients • Snuhi Ksheera-latex of Euphorbia neriifolia Ksheera- • Apamarga Kshara (Achyrantus aspera) aspera) • Fine powder of haridra-(Curcuma longa) haridra- longa) • Barbour’s surgical thread No. 20 Barbour’ Ksharasutra offers effective ambulatory and safe alternative to surgery in fistula in ano. Recurrence rate was 4% in Ksharsutra group when compared 11 %with surgery. Findings : The study revealed 98.7% cure rate. In this OPD procedure Cutting and Healing took place simultaneously so that no raw area was left besides Minimal tissue damage and less pain. No recurrence has been reported. (Randomized controlled study ) IPR Status - Patent No.186243 dated 15.2.2002 24
  • 25. AYURVEDIC NUTRACEUTICAL SUPPLEMENTS -AYUSH POSHAKA PEYA & AYUSH POSHAKA YOGA FINDINGS Clinical trial was conducted on Antarctic Expedition members (n=20, trial group) for a period of 6 weeks. The study revealed, Potential adaptogenic properties. Immuno-stimulant and anti oxidant effects besides significant anti stress effect against a series of stress like extreme cold, mental stress. (isolation and some psychological factors),and nutritional stress . No clinical toxicity was noticed and lipid profile as well as body weight, body mass Index / lean body mass were not effected. IPR Status - Patent Application No. 961/DEL/2004 25
  • 26. AYUSH FACE PACK FOR MELASMA Findings -The result was assessed using Melasma. Area & Severity Index (MASI score) (n=20). -The response was statistically significant with P< . 05. the average score was 7.32 compared with 19.25 pretreatment score. No side effect was recorded in all the treated patients. After treatment 26 Before treatment
  • 27. SHUNTHI GUGGULU FOR RHEUMATOID ARTHRITIS DRUG : SHUNTHI GUGGULU [Zingiber officinale & Commiphora mukul] FINDINGS : Significant response was observed in 72% cases. There was marked improvement of signs and symptoms besides significant changes in lab. parameters like,ESR etc. (open study ) Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi-2002 27
  • 28. AYUSH-82 FOR DIABETES MELLITUS DRUG : AYUSH-82 [Mangifera indica, Syzygium cumini, Gymnema sylvestris, Momordia charantia] FINDINGS : Fall in FBS, PPBS after treatment was significant (0.001) besides 75% good response on subjective assessment. (open study ) Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi-2002 28
  • 29. A CONTROLLED CLINICAL TRIAL OF GUGGULU AND P.E. EXT. OF GUGGULU IN OBESITY AND LIPID DISORDERS Drugs : Guggulu , P.E. Ext. of Guggulu Vs Placebo Findings: - Reduction in serum cholesterol was observed in all cases. - Significant weight reduction was found in P.E. extract treated group [2 kg/month] when compared with Guggulu group [1 kg/month]. (Double blind) Ref;Clinical and Experimental Trial of Guggulu (Medo-Roga). 1989Central Council 29 for Research in Ayurveda and Siddha. Janakpuri, New Delhi.
  • 30. AYUSHMAN-8 IN MENTAL RETARDATION DRUGS : AYUSHMAN-8 VS PLACEBO[STARCH] [Centella asiatica & Bacopa monierri] Age Group : 5-16 years Findings : * Binet-Kamat Test-Numerical increase in mental age was greater in drugs group [p=0.05<P<0.1]. * SEGUIN- Form board Test: Increase in mental age shown was significant when compared to Placebo group [P>0.01] * Clinical improvement. Ref V. Rajagopalan et al Effect of Ayushman-8 in Mental retardation, Journal of Research in Ayurveda and Siddha, Vol.XIX-No.3-4 (1998), p. 89-97. 30 (Double blind)
  • 31. ADOUBLE BLIND CONTROLLED STUDY ON THE ROLE OF BRAHMYADIYOGA AND TAGARA IN ACUTE SCHIZOPHRENIA Drugs : 1. Brahmyadi Yoga 1NGREDIENTS i. Manduk parni (Centella asiatica) ii. Jatamansi Root ( Nardostachys jatamansi) iii. Kustha (Sausurea lappa) iv. Sarpagandha ( Rauwolfia serpentina) v. Vacha (Acorus calamus)) 2.Tagara. 3.Standard control : Chlorpromazine Vs Placebo[Starch] Findings : 1. The mean difference effectiveness of Brahmyadi Yoga is better than that of Tagara[P<0.005] and Placebo[P<0.001] besides clinical improvement. 2. The mean effectiveness of Brahmyadi Yoga and chlorpromazine is not significant [P>0.05]. 3. The Anti-psychotic effect of Brahmayadi Yoga is better than Tagara and Placebo and comparable to standard control. Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and 31 Siddha. Janakpuri, New Delhi-2002 (Double blind)
  • 32. ANTI ANXIETY EFFECT OF AN AYURVEDIC COMPOUND DRUG – A CROSS OVER TRIAL •Double blind study with sequential crossover design comparing the efficacy of Ayurvedic preparation with modern control. • •Ayurvedic preparation- Mandukaparni (Centella asiatica), Yasti (Glycyrrhiza glabra), Jatamansi (Nardostachys Jatamansi) in the ration of 1:1:2. Vs. Diazepam and Placebo Results :Psychological parameters show that Ayurvedic drug is more effective in enhancing the perceptual discrimination and Psychomotor performance than the other two control drugs. Ref .K. Kuppurajan, C. Seshadri, V Rajagopalan, Kanchan Srinivasan, R. Sitaraman, Janak indurathi & S Venkatraghavan – Dr. A Lakshmipathi Research Center for Ayurveda (CCRAS) VHS Campus, Chennai 32
  • 33. ROLE OF THE AYURVEDIC DRUG BRAHMI (BACOPA MONNIERI) IN THE MANAGEMENT OF SENILE DEMENTIA. Drug & Dosage: Brahmi Vs Placebo Brahmi extract 1 gm. BD . Duration : 5 years Results : The drug not only arrests further memory loss but slows the process of subsequent acetylcholine reduction in person suffering from senile dementia. Ref ;Pharmacopsychoecologia (1990), 3, 47-52. 33
  • 34. AYUSH -56 AN AYURVEDIC ANTI-EPILEPTIC DRUG DRUG : AYUSH -56 [Nardostachys jatamansi & Marseliaminuta] (N=273) Adult 2 tablets of 50mg. TDS for 6 months Children – 1 tablet TDS (<11 years) FINDINGS : SIGNIFICANT DECREASE IN FREQUENCY OF ATTACKS & DURATION OF SIEZURE . •Post seizure symptoms like headache, confusion, excitement,sleeplessness, excessive sleep, anorexia, lethargy, amnesia, irritability and mood changes etc. also decreased considerably in epileptics after treatment with Ayush –56. •No Drug interaction or toxic effects were observed even after prolonged used up to 10 years. Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi-2002 (Double blind)
  • 35. KATUKI (Picrorhiza kurroa )FOR LIVER DISORDERS • Hepatoprotective activities of Katuki which is a common ingredient in many of Ayurvedic formulations have been demonstrated through experimental studies. • Alcoholic extracts of Picrorhiza kurroa has been tested against CCl4 induced hepatotoxic studies on experimental rats revealed hepatoprotective effect viz. improvement of bio chemical parameters - SGOT, SGPT, and liver glycogen. • Powdered rhizome of Katuki 4 gm. Per day in four divided doses for 6 weeks has shown remarkable recovery of liver function and inhibition of HBV replication. Ref;CCRAS Research An Over View, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi-2002 35
  • 36. DEVELOPMENT OF AYUSH QOL-2A ; A CODED DRUG FOR IMPROVING QUALITY OF LIFE IN HIV/AIDS -Keeping the global prevalence of HIV/AIDS and potentials of Ayurveda in view, the council has formulated and developed AYUSH QOL-2 for symptom management, Improvement of quality of Life through extensive pre clinical standardization /safety /targeted activity studies. -AYUSH QOL-2 has been formulated and standardized Section of kidney showing adopting the WHO/Global norms (including microbial normal glomeruli (Ayush QOL 2(TD), Female). growth, estimation of pesticides, presence of adulterants, heavy metals etc). -The preclinical safety and toxicity studies have been conducted adopting WHO/International norms and revealed its safety. - The Biological activity study revealed significant immunomodulator, adaptogenic activities(antagonized the effect of Cyclophosphamide and confirmed Section of Liver showing normal portal areas and immunomodulatory effect * P<0.001 ) which are hepatocytes. (VC, Female). essential for improvement quality of life and symptoms management in HIV/AIDS. 36
  • 37. STANDARDIZATION AYUSH – QOL-2 Ayush – Description: Dark brown moderately fine powder with Microbiological QOL-2 characteristic smell. analysis 3.3 x 103 col/g Total viable aerobic Nil Parameters count Nil Ash % 11.63 11.60 11.62 Total Enterobacteriaceae Acid-insoluble ash % 0.79 0.30 0.63 Total fungal count Water-soluble extractive % 51.39 53.61 52.50 Test for specific Alcohol-soluble extractive % 21.75 22.33 22.04 Pathogen Nil E. coli Nil Loss on drying at 105°C % ° 14.10 14.80 14.45 Salmonella sp. Nil pH (5% aq. solution) 4.60 S. aureus Nil Pseudomonas Bulk density g/cc 0.55 aeruginosa Tap density g/cc 0.63 Lethal dose No mortality and toxic Calcium % 0.30 0.295 0.30 symptoms upto a dose level of 5 g/kg body wt. Total sugar % 12.37 12.44 12.41 TLC Done Reducing sugar % 5.65 5.69 5.67 Non reducing sugar % 6.72 6.75 6.74 Sulphur % 1.65 1.72 1.69 Calcium % 0.30 0.295 0.30 Toluene : Ethyl Chloroform : Acetate 93 : 7 methanol90 : 10 Solvent system: n-Butanol : TLC profiles of ingredients 37 TLC of Ayush QOL - 2 Acetic acid : Water 63:27:10
  • 38. IN F L U E N C E O F A Y U S H Q O L -2 O N INFLUENCE OF AYUSH QOL-2 T A IL S U S P E N S IO N T E S T ON FORCED SWIM TEST IN ALBINO MICE 1 1 th 1 2 th 1 3 th 250.00 2 5 0 .0 0 11th 12th 13th 200.00 IMMOBILITY PERIOD 2 0 0 .0 0 * * * * * * IMMOBILITY PERIOD (Seconds) 150.00 (Seconds) 1 5 0 .0 0 100.00 * 1 0 0 .0 0 * * * 50.00 * * 5 0 .0 0 0.00 CONTROL AYUSH QOL-2 AYUSH QOL-2 CYCLOPHOSPHAMIDE 0 .0 0 C ON TR OL A Y U S H Q O L- 2 A Y U S H Q O L- 2 C Y C LO P H O S P H A M ID E + C Y C LO P H S P H A M ID E +CYCLOPHSPHAMIDE GR OU P GROUP INFERENCE TARGETED ACTIVITIES 1. Cyclophosphamide has significantly decreased the 1.the effect of Aush QOL-2 on body immobility period when compared to control * weight and hematological parameters P<0.001 such as TLC, DLC & Hb. 2. Ayush QOL-2 has antagonized QOL- the effect of 2. preliminary effect of Ayush QOL-2 Cyclophosphamide and confirmed on stem cell proliferation. 3. the effect on the T Cell subjsets immunomodulatory effect * P<0.001 CD4+ & CD8+ cells. 4.effect on macrophage mediated Phagocytosis. Inference: 5.To study the effect on the BLOOD NEUTROPHIL COUNT AFTER 1.Cyclophosphamide has proliferation of lymphocytes. 14 DAYS ADMINISTRATION OF AYUSH QOL-2 significantly decreased the 6. effect of Ayush QOL-2 on the level 12.00 10.00 neutrophils counts *P<0.001 of cytokines liberated by TH1 (IL-2, IFN- 7), TH2 (IL-4, EL-6, IL-10) and NEUTROPHIL PERCENTAGE 8.00 2. Ayush QOL-2 has QOL- 6.00 antagonized the effect of macrophages (IL-12, ILN-8) * 8. effect of Ayush-QOL2 on the 4.00 Cyclophosphamide and expression of TH1 and TH2, Cytokines. 2.00 neutrophil count is 8. In vitro anti retro viral activity on cell 0.00 comparable with central CONTROL AYU SH QOL- 2 AY US H QOL- CYCLOPHOS PHAM IDE lines. 38 2 +CYC LOPHS PHAM IDE GROUP group
  • 39. EVIDENCE BASED OPERATIONAL STUDIES The study was executed in 13 states through CCRAS field units Objective Subjects /population covered OBJECTIVES 1.Prakriti and its relation to 56,600 • study the role of Prakriti in relation to disease causation and the socio-economic and susceptibility demographic aspects, 2. Disease Prevalence 49,992 •the relation between the food habits studies and the incidence of diseases 3. Clinical observational 21,348 • the nature and frequency of studies on efficacy of prevalent diseases certain Ayurvedic drugs in various common clinical • ways and means of prevention of conditions in rural areas diseases and maintenance of positive health. OUTCOME 1. The majority of the population covered during the study was found of Dvandaja Prakriti - Personality with combination of two humors, i.e. 64.53%. 2. Of these, the highest rate was observed in Vatakapha Prakriti (25.58%). 3. The over all incidence rate of illness in the whole of the population 49,992covered during the study period remained at 735.10 per thousand. 4. Among the specific diseases, the highest incidence rate was observed in Jwara (Fevers) 106.66 per thousand followed by Kasa (respiratory problems ) 63.65 per thousand. Other ailments found prevalent were Atisara (diarrhoea), Pratishyaya (rhinitis), Vata Vyadhi (neurological diseases),) and Pandu(anaemia ) 39
  • 40. INTEGRATION AND MAIN STREAMING Feasibility of introducing Indian systems of medicine (Ayurveda & Siddha) In the “National RCH at the primary health care (PHC) Level”: (CCRAS-ICMR Collaborative venture) OBJECTIVE -Main streaming of practices of Indian Systems of Medicine (Ayurveda and Siddha ) by integrating them with the Reproductive and Child Health (RCH) Programme at Primary Health Centre (PHC) level in five states of the country -Focus on prevention & management of on common conditions that lead to morbidity & mortality during Ante-natal to post- natal periods. -Evolved Special Modules and Imparted Training -Developed Pharmacopoeal standards/Q.A parameters for 17 Ayurveda and 16 Siddha formulations . -Acute/sub chronic and chronic toxicity studies reveled safety -The project will be launched shortly 40
  • 41. EVIDENCES ON SAFETY ISSUES SAFETYEVALUATION OF METAL BASED BHASMAS/RASA KALPAS OBJECTIVES 1. Preparation of selected Ayurvedic Bhasmas and Rasakalpas 2. Formulation of SOPs for preparation. 3. Physio-Chemical analysis of prepared Bhasmas. 4. Evaluation of safety & toxicity profiles 5. Formulation of Pharmacopoeial standards of identified Bhasmas. OUT COME (two samples at two labs ) -Physio-Chemical analysis of prepared Bhasmas reveled heavy metal contents with in permissible limits . -The acure /sub chronic and chronic toxicity study profiles of Bhasmas and Rasakalpas reveled safety . 41
  • 42. Evaluation for Heavy Metals and safety profiles of Ayurvedic formulationsPublished in JAMA, December 15, 2004-/Vol. 292 No. 23 •It has been reported in JAMA, December 15 2004-/Vol. 292 No. 23 for having heavy metal contents in some Ayurvedic medicines . •This has created fear and misconception among Physicians, Scientists and consumers as well. •In view of this the dept of AYUSH has taken up chemical analysis for heavy metal contents and evaluation of safety profiles of these drugs biologically through sub-chronic and chronic toxicity studies OUT COME • The outcome of the study has reassured the chemical and biological safety . 42
  • 43. S.N. Drug Chemical Analysis Acute toxicity Sub-acute Chronic (CCRAS) (ppm) toxicity Toxicity 90 days 1. Swaran Mahayogaraj Hg-0.04 Non toxic upto 10 NA Histopathol Guggulu(Baidyanath) As-4.79 times more dose ogicaly even the sample Pb-46 Shows no exceed permissible Cd-0.42 limit toxic effect 2. Navaratna Hg-0.05 Non toxic upto 10 NA Histopathol Rasa(Unjha As-4.18 times more dose ogicaly even the sample Pharmacy)` Pb-47.05 Shows no exceed permissible Cd-0.48 limit toxic effect 3. Mahayogaraj Hg-0.07 Non toxic upto 10 NA Histopathol Guggulu(Baidyanath) As-5.19 times more dose ogicaly even the sample Pb-25.8 Shows no exceed permissible Cd-0.94 limit toxic effect 4. Mahalaxmibilas Rasa Hg-0.06 Non toxic upto 10 NA Histopathol with Gold As-5.39 times more dose ogicaly even the sample (Baidyanath) Pb-164.04 Shows no exceed permissible Cd-0.54 limit toxic effect 43 Permissible limit (ppm) Hg- 1, As-10 (FDA), Pb-10, Cd-0.3 (WHO)
  • 44. 5. Mahasudarshan Ghan Hg-0.07 Non toxic up to 10 NA Completed Vati (Zandu) As-6.96 times more dose Pb-9.96 Cd-0.27 6. Karela Capsules Hg-below det. limit Non toxic upto 10 Histopathological NA (Himalaya) As-2.01 times more dose y Shows no toxic Pb-4.58 effect Cd-0.08 7. Mahasudarshan Hg-below det. limit Non toxic upto 10 Histopathological NA Churna (Zandu) As-1.08 times more dose y Shows no toxic Pb-3.8 effect Cd-0.16 8. Gesari Pills Hg-0.40 Non toxic upto 10 Histopathological NA (Harinarayana As-0.20 times more dose y Shows no toxic Pharmacy) Pb- below det. limit effect Cd-below det. limit 9. Balghutti Kesaria Hg-below det. limit Non toxic upto 10 NA Histopathologica (Kesari Ayurved As-26.60 times more ly Shows no toxic Pharmacy) Pb- 11.56 doseeven the effect Cd-below det. Limit sample exceed permissible limit 44 Permissible limit (ppm) Hg- 1, As-10 (FDA), Pb-10, Cd-0.3 (WHO)
  • 45. •Rasakalpas and Bhasmas are safe, if they are prepared and used as per the specifications mentioned in the Literature (Ayurvedic Pharmaceutical practices strongly recommend various aspects like GAP, GFCP and GMPs ) •Drug Design: Bhasmas and Rasa Kalpas are prepared with metals as basic ingredients and they naturally possess certain amount of original ingredients in native form. •Natural biological form: Besides this certain plants used for processing these preparations also possess metals in natural biological form e.g. Vitis Vinifera L. ( Draksha) - 0.02-9 ppm lead Glycyrrhiza glabra (Liconci/Yastimadhu)-24 ppm Tin (http.//www.levity.com/alchemy/metals.html). •These factors may sometimes appear in the finished products if not properly observed, the manufacturing procedure. 45
  • 46. BIO-MEDICAL / THERAPEUTIC INSTRUMENTATION RESEARCH (Development of Automated instruments in collaboration with IIT Delhi) • Automated Sarvngadhara yantra (Commercialization is in pipe line) • Automated Bhaspasweda yantra (Lab. Prototype is developed) • Automated Kasharasutra preparing machine (Lab. Prototype is developed) ADVANTAGES OF THE AUTOMATED SYSTEM Standardization: Entire X-Y locus motion suiting body profile can be online set, stored and replayed and unaffected by operator’s fatigue. Temperature and flow can be preset and clean oil used to dispense standardized treatment. Minimal fluid & energy: The pumping, filtering and temperature control utilizes small medicated fluid volumes and hence less of the costly fluid is required per patient. It also saves electrical energy. Only one trained operator is needed. Programmability : The therapy time is programmable suiting the different needs of the patients and treatments. Easy setting: Digital camera with a Flat Screen display 46 and joystick help quick setting of dispensation locus.
  • 47. GOLDEN TRIANGLE” PARTNERSHIP (GTP) SCHEME FOR VALIDATION OF TRADITIONAL ASHU DRUGS (AYURVEDA, SIDDHA, HOMOEOPATHY & UNANI) AND DEVELOPMENT OF NEW DRUGS AYUSH –RESEARCH COUNCILS ICMR CSIR Department of AYUSH/ CCRAS,CSIR and ICMR decided to work together to achieve safe, effective and standardized classical ASHU products for the identified disease conditions and to develop new Drugs effective in disease conditions of national/global importance. 47
  • 48. OBJECTIVES •To bring safe, effective and standardized ASHU (Ayurveda, Siddha, Homoeopathy & Unani) products for the identified disease conditions; •To develop new Ayurvedic / Siddha / Unani / Homeopathic products effective in the disease conditions of national/global importance. Products should be better than the available products in the market for such disease conditions; •The criteria will be to have best quality, safe and effective products. Mechanism will be evolved to make products affordable for the domestic market; •To utilize appropriate technologies for development of single and poly-herbal products to make it globally acceptable; •To promote collaborative research on AYUSH with modern medicine/modern science institutions. 48
  • 49. DISEASES/AREAS OF PRIORITY 1. Rasayana (Rejuvenators / Immunomodulators) for healthy ageing. 2. Joint disorders 3. Memory disorders 4. Menopausal syndrome 5. Bronchial allergy 6. Infertility 7. Cardiac disorders (cardio-protective & anti-atherosclerosis) 8. Sleep disorders 9. Irritable Bowel Syndrome (IBS) 10. Vision disorders 11. Urolithiasis & Benign Prostrate Hypertrophy (BPH) 12. Malaria/Filariasis / Lieshmaniasis 13. Diabetes 14. Obesity 15. Cancer 16. Bhasmas/ Rasa Kalpas (Herbomineral Preparations) 17.Development of Pharmacopoeial software 18. Development of Research Council Labs as per NABL / GLP 19. Fundamental and Basic Research in ASHU disciplines 49
  • 50. KEY ELEMENTS FOR RESEARCH &DEVELOPMENT Standardization and Quality Control of traditional drugs Creation of scientific evidences on Safety and Efficacy Refractory and Chronic disease Management Mainstreaming of strengths of Ayurveda through integration 50
  • 51. SUGGESTED APPROACHES FOR CREATION OF BETTER SCIENTIFIC EVIDENCE IN TM/CAM EVOLVING OBJECTIVE PARAMETERS OF BASIC CLASICAL METHIODS (STANDARDIZATION/ DIAGNOSTIC/THERAPEUTIC ASSESSMENT) FOR VALIDATION OF TSM/CAM EVOLVING CRITERIA FOR PRIORITIZING RESEARCH OPPORTUNITIES IN TSM/CAM EMPHASIS ON INTEGRATION – A KEY SOLUTION FOR RESEARCH IN TSM/CAM 51
  • 52. EVOLVING CRITERIA FOR PRIORITIZING RESEARCH OPPORTUNITIES •Quantity and quality of available preliminary data to help determine the most appropriate type of research (basic versus clinical research; phase I or II clinical trial versus phase III trial). •Extent of use by the public (greatest weight given to interventions in wide use). •Public health importance of diseases being treated (greatest weight to diseases associated with highest mortality or morbidity or for which conventional medicine has not proved optimal). •Feasibility of conducting the research. 52
  • 53. PRIORITY AREAS FOR RESEARCH Effects of each individual therapy: efficacy, safety and cost- effectiveness. Research into mechanisms of action of individual therapies, including patterns of response to treatment. Research into new research strategies which are sensitive to the TM/CAM paradigm. Research into efficacy of diagnostic methods used. 53
  • 54. RESEARCH FOCUS ON CHRONIC AND REFRECTORY DISEASE It would be worth to direct our research efforts to those traditional drugs which may be of use …. (a) in combating the so-called ‘Refractory Diseases’ for which modern medicine has not been able to offer any lasting remedies so far; and (b) as supplementary remedies to well-established modern chemotherapy. 54
  • 55. AMONG THE REFRACTORY DISEASES, THE FOLLOWING MAY PRIOTORISED FOR DEVELOPMENT OF SAFE, EFFECTIVE TM/CAM REMEDIES (i) Cancer/HIV/AIDS (ii) Rheumatoid arthritis and Allied conditions; (iii) Conditions with an allergic component in their etiology (e.g. bronchial asthma, skin allergies, eczema, psoriasis etc.); (iv) Liver disorders (including viral diseases like poliomyelitis, herpes, zoster; (v) Urolithiasis; (vi) Obesity, Hyperlipidaemia and Atherosclerosis; (vii) Metabolic disorders like diabetes mellitus; (viii) Peptic ulcer; (ix) Cerebrovascular disorders like Hemiplegia and Paraplegia; (x) Malabsorption syndromes included Ulcerative colitis; (xi) Ischemic Heart Disease; (xii) Epilepsy; (xiii) Mental disorders including psychosis, anxiety neurosis, stress disorders, drug dependence etc. 55
  • 56. AMONG THE REFRACTORY DISEASES, THE FOLLOWING MAY PRIOTORISED FOR DEVELOPMENT OF SAFE, EFFECTIVE TM/CAM REMEDIES (i) Cancer/HIV/AIDS (ii) Rheumatoid arthritis and Allied conditions; (iii) Conditions with an allergic component in their etiology (e.g. bronchial asthma, skin allergies, eczema, psoriasis etc.); (iv) Liver disorders (including viral diseases like poliomyelitis, herpes, zoster; (v) Urolithiasis; (vi) Obesity, Hyperlipidaemia and Atherosclerosis; (vii) Metabolic disorders like diabetes mellitus; (viii) Peptic ulcer; (ix) Cerebrovascular disorders like Hemiplegia and Paraplegia; (x) Malabsorption syndromes included Ulcerative colitis; (xi) Ischemic Heart Disease; (xii) Epilepsy; (xiii) Mental disorders including psychosis, anxiety neurosis, stress disorders, drug dependence etc. 56
  • 57. Thank You 48 57