Aushadha

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Aushadha means medicine or drug. It is used for the preservation of health and the treatment of diseases. Aushadha is used for regaining health, and its appropriate use is as beneficial as nector, whereas inappropriate use makes it a poison.[1] The aushadha may be used either in combination or as a single drug. In the context of using a single aushadha, a description of agrya prakarana (superior aushadha) with 152 entities is found in Charak Samhita [Cha. Sa. Sutra Sthana 25/40] and 155 entitites in Ashtanga sangraha.[2] Ashtanga Hridaya described 55 entities.[3] [A. Hri. Uttar Tantra 40/48-58] Aushadha is among the four aspects of the healthcare system with the physician, attendant, and patient. [Cha. Sa. Sutra Sthana 9/3] All dravya in the world are derived from five mahabhutas (prithvi, apa, agni, vayu and akasha). The sharira is a constitution of panchamahabhuta in variable proportion. Any imbalance in this proportion can alter homeostasis and cause disorders. Dravya of a particular panchamahabhautika composition is required to normalize the composition of panchamahabhuta in sharira. For example, if a disease originated due to insufficiency of apa mahabhuta, then dravya rich in apa mahabhuta is administered to patient to increase the quantity of apa mahabhuta back to normal. Since all dravyas have a specific panchamahabhautika constitution, they can be used to establish normal homeostasis of panchamahabhutas of sharira and treat disease. Since aushadhi too is a dravya and similarly treats the disease, thus all the dravyas are aushadhi[4] [Cha. Sa. Sutra Sthana 26/12] [Su. Sa. Sutra Sthana 41/9] Effectively managing a disease requires correct identification, dosage and time of administration of aushadha. Selection of the right aushadha requires understanding its mode of action. To prevent the untoward effects of aushadha, it’s essential to know that the aushadha are patient-specific, location-specific, and season specific. Examination of aushadha must not be missed prior to its use. This chapter describes various aspects of aushadha.
Contributors
Section/Chapter/topic Concepts / Aushadha
Authors Bhojani M.K.1,
Rahul Anand1
Reviewer Basisht G.2
Editor Deole Y.S.3
Affiliations 1 Department of Kriya Sharira, A.I.I.A., New Delhi, India,
2 Rheumatologist, Orlando, Florida, U.S.A.,
3 Department of Kayachikitsa, G.J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Anand, Gujarat, India
Correspondence email meera.samhita@aiia.gov.in,
carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of first publication: December 13, 2022
DOI 10.47468/CSNE.2022.e01.s09.120

Etymology and derivation

  • The vegetations that die when their fruits mature are called ‘aushadhi’. Example, the plants of banana and grain.[5]

The rasa (essence) is called osa. Entity that contains this rasa is called ‘aushadhi’. As disease-free state is obtained through rasa, so the entity that contains rasa is called aushadha.[6]

  • Aushadha is the plant which perish after fruits mature. [Cha. Sa. Sutra Sthana 1/73].

Synonyms [Cha. Sa. Chikitsa Sthana 1/1/3]

  • Chikitsita: That which alleviates disorders.
  • Vyadhihara: destroyer of diseases.
  • Pathya: beneficial for the channels in body.
  • Sadhana: that which is an instrument for performance.
  • Prayaschitta: expiation.
  • Prashamana: pacification.
  • Prakritisthapana: that which helps recovery.
  • Hita: wholesome.
  • Bheshaja: therapeutics

Classification

  1. Aushadha is of two types- [Cha. Sa. Chikitsa Sthana 1/1/4]
    1. That which promotes strength (and immunity).
    2. That which alleviates disorders.
  2. Aushadha can also be classified as-[7]
    1. Shamana aushadha: Shamana therapy is a palliative approach that normalizes the vitiated dosha at the seat of aggravation.
    2. Shodhana aushadha: Shodhana (purification) is a therapy in which the aggravated dosha is expelled from the body, thereby eliminating the internal causative factors of the disease.
      Shodhan aushadha is again of two types:
      1. Agneya aushadha: Aushadha that are predominant in agni and vayu mahabhuta.
      2. Soumya aushadha: Aushadha predominant in apa, akash and prithvi mahabhuta.
  3. Sushruta mentioned that all dravya is aushadha, and then classified aushadha into two:
    1. Sthavara: Entities of plant origin are called sthavara. The sthavara are of four types:
      1. Vanaspati: Those bearing fruits without being preceded by flowers.
      2. Vriksha: Those bearing both flowers and fruits.
      3. Virudh: These are creepers and shrubs.
      4. Aushadhi: Those which perish after the ripening of fruits.
    2. Jangama: Entities of animal origin are called jangama. The jangama are of four types:
      1. Jarayuja: Viviporous class of creatures like animals, human beings, beasts, etc.
      2. Andaja: Living beings originated from eggs like birds, snakes, creeping animals, etc.
      3. Swedaja: Organisms believed to be originated from sweat, like worms, insects, ants, etc.
      4. Udbhijja: Organisms believed to be originated from the soil, like cochineal insects, frogs, etc.

    Assessment criteria

    Qualities for assessing the superior nature of an aushadha are its abundant availability, effectiveness, capability to be converted into various pharmaceutical forms, and excellence of composition. [Cha. Sa. Sutra Sthana 9/7] Moreover, the aushadha possessing appropriate lightness, appearance, taste, roughness or softness, smell, grown in proper place, not vitiated by insects, and not burnt is considered a superior quality product.

    Characteristics

    Identification and proper administration of aushadha

    The aushadha are found in all vegetation like hills, forest, etc.; one may find it difficult to identify the correct aushadha. In this situation, help can be sought from the local goatherds, shepherds, cowherds, and other forest dwellers. The local people are accustomed to the aushadha of their respective areas by name and form. The aushadha may treat the patient if administered by the physician who knows the aushadha in its entirety or may prove lethal if administered by a physician who is unaware of the principles governing the correct application of aushadha. Thus, the patient should not take aushadha prescribed by psudo-physicians, nor by a physician who is not proficient in the principles governing the application of aushadha. [Cha. Sa. Sutra Sthana /121-133] Only the substance which can bring about a cure, is a correct medicine. [Cha. Sa. Sutra Sthana 1/135].
    The aushadha was identified in ancient era mainly by their morphological characteristics and aroma. Current advanced techniques for identification of herbs include DNA markers that use nucleotide sequences to identify species. This technique is tissue specific and has a high discriminating power.[8] Several researchers use DNA barcoding for identification of medicinal herbs.[9] Researches are carried out to develop a modern smartphone leaf picture recognition tool for medicinal plants. This is a software that operates on the operating system Android. It will have two key functions, i.e. recognition of medicinal plants and quest data for medicinal plants.[10] In Sri Lanka, a database was created from scanned images of leaves and flowers for identification of rare species of plants.[11] Identification of medicinal herbs is also carried out based on their image using first order feature extraction and multiclass svm algorithm.[12]

    Dose (matra) of aushadha

    • Matra is a measure of any kind, quantity, size, duration, number, degree, etc. Aushadha matra can be divided into:
      1. Matravat aushadha: When aushadha is administered in optimum dose.
      2. Amatravat aushadha: When aushadha is administered in improper dose. Amatravat aushadha can be divided into
        1. Heena matra (insufficient dose): The quantity of administered aushadha less than its optimum dose is its heena matra. Heena matra is unable to treat disease and does not bring about the homeostasis of dhatu.
        2. Ati matra (excess dose): The quantity of administered aushadha more than its optimum dose is its ati matra. The ati matra causes the vitiation of tridoshas leading to other undesired results. The ati matra of aushadha is excreted out of the body without being absorbed. It can lead to complications.
    • Aushadha matra (particularly in context to aushadha of snehapana i.e., oral administration of medicated ghee or oil) can also be classified into:[13][14] [Ast. Hri. Sutra Sthana 16/17-18]
      1. Laghu or hriswa matra: The quantity of aushadha that gets digested in 6 hours.
      2. Madhyam matra: The quantity of aushadha that gets digested in 12 hours.
      3. Uttam matra: The quantity of aushadha that gets digested in 24 hours.
    • Other special matras mentioned for aushadha are as follows:
      • Vardhamana matra (increasing dose gradually): It is a dose which is progressively increased for a few days until the dose of aushadha reaches its optimum quantity. Then this dose is decreased gradually. This phenomenon avoids the dependency and withdrawl symptoms of aushadha. It protects the patient from an abrupt increase in the dose of aushadha in a short period. Aushadha administered in this way are vardhamana pippali rasayana, bhallataka kalpa, etc.
      • Hrasiyasi matra (minimum dose): This dose of aushadha is smaller than the hriswa or laghu matra and thus gets digested before 6 hours. This dose is used as a test dose when the strength of the digestive system in unknown.[15]

    There is no specific common matra of aushadhi for everyone. The matra of aushadha of individual depends on time (kala), digestive capacity (agni), age (vaya), strength (bala), body constitution (prakriti), dosha and habitat (desha).[16] [Cha. Sa. Kalpa Sthana 12/86].

    Time of consumption of aushadha

    The pharmacokinetics of aushadha is dependent on the biological rhythm of the body. Thus, to obtain maximum health benefits, aushadha must be administered at proper time depending on the patient's disease, strength, and age. Bheshaj kala (or aushadha sevana kala or aushadha apeksha kala) is the proper time for administration of aushadha. Ashtang Sangraha mentioned eleven[17]; Charak [Cha. Sa. Chikitsa Sthana 30/298], Sushruta[18] [Su. Sa. Uttara Tantra 64/67], Ashtangh Hridaya[19] [A. Hri. Sutra Sthana 13/37] and Kashyap[20] mentioned ten aushadha sevan kala. Sharangadhara[21] mentioned five suitable periods of administration of aushadha (aushadha kala). The aushadha kala are as below: [Cha. Sa. Chikitsa Sthana 30/298]
    1. A strong patient must consume aushadha empty stomach in the morning
    2. A weak patient must consume aushadha mixed with light and digestible wholesome food
    3. Bhukta-adau: before the meals.
    4. Bhukta-madhye: during the meal or in the middle of the meal.
    5. Bhukta-pashchat: after the meal.
    6. Muhurmuhu: Frequently during the day and night.
    7. Samudga: between two meals.
    8. Bhakta-samyujta: mixed with the food.
    9. Grase: along with each morsel of food.
    10. Grasantare: between two morsels of food.

    Mode of action of aushadha

    The action of the aushadha depends upon its potency.[22] [Su. Sa. Sutra Sthana 40/5] Some scholars believed the potency to be of two types (hot and cold) while others believed it to be of eight types (cold, hot, oily, dry, clear, slimy, mild and sharp). For example, mahatpanchamula (combination of roots of Aegle marmelos, Clerodendrum phlomidis, Oroxylum indicum, Stereospermum suaveolens and Gmelina arborea) alleviate vata dosha due to their hot potency (since vata dosha is cold in property). Kulattha (Dolichos biflorus) and onion (Allium cepa) alleviate vata due to oily character (since vata is dry in property). Cane sugar (Saccharum officinarum) increases vata due to its cold potency.

    The action of aushadha is location specific

    The aushadha that is effective at one site in the body might not be as effective at other site.[23] The location of dosha in the body is specific and the diseases are most probably caused by aggravation of dosha at their native sites. Particular aushadha acts on particular dosha, hence the site of action of aushadha must be specific. Thus the site of aggravated dosha must be determined first. Reason of aushadha being location specific may be presence of specific receptors at specific sites. For example, beta-blockers act on the heart and reduce blood pressure as the receptors on which beta blockers acts (B1 receptors) are found in the heart.[24][25][26]

    The action of aushadha is individual specific[27]

    The individuals who are obese, very lean, whose muscles, blood, bones and other body parts are of unsteady mass, whose digestive fire is weak, who take less quantity of food or unwholesome food, are emaciated or exhausted of essence, cannot tolerate and bear the strong medicines. Hence such persons are to be treated with aushadha, that are soft and pleasant, gradually strong and heavy, and which do not create unhappiness due to exhaustion or disturb the dosha. Women, tender individuals and children are to be treated like this due to less endurance.
    In the same way, aushadha in low dose or of less efficacy administered in severe diseases or strong persons will be of little use and further disturb and aggravate the dosha and the disease.[28]
    Ayurveda scholars quoted that children under 12 years should not be advised aushadha alone as the children are delicate. The use of aushadha alone may destroy their strength and longetivity. Use of aushadha alone should also be avoided in emaciated, old and short-tempered individuals suffering from loss of dhatu, indriya and ojas. This aushadha may destroy them in a way the sun desiccates small amount of water.[29]
    These treatment protocols are practiced by ayurveda practitioners. The medicines that contains metals or are required in small doses like rasaushadhi, rasamanikya, etc. are avoided in very old, very young and emaciated individuals. The chidren are almost always administered the aushadha with anupana (liquid taken soon after medicine), bal chaturbhadra churna is administered to children along with honey. Customized or a person specific medicine, form, dose is a thrust area for research.

    Untoward effects of aushadha consumed in inappropriate doses

    The aushadha, its potency and doses should be determined after evaluating dosha, the strength of the disease, and the person. Even the use of emergency aushadha, or the aushadha with mild properties in greater doses, or treatments such as use of alkali or surgical instruments, may cause harm to patients of poor physical strength and stamina. When aushadha with doses or potency greater than the strength of disease are used, this aushadha may relieve the patient from the existing disease, but soon may generate diseases of opposite qualities. These aushadha may cause exhaustion, fainting, toxicity, delusion, and a decrease in strength; those more potent than the digestive capacity will produce exhaustion and poor digestion.[30]
    The drug induced toxicity can be due to either of the four causes: hypersensitivity and related immunological reactions; off-target pharmacology; biological activation to toxic metabolites; and idiosyncratic toxicities.[31] For example, drug toxicity by drugs administered in high doses was observed in a study in which Lauha Bhasma and Mandura Bhasma were given five times (55 mg/kg) more than therapeutic dose (11 mg/kg) for a long duration (60 days) in albino rats. The signs observed in the rats were increase in body weight, blood sugar level, serum urea level, serum creatinine level, SGOT and serum alakaline phosphatase. Moderate fatty degenerative changes, diffuse necrosis, periportal necrosis, central vein congestion and sinusoidal dilatation was observed in Lauha bhasma treated group. Mild fatty changes and sinusoidal dilatation was observed in Mandur Bhasma treated group.[32]

    Examination of aushadha

    Even if one aushadha is known to mitigate the existing disease, it should still be examined to compare its taste, potency, taste after digestion, qualities, nature of the substance, actions, special effects, place of growth, season of collection, method of preservation, correct method of using, prohibited mode of use, methods of processing combinations, procedure of use, dosage, the type of patient for whom its meant, time of use, the actions on dosha. The best aushadha should be selected for management of the disease.[33]

    Features of undesirable aushadha

    The aushadha, whose potency is either less or more in regards to disease, dosha, strength and digestive capacity, which is new or not known, which is devoid of described properties, is not mitigating the diseases, have aversion towards mind that do not completely suppresses the aggravated dosha and do not subsides the disease completely should be avoided.[34] These are disqualifying criteria for medicines.

    Features of desirable aushadha

    Ideal aushadha for a person is the one that is grown locally in same climatic conditions or land as that of the patient.[35] The aushadha growing in a region has the properties similar to that specific place. When the aushadha and the person are of same region, then the aushadha is nearly homogenous to the constitution of the persons. Hence the chances that the body of person being considered, the aushadha as foreign matter is more, so are the chances of immune reactions against the aushadha. The aushadha of hot regions like vindhya and shaila mountains have hot potency, whereas the aushadha of cold regions like mountain ranges of Himalayas have cold potency. Moreover the aushadha that does not destroy the strength of the patient but destroys the potency of the disease is the desirable aushadha.[36]
    In current scenario, the ideal criteria for selecting a medicine are:[37]
    • Only those drugs for which adequate scientific data are available from controlled studies should be selected.
    • Each selected pharmaceutical product must meet adequate standards of quality, including bioavailability.
    • Those medicine should be selected whose concise, accurate and comprehensive drug information drawn from unbiased sources are available.
    • Drug selection should be based on the results of benefit and safety evaluations obtained in controlled clinical trials and/or epidemiological studies.
    • Cost represents a major selection criterion. In cost comparisons between drugs, the cost of the total treatment, and not only the unit cost, must be considered. In addition, the cost of non-pharmaceutical therapeutic modalities should be taken into account.
    • Local health authorities should decide the level of expertise required to prescribe single drugs or a group of drugs in a therapeutic category.
    • The influence of local diseases or condition on pharmackinetic and pharmacodynamic parameters should be considered in making the selection e.g. malnutrition, liver disease.
    • When several drugs are available for the same indication, then such a medicine must be selected which provides the highest benefit/ risk ratio.
    • When two or more drugs are therapeutically equivalent, preference should be given to:
      1. the drug which has been most thoroughly investigated.
      2. the drug with the most favourable pharmacokinetic properties, e.g. to improve compliance, to minimize risk in various pathophysiological state.
      3. drug for which local, reliable manufacturing facilities for pharmaceutical products exist.
      4. drugs, pharmaceutical products and dosage forms with favourable stability, or for which storage facilities exist.
    • Fixed ratio combinations are only acceptable if the following criteria are met:
      1. clinical documenttaion justifies the concomitant use of more than one drug.
      2. the therapeutic effect is greater than the sum of the effect of each.
      3. the cost of the combination product is less than the sum of the individual products.
      4. compliance is improved.
      5. sufficient drug ratios are provided to allow dosage adjustment satisfactory for the majority of the population.
    • New drugs should be introduced only if they offer distinct advantages over drugs previously selected.

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    References

    1. ↑ Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 4. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 363.
    2. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Agryasangraha Adhyaya: Chapter 13, Verse 3. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 269-271.
    3. ↑ Murthy K.R.S., editor, (8th ed.). Vagbhata’s Ashtanga Hridayam, Uttar Tantra: Vajikaranavidhi Adhyaya: Chapter 40, Verse 48-58. Varanasi: Chowkhamba Krishnadas Academy, 2011; 420.
    4. ↑ Shastri A D, editor, (1st ed.). Commentary Ayurveda Tattva Sandipika of Ambikadutta Shastri on Sushruta Samhita, Sutra Sthana; Dravyavisheshavigyaniya Adhyaya: Chapter 41, Verse 9. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 199.
    5. ↑ Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 1. Delhi: Amar Publications, 2018; 303.
    6. ↑ Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 27. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 366.
    7. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 6. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 424.
    8. ↑ Showkat Hussain Ganie, Priti Upadhyay, Sandip Das, Maheshwer Prasad Sharma, Authentication of medicinal plants by DNA markers, Plant Gene, Volume 4, 2015, Pages 83-99, ISSN 2352-4073, https://doi.org/10.1016/j.plgene.2015.10.002.
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    14. ↑ Murthy K.R.S., editor, (8th ed.). Vagbhata’s Ashtanga Hridayam, Sutra Sthana; Snehavidhi Adhyaya: Chapter 16, Verse 17-18. Varanasi: Chowkhamba Krishnadas Academy, 2011; 212.
    15. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Snehavidhi Adhyaya: Chapter 25, Verse 23. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 452.
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    19. ↑ Murthy K.R.S., editor, (8th ed.). Vagbhata’s Ashtanga Hridayam, Sutra Sthana; Doshopakramaniya Adhyaya: Chapter 13, Verse 37. Varanasi: Chowkhamba Krishnadas Academy, 2011; 190.
    20. ↑ Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 52. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 369.
    21. ↑ Tripathi B, editor, (1st ed.). Commentary Dipika on Sharangadhar Samhita of Pandita Sharangadharacharya, Purva Khanda; Bhaishajyakhyan: Chapter 2, Verse 2-3. Varanasi: Chaukhamba Surbharti Prakashan, 2011; 24.
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    27. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 5. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 424.
    28. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 7. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 424-425.
    29. ↑ Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 58-59. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 369.
    30. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 6. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 424.
    31. ↑ Liebler, D., Guengerich, F. Elucidating mechanisms of drug-induced toxicity. Nat Rev Drug Discov 4, 410–420 (2005). https://doi.org/10.1038/nrd1720
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    33. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 8. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 425.
    34. ↑ Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 61-62. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 370.
    35. ↑ Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 35. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 433.
    36. ↑ Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 63. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 370.
    37. ↑ WHO criteria for the selection of essential drugs, adopted by the forty-first World Health Assembly, Geneva, Switzerland, 2-13 May 1986, in resolution WHA39.27 https://healthydocuments.org/public/healthydocuments-doc21.pdf
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