Volume - 1

Chief Editor
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National Institute of Unani Medicine, Bangalore, Karnataka, India

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 Contents

Chapters Page No.

1. Practitioner’s Guide to Type 2 Diabetes Mellitus 01-21
(Dr. Siva Rami Reddy E)

2. Nutraceuticals: A Re-Emerging Health Aid 23-52

(Anjoo Kamboj, Ankita Rana and Ajay Kumar Saluja)

3. Introduction of Homoeopathic Posology 53-72

(Dr. Basavaraj S. Adi and Dr. Siva Rami Reddy E)

4. Advancement in Treatment of Nutritional Deficiency Disorder

in Ayurveda 73-94
(Dr. Niraj Srivastava)

5. Glimpse on Ayurveda 95-111

(Dr. Radha Palaniswamy)

6. Basic Concept of “5P” Muscles 113-126

(Dr. Swarup P Kulkarni, Dr. Swarupa S Mane, Dr. Vedashri A Kalavade and
Dr. Anuja A Kulkarni)

7. Research and Development of Kshara Sutra for the Treatment

of Ano-Rectal Disorders (ARDs) 127-143
(Dr. Varsha Saxena)
 Chapter - 1
Practitioner’s Guide to Type 2 Diabetes Mellitus

Author
Dr. Siva Rami Reddy E
Faculty of Homoeopathy, Tantia University, Sri Ganganagar,
Rajasthan, India

Page | 1
Page | 2
 Chapter - 1
Practitioner’s Guide to Type 2 Diabetes Mellitus
Dr. Siva Rami Reddy E

Abstract
Diabetes mellitus (DM) is associated with increased hepatic production
of glucose, resistance to the action of insulin and impaired insulin secretion.
Insulin resistance may be due to any one of three general causes: an
abnormal insulin molecule, an excessive amount of circulating antagonists
and target defects. The onset of symptoms may be abrupt with Polyuria,
polydipsia, polyphagia and weight loss developing over days or weeks.
Keywords: Type 2 diabetes mellitus, miasm, diet
Introduction
Development of Pancreas: Pancreas develops as an outgrowth of the
endoderm of the small intestine and ultimately becomes hollowed out to
form the alveoli or acini. The islets of Langerhans develop as buds from the
ducts and remain as solid clumps of cells. During development in most
cases, the connections with the duct vanishes and the islets become
completely isolate. But in a few cases the connections persist as solid chords.
Physiology of Pancreas: The pancreas is both an endocrine as well as
exocrine gland. It is devoid of distinct connective tissue capsule and is
covered by a fine layer of the loose tissue which passes into the gland as
septa and subdivides the gland into many lobules in the lower animals [cat]
the lobules are completely separated from one another by the connective
tissue.
Mechanism of Pancreatic Secretion
Experiments
Most of our knowledge regarding pancreatic secretion has been derived
from experiments on animals. Some direct evidences in man have been
obtained from cases of accidental or postoperative duodenal fistula, through
which pancreatic juice could be collected outside. In dog the process is
studied by establishing a pancreatic fistula by cutting out the duodenal
papilla [through which the duct opens] which is brought to the surface and

Page | 3
sutured to an opening in the abdominal wall. The duodenum wound is
stitched up. Pancreatic juice is collected by a cannula inserted into the duct.
In man some information may be obtained with the help of a duodenal tube
[ryle’s tube swallowed upto the third mark].
With these experiments it is seen that during fasting there may not be
any secretion for long periods. Occasionally a little secretion takes place.
The rate of secretion actually starts 1-2 minutes after taking food. The rate of
secretion steadily rises, lasts for above 3 hours and then gradually declines.
Greatest increase of secretion is observed at the time when gastric contents
enter duodenum. This indicates that the acid chyme of the gastric juice exerts
a stimulant effect on pancreatic secretion.
On Closer Study it is found that Pancreatic Secretion Consists of 2
phases
1) Nervous phase
2) Chemical phase
1. Nervous Phase: Pancreatic secretion starts 1-2 minutes after taking
food. When the vagi are cut, the secretion is abolished. This proves
that the initial phase of pancreatic secretion is a reflex response.
The stimulus for this reflex arises in the mouth during mastication
as well as in the stomach when food enters the later [gastro
pancreatic reflex]. It is to be noted that this reflex is purely
unconditioned. There is no conditioned stimulus here. This stands in
great contrast with the nervous phase of gastric secretion. That the
vagi are the motor nerves of pancreas is proved by the fact that
when they are stimulated, increased pancreatic secretion takes
place. This vagal secretion is rich in enzymes but has very little
effect on bicarbonate concentration. In addition there is a local
cholinergic reflex mechanism independent of vagal innervation.
Thus, the vagal juice has got a greater digestive power.
Acetylcholine is the mediator and parasympathomimetic drugs,
example pilocarpine are also effective. The response is blocked by
atropine. Inhibition of secretion may also be obtained by
stimulating adrenergic nerves producing vasoconstriction and
constriction of ducts. Thus stimulation of sympathetic nerves may
decrease secretion of pancreatic juice by reducing the blood flow
through the organ and flow of juice through the duct.
Chemical Phase
There are many controversial opinion regarding the cell responding to a
stimulus with a characteristic type of functional activity regardless of the

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nature of stimulus. It is known through the cells of intralobular ducts secrete
water and bicarbonate and the enzymes are secreted by acinus cells. It has
already been noted that the rate of secretion of pancreatic juice raises shortly
when the gastric contents enter duodenum. This is the onset of chemical
phase. Bayliss and starling isolated a loop of jejunum maintaining its
vascular supply intact but destroying all possible nerve connections. When
acid was introduced into this loop, pancreas was found to secrete. Since there
is no nervous connection between this loop and the pancreas, it is evident
that the stimulus must be carried to pancreas through blood streams. That
HCl itself is not the stimulus is proved by the fact that injection of the acid
into the portal vein did not produce any effect. But when acid extracts of
intestinal mucosa were injected into the portal vein, pancreatic secretion was
stimulated. This proves that acid liberates some substances from the mucus
membrane which act as the real stimulus. This substance is called secretin
originally by Bayliss and starling. Recently this has been separated into the
following different components.
1) Secretin
2) Pancreozymin
3) Hepatocrinin stimulates liver to secrete bile
4) Cholecystokinin causes contraction of gall bladder and
5) Enterokinin stimulates release of intestinal juice.
The first two which are related to the pancreas are described below.
Nature and Action of Secretin
It can be extracted from the mucus membranes of the duodenum and
upper part of the small intestine with water, 0.4% HCl, soap solution or
alkali. From the nature of the solvents it is obvious that during normal
process of digestion secretin can be extracted by the HCl of the gastric
chyme as well as by the alkali of bile. Secretin has been isolated by various
workers and is believed to be a polypeptide containing, 27 amino acid
reisdues. Its molecular is about 5000. It is rapidly destroyed by pepsin and
trypsin in alkaline or neutral medium. It remains stable in acid solution.
Recently secretin has been synthesized when secretin is injected
intravenously, the flow pancreatic juice increases. This juice is watery, rich
in bicarbonate but poor in enzyme.
Pancreozymin
It is a polypeptide containing 33 amino acids. This causes release of
zymogen granules from the pancreatic acinus cells resulting in release of a
pancreatic juice rich in enzymes but poor in bicarbonates.

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Influence of Various Food Stuffs on Pancreatic Secretion
It has been observed that pancreatic secretion remains high for about 3
hours and then declines. This is due to the fact that stomach is completely
emptied within 3 hours when mixed meal is injected so contact of gastric
chyme is lost with the mucosa of proximal part of the small intestine.
Pancreatic juice is found to vary in quality and quantity with different
types of food. Meat stimulates a secretin type of response, that is large
volume, more alkali and les enzyme. Fat elicits a vagal type of response that
is moderate volume, low alkali and rich in enzyme. Bread produces a mixed
type of response.

The exocrine component portion of the pancreas is compound tubular

gland. The terminal secretory portions of this gland are known as acini or
alveoli which are tubular and somewhat and convoluted and secrete
pancreatic juice. These acini resemble those of serous [Sero zymogenic]
alveoli of salivary glands and do not contain myoepithelial cells. The main
excretory duct of the gland is the duct of Wirsung, which extends the entire
length of the gland, giving out several intralobular ducts or intercalated
ducts. The duct of wirsung opens in company with the common bile duct
into the ampulla of vater, which opens into the second part of the duodenum.
An accessory pancreatic duct, duct of santorini is often present within
the lumina of many acini, one or more cubical cells are lying in contact with
the apices of the apices of the secretory cells. These cells are known as
centro-acinus [acinar] cells. The cytoplasm of this cell does not possess any
secretory granules.in each secretory cell, there are two well-marked
granules-an inner apical zone towards the lumen and outer basal zone
towards the basement membrane. In the inner zone there are numerous

Page | 6
course zymogen granules and their number are varying with the functional
activity of the cell. Their number are diminished during the digestion but
increased during rest. The basal zone contains the nucleus as well as the
basophilic or chromophilic substance. Electron microscope structure shows
highly developed rough walled endoplasmic reticulum and a supranuclear
golgi apparatus. Surface membranes are studded with ribosome granules
which give basophilic staining. in resting stages the granular zone gradually
increases upto ¾th of the cell, but during activity the granular zone gradually
diminishes in size. The pancreatic excretory duct is also similar to that of the
salivary gland. Larger ducts contain elastic fibres and plain muscles which,
when contract, may prevent the flow of juice into the duodenum. Near the
duodenum small mucus glands are seen in the lamina propria.
Zymogen granules contain pro enzymes. The pro enzymes become
activated on secretion to form enzymes. These enzymes are responsible for
later stages of digestion of proteins, carbohydrates and fats.

Between acini or alveoli there are found groups of solid cells, termed as
inter- acinus [interalveolar] cells, islets [or islets of Langerhans]. Which is
the endocrine component portion of the pancreas. These islets are scattered
throughout the pancreas but from the exocrine tissue by a thin basement
membrane.
The endocrine pancreatic tissue cells are formed with much less
cytoplasm than those of the ex-more numerous in the tail than elsewhere.
These are main two types of cells in the islets: alpha and beta cells. The B
cell contains numerous insulin granules and secrete insulin.
Recent studies by Steiner and his colleague oyer showed the existence
of biosynthetic precursor of insulin termed proinsulin. The concept of
proinsulin is supported by the following evidences.
1) Oxidative degeneration of reduced proinsulin is much more
efficient than that of reduced insulin.
2) Pancreas slice incorporate labeled amino acids into proinsulin
fraction 1.

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 3) Low concentration of trypsin readily cleave sensitive bonds in
proinsulin giving a insulin like product.
The alpha cells contain glucagon granules and secrete glucagon. A few
gamma and delta cells scattered in the islets. According to Hellerstrom et al.
it reveals that alpha cells can be classified as alpha 1 which is argyrophilic
and alpha 2, non argyrophilic but rich in protein bound tryptophan.
Faculty of Homoeopathy, Tantia University, Sri Ganganagar,
Rajasthan, India
Insulin is produced in the beta cells of the pancreatic islets. It is initially
synthesized as single-chain86-amino-acid precursor polypeptide,
preproinsulin. Subsequent proteolytic processing removes the amino-
terminal single peptide, giving rise to preproinsulin. Proinsulin structurally
related to insulin-like growth factors I and II, which bind weakly to the
insulin receptor. Cleavage of an internal 31- residue fragment from
proinsulin generates the C peptide and the A (2l amino acids) and B (30
amino acids) of insulin, which are connected by disulfide bonds. The mature
insulin molecule and C peptide are stored together and co-secreted from
secretory granules in beta cells. Because C peptide is clearly more slowly
than insulin, it is a useful maker of insulin secretion and allows
discrimination of endogenous and exogenous sources of insulin in the
evaluation of hypoglycemia. Pancreatic beta cells co-secrete islet amyloid
polypeptide or amylin, a 37-amino-acid peptide, along with insulin. The role
of IAPP in normal physiology is incompletely defined, but it is major
component of the amyloid fibrils found in the islets of the patients with
type2 diabetes, and an analogue is sometimes used in training type 1 and
type 2 DM. Human insulin is produced by recombinant DNA technology,
structural alterations at one or more amino acids residues modify its physical
and pharmacologic characteristics.
Secretion
Glucose is the key regulator of insulin secretion by the pancreatic beta
cell, although amino acids, ketones, various nutrients, gastrointestinal
peptides and neurotransmitters also influence glucose secretion. Glucose
levels more than 3.9mmol/L [70mg/dl] stimulate insulin synthesis, primarily
by enhancing protein translation and processing.
Glucose stimulation of insulin secretion begins with its transport into the
beta cell by a facilitative glucose transporter. Glucose phosphorylation by
glucokinase is the rate limiting step that controls glucose regulated insulin
secretion. Further metabolism of glucose -6- phosphate via glycolysis
generates ATP, which inhibits the activity of ATP sensitive K+ channel.

Page | 8
This channel consists of two separate proteins: one is the binding site for
certain oral hypoglycemic; the other is an inwardly rectifying K+ channel
protein. Inhibition of this K+ channel induces beta cell membrane
depolarization, which opens voltage dependent calcium channels [leading to
an influx of calcium], and stimulates insulin secretion. Insulin secretory
profiles reveal a pulsatile pattern of hormone release, with small secretory
bursts occurring about every 10 minutes, superimposed upon greater
amplitude oscillations of about 80-150 min. incretins are released from
neuroendocrine cells of the gastrointestinal tract following food ingestion
and amplify glucose stimulated insulin secretion and suppress glucagon
secretion. Glucagon like peptide 1 [GLP1], the most potent incretin, is
released from L cells in the small intestine and stimulates insulin secretion
only when the blood glucose is above fasting level. Incretin analogues, are
used to enhance endogenous insulin secretion.
Action
Once insulin is secreted into the portal venous system, about 50% is
removed and degraded by the liver. Unextracted insulin enters the systemic
circulation where it binds to receptors in target sites. Insulin binding to its
receptor stimulates intrinsic tyrosine kinase activity, leading to receptor, auto
phosphorylation and the recruitment of intracellular signaling molecules,
such as insulin receptor substrates [IRS]. IRS and other adaptor proteins
initiate a complex cascade of phosphorylation and dephosphorylation
reactions, resulting in the widespread metabolic and mitogenic effects of
insulin. As an example, activation of the phosphatidylinositol-3-kinase
pathway stimulates translocation of a facilitative glucose transporter ex:
GLUT4, to the cell surface an event that is crucial for glucose uptake by
skeletal muscle and fat. Activation of other insulin receptor signaling
pathways induces glycogen synthesis, protein synthesis, lipogenesis and the
regulation of various genes in insulin responsive cells.
Glucose homeostasis reflects a balance between hepatic glucose
production and peripheral glucose uptake underutilization. Insulin is the
most important regulator of this metabolic equilibrium, but neural input,
metabolic signals and other hormones [ex: glucagon] result in integrated
control of glucose supply and utilization. in the fasting state, low insulin
levels increase glucose production by promoting hepatic gluconeogenesis
and glycogenolysis and reduce glucose uptake in insulin sensitive tissues
[skeletal muscle and fat], there by promoting mobilization of stored
precursors such as amino acids and free fatty acids [lipolysis]. Glucagon,
secreted by pancreatic alpha cells when blood glucose or insulin levels are
low, stimulates glycogenolysis and gluconeogenesis by the liver and renal

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medulla. Postprandially, the glucose load elicits a rise in insulin and fall in
glucagon, leading to a reversal of these processes. Insulin, an anabolic
hormone, promotes the storage of carbohydrate and fat and protein synthesis.
The major portion of postprandial glucose is utilized by skeletal muscle, an
effect of insulin stimulated glucose uptake. Other tissues, most notably the
brain, utilize glucose in an insulin dependent fashion.
Type 2 Diabetes mellitus
Definition
Diabetes mellitus refers to a group of common metabolic disorders that
share the phenotype of hyperglycemia. Several distinct types of diabetes
mellitus are caused by a complex interaction of genetics and environmental
factors depending on the etiology of diabetes mellitus. Factors contributing
to the hyperglycemia include reduced insulin secretion, decreased glucose
utilization and increased glucose production. The metabolic dysregulation
associated with diabetes mellitus causes secondary pathophysiologic changes
in multiple organ systems that impose a tremendous burden on the individual
with diabetes and on the health care system. In the United States, diabetes
mellitus is the leading cause of end stage renal disease, non-traumatic lower
extremity amputations and adult blindness. It also predisposes to
cardiovascular diseases. With an increasing incidence worldwide diabetes
mellitus will be the leading cause of morbidity and mortality for the for
seeable future.
Classification
Diabetes mellitus classified on the basis of the pathogenic process that
leads to hyperglycemia, as opposed to earlier criteria such as onset or type of
therapy. The two broad categories of diabetes mellitus are designated type 1
and type 2. Both types of diabetes are preceded by a phase of abnormal
glucose homeostasis as the pathogenic processes progress. Type 1 diabetes
mellitus is the result of complete or near total insulin deficiency. Type 2
diabetes mellitus is a heterogeneous group of disorders characterized by
variable degrees of insulin resistance, impaired insulin secretion and
increased glucose production. Distinct genetic and metabolic defects in
insulin action and secretion give rise to the common phenotype of
hyperglycemia in type 2 diabetes mellitus and have important potential
therapeutic implications now that pharmacologic agents are available to
target specific metabolic derangements. Type 2 diabetes mellitus is preceded
by a period of abnormal glucose homoeostasis classified as impaired fasting
glucose or impaired glucose tolerance.
Two features of the current classification of diabetes mellitus diverge

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from previous classifications. First, the terms insulin dependent diabetes
mellitus [IDDM] and non-insulin dependent diabetes mellitus [NIDDM] are
obsolete. Since many individuals with type 2 diabetes mellitus eventually
require insulin treatment for control of glycaemia. The use of the term
NIDDM generally considerable confusion. A second difference is that age is
not a criterion in the classification system. Although type 2 diabetes mellitus
most commonly develops before the 30, an auto immune beta cell
destructive process can develop at any age. It is estimated that between 5 and
10% individuals who develop diabetes mellitus after age of 30 years have
type 1 diabetes mellitus. Although type 2 diabetes mellitus more typically
develops with increasing age, it is now being diagnosed more frequently in
children and young adults, particularly in obese adolescents.
Other Types of Diabetes Mellitus
Other etiologies for diabetes mellitus include specific genetic defects in
insulin secretion or action, metabolic abnormalities that impair insulin
secretion, mitochondrial abnormalities and a host of conditions that impair
glucose tolerance. Maturity onset diabetes of the young [MODY] is a
subtype of diabetes mellitus characterized by autosomal dominant
inheritance, early onset hyperglycemia [usually < 25 years] and impairment
in insulin secretion. Mutations in the insulin receptor cause a group of rare
disorders characterized by severe insulin resistance.
Diabetes mellitus can result from pancreatic exocrine disease when the
majority of pancreatic islets are destroyed. Cystic fibrosis related diabetes
mellitus is an important consideration in the patient population. Hormones
that antagonize insulin action can also lead to diabetes mellitus. Thus
diabetes mellitus is often a feature of endocrinopathies such as acromegaly
and Cushing’s disease. Viral infections have been implicated in pancreatic
islet destruction but are an extremely rare cause of diabetes mellitus. A form
of cute onset of type 1 diabetes mellitus, termed fulminant diabetes, has been
noted in Japan and may be related to viral infection of islets.
Epidemiology
The worldwide prevalence of diabetes mellitus has risen dramatically
over the past two decades, from an estimated 30 million cases in 1985 to 285
million in 2010. Based on current trends, the international diabetes
federation projects that 438 million individuals will have diabetes by the
year 2030. Although the prevalence of both type 1 and type 2 diabetes
mellitus is increasing worldwide, the prevalence of type 2 diabetes mellitus
is rising much more rapidly, presumably because of increasing obesity,
reduced activity levels, as countries become more industrialized and the
aging of the population. Worldwide estimate projects that in 2030 the
greatest number of individuals with diabetes will be aged 45-64 years.

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 There is considerable geographic variation in the incidence of both type
1 and type 2 diabetes mellitus. Much of the increased of type 1 diabetes
mellitus is believed to reflect the frequency of high risk human leucocyte
antigen [HLA] alleles among ethnic groups in different geographic locations.
The prevalence of type 2 diabetes mellitus and its harbinger, IGT is highest
in certain pacific islands and the Middle East and intermediate in countries
such as India and United states. This variability is likely due to genetic,
behavioral and environmental factors. Diabetes mellitus prevalence also
varies among different ethnic populations within a given country. For
example the CDC estimated that the age adjusted prevalence of diabetes
mellitus in the United states was [age >20 years, 2007- 2009] 7.1% in non-
Hispanic whites, 7.5% in Asian Americans, 11.8% in Hispanics 12.6% in
non-Hispanic blacks. In Asia the prevalence of diabetes is increasing rapidly
and the diabetes phenotype appears to be different from that in the United
States and Europe-onset at a lower BMI and younger age, greater visceral
adiposity, and reduced insulin secretary capacity [1].
Diabetes is a major cause of mortality, but several studies indicate that
diabetes is likely underreported as a cause of death. In the United States,
diabetes was listed as the seventh leading cause of death in 2007, a recent
estimate suggested that diabetes was the fifth leading cause of death
worldwide and was responsible for the almost 4 million deaths in 2010.
Glucose intolerance is classified into three broad categories: normal
glucose homeostasis, diabetes mellitus and impaired glucose homeostasis.
Glucose tolerance can be assessed using the fasting plasma glucose [FPS],
the response to oral glucose or the haemoglobin A1C. An FPG < 5.6 mmol/L
[100 mg/dl], a plasma glucose < 140 mg/ dl [11.1mmol/ L] following an oral
glucose challenge, and an A1C < 5.6% are considered to define normal
glucose tolerance. The international expert committee with members
appointed by the American diabetes association, the European association
for the study of diabetes, and the international diabetes federation has issued
diagnostic criteria for diabetes mellitus based on the following premises:
1) The FPG, the response to the oral glucose challenge [OGTT- oral
glucose tolerance test] and A1 C differ, among individuals and
2) Diabetes mellitus is defined as the level of glycaemia at which
diabetes specific complications occur rather than on deviations from
population based mean.
Insulin resistance and abnormal insulin secretion are central to the
development of type 2 diabetes mellitus. Although the primary defect is
controversial, most studies support the view that insulin resistance precedes
an insulin secretory defect but that diabetes develops only when insulin

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secretion becomes inadequate. Type2 diabetes mellitus likely encompasses a
range of disorders with common phenotype of hypoglycemia. Most of our
current understanding is based on studies of individuals of European descent.
It is becoming increasing apparent that DM in other ethnic groups [Asian,
African, and Latin American] has a different, but yet undefined,
pathophysiology. In these groups, diabetes mellitus is ketosis prone [often
obese] or ketosis resistant [often lean] is commonly seen.
Type 2 diabetes mellitus has a strong genetic component. The
concordance of type 2 diabetes mellitus in identical twins is between 70-
90%. Individuals with parent with type 2 diabetes mellitus have an increased
risk of diabetes; if both parents have type 2 diabetes mellitus, the risk
approaches 40%. Insulin resistance, as demonstrated by reduced glucose
utilization in skeletal muscle, is present in many non-diabetic, first degree
relatives of individuals with type 2 diabetes mellitus. The disease is
polygenic and multifactorial, since in addition to genetic susceptibility,
environmental factors [such as obesity, nutrition and physical activity]
modulate the phenotype. The genes that predispose to type 2 diabetes
mellitus are incompletely identified, but recent genome wide association
studies have identified a large number of genes that convey a relatively small
risk for type2 diabetes mellitus [>20 genes, each with a relative risk of 1.06-
1.5]. Most prominent is a variant of the transcription factor 7 like gene that
has been associated with type 2 diabetes in several populations and with
impaired glucose tolerance in one population at high risk of diabetes.
Genetic polymorphisms associated with type 2 diabetes have also been found
in the genes encoding the peroxisome proliferators activated receptor –
gamma, inward rectifying potassium channel, zinc transporter, IRS and
calplain 10. The mechanisms which these genetic loci increase the
susceptibility to type 2 diabetes is under active investigation [estimation that
<10% of genetic risk is determined by loci identified thus far]. It is currently
not possible to use a combination of known genetic loci to predict type 2
diabetes [2].
Pathophysiology
Type 2 diabetes mellitus is characterized by impaired insulin secretion,
insulin resistance, excessive hepatic glucose production and abnormal fat
metabolism. Obesity, particularly visceral or central [as evidenced by the
hip- waist ratio], is very common in type 2 diabetes mellitus [80% or more
are obese].In the early stages of the disorder, glucose tolerance remains near
normal, despite insulin resistance, because the pancreatic beta cell
compensate by increasing insulin output. As insulin resistance and
compensatory hyperinsulinemia progress, the pancreatic islets in certain

Page | 13
individuals are unable to sustain the hyperinsulinemic state. IGT,
characterized by elevations in postprandial glucose, then develops. A further
decline in insulin secretion and an increase in hepatic glucose production
lead to overt diabetes with fasting hyperglycemia. Ultimately, beta cell
failure census.
Metabolic Abnormalities
Abnormal Muscle and Fat Metabolism
Insulin resistance, the decreased ability of insulin to act effectively on
target tissues [especially muscle, liver and fat], is a prominent feature of type
2 diabetes mellitus and results from a combination of a genetic susceptibility
and obesity. Insulin resistance is relative, however since supra normal levels
of circulating insulin will normalize the plasma glucose. Insulin-dose
response curves exhibit a right ward shift, indicting reduced sensitivity and a
reduced maximal response, indicting an overall decrease in maximum
glucose utilization [30-60% lower than in normal individuals]. Insulin
resistance impairs glucose utilization by insulin-sensitive tissues and
increases hepatic glucose output; both effects contribute to the
hyperglycemia. Increased hepatic glucose output predominantly accounts for
increased FPG levels, whereas decreased peripheral glucose usage results in
post prandial hyperglycemia. In skeletal muscle, there is greater impairment
in nonoxidative glucose usage [glycogen formation] than in oxidative
glucose metabolism through glycolysis. Glucose metabolism in insulin
dependent tissues is not altered in type 2 diabetes mellitus.
The precise molecular mechanism leading ti insulin resistance in type 2
diabetes mellitus has not been elucidated. Insulin receptor levels and tyrosine
kinase activity in skeletal muscle are reduced, but these alterations are most
likely secondary to hyperinsulinemia and are not primary defect. Therefore,
postreceptor defects in insulin regulated phosphorylation/dephosphorylation
appear to play the predominant role in insulin resistance. For example, a PI-
3 kinase signaling defect might reduce translocation of GLUT4 to the plasma
membrane. Other abnormalities include the accumulation of lipid within
skeletal myocytes, which may impair mitochondrial oxidative
phosphorylation and reduce insulin stimulated mitochondrial ATP
production. Impaired fatty acid oxidation and lipid accumulation within
skeletal myocytes also may generate reactive oxygen species such as lipid
peroxides. Of note, not all insulin signal transduction pathways are resistant
to the effects of insulin [eg: those controlling cell growth and differentiation
using the mitogenic-activated protein kinase pathway]. Consequently,
hyperinsulinemia may increase the insulin action through these pathways,
potentially accelerating diabetes- related conditions such as atherosclerosis.

Page | 14
 The obesity accompanying type 2 diabetes mellitus, particularly in a
centrally or visceral location, is thought to be a part of pathogenic process.
The increased adipocyte mass leads to increase levels of circulating free fatty
acids and other fat cell products. For example adipocytes secrete a number of
biologic products [non esterified free fatty acids, retinol binding protein 4,
leptin, TNF- alpha, resistin and adiponectin]. In addition to regulating body
weight, appetite and energy expenditure, adipokines also modulate insulin
sensitivity. The increased production of free fatty acids and some adipokines
may cause insulin resistance in skeletal muscle and liver. For example, free
fatty acids impair glucose utilization in skeletal muscle, promote glucose
production by the liver and impair beta cell function. In contrast the
production by adipocytes of adiponectin, an insulin sensitizing peptide is
reduced in obesity and this may contribute to hepatic insulin resistance.
Adipocyte products and adipokines also produce an inflammatory state and
may explain why markers of inflammation such as IL-6 and C- reactive
protein are often elevated in type 2 diabetes mellitus. In addition
inflammatory cells have been found infiltrating adipose tissue. Inhibition of
inflammatory signaling pathways such as the nuclear factor kB [NF-kB]
pathway appears to reduce insulin resistance and improve hyperglycemia in
animal models.
Impaired Insulin Secretion
Insulin secretion and sensitivity are interrelated. In type 2 diabetes
mellitus, insulin secretion initially increases in response to insulin resistance
to maintain normal glucose tolerance. Initially, the insulin secretory defect is
mild and selectively involves glucose stimulated insulin secretion. The
response to other non-glucose secretagogues, such as arginine is preserved.
Abnormalities in proinsulin processing is reflected by increased secretion of
proinsulin in type 2 diabetes mellitus. Eventually, the insulin secretory defect
progresses to a state of inadequate insulin secretion.
The reason for the decline in insulin secretory capacity in type 2
diabetes mellitus is unclear. The assumption is that a second genetic effect is
superimposed upon insulin resistance-leads to beta cell failure. Beta cell
mass is decreased by approximately 50% in individuals with longstanding
type 2 diabetes. Islet amyloid fibrillar deposit found in the islets of
individuals with longstanding type 2 diabetes mellitus. Whether such islet
amyloid deposits are primary or secondary event is unknown. The metabolic
environment of diabetes may also negatively impact islet function. For
example chronic hyperglycemia paradoxically impairs islet function [glucose
toxicity] and leads to worsening of hyperglycemia. Improvement in
glycaemic control is often associated with improved islet function. In

Page | 15
addition, elevation of free fatty acid levels [lipotoxicity] and dietary fat amy
also worsen islet function [3].
Increased Hepatic Glucose and Lipid Production
In type 2 diabetes mellitus, insulin resistance in the liver reflects the
failure of hyperinsulinemia to suppress gluconeogenesis, which results in
fasting hyperglycemia and decreased glycogen storage by the liver in the
postprandial state. Increased hepatic glucose production occurs early in the
course of diabetes, though likely after the onset of insulin secretory
abnormalities and insulin resistance in skeletal muscles. As a result of insulin
resistance in adipose tissue, lipolysis and free fatty acid flux from adipocytes
are increased, leading to increased lipid [very low density lipoprotein
[VLDL, triglyceride] synthesis in hepatocytes. This lipid storage of steatosis
in the liver may lead to nonalcoholic liver disease and abnormal liver
function tests. This is also responsible for the dyslipidemia found in type 2
diabetes mellitus [elevated triglycerides, reduced high density lipoprotein
[HDL] and increased small dense low density lipoprotein [LDL] particles].
Insulin Resistance Syndromes
The insulin resistance condition comprises a spectrum of disorders, with
hyperglycemia representing one of the most readily diagnosed features. The
metabolic syndrome, the insulin resistance syndrome, or syndrome X are the
terms used to describe a constellation of metabolic derangements that
includes insulin resistance, hypertension, dyslipidemia (decreased HDL and
elevated triglycerides), central or visceral obesity, type 2 diabetes or
IGT/IGF, and accelerated cardio-vascular disease.
Mutations in the insulin receptor that interfere with binding or signal
transduction are a cause of insulin resistance. Acanthosisnigricans and signs
hyperandrogenism (hirsutism, acne and oligomenorrhea in women) are also
common physical features. Two distinct syndromes of severe insulin
resistance have been described in adults: (1) type A, which affects young
women and is characterized by severe hyperinsulinemia, obesity and features
of hyperandrogenism; and (2) type B, which affects middle-aged women and
is characterized by severe hyperinsulinemia, obesity, and features of
hyperandrogenism, and autoimmune disorders. Individuals with the type A
insulin resistance syndrome have an undefined defect in the insulin-signaling
pathway; individuals with the type B insulin resistance syndrome have
antibodies may block insulin binding or may stimulate the insulin receptor,
leading to intermittent hypoglycemia.
Polycystic ovary syndrome (PCOS) is a common disorder affects
premenopausal women and is characterized by chronic anovulation and

Page | 16
hyperandrogenism. Insulin resistance is seen in a significant subset of
women with PCOS, and the disorder substantially increases the risk for
type2 DM, independent of the effects of obesity.
Prevention
Type2 diabetes mellitus is preceded by a period of IGT or IGF and a
number of lifestyle modifications and pharmacologic agents prevent or delay
the onset of diabetes mellitus. The Diabetes Prevention Program (DPP)
demonstrated that intensive changes in lifestyle diet and exercise for 30min/d
five times/week) in individuals with is IGT prevented or delayed the
development of type 2 diabetes mellitus by 58% compared to placebo. This
effect was seen in individual regardless of age, sex or ethnic group. In the
same study, metformin prevented or delayed diabetes by 31% compared to
placebo. The lifestyle intervention group lost 5-7% of their body weight
during the last 3 years of the study. Studies in Finnish and Chinese
populations noted similar efficacy of diet and exercise in preventing or
delaying type 2 diabetes mellitus; alpha-glucosidase inhibitors, metformin,
thiazolidinediones, and orlistat prevent or delay type 2 diabetes mellitus but
are not approved for this purpose.
Individuals with a strong family history of type 2 diabetes mellitus and
individuals with IGF or IGT should be strongly encouraged to maintain a
normal BMI and engage in regular physical activity. Pharmacologic therapy
for individuals with prediabetes is currently controversial because its cost-
effectiveness and safety profile are not known. The ADA has suggested who
are very high risk for progression to diabetes (age < 60 years, BMI >= 35
kg/m2, family history of diabetes in first-degree relative, elevated
triglycerides, reduced HDL, hypertension, or AIC>6.0%). Individuals with
IFG, IGT, or an AIC of 5.7-6.4%, should be monitored annually to
determine if diagnostic criteria for diabetes are present.
Clinical Features of Diabetes Mellitus
Type 2 diabetes mellitus present with polyuria and polydipsia, but
unlike type1 diabetes, patients are often older [over 40 years] and frequently
obese. However, with the increase in obesity and sedentary life style in our
society, type 2 diabetes is now seen in children and adolescent with
increasing frequency. In some medical attention is sought because of
unexplained weakness or weight loss. Most frequently, however, the
diagnosis s made after routine blood or urine testing in asymptomatic
persons. The infrequency of ketoacidosis and milder presentation in type 2
diabetes is presumably because of higher portal vein insulin levels in these
patients than in type 1 diabetics, which prevents unrestricted hepatic fatty
acid oxidation and keeps the formation of ketone bodies in check. In the

Page | 17
decompensated state, these patients may develop hyperosmolar nonketotic
coma due to severe dehydration resulting from sustained osmotic diuresis
[particularly in patients who do not drink enough water to compensate for
urinary losses from chronic hyperglycemia].
Typically, the patient is an elderly diabetic who is disabled by stroke or
an infection and is unable to maintain adequate water intake. Furthermore,
the absence of ketoacidosis and It’s symptoms [nausea, vomiting, respiratory
difficulties] delays the seeking of medical attention until severe dehydration
and coma occur.
Miasmatic Approach
Diabetes mellitus is classically considered to be of tubercular origin. All
the classical symptoms of diabetes mellitus have been mentioned as being
tubercular. The following symptoms have all been grouped under tubercular
miasm or pseudo-psora.
 Loss of strength after urinating.
 Copiousness of urine is a tubercular trait.
 The majority of renal difficulties have a tubercular basis, which can
be demonstrated by a careful study of all the latent miasmatic
symptoms of the whole person.
 Neuralgic pains are of tubercular origin.
 Excessive suppuration is a tubercular trait.
 In abscesses and ulcers of skin, the tubercular element is always
uppermost.
 Injuries to the skin, especially slight injuries heal readily in the
psoric patients; but it is in the tubercular individual that we see the
abscess, the ulcerative process and the copious formation and
elimination of pus, far beyond that necessary in the ordinary healing
process.
 Gangrene has a syphilitic or tubercular taint.
 Perversions of form, shape, or size are tubercular or syphilitic in
origin.
 Hunger with an all gone sensation in the pit of the stomach is again
a tubercular symptom.
 The tendency to secondary complications is a tubercular trait.
Diabetic patients are as a rule strongly tubercular, with the tubercular
physiology throughout them. If sycosis is present, these cases are of course
more malignant in their nature and more fatal.

Page | 18
 Fibrous changes in the kidneys also have the three miasms present
although the tubercular and sycotic are present in majority of the cases.
IDDM is considered to be due to an autoimmune response and this is
classified as an aberrant immune response and hence is a tubercular trait [4].
Homoeopathy Treatment
Homoeopathy medicines are prescribed based up on the totality of
symptoms. Homoeopathic medicines are indicated for diabetes mellitus, acet
ac, arg m, ars brom, pancreas, syzygy, cephalanedra, rhus ar, Gymnema,
uran nict, urea [5-10].
Diet for Diabetes Patients
Diet of diabetic patient place a very important role in the management
and treatment of diabetes mellitus.
Important Rules
The rules governing the diet of a diabetic patient depends on the
following principles:
1) Diet of a diabetic patient like other people must have a square meal
containing-
A) Carbohydrates, fats, proteins in proper amounts suitable to their
caloric requirements.
B) Salts& roughage to prevent constipation.
C) Vitamins to prevent deficiency diseases.
D) Water
2) The diet should be able to provide the necessary number of calories
required by the patient. This amount depends on the following
conditions:
A) The age, height and weight of the patient
B) The kind of life led by the patient, whether he leads a sedentary
life, a desk worker or a field worker, naturally a field worker
needs more calories than a desk worker
C) The clinical type of diabetes of the patient whether he is
suffering from mild type or severe form or diabetes with
complications
3) The diet of the patient should be able to maintain a satisfactory
body weight. Diet for overweight and underweight patients should
be modified to maintain and reduce or improve weight in those who
are not normal in their weight according to their height.

Page | 19
 4) The diet should not contain any article, which raises the blood sugar
level like sugar, sugar preparations, etc.
5) The diet must not contain any article of food to which he is allergic.
Some patients are allergic to eggs, fish, milk, fats, fruits, vegetables,
beer, etc.
Principles of the Diet
Body requires energy for its working constantly every day. This energy
is supplied by consumption of food. The objects of finding the caloric
requirements for diabetic patients are:
1) To stop the discharge of sugar in the urine
2) To control the abnormal weight of the patient
3) To supply him sufficient food energy for his daily requirements
The caloric requirements for different types of patients are as follows:
1) In case of obese patients, 1200 calories
2) Adult males, 1800 calories
3) Females, 1500 calories
4) Pregnant women, 2200 calories
5) Old persons, 1500 calories
6) Field workers require more calories than the desk workers
7) The exact number of calories required depends on height, weight,
work, type of diabetes, complications and treatment of each
persons. Hence, the above figures are suggestive only
The amount of carbohydrates, fats and proteins required by each
diabetic patient also depends upon different conditions manifested by each
patient.
1) The following articles of food should not be given
A) Sugar, glucose, honey, jam, marmalade, syrups, thinned fruits,
sweets, chocolates, lemonade and other foods sweetened with
sugar.
B) Cakes, sweet biscuits, pastries, etc.
C) Wines, strong alcoholic drinks, etc.
2) Articles of food to be taken in moderation only
A) Bread of all kinds
B) Milk, butter, ghee
C) Dry fruits and fresh fruits

Page | 20
 3) Articles of food to be taken as desired
A) Meat, fish, eggs
B) Vegetables
References
1. Davidsons. Text book of principles and practice of Medicine. 18th
Edition. Churchill Livingstone, London, 2000, 473.
2. George Mathew, Aggarwal P. Medicine Text Book. 3rd Edition.
Elsevier, 2008, 726.
3. Lawrence Tierney M, Stephen McPhee J, Maxine Papadakis A. Current
Medical Diagnosis and Treatment. Lange, 2005, 1157.
4. Allen JH. The chronic miasm psora and pseudo-psora B. Jai publishers
Pvt Ltd, New Delhi. 1990; I &II:110-115.
5. Choudhuri NM. A study on Materia Medica. B. Jain publishers, New
Delhi, 646.
6. William boericke. Pocket manual of homoeopathic materia medica. 4th
Edition, B. Jain publishers, New Delhi, 1995, 173.
7. Kent JT. Lectures on homoeopathic philosophy. B. Jain publishers, New
Delhi, 1999, 196-198.
8. Allen AM. Hand book of materia medica and homoeopathic
therapeutics. B. Jain publishers, New Delhi, 1994, 350-351.
9. Dubey SK. Text book of materia medica. 3rd Edition. Books and Allied
Pvt. Ltd., Calcutta, 1998, 36.
10. Roberts HA. The principle and arts of cure by homoeopathy. B. Jain
publishers, New Delhi, 2000, 150-152.

Page | 21
Page | 22
 Chapter - 2
Nutraceuticals: A Re-Emerging Health Aid

Authors
Anjoo Kamboj
Chandigarh College of Pharmacy, Landran, Mohali, Punjab,
India
Ankita Rana
Chandigarh College of Pharmacy, Landran, Mohali, Punjab,
India
Ajay Kumar Saluja
A.R. College of Pharmacy, Vallabh Vidyanagar, Gujarat, India

Page | 23
Page | 24
 Chapter - 2
Nutraceuticals: A Re-Emerging Health Aid
Anjoo Kamboj, Ankita Rana and Ajay Kumar Saluja

Abstract
Nutraceuticals are the food products that possess health promoting,
disease preventing as well as medicinal benefits. The word “nutraceuticals”
was formed from “nutrition” and “pharmaceutical” discovered by Stephen
DeFelice in 1989. They are naturally derived biologically active components
present in foods, dietary supplements and herbal products, with wide range
healthiness and disease preventing effects. Plant based nutraceuticals and
functional foods have acquired significant attentiveness due to their
hypothesized safety and potential, nutritional and therapeutic value. Such
products include food, food sources, novel foods, isolated nutrients, dietary
supplements, designer food, herbal products, processed foods and beverages.
Nutraceuticals are the product of collaborative research attempt of pharmacy,
food and chemical industry. With the growth of healthcare industry,
nutraceuticals become more popularize because people want to treat their
illness along with improving their healthiness with the use of healthcare
products. As India has extensive markets and substantial facilities such as
huge bio-diversity, outstanding research facilities, resources, qualified
manpower, and diverse raw materials that provides lead to our country.
Today “nutraceutical a day may keep the doctor away” substitutes the old
saying “an apple a day will keep the doctor away”.
The major area of concern for nutraceuticals is lack of standardization
and its quality control. As quality parameters of plant materials and
manufacturing techniques or processes involved in preparation of
nutraceuticals are regulated by food laws (no clinical testing is required),
which lack specificity, preciseness and purity required which generally leads
to serious consequences. Hence nutraceutical professionals and regulatory
bodies need to play a major role to control the safety parameters and its
advances. Even though nutraceuticals and functional food play important
role in the prevention and cure of diseases, the health professionals,
biotechnologists, nutritionists, nutraceutical industrialist and regulatory

Page | 25
toxicologist should deliberately come together to work out the appropriate
guidelines to deliver the best health and medical benefits with better purity,
efficacy, and safety of human health. Another important area of
consideration is the interaction of nutraceuticals with food constituents,
herbal drugs and allopathic drugs. The effect of different techniques and
processing methods on the bioavailability and effectiveness of nutraceuticals
also needs to be determined. Hence strict regulatory guidelines for
nutraceuticals are the need of the day.
The present chapter will be devoted towards an overview of the phyto
nutraceuticals containing different herbal plants used in particular disease
specific indications.
Keywords: phyto nutraceuticals, nutrients, dietary supplements, functional
foods, designer foods, regulatory bodies.
1. Introduction
The word ‘Nutraceutical’ was originated from two words ‘nutrition’ and
‘pharmaceutical technology’ by Stephen Defelice in 1989 (Defelice, 1995).
According to Defelice “nutraceuticals are food or part of a food that provides
medical or health benefits including the prevention and/or treatment of a
disease”. Research has confirmed that foods consists of phytochemicals may
support our body by providing protection against diseases like diabetes,
hypertension, heart disease, and cancer. So with time nutraceuticals has been
exemplified to involve herbs, vitamins, minerals, other botanicals, amino
acids and any dietary substance for use by humans to supplement the diet by
increasing total dietary intake and eventually the use of nutraceuticals
increased effectively. Major constituents of nutraceuticals are herbals,
nutrients, and dietary supplements responsible for maintaining the health and
effectively act against diverse ill health conditions and hence improve the
quality of life.
The concept of ‘adequate nutrition’ is now replaced by ‘optimal
nutrition’ with unmatchable increase in consumer belief. Increasing
knowledge regarding the impact of diet at the genetic and molecular levels is
changing the role of nutrition and results in new dietary strategies. At the
same time, modern technologies, including biotechnology, have led to
nutritional discoveries, product innovations, and production on a large scale.
These developments leads to an important and effective area of research,
with increasing numbers of nutritional products with more potent medical
and health benefits. These scientific and technologic developments improved
the traditional foods and developing new food sources to meet these newly

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discovered requirements. Using modern chemistry, genetics and molecular
biology, the scientific community is now able to design and prepare foods
having specific attributes.
In response to the overwhelming health conscious consumers, food
industries are developing the products which provide nutritional as well as
health benefits. These scientists and food manufacturers have invented
several terms like, ‘functional food’, ‘food for specific health use’,
‘nutraceutical’, ‘health supplement’, ‘health promoting food’, ‘food for
particular nutritional use’, ‘medical food’, and ‘pharma food’, to describe
physiologically active constituents and the foods present in them. While
none of these have clearly expressed and accepted definitions, these terms
are generally used indistinguishably (Arvanitoyannis, 2005). The
pharmaceutical companies recommended the terms medical foods,
nutraceuticals, and functional foods, while the food companies favors
functional foods and nutritional foods. Food industry’s approach is based on
a nutritional concept, while the pharmaceutical industry’s approach is based
on medicinal concept. These new products represent a major difference from
traditional foods, as they are based on a new approach to nutrition, i.e., as
having the potential to lower the risk of chronic disease.
India is the hub of international health foods market because of fast
urbanization, rising standards, modern lifestyles, dietary patterns, and
growing health consciousness which provoked the healthiness and wellness
in India.
2. History
The nutraceutical revolution started in the early 1980s, and get triggered
when the potential clinical benefits of fiber, calcium, and fish oil were
supported by clinical studies data published in medical journals, and when
physicians started educating their colleagues and consumers about these
substances via mass media. The age-old culture also provided the evidence
suggesting that foods can be effectively used as medicine to treat and prevent
disease or an illness. Around 3000 years ago, father of modern medicine;
Hippocrates, stated “Let food be thy medicine and medicine be thy food” to
correlate the relationship between appropriate foods for health and their
therapeutic benefits (Defelice, 1995).
The concept of nutraceutical started flourishing in Europe, Germany and
France long back but in USA it got famous in 1900s. In 1980’s the modern
nutraceutical market began to develop in Japan. In the early 1900s, in US
food manufacturers start adding small quantity of iodine to salt to prevent

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goiter. Nowadays in Japan, England and other countries, nutraceuticals are
already become part of dietary landscape, (Bagchi, 2006).
3. Nutraceutical
The nutraceutical revolution made the food industry a research-based
sector similar to the pharmaceutical industry (Defelice, 1995). Nutritional
genomics is a recent outcome of scientific evolution that includes
nutrigenomics: the study of interaction of food and food constituents with
the gene expression and the resulting proteomic and metabolic effects; and
nutrigenetics: the study of understanding the gene-based variation in
response to dietary constituents and developing nutraceuticals that are most
compatible with health based on individual genetic makeup.
In the past few years, many food bioactive components have been
commercialized in the form of pharmaceutical products (solutions, liquors,
gels, pills, capsules, powders, granulates, etc.) that contains food extracts or
phytochemical-enriched extracts or bioactive constituents as active
principles to which a beneficial physiological function has been directly or
indirectly attributed. These products cannot be named as either “food” or
“pharmaceutical”, but a new hybrid name in between nutrients and
pharmaceuticals, i.e., ‘nutraceuticals’, has been introduced to designate
them. Nutraceuticals have been manifested to offer physiologic benefits or to
reduce the risk of chronic disease, or both, beyond their basic nutritional
functions (Espin, 2007).
Nutraceuticals includes wide range products such as herbal products,
dietary supplements, isolated nutrients, genetically modified designer foods
and processed food products like cereals, soups and beverages. Many of
these products have suitable medicinal functions and have potential
biological activities. Bioactive constituents are present in food products
provide health benefits in addition to the basic nutritional value of the
product (Kalra, 2003).
The scope of nutraceuticals is remarkably different from functional food
due to number of reasons which includes:
i) Nutraceuticals involves in prevention as well as treatment of
disease, while functional foods involves only in reduction of
disease.
ii) Nutraceuticals includes dietary supplements sold in forms of
pharmaceutical products: extracts, pills, tablets, etc as well as other
type of foods, while functional foods are sold in the form of
ordinary food (Espin, 2007).

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 Since there is no clear-cut regulations for ‘‘functional foods’’ or
‘‘nutraceuticals’’, very often both are regulated as foods (Kruger, 2003). In
present scenario, with rapid modernization and technological advancement
has led to improved quality of life in terms of standard of living and modern
lifestyle along with the economic growth which leads to profound changes in
food habits which further imposed huge challenges in the form of lifestyle
diseases. Consumption of junk food has increased enormously, which leads
to number of diseases due to nutritional deficiencies. Nutraceuticals can play
significant role in controlling these nutritional deficiencies and lifestyle
disease by increasing the supply of natural building blocks in the body. This
provides the beneficial effects in two ways: one by decreasing the signs and
symptoms of disease and secondly by enhancing the performance.
Nutraceuticals is a broad term normally contain vitamins, lipids, proteins,
carbohydrates, minerals, or other necessary nutrients as per the need.

Fig 1: Nutraceuticals are partly as food and partly as drugs

3.1 Nutraceuticals vs. Drug

Nutraceuticals are foods or food constituents that provide medicinal as
well as health benefits. This emerging class of products blurred the line of
demarcation between food and drugs/ pharmaceuticals. They do not easily
fall into the legal categories of food or drug and often inhabit area between
the two (Figure 1). As per European Medicines law a nutraceutical is a
medicine for two reasons:
1) It involves in prevention, treatment of diseases both physically and
mentally with enhanced performance.

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 2) It can be administered with a view to restore, correct and modify the
physiological functions as it has specific physiological effects
(DSHEA, 1994).
Drugs are subject to an approval process prior to marketing to
demonstrate the quality, safety and efficacy for its intended use.
Nutraceuticals are not subjected to approval process as drugs as considered
under food products.
3.2 Nutraceuticals vs. Food
Food is any eatable substance or material consumed with a view to
provide nutritional support for the body. Nutraceuticals are considered food
as they provide nutrition as well as health benefits. Food is generally
identified as safe while Nutraceuticals may contain substances of natural
origin that may not be safe.
3.3 Nutraceutical vs. Dietary Supplements
Dietary supplement is a product that are intended to be the supplement
of diet i.e., nutrients derived from food sources available in form of pills,
capsule, tablet, liquid, and powder. They are regulated by FDA as foods but
their regulations are different from drugs. Dietary Supplement Health and
Education Act (DHSEA) define a dietary supplement as: a product that
deliberately replaces the diet and consists of dietary constituents like herb,
vitamin, mineral, botanical, an amino acid and substances such as
concentrates, extracts, enzymes, organ tissues, glandular, metabolites, or in
combinations; a product intended for use in form of pill, capsule, tablet, soft
gels, gelcaps, powder or liquids; a product not represented for use as a
traditional food or as complete meal or diet; a product with label "dietary
supplement."; it includes products such as an approved new drug, certified
antibiotic, or licensed biologic which earlier marketed as a dietary
supplement or food before approval, certification, or license (unless the
Secretary of Health and Human Services waives this provision).
Nutraceuticals differs from dietary supplements in the following aspects:
like; nutraceuticals do not only supply the diet but should also help in the
prevention as well as treatment of disease and/or ill health conditions. They
are used as a traditional food or as complete meal or diet.
Widely used nutraceuticals include β-carotene, lycopene (antioxidant),
curcumin (anti-inflammatory), vitaminQ10 (CHF), glucosamine (arthritis),
lutein (macular degeneration), ginseng (cold), echinacea (anti-immune),
vitamin supplement, cod liver oil capsules, etc. The most popular products

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include omega-3-eggs, omega-3 enriched yoghurts, calcium-enriched orange
juice, resveratrol (immune supplement) and green tea (Kalra, 2003).
3.4 Nutraceutical vs. Functional Food
Nutraceuticals are slightly different from functional foods. Functional
food is the food products which are consumed as a part of normal diet and
contains biologically active ingredients responsible for physiologic benefits
and reduces the risk of diseases. Hence provides nutritive substances in
required amount like specific minerals (Ca, Mg, Zn), iodized salt, vitamins,
fats, proteins, carbohydrates, dietary fibers, needed to boost health and
improved quality of life.
While nutraceuticals are defined as a part of food or whole food that
have medicinal as well as nutritional health benefits which includes
prevention and treatment of diseases or disorders other than anemia i.e.
products consist of whole food not an isolated nutrients or constituents that is
concentrated and repacked in non-food format like in tablet, capsule and pills
form e.g. garlic capsules, spinach leaf or beets concentrates. Thus functional
food for one consumer can act as a nutraceuticals for another. Examples of
nutraceuticals include traditional foods, fortified dairy products (milk is
nutrient while casein is a pharmaceutical) and citrus fruits (juice is nutrient
while ascorbic acid is a pharmaceutical) (Kalra, 2003).
Functional foods are designed as modified food with greater nutritional
value. It contains whole food or normal diet enriched with additional
constituents for potentially health benefits when consumed on regular basis.
They are prepared by nutrification process to restores the nutrients lost
during the processing of food to similar levels as before the food was
processed. Sometimes additional complementary nutrients are added, such as
vitamin D is added to milk.
 Oats bran, psyllium and lignin's for heart disease and colon cancer.
 Prebiotics - Oligofructose for control of intestinal flora.
 Soy protein milk and Omega-3 milk in prevention of heart disease.
 Cholesterol reduction by canola oil with lowered triglycerides.
 Polyphenols and stanols (Benecol) in reduction of cholesterol
adsorption.
3.5 Traditional and Non-Traditional Nutraceuticals
Nutraceuticals in the market today consists of wide variety of both
traditional and non-traditional foods. Traditional nutraceuticals are simple,

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natural, whole foods with new information about its potential health benefits.
These products includes grains, vegetables, fruits, fish, dairy and meat
products contains natural components that deliver benefits beyond basic
nutrition, such as lycopene in tomatoes, omega-3 fatty acids in salmon or
saponins in soya, tea, chocolate etc.
Non-traditional nutraceuticals, are products resulting from scientific
intelligence like agricultural breeding or added nutrients and/or ingredients,
to boost their nutritional values. Like β-carotene-enriched rice and soybeans,
orange juice with added calcium, cereals with added vitamins or minerals,
flour with added folic acid.
3.6 Food and Non-Food Sources of Nutraceutical Factors
Nutraceuticals may be obtained from plant, animal, and microbes. Food
source may not necessarily be the point of origin for one or more substances
e.g. conjugated linoleic acid, which is part of the human diet, mostly as a
component of beef and dairy foods. However, it is actually made by bacteria
in the rumen of the cow. Also many nutraceutical substances are found in
both plants and animals, and sometimes in microbes e.g., choline,
phosphatidylcholine, sphingolipids, linolenic acid (18:3) omega-3 (ω-3) fatty
acid.
Non-food sources of nutraceuticals have been developed from modern
fermentation methods e.g., amino acids and their derivatives. Secondly
recombinant-DNA technique to develop nutraceuticals e.g. production of
eicosapentaenoic acid (EPA) by genetically modified bacteria. This fatty
acid is also produced by some algae. The EPA derived from salmon is
produced by algae and are later incorporated in the salmon that consume the
algae. Now a day’s EPA can be produced by non-EPA producing bacteria by
importing the appropriate DNA by recombinant technique. This technique to
transfer the production of nutrient molecules into organisms that allows for
economically feasible production is cause for both optimism and popular
acceptance.
3.7 Farmaceuticals
The term Farmaceuticals was coined from two terms ‘farm’ and
‘pharmaceuticals’. It refers to medicinally active compounds produced from
modified agricultural crops or animals (usually through biotechnology).
Using modified crops and possibly even animals as pharmaceutical factories
could be much more cost effective than traditional methods.

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3.8 Pharmaceuticals
Pharmaceuticals are chemical substances which are used for medicinal
purpose and have been patented protection as a result of expensive testing to
conform to the specifications of respective Governments. However, many
nutrients may never receive government approval since no one could justify
the expense of testing requirements for substances that cannot be protected
by patent laws. Pharmaceuticals and nutrients are together used in diagnoses,
cures, treat or prevent disease(s). Pharmaceuticals may have their origin in
plants and animals or may be synthetically prepared nutrients. Classic
example of nutrients is synthetic vitamins, herbal and partial synthetic
(steroidal drugs), animals (hormones, enzymes), microbes (antibiotics)
(Rajasekaran, 2008).
3.9 Medical Foods
Medical foods are a specific category of therapeutic agents which are
specially prepared to be consumed or administered under the supervision of
physician and intended for the nutritional management of a specific disease
or condition for which distinctive nutritional requirements based on
recognized scientific principles are established by medical evaluation. Like,
formulations used to treat diabetes, obesity or heart diseases, to manage
patients with inborn errors in amino acid metabolism. Medical food must
comply with FDA requirements for food but exempt from labeling
requirement for specific health claims and nutrient content under the
nutrition labeling and education act claims 1990. Hence must comply with
all food labeling requirement except specific requirement from which
medical food exempted.
Medical food products are described as food in number of ways like
food for oral intake or eternal feeding by tube (nasogastric tube); for dietary
management of a patient with specific disorder, disease or conditions needs
specific nutritional requirements which cannot be achieved by modification
of normal diet alone; to be used under medical supervision; not considered
medically necessary for diagnosis; must provide nutritional support to meet
the nutrient needs that arises from specific medical disease or condition,
determined by medical examination. The various categories of functional
foods are: Nutritionally complete formulas; nutritionally incomplete
formulas; metabolic disorders formulas; Oral rehydration products.
Medical foods are designed to manage inherited metabolic disorder
(inborn errors of metabolism) phenylketonuria, maple syrup urine disease,
homocystinuria, urea cycle disorders, organic academia, tyrosinemia,

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pancreatic exocrine insufficiency, inflammatory conditions, cancer cachexia,
and other diseases.
 Transgenic cows and lactoferrin for immune enhancement
 Transgenic plants for oral vaccination against infectious diseases
 Health bars with added medications.
Nutraceuticals covers all therapeutic areas like cold and cough, pain
killers, anti-arthritic, sleeping disorders, digestion problems, prevention of
certain cancers, osteoporosis, blood pressure, cholesterol, depression and
diabetes, etc. Hence nutraceuticals are efficiently used in detoxifying the
body, reducing vitamin and mineral deficiencies, and restores healthy
digestion and dietary habit. Phytonutrients are basically plant nutrients with
particular biological activities which help in maintaining human health.
These phytochemicals may works by following ways: as a substrate for
various biochemical reactions; as a cofactors of various enzymatic reactions;
as an inhibitors of various enzymatic reactions; as an absorbents that bind to
and eliminate undesirable constituent in the intestine; by enhancing the
absorption and/or stability of essential nutrients; as a selective growth factor
for beneficial bacteria; as a fermentation substrate for beneficial bacteria; as
a selective inhibitors of deleterious intestinal bacteria; as a scavengers of
reactive or toxic substances; as a ligands that agonize/antagonize cell surface
or intracellular receptors (Pandey, 2010; Dillard, 2000).
4. Health Benefits of Nutraceuticals
The nutraceuticals play significant role in supporting the health is that
they provide all the essential components that are required in a healthy diet.
Very often the daily routine and diet lead to unhealthy life. This will create
imbalance if we neglect it for longer duration and results in unhealthy
conditions or ailments. The administration of right nutraceuticals provides
better quality of life, which means: healthy life, healthy mood and self-
confidence, better working capacity, superior social environment.
Nutraceuticals are also characterize by following health benefits like
may increase the nutrient value of our diet, provides healthier and longer
life; may prevent particular medical conditions; may have better
psychological effect from doing something for oneself; may be recognizing
to be more natural than traditional medicine with no or least side-effects;
may fulfill the food requirement of populations with special needs (e.g.
nutrient-rich food for the elderly); may reduces the health expenditure, social
expenditure and make the individual more productive(Pandey, 2010).

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 Nutrition used in therapy is based on the belief that food as dietary
therapeutics cannot only be the sources of energy and nutrients, but could
also provides medicinal benefits. Most of the nutraceuticals do possesses
multiple therapeutic benefits and have been claimed to have a physiological
benefit or provide protection against the various diseases or disorders like;
anti diabetics, cardiovascular agents, anticancer agents, immune boosters,
anti-obese agents, chronic inflammatory disorders, degenerative diseases.
4.1 Advantages with Nutraceuticals
Nutraceuticals are products which do not require an appointment with a
healthcare provider and are easily available without a prescription. Also
many people believe this approach is more natural than using prescription
drugs. They feel that these products will help them feel stronger and
healthier, give them more energy, and prevent illness with no or least side
effects. Some people feel that these products have desirable health beneficial
effects and less toxic, when the standard allopathic treatment for specific
illness fails. Nutraceuticals are more preferred because discovery of new
drug molecules are difficult and very expensive to synthesize or separate.
They are associated with prevention and treatment of various kinds of
diseases like diabetes, digestion problems, blood pressure, anti-arthritic,
cancer, osteoporosis, neurological disorders, obesity etc. (Elizabeth, 2002).
4.2 Drawbacks with Nutraceuticals
The main drawback with nutraceuticals is lack of definite distinctive
regulations while drugs including prescription drugs and those sold over the
counter are regulated by the US FDA. Drug manufacturers must submit
scientific evidence that their products are pure, safe and effective. They must
manufacture the drugs adhering to strict GMP and GLP guidelines that
ensures the products be pure, safe and contain the exact amount of the
labeled ingredients. On the other side, nutraceuticals manufacturers are not
required to submit scientific (clinical data) studies proving their product’s
safety and effectiveness.
 Bioavailability one of the major challenges with nutraceutical is
absorption rate of intended component. The bioavailability of
nutrients is higher in food eaten in its natural form than synthetic or
modified form. Nutraceuticals with poor absorption rates results in
nutrients being disposed of from the body without providing any
nutritional or medicinal benefit.
 Influence of Placebo Effect: Like pharmaceuticals, part of the
effectiveness of nutraceuticals may be due to the placebo effect.
Consumers using nutraceuticals may inaccurately credit that healing

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 illness, is due to nutraceutical even though sometime body on its
own may recover from disease.
 Product Quality Issues: Nutraceuticals are regulated as foods, not
as drugs. They may contain more, less, or none of the actual
effective ingredient, and they may be contaminated with other
substances. As not subjected testing and regulations as
pharmaceuticals manufacturing companies, unregulated products to
create wide profit may compromise the purity, safety and
effectiveness of products.
 Safety & Interactions with Other Drugs: Just because
nutraceuticals seem natural does not mean they are safe, or that they
will have the effects they promise. Supplements, just like drugs, can
have unwanted side effects as well as desirable effects. Some
supplements can interact with prescription drugs, causing harm. The
danger is that many of these products do not provide consumers
with solid information about their safety and effectiveness, possible
side effects, interactions with prescription medicines or the impact
they may have on existing medical conditions.
5. Classification of Nutraceutical
Nutraceuticals can be classified on the basis of their natural sources,
mechanism of action, and chemical nature. On the basis of natural source, it
can be classified as: products obtained from plants (tomato, garlic,
momordica); products obtained from animals (shark liver oil, cod liver oil);
products contains minerals (Ca, Mg, P, Zn, Fe); products obtained from
microbes (Bifidobacterium, Lactobacilli).
Nutraceutical can also be broadly classified into two groups: Potential
nutraceuticals and Established nutraceuticals. Potential nutraceuticals are the
product who claims for a particular health or medicinal benefit. The potential
nutraceuticals becomes an established nutraceutical only after there is
sufficient clinical evidence (data) to demonstrate a particular health benefit.
Established nutraceutical are products having sufficient clinical data to
reveal the promised or labeled benefit (Pandey, 2010).
Nutraceuticals Classification on the Basis of Chemical Nature
On the basis of chemical nature the nutraceuticals are categorized under
molecular group’s i.e. on the basis of chemical constituent. This includes
several groups such as described in figure 1.

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 Fig 2: Classification of Nutraceuticals

5.1 Nutrients
These are chemicals constituents with confirmed nutritional properties
and their associated health benefits like amino acids, minerals, vitamins, co-
enzymes and fatty acids are known as nutrients. Commonly used nutrients
are antioxidant (natural: ascorbic acid, carotene, tocopherol, vitamin E;
Synthetic: BHA, BHT, propyl gallate, tertiary butyl hydroquinone), water
and fat-soluble vitamins. Antioxidants are substances present in low
concentration that significantly reduce/inhibit oxidation by blocking or
inhibiting the action of free radical molecules which speedup the ageing
process leads to illness. They may be useful in the prevention and treatment
of cancer and cerebrovascular disease. High dietary intake of vitamin E may
prevent Parkinson’s disease. In addition to macro and micro nutrients,
vitamins or minerals are also necessary for normal metabolism. Plant based
products contains numerous phytoconstituents which may play important
role in healthy enhancement (Clare, 2006).
5.2 Herbals
It includes herbs or botanical plants in form of concentrates and extracts.
Herbs are as old as human civilization and they have provided a complete
storehouse of remedies to cure acute and chronic diseases.
Table 1: Some examples of Herbals and their therapeutic activity

Herbals (Botanical Source) Therapeutic Activity

Aloe Vera gel (A. vera L.) Dilates capillaries, anti-inflammatory, emollient,
wound healing properties.
Ephedra (E. sinica Stap f.) Bronchodilator, vasoconstrictor, reduces bronchial
Edema.

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Garlic (A. sativum L.) Antibacterial, antifungal, antithrombotic, hypotensive,
anti-inflammatory.
Licorice (G. glabra L.) Expectorant, secretolytic, treatment of peptic ulcer
Ginger (Z. officinale Rosc.) Carminative, antiemetic, cholagogue, positive
inotropic.

5.3 Dietary Supplement

Products for oral administration that contain dietary constituents
intended to add something to the food to be eaten like black cohosh for
menopausal symptoms, G. biloba for memory loss, and glucosamine/
chondroitin for arthritis. They also serve specific functions such as sports
nutrition, weight-loss supplements and meal replacements. They contain
herbs or botanicals, amino acids, vitamins, minerals, enzymes, organ tissues,
gland extracts, or other dietary substances. They are available in various
dosage forms, like tablets, capsules, liquids, powders, extracts, concentrates,
probiotics (L. acidophilus, S. thermophiles), Prebiotics (oligofructose,
lactulose), antioxidants, enzymes (pepsin, trypsin, streptokinase, papain),
dietary fiber (water soluble: dried beans, legumes, oats, lentils, fruits,
vegetables; water insoluble: grains, cereals, whole wheat product, brown
rice, fruit, vegetables with peels) (NHS, 2008; Bagchi, 2006).
6. Functional Foods with Health-Related Properties
Functional food contains physiologically active components i.e non-
nutrient components originated from plant or animal sources, marketed with
the claim of their ability to reduce disease risk or health benefits beyond
traditional nutrients like blood cholesterol, diabetes, and hypertension. Many
functional food products are also specifically formulated with high nutrients
content or phytoconstituents than would naturally present in that food, are
called as designer foods. In each family of bioactive compounds there are
usually many members having potential uses/benefits on human health as
discussed in Table 2.
Table 2: Nutraceutical components, sources and their potential benefits

Chemical Constituent Source Potential Benefits/uses

Carotenoids Carrots, fruits, Oat, Antioxidant boosts activity of
(Isoprenoids) vegetables, corn, avocado, Natural Killer immune cell,
β-Carotene egg yolk, spinach, protect cornea against UV light
Lutein Tomatoes, watermelon, and development of Age-related
Lycopene pink grapefruit, guava, Macular Degeneration,
papaya Cataracts, powerful antioxidant
protects against formation of
cancers (Prostate, Bladder,

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 Cervical), Leukemia, reduces
cholesterol levels.
Tocotrienol Grains, Palm oil Anticancer (breast cancer),
(Isoprenoids) Promotes cardiovascular health
Saponins chickpeas and soybeans Lowers cholesterol, effective
against colon cancer
Polyphenolic Citrus fruits, Onions, Strong anti-inflammatory,
Compounds apples, broccoli, green Tea, anticarcinogenic, antioxidant,
Flavonones, Flavonols, soya bean Blueberries, hypoglycemic, anticlotting,
EGCG, Flavones, Blackberries, black hypocholesterolemic agent.
Anthocyanins raspberries, sorghum Blocks the activities of TNF,
Luteolinidin Berries, corn, wheat, VEGF, EGF. Increases LDL
apigeninidin. legumes, cactus fruit pulp, receptor. Slightly increases
Phenolic acids, Dark grapes, Raisins, HMG-CoA reductase and
Resveratrol berries, peanuts, Turmeric farnesyl diphosphate synthetase,
Curcumin root increases SREBP gene. Reduce
risk of cancer, Reduce
atherosclerotic CVD.
Glucosinolates Cauliflower Anticancer (bladder cancer)
Phytoestrogens Soybeans, legumes, cereal Lowers LDL cholesterol,
Isoflavones (genistein, grains, fruits, vegetables, antioxidants, prostate, breast,
daidzein) Lignans cocoa, red wine or grape, bowel, and other cancers. Soy
black/ green tea, chocolate, decreases micellar content and
Flaxseed, rye absorption of lipids by fiber.
Dietary fibre Legumes, wheat, oats, Maintain healthy digestive tract,
Soluble fibre: barley, psyllium, pectin, anticancer, reduces risk of CHD,
(Prebiotics) guar gum, fenugreek. Fenugreek is in diabetes with
Β-glucan, lignins, whole grain foods wheat additional lipid-modifying and
Cellulose, and corn bran, nuts anti-inflammatory, antipyretic
Glucomannan, sterol effect
saponin
Insoluble fibre
Sulfides/Thiols: Cruciferous vegetables May contribute to maintenance
Dithiolethiones of healthy immune function
Fatty Acids: Omega-3 Flax seed, oily fish Control inflammatory processes,
FA (PUFA), α- (Salmon), Nuts (Almonds, maintain brain function, Reduce
linolenic acid, EPA, walnuts, hazelnuts, risk of coronary heart disease
DHA, γ-oryzanol pistachios),
Monounsaturated fatty Rice, rice bran, Tree nuts
acids
Probiotics/ Prebiotics Lactobacilli, bifidobacteria Improve GI health, systematic
Yogurt, other dairy and immunity. Probiotics reduce
non-dairy applications lipids, It increase antioxidant
potential, lowers BP.
Minerals Food, meat, cactus fruit Important constituents of
Ca, Se, K, Mg, I, Fe, pulp, Mushroom, rice bran, balanced diet. Deficiency causes
Mn, Zn, Cu, P wheat, millet, corn, poor growth, impaired immune

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 Buckwheat
Polyols Sugar alcohols Fruits
(xylitol, sorbitol)
Vitamins vitamin Q10, Beef, Soy oil, Sardines,
ubiquinone, or rice bran, Mackerel,
ubidecarenone Peanuts, Organ meats such
Vitamin B1, B2, B3 as heart, liver, and kidney.
Vitamin A, E, K, C, Buckwheat, whole grains,
Folic acid brown rice, wheat, oats,
yeast, vegetables, legumes,
seeds, nuts, milk, egg, fish,
animal liver oil, spinach,
asparagus, kale, broccoli.
functions and delayed mental
development. Instant source of
energy for brain and nerve cells.
Boost the immune system, have
anti-cancerous properties,
aphrodisiacs, anti-
hypercholesterolemia and
hepatoprotective agents, show
anti-HIV, antiviral activity,
ameliorate the toxic effect of
chemo- and radiotherapy.
Reduce dental caries (cavities)
CoQ10 helps in CHF, cancer,
muscular dystrophy, and
periodontal disease. Vitamin B2
(in arteriosclerosis), maintain
healthy eyes, skin, nerve
function, B3 helps to convert
food in to energy and maintain
proper brain function.
Vitamin K essential for blood
clotting, Vitamin-C as
Antioxidant, for healthy bones,
gums, teeth and skin, in wound
healing. Folic acid Produce the
genetic materials of cells, in
pregnancy for preventing birth
defects, RBCs formation,
protects against heart disease.

7. Dietary Patterns with Reduced Disease Risk

Eating habits or food consuming pattern may vary significantly across
nations, states, districts and homes which have health, environmental, and
social impacts. Despite the high levels of interest in the diet and health
relationship, the traditional approach in nutritional epidemiology has mainly
focused on the effects of individual nutrient or food. However, individuals
do not consume nutrients in isolation but, rather, meals consisting of a
variety of foods in combinations of nutrients that are likely to be interactive
or synergistic effects. Phytochemicals linked to decreased cancer risk
include: Allyl Sulfides (onions, scallions), Dithiolethiones and
isothiocyanates (broccoli, cauliflower, brussels, sprouts, cabbage, turnips),
Lignans (flaxseed, rye), Isoflavones (soy foods), Flavonoids (quercetin:
tomatoes; kaempferol: kale, endive), Carotenoids (β-carotene, lycopene,
lutein)

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7.1 Mediterranean Diet
Mediterranean diets have been associated with good health with
healthier heart which has 30% lower risk of heart disease, cancer,
parkinsonism, alzheimer etc. It incorporates traditional healthy eating habits
which may varies from region to region but largely contains cereals, grains,
vegetables, beans, fruits, nuts, seeds, olive oil and fish. Several
Mediterranean diet foods, includes vegetables, fruit, whole grains, legumes,
polyunsaturated fat products and low glycaemic index starchy foods with
functional properties may protect against type-2 diabetes. They also reduce
serum homocysteine concentrations and subsequently the risk of coronary
events, especially in high-risk individuals (Esposito, 2006). Olive oil appears
to be chiefly responsible for the apparent protection against hypertension
(Psaltopoulou, 2004; Sofi, 2008).
The Mediterranean diet has more emphasis on following parameters:
like eating mainly plant originated foods such as whole grains, legumes,
vegetables, fruits, beans, seeds and nuts; replacing butter with healthy fats
such as olive oil (omega-3-FA) which lower triglycerides, decreases blood
clotting and hence decreases incidence of sudden heart attack; use of herbs
and spices instead of salt to increase flavor of the food; very little red meat
(not more than few times a month); fish and poultry are consumed at least
twice a week; wine intake in moderation no more than148ml of wine daily
for all ages women and men older than age 65 and no more than 296ml of
wine daily for younger men. Mediterranean style eating pattern proved to
have improved weight loss, better control of blood glucose levels and
reduced risk of depression, reduced level of inflammation, heart attack,
stroke and alzheimer disease.
7.2 DASH (Dietary Approaches to Stop Hypertension) Diet
DASH is an eating pattern that is rich in fruits, vegetables, whole grains,
nuts, fat free or low fat milk, and non-fat dairy foods. The eating pattern has
more emphasizes on whole grains, lean meat, fish, poultry, nuts, legumes,
seeds, rich in K, Ca, Mg and fibers etc. This dietary pattern has proven to
lower BP, reduce cholesterol and improve insulin sensitivity (reduce risk of
diabetes), reduce triglycerides, reduce LDL (bad cholesterol), improve HDL
(good cholesterol). It also limits saturated fat, red meat, sweets, and sugar-
containing beverages. Consistent weight loss due to very low caloric diet
improves vasodilatation-mediated blood flow, an effect associated with
decreased blood glucose levels. Regular physical exercise, decreased salt
intake, moderate alcoholic ingestion, and increase K content constitute

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strategies to reduce BP. In addition to its effects on BP and incident CHD, it
appears to have beneficial effects on several CVD risk factors, including
total cholesterol, LDL-C, inflammation, and homocysteine. As a whole, it is
flexible and adaptable to favorite foods, tastes and life style offers best plan
for all ages of people to be healthy.
7.3 Portfolio Diet
It is a vegetarian way of eating that constitutes plant fibers, grains,
vegetables, fruits, beans, nuts, plant sterol/stanols and soy protein. It can
lower LDL (bad cholesterol), lowers BP, reduce risk of heart disease, stroke
and helps to improve blood sugar control. Another important characteristic
of the Portfolio diet is its beneficial effects on C-reactive protein lowering, a
strong independent predictor of cardiovascular risk (Ridker, 2000). Portfolio
diet plan follow in five steps:
 Step I: A balanced low fat diet with low in saturated fat, high in
fiber, low in salt and rich in fruit and vegetables to reduce
cholesterol.
 Step II: It follows plant sterols/stanols products which blocks
cholesterol absorption from the gut. If taken in required amount can
lower LDL cholesterol by 10-15% e.g. spreads juices, yogurts and
milk.
 Step III: It follows almonds and tree nuts 30gm daily. Nuts are the
good source of protein, fiber, Monounsaturated FA and vitamin E.
e.g. Brazil nuts, almonds, pistachios, walnuts, pecans, cashew and
peanuts.
 Step IV: It includes soluble fiber 20gm daily. Soluble fibers are
found naturally in foods like oats, oat meal, oat bran, barley,
psyllium, beans, fruits, eggplant and okra which reduce cholesterol
levels by obstructing the cholesterol absorption in the gut from food
and bile acid cholesterol.
 Step V: It includes soya protein 15-25gm daily. Soya is a good
source of vegetable protein, with low saturated fats and high fiber
content. They are found in tofu, soy cheese, fresh soybeans, soy
milk, soy beverages, and soy-based meat substitutes.
7.4 Vegetarian Diet
Vegetarian diet focuses on plants for food, without meat and fish. It
includes peas, grains, fruits, vegetables, nuts, dried beans, seeds. A well
planned vegetarian diet can meet needs of people of all ages. The diet is

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usually lower in total fat, saturated fat, calorie and cholesterol content,
responsible to lower the risk of diabetes mellitus, high BP, obesity, CHD and
some form of cancer. They are rich sources of proteins (essential amino
acids), soy protein, iron, vitamin B12, Vitamin D, Ca, and Zn. Vegetarians
are reported to have a lower risk of dying from ischemic heart disease and
have reduced all-cause mortality.
7.5 Okinawan Diet
Okinawan diet has low caloric content which is the most robust and
reproducible means of reducing age related diseases and extending the life
span by escaping the chronic diseases of aging including dementia, CVD and
cancer. The important features of Okinawan diet is: Calorie restricted diet i.e
average no more than one calorie per gram; antioxidant rich diet as consists
of mainly green/orange/yellow vegetables, fruits, roots and tuber with high
antioxidant vitamins like vitamin A, C and flavonoids; polyphenols like β-
carotene, luteins, xanthines; minerals like Ca, Fe, K and Zn.; low in fat and
sugar content i.e. only 25% sugar and low in fat which helps in preventing
CHD and stroke risk; Vegetarian and sea food rich includes small amount of
fish and soy, low calorie vegetable (bitter melon, legumes). Fish provides
omega-3-essential FA like α-linolenic acid, eicosapentaenoic acid and
docosahexaenoic acid. Soy (tofu) is good source of proteins contains health
promoting components like soluble dietary fiber, antioxidant tannins, and
plant sterols. The longevity of Okinawan populations suggests that such a
diet may even help to slow the aging process itself.
8. Scope and Oppourtunity: Indian Nutraceutical Markets
The Indian nutraceutical market valued at $ 1,480 million in 2011 and
has grown expected to be roughly US$ 5 billion in 2015 and 6.1 billion by
2019-20. Nutraceutical are divided into three parts: functional food,
functional beverages (68%) and dietary supplements (32%) in India. The
report suggests that penetration of nutraceuticals market in urban India is
around 22.5%, while in rural India is around 6.3%. The urban penetration is
more as demand for protein supplements increasing due to rising desire
towards fitness and building strong physique. In India market is dominated
primarily by pharmaceutical sector. The opportunities and challenges in
nutraceuticals includes the size of the market which is very small, India is
just 2% of global market. So product development companies should
develop more consumer focused products. The rising incidence of certain
diet-related health problems, so product differentiation brands should take
the lead by building the credibility and lowering prices. Also growing

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consumer awareness with mass media conservative players in this segment is
educating the consumers. So product promotion by advertisements and
through media educating the consumer will increase the awareness regarding
the products.
Nutraceuticals Company’s main focus should be on product innovation.
India will be a strong market for nutraceuticals as players in the industry will
be a combination of large multi-nationals, companies using proprietary
formulation and small players who constitute the unorganized market.
Pharmaceutical companies are now adopting the nutraceuticals and recent
trend is convergence of food manufacturing companies with pharmaceutical
to implement research necessary for drug discovery, the move into less
expensive and time consuming nutraceuticals research process. Resulting
many food companies are entering into nutraceutical market. Other
supporting factors responsible for growth of nutraceuticals in India are
increasing health issues like malnutrition, obesity, diabetes and
cardiovascular diseases. The government is also chipping in by funding
vitamin fortification initiatives due to increasing food security concerns in
India and need for additional nutrition.
8.1 Increasing Expectations for the Functional Food Industry
Functional foods is now being recognized as the best global food
industry with changing trends in population demography, consumer richness,
their health consciousness, increased education, life expectancy and
improved healthcare which make the functional foods number one food
industry (Dillard & German,2000). Health consciousness among the
consumers is the main stimulating factor for the rapid global growth of the
nutraceutical and functional food industry. Based on public survey
conducted in 1998 by the International Food Information Council (IFIC),
reported that about 95% of the participants expressed a view that some foods
are capable of reducing health risks and that consumption of these foods can
result in an improved quality of life. Similar survey conducted by American
Dietetic Association ADA (2000) reported that 85% of participants think that
nutrients and diet are very important to them. Some of the factors associated
with increased popularity of nutraceuticals and functional foods are (De
Felice, 1995; Elliott & Ong, 2002):
 Amendments in Government Regulations: Changes in policies
and laws governing the distribution and marketing of food
observing the change in attitude towards consumer awareness and
accountability of government. Increased recognition of functional

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 food benefits, increased numbers of reports now recognize health
and clinical benefits associated with access to high quality
nutritional foods.
 Extension of the Global Market place: Better communications
and transport for marketable goods is resulting in a more accessible
global market place and an increase in international business
opportunities. This, coupled with increased recognition for
proprietary patented products is resulting in a more business
friendly environment for expansion of industry.
 A Supportive Media: Significant advances being made in research
and development of food, its processing, packaging and
transportation a supportive and promotional environment is being
generated by the media results in wide global acceptance and rising
demand.
 Clinical Evidence: The health promoting effects of phytochemicals
and nutraceuticals and/or functional foods are due to its complex
chemical nature and cellular interactions which together exert
cumulative or synergistic effect results in improving the overall
health of the individual.
 Increased Public Health Consciousness: Increased access to
information through education and media in public resulted in a
rapidly emerging self-care consciousness among consumers. Also,
understanding them the mode of action, health improving effects
and better properties of food and non-food products is increasing
rapidly.
 Aging Population: Aging population and growing senior
population are important markets for functional foods i.e. health
care system that promises to control wide range of age-related
health illness that this group now facing in their old age.
 Accelerated Health Care Cost: Because of exponential increase in
the expenses within the health care system and concern for
maintenance and viability of the system forcing many consumers to
shift out from high cost medicines to alternatives i.e. to those being
provided by traditional forms.
 Recent Advancement in Technology: Recent advances in food
technology, biochemistry and nutritional sciences (nutrigenomics)
are providing consumers with access to remarkable health benefits.
Modern technologies being used by the food industry to isolate,

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 characterize, extract and purify nutraceuticals from bacterial, plant
and animal sources leads to reduced cost as well as providing new
and variable options for use of functional food products.
9. A Global Picture of the Nutraceutical Industry
Globally USA possesses the largest and most rapidly expanding
functional food and nutraceutical market in the world. In 2006 value of the
industry was $21.3 billion. Its strong domestic market supports major
imports from Japan, North and South Korea, China, India, Brazil, European
Union (EU), Australia, New Zealand and other parts of the world. For the
USA it has been suggested that about 50% of its multi-billion dollar food
market are related nutraceuticals and functional food products. While
comparing, the Canadian food market is relatively young and is growing.
The global nutraceutical market was valued around $ 250 billion in 2014.
The market is expected to reach around $ 385 billion by 2020 at compound
attenuated growth rate 7.5% from 2014 to 2020.
Eastern cultures have a long history of use of traditional medicines
associated with health foods as recognized nutritional foods, food
supplements, medicinal herbs, and crude extracts from plant, animal and
marine sources. India and China are the two well-known countries for
production of traditional functional food products and nutraceuticals. Both of
these countries have large populations, in particular in rural, remote and
inaccessible areas where people are totally dependent upon herbs and other
naturally available bioresources to treat common ailments, as general
preventive and protective medications. In India the most common forms of
functional foods and nutraceuticals are available as traditional Indian
Ayurvedic Medicines (IAM); these are marketed under different brand
names.
India is a rich hub of large number of medicinal herbs, spices and tree
species that have a substantially large domestic market with no major foreign
competition at present. India has a large share of the international functional
food and nutraceutical market, and exports products to the far-east, south-
east, west and middle-east Asia as well as to parts of North Africa and the
EU. However, India’s major export destination is the USA and Japan. There
is a steady demand for functional foods and nutraceuticals in the country and
a friendly business environment. However, because of less stringent
regulations, cheap labor, less production cost and the enormous market
involved, China has the potential to emerge as a leader in the international
market. Japan, Korea, Hong Kong and Singapore are major importers of

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TCMs and represent 66% of Chinese plant drug exports. The annual Chinese
herbal drug production is estimated at $48 billion, with estimated exports of
$3.6 billion. Japan is the second largest market in the world for nutraceutical
products after the US. Its nutraceutical market has exhibited a steady average
growth rate of 9.6% per annum for the past decade, and in 2006 its
functional food industry was estimated to have a value of $27.1 billion.
Other large, emerging international markets in south and south-east Asia are
seen in Taiwan, Sri Lanka, Thailand, the Philippines, Vietnam, Lagos,
Kampuchea, Indonesia, Malaysia, North and South Korea. In addition
Australia and New Zealand are emerging quickly as international
competitors.
At present vitamins, minerals and nutrients constitute about 85%of the
global market while antioxidants and related products account for about
10%. The other segments such as herbal extracts occupy 5% of the market.
Another area which has received considerable attention in the recent times is
that of the prebiotics and polyunsaturated fatty acids (PUFAs).
Table 3: Various Nutraceutical Products with its Constituent, Category and
Manufacturing Company

Product Constituent/Category Company

Beta Factor® Beta-glucan/ Immune supplement Ameriden®
Capsules International, Inc., USA
TOZAL Eye Health Omega-3-FA, Zn, antioxidants and AmeriSciences, USA
Formula lutein/improved vision
Lycopene® Softgel Lycopene (carotenoids)/Antioxidant Source Naturals
POMx Antioxidant Polyphenols/ speed muscle recovery POM Wonderful Ltd,
Recovery ® Drink USA
PediaSure® Protein, vitamin, other natural Abbott Nutrition
supplement
Proteinex® Predigested proteins, vitamins, Pfizer Ltd., India
minerals, carbohydrates
BeneFlora® L. Acidophilus, B. Bifidum./Improve Nupro, USA
Probiotic systematic immunity.
Ferradol Food® Carbohydrate, Protein, Vitamins, Ca, Pfizer Limited, India
powder Fe, Zn supplement
brainSpeed blend of vitamins and minerals/Brain Natrol, USA
Memory® health
NeuroHelp Vitamin supplement with natural NeuroHelp, USA
Essential™ antioxidants
Omega women Antioxidants, Vitamins, Lycopene, Wassen, U.K
Resveratrol/Immune supplement

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10. Nutraceuticals and Diseases
The nutraceuticals are well in use for the prevention and treatment of
various chronic diseases like cardiovascular diseases, cancers, diabetes and
obesity is expeditiously increasing throughout the world.
Table 4: Disease, causes with its Nutritional and Nutraceutical treatment

Disease/Cause Nutritional Treatment Nutraceutical Treatment

Cardiovascular Antioxidants, dietary Grapes, onions, milk thistle,
Disorder: Improper diet fibres, (PUFAS), chamomile, rutin buckwheat,
and unhealthy lifestyle; flavonol, polyphenols, ginkgo, citrus fruits, apple,
Low intake of fruits and flavonoid, flavone, cherries, berries, cruciferous
vegetables hesperidin, silybin, γ- vegetables, black grapes, red
linolenic acid, wine.
octacosanol, ginkgo-
flavon glycosides,
vitamins, minerals.
Obesity: Excessive Herbal stimulants; herbs Ephedrine, caffeine, mahuang-
consumption of energy and spices. guarana, chitosan, green tea,
rich foods; Less/no buck weed seed protein, ellagic
physical activity. acid, pectin etc.
Diabetes mellitus: Due to Dietary fibres, Mg, Psyllium, banana, melon,
insufficient insulin chromium picolinate, Ca, cinnamon, bitter guard, etc.
production or due to its vitamin D, extracts of
ineffectiveness bitter melon, cinnamon.
Cancer: Improper diet; Food containing Ginseng, citrus fruits,
unhealthy lifestyle. Phytoestrogens, curcumin, tea, peas, soybeans,
flavonoids, antioxidants, spinach, tomatoes, potatoes,
polyphenols, isoflavones, alfalfa, cloves, cranberries, blue
carotenoids, β-carotene, berries, grapes, lentils, wine,
lutein, saponins, tannins, strawberries, walnuts, pecans,
proanthocyanidins, etc. apples, cabbage, pomegranates,
red raspberry seeds, broccoli,
brussel sprouts, water cress,
mustard, garlic etc.
Inflammatory Disorder: Γ- linolenic acid (GLA, Cat’s claw (U. guianensis; U.
Tissue injury; irritation. all cis 6,9,12, octa tomentosa), bilberry (V.
decatrienoic acid, C-18:3, myrtillus), low bush wild
n-6), linolenic acid, blueberry (V. angustifolium),
sirtuins, resveratrol, rabbit eye blueberry (V. ashei),
flavonoids, tannins, high bush (V. corymbosum)
glycosides, sterols, etc.
Immune Boosters or Soy isoflavones Cone flowers, herbs of genus
Antiviral agents: (genistein, daidzein, Echinacea, elder berries; and
Disturbed hormonal biochanin) Golden seal extracts, A.
balance membranaceus, A mongolicus.
Osteoarthritis: Weight Glycosaminoglycan, Glycosaminoglycan,
gain; energy imbalance. chondroitin sulfate, Chondroitin sulfate, MSM, B.

Page | 48
 methylsulfonyl methane serrata cat’s claw, Devil’s
(MSM). claw. Avocado/Soybean
unsaponifiables green lipped
Mussel extract, s-adenosyl
methionine, PUFA
Allergy: Exaggerated Quercetin, flavonols, Onions, red wine, green tea,
response to either a drug flavonoids, etc. etc.
or food.
Alzheimer’s Disease: Β- carotene, curcumin, Αlipoic acid (ALA), green
Oxidative stress lutein, lycopene, turmeric, vegetables, nuts.
etc.
Parkinson’s Disease: Glutathione glutathione
brain damage causing
muscle rigidity, shaking,
and difficult walking
Degenerative disease combination of vitamin garlic (allicin), green tea
C, vitamin E, β-carotene, (catechins and bioflavonoids
and Zn (with CuO), QR, hesperidin, rutin), sea food
antioxidants, like lutein such as salmon, trout, seabream
and zeaxanthin, n-3 fatty and shrimps
acids, Astaxanthin
Vision improving agents Lutein (helenium), Fruits, vegetables mangoes,
Zeaxanthin sweet potatoes, carrots, squash,
tomatoes, dark-leafy greens like
kale, collards and bok choy.
broccoli, green beans, green
peas, brussel sprouts, cabbage,
collard greens, spinach, lettuce,
kiwi and honey dew, nettles,
algae and the petals of many
yellow flowers.
In Apoptosis and Disease Carotenoids like Tea, garlic, ginger, soya bean,
Prevention genistein, quercetin, and tomato, lycopene and β-
rutin, Stilbenes carotene, Grapes, peanuts, and
(resveratrol) pines.
In Stem Cell Therapy Ca, Mg, Fe, P, Zn, I and Blueberry, green tea, catechin,
B, as well as vitamins D carnosine, and vitamin D3
and K
Spermatogenesis: vitamin B12, arginine, folic
maintenance of sperm acid, acetylcarnitine, L-
and sperm maturation, carnitine, co-enzymeQ10,
DNA synthesis, repair lycopene, vitamin-C, Vitamin
and transcription E, glutathione, Se, Zn
Adaptogens: Used to O. sanctum, W. somnifera, G.
balance physiological biloba, P. ginseng, T.
processes and promote cordifolia, E. senticosus, and C.
homeostasis of body sinensis. eleutherosides A-M

Page | 49
11. Future Issues and Proposals
Change in the lifestyle can prevent the diseases like metabolic
syndromes. One of the solutions in the lifestyle change is changes in their
diet. The key issues for nutraceuticals are: establishment of clinical data to
assess the standard for prevention of diseases; establishment of well
regulated and secure assessment system for prevention of disease by human
trials; establishment of perfect system to transfer stage from basic research to
industrialization.
Nutraceuticals are not necessarily a single material; therefore the
expected effect for the prevention of disease might be the complex action of
several components which are present in the product, it is also necessary to
compare preventative effects for different types of food. Hence, it is
necessary to conduct biomarker research for prevention of target diseases.
Therefore, it is also necessary to define the various methods for
measurement of biomarkers and to standardize indicators.
12. Conclusion
Nutraceuticals are naturally obtained biologically active components
present in food products, herbal products and dietary supplements, and have
wide range of health nurturing, disease inhibiting effects. These products are
result of collective efforts of pharma industry, food and chemistry. India is
outstanding player because of its extensive markets and facilities like wide
resources, rich bio-diversity, well qualified manpower, outstanding R & D
facilities, and varied raw materials that provide edge to our country. But for
nutraceuticals, lack of standardization and quality control is a prime area of
concern because quality of plant materials and manufacturing techniques
used in preparation are governed by food laws, which lacks specificity
required for medicinal herbs which leads to serious outcomes. Hence it is the
crucial time that nutraceutical professionals and regulatory bodies need to
play important role to control safety parameters and advances of
nutraceuticals. Even though nutraceuticals and functional foods play
remarkable role in the promoting and caring human health to prevent
diseases, the health professionals, nutritionists, biotechnologists,
nutraceutical industrialist and regulatory toxicologist should voluntarily
come together to provide appropriate rules and regulations to provide the
best health and therapeutic benefits to mankind with better safety, efficacy,
and purity. Another important area of concern is the interaction of
nutraceuticals with food constituents and drugs. Also effect of different
processing methods on the biological availability and effectiveness of

Page | 50
nutraceuticals need to be concentrate. As like drugs, strict regulatory controls
for nutraceuticals are the demand of present time.
References
1. Alexander G, Kuang YC. Nutraceuticals, Apoptosis, and Disease
Prevention. Nutrition. 2004; 20:95-102.
2. Arvanitoyannis IS, Houwelingen-Koukaliaroglou MV. Functional
Foods: A Survey of Health Claims, Pros and Cons, and Current
Legislation. Crit Rev. Food Sci. Nutr. 2005; 45(5):385-404.
3. Bagchi D. Nutraceuticals and functional foods regulations in the United
States and around the world. Toxicology. 2006; 221(1):1-3.
4. Coppens P, Da Silva MF, Pettman S. European regulations on
nutraceuticals, dietary supplements and functional foods: a framework
based on safety. Toxicology. 2006; 221(1):59-74.
5. DeFelice S. The nutraceutical revolution: its impact on food industry R
& D. Trends in Food Science and Technology. 1995; 6:59-61.
6. Dietary Supplement Health Education Act (DSHEA) of Public Law,
1994, 103-417.
7. Dillard CJ, German JB. Phytochemicals: Nutraceuticals and human
health. J Sci. Food Agric. 2000; 80:1744-1756.
8. Directive 2002/46/EC of the European Parliament and of the Council of
10 June 2002 on the approximation of the laws of the Member States
relating to food supplements: Official Journal of the European
Communities, 2002.
9. EFSA (European Food Safety Authority). Scientific Opinion of the
Panel on Dietetic Products, Nutrition and Allergies on a request from the
EC on Food-Based Dietary Guidelines. The EFSA J, 2008, 1-44.
10. Elizabeth AC. Over the counter products: nonprescription medications,
nutraceuticals, and herbal agents. Clin Obstet Gynecol. 2002; 45(1):89-
98.
11. Elliott R, Ong TJ. Science, medicine and the future: Nutritional
genomics. Brit Med. J, 2002; 324:1438-1442.
12. Espin JC, Teresa M, Conesa G, Francisco A, Barberan T.
Nutraceuticals: Facts and fiction. Phytochemistry. 2007; 68:2986-3008.
13. Food and Drugs Act. Natural Health Products Regulations P.C. 847 5
June, 2003.

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14. Hardy G. Nutraceuticals and functional foods: introduction and
meaning. Nutrition. 2000; 16(7-8):688-689.
15. Kalra EK. Nutraceutical-Definition and Introduction. AAPS Pharm Sci.
2003; 5:1-2.
16. NHS. Exploration of Adult Food Portion Size Tools Health, Edinburgh,
NHS Health, Scotland, 2008.
17. Obarzanek E, Sacks FM, Vollmer WM Effects on blood lipids of a
blood pressure-lowering diet. The Dietary Approaches to Stop
Hypertension (DASH) Trial. American Journal of Clinical Nutrition.
2001; 74(1):80-89.
18. Pandey M, Verma RK, Shubhini A. Nutraceuticals: New era of
medicine and health. Asian J of Pharm. and Clin. Res, 2010, 3(1).
19. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T,
Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood
pressure: the Greek European Prospective Investigation into Cancer and
Nutrition (EPIC) study. The American Journal of Clinical Nutrition.
2004; 80(4):1012-1018.
20. Rajasekaran A, Sivagnanam G, Xavier R. Nutraceuticals as therapeutic
agents: A Review. Research J Pharm. and Tech. 2008; 1(4):328-340.
21. Ridinger MH. Nutraceuticals: miracle or meme? Clin Pharmacol Ther,
82(4), 352-356.
22. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to
Mediterranean diet and health status: metaanalysis. British Medical
Journal. 337, article 1344, 2008.
23. Tewfik S, Tewfik I. Nutraceuticals, functional foods and botanical
dietary supplements; promote wellbeing and underpin public health.
World Review of Science, Technology and Sustainable Development.
2008; 5(2):104-123.

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 Chapter - 3
Introduction of Homoeopathic Posology

Authors
Dr. Basavaraj S. Adi
Reader, Department of Pharmacy, Bharatesh Homoeopathic
Medical College, Belgaum, Karnataka, India
Dr. Siva Rami Reddy E
Faculty of Homoeopathy, Tantia University, Sri Ganganagar,
Rajasthan, India

Page | 53
Page | 54
 Chapter - 3
Introduction of Homoeopathic Posology
Dr. Basavaraj S. Adi and Dr. Siva Rami Reddy E

Abstract
The idea of posology in homoeopathy had been in use since its
discovery by Dr. S.F. Hahnemann. But the real understanding of the proper
use of potency and the proper dose that constitutes the real realm of the
simple curative science has been in vogue and there has not been any
standardization as to the idea of curative potency and the dose.
Keywords: Homoeopathic, posology
Introduction
‘Posology’ (Derived from the Greek word ‘posos’ meaning how much,
and ‘logos’, meaning science) is the branch of medicine/pharmacy dealing
with doses while ‘dose’ is the quantitative amount administered or taken by a
patient for the intended medicinal effect According to Chamber’s dictionary-
Posology is the science of quantity or the science of Doses [1].
According to Stedman’s Medical dictionary- it is the branch of Materia
Medica and therapeutics that has to do with determination of the doses of
remedies or the science of dose.
Back Ground
The subject of dose in homoeopathy had been very important. The
subject matter of posology was so misunderstood that the early physicians
developed controversies regarding it and divided into two factions, one
group restricted themselves to the crude tinctures and triturations, or the very
low dilutions, ranging from 1x to 6x while the other ranged from the third to
the thirtieth potencies. And another small class of metaphysical group tends
to use only the very high potencies, ranging from the two hundredth to the
millionth, each according to his personal preference.
To understand the concept of what constitutes a dose, it is essential to
throw some light on the concept of the history of homoeopathy, and upon the
development of the problem of dosage. Before Hahnemann, large or massive

Page | 55
doses were used quite often as a rule. Even in the early part of his practice he
made cures with massive doses of crude medicine, but from his close
observations and continual experiments he found that he obtained adverse
drug effects quite often than he could make successful cures.
On this he started reducing the dose by further dividing the dose and
found that the smaller the dose was, the more beneficent were the results.
His experiments with the divided dose did not come until he had discovered
the dynamic action of disease. Then after logical understanding, he
formulated that, if disease is dynamic in nature, then the use of a remedy to
cure, or even to reach the disease, must be dynamic, rather than
physiological, in form and power. When he became convinced of this, he
reduced the dose, by dividing the dose again and again, and thereafter
watching closely the results [2].
The more Hahnemann became convinced of the dynamic nature of
disease, the more he sought the dynamic plane in medicine, and the more
beneficial he found the administration of the similia. Slowly and gradually,
the minimum dose which is always a flexible measure became ever smaller
and smaller, until it has developed into the infinitesimal.
H.A Roberts also mentions in his book ‘The Principles and Art of Cure
by Homoeopathy’, Hahnemann's final views and practice in regard to the
dose which were arrived at gradually, through long years of careful
experiment and observation. His discovery of the principle of potentiation
came about gradually as he experimented in the reduction of his doses, in
order to arrive at a point where severe aggravations would not occur [3].
Roberts also mentioned in the chapter ‘Dose’ that the homoeopathic
doctrine of dosage was based upon the discovery of the opposite action of
large and small doses of medicine. Describing the Law of Mutual Action he
gave an example of Ipecac, which in large doses causes nausea and vomiting
and in small doses, under certain conditions, will cure the same; that Opium
in large doses will cause a deep sleep or narcosis, and in small doses, under
certain, conditions, will cure the same. Further he had given the distinction
between physiological, therapeutic, and pathogenetic action of drugs, used
by the two schools of medicine to express the nature of the action of the
drugs. According to him the action of a drug may be pathogenetic (toxic), or
therapeutic (curative), depending upon the size and strength of the dose, the
susceptibility of the patient and the principle upon which it is given.
Homoeopathy requires that the therapeutic dose must be capable only of
producing a slight temporary aggravation or intensification of already
existing symptoms, never of producing new symptoms [4].

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 Considering the reasons why the dose of the medicine chosen
homeopathically is necessarily smaller than the physiological dose of
antipathic or allopathic prescription, we meet first the fact of organic
resistance. The homeopathic dose, therefore, is always a sub-physiological
or sub-pathogenetic dose; that is, a dose so small as not to produce
pathogenetic symptoms.
A third reason is that the homeopathic drug is always given singly, so
that its action is complete and unmodified by other drugs. Thus he arrived at
his final conclusion that the proper dose is always the least possible dose
which will effect cure. Regarding choosing of the Potency there are many
opinions about the selection of the dose but there is no clear cut
understanding that help us to choose the best potency for a given case.
The series of potencies has been compared to the gamut in music, "A
skillful artist may indeed construct a harmony with the various vibrations of
the same chord; but what a more beautiful and perfect harmony might he
construct by a proper combination of all the sounds that can be elicited from
his instrument." (Guernsey.)
Generally it may be said that any curable disease may be cured by any
potency of the drug so selected on the basis of individualized approach, but
the fact is that it may fail to act speedily as may be expected due to its non-
selection of the proper potency.
Jahr says, “By continual diluting and succussing, remedies get neither
stronger nor weaker, but their individual peculiarities become more and
more developed;" i.e., their sphere of action is enlarged.
According to Jahr in a given case, where the symptoms are not clearly
developed and there is an absence or scarcity of characteristic features; or
where two or three remedies seem about equally indicated, susceptibility and
reaction may be regarded as low. We give, therefore, the remedy which
seems most similar, in low (third to twelfth) potency. And when the
characteristics of the case correspond to the characteristics of the one single
remedy, high potencies- thirtieth, two hundredth, thousandth, or higher are
given.
The choice of the dose is influenced by the factors like the susceptibility
of the patient, the seat of the disease, the nature and intensity of the disease,
the stage and duration of the disease and the previous treatment of the
disease. Higher is the symptom similarity of the remedy to that of the
characteristics of the patient, the greater the susceptibility to that remedy,
and the higher the-potency required.

Page | 57
 The Susceptibility is modified by age. Susceptibility is greatest in
children and young, vigorous persons, and diminishes with age.
Susceptibility is modified by Constitution and Temperament. The higher
potencies are best adapted to sensitive persons of the nervous, sanguine or
choleric temperament; to intelligent, intellectual persons, quick to act and
react; to zealous and impulsive persons [5].
Lower potencies and larger and more frequent doses correspond better
to torpid, mentally dull, sluggish and phlegmatic individuals, to coarse
fibered, sluggish individuals of gross habits; to those who possess great
muscular power but who require a powerful stimulus to excite them, can take
large amounts of stimulants like whiskey without any side effects, and show
little effect from it. They often require low potencies, or even sometimes,
material doses when fall ill.

Fig 1: Preparation of potencies

Susceptibility is modified by habit and environment. - It is increased by
intellectual occupation, by excitement of the imagination and emotions, by
sedentary occupations, by long sleep, by an effeminate life. Such persons
require high potencies.
Susceptibility is modified by pathological conditions. In certain terminal
conditions the power of the organism to react, even to the indicated

Page | 58
homoeopathic remedy, may become so low that only material doses can
arouse it.
Principles of Homoeopathic Posology
In order to understand the principles behind the doctrine of
homoeopathic Posology the three things necessary to be understood are:-
1) The Dynamic concept of disease
2) Susceptibility and
3) Remedy reaction
If we wish to differentiate Posology versus Law of similar, it is found
that Law of Similars are the fundamental unalterable principles while the
science of Posology i.e. doses, can be altered and the rules relating to it are
subject to modifications as per the experience. This can be understood by
seeing Hahnemann’s changing views on Posology.
On perusal of Organon it is found that the concept of posology exhibits
ever modifying and changing ideas. What is required to grasp the idea of
Posology is the thorough knowledge of dynamic action of homoeopathic
medicine and rules of Posology. The fundamentals of homoeopathic
Posology are represented in trinity of Single remedy, Minimum dose and
Minimum repetition.
By Single remedy is meant that one medicine is to be given at a time as
only one remedy can be exactly similar to the case. If we make a
combination prescribing which is a mixture that can never act as
homogenous but rather act as heterogeneous substance having no consistent
pathogenesis in proving so will be of no later clinical use. There are routine
alternators using one remedy in alternation with the other; alternation of
remedies can be considered only when symptom groups tend to alternate
e.g., Bryonia and Rhus tox in enteric fever. But in Chronic case alternation
of symptoms it becomes characteristic which must be covered by a single
remedy.
Regarding Minimum dose it can be explained by the fact that the
Patient exhibits maximum susceptibility to the similimum and Susceptibility
decreases as the remedy moves away from the pivotal point. Hahnemann’s
drifted from crude dose to progressive reduction in doses by way of
succussion and trituration that led to the process of potentization, a unique
way of liberating the dynamic power of the drugs. Also minimum force is
sufficient to restore the lost balance. But for low susceptible states like
cancer and other pathological conditions minimum dose may be tincture.

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 Homoeopathic therapeutics is based on Law of Similars and not on
Infinitesimal dose. We need to assess the susceptibility of the patient to
decide the potency. Any error may lead to poor response or in exaggerated
response even though the remedy may be right.
General Guidelines for Potency Selection
1) The closer the similarity between the remedy and the patient’s state,
higher the potency
2) Well defined characteristic mentals will require High potency
3) Remedies that are inert in crude states demand higher potency
4) Potency that helped in the last need be repeated in same to avoid
aggravation.
5) In chronic cases where Highest potencies are tried with little
benefit, low potency
6) (30th) may yield result
7) In allergic patients after a remission, if again exhibits old
symptoms, a
8) Constitutional high potency may precipitate aggravation.
9) Remedy prescribed on poor indications or for a particular effect,
low potency or θ is helpful.
10) In acute illness affecting vital organs;
11) High potency frequently repeated. May bring crisis
12) Low or medium potency with frequent repitition. Lead to crisis.
Error
To presume that lower potencies exempts one to exercise causation in
repeating the medicine. E.g. Repetition of Merc. cor 6 in acute dysentery
may aggravate. If the deterioration is not advanced, withholding the
medicine will be curative otherwise an antidote to Merc cor has to be given
as per the relationship of medicine.
Guidelines for Time of Administration of Homoeopathic
Remedies
1. Most remedies to be given at bed time except Sulphur (Sulph. Only
in cases of Insomnia) Sulphur has to be given in morning except in
cases of insomnia otherwise it may cause night aggravation. Rest
most medicines if given at night may be better adapted &
assimilated by the body when the body is at rest & their effects may
be visible in the morning.

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 2. Not to be given before or during the period of aggravation; be given
after the time of aggravation like Nat Mur in morning; Lyco in the
evening.
3. Deep acting remedies not to be administered before and during
paroxysm in periodical diseases, while superficial remedy can be
administered e.g., In case of Nat Mur, Bry can be given for acute
stage to be followed later by Nat mur.
4. In chronic case acute exacerbation is to be controlled by acute
(superficial) remedy.
5. For menstrual troubles, constitutional remedy is to be given after
the menses is over and any acute or superficial medicine can be
given for pain etc.
6. In asthma, after every acute (superficial) remedy, follow up has to
be done with the constitutional.
7. Tuberculinum is to be given during quiescent state.
Guidelines for Repetition
1. Medicine to be stopped as soon as adequate response is observed.
2. Not to be repeated till the favourable response continues.
3. Cessation of progress not to be taken as indication for repetition.
4. To be repeated only when there is return of symptoms.
5. In acute cases the action of a remedy exhaust early so can be
frequently repeated; premature cessation of the remedy may cause
relapse.
6. In chronic cases single dose stimulation should be the rule but
multiple dose stimulation can be given where single dose
stimulation has failed.
7. Before changing potency multiple dose stimulation can be tried to
avoid needless aggravation.
This discussion is intended for students already possessing a basic
knowledge of pharmacy in general and homoeopathic pharmacy in
particular. The focus of this present work is the evolution of Hahnemann's
posology from the preparation of potencies to dispensing methods he
developed. It is recommended that the reader familiarise themselves with
original sources referred to throughout this discussion.
First Preparations
Hahnemann began by using medicines diluted in the ratio of 1:100-

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those today referred to as 'centesimal' potencies. The basic procedure for
processing from the crude drug is shown as follows:
These potencies have long formed the mainstream of homoeopathic
dispensing, such that potencies of this scale are referred to simply by the
number of the potency, without needing to suffix the letter 'C' to indicate that
they are centesimal. Thus, 30C can be written simply as 30; 200C as 200,
etc. In Europe however, the practice is to attach the suffix 'C' only when the
potencies are prepared according to the Hahnemannian (separate phial)
method. Some manufacturers use the suffix 'CH' for 'Centesimal
Hahnemanni'. I prefer to consider the separate phial method of Hahnemann
as standard, using a suffix only for other methods of potency preparations
e.g., 200K for Korsakovian, 200F for Fincken, etc. The reasons for such
widespread general use of centesimal potencies, include the fact that
Hahnemann's later method was not published until the publication of the 6th
edition Organon in 1921 by Boericke & Tafel of Philadelphia, with the
resultant use of the centesimal potency scale by Dr. Kent (who died in 1916,
and was therefore unaware of the 50-millesimal scale), and its extension into
higher and higher potencies by the methods of the Russian General;
Korsakoff (single phial method).
The two other scales of potency used in Homoeopathy have their own
conventions in terms of their written communication. Decimal scale
potencies (prepared with a dilution factor of 1:10 at each step) are denoted
by the suffix 'X' (Australia, England) or 'D' (France, Germany, and other
European countries), such that the 30th decimal potency must be written as
30X or 30D to indicate its preparation. 50-Millesimal potencies are indicated
by the prefix '0/', such that the 30th potency of the 50-Millesimal scale is
written as 0/30. In England, the prefix 'LM' is used to indicate a 50-
Millesimal potency (eg, 0/30 would be written as LM30), but this is not
acceptable, since, as correctly pointed out by Dr. Hansjorg Hee of
Switzerland, 'LM' is an abbreviation for “50 thousand”, whilst the potencies
on this scale involve a 1:50,000 or in other words, a 50 thousandth dilution.
In most parts of Europe, these preparations are referred to as 'Q' potencies,
the Q representing the term “Quinquies Millesimal”, the Latin term for “50
thousandth”.
So, Hahnemann began to systematically prepare medicines by serial
dilution (& succussion) in the proportion of 1:100, and this was kept up until
the adoption of his latest method which he called the "new altered but
perfected method", wherein he directed the preparation of medicines in the
proportion of approximately 1:50,000.

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 The question to be asked is why did Hahnemann, after nearly half a
century of applying the principle of Similia in clinical practice, seek to
develop a new method of preparing and dispensing medicines? There is only
one possible answer to this question. Hahnemann was not completely
satisfied with the tools (the medicines) he was using in his application of
Homoeopathy; there was always some dissatisfaction with the amount of
aggravation he observed, and he continually experimented with the
adjustment of dose in his dispensing, and ultimately, in the method of
manufacture of the potencies themselves.
This ongoing development in Hahnemann's posology was the result of
his increasingly accurate prescribing, which especially coincided with the
development and fine-tuning (from around the mid-1820's) of his chronic
disease theory and its application to the case-taking and evaluation, resulting
in Hahnemann seeking to match the entire array of peculiar or characteristic
symptoms across the whole history of a patient's chronic illness (and thereby
adding a temporal component in the determination of the totality of
symptoms), thus making his prescribing much more accurate than it had
been in similar cases previously. Understandably, with growing accuracy in
prescribing, Hahnemann increasingly found that the dose of medicine had to
be reduced in order to avoid unnecessary aggravations and thereby adhere to
the ideals expressed in § 2 of his Organon of Medicine. His initial
experiments in dose reduction involved the prescribing of the
homoeopathically selected medicine in quantities of only a small portion of a
drop.
Hahnemann's Potency Symbols
Hahnemann used a sequence of Roman numerals to represent the
potencies he used, such that each single ascendant represented a rise in 10-6
or the 3rd centesimal potency. Thus the Roman numeral I represented the
millionth attenuation (i.e., six ciphers in the denominator; 10-6 or 3rd
potency); the Roman numeral II, 10-12 or the 6th potency; the Roman
numeral III, 10-18 or the 9th potency; V for the 10-30 or the 15th potency;
and the X numeral represented the 30th potency, and so on. (Chronic
Diseases, vol. 1, p.149 footnote; p.150.) The following is a list of Roman
numerals and the potencies they represent.
(Refer MMP, II, p.61 under Magnes; also throughout various remedies
in MMP wherein he equates the 30th potency with decillion and marks it
with the roman numeral X; also see Organon, 5th ed., § 287 footnote).
I = millionth = 10 - 6 = 3… (Refer MMP, II, p.209 under Muriatic acid,
1826)

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 II = billionth = 10 - = 6… (Refer MMP, II, p.270 under Oleander,
12

1830)
III = trillionth = 10 - 18= 9
IV = quadrillionth = 10 - 24
= 12… (Refer MMP, I, p.117, under
Arsenicum, 1833)
V = quintillionth = 10 - = 15… (Refer MMP, I, p.117, under
30

Arsenicum, 1833)
VI = sextillionth = 10 - 36= 18… (Refer MMP, II, p.61, under Magnes,
1826)
VII = septillionth = 10 - 42= 21
VIII = octillionth = 10 - 48
= 24… (Refer MMP, I, p.117, under
Arsenicum, 1833)
IX = nonillionth = 10 - 54= 27
X = decillion = 10 - 60= 30… (Refer MMP, I, p.117, under Arsenicum,
1833)
XX = gazillionth = 10 - 120
=… 60 (refer MMP, II, p.648, under Thuja,
1826)
L = quinquagintillion = 10 - 300 =… 150
C = quintillionth = 10 - 600 =… 300 (refer MMP, II, p.61, under Magnes,
1826)
Thus, one can see that Hahnemann spoke in multiples of the millionth
(million-fold) attenuation. Why this was done at first seems unclear, but a
little careful thought on the information he has left behind does provide an
answer. In the following quote, Hahnemann has just finished describing the
process of triturating 1 grain of the crude drug in 100 grains lactose (in 3
separate stages) up to the 1st (centesimal) potency. He then says:
Chronic Diseases, I, pp.147-150 (2nd edition, 1835-9) - 2 succussions =
1835 - 1837
…the powder is preserved in a well-stoppered bottle with the name of
the substance and the signature 100 because it is potentized one hundred
fold.
After repeating this procedure using the first (centesimal) trituration,
Hahnemann says of the resulting powder:

Page | 64
* In a Footnote to this Paragraph he says
Thus it will be seen that every attenuation (that to /100, that to /10000,
and also the third to/1000000 or I) is prepared by six times triturating for six
minutes and six times scraping together for four minutes each time. Thus
each one requires one hour.
Chronic Diseases, I, p.149
In order to produce homogeneity in the preparation of the homoeopathic
and especially the antipsoric remedies, at least in the form of powders, I
advise the reducing of medicines only to this millionth potency, no more and
no less and to prepare from this the solutions and the necessary potencies of
these solutions; this has been my own custom. Now in preparing the
solutions from this, and in bringing the medicines thus potentized one
million-fold, into the fluid form, (so that their dynamization may be still
further continued), we are aided by the property of all medicinal substances,
that, when brought to the potency I, they are soluble* in water and alcohol;
this property is still unknown to chemistry.
* Chemistry now recognises that such dilutions form a non-precipitating
suspension (colloid) of the original drug substance (which produces a
cloudy).
Chronic Diseases, I, p.150
The first solution cannot be made in pure alcohol, because sugar of milk
will not dissolve in alcohol. The first solution is therefore made in a mixture
of half water and half alcohol. To one grain of the medicinal powder
triturated to the million-fold potency I, fifty drops of distilled water are
dropped in and by turning the vial a few times round on its axis it is easily
dissolved, when fifty drops of good alcohol are added, and the vial, which
ought only to be filled to two-thirds of its capacity by the mixture, ought to
be stoppered and shaken twice (i.e., with two down-strokes of the arm). It is
marked with the name of the medicine and 100 I. One drop of this is added
to ninety-nine or one hundred drops of pure alcohol, the stoppered vial is
then shaken with two strokes of the arm and marked with the name of the
medicine and designated. 10000 I One drop of this is added to ninety-nine or
one hundred drops of pure alcohol, the corked vial is then shaken with two
strokes of the arm and marked with the name of the medicines and II. The
preparation of the higher potencies is then continued with two strokes of the
arm every time to the/100 II, /10000 II, III, etc., but to attain a simple
uniformity in practice only the vials with the full numbers II, III, IV, V, etc.,
are used in practice, but the intermediate numbers are preserved in boxes or
cases with their labels.

Page | 65
 Thus they will be protected from the effect of daylight appearance when
held up to a light source due to the fine particles interfering with the passage
of light), are therefore not accurately termed a “solution” (which, by
contrast, is not cloudy).
Now, back to the question of why Hahnemann used this particular
terminology, in multiples of millionths (10-6), for his potencies. Basically it
was because of simple language parameters. You see, our language, even
today, only has terminology representing multiples of one million. For
instance, we talk about money in terms millions, billions (million 2), and
even trillions (million 3).
There is no terminology to represent squares of one hundred (first
centesimal potency) or squares of ten thousand (second centesimal potency).
So Hahnemann saw his potencies in multiples of one millionth, which can be
represented as follows.
1/million, 1/million 2, 1/million 3, 1/million 4, 1/million 5, etc.
Each of these individual steps were achieved through three separate
dilution stages, each of which was 1 /100 (centesimal) dilution, such that the
1st and second potencies were merely stepping-stones to the 3rd or millionth
(I) potency; whilst the 4th and 5th potencies were stepping-stones for the
billionth (II) potency; the 7th and 8th for the trillionth (III), etc. Through the
use of this notation, Hahnemann was conveniently able to refer to his
medicines according to a standardised notation.
Dispensing Small Portions of a Drop
Now, getting back to Hahnemann's dispensing only small portions of a
drop, of a potency, rather than the whole drop itself. The reasons for this can
be appreciated in the following statements:
MMP, II, p.459 under Sarsaparilla (1825)
For homoeopathic use the undiluted tincture in the dose of one drop is
much too strong.
MMP, II, p.439 under Ruta (1825)
A dilution which in every drop contains 1/100,000 of a grain (10 - 5) of
this juice, one drop for a dose-all heterogeneous irritants being kept away – I
have found to be even somewhat too large a dose in many cases.
MMP, I, p.47 under Ambra Grisea (1827)
This furnishes a potentized millionth attenuation of ambergris, a small

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portion of a grain of which is not only sufficient for a dose for most
homoeopathic purposes, but is often to be quite too powerful…
Hence, in order to try and reduce the strength (and minimise on
aggravations), Hahnemann continued to experiment with dosage, by
subdividing the dose and giving only a portion of a drop. This became a
matter of increasing necessity as his prescribing became finely tuned, as
mentioned before, especially when he began considering diseases as more
than just the totality of symptoms at the present, and instead looked at
totality of symptoms in time. On this subdivision of doses Hahnemann says:
Chronic Diseases, I, p.149, Footnote
In the beginning I used to give a small part of a grain of the powders
potentized to the 10000 or the I * degree by trituration, as a dose. But since a
small part of a grain is too indefinite a quantity, and since Homoeopathy
must avoid all indefiniteness and inexactness as much as possible, the
discovery that all medicines may be changed from potentized medicinal
powders into fluids with which a definite number of pellets may be
moistened for a dose, was of great value to me. From liquids the higher
potencies may also be easily prepared.
*These Represent the 2nd and 3rd (Centesimal) Potencies Respectively
We should remember that Hahnemann's ideas on disease in general and
chronic diseases in particular were developing over many years, and
culminated in his initial expressed concepts as early as 1827, publishing his
work on Chronic Diseases the following year. With this kept in mind, we can
read sequentially through his writings in materia medica, and note the
changes in dosage.
For example: MMP, II, p.587 under Stramonium (1825) - the freshly
expressed juice + equal parts of alcohol. A drop, often even but a small
portion of a drop of the trillion-fold dilution of the juice, is an adequate
homoeopathic dose, all other extraneous medicinal influences being
removed.
And in the same year (1825), he was more direct in his findings:
MMP, II, p.674 under Veratrum Album
I have never found it necessary to give a dose of more than a single
drop, often only a small portion of a drop, of white hellebore tincture, diluted
to such an extent that one drop contains a quadrillionth of a grain of this root.

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MMP, I, p.182 under Aurum
By further trituration and dilution the power of gold is still more
developed and spiritualized, so that I now employ for all curative purposes
only a very small portion of a grain of the quadrillion-fold dilution for a dose
MMP, II, p.47 under Ledum
The dose, in cases of disease for which Ledum in homoeopathically
adapted, I have found, by numerous trials and multiplied experience,
requires to be reduced to a small portion of a drop of the quintillion-fold
attenuation of the tincture Notice that, within the same year (1825), he has
recommended various preparations ranging from less than a drop of the
tincture, to a small portion of a drop of the quintillionth (15th centesimal
potency).
The Very Next Year (1826), we Read
MMP, II, p.131 under Menyanthes trifoliata - the freshly expressed juice
+ equal parts of alcohol. The smallest portion of a drop of the undiluted juice
I have found to be an adequate dose for homoeopathic employment in every
case; further experience will perhaps show that a further dilution will suffice
for sensitive persons or children.
MMP, II, p.453 under Sambucus - the freshly expressed juice + equal parts
of alcohol.
For homoeopathic use we require only a small part of a drop of the
above-mentioned juice for a dose in order to effect all that can be done with
it in a curative way.
MMP, II, p.209 under Muriatic Acid
One globule the size of a poppy seed, moistened with this million-fold
dilution, is given for a homoeopathic dose. This represents the smallest
portion of a drop, for with one drop 200 such globules are sufficiently
moistened. Yet this million-fold dilution, although administered in such a
small volume, will be found in many cases to be still too powerful when
muriatic acid is homoeopathically indicated, because this medicine possesses
a high degree of efficacy. MMP, II, p.319 under Phosphoricum acidum
A sugar globule the size of a poppy seed, and moistened with this
trillion-fold dilution, is administered for a homoeopathic dose.
MMP, II, p.480 under Spigelia
For the homoeopathic employment the decillion-fold dilution, each
diluting phial of 100 drops being shaken not oftener than twice, is almost too

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strong, even when but a small portion of a drop of it is given for a dose. And
so, in 1826, Hahnemann is seen to recommend up to, but not exclusively, the
decillion (30th potency) attenuation. And there was not much change by
1827:
MMP, II, p.527 under Stannum …a very small portion of a grain of the
above-described million-fold dilution of tin powder is more than sufficient
for a dose.
MMP, II, p.510 under Spongia
I found a still farther dilution and diminution of the dose necessary-
latterly a very small portion of a drop of the decillion-fold dilution for a dose
but, by 1830 and beyond, every medicine which Hahnemann discusses in his
Materia Medica Pura, was recommended as most serviceable in the
decillion (30th) potency. Some examples include:
MMP, I, p.4 under Aconitum Napellus
…its curative power is marvellous, when…it is given alone, all other
medicinal substances, even vegetable acids, being avoided, in the dose of a
thousandth* part of a drop of the decillion development of power.
* That is, a small globule the size of a poppy-seed moistened with it, of
which more than a thousand are moistened by one drop of spirits of wine,
and which are so small that 300 of them weigh only one grain.
MMP, II, p.146 under Mercurius
One small globule (300 of which weigh one grain), moistened with the
last dilution (X), is the appropriate dose of the very medicinal metal for all
suitable cases.
Similarly, Cannabis, Cantharis, Cina, Dulcamara, Nux vomica, (all
recorded in 1830), were recommended in the 30th potency.
The same is true of the medicines therein recorded in 1833 - Arsenicum,
Bryonia, Ferrum, Ignatia, Pulsatilla, Rheum, Rhus toxicodendron, have all
been recommended in the 30th potency. Examples include:
MMP, II, p.346 under Pulsatilla
The proper dose is a small globule moistened with the thirtieth potency,
repeated at most every twenty-four hours; in acute diseases the olfaction of a
globule the size of a mustard seed is preferable.
MMP, II, p.391 under Rheum
A very minute globule moistened with the thirtieth dilution (X) suffices

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for all homoeopathic curative purposes, to be repeated if necessary. The
olfaction of a globule the size of a mustard seed moistened with this dilution
is almost always sufficient.
MMP, II, p.401 under Rhus Toxicodendron
One single globule, the size of a mustard seed, moistened with the
thirtieth potency effects a magical cure. And so, we see that, as time
progressed, as Hahnemann's prescribing was sharpened with experience and
his ever-increasing study of the phenomenon of disease (and the
consolidation of his ideas on chronic disease), he became more and more
aware of the increased utility of higher potencies, and simultaneously, of the
absolute need for smaller (less troublesome, more manageable) doses. It is
important here to realise, that in the above examples from Hahnemann's own
writings, dose, refers to actual physical amount, whereas potency refers to
the process of attenuation (dynamization, succussion/trituration).
From the preceding, we see that, regardless of the potency used,
Hahnemann recommended a small portion of a drop be used as a dose. This
was soon common-place in Hahnemann's posology, and eventually he would
always use only a small portion of a drop (obtained by saturating globules
the size of which a large number would absorb one drop). In his Materia
Medica Pura, under Arsenicum, we read:
MMP, I, p.119 under Arsenicum (1833)
It is much better to make a quantity of globules so saturated with the
tincture* for dispensing purposes than to moisten one globule every time it is
required.
*The Tincture here refers to the Liquid Decillion Potency
In other words, he would carry around and use only the globules of the
prepared centesimal potencies. Now then, with this in mind, let us
summarise the process of centesimal potency preparations up to this point.
The following diagram shows how globules were simply moistened with the
previously prepared liquid medicinal potency of the medicine. The globules
were then no more than a vehicle for the proper small dose dispensing (of a
portion of a drop) as required by Hahnemann.
It is important to realise that a globule, prepared according to the above
manner, of say the 30th potency, is able to absorb only a small portion of a
drop (depending on globule size) before reaching full saturation with that
potency. From here, it was a simple step for Hahnemann to go to his new
altered but perfected method of potency preparations as detailed in the 6th
edition of his Organon.

Page | 70
 Simply put, what Hahnemann did was to incorporate the impregnated
globules within the actual preparation process, as an integral part of
preparing the higher from the lower potencies, rather than as an adjacent
step. By studying, we notice that this results in a two-stage globule → drop
dilution process at each potency step, as opposed to the single-stage process
in the earlier method. Indeed, if we remove the second (globule) stage of the
dilution phase, the remainder of this process resembles that of the centesimal
scale potencies, even as far as the 1/100 dilution factor, the main remaining
difference being that the number of succussions here is 100, whilst that of
the centesimal potencies was finally set at 10 by Hahnemann (1837, Chronic
Diseases, vol.1., p.159).
When we carefully compare the earlier manufacture of potencies
(1:100) with the latter method (1:50,000) adopted by Hahnemann, it is quite
clear there was no quantal leap in the development of Hahnemann's
posology. Rather, one gradually flows into the other, without any
disconnection or sudden change in step. One vital point to remember is that
the final dilution ratio is not precisely 1:50,000, since the globule size is
never exactly uniform.
This means that these potencies are not accurately termed 50-
Millesimal. Indeed, Hahnemann did not call them 50-Millesimal potencies at
all, rather, he acknowledged that the distinction came in the method of
manufacture incorporating the globule as an integral component of the
process. He thus called this the method of the globule, as opposed to the
earlier method of the drop.
The question therefore arises as to what we should call these potencies.
Certainly the term LM is unacceptable (for the reason given above). But
since we know that the ratio is not exact, then any name based on a ratio of
dilution (e.g. 50-Millesimal) is also misleading. The written designation for
these potencies is much easier. Hahnemann used a small "0" to indicate the
new globule method, with the potencies written as 0/1, 0/2, 0/3, etc., up to
0/30. But what shall we call them verbally and in written communications, in
overview? We could term them 'O' (representing the globule) potencies, but
this is not ideal. Perhaps 'G' for potencies au globule is another idea.
However, I think that 'Q' for 50 thousandth - my thanks to Dr. K-H Gypser
for the correct Latin, as used in European countries, is a good compromise.
References
1. Herbert a Roberts. The Princples and Art of Cure by Homoeopathy, B.
Jain Publishers Pvt ltd, new Delhi, 1936, 113-123.

Page | 71
2. Dudgeon RE. Lectures on the Theory and Practice of Homoeopathy, B.
Jain Publishers, 34.
3. Dhawale ML. Principles and Practice of Homoeopathy, Part-1, 5th
Reprint, 2008, 77.
4. Bhattacharyya SK. ‘Posology of Homoeopathic Medicine’, B. Jain
publisher Pvt. Ltd, New Delhi, 2007.
5. Dudgeon R.E. Organon of Medicine; 5th and 6th Edition, B. Jain
Publishers, New Delhi, 1997.

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 Chapter - 4
Advancement in Treatment of Nutritional
Deficiency Disorder in Ayurveda

Author
Dr. Niraj Srivastava
Associate Professor, Department of Kaumarbhritya/Balroga,
Government Ayurvedic P.G College & Hospital, Varanasi,
Sampurnanand Sanskrit University, Varanasi, Uttar Pradesh,
India

Page | 73
Page | 74
 Chapter - 4
Advancement in Treatment of Nutritional Deficiency
Disorder in Ayurveda
Dr. Niraj Srivastava

Abstract
Malnutrition is a major problem in India. This problem is mainly related
with routine intake of nutritional supplements through food. Ayurveda
suggest balance intake of Ahara to fulfill the various nutritional requirements
of body (like protein and carbohydrates) which are essential for proper
growth & development of children in early age. Nutritional deficiency
disorders are viewed under Apatarpanajanya vyadhis in Ayurveda. Based on
severity and etiology they may be considered as Karshya, Phakka roga,
Parigarbhika and Balashosha. In modern medicine, protein–energy
malnutrition (PEM), Vitamin A deficiency (VAD), Rickets and Scurvy is
main nutritional deficiency disorder in children. There are many herbs
described in traditional ayurvedic text as nutritional herbs to boost the
nutritional deficiency. Counseling regarding nutritional diet & its proper
intake is a primary line of treatment of malnutrition.
Keywords: Phakka roga, parigarbhika, balashosha, PEM, herbal drugs
Introduction
Nutrition is major concern of the mankind. Abnormal nutrition causes
over or under nutrition hazards and nutrition deficiency disorder is one of
them. Nutrition deficiency is such a condition where children fail to maintain
natural body capacities such as growth, resisting power to infections as well
as recovering from disease, learning and physical activities. As per WHO
poor feeding of infants and young children resulting in under nutrition is;
“The single most important risk factor for diseases”. It has a role in more
than half of the nearly 11 million deaths in each year among children under
five [1]. Nutrition is an important part for the survival, growth and
development of children. It also reduces infant mortality and helps to
construct a healthy society. Vagbhata highlights the importance of nutrition.
Nutritional deficiency disorders are viewed under Apatarpanajanya

Page | 75
vyadhis in Ayurveda. Based on severity and etiology they may be considered
as Karshya, Phakka roga, Parigarbhika and Balashosha. In modern medicine,
protein-energy malnutrition (PEM), Vitamin A deficiency (VAD), Rickets
and Scurvy is main nutritional deficiency disorder in children. Recently
World Health Organization (W.H.O) attentions towards the malnutrition
disorder in children because they may have some severe consequences like;
mental and physical growth retardation, weight loss and retardation of tissue
growth. Kashyap says Ahara as Maha bhaishajya and good quality of food
lead to growth in physical activity, increase in mental faculty like
discrimination power, intelligence, enthusiasm and strength. It also increases
voice quality and complexion in children. In Ayurveda many herbs are
available which is used in prevention and treatment of nutritional deficiency
disorder in children.
Nutritional Deficiency Disorder (Kuposhan Janya Rog) in Ayurveda
Childhood is the period where maximum growth and development will
be achieved. In Ayurveda Vagbhata highlights the importance of nutrition.
According to Vagbhata [2] food should be taken as per rule and irregular food
habits, irregular timing, incompatible combinations of food, qualitatively
poor food consumption lead to death of person. Certain nutritional disorder
of childhood is explained in Ayurveda.
Karshya-(Emaciation)
Karshya is a condition which involves insufficient supply of nutrient in
any stage of ages. Growing children are most vulnerable to its consequences.
The nutritional requirements of growing children are more since their energy
requirements is high due to the fast growth in early age. This disease is
described by Charaka samhita [3], Sushruta samhita [4] and Yoga Ratnakar
(BAL roga chikitsa).
Etiology of Karshya
If a child is given more of dry food items to eat, or less quantity of food,
or unbalanced food, or goes without food and therefore is hungry for long
periods of time every day, cries a lot, has dry body surface (due to lack of oil
massage) then the child will suffer from Karshya (emaciated body).
Clinical Features of Karshya
 Dried buttocks, abdomen and neck.
 Prominent vascular network on body.
 Thick body joints.
 Only remnant of skin and bone on body.

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 Treatment: Treatment in Karshya can be completed in 2 steps:
1) Nidan Parivarjana
2) Brimhana Chikitsa [5]
Nidan 1. Avoid Vata vardhaka ahara and vihara.
Parivarjana 2. Counseling of peoples of area where the chances and incidents of
malnutrition are common.
3. Treat the diseases which can cause Karshya in children.
Brimhana Brimhana Chikitsa is anabolic treatment by using more nutritional
Chikitsa supplements) as-
1. The drug possessing heavy, cold, soft, unctuous, solid, gross, slimy,
dull, stable and smooth properties is mostly brimhana in property. It
promotes the bulk of the body.
2. Ashwagandha Ghrita: This is prepared by cow ghrita +
ashwagandha kalka + com milk. This preparation increase strength
of body.
3. Suvarna yoga
4. Vidarikand churna
5. Lakshadi Taila: Laksha is an exudation product from lac insect. Oil
from Laksha is used for massage all over the body. Ingredient of
this product is Laksha kwath + Tila taila + Rasna, rakta chandan,
Haridra, Daru haridra and Satpuspha etc.

Phakka Roga
This disease is described by only Acharya Kashyap [6] and it is a special
contribution of Kashyapa Samhita. Basically Phakka roga is not a disease but
it’s a symptom which is present in many diseases. It is also an observation of
milestone especially the period of walking. The word Phakka denotes
sluggish movement due to poor physical development associated with
psychomotor changes.
In Kashyap samhita it is clearly mention that child should be able to
walk at the age of one year. If child is not able to walk or delayed in walk
that condition is abnormal and known as Phakka roga.
“Phakkati Neechairgacchati iti Phakka”
Phakka roga is clinical manifestation with continuous deterioration of
growth, associated with delayed motor and developmental milestone. Phakka
roga manifested as running down condition of health in a baby.
vukFk% fDy’;rs cky% {kh.kekalcy|qfr% A
fuúks"Vk/kjdk;ks ok ikf.ktkuqxeks·fi ok AA
Clinical Feature: Phakka roga shows two most important clinical features-
1) Continuous deterioration of health
2) Delayed milestone

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 Type of Phakka Roga: Kashyapa Samhita has described 3 types of
disorders due to nutritional deficiency. Phakka is the term used to describe
weakness in movement due to nutritional deficiency in children-
1) Kshiraja phakka
2) Garbhaja phakka
3) Vyadhija phakka.
Kshiraja Phakka
/kk=h 'ySf"ednqX/kk rq QDdnqX/ksfr lafKrk A
rR{khjiks cgqO;kf/k% dk’;kZr~ QDdRoekIuq;kr~ AA
If child consumes breast milk which is vitiated with kapha dosha, that
milk is bad for the child. That milk causes multiple diseases, due to which
the body becomes emaciated and that condition is called ‘Kshiraja Phakka’.
Explanation: Stanya vitiated with Kapha Dosha is called Phakka-
dugdha. This Phakka-dugdha causes obstruction in rasa vahastrotasa and
cause nutritional deficiency in a child resulting in to Kshiraja Phakkaroga.
Garbhaja Phakka
xfHkZ.khekr`d% f{kiz LrU;L; fofuorZukr~ A
{kh;rs fez;rs ok·fi l QDdks xHkZihfMr% AA
If the mother of the child becomes pregnant again while the first was
still on breast milk, the body automatically prioritizes and the nutrition will
go first to the new fetus for its proper growth and maturation in the uterus.
Due to early cessation of breast milk in the mother the breastfed older child
suffers nutritional deprivation and the disease that occurs as a result is called
‘Garbhaja phakka’. Parigarbhika may be considered as early stage of
garbhaja phakka.
Explanation: The milk fed by mother is primary source of nourishment.
Mother's milk if deficient in quantity and quality is responsible for impaired
and delayed growth of child's physical and mental faculties.
Vyadhija Phakka
futSjkxUrqfHkúkSo----------------jks TojkfnfHk% A
vukFk% fDy’;rs cky% {kh.kekalcy|qfr% AA
l’kq"dfLQpckgw#eZgksnjf’kjkseq[k% A
ihrk{kks âf"krk¯úk n`’;ekukfLFki°kj% AA
izEykuk/kjdk;úk fuR;ew=iqjh"kd`r~ A

Page | 78
 fuúks"Vk/kjdk;ks ok ikf.ktkuqxeks·fi ok AA
nkScZY;kUeUnps"Vúk eUnRokr~ ifjHkwrd% A
ef{kdkd`fedhVkuka xE;úkklUue`R;q#d~ AA
fo’kh.kZâ"Vjksek p LrC/kjksek egku[k% A
nqxZU/kh efyu% Øks/kh QDd% ðkflfr rkE;fr AA
vfrfo.ew=nwf"kdkf’k«k.kdeyksöo% A
bR;srS% dkj.kSfoZ|k}îkkf/ktka QDdrka f’k’kks% A
The child suffers from nutritional deficit due to endogenous and
exogenous causes such as long-term fever. The child’s strength and luster
decreases. The child has emaciated hips and arms, protuberant abdomen, dry
head with facial muscle wasting, yellowish eyes, horripilation (this is a
condition where the child feels cold all over the body and the body hair
bristles (goose bumps occur) for a short period of time). This term used in
Ayurvedic text as romaharsha (bristling of the hairs of the body) occurs;
child appears just like a skeleton, lower extremities become weak and
emaciated, and the child passes more faces and urine. Due to weakness he
crawls with hands and knees. Flies, insects, worms are attracted and come to
him due to less activity and death results ultimately.
Explanation: In some diseases if proper care and treatment is not
provided it leads to emaciation with improper formation of
metabolites/dhatus (Rasa, mamsa, meda and asthi dhatu). This leads to
severe malnourishment associated with weak limbs as well as mobilization
of subcutaneous fat from gluteal region, chest and extremities with increase
in frequency of stool and urine, irritability, untrimmed nails and uncleanness
of skin. This condition of child known as Vyadhija Phakka. Neonatal insult
exposure like chronic diseases i.e., recurrent gastrointestinal and respiratory
infection, worm infestation, bleeding disorder, endocrine and metabolic
disease decelerates the process of growth and overall wellbeing of a child. It
can be correlated with protein energy malnutrition, marasmus, rickets, or
chronic malabsorption conditions. Most of the characters are correlating with
marasmic child.
Kshiraja and Garbhaja Phakka can be classified as acute malnutrition,
while Vyadhija Phakka is a state chronic malnutrition with general debility.
Management
Balyavastha is the more prone period for Kapha dosha. Due to this
reason children are more prone to Kaphaj vikara. There are references for the

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treatment of Phakkaroga available in Phakka chikitsa adhyaya in Kashyap
Samhita. They are based on mainly three steps-
1. Shodhana chikitsa
2. Shaman chikitsa
3. Physiotherapy
Shodhana Chikitsa  There is vitiation of Rasa dhatu and weakness of Agni in
patients of Phakka roga so treatment should be Deepan and
Pachana.
 Snehan should start with Kalyan ghrita, Satapala ghrita and
Amrita ghrita or Brahmi followed by Shodhan treatment after
7 days with Trivrut Kshira.
 Acharya Kashyap also described the role of Gomutra (urine of
cow) along with kshira in condition of increased Kapha level.
Shaman Chikitsa/  Balya chikitsa should be advised by Mamsa yusha, Payas and
Balya Chikitsa sali anna.
 Milk medicated with Rasna, Madhuka, Punarnava, Eranda,
Satapuspa, Draksha, Pilu and Trivrit should be given.
 Ghrita, vegetable soup, meat soup, milk with Rasna and honey
should be given.
 Raja taila should be advised for body massage daily. Main
ingredient of Raja tail is Eranda, Anshumati, Bilva, Yava,
Kola and Kulatha.
Abhyanga  For Abhyanga Raj Taila is use and this is especially for Raj
putra.
Physiotherapy  Child should be encouraged to walk by pushing a small three-
wheeled wooden frame Tricycle (Phakka ratha) for practice of
walking.

Balashosha
This disease is explained by Vagbhata [7]. As the name indicates there
will be Sosha i.e. emaciation of body due to depletion of subcutaneous fat
and tissues. Pathology of development of Bala shosha is almost similar to
protein energy malnutrition.
vR;g%LoIu’khrkEcq’ySf"edLrU;lsfou% A
f’k’kks% dQsu òksr%lq jlokfg"kq AA
vjkspd% izfr’;k;ks Toj% dklúk tk;rs A
dqekj% 'kq";fr rr% fLuX/k’kqDyeq[ks{k.k% AA (A.S.U 2/46 and A.H.U 2/44)
Etiology of BAL Sosha
The causes of BAL Shoshan are Shlaishmika anna sevana (Excessive
energy dense food), Shivambu (cold liquid terms) and Diva swapna
(excessive day sleep), these factor can create impairment of Agni.

Page | 80
Pathology of BAL Sosha
By above causative factors Kapha will abnormally increase in the body
and after that Agnimantha and Ama formation which further block the
Rasavaha Srotas. This disease explain sequel of protein energy malnutrition.
Symptoms of Bala Shosha
S. No Symptoms of Bala Shosha Modern Correlation
1. Arochaka Reduced digestive capacity
2. Pratishyaya Running nose
3. Jwara Fever
4. Kasa Cough
5. Shosha Emaciation- running down condition of body
6. Shuklatwa Severe pallor
7. Snigdha shukla mukh akshi Edema develop over face

Treatment of BAL Sosha: Treatment of BAL sosha is done on mainly

three steps-
Sroto-  Mainly Ghrita are uses for Sroto-Shodhan.
Shodhan  Shalparni, Pippali, Bharangi and Prishniparni are taken in prastha
pramana and then mix with ½ prastha of Ghrita. This Ghrita cause
Sroto shodhana.
Increase Agni  For increase Agni, Ashika, Rohini mixed with Panchakola churna.
 Badari, Dhataki, Amalaki mixed with Madhu- Ghrita are taken
orally for increase Agni.
Ati Pustikara  Madhu-Yasthi sadhita ghrita
Yoga  A decoction prepared with Madhulika, pippali, Devadaru and
Ashwagandha with Ghrita.
 A taila prepared for massage by Vacha, Balamoola and Madhu.
 Ati pusti Kara kwath is prepared by mixing goat urine with Vacha,
Vayasya, Tagara, Kayastha and Choraka powder.
 Vidarikand churna
 Ashwagandha ghrita
 Satpala Ghrita
 Kumar Kalyana Ghrita
 Sishu sosha nashak ghrita
 Lakshadi taila is uses and its main ingredient is Laksha rasa1 part,
Taila 1 part and Mastu 4 parts etc.

Parigarbhika Roga
This disease is described in Astanga sangraha [7] and Madhav nidan.
This is special nutritional disorder explained in Ayurveda, which highlights
the development of malnutrition during infancy period.
This disease is also called as Paribhava, Parigarbhika, A Hindi and

Page | 81
Dugdha katta. Parigarbhika is nearly equivalent to the description of
‘Garbhaja Phakka’. Kashyap has not mention the disease by name
Parigarbhika but, while explaining Jataharini mentions that a women
becomes pregnant again while the first child breast feeding then the prior
child will definitely die. That Jataahrini is Shuska revati.
A similar disease has been explained by Cicely Williams in 1932, which
is most commonly found in African countries especially in “Ghana”. That
disease was named as “Kwashiorkor” and meaning of this word is-
Kwashio = First child
Orkor = Second in progress
So meaning of Kwashiorkor is second child in uterus when first child is
still breast feeding.
dk;kfXulknoeFkqrUnzkdk’;kZ#fpHkzeS% AA
;qT;rs dks"Bo`)îkk p rekgq% ikfjxfHkZde~ A
jksxa ifjHkok[;a p ;qaT;kÙk=kfXunhiue~ AA
Etiology: If mother became pregnant quickly after the 1st delivery.
Their milk lacks nutrients values besides quantitative reduction and child
who depends on such milk remain weak during its Ksheerada Avastha.
Clinical Features: Affected child suffers from-
Agnisada Loss of appetite or Aversion to take food
Aruchi Tastelessness or disgust for food
Karshya Emaciation
Kasa Cough
Vamatu Nausea
Tandra Drowsiness
Brahma Vertigo
Kostha Vriddhi Abdomen becomes distended

Treatment: In this disorder, the functions of ‘Agni’ are diminished;

therefore the main object of therapy should be to keep the Agni in normal
state and treatment of associated complication. Agni deepana is the main
stay of treatment.
If associated with Cough It should be treated by providing Ghrita medicated with
Pippali, Pippali Mula, Kutaki, Devadaru and Chitraka.
If Associated with Hunger Goat milk medicated with Vibhitaka, Kakoli and
Madhuyashti.
For Agni deepana  Ghrita medicated with Bala, Vidari, Trikatu and

Page | 82
 Khasa is effective in treating parigarbhika.
 Recommends appetizer drugs in the above condition
like Pippali, Pippali Mula (i.e. fruit and nodal roots of
pippali), katuki, Devadaru, Palasha Kshara and vajra
kshara, vid salt (black salt), Jeeraka, unripened Bilva
fruit and Chitrak. Boil those kalkas with curd and
prepare kanji; afterwards boil with cow’s ghee in ghar
tapaka methods [8].
Different Bath Various types of bath are advocated for Parigarbhika
roga-
 Water medicated with Kshiri Vriksha.
Diet  Fried Churna of Vidarikand, Yava, Godhuma and
Pippali should be given with Ghee as diet [9].
 Luke-warm milk with honey and sugar as per
requirement.

Shuska Revati
Shushka revati one of Graha (Demon) affecting the child represents
infectious spectrum of diseases resulting Sarvanga kashaya (Emaciation). In
this child though fed with enough quantity of high quality food ends up in
malnutrition. Child shows progressive emaciation at the outset the clinical
condition which can be correlated with abdominal tuberculosis. When it
becomes chronic child presents following features [10].
Features Modern Correlation
Anna dwesha Aversion to food
Vivarnata Loss of lustre
Nanavidha shakrita Variegated colour stools
Udara granthi Abdominal nodular swellings
Jihvayanimnata Geographic tongue

Nutritional Deficiency Disorder in Modern Medical Sciences

Nutrition is directly related with growth and development. Childhood is
the period where maximum growth and development will be achieved. Food
of child should contain all essential components like protein, fat,
carbohydrate, minerals, vitamin and water.
Essential Component Function
Protein For building of body tissue
Carbohydrate Energy source
Fat Source of energy and Storage
Mineral/Vitamin Catalyst in metabolic activities
Water Provide liquid media.

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 In modern medicine, protein-energy malnutrition (PEM), Vitamin A
deficiency (VAD), Iron Deficiency and Vitamin B complex Deficiency is
main nutritional deficiency disorder in children.
PEM (Protein Energy Malnutrition)
Protein-energy malnutrition (PEM) or protein–calorie malnutrition
refers to a form of malnutrition where there is inadequate calorie or protein
intake. Malnutrition is a range of conditions occurring when intake of one or
more nutrients doesn’t meet the requirements. PEM is an important
nutritional problem among preschool age children. The main cause of PEM
is food inadequacy and it is not only the deficiency of proteins but
inappropriate food (low in energy density, protein and micronutrients ‐
Vitamin A, Iron, Zinc).
Classification of PEM
Various classifications are given
 IAP classification
 WHO classification
 Gomez classification
 Welcomes classification
 Arnold classification
IAP Classification (1972): Based on Weight for age.
Stage of Malnutrition Weight for Age (%)
Normal > 80%
Grade I 71-80%
Mild Grade II 61-70%
Moderate Grade III 51‐60%
Severe Grade IV < 50%

WHO Classification
Features Moderate Under Nutrition Severe Under Nutrition
Generalized edema No Yes
Weight for height Wasting (70-79%) Severe wasting <70% of
(Wasting measurement) expected.
Height for age (Stunting) Stunting (85-89%) of Severe stunting <85% of
expected expected.

Gomez Classification: Based on Weight for age and Boston standard

used in this classification is no longer an international reference data.

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 Stage of Malnutrition Weight for Age (%)
Normal > 90%
Grade I 75-90%
Grade II 60-75%
Grade III <60%

Arnold Classification: It is based on mid arm circumference (MAC)

does not vary much between age of 1-5 years.
Satisfactory nutritional status MAC > 13. 5 cm
Mild to moderate MAC Between 12.5 to 13.5 cm
Severe MAC <12.5 cm

Kanawati Index = mid arm circumferences (MAC) in cm/Head

Circumferences in cm
Normal Value = 0.32 to 0.33cm
PEM = When value is <0.25 cm
Type of PEM: It is mainly three types
 Marasmus-Deficiency of calories
 Kwashiorkor-Deficiency of protein
 Marasmic-Kwashiorkor-Deficiency of both calories and protein
Marasmus: It is type of PEM due to deficiency of mainly calories
(energy) through protein deficiency also exists.
Word- “marasmus” comes from Greek origin of word “to waste”
Age-below 3 years of age but peak during first year of age.
Clinical Features
a) Essential Features
1) Growth Retardation: Weight below 60% of expiated and
subnormal height
2) Loss of Subcutaneous Fat: Loss of fat
3) No edema
b) Other Features
1) Emaciated child, loose fold of skin over gluteal and inner side of
thigh.
2) Dry, scaly and inelastic skin

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 3) Hair are hypo pigmented
4) Abdomen distended due to wasting and hypotonia.
5) Mid arm circumference-reduced
6) Bony point prominent
7) Baby is alert but irritable
8) Appetite-Voracious
Kwashiorkor
Cecilly Williams had introduced the word Kwashiorkor to the medical
literature in 1932. Kwashiorkor can occur in infancy but its maximal
incidence is in the 2nd years of life following abrupt weaning. Kwashiorkor
is not only dietary in origin but Infective, psycho-social, and cultural factors
are also considered.
A. Essential Features
1) Growth Retardation: Evidence by low weight and low height.
2) Muscle Wasting: with retention of subcutaneous fat
3) Psychomotor Change: As evidence by mental apathy, listless with
no interested in the surrounding.
a) Other Features
1) Hair Changes: Hair is sparse, light colored, thin and easily
pluckable.
2) Flag Sign: Alternate band of light and dark colored hair signifying
period of inadequate and adequate nutrition over a prolonged
period.
3) Skin Changes: Erythema, hyper pigmented area, Flaky paint
dermatosis and crazy pavement dermatosis.
4) Infection: Diarrhea, Vomiting, Anorexia, Tuberculosis, Pyoderma
and Bronchopneumonia.
5) Hepatomegaly
6) Vitamin Deficiency: Vitamin A deficiency is frequent and may
lead to night blindness, Xerosis and Keratomalacia. Vitamin B
complex, Vitamin C and Vitamin D deficiency.
7) Worm infestation and Clubbing due to steatorrhea.

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Difference between Marasmus and Kwashiorkor
Marasmus Kwashiorkor
Obvious muscle wasting Hidden edema may mask weight loss
Severe loss of subcutaneous fat Some loss of fat
Severe malnutrition Edema over legs, arm and face
Mental changes present, quite apathetic Irritable, apathetic and Moaning
No skin change Flaky paint dermatosis
Less hair changes sparse, silky and easily pluckable
No organomegaly Hepatomegaly and low albumin
Good appetite Poor appetite

Management of Acute Complications

Mortality rates can vary from less than 5% to more than 50% of
children, depending on the quality of care.
1) Infectious Complications: Every hospitalized child with marasmus
should be considered as having a bacterial infection. Treatment of
bacterial infections prevents the development of septic shock,
improves the response to nutritional rehabilitation, and decreases
mortality if the child presents with clinical signs of infection then
broad spectrum antibiotics are uses. Antimalarial treatment is also
indicated in endemic areas, either orally or by injection.
2) Severe and Symptomatic Anemia: Blood transfusion of packed
red cells to a maximum of 10 mL/kg administered over at least 3
hours. Cardiovascular tolerance should be closely monitored. The
benefit of blood transfusion must be balanced with the risks of
cardiovascular failure and the risk of infection (e.g., hepatitis, HIV)
associated with blood.
3) Persistent and Profuse Diarrhea: 2 main causes is.
 Infectious Etiology: This can be promptly treated with
metronidazole and antibiotics.
 Osmotic Diarrhea: Sugar of the F75 solution should be
replaced by cereal flour for 1-2 weeks.
1) Vitamin A deficiency is always present and should be treated in the
first few days. Vitamin A replacement facilitates recovery from
diarrhea, measles, and respiratory diseases and decreases the risk of
blindness.
2) Lactose intolerance is unusual and often secondary to prolonged

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 diarrhea. Lactose intolerance is possible, especially if stools have a
low pH and if the child presents with a perianal skin inflammation
(diaper rash). In case of lactose intolerance, milk should be
withheld and yogurt or a commercially available lactose-free
formula can be used.
1) Supplementation of Minerals
Name of Minerals Doe of Minerals
Calcium 800 -1000 mg/kg
Phosphorus 600 -800 mg/kg
Iron 3-6 mg/kg/day for three month
Zinc 20mg/day
Copper 0.1 mg/kg/day
Selenium 6-10 mg/kg/day
Magnesium sulphate 0.3 ml/kg/day (50% Solution)

Vitamin A Deficiency (VAD)

Vitamin A deficiency (VAD) is a lack of vitamin A in children. It is
common in poorer countries but rarely seen in more developed countries and
its main features is-
 Nyctalopia (night blindness) is one of the first signs of VAD.
 Xerophthalmia
 Keratomalacia
 Complete blindness
Vitamin A has a major role in photo transduction.
Treatment
1. WHO Treatment of Xerophthalmia
Oral Vitamin A- First dose For < 6 months = 50,000 Units -
For 6 months – 1 year = 1 lac Units
For >1 year = 2 lac Units
Second dose Repeat on 2nd day
Third dose After 1 month
Parenteral Vitamin A can be given for night blindness or Bitot spots-10,000 IU daily
for 14 days.

2. Prophylaxis: National Vitamin A prophylaxis schedule is 6 months to 3

years-2 lac IU units in oil base every 6 months (1 lac/1 ml).

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Rickets
Definition
It is a disease caused by deficiency of vitamin D leading to failure of
mineralization of growing bone or osteoid tissue. Osteomalacia is present
when there is inadequate mineralization of bone osteoid and occurs in
children and adults.
Risk Factors: There are a few factors that greatly increase the risk of
rickets, including:
 Poverty: Rickets is more likely to occur among children who are
poor because access to adequate nutrition may be limited.
 Poor Exposure to Sunlight: Children who do not get enough
sunlight are more dependent on good nutrition to make sure they are
getting enough vitamin D.
 Malnutrition: Rickets is more common in areas of the world where
severe droughts and starvation occur.
Etiology
 Inadequate intake of vitamin D.
 In breast fed infant if infant is not exposed to sunlight or mother is
not exposed to sunlight.
 Interference with absorption of vitamin D in steatorrhoea.
 Chronic hepatic disease and chronic renal disease.
Clinical Features
1) Common age of rickets is 6 months to 2 years of age.
2) Early Features: Irritability restlessness, profuse sweating overhead
more during night.
3) Major Features
 Head: Bossing, macrocephaly with flattening of vertex (box
head).
 Fontanel: Increased size, and delayed closure.
 Craniotabes: Softening of occipital and parietal bones (ping
pong ball feeling under pressure).
 Teeth: Delayed dentition.
 Thorax: Rachitic rosary (smooth, rounded, nontender
costochondral beading) and Pigeon-chest deformity.

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  Harrison sulcus or groove (Depression along insertion of
diaphragm into ribs.
 Flaring of lower ribs (violin shapes).
 Concavity at inferior angle of scapula.
 Spine: Scoliosis, kyphosis.
 Limbs: Widening of wrist and ankle, Knock knees (Genu
valgum) and Bow legs (Genu varum).
 Bow legs in toddler not in infants.
 Milestones: Delayed due to poor muscle tone and lax ligament.
 Constipation, Generalized hypotonia and recurrent respiratory
infection.
Diagnosis
1) Biochemical Findings
a) Increase alkaline phosphatase due to osteoblastic activity
b) Serum calcium-normal
c) Serum phosphorus-decreased
d) Decreased serum 25-hydroxy vitamin D reliable index.
2) X-Ray Finding (Wrist)
a) Cupping lower end of radius and ulna
b) Widening (Flaring, champagne glass)
Treatment
1. Dose of Vitamin D
a) Single Dose: 6 lacs (15000 μgm of vitamin D) units IM stat dose.
Repeat after 4 weeks. If no improvement suspect refractory rickets.
b) Daily Doses: 50-150 μgm daily of vitamin D for 2-4 weeks.
Radiological healing within 2-4 weeks.
2. Supplement Calcium: Calcium carbonate and citrate are the most
common forms of calcium supplements. Calcium carbonate, the
most effective form should be taken with a meal to ensure optimal
absorption. Maximal dose of elemental calcium that should be taken
at a time is 500 mg.
Scurvy
Definition: Disease caused by deficiency of vitamin C (ascorbic acid).

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Clinical Features
 Age: Any age but unusual in newborn period because it require
time to develop.
 Usual age is 6-24 months.
 Vague Symptoms: Irritability, tachypnea, digestive disturbances
and loss of appetite.
 Generalized Tenderness: Particularly when infant is picked up or
when diaper is changed. Pain result in pseudo paralysis.
 Legs are held in frog like position.
 Edematous swelling over shaft of legs.
 Sub periosteal haemorrhage can be felt at the end of femur.
 Apprehensive facial expression.
 Gums: Bluish, purple, spongy swelling of mucus membrane esp.
over upper incisors.
 Scorbutic Rosary: At costochondral junction. Scorbutic rosary
have sharp borders due to subluxation of sternum.
 Bleeding Tendencies: Petechial hemorrhage over skin, mucous
membrane and gums. Hematuria, malena, orbital and subdural
hemorrhage.
 Low grade fever.
 Wound healing-slow.
 Swollen joints.
Diagnosis
a) On the basis of clinical picture.
b) History of poor vitamin C intake.
c) Radiological Changes
 Site-distal end of long bone especially knee.
 Ground glass appearance of bone.
 White line of frenkel-irregular thick white line at metaphysis
represent zone of well calcified cartilage.
 Epiphyseal center of ossification have ground glass appearance
and surrounded by white ring.

Page | 91
  Zone of rarefaction-under white line at metaphysis is necessary
for diagnosis.
d) Plasma concentration of vitamin C:
Treatment
A. Vitamin C Tab. 250 mg daily for 10 days: (Ascorbic acid-100-
300 mg/day).
B. Diet Sources: Citrus fruits and vegetables including tomatoes
cabbage, green leafy vegetables, germinating pulses, lemon, Amla
and Guava.
Advancement in Treatment of Nutritional Deficiency Disorder in
Ayurveda
1. Absorption and Digestion of Food
Absorption and digestion of food items mainly depend on liver function
and in some case of malnutrition liver functions reduced, so in such
condition liver function boosting medicine play a major role for increase
appetite and absorption some examples of liver boosting herbs such as: -
 Cichorium Intybus: Traditionally used for hepatic conditions and
liver rejuvenation.
 Boerhavia Diffusa: For hepatic disorders and for poor digestions of
food.
 Picrorhiza Kurroa: Traditionally in Ayurveda for centuries as a
general liver tonic.
 Phyllanthus Niruri: The fresh root is traditionally given in
jaundice and a liver for rejuvenating from.
2. Immunotherapy
Malnourished children more prone to infection due to poor immune
function, most common site of infection are the skin, the alimentary tract, the
respiratory tract and the urinary tract. Hence in such condition
immunotherapy play a major role for protect the child from serious infection.
 Lehana Karma: The lehana karma a play major role in enhance
immune function of malnourished child due to its properties of
enhances growth & development.
 Swarna Prashana: It has ancient technique to modulate the
immunity and improve quality of life. One pharmacology-clinical
study, done on the Madhu Ghrita-Swarna-Vacha combination

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 showed a significant effect of humoral antibody formation and it
acted on immunological system, which raise serum IgG level.
 Macrophage activation property given by Tinospora cordifolia.
 Some Indian herbs use in malnutrition such as Asparagus
racemosus, Tinospora cordifolia, Withania somnifera and
Picrorhiza kurrooa.
 Immune is also boast by Withania somnifera, Tinospora cordifolia
and Asparagus racemosus [11].
3. Nutritional Supplements

 Nutritional intervention with Moringa oleifera leaf powder showed

significant weight gain among children with grade I and grade II
protein energy malnutrition. The Moringa leaf powder can be
effectively utilized for treatment of PEM by spreading the
awareness about the nutritional value of Moringa oleifera to
mothers of children with PEM [12].

 Seeds of lotus (Nelumbo nucifera) are rich in protein as well as

minerals. Rhizomes consist of 1.7% protein, 0.1% fat, 9.7%
carbohydrate, seeds possess saponins, phenolics and carbohydrates
in appreciable quantities also contains protein, carbohydrate, 2.7%
energy 348.45 calorie/100 g, chromium (0.0042%), sodium (1%),
potassium (28.5%), calcium (22.1%), magnesium (9.2%), copper
(0.0463%), zinc, etc. Thus in the malnutrition lotus rhizomes and
seeds can be used as remedy constituents to supply deficient
nutrient especially protein [13].

 Vidarikanda (Pueraria tuberosa) plant contains carbohydrates fibres

28.4% and crude proteins 10.9%. It poses Brimhaniya, Balya,
Rasayana, Jivaniya, Vatahara Karma and hence commonly used in
Daurbalya, Kshaya and Shosha [14].
References
1. Gangnolati M, Meera S, Das Gupta M. India’s undernourished children:
A call for reform and action. World Bank, 2005, 7.
2. Vagbhata Astanga Hriday, English translation by Srikantha Murty KR,
Uttar Tantra, Chaukhambha, Krishnadas Academy Varanasi. 2015;
III(8):33-34.
3. Agnivesha Charaka samhita, English translation by Sharma RK, Dash

Page | 93
 B. Sutra sthana, Chaukhambha Sanskrit series office, Varanasi. 2010;
1(21):15-17.
4. Sushruta. Sushruta samhita, English translation by Sharma PV, Sutra
sthana, Chaukhambha Visva Bharati, Varanasi. 2005; I:15-33.
5. Agnivesha Charaka samhita, English translation by Sharma RK, Dash
B. Sutra sthana, Chaukhambha Sanskrit series office, Varanasi. 2010;
1:21-16.
6. Tewari PV. Kasyapa samhita (Chikitsa sthana). Edition Varanasi.
Chaukhambha Bharati Academy, 1996.
7. Vagbhata. Astanga samgraha, English translation by Srikantha Murty
KR, Uttar tantra, Chaukhambha Orientalia, Varanasi. 2001; III: (2-64.
8. Vagbhata. Astanga samgraha, English translation by Srikantha Murty
KR, Uttar tantra, Chaukhambha Orientalia, Varanasi. 2001; III:2-65.
9. Vagbhata. Astanga samgraha, English translation by Srikantha Murty
KR, Uttar tantra, Chaukhambha Orientalia, Varanasi. 2001; III:2-67.
10. Vagbhat. Ashtanga sangraha Shashilekha Sanskrit commentary by Indu,
Edited by Sharma Shiva prashada. 1st ed. Varanasi. Chaukhambha
sanskrita series, 2006, 651.
11. Meena MK. Review on etiology and management of karshya
(malnutrition) in children. Int. J Res. Ayurveda Pharm. 2017; 8(2):56-
60.
12. Srikanth VS, Mangala S, Subrahmanyam G. Improvement of Protein
Energy Malnutrition by Nutritional Intervention with Moringa Oleifera
among Anganwadi Children in Rural Area in Bangalore, India.
International Journal of Scientific Study | April, 2014, 2(1).
13. Sridhar KR, Rajeev Bhat. Lotus-A potential nutraceutical source.
Journal of Agricultural Technology. 2007; 3:144-155.
14. The Ayurvedic Pharmacopeia of India Part-I, 2:1-173.

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 Chapter - 5
Glimpse on Ayurveda

Author
Dr. Radha Palaniswamy
Department of Biotechnology, Dr. N.G.P. Arts and Science
College, Coimbatore, Tamil Nadu, India

Page | 95
Page | 96
 Chapter - 5
Glimpse on Ayurveda
Dr. Radha Palaniswamy

Abstract
The science of life begins with Ayurveda-an age old science for the
treatment of disorders and diseases. It is completely based on plant sciences
essentially by using different forms of plants and its secondary metabolites
as medicines. The medicines are prepared in various forms ranging from
liquid to solid and customized based on the characteristics of the individual.
This is the specialty of Ayurveda where it caters to the needs of an individual
and it is not generalized. It looks at the individual from two aspects the
prakriti and vikriti aspect during the investigations, diagnosis and treatment.
The western medicines have resulted in numerous side effects to patients of
all ages which has brightened the future of the alternative medical branches
like Ayurveda, Siddha, Unani and many others. These branches of medicine
do not embark on any component called side effects. It could be a little slow
in its action compared to the allopathy stream of medicine; however, its
efficacy or impact on treatment is in no way inferior. It is imperative for us
to understand such a science which originated in our country and was
practiced by some of the legendry saints.
Keywords: Ayurveda, prakriti, doshas, vatta, pitta, kapha
Introduction
Right from the Vedic period, in India, the traditional knowledge on
medicinal plants has been passed on through generations. Ayurveda, is
sourced from Atharvaveda (knowledge store house of atharvanas and it is a
fourth type of Veda) which developed and grew into a well-established
medical system due to the untiring efforts and great minds of the sages of
“gurukulas”. The impact of Ayurveda on the public mind in our country was
so deep that even the influence of Middle East and Europe could not deter its
popularity among the masses of India and neighboring countries. Herbal
medicines in the form of Ayurvedic medicines are still popular and available
for common masses due to the untiring efforts of herbal industries of India,

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especially the Patanjali, Dabur, Zandu, Baidyanath, Himalaya, etc. These
days, the drug discovery is based on the reverse pharmacology of Ayurveda
in which the drug candidates are first identified based on their traditional
medicinal knowledge, followed by the validations through clinical trials [1].
Herbal medicines have contributed immensely to the world of medicine in
various forms. Due to the lack of documentation, today herbal medicine is
unable to outgrow the various other forms of medicines [2].
Ayurveda is a Sanskrit Word Derived from two Roots: Ayu (Life) +
Veda (Science)
The Literal meaning of the term is 'Science of Life'. The Origin of
Ayurveda has been said to be from 'Brahma' the Creator. In India more than
5000 years ago but modern science and allopathy now believe in its principle
and more and more research is being directed towards ancient herbs and
natural therapies. The specific characteristic of this science is that it
emphasizes on the protective aspect, to protect the health of the healthy and
normal individual. The Charak Samhita is an ancient text that much of this
knowledge, especially related to diet. Ayurveda sees health as a perfect
balance between mind, body and consciousness. It disseminates a daily
regimen of exercise, emotional balance and healthy diet to achieve this. So it
is a great way to suppress the rise of many life style diseases. Ayurveda, the
ancient Indian medicine system of herbal drugs are known from very early
times for preventing or suppressing various tumors using these natural drugs
[3]
. The plants are rich in phytochemicals which are the plant chemicals that
are naturally present in the plants. These components play active role in
curing diseases with phenomenal response without any side effects.
Therefore, phytochemicals are called as man friendly medicines which forms
the backbone of Ayurveda [4]. Key concepts of Ayurvedic medicine include
universal interconnection of people, their health, the universe, body’s
constitution (prakriti) and life forces (dosha). Using these concepts,
Ayurvedic physicians prescribe individualized treatments, including
compounds of herbs or proprietary ingredients, diet, exercise and lifestyle
recommendations [5].
Ayurveda and Medicinal Plants: Most of the ayurvedic preparations
are plant based. Ayurvedic plants have a stronger action on the body than
either food or spices. Such actions enable the plant to reverse
pathophysiological processes and stabilize the doshas. For this reason, one
should use such plants with caution. Classical ayurvedic preparations, made
from such plants, are known as ‘‘yoga’’ in Sanskrit. Yogas have developed
following years’ of practical experience combining plants to get the optimal

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effect. Polyherbal combinations have also proven lastingly effective than
single herbs. In ayurveda, most of the classical preparations are polyherbal,
with a combination of 3 to 30 plants involved. These constituents are
combined accurately, in such a way that the formula is balanced and
reproducible. One or two of the plants in these combinations will be active
and the others will play a supporting role. The supporting herbs will each
have different actions, acting as catalysts to help proper absorption,
transportation, and to reduce toxicity. If an ideal combination is delivered,
then the result can be excellent, but such outcomes are based on thorough
plant knowledge [6].
Difference between Ayurveda and Western Medicine: Western
medicine focusses on symptomatology and disease and uses drugs or surgery
to get rid of the pathogens. But, inspite of this systematic approach there are
several side effects which is developed due to the toxicity which often tends
to weaken the body. Ayurveda maintain a life with balanced energy which
flows throughout the body. When this energy flow is minimal it cannot
produce natural defense and however the individual tends to fall sick with
reduced immune power [7].
The main difference between Ayurveda and modern or western
medicine is that modern medicine typically treats the symptoms only while
Ayurveda treats the entire body as a whole. According to many experts on
Ayurveda, most drugs do not overcome the problem and instead, they reduce
the mild symptoms.
Ayurveda is considered a way of living. For a person to be healthy
according to Dr. Robert Svoboda, an Ayurvedic physician, your body must
be in balance with nature, your mind must be in harmony with your society,
and your soul must be satisfied spiritually. There are five forms of material
energy in Ayurveda, Akash (Ether), Vayu (air), Tejas (fire), Apas (water),
and Pritvi (earth). Our body is composed of all the 5 attributes and the
universe is built in and composed of all the energy forms in different
proportions. Thus, for a healthy life, one has to determine the nature of their
physical and social environment to know the remedies to take.
The scientific medical and cultural differences between the two fields
require different understandings and approaches. On one hand, conventional
medicine depends upon scientific research while Ayurveda encourages a
more holistic approach towards healing.
The need for preservation of the environment is a critical issue.
According to Sanjeev Rastogi, there is a rapid reduction in natural resources

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which poses a threat to the sustainability of traditional medicine. Relying on
Ayurveda rather than modern science could encourage the protection of
heritage and the environment. Ayurveda allows the use of animal products
without doing actual harm to them and therefore doesn’t pose a threat to
their existence. To find a balance between our natural habitats and proper
medication, we need to re-visit traditional approaches to medicine.
Here are some of the benefits of integrating Ayurveda in modern
science:
- Sustaining traditional medicine
- Preserving the environment and plant-based medicines
- Encouraging respect for animals
With additional research, modern science and Ayurveda can be bonded
together. The research so far has provided clear evidence that Ayurvedic
medicines provide valid treatment alternatives. The ultimate benefit would
be to humankind as well as the environment. Quite simply, holistic medicine
is more environmentally friendly [8].
Need for Ayurveda: According to the World Health Organization,
about 70-80% of the world populations rely on nonconventional medicines
mainly of herbal sources in their healthcare. Due to lack of proper
documentation Ayurveda is unable to outgrow various other forms of
therapies 7. Public interest for the treatment with complementary and
alternative medicine is mainly due to increased side effects in synthetic
drugs, lack of curative treatment for several chronic disease high cost of new
drugs, microbial resistance and emerging diseases etc. [9].
Preference for Ayurvedic Treatment over Synthetic Drugs: Most of
the synthetic drugs act in the brain to produce their euphoric effects and at
times leads to seizures, stroke or toxic effects on brain cells. It may even lead
to brain disorders which occur when repeated drug use leads to changes in
the function of multiple brain circuits controlling the stress, decision making,
pleasures, impulse control, memory, learning and other functions. Most of
the synthetic drugs for brain disorders are prescribed for a long term use and
have been showing some kind of side and after effects due to the toxic
synthetic compounds present in them [1].
Allopathy: The effectiveness of allopathic medicines during an
emergency is the main reason why it is adopted by most of the people all
around the world. In allopathy, the doctors usually will concentrate on the
specific symptoms of a disease, not making an immediate attempt to

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understand the causes of those symptoms or disease. In situations where the
side effects need to be treated, they are prescribed pills for that. In other
words, there is a pill for each symptom and a pill for all their side effects.
This offers only a partial cure since it does not act on the root cause of the
pain or disease or symptoms. The medications are not tailor made for the
individuals physiologic conditions, however, in Ayurveda, each drug is tailor
made exclusively for the use of that particular individual with the prescribed
dosage. It is important to note that there is no place for individuality in
allopathy [10].
Causes for Disease: The four components of a person’s daily life are
Ahara (food), Achara (conduct), Vihara (behavior) and Vichara (thoughts).
When any one of these components turn unhealthy, it results in Tridosha
which will manifest as a disease and cause imbalance in the shareera or
body. How to avoid this? There are several measures employed specified as
Swasthavritta which means avoidance of one which causes the imbalance
[11]
. Ayurveda holds that specific disease conditions are symptoms of an
underlying imbalance. The main focus lies in restoration of the balance and
to create a balance such that the disease does not recur. Relief from the
symptoms will automatically adhere once the root cause of the illness is
understood and eradicated. This will help to create a healthy lifestyle that the
imbalance won't occur again. Living in health and balance is the key to a
long life free from disease [12]. In the treatises of Ayurveda much more
emphasis is given on the deeds of an individual as a causative factor of the
disease. The wise man should not blame any deity, ancestors or Raksas as
(an evil spirit) for diseases caused by his own misdeeds. The action
performed in the previous life which is also known as Daiva constitutes in
due course causative factors for the manifestation of diseases [13]. Some of
the diseases arises due to Karma –bad deeds, some others due to the vitiation
of the Doshas and some diseases occurs by the combination of both Karma
as well as vitiated Dosha. All the diseases in the human beings are due to
their bad deeds and it leads to terrific suffering [14].
Ayurvedic Body Types
According to Ayurveda, the three main body principals which constitute
our life is a mix of our mental, physical and spiritual well-being. These
components are known as doshas, which can be subclassified into Vata (air-
ether), pitta (water) and Kapha (water-earth). Every living being on earth has
a unique constitution of the doshas and they are governed by the doshas.
These doshas may be in any combination as Vata & Kapa, Kapa & Pitta or
Vata & Pitta.

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Vata
The vata dosha is known to govern all the movements of mind and
body. From controlling the blood flow to elimination of the waste and
harmful toxins to breathing and the flow of thoughts in the mind; the vata
dosha is like a predominant force that minimizes stress and feeds the
creativity within you. If the vata dosha is in balance, you will feel energetic,
enthusiastic and lively, but the moment it becomes imbalanced, it manifests
in the body problems like constipation, hypertension, fatigue, digestive
challenges and restlessness among others.
Pitta: The pitta Dosha controls digestion, metabolism, and energy
production. The primary function of Pitta is transformation. Those with a
predominance of the Pitta principle have a fiery nature that manifests in both
body and mind. Pittas have a lustrous complexion, perfect digestion,
abundant energy, and a strong appetite. When out of balance, Pittas may
suffer from skin rashes, burning sensations, peptic ulcers, excessive body
heat, heartburn, and indigestion. Learn How To Reduce Pitta Immediately.
Kapha: Kapha dosha governs all structure and lubrication in the mind
and body. It is the principle that holds the cells together and forms the
muscle, fat, bone, and sinew. It controls weight, growth, lubrication for the
joints and lungs, and formation of all the seven tissues-nutritive fluids,
blood, fat, muscles, bones, marrow and reproductive tissues. It helps build
excellent stamina but when it goes out of balance it can also cause a person
to become overweight, sleep excessively, and suffer from the problem of
diabetes, asthma and depression [15].
Kapha is essentially composed out of earth and water components. It is
heavy, slow, cool, sleek, smooth, delicate, thick, stable, gross, and cloudy.
Kapha provides structure and robustness to all things; it gives the
cohesiveness needed to maintain a particular form. Kapha additionally
hydrates all cells and frameworks, lubricates the joints, saturates the skin,
maintains immunity and safeguards the tissues. Kapha is often associated
with water energy, and with love and compassion. The kapha body is
physically solid, compact and wide with extensive thighs, hips, bums, and
chest and is overweight. Kapha types have large, appealing eyes, fair skin
and glowing. They possess thick hair, blond or dark, and wavy. Kapha
individuals over produce mucus, have delicate voice, natural sensuality and
are mostly fertile. Kapha individuals prefer heat and they suffer in cold,
damp climates [16].
Ayurveda states that Pitta controls heat, metabolism and transformation

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in the mind and body which includes digestion. Pitta controls the essential
digestive “Agni” or fire of the body. Other qualities are they may be sharp,
pungent, intense or penetrating. But pitta imbalance causes many body
changes like nausea, vomiting, short temper, diarrhea, arthritis, infections,
ulcer etc.
The word Vata means to blow or to move like the wind. Containing the
elements like air and space, Vata manages all the movements in the mind
and body. It controls blood flow, evacuation of wastes, breathing and the
movement of thoughts across the brain. Vata is dry, cold, light, moving,
changeable, subtle, rough and quick.
Since Pitta dosha and Kapha dosha can't move without it, Vata is viewed
as the pioneer of the three Ayurvedic Body Types. It is very essential to keep
Vata in good balance.
Vata Dosha Characteristics: Vata dosha is best understood by its
segment parts, its subdoshas, which are the five types of vata or five types of
movement. Each subdosha explains a direction of movement and controls
specific actions in the body. The five subdoshas are explained below:
Prana Vayu: (Forward-moving air): Primary air or nervous force,
reaches out from the stomach to the throat, focused in the cerebrum,
administering inhaling and swallowing, and also sneezing, spitting and
belching. It controls the senses, brain, heart and consciousness.
Samana Vayu: (Equalizing air): Extends from the stomach to the navel,
centered in the small intestine and the nervous system behind the digestive
framework which facilitates digestion and assimilation, and helps keep Prana
and Apana balanced.
Vyana Vayu: (Pervasive air): Pervades the whole body from heart,
dissemination of nourishment by making blood and different liquids to
circulate, and producing locomotion, extension and contraction, perspiration
and other such actions (discharge of impulses and secretions)
Udana Vayu: (Upward moving air): This extends from the throat and
controls the exhalation and speech. Udana decides our desires in life and
after death it guides our body to travel through.
Apana Vayu: (Downward moving air): This extends from navel to the
anus, centered in the colon which is responsible for elimination, urination,
menstruation, parturition and sexual activities. It backs and controls all the
other forms of Vata, and disturbances of it are the basis of most Vata issues
(as the colon is Vata's primary seat) [17].

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Food According to Ayurveda
Ayurveda has given three sub pillars- Ahara, Nidra and Brahmacarya
port the body itself. Ahara has been enumerated first, which shows its
importance. The word “Ahara” is an ancient word meaning food. Various
dictionaries describe in different ways, some of the synonyms are Bhojana,
Lehya, Nighasa, Vidyasa, Pratyasanama, Bhaksanam, Abhyavarana and
Niagara. A balanced diet should provide around 60-70% of total calories
form carbohydrates, 10-12% from protein and 20-25% from fat.
Ahara Vidhi Vishesha Ayatana is Made of 3 Words as Described Below
1) Ahara Vishesa: It means specialty, special property of Ahara.
2) Vidhi Vishesa: denotes a special system or method or manner or
way in which it is prepared or arranged or rule of intake.
3) Ayatana: It indicates support.
Hence, Ahara Vidhi Vishesha Ayatana together means the factors
responsible for the effect of the food or of the method for the diet intake.
These 3 factors form the special factors in the science of diet pertaining to
Ayurveda.
According to the Ayurvedic classical texts, there are 8 factors which
determine the utility of various types of food, i.e., prakriti (nature of the food
substance), karana (processing of the food substance), samyoga
(combination of two or more food substances), rashi (quantity of substances
to be taken), desha (habitat of food substances), kala (based on seasons and
conditions), upayoga samstha (dietetic rules) and upayukta (habit and state
of individual).
Stability of life is accomplished by food which is highly essential for
sustaining life of living beings. Ahara is said to be Mahabhashya by Acharya
Kashyap. It means, one can make man free of disease only with food
(congenial diet). One is not able to sustain life without diet even when
endowed with medicine that is why the diet is said to be the great
medicament by physician. Diet adds many elements to life like strength,
complexion, Ojas, growth and development, functioning of Indriyas,
happiness, clarity of voice, luster, pleasure, increase of Dhatus, intellect,
health etc. Satisfaction, nutrition, patience, Buddhi (critical understanding)
enthusiasm, virility, strength, good voice, Ojas, glare, life, geniuses and
radiance.
Food is abode for six tastes and these tastes are a cause for increase,
decrease and normalcy of the Doshas. A self-controlled man has a longer life

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as he is free from diseases. Good voice, longevity, geniuses’ happiness,
nourishment, strength and intellect are all conditioned by food. Professional
activities leading to happiness in the world, Vedic rituals leading to abode in
heaven and observance of truth, Brahmacarya leading to salvation are all
based on balanced food (Sawhney and Versha).
Ayurveda lays great emphasis on taste known as rasa in Sanskrit which
c includes 6 tastes - sweet, sour, salty, spicy, bitter and astringent.
1) Sweet Taste: When taken in moderation, provides longevity,
strength and healthy body fluids. Increased consumption leads to
weight gain, obesity and diabetes. Sweet taste is prominent in food
items like wheat, rice, pumpkin, maple syrup etc.
2) Sour Taste: Consisting of the elements of water and fire, it is
known to stimulate pitta and kapha dosha in the body and decrease
the vata dosha. It increases appetite and production of saliva and
awaken thoughts and emotions and improve digestion. Examples -
lemon, vinegar, pickled vegetables and tamarind among others.
3) Salty Taste: It is made up of elements of earth and fire and leads to
decrease of vata and increase of pitta and kapha doshas. It aids in
digestion and cleansing of the tissues but excess leads to blood
pressure and have impact on your skin and blood. Examples - sea
vegetables, sea salt, and black olives among others.
4) Spicy (Pungent Taste): Made up of elements of fire and air and of
the 6 tastes in Ayurveda, it is the hottest - aid digestion, improve
appetite, cleanse tissues and enhance blood circulation. Balances
kapha but if excess, can aggravate pitta and lead to other health
related issues. Vata handles pungent taste when combined with
sweet, sour or salty foods. Examples - chilies, garlic, ginger, hot
peppers and onions etc.
5) Bitter Taste: Made up of elements of air and space and is coolest
of all the six tastes. Naturally detoxifying in nature, remove waste
and purifies the body. Best suited for pitta and kapha doshas and
least beneficial bodies with vata dosha. Turmeric, green vegetables,
and herbal teas fall in the category of foods with bitter taste.
6) Astringent Taste: Made up of air and earth elements, it is cool,
firm and dry. People with vata are advised to consume less of
astringent taste as it can lead to problem of gas in them. It benefits
people with pitta dosha. Unripe bananas, cranberries, and green
beans etc., carry astringent taste [18].

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 Increase Lifespan of Model Organism: According to Ayurveda jara
(aging) is a “swabhavika” (natural) property of all organisms. However,
there could be external or internal interventions like environment, life style,
genetic or chemical. One such example to increase the lifespan was
experimented with Drosophila melanogaster in 2002 and late Seymour
Benzer and colleagues reported life extension was possible by feeding a
“drug” 4-phenylbutyrate (PBA). This was due to mode of action of a global
increase in histone acetylation as well as a dramatically altered pattern of
gene expression, including induction or repression of numerous genes” [19].
Prakriti and Its Validation: Current advances in the fields of
Ayurveda, genomics, and personalized medicine have motivated several
workers to explore the association between the Prakriti (Ayurveda
constitution) and other fields like hematology, biochemistry, physiology,
psychology, and genomics. Though is an accepted step in validating and
evaluating the applicability of the Ayurvedic conceptual framework, there is
discrepancy in the results reported by these studies into generalizable,
reproducible, and applicable inferences.
Although several attempts have been in the designing of reliable tools
and protocols, each of these has its own limitations. The common problems
that are encountered in these protocols can be listed as follows: (a)
Discrepancies related to the adherence to the textbooks, (b) ambiguities in
assessing the characters, (c) inadequate attention given to inter-rater
variability, (d) inadequate attention paid at the scoring pattern and weightage
assignment, (e) ambiguities in assigning the criteria followed to express the
final “Prakriti” type, (f) nondisclosure of the complete protocol used to
identify Prakriti, etc.
Since the Prakriti-based research work is still in its infantile stage, the
workers need to be open-minded to publish the full questionnaire/tool that
they used to assess Prakriti along with the weightage they assigned to each
item along with the publication. This would certainly help other workers in
the field to test their tools or to improvise the tool in question so that a
standard protocol may eventually emerge for prakriti based valuation of the
patients [20].
Ayurveda and Sleep
Ayurveda is an ancient science having a wholesome and holistic view
about the health of human beings. So, descriptive guidelines are given for
following the factors responsible for maintenance of health and non-
production of disease. Dhatusamya factor for aarogya (health). Also three

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helping points are mentioned which support our well-being just like pillars
support the house. Sleep is one of these points. Sleep is also mentioned as
adharniya an urge which should not be controlled. Since it may lead to
complaints like tandra, shiroroga and akshay gaurav.
Bala, Varna, upchaya is achieved due to proper sleep. Also like aahar,
nidra is importance of nidra lies in the fact that it is one factors, the other
being aahar, responsible for sthaulya or karsya of the body.
Vidhi Purvak nidra bestows sukha, pushti, bala, vrushti, dnyan and
finally jeevita and asamyak nidrasana leads to opposite namely dukha,
karshya, abala, kalibata and finally alpayu or mrityu depends on it. Sushruta
samhita says timely sleep (kalashayan) leads to pushti, Varna, bala, utsaha,
agnidipta, atandra and dhatusamya. Here both physical and mental aspects
are included. Means sleep bestows nourishment, strength, sexual urges,
learning, good digestive ability, complexion, proper proportion of body
constituents required for health as physical benefits. Mental benefits include
enthusiasm, learning and happiness. Sleep pattern is of paramount
importance in terms of digestion too. Only ingestion of food is not enough. It
should be properly digested and assimilated for nourishment. However,
improper sleep due to reasons like shift working or late night sleep leads to
digestive disturbances. Sleeping on time for adequate hours helps in
digestion (agnidipta). Sleep has a positive effect on digestion and
metabolism. All this leads to proper nourishment and health (dhatusamya) [21].
Detoxification
We don't like to think of our bodies as active toxic waste sites, but
something like that happens. Toxins build up in your body faster than it can
purify them. Pollution from air and water, food chemicals and preservatives,
emotional stress and poorly-digested foods pile up, creating deposits of
waste. It is very important to detoxify oneself to get rid of the diseases and
make one’s immunity strong. Toxins are one of the main reasons for falling
sick every weather change and can slowly accumulate diseases causing long-
term harm. The two types of accumulation of toxins that build up in the body
are internal toxins and the external toxins. The external ones are those which
are collected through our intake of food and the internal toxins are sourced
by our metabolism. Internal toxins in ayurveda are called ama, which are
aggravated when the digestive fires get weakened over the course of time.
There are four conditions of digestive fires or AMAs which is resulted when
the fire weakens.
Balanced Fire: Ideal condition for digestion as the balanced fire does
not produce ama and therefore toxin removal is done on its own.

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 Low Fire: When the digestive fire is too low it accumulates a lot of
toxins and produces ama.
Sharp Fire: Sharp fire is too strong and extreme and produces ama.
Imbalanced Fire: It is disproportionate with both high and low phases
and hence capable of producing ama [22].
In order to remove toxins from the body, one needs to eat healthy and
balanced diet to improve immunity. It provides a natural, effective way to
cleanse the body. While most internal cleansing programs purify the colon
and digestive tract only, the detoxification system does much more. It helps
purify the liver, supports balanced fat metabolism, helps purify the sweat
glands and the organs of elimination, reduces digestive impurities, curbs the
buildup of impurities in fat and muscle tissue and promotes natural, effective
elimination for greater health and vitality, strengthens the entire urinary tract
and aids liver function, for pure blood and better absorption of nutrients.
Dietary Recommendations
Avoid preservatives and leftovers. If you eat foods that contain
impurities, the body has to work harder.
Recommendations
Avoid cold drinks, which reduce the digestive fire.
Drink plenty of warm water.
Eat sweet, juicy fruits (daily if possible).
Lifestyle Recommendations
Avoid cigarette smoke, alcohol, drugs, chemicals, pollution and other
toxins as much as possible.
Go to bed by 10:00 p.m. so the body is at rest during the natural
purification period from 10:00 p.m. to 2:00 a.m.
Land and Seed theory or the Beej Bhumi theory
The land and seed theory in Ayurveda believes that infertile soil is
incapable of growing the best or strongest of seeds. Considering our body as
the land and bacteria, virus and allergens etc. as the seeds, the theory states
that if we take care of the land, aka our body, even if the seasons change we
will be able to sustain our immunity and keep the diseases away. The
fertilizers are used to give the seeds a better chance of growing. A balanced
ayurvedic diet, lifestyle and exercise can sustain life longer and healthier by
removing toxins and ama from the body.

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There are Many Herbal Formulas that are required to Boost Immunity
Panchakarma is not only for detoxifying the body, but also for
rejuvenation-strengthening the immune system, and restoring balance and
well-being. It is one of the most effective healing modalities in Ayurvedic
Medicine. It is recommended on a seasonal basis, as well as when an
individual feels out of balance or is experiencing illness. Some of the
treatments used are as follows:
1) Daily warm oil massage (abhyanga)
2) Herbal steam therapy (swedana)
3) Lymphatic massage
4) Herbal enemas (basti)
5) Nasal administrations (nasya)
Educational Policy Research: AYUSH systems have since long been
marginalized because of policy dominance favoring modern medicine.
Furthermore, policy-makers often do not take into consideration the regional
differences in terms of population characters, healthcare-seeking behavior,
socio-economic and socio-cultural factors, awareness and literacy level etc.,
within India. This fact becomes obvious when one compares the prescription
pattern of physicians of Ayurveda in southern parts of India with those in
northern states of India. This region-dependent variation is seen even in the
way how AYUSH systems are taught in the colleges. Many institutions such
as Banaras Hindu University have adopted an integrative approach while
teaching Ayurveda, whereas many others (such as those located in Kerala)
have maintained a mostly ‘classics-oriented’ approach (Shuddha Ayurveda).
The differences in terms of practices and educational standards amongst
different states have been documented in the Udupa Committee report as
early as in 1958. Therefore, expecting to impose uniformity in training may
not be practical and fruitful considering the prevalent patterns and practice
traditions. Realistically, as stakeholders, we have not been able to gather
sufficient data to categorically state which model of AYUSH education is
better in which kind of set-up. The proponents of neither ‘integrative
approach’ nor ‘Shuddha Ayurveda approach’ have yet been able to produce
evidence to demonstrate suitability of either to particular context. Most
importantly, we hardly carry out ‘policy research’ in educational institutions
in India. Most of the nations and reputed universities world over have their
own dedicated ‘policy research institutes on medical education’. In India,
unfortunately, there is no such dedicated mechanism in force (24).
Motto of Ayurveda: “Swasthasya swaasthya rakshanam, aaturasay

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vikaara prashamanam, i.e., ayurveda aims to maintain the health of a healthy
person and to restore the health lf diseased. Instead of pacifying the
symptoms, it targets to achieve harmony in the body. Health is mentioned as
swaasthya-a balance in one’s system biology. It is the state of equilibrium of
the three principles of the body, namely, Vata, Pitta and Kapha, along with a
contented state of senses mind and soul (25).
References
1. Vasant lad-Ayurveda, A Brief Introduction and Guide, the Ayurvedic
Institute, Albuquerque, 2016, 1-2.
2. Thangavelu M. Model organism in Ayurvedic Research. Journal of
Ayurvedic and Integrative Medicine. 2010; 1(3):173-174.
3. Bhalerao and Patwardhan. Prakriti-based research: Good reporting
practices. Journal of Ayurveda and Integrative Medicine. 2016; 7(1):69-
72.
4. Patwardhan. Ayurveda education reforms in India. Journal of Ayurveda
and Integrative Medicine. 2017; 8:59-61.
5. Balkrishna A, Misra LN. Ayurvedic Plants in Brain Disorders: The
Herbal Hope. Journal of Traditional Medicine & Clinical Naturopathy,
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anticancer property. Pharma Tutor. 2016; 4(7):25-28.
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Medical Journal. 2018; 6(5):1019-1022.
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Ayurvedic Medical Journal. 2018; 6 (5):1123-1130.
9. www.dabur.com/in/en-us/about/science-of-ayurveda.
10. Dalhana. Edited by Acharya Jadavji Trikamji. Ed. Susruta Samhita.
Reprint edition, Varanasi: Chaukhambha Orientalia, 2014, 1-15.
11. Palaniswamy R, Veluchamy C. Therapeutic Uses of Spirulina: A
Review. International J Curr Innov Res. 2017; 4(1):975-979.
12. Pandya B. Concepts of Ayurveda in Shrimad Bhagavat Gita: A Review.
International Journal of Ayurveda in Pharmacy Research. 2017;
5(11):28-30.
13. Sreedevi S, Tripathy RN. Life Style Disease and Ayurveda:An
Overview and Prospective. International Journal of Research in
Ayurveda and Pharmacology. 2017; 8(1):22-26.

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14. Sharma RK, Dash B, Charak Samhita, Sharirasthana, Chapter 5, Verse
no. 3, Varanasi; Chaukhamba Sanskrit Series. 2012; II:414.
15. Travis FT, Wallace RK. Dosha brain types: A neural model of
individual differences. Journal of Ayurvedic and Integrated Medicine.
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16. Palaniswamy R, Padma PR. Phytochemical Analysis of Majorana
hortensis leaves. Journal of Pharmaceutical Research. 2018; 7(5):70-72.
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radical scavenging activity, International Journal of Current
Pharmaceutical Research. 2017; 9(3):62-64.
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care.html
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20. Rastogi S. Building bridges between Ayurveda and Modern Science.
International Journal of Ayurveda Research. 2010; 1(1):41-46.
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22. Kumar S, Dobos GJ, Rampp, T. The Significance of Ayurvedic
Medicinal Plants. Journal of Evidence-Based Complementary &
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23. Gopinath BG. Foundational ideas of ayurveda (Chap 2). In B.V.
Subbarayappa (Ed.), Medicine and life sciences in India (Part 2).
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24. Pal M. The Tridosha Theory. Ancient Science of Life, 1991; 10(3):144-
155.

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Page | 112
 Chapter - 6
Basic Concept of “5P” Muscles

Authors
Dr. Swarup P Kulkarni
Associate Professor, Ph.D. (Registered Scholar) and H.O.D.,
Department of Rachana Sharir, Dr. J.J. Magdum Ayurved
Medical College, Jaysingpur, Maharashtra, India
Dr. Swarupa S Mane
Assistant Professor, Department of Rachana Sharir, Dr. J.J.
Magdum Ayurved Medical College, Jaysingpur, Maharashtra,
India
Dr. Vedashri A Kalavade
Associate Professor, Department of Rog Nidan Evam Vikriti
Vigyan, Dr. J.J. Magdum Ayurved Medical College,
Jaysingpur, Maharashtra, India
Dr. Anuja A Kulkarni
Professor, Department of Strirog Evum Prasuti Tantra, Dr. J.J.
Magdum Ayurved Medical College, Jaysingpur, Maharashtra,
India

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Page | 114
 Chapter - 6
Basic Concept of “5P” Muscles
Dr. Swarup P Kulkarni, Dr. Swarupa S Mane, Dr. Vedashri A Kalavade and Dr. Anuja A
Kulkarni

Abstract
Human body contains number of muscles which are basically
categorised under three types. These three types are as skeletal muscles,
smooth muscles and cardiac muscles. Out of these three types, 5P muscles
come under skeletal muscle category. Means the muscles which are attached
to the skeleton or bones. The “5” P muscles are as Palmaris longus in upper
extremity forearm, Plantaris in lower extremity leg region, Peroneus tertius
in lower extremity leg, Pyramidalis muscle in the lower part of anterior
abdominal wall and finally Psoas minor muscle in the posterior abdominal
wall. These five muscles have the variations as far as their existence is
concern. These are also called as vestigial muscles of human body as their
presence or absence does not affect the respective body part action. These
muscles are distributed in the extremities and in the anterior and posterior
abdominal wall regions of human body. 5P muscles may be present or absent
unilaterally or bilaterally in the human body.
Keywords: 5P muscles, unilaterally or bilaterally present or absent, skeletal
muscles.
Introduction
Myology is the branch of medical sciences that deals with the study of
muscles. Muscle is a soft tissue found in most animals. Muscle cells contain
protein filaments of actin and myosin that slide past one another, producing
a contraction that changes both the length and the shape of the cell. Muscles
function to produce force and motion. They are primarily responsible for
maintaining and changing posture, locomotion, as well as movement
of internal organs, such as the contraction of the heart and the movement of
food through the digestive system via peristalsis. The study of muscle
includes its origin, insertion i.e. starting and end point any muscle
respectively. It also includes nerve supply, action, variations if any and
clinical anatomy with clinical testing of the muscle. A muscle is a

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"contractile organ" of the body. Muscles make up between 40 to 50 percent
of our total body weight and work to help us move, maintain posture and
produce heat. Muscles respond to stimuli, contract, extend and have
elasticity to return to their original shape and length after contracting or
extending. Each type of muscle has different characteristics and structures.
Muscle tissue has four main properties: Excitability (ability to respond to
stimuli), Contractibility (ability to contract), Extensibility (ability to be
stretched without tearing) and Elasticity (ability to return to its normal
shape). Based on certain structural and functional characteristics, muscle
tissue is classified into three types: cardiac, smooth and skeletal.
Types & Structure of Muscles
Skeletal
Skeletal muscle tissue is named for its location - attached to bones. It is
striated; the fibres (cells) contain alternating light and dark bands (striations).
Skeletal muscle tissue can be made to contract or relax by conscious control
(voluntary). All skeletal muscle fibres are not alike in structure or function.
For example, skeletal muscle fibres vary in colour depending on their
content of myoglobin (myoglobin stores oxygen until needed by the
mitochondria). Skeletal muscle fibres contract with different velocities,
depending on their ability to split Adenosine Triphosphate (ATP). Based on
various structural and functional characteristics, skeletal muscle fibres are
classified into two types: Type I fibres and Type II fibres.
Type I fibres have a lot of mitochondria, depend on cellular respiration
to make energy and are resistant to fatigue. They are known as slow-twitch
fibres and are largely found in muscles that require endurance, like the leg
muscles and those used for keeping us upright. Type II fibres have few
mitochondria, depend on phosphate and glycolysis for energy production and
fatigue easily. They are fast-twitch fibres and are seen largely in muscles
used for rapid movement, like moving the eyes.

Fig 1: Skeletal Muscle Fibre

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 Fig 2: Skeletal Muscle Striations

Smooth
Smooth muscle tissue is located in the walls of hollow internal
structures such as blood vessels, the stomach, intestines, and urinary bladder.
Smooth muscle fibres are usually involuntary (not under conscious control),
and they are nonstriated (smooth). Smooth muscle tissue, like skeletal and
cardiac muscle tissue, can undergo hypertrophy. They are made up of single,
spindle-shaped cells and have thick and thin filaments that move against
each other to make the cell contract. Smooth muscles are also influenced by
other substances released in the body near it, like an allergen that causes a
sneeze or cough, or by hormones in the blood, as when the signal to start
childbirth causes contractions. Smooth muscles contract more slowly than
cardiac or skeletal muscles.

Fig 3: Smooth Muscle

Cardiac
Cardiac muscle tissue forms the bulk of the wall of the heart. Like
skeletal muscle tissue, it is striated (the muscle fibres contain alternating
light and dark bands (striations). Unlike skeletal muscle tissue, contraction is
usually not under conscious control (involuntary). Cardiac muscles are those
that make up the wall of the heart. They contract about 70 times and pump

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about five litres of blood each minute. Cardiac muscles are made up of single
cells, each with a nucleus, and the cells are branched. These branches then
attach and interlock with adjacent fibres using adherence junctions. This
enables the heart to contract forcefully without damaging the fibres. The
heart beats when the action, or contraction, passes from one fibre to another
through the junctions. Cardiac muscles have more mitochondria than skeletal
muscles [1].

Fig 4: Cardiac Muscle

Fig 5: Cardiac Muscle structure

Fig 6: Location of Skeletal, Smooth and Cardiac muscles

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5P Muscles
Human body is having certain muscles which are having the variations
as far as their location wise existence or non-existence matters. These 5P
muscles are as Palmaris longus muscle which is present in the flexor region
of the forearm in the superficial muscle variety. Second muscle is Plantaris,
located in the posterior compartment of the leg superficially along with the
gastrocnemius and soleus muscles in the lower extremity. Peroneus tertius
muscle also present in the lower extremity, in the anterior section of the leg.
Psoas minor muscle is available in the posterior abdominal wall region along
with psoas major muscle. And finally, pyramidalis muscle is present in the
lower aspect of the anterior abdominal wall region. These muscles may be
present or absent unilaterally or bilaterally in the human body. Their
existence or non-existence does not affect the different movements of the
body as their structural and functional importance is negligible.
Chapter Content
Palmaris Longus Muscle
It is one of the superficial muscles of flexor compartment of the
forearm. The other muscles in the same category are as pronator teres, flexor
carpi radialis, flexor digitorum superficialis and flexor carpi ulnaris.
Palmaris longus is slender fusiform muscle medial to flexor carpi radialis. It
springs from the medial epicondyle by the common tendon, from adjacent
intermuscular septa and the deep fascia. It converges on a long tendon,
which passes anterior (superficial) to the flexor retinaculum. A few fibres
leave the tendon and interweave with the transverse fibres of the
retinaculum, most of the tendon passes distally.
Origin
Medial epicondyle of the Humerus (Common flexor origin).
Insertion
Distal half of flexor retinaculum and the apex of the palmar aponeurosis.
Innervation
Median nerve
Action
Flexes the wrist and makes the palmar aponeurosis tense.
Additional Points
1) At, the wrist the tendon lies over the median nerve which projects
on its lateral side.

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2) The palmaris longus muscle is more important morphologically
than functionally. It is a degenerating muscle as it has a short
muscle belly and a long tendon. It is frequently absent muscle. It is
absent in 10 to 15% subjects.
3) The palmar aponeurosis represents the distal part of the tendon of
the palmaris longus, another evidence of retrogression of the muscle
is Plantaris in the leg.
4) Variations in size shape and attachments are common [2].

Fig 7 & 8: Location of Palmaris longus muscle

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Psoas Minor
Psoas minor is small muscle which lies infront of the psoas major
muscle entirely within in the abdomen. It is considered amongst one of the
posterior abdominal wall muscle. The other posterior abdominal wall
muscles are psoas major, quadratus lumborum and Iliacus. It is present only
in 60% of the cadavers. It is absent in about 40% of cases.
Origin
It arises from the sides of the bodies of vertebrae T12 and L1 and the
disc between them.
Insertion
The muscle ends in a long, flat tendon which is inserted into the pectin
pubis and the illiopubic eminence, laterally to the illiac fascia.
Vascular Supply
Lumbar arteries, lumbar branch of iliolumbar artery, common illiac
artery, sometimes obturator artery and deep circumflex artery.
Nerve Supply
A branch from the first lumbar nerve.
Action
Weak flexor of the trunk [3, 4, 5]
.

Fig 8 and 9: Location of Psoas Minor muscle

Plantaris
This muscle is sometimes double or absent in 10% of cases.
Origin & Insertion
It arises from lower part of lateral supracondylar line & the oblique
popliteal ligament. Its small belly is 7-13 cm long & ends in a long slender
tendon which crosses obliquely between Gastrocnemius & Soleus, runs

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distally along the medial border of the calcaneal tendon, fuses or insert with
it. It is inserted on the posterior surface of the calcaneum, medial to the
tendocalcaneus. Plantar aponeurosis is the enlarged part of the plantaris.
Vascular Supply
Superficially by lateral sural & popliteal arteries & deeply by lateral
superior genicular artery.
Innervation
Tibial nerve (S1& S2)
Actions
In human muscle is almost vestigial & is normally inserted well short of
plantar aponeurosis, usually in to calcaneus. Hence presumed to act with
Gastrocnemius. I.e. weak plantar flexor of foot & weak flexor of knee joint.
It has been considered to be an organ of proprioceptive function for the
larger, more powerful plantar flexors as it contains a high density of muscle
spindles. Plantaris may also provide proprioceptive feedback information to
the central nervous system regarding the position of the foot. The unusually
high density of proprioceptive receptor end organs supports this notion. Its
motor function is so minimal that its long tendon can readily be harvested for
reconstruction elsewhere with little functional deficit. It is an important
muscle in animals that walk on their toes for it then continuous over heel in
to the plantar aponeurosis [5, 6, 7].

Fig 10: Location of Plantaris muscle

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Pyramidalis
This is small triangular muscle. It is rudimentary in human beings. The
fibres run superiorly and medially to insert into the linea Alba at a point
midway between umbilicus and pubis. It lies within the rectus sheath,
anterior to the rectus abdominis muscle. Absent in 20% of cases. The muscle
varies considerably in size. It may be larger on one or both the side or
unilaterally present or absent.
Origin
Anterior surface of the body of the pubis
Insertion
Linea Alba at the midway point between umbilicus and pubis
Innervation
Subcostal nerve (T12)
Action
Uncertain; thought to tense the linea Alba [5, 8, 9].

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 Fig 11 and 12: Pyramidalis Muscle

Peroneus Tertius
It is separated part of the extensor digitorum longus, and may be
regarded as its fifth tendon. It may be absent. It is completely absent in 4.4%
cases. The muscle is highly variable.
Origin
Lower one fourth of the medial surface of the fibula and adjoining part
of the interosseous membrane.
Insertion
Medial part of the dorsal surface of the base of the fifth metatarsal bone.
Innervation
Deep peroneal nerve (L5, S1)
Action
Dorsiflexor of the foot at the ankle joint [5, 10]
.

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 Fig 13: Peroneus Tertius Muscle

References
1. https://en.m.wikipedia.org>wiki>Muscle
2. Dr. Chourasia BD. Human Anatomy, 4th Edition, CBS Publishers and
Distributers, New Delhi. 2007; 1:101-102.
3. Dr. Chourasia BD. Human Anatomy, 4th Edition, CBS Publishers and
Distributers, New Delhi. 2007; 2:318.
4. Romanes GJ. Cunningham’s Manual of Practical Anatomy, 15th Edition,
Oxford Medical Publications, New York. 2002; 2:180-181.
5. Henry Gray. Gray’s Anatomy. 38th edition, Edited by Williams PL,
Warwick R et al. Churchill Livingstone, New York, 1995, Section 7-
Muscle.

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6. Dr. Chourasia BD. Human Anatomy, 4th Edition, CBS Publishers and
Distributers, New Delhi. 2007; 2:112-113.
7. Romanes GJ. Cunningham’s Manual of Practical Anatomy, 15th Edition,
Oxford Medical Publications, New York. 2002; 1:195.
8. Dr. Chourasia BD. Human Anatomy, 4th Edition, CBS Publishers and
Distributers, New Delhi. 2007; 2:202.
9. Romanes GJ. Cunningham’s Manual of Practical Anatomy, 15th Edition,
Oxford Medical Publications, New York. 2002; 2:98.
10. Dr. Chourasia BD. Human Anatomy, 4th Edition, CBS Publishers and
Distributers, New Delhi. 2007; 2:100.

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 Chapter - 7
Research and Development of Kshara Sutra for
the Treatment of Ano-Rectal Disorders (ARDs)

Author
Dr. Varsha Saxena
Assistant Professor, Department of Shalya Tantra, Uttarakhand
Ayurveda University (UAU), Dehradun Main Campus,
Harrawala, Dehradun, Uttarakhand, India

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Page | 128
 Chapter - 7
Research and Development of Kshara Sutra for the
Treatment of Ano-Rectal Disorders (ARDs)
Dr. Varsha Saxena

Abstract
Ayurveda emphasizes the preventive and curative aspects of disease.
Common disorders of ano-rectal area treated with Kshara-sutra (medicated
thread) are Bhagandara (fistula-in-ano), Arsha (Hemorrhoids) and
Parikartika (Anal fissure) etc. Bhagandara and Arsha are categorized under
Astamahagada (eight major diseases) keeping in view their prognostic
significance. These disorders occur in peri-anal and perineal region, the seat
of Sadyahpranahara marma (vital area) and require skilled management.
Current surgical treatment methodologies for Bhagandara (fistula-in-ano) is
fistulotomy with secondary healing, fistulectomy with primary suturing and
Current surgical treatment methodologies is Arsha (Hemorrhoids) is
sclerotherapy, rubber band ligation, infra-red coagulation, cryo-surgery
(using nitrous oxide gas) and excisional hemorrhoidectomy. But sometime
complications following the treatment (sphincter incontinence, stricture,
continuous pus discharge etc.) are more severe than the disease.
To conflict above-mentioned complications, Kshar sutra (medicated
thread) is the accepted best alternative, surgical procedure, which is
successfully practiced in Ayurveda. This is first described in Sushruta
Samhita, later by Chakrapani datta. In 1964, the theoretical basis for revival
of Kshar sutra preparation was laid down by Dr. Shankaran and Dr. Pathak
under the guidance of Prof. Deshpande at Department of Shalya-Shalakya,
faculty of Ayurveda, BHU, Varanasi. They prepared Kshar sutra with
surgical linen (Barbour) 20 thread coated with latex of Snuhi (Euphorbia
neriifolia), Haridra (Curcuma longa) powder and Kshara made from the
whole plant of Apamarga (Achyranthes aspera). After that many researches
are completed successfully on treatment of ano rectal disorder by different
type of Kshara sutra in different Ayurvedic institution.
Keywords: Kshara sutra, bhagandara, fistula-in-ano, arsha, parikartika

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Introduction
Anorectal disorders are a group of medical disorders that occur at
perianal and the junction of the anal canal and the rectum. These disorders
are commonly encountered in general surgical practice. Patients with
diseases of the anus and rectum are some of the unhappy people in the
world. Anorectal disorders are common, and their prevalence in the general
population is probably much higher than that seen in clinical practice as most
patients do not seek medical attention. These affect men and women of all
ages. The spectrum of Anorectal disorders ranges from benign and irritating
(pruritus ani) to potentially life-threatening (anorectal cancer).
According to Indian Journal of Surgery, among 2000 consecutive
proctological examination, 72% incidence of haemorrhoids was found.
About 50% of the population of the world above fifty years aged people
suffers from haemorrhoids. According to Mayo’s Clinic, 3.4% of all the
entered patients were suffering from haemorrhoids. The condition was found
to be present in 10.3% of 283 males and 6.8% of 305 females between 10 to
30 years of age. In spite of tremendous advancement in modern surgical
field, still the Anorectal diseases have remained as a challenging task for its
management. Constant efforts have been made globally to meet this
challenge. Anorectal diseases are the group of diseases which are usually
neglected by general surgeons and physician. It may be due to various
factors like involvement of fecal matters, more probability of recurrence &
very complex related anatomy. Ayurveda creates some opportunities to
manage these neglected or referred Anorectal diseases for which Kshara
sutra has been chosen as choice of treatment and now a days with certain
ideal qualities, the Kshara sutra therapy has attained tremendous popularity
in the country. There are so many diseases of anorectal region but in present
era Kshara Sutra is applied to Bhagandara (Fistula in ano), Arshas
(Haemorrhoids), Parikartika (Anal fissure), Nadi Vrana (Pilonidal sinus)
and Apabhramsa (Rectal prolapse) etc. because these diseases have
grievance, high recurrence, more incidences and are difficult to treat. So it
can be said that among the available treatment modalities of ano-rectal
disorders (ARDs), Kshar sutra (medicated thread) appears to be the best in
terms of relief and non-recurrence.
Bhagandara (Fistula in Ano)
Sushruta defined it as a disease which causes splitting pain in vagina,
anorectal region and urinary bladder with resultant discontinuity of these
sites. He further added that a boil called as Pidikka when suppurates and

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bursts open become Bhagandara [1]. Vagbhata also mentioned it under Asta
Mahagadas [2] but added 3 types as Pariksha, Riju, Arsho-bhagandara.
Charaka gave a little description about Bhagandara in the chapter of Shotha
chikitsa of Chikitsa sthana [3].
The word Bhagandara is the combination of two terms “Bhaga” and
“Dharana” and the meaning of Bhaga is, all the structures around the Guda
including Yoni and Vasti. The second word Darana means splitting or
discontinuity with severe pain in any part of the body. Thus, Bhagandara is
a disease which causes tear or discontinuity in the region of Bhaga, Vasti and
Guda.
Classification of Bhagandara
Acharyas have classified the Bhagandara on the basis of Doshik
involvement and its pathogenesis.
Acharyas Classification of Bhagandara
Charak Samhita There is no description about the types of Bhagandara
According to Sushruta, there are five types of Bhagandara [4].
1) Satonaka-from Vata-dosha.
Sushruta 2) Ushtragreeva-from Pitta dosha.
Samhita 3) Parishrami-from Kapha-dosha.
4) Shambukavarta-from Tridosha.
5) Unmargi-from Agantuja factors
Vagbhata described eight types of Bhagandra and among these five
types are same as Sushruta and three types are extra-
Ashtanga
1) Pariksha- from Vata and Pitta dosha.
Sangraha
2) Riju- from Vata & Kaphadosha
3) Arsho-Bhagandara- from Pitta and Kaphadosha.

Prognosis
All types of Bhagandara are Krichchh-sadhya (curable with difficulty)
except Shambukavarta (Tridoshaja) and Unmargi (Agantuja), which are
Asadhya (incurable) [5, 6].
Fistula in Ano
A fistula is the Latin word for a reed, pipe or flute.
In surgery, it implies a chronic granulating track connecting two
epithelial lined surfaces. These may be cutaneous or mucosal. The
commonest source of ano-rectal abscess is believed to be the infection of a
hair follicle or a sebaceous gland or a sweet gland caused by local irritation,
excessive perspiration or purulent discharge from the rectum, vagina or
urethra.

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Cause of Fistula in Ano
An acute abscess in one or more potential spaces around anal canal.
Source of infection could be number of predisposing condition as-
 Anal fissure-infection
 An ulcer at the root of pile mass
 Infection from hair follicle
 Infected sebaceous gland
 Retained sutures after haemorrhoidectomy etc.
Symptoms of Fistula in Ano
 Swelling pain and discharge are the most frequent presenting
complaints of patients with an anal fistula.
 Swelling and pain are usually associated with abscess when the
external or secondary opening has closed.
 Pain off and on, pus discharge from an extra opening sometimes it
close itself and again open after pus formation.
 Deep seated abscess is the source of pus.
 Discharge may be from the external opening or may be reported by
the patient as mucus or pus mixed with the stool.
Diagnosis Fistula in Ano: Diagnosis is based on sign, symptoms and
examination of fistula-
 Chronic pus discharge sinus around the anal opening perianal
area.
Sign & Symptoms
 Off and on opening and closure of external opening.
 Pain due to accumulation of pus.
 Visual examination
 Per rectal (PR) Examination
Examination
 Probing
 Proctoscopy etc.

Investigations
Main purpose of investigation is to assess the general condition of
patients as well as associated systemic diseases. To find out the extent of
fistula and cause of recurrence.
 TLC, DLC, HB and ESR
Hematological examination
 Blood sugar, urea and cholesterol.
Radiological examination  X-Ray chest

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  KUB
 Spine, Hip joint
 Barium enema
 Fistulography
MRI
 ECG
Other miscellaneous examination  mantoux test
 Biopsy for tuberculosis/carcinoma.

Treatment of Fistula in Ano

1. Kshara Sutra Therapy
2. Laxatives: Stool softening measures are essential in fistula in ano
as soft and formed stools negotiate the rectum and anal canal in
non-traumatic physiologic maneuver.
3. For Easy Evacuation of Stools: Vaishvanara churna and
Panchasakha churna 1-2 g bedtimes.
4. Avagaha-Swedana (Sitz Bath): Triphala kwatha twice daily to
maintain local hygiene and diminish pain and inflammation.
5. Local Application: Jatyadi ghrita or Vrana Sodhana taila over the
wound to boost early healing.
6. To Reduce Pain and Inflammation: Triphala guggulu twice daily.
7. Antibiotic: A course of suitable antibiotic oral/injection is
recommended for 5 days after surgery.
8. Analgesics: Oral/ Injection analgesics recommended to alleviate
pain.
Arsha Roga (Hemorrhoid/Piles)
Arsha (Hemorrhoid) is a disease, which is very specific to human race
only, due to its erect posture. According to Ayurveda the disease comes
under the heading of Mahagadas [7] as it is: Dirghakal anubandh,
Dushchikitsya in nature, Tridoshic and involves the Marma. Arshas occurs in
Godabhaga, which is undoubtedly a Marma, and it is well known for its
chronicity and is difficult to treat. If not treated properly or neglected, it may
lead to complications such as strangulation, thrombosis, portal pyaemia,
fibrosis, suppuration, hemorrhage etc. Sushruta has mentioned four lines of
management such as: Bhaisaja-chikitsa, Kshara-karma, Agni-karma and
Sastra-Karma [8]. According to Vagbhata, Arsha is a muscular projection
(Mans-kila) which troubles the patient like an enemy [9]. Arso Bhagandara is

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a disease in which Arshas is associated with Bhagandara as suggested by
Vagbhata, where it has been suggested Arshas is treated before the treatment
of Bhagandara.
 Arsha is originated by Sanskrit word “Ari” means enemy.
 Piles is originated from Latin word “pila” means ball.
 Hemorrhoid is originated from Greek word “Haema” means blood
and “rhoos” means flowing.
Etiology of Piles
 Hereditary
 Constipation and straing
 Chronic dysentery and diarrhea
 Diet which is excessive chills, excessive hot and spicy, less fiber
product and less intake of milk product.
 Suppression of natural urges of passing urine, stools and flatus.
 Increased pressure on superior hemorrhoid vein as pregnancy.
 Other secondary cause as liver disorders etc. and abdominal tumors.
Features of Piles (Arsha)
 Bleeding with stool
 With or without constipation
 Protruding mass on straining or defecation
 Blood loss causes anemia and associated weakness, lethargy and
dizziness etc.
 It is classified in 1st degree, 2nd degree, 3rd degree and 4th degree
piles.
Treatment of Piles
 For 1st degree piles = Ayurvedic medicines
 For 2nd degree, 3rd degree = Kshara sutra treatment
 4th degree piles = Surgery
Complication of Piles: If piles not treated
 Bleeding-Anemia
 Strangulation piles-Emergency
 Thrombosed piles-Emergency

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  Ulceration
 Suppuration-Infection
 Leading to fistula formation.
Parikartika (Anal Fissure)
Jejjata have clearly described Parikartika as a condition which causes
cutting pain in anorectal region.
Anal fissure is a longitudinal crack in the long axis of lower anal canal.
Main Features
 Pain at anal area, which increase after passing stool
 Agonizing pain, patient prefers to remain constipated rather than
going through the agony of defecation.
 Bleeding- Stool are streaked with blood.
 Pain in either initiated or aggravated with the passage of hard
stools.
 Burning sensation at the anal opening.
 Swelling: A large sentinel tag causing painful external swelling.
 Urinary symptoms: Some patients may develop retention, dysuria or
increased frequency.
Treatment of Anal Fissure
 Sitz bath (hot water fomentation)
 Local medicated oil application for healing of wound.
 Laxative and Digestants for smooth passage of stool and gases.
 Sometimes medicine to check the bleeding.
 Kshara sutra application for chronic cases.
Development of Kshara Sutra
This is very simple and safe method for treatment of different Ano-
rectal disorders (ARDs). This is scientifically validated technique by ICMR
at PGI (Chandigarh), AIIMS Delhi, JIPMER Pondicherry and proved better
and conventional surgery. This is one of the biggest scientific breakthroughs
of ayurvedic research in the last 50 years. Now a day Kshara sutras is
practiced in abroad like Japan, Sri Lanka etc. and Kshara sutra references
existing in allopathic surgery text books also.

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Kshara + Sutra= Kshara Sutra
Kshara is an alkaline salt of plant origin and Sutra is thread so it can be
said that Kshara Sutra is an alkaline thread. Kshara Sutra is first described
in Sushruta Samhita, later by Chakrapani datta. In 1964, the theoretical
basis for revival of Kshara-sutra preparation was laid down by Dr.
Shankaran and Dr. Pathak under the guidance of Prof. Deshpande at
Department of Shalya-Shalakya, faculty of Ayurveda, BHU, Varanasi. They
prepared Kshara-sutra with surgical linen (Barbour) 20 thread coated with
latex of Snuhi (Euphorbia neriifolia), Haridra (Curcuma longa) powder and
Kshara made from the whole plant of Apamarga (Achyranthes aspera) etc.
Contraindications of Kshara Sutra Application
It is necessary to treat these conditions before the application of Kshara
sutra-
1) Diabetes mellitus.
2) Tuberculosis.
3) Chronic ulcerative colitis.
4) Prostatic infections.
5) Osteomyelitis of pelvic bone.
6) Pott’s disease of spine.
7) Carcinoma of rectal region.
Standardization of Kshara Sutra
Standardization is an important step for the establishment of a consistent
biological activity, a consistent chemical profile or simply a quality
assurance program for production and manufacturing of herbal drugs. WHO
specific guidelines for the assessment of the safety, efficacy and quality of
herbal medicines, as a prerequisite for global harmonization, are of utmost
importance. For gaining popularity and acceptability, any treatment needs to
be standardized and Kshara sutra is considered as medical device, so to
maintain its quality level depending on different parameters it should be
standardized. Standardization includes.
1) Selection and Collection of Raw Drug
2) Pharmacognostical characteristics
 Stem bark extract
 Latex extraction
3) Analysis of extracts

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  Solubility and pH value
 Organoleptic characters
 Physico-Chemical parameters
 Phytochemical Analysis: (Phytochemicals are those chemical
compounds that occur naturally in plants and responsible for color
and organoleptic properties, such as the deep purple of blue berries
and smell of garlic).
Thin Layer Chromatography (TLC)
Thin-layer chromatography, is a solid-liquid form of chromatography
where the stationary phase is normally a polar absorbent and the mobile
phase can be a single solvent or combination of solvents.
High Performance Liquid Chromatography (HPLC)
High performance liquid chromatography (HPLC) is a technique used in
herbal drugs identification and characterization. Preparative and analytical
HPLC are widely used in pharmaceutical industry for isolating and
purification of herbal compounds. There are two type of preparative HPLC:
Low pressure HPLC (typically under 5 bar) and high pressure HPLC
(pressure >20 bar) [10, 11].
Fluorescence Analysis Study
Fluorescence analysis study of powdered drug material with different
reagents was carried out to observe the color reactions.
Mechanism of Action of Kshara Sutra
 Kshara sutra is attributed with anti-bacterial effect [12]
 Turmeric is universally known for its anti-bacterial, anti-fungal and
anti-inflammatory properties.
 Necrosis of unhealthy granulation and proliferation of new
connective tissue takes place under the influence of Kshara present
in the thread prepared with Achyranthes and corrosive nature of
latex of Euphorbia.
 Drugs incorporated in the thread are delivered layer by layer to the
local pathological tissue planes and debrides the unhealthy
granulation, this enhances the healing process.
 Kshara sutra exerts mechanical pressure on the tissue as it is tightly
applied on the fistulous tract. It cuts the tissue and augments
healing.

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  Kshara acts as a powerful debridement agent and selectively acts on
unhealthy granulation, pus pockets, etc. This process of
debridement and healing starts from deeper tissues and travels
toward periphery [13].
 Latex of Snuhi is proteolytic; therefore dissolve the tissue of
fistulous tract.
 Apamarga kshara is alkali which debrides the fistulous tract and
liquidates the thick pus. It keeps the tract clean and help in drainage
of pus.
 Special linen thread holds the medicine with the help of latex for 3-
4 days in the fistulous tract.
 Physical presence of Kshara sutra in the fistulous tract keeps the
passage patents and helps in the drainage of pus.
 Kshara Sutra ligation exerts mechanical pressure along with
chemical cauterization. Therefore in initial 3 days cutting of the
tract occur.
 After cutting of fistulous tracked by Kshara sutra in initial days the
follow up of 3-4 days is healing time for the wound. Therefore
cutting and healing per week is achieved.
 Cutting and healing go side by side so there is no time for
accumulation of pus in cavity.
 Alkali of Kshara sutra when applied with medicated oil it forms
foam which clean the tract.
Research Work Done on Kshara Sutra
As it is already mentioned that the supremacy of Kshara sutra has been
proved for its simplicity, surety and safety with least inconvenience
recurrence and ambulatory modalities. With these certain ideal qualities, the
Kshara sutra therapy has attained tremendous popularity in the country.
Such dynamic therapy has to be scientifically analysed from every angle for
its efficacy.
The standard Kshara sutra being prepared in the department with the
combination of mainly 3 ingredients Snuhi ksheer, Apamarga kshara,
Haridra churna. Time to time modifications has been carried out in
manufacturing of Kshar sutra.

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 Research Work Researcher Year
Role of Kshara Sutra in the Treatment of Bhagandara K.R. Sharma 1968
(F.I.A.)
Ingredient: Snuhi Ksheer 11 coating
Apamarga Ksheer- 7 coating
Haridra Powder- 3 coating
Brief: The Kshara Sutra prepared by this ingredient by Dr.
K.R. Sharma was considered as Standard “Kshara Sutra” and
the method is known as Standard method. After that various
modification during development of Kshara Sutra preparation
was done.
Effect of Arka Kshar Sutra in the Treatment of F.I.A. R.K. Jain 1975
Role of Udumbar Ksheera Sutra in Bhagandra Raman Singh 1984
Role of Udumbar Ksheera Sutra in the Management of M.K. Jalan 1984
Bhagandra
Ingredient: Undumbar Ksheer
Apamarga Ksheer
Haridra Powder
Brief: Udumbar Kshara is easily available in abundance has
no problem of collection and has better results, if it is
judicially used in selected cases of F.I.A. especially of low
anal type. Tying the knot is an extra care during treatment it’s
bleeding nature by using Udumbar Kshara sutra. Thread may
be slip during the course of treatment so take special
precaution
Role of Papaya Ksheera Sutra in Bhagandara O.P. Singh 1985
Ingredient: Papaya fruit juice
Papain powder (Coating 11 time)
Haridra Powder (Coating 2-3 times)
Surgical linen thread no. 20
Unit Cutting Time (U.C.T.)= Ranged from 9-10 days/cm
Average U.C.T. =10.04
days/cm
Brief: In 50 cases of F.I.A. treated by Papaya sutra 49 cases
cured and would completely healed with healthy scar, 1 case
recurred after 6 months and again treated by Papaya sutra.
Studies on Kshara Sutra Prepared by Snuhi Swarasa Arvind Gupta 1986
Ingredient: Snuhi Swaras juice (by crushing Snuhi plant stem)
Apamarga Kshar
Haridra churna
In Swaras requires little bit more coating of Swaras than the
Snuhi ksheera.
Studies on Papaya Ksheera Sutra in Cases of F.I.A. Rajendra 1987
Prasad
Effect of Modified Kshara Sutra in the Management of P.C. 1988
F.I.A. Ravishankar
Studies on Yava Kshara (gated) in the Management of Anand 1990
F.I.A. Vidyarthi

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Ingredient: Snuhi Ksheer
Yava Ksheer
Haridra Powder
 Yava Kshara is hygroscopic in nature, anti-inflammatory
fibrinolytic due to its hygroscopic and debriding capacity.
 UCT - 7.15 days/cm in 31-40 years of age group
 More in previously operated cases than fresh case. Lesser
the track faster the cutting and longer the track slower the
cutting.
Effect of Kshara Sutra prepared from Chloroform Soluble S. Ram Reddy 1991
latex of Euphorbia
Ingredient: Apamarga Kshar
Snuhi Ksheer Pista (collected material of whole
latex)
Haridra Churna
Chloroform
Surgical linen thread no. 20
Brief: Duration of treatment greatly reduced. UCT is lower
than any modified Kshara Sutra and is also lower than partial
fistulectomy followed by Kshara Sutra application. No
recurrent case, economic method, useful in preservation of
latex and in large scale production.
Critical Analysis and Assessment of Kshara Sutra in the Rao J. 1993
Management of F.I.A. Narsingha
UCT is short in younger age and its increased in proportion to
increase of the age
UCT
 Significantly less in males than females
 Less in Paris Ravi bhagandara
 High in Shambukavarta bhagandara
 Minimum in sub mucous type
 UCT increased in proportion to chronicity of disease
 UCT maximum in previously operated cases, recurrence
cases
 The success rate of Kshara Sutra has been studied as
97.52% wit negligible recurrence of 2.48% in 2500 cases of
anal fistulae.
Evaluation of Ghrita-Kumari Kshara Sutra in F.I.A. P. Subba 1994
Ingredient Ghrita Kumari 11 coating Reddy
Apamarga Kshara 7 coating
Haridra powder 3 coating
Brief
 Average unit cutting time with Ghrita Kumari in relation to
age group shows almost uniform cutting in all age groups
from 10-50 years except slight variation in 21-30 year age
group.
 UCT is faster in more chronic fistula in comparison to
fistula of recently recent origin. No specific relation
between UCT and site of the fistulous opening.

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 Cutting rate is faster in Paris Ravi and sub-mucous type of
Bhagandara in comparison to other varieties.
 Cutting rate is slow in previously operated cases (recurrent)
than the non-operated cases in both groups.
 UCT by Snuhi Kshar Sutra in both groups-8.93 days/cm and
UCT by Ghrita Kumari- 7.55 days/cm.
 It shows Ghrita Kumari Kshara Sutra is more effective than
the Snuhi Kshara Sutra.
 No recurrence has been found since 1 year
Effect of Snuhi Ksheer Extract Kshar Sutra in F.I.A. Raj Kishore 1995
Ingredient: Latex of Snuhi Shah
Apamarga Kshara
Haridra Churna
Brief
 The Kshara Sutra prepared by active principles of Snuhi
ksheer (Triterpene) has greatly reduced the total duration of
the time in comparison to standard Kshar sutra.
 Burning and irritation during the primary application and
successive change of K.S. was quite less, probably different
anti-inflammatory properties of triterpene and Preservatory
problem and recurrence cases were very less.
Studies on F.I.A. Treated with Kshara Sutra with Tankana Ravi Kumar 1996
(Borax) Singh
Ingredients
- Purified borax powder
- Apamarga Kshara powder
- Snuhi Ksheer
- Haridra powder
- Surgical linen thread no. 20
Brief
 The easy availability of Sudha Tankan powder and non-
absorbing quality for moisture are the basis of this present
work.
 Tankana Kshara Sutra is easily tolerated by the patient
during treatment irritation in comparison to control cases, no
burning sensation during and after application.
 Unit cutting time in comparison to control cases is almost
similar.
 Tankan Kshara is easily available easy to prepare Kshara
Sutra, does not take moisture on storage of Kshara Sutra, so
stored for long time, and helpful to increase the duration of
regular visit of patient to doctor to change their threads.
Role of Tikshna Kshara Bhavita Sutra in the Management M. Mrityunjay 1996
of F.I.A. Rao
Study of Guggulu Based Kshara Sutra in the Management Praveen 1999
of Bhagandara (F.I.A.) Kumar
Study of Guggulu Based Kshara Sutra in the Management A.K. Yadav 2000
of High Anal Fistula

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Ingredient
- Guggulu latex
- Apamarga Kshara
- Haridra Churna
Brief
 Guggulu has sticking property, Vrana Shodhana,
Vranaropana, Putihara, Jantughna and Vedana sthapana
properties.
 It has anti-inflammatory property, effective in controlling
inflammation and edema and wound healing. Guggulu based
Kshara sutra is not mentioned in any text book.
 Preparation of Guggulu based Kshara sutra is relatively
easy in comparison to standard Apamarga Kshara sutra and
have easy availability in every season.
 Causing minimal pain during and after application of
comparison to standard Apamarga with K.S.
 Well tolerated by patient, no allergic reaction, discharge
from fistulous track reduced relatively.
 Total duration of treatment can be reduced relatively with
standard K.S and inflammation is markedly reduced.
Role of Guggulu Based Kshara Sutra in the Management S.K. Singh 2002
of Recurrent High Anal Fistula
A Study of Anal Sphincter Tone of Patient with F.I.A. A.A.J. Pushpa 2005
Treated by Kshara Sutra Kumar
Study on Karvira Kshara Sutra for Treatment of Sunil Kumar 2010
Shambukavarta Bhagandara Pandey
Standardization of Kshara Sutra and Its Application in Varsha Saxena 2014
Different Anorectal Diseases
Brief
 To standardize preparation of Udumber (latex and stem
bark) based Kshara-sutra.
 To prepare the clinically useable forms and application of
three types of Kshara-sutra (Snuhi, Guggulu & Udumber) in
the management of selected Anorectal diseases i.e. Fistula in
ano, Hemorrhoids, Pilonidal Sinus and Prolapse Rectum.

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