The Concept and Practice of Immunomodulation in Ayurveda PDF

Ancient Science of Life Vol. No. XIX (1&2) July, August, September, October 99 The Concept and Practice of Immunomodulation in Ayurveda and the Role of Rasayanas as Immunomodulators Dr. J.S. Tripathi & Prof. R.H...

Ancient Science of Life Vol. No. XIX (1&2) July, August, September, October 99 The Concept and Practice of Immunomodulation in Ayurveda and the Role of Rasayanas as Immunomodulators Dr. J.S. Tripathi & Prof. R.H. Singh Division of Panchakarma, Rasayana and Manas Chikitsa Department of Kayachikitsa, Institute of Medical Sciences Banaras Hindu University, Varanasi – 221 005. Received : 04.08.1998 Accepted : 12.01.1999 The modulation of immune response by using Ayurvedic herbal medications as a possible The basic concept of immunomodulation not therapeutic measure has now become a only existed in Ayurveda but is being really subject of scientific investigation. The practiced by the Ayurvedists for centuries. In concept in modern scientific understanding fact, one of the therapeutic strategies in would mean enhancement of immune Ayurvedic medicines is to enhance the body’s responsiveness of an organism against a overall natural resistance to the disease pathogen by nonspecifically activating the causing agent rather than directly neutralizing immune system using immunomodulatory the agent itself. Here lies the difference agents of plant origin. It is now being between the fundamental therapeutic recognized that modulation of immunological approach of Ayurveda and modern medicine, response could provide an alternative to which emphasize on direct attack on the conventional chemotherapy for a variety of disease causing agents using diseased conditions of impaired immune chemotherapeutic drugs. In Ayurvedic responsiveness or when a selective practice, the objective of immune immunosuppression has to be induced in enhancement is achieved through the use of situations like autoimmune disorders and the Rasayana and Vajikarana therapy, organ transplantations. following Acar Rasayana measures and also by use of Ojovardhaka remedies. Immunomodulators are considered now as one of the most potent tools in the Vyadhi-ksamatwa, as it is understood in management of health and disease by modern Ayurveda has much wider implications than medicine. In fact the role of the term “Immunity” used in modern immunomodulators in modern medicine is yet medicine. Chakrapanidatta has interpreted to be fully appreciated or perceived as our the term Vyadhi-ksamatwa as Vyadhi bala understanding of immune system is changing Virodhitwa i.e., antagonistic to the strength at a rapid pace. The more recent and virulence of the disease and understanding of neuro – endocrine – immune Vyadhyutpada Pratibandhakatwa i.e., the axis or the influence of exercise, circadian capacity to inhibit and bind the causes and rhythms, seasonal variations, different factors of the disease. Charaka has also psychological states on immune system are described Bala as the factor, that destroys the unfolding many such issues which are brining Dosas or disease causing factors viz., the modern concept closer to Ayurvedic principles of Vyadhi-ksamatva, Ojas and “Balam hyalam dosaharam Nigrahaya Bala. dosanam” (Ch.Chi. 3/16). Pages 59 - 63 1  disease causing agencies which invade the The Bala is used as synonym to Prana and body. Ojas. They have underlying meaning of biostrength and vitally with natural resistance As regards the functions and transport of the against ageing and disease. Ojas has the Ojas, Chakrapanidatta observes that Ojas property similar to ‘Slesma but in the which is the Sara of all the Dhatus in virtually Ayurvedic texts it is stated to stand not only not different than them, comparable to Ghee for Sleshma (Tavadeva Slaismika syaujasah – of the milk, honey of flowers and fruits, being Ch.Sh. 7/15) but also for Rasa (Rasacaujah located in Hrdaya, mixes with Rasa and Samkhyatah-Ch.Ni.4/7) and Rakta (Jiva circulates through the blood vessels and sonitam api Ojah- Dalhana on Su.Su. 15/91). capillaries and perform Tarpana of the entire Reference has been made of the two kinds of body. It represents the strength of all the Ojas viz., Ardhanjali or Slaismik Ojas and tissues and is present in the organism from Para or Asta Bindu Ojas. They are important time of fertilization of the sperm and ova, due and significant in the context of Vyadhi- to its natural powder (Chakrapani on Su. Su. ksamatwa. The two kinds of Ojas have direct 15/99). The ten larger blood vessels influence on the body’s defense against (Mahamula Dhamanis) are the channels of decay, degeneration and infections. transport of Ojas to entire body and the heart and circulation plays an important role in the The Ojas prevents, resists and overcomes distribution of Slaismika Ojas to all the body such factors which are produced in the course tissues and bestows them protection against of the vital activities of the organism and may degeneration and diseases. lead to decay and degeneration of the tissues (Dhatus) of the bdoy. A few examples of There are the three clinical conditions viz., such events are Prameha (Diabets mellitus), Ojo Visramsa, Ojo-Vyapat and Ojoksaya, Rajyaksma (Pulmonary tuberculosis), Pandu which result due to mild, moderate and severe (Anaemias), Arbudas (Malignant and other impairment in the availability of Ojas to the tumours), premature senility, natural tissues. These conditions arise out of injury degenerative changes, that take place in old to or diseases of the channels of distribution age, impaired nutritional states, Starvation of this vital substance, its altered composition and such psychosomatic stress conditions as and deficiency respectively. The aetiological Bhaya (fear), Krodha (anger), Kama (libidinal factors which bring about these conditions or impulse), Soka (grief) etc., This action of the causes for reduced immune capability, Ojas relates to its capacity of providing the according to Ayurveda, range from trauma substances (which resemble Slaismika in (both physical and microbial), severe qualities), the presence of which in the Rasa degenerative and wasting diseases, and Rakta confers adequate protection to the malnutrition, starvation to psychological Dhatus against decay and degeneration. stresses – anger, anxiety and grief etc. These factors depending upon their extent, degree The second important group of functions and intensity of operation may result in the performed by Ojas is to provide the body with production of one of the above mentioned an appropriate substance, which inhabits, conditions (Su.Su. 15/23). neutralizes and destroys the virulent factors of the disease. These obviously relate to It is pertinent to emphasize here that the role immunological factors both cellular and of the emotional and psychological factors humoral, that destroy or neutralizes the over the proper functioning of immune Pages 59 - 63 2 system has been very clearly appreciated by i.e., Acar, which may be helpful in achieving Ayurveda, which is now being increasingly the above goal. The Rasayanas are supposed recognized by the modern science based on to strengthen Oja and Bala i.e., vitality and the evidences of the various experimental and biostrength with natural resistance against clinical studies. aging and disease. It is stated to contribute to the integrity of body tissues and thus In fact, a new branch of medical sciences increases longevity. The other benefits of this known as – “Phychoneuroimmunology” is therapy are the promotion of memory and fastly developing, which studies the intelligence, the preservation of youth, luster interrelationship of psychological factors, and complexion and voice. The various nervous system and immune system. measures comprehended by this therapy are termed as Rasayana, because they conduce to Vyadhi-ksamatwa (natural resistance) is not the replenishment of Rasa and other body of the same order constitutions i.e., it varies tissues. with individuals. It also depends upon nutritional, environmental and individual Rasayana Tantra is one of the eight clinical factors – both physical and mental. The specialties of Ayurveda. It refers to nutrition, Vyadhiksamatwa or Bala is stated to be of natural resistance and geriatrics. Apparently, three types: Rasayana means an improved state of nourishment, which in turn upholds increased (1) Sahaja Bala – It is genetic and inborn immunity and youthfulness. Rasayana can be resistance to disease, which exists a drug, diet or even a life style and conduct since birth. It is said to increase with i.e., Acar, which may be helpful in achieving the growth of tissues and does not the above goal. The Rasayanas are supposed depend upon any other cause to strengthen Oja and Bala i.e., vitality and (Chakrapani Ca.Su. 11/36). biostrength with natural resistance against aging and disease. It is stated to contribute to (2) Kalaja Bala - This type of immunity the integrity of body tissues and thus is said to be influenced by seasonal increases longevity. The other benefits of this traits and the age of the person. therapy are the promotion of memory and intelligence, the preservation of youth, luster, (3) Yuktikrit Bala – This type of Sarira complexion and voice. The various measures Bala refers to modulation of body’s comprehended by this therapy are termed as resistance against diseases by resort to Rasayana, because they conduce to the appropriate Ojovardhak diet, physical replenishment of Rasa and other body tissues. exercise, rest, restorative and Rasayana, therapies in keeping with Rasayana measures act by one of the seasonal needs. following three ways – (M. Paul & Singh R.H., 1979): Rasayana Tantra, is one of the eight clinical specialties of Ayurveda. It refers to nutrition, (1) Acting at the level of Rasa: Thus natural resistance and geriatrics. Apparently, directly improving the quality of Rasayana means and improved state of nutrition. nourishment, which in turn upholds increased immunity and youthfulness. Rasayana can be (2) Acting at the level of Agni: i.e., by a drug, diet or even a life style and conduct improving the digestion and Pages 59 - 63 3  metabolism of the body and thereby scavenger mechanism (Wagner H. et al, affording better nutrition. 1986). (3) Acting at the level of srotas: i.e., by The active principles of Guduci (Tinospora improving the micro-circulation, it cordifolia), an important Rasayana drug, have ensures proper perfusion and been found to possess anticomplementary and nourishment of the tissues. The immunostimulating activities. Previous integrity of channels is equally studies on the extracts of Guduci reported important for the distribution of Ojas antidiabetic, anti-inflammatory and to the Dhatus, as discussed earlier, hepatoprotective activities. Syringin (TC-4) which provides body immunity inhibited the invitro immunohaemolysis of against degeneration and diseases. antibody coated erythrocytes. The reduced immunohaemolysis was found to be due to Ayurveda describes a number of drugs as inhibition of the C3-convertase of the Rasayana and Ojovardhak remedies, which classical complement pathway. The are claimed to posses’ immunomodulatory commounds gave rise to significant increase effect. Some of the Rasayans which have in IgG antibodies in the serum. Humoral and been subjected to scientific studies and found cell mediated immunity were also dose to possess immunomodulatory effect are dependently enhanced. Macrophase Aswagandha (Withania somnifera), Shilajatu, activation was reported for cordioside (TC-2), Amalaki (Emblica officinalis), Tulasi cardiofolioside – A (TC-5) and Cordiol (TC- (Ocimun sanctum), Guduci (Tinospora 7). These compounds induced significant cordifolia), Pippali (Piper longum) and increase in phagocytic activity by activation Punarnava (Boerhaavia diffusa), of which of the peritoneal macrophases (Kapil A. and Guduci and Tulasi have been extensively Sharma S., 1997). It is important recall here studied. that macrophases play an important role in nonspecific and specific immune responses. The recent trend in evaluation of the herbal In innate immunity, the phagocytosis of immunodulators is towards assessing the foreign bodies by macrophases and other activity profile of the isolated principles in a phygocytes contributes to regulation of both battery of experiments with a view to identify humoral and cellular immune responses. the components responsible for the activity Macrophases serve as effector cells to provide profile of the isolated principles in a battery of immune surveillance against tumour cells. experiments with a view to identify the components responsible for the activity as Yastimadhu (Glycirrhiza glabra), another also to understand the mechanism of their important Rasayana drug has been found to action. Amongst diverse class of compounds, be immunostimulative, which accelerates it was observed the flavonol series possess the lymphocytic transformation activation of most potent anticomplementary activity. The macrophage and increases the leucocyte potent antiphlogistic and antiallergic activity count. It also have antiallergic, anti- of the flavonoid wedelolactone from inflammatory and antioxidant activity Rasayana drug Bhringraj (Eclipta alba and (Yamamoto M., 1975). A controlled clinical wedelia calandulacea) was found to be due to study with combination of the Rasayana its 5-lipoxygenase inhibitory activity, drugs – Amalaki, Vidang and Atibala suggesting that it act by free oxygen radical (Amalaki compound) have shown an increase in immunoglobulin levels in infants which is Pages 59 - 63 4 significantly greater than that of multivitamin conditions (Chatterjee S., 1994; Rao A.T. et used cases (Tuteja V., 1993). al, 1996). A combination of four important Rasayana Attempts may be made to develop newer drugs viz. Guduci (T.Cordifolia), methodologies for such a research focusing Ashwagandha (W.Somnifera), Amalaki on the nutritional dynamics as the basis of the (Emblica officinalis) and Tulasi (Ocimum immunomodulatory effect of a Rasayana sanctum) in equal amounts was found to drug. These herbal Rasayana drugs, which potenciate both the cellular and humoral are widely available in our country, have wide components of immunity (Chatterjee S. & scope for application in the normal population Das S.N., 1996). It is significantly increased for the enhancement of their immune status the microbicidal activity of the neutrophils i.e., Yuktikrita Bala and prevention of various and circulating levels of globulins and other communicable and infectious diseases, and components. It also significantly elevated the also as an adjunct in the therapy in the number of lymphocytes along with immunocompromised disease states. improvement in T-cell memory. The macrophage function study showed a Ayurveda’s emphasis on the role of Dosas significant increases in cell size, number of and their imbalance as the main causative cells and phagocytic activity of macrophages factor of the diseases assumes importance in with the administration of this combination. the light of the fact that mere presence of Chemotactic assay for phagocytic cell causative organisms in the environment does indicated positive chemotaxix for leucocytes not necessarily results in the manifestation of (Gomes A., 1966). The combination was the disease. The concepts of Ojas and Bala, found to potentiate the immune status and of the inherent immunological capabilities helped in faster recovery when used as an including innate immunity and acquired adjunct to specific therapy in cancer, chronic immunity in terms of Sahajabala and wasting diseases, multidrug resistant Yuktikritabala etc., playing key role in the tuberculosis and other immunocompromised health and disease have to be understood and appreciated by the modern immunolgists. REFERENCES: Agnivesa : Charaka Samhita with Ayurveda deepika commentary of chakrapanidatta : Vidyotini commentary by Pandit Kashi Nath Shastri, Chaukhambha Sanskrit Series. Ist & IInd Part (1970), Varanasi. Amarsinghe A.P.G. : Study of immunomodulatory action of Ratakalka in children Ph.D. Thesis Kaumarbhritya (1997), IMS, BHU, Varanasi. Chatterjee S & Das S.N.: Effect of herbal Immu-21 on murine peritoneal macrophages and splenic lymphocytes, Ancient Science of Life 1996, 15:250 – 253. Chatterjee S & Das S.N.: Immunopotentiating effect of proimm, a polyherbal formulation, Indian J. Pharmacol, 28 (1) 58. Chatterji S (1994) : Modulation of host immuno functions by herbal product Immu-21, an Pages 59 - 63 5  experimental study, Indian J. Indg. Med. II (I), 43-50. Dwarikanath C. : Introduction to Kayachikitisa, 1st ed. Chaukhamba Sanskrit Sansthan, Varanasi. Gomes A : Immunomodulatory activity of Immu-21, laboratory of toxinology and experimental pharmacodynamics (1997), Dept. of Physiology, University of Calcutta. Kapil A & Sharma S : Probe (1998) : Vol.37, No.3,1. Kapil A & Sharma S : Immunopotentiating compounds from Tinospora cordifolia, J. Ethnopharmacol (1997) ; 58,89. Mehrotra N.N. : In a handbook of practical immunology, Talwar G.P. (Ed.), Vikas Publishing house, New Delhi, India (1993) : 302 Paul. M & Singh R.H (Supervisor) : Studies on the psychosomatic basis of ageing and the role of an indigenous drug, Ashwagandha as an antiaging agent, M.D. (Ay.) Thesis, 1979, Dept. of Kayachikitsa, IMS, BHU, Varanasi. Singh R.H. : Holistic Principles of Ayurvedic medicine, Ist ed. (1998). Ist edition Chaukhamba Viswabharti Prakashan, Varanasi, India. Singh R.H. : In science and philosophy of Indian Medicine; Udupa K.N. & Singh R.H. (eds), Shrivaidynath Ayurveda Bhawn Ltd., Nagpur, ed. 1,128, 1978. Sushruta Samhita : With commentary by B.G. Ghnekar, 5th Ed. (1989), Moti Lal Banarasi Das, Bunglow Road, Delhi. Tuteja V : Study of immunoenhancing effect of Amalaki compound in infants. M.D. (Ay.) Thesis (1993), IMS, BHU, Varanasi. Wagner H. et al : Planta Med. 52 (6), 542, 1986. Yamamoto M : Glycirrhizine as immunostimulant, Proc. Syup. Waken, Yakee 9: 127, 1975. Pages 59 - 63 6