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Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Management of oedema and swelling using a combination of Haridra (Curcuma longa extracts as curcumin), Pine Apple stem (Anana squamosal extracts as
bromelain) and Shallaki (Boswellia Serrata extracts as boswellic acid)
Dr. Nitin ChaubeAyushya Varsha Clinics and Ayurveda Health Café
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
INTRODUCTION
The Ayurvedic view of swelling is primarily pittaja with a kaphaja co-existence (in a freshly induced injury resulting in a vitiated Agni and Vayu mahabhoota’s); however in all other latter conditions this translates to either a kapha-vataj or a kaphaj condition with pitta getting self-limited (progressive vitiation of Jal, Vayu and Prithvi mahabhoota’s and regression of agni mahabhoot).
Inflammation
oedema
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
INTRODUCTION
vitiate pitta by different mechanisms
Pine Apple (Anana squamosal)
Shallaki (Boswellia serrata)
Turmeric (Curcuma longa)
TRAUMATISED TISSUE
+
reduce jal and prithvi mahabhoot’s,
the vitiated and trapped vata moves out of the srotas
Anti-InflammatoryAnti-Oedematic
activity
+
+
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
MATERIAL
MaterialThe clinical observational study included using extracts in the form of Bromelain, Boswellic Acid and curcumin. The study has been on-going and observations recorded across various patient pools as represented by the table below.
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
INDIVIDUAL INGREDIENTS
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
INDIVIDUAL INGREDIENTS (BROMELAIN)
Bromelain – extract derived from the stems of pineapples has - anti-inflammatory effectsmight interfere with the growth of tumor cells and slow blood clotting.
Ayurvedic constitution – In the Ayurvedic sense since it has an enzymatic property which is catabolic in character (a Pitta-Vataja function) representing lyasing activity and replacement (a vataja property)The anti–oedematic property may likely be due to the nature of chemical bonding and covalent characters of the carbon chain and nitrogen in the context of proteins.
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Boswellic Acid – Boswellic acids are pentacyclic triterpene molecules found in the resin of the plant that exudes them.
INDIVIDUAL INGREDIENTS (BOSWELLIC ACID)
Ayurvedic constitution – Boswellic acid would present this complex group of chemicals with an amla attribute which is a pittaja function. The pathway of action of these molecular substrates is likely to be classically similar to traditional enzymatic activity of catabolism. The reason why it reduces stiffness is due to the likely model of acid and base and hence it may induces some formation of jal mahabhoot which seems to induce lubrication in case of its singular use in arthritis and also reduces inflammation, rubour and heat..
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Curcumin is the principal curcuminoid of turmeric and is a natural phenol.curcumin, as an antioxidants, can be a "double-edged sword" and may have carcinogenic and pro-oxidant effects in addition to anticancer and antioxidant effects. Curcumin is known to be anti-inflammatory, antioxidant, chemopreventive and chemotherapeutic
INDIVIDUAL INGREDIENTS (CURCUMIN)
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Ayurvedic Constitution – In the Ayurvedic context curcumin may be understood to have pittaja properties.The chemical character of curcuminoids is that of Alkaloids which are primarily lipid derivatives and usually lipid soluble or emulsifiable constituents.This may be a reason for its anti-inflammatory response coupled with anti-pyretic responses at the same time. This combination of the activity may signify a pitta-kaphaja coexistence and may explain the bilateral activity of curcuminoids acting both as anti-inflammatory and anti-pyretic at the same time.
INDIVIDUAL INGREDIENTS (CURCUMIN)
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
MECHANISM OF ACTION OF INDIVIDUAL INGREDIENTS AND SYNERGIES
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
BROMELAIN
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
ROLE OF BROMELAIN ACCORDING TO MODERN MEDICINE -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
MUSCLE CELL SURFACE ENVIRONMENT –
The lipoproteinous environment of muscle cell membrane -
Proteins in the Ayurvedic context may be interpreted as (Prithvi+Agni+Akash).
ROLE OF BROMELAIN ACCORDING TO AYURVEDA -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
HYPOTHESIS OF CHANGES TO MUSCLE CELL STRUCTURE IN TRAUMA -
Post Traumatic Lipoprotein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak)
Lipoprotein(P(pr)+Ag(pr)+Ak(pr))
+ Trauma (V(t)
Post Traumatic freshly oedematised Lipoprotein environment (P(tr)+V(tr)+J(tr))
Post Traumatic oedematised Lipoprotein environment (P(tr)+J(tr))
(Vata and Jal due to induction of microvascular injuries take the place of Akash)
(combine with Prithvi to create a stiff and lesioned site with rubour)
(Prithvi is reduced and Agni is replaced with Jal component which is increased)
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
UNDER TREATMENT HYPOTHESIS FOR BROMELAIN -
Bromelain (Agni and Vata) (P(br)+Ag(br)+V(br)
Post Traumatic oedematised Lipoprotein environment (P(tr)+J(tr))
+
Under Treatment Lipoprotein Environment (P(ut)+Ag(ut)+V(ut)+J(ut)) [stage 1]
Under Treatment Lipoprotein Environment (P(ut)+Ag(ut)+V(ut)) [stage 2]
Lipoprotein(P(pr)+Ag(pr)+Ak(pr))
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
SUMMARY OF EVENTS -
Protein(P(pr)+Ag(pr)+Ak(pr)) + Trauma (V(t) Post Traumatic Protein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak) Post Traumatic freshly oedematised Protein environment (P(tr)+V(tr)+J(tr)) Post Traumatic oedematised Protein environment (P(tr)+J(tr)) + Bromelain (P(br)+Ag(br)+V(br) Under Treatment Protein Environment P(ut)+Ag(ut)+V(ut)+J(ut)) [stage 1] Under Treatment Protein Environment (P(ut)+Ag(ut)+V(ut)) [stage 2] Protein(P(pr)+Ag(pr)+Ak(pr))
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
MODEL OF AYURVEDIC ACTION OF BROMELAIN -
Fig. 1. – Proposed model for Action of Bromelain in a traumatised tissue.
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
BOSWELLIC ACID
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
ROLE OF BOSWELLIC ACID -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
ROLE OF BOSWELLIC ACID -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Boswellic (rich in Agni, Jal and Vayu Mahabhoot’s
Post Traumatic Lipoprotein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak)
+
Under Treatment Lipoprotein (P(ut)+Ag(ut)) + (J + V)
Lipoprotein(P(pr)+Ag(pr)+Ak(pr))
AYURVEDIC HYPOTHESIS OF ACTION OF BOSWELLIC ACID -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Lipoprotein(P(pr)+Ag(pr)+Ak(pr)) + Trauma (V(t) Post Traumatic Lipoprotein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak) +Boswellic Acid (Ag(ba)+J(ba)+V(ba)) Under Treatment Lipoprotein (P(ut)+Ag(ut)) + (J + V) [Stage 1] Lipoprotein(P(pr)+Ag(pr)+Ak(pr))
SUMMARY OF EVENTS-
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
MODEL OF AYURVEDIC ACTION OF BOSWELLIC ACID -
Fig. 2. – Proposed model for Action of Boswellic Acid in a traumatised tissue.
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
CURCUMIN
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
ROLE OF CURCUMIN –
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
ROLE OF CURCUMIN –
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
HYPOTHESIS FOR THE AYURVEDIC MODEL OF ACTION OF CURCUMIN –
Post Traumatic Lipoprotein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak)
+
Under Treatment Lipoprotein (P(ut)+Ag(ut)) + J(ut) + V(ut) +Ak) [Stage 1]
Lipoprotein(P(pr)+Ag(pr)+Ak(pr))
Curcumin (P(cr)+Ag(cr)+J(cr)+V(cr))
Under Treatment Lipoprotein (P(ut)+Ag(ut)) +Ak )+(J+V) [Stage 2]
Heat
Heat + Jal as Sweat
Jal as Sweat
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
SUMMARY OF EVENTS -
Lipoprotein(P(pr)+Ag(pr)+Ak(pr)) + Trauma (V(t) Post Traumatic Lipoprotein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak) + Curcumin (P(cr)+Ag(cr)+J(cr)+V(cr)) Under Treatment Lipoprotein (P(ut)+Ag(ut)) + J(ut) + V(ut) +Ak) [Stage 1] Under Treatment Lipoprotein (P(ut)+Ag(ut)) +Ak )+(J+V) [Stage 2] Lipoprotein(P(pr)+Ag(pr)+Ak(pr))
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
MODEL OF AYURVEDIC ACTION OF CURCUMIN -
Fig. 3. – Proposed model for Action of Curcumin in a traumatised tissue.
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
SYNERGY
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
Protein(P(pr)+Ag(pr)+Ak(pr)) + Trauma (V(t) Post Traumatic Protein environment (P(tr)+Ag(tr)+V(tr)+J(tr)) + Ak) Post Traumatic freshly oedematised Protein environment (P(tr)+V(tr)+J(tr)) Post Traumatic oedematised Protein environment (P(tr)+J(tr)) + Bromelain (P(br)+Ag(br)+V(br) +Boswellic Acid (Ag(ba)+J(ba)+V(ba)) + Curcumin (P(cr)+Ag(cr)+J(cr)+V(cr)) Under Treatment Protein Environment (P(ut)+Ag(ut)+V(ut)+J(ut)) + [(Heat + stiffness)V(ut)+P(ut)] [stage 1] Under Treatment Protein Environment (P(ut)+Ag(ut)+V(ut)) [stage 2] Protein(P(pr)+Ag(pr)+Ak(pr))
THE SYNERGY -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
THE SYNERGY -
Fig. 4. The mechanism of action of the combination
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
CLINICAL EVIDENCES
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
The formulation has been used in about 135 patients across various conditions as in – Allergic RhinitisArthritisRheumatoid ArthritisHaemorrhoidsTraumaPyometraDiabetic foot SCLC stage 3 B
Disorder Number of patients
Allergic Rhinitis 28
Arthritis 70
Rheumatoid Arthritis 9
Haemorrhoids (grade III) 15
Traumatic injury 7
Pyometra 3
Diabetic foot 2
SCLC Stage 3b (1 Patient) 1
CLINICAL EVIDENCES -
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
CLINICAL EVIDENCES -
Conditions Evaluated Starting dose End doseSigns Monitored
Period of evaluation
7 days 15 days 30 days 90 days 120 days 180 days
Allergic Rhinitis2 Bid X 15 days for first month
2 BidX 7 days every month
Heaviness in chest
Reduced Reduced Not Found Not Found Not Found Not Found
28 PatientsPurulence of cough
Absent Absent Absent Absent Absent Absent
Rhinohrrhoea Absent Absent Absent Absent Absent Absent
Arthritis2 BidX 30 days for first month
2 BidX 7 days or 15 days
Osteo ArthritisSwelling around joints
Reduced Reduced Absent Absent Absent Absent
70 patientsRestriction in movements
Reduced Reduced ReducedNo movement restriction felt
No movement restriction felt
No movement restriction felt
Oedema ReducedGreatly Reduced
Absent Absent Absent Absent
weight No change No change No change No change No change No change
Pain Reduced Reduced Reduced Reduced Reduced Reduced
Rheumatoid Arthritis
Aggravated stateSwelling around joints
Reduced Reduced Reduced Absent
7 patientsRestriction in movements
Reduced Reduced Reduced Absent
Oedema Reduced Reduced Reduced Absent
Pain No change No changeslightly reduced
reduced
Conrolled StateSwelling around joints
Reduced Reduced Absent Absent
2 patientsRestriction in movements
Reduced Reduced Absent Absent
Oedema Reduced Reduced Absent Absent
Pain Reduced Reduced reduced reduced
(ABC - Triple Combination) observations as an adjuvant therapy
Not evaluated
Not evaluated
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
CONCLUSION
Ayushya Varsha Clinics and Health Café’s
10/12/2013 International Conference and Exhibition On Traditional & Alternative Medicine - 2013
CONCLUSION –
On the basis of the likely models and the clinical table posted above it is of significance to note that as an adjuvant it is an effective combination – in the management of oedema.It has potent anti-inflammatory properties
The likely models of activities and their synergies present with a wide range of possibilities as in –
trauma or trauma like conditions which may be induced for varied reasons – As disease related infectionAutoimmune reactions and associated inflammationsAge related degradations as in osteo-arthritis and related inflammationIn conditions like allergic rhinitis and psoriasis which have a genetic or immune disposition and as a result may present a cross infected state accompanying in pain, inflammation, oedema; as in either of the conditions or all of them together in complexity.
Hence, it may be used variably across a wide ranging platform as a primary medication for supportive and also parallel therapies.