Dr. nitin chaube at 1st traditional medicine conference in hyderabad

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



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



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

+

+



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.



INDIVIDUAL INGREDIENTS



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.



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..



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)



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)



MECHANISM OF ACTION OF INDIVIDUAL INGREDIENTS AND SYNERGIES



BROMELAIN



ROLE OF BROMELAIN ACCORDING TO MODERN MEDICINE -



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 -



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)



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]




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))



MODEL OF AYURVEDIC ACTION OF BROMELAIN -

Fig. 1. – Proposed model for Action of Bromelain in a traumatised tissue.



BOSWELLIC ACID



ROLE OF BOSWELLIC ACID -



ROLE OF BOSWELLIC ACID -



Boswellic (rich in Agni, Jal and Vayu Mahabhoot’s


+

Under Treatment Lipoprotein (P(ut)+Ag(ut)) + (J + V)


AYURVEDIC HYPOTHESIS OF ACTION OF BOSWELLIC ACID -



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-



MODEL OF AYURVEDIC ACTION OF BOSWELLIC ACID -

Fig. 2. – Proposed model for Action of Boswellic Acid in a traumatised tissue.



CURCUMIN



ROLE OF CURCUMIN –



ROLE OF CURCUMIN –



HYPOTHESIS FOR THE AYURVEDIC MODEL OF ACTION OF CURCUMIN –


+

Under Treatment Lipoprotein (P(ut)+Ag(ut)) + J(ut) + V(ut) +Ak) [Stage 1]


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



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))



MODEL OF AYURVEDIC ACTION OF CURCUMIN -

Fig. 3. – Proposed model for Action of Curcumin in a traumatised tissue.



SYNERGY



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 -



THE SYNERGY -

Fig. 4. The mechanism of action of the combination



CLINICAL EVIDENCES



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 -



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


Reduced Reduced Reduced Absent

Oedema Reduced Reduced Reduced Absent

Pain No change No changeslightly reduced

reduced

Conrolled StateSwelling around joints

Reduced Reduced Absent Absent


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



CONCLUSION



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.

Health & Medicine

Dr. nitin chaube at 1st traditional medicine conference in hyderabad