In Ayurvedic pharmacology the term dravya means drug. Essentially drug is a substance made up of the five existents (panjca bhoota) viz. earth, water, fire, air and ether. In a broader sense the term dravya has two connotations – one at a philosophical level and other at a physical level.
At the philosophical plane dravya includes even time, direction, mind and soul which are nonmaterial concepts. Usually the term dravya is translated as substance. In Indian philosophy a substance need not be essen- tially a material. This concept is from the Vaiseshika philosophy. According to the definition in Vaiseshika philosophy, a dravya is anything which has property and or action and which can be the material cause. Time, direction, mind and soul satisfy this definition and enter into the category of substance. Vaiseshika system identified nine things as casual substances that generate effective sub- stances. The nine casual substances are the five existents viz. earth, water, fire, air and ether and the four nonmate- rial concepts referred above. From the western point of view even ether, one among the five existents is not a mate- rial. But from such a perspective even the other four existents are not ma- terials as they are conceptual entities attributed with existence. Hence, on the philosophical plane all the nine substances are conceptual.
When we come to the physical plane, dravya is any substance that we deal with, in day to day life. Thus sugar, salt, water, air, iron etc. are dravyas. Note that all of them are materials and according to the majority of Indian philosophies they are made of all the five existents at varying proportions. As Ayurveda holds that there is no substance which is not a drug, all gross substances are drugs or medicines. This means that any material can be put to some medical use either as medicine or medicament.
But even conventional medicinal formulations cannot be designat- ed as medicines unless there is a proper prescription by a qualified doctor. In the process of prescrip- tion the doctor has to consider many factors of the patient such as the humor involved, the tissues involved, the region affected, strength and immunity, the condi- tion of the bio-fire, constitution, age, mental strength, habitua- tion, diet and specific condition of the disease. The strength of the drug, time of administration, season and time of appearance ofthe disease, dose of drug to be admin- istered, season and time of collection of the drug, the region of origin of the drug etc. also are to be considered. Thus only when a doctor prescribes a substance after all these considerations the substance could be designated as a medicine.
As Ayurveda is based on the three humor theory, to interpret anything we should consider it in terms of the humors. Hence in each disease and its different stages the predominance of humor and the accompaniment of humor, if any, are to be considered in selecting the drug. For example in intense internal unction it is stated that if the disease is caused purely by pitta ghee should not be given. But in conditions where vaata and pitta associated ghee is the fat of choice. Another example is the use of garlic. Garlic is a very good drug to combat vaata. But it should not be given in conditions where pitta is predomi- nant or is an accompaniment.
Region has two implications in Ayurveda. They are the anatomical region and the geographical region. Headache and stomach ache are different diseases though both of them are aches. Edema of foot and edema of face may have different pathological background. Edema of foot may be due to circulatory impairment caused by the inefficiency of heart but edema of face, especially the puffiness around the eyes (periorbital edema) usually suggest a kidney problem. Hence consideration of anatomical region is very important. There are vital areas in our body. They are called marma in Sanskrit. If even a trivial disease occurs in some marma, the disease might turn incurable or fatal. Hence an enquiry into the region as to whether the disease has occurred in any vital area is important. This comes under the purview of anatomical region.
The humors have specific abodes in the body. Treatment of a humor stationed in its own abode and migrated to other abodes is different. Hence to prescribe such anatomical considerations are also essential.
The consideration of geographic region where the patient was born, brought up and affected by disease is also important. Some diseases are endemic to certain regional pockets. For example sickle cell anemia is met with in high ranges of Kerala and especially among the tribes. Elephantiasis is mostly seen in Thiruvananthapuram, Chertala and Talassery regions of Kerala. Hence even a mild foot edema in a patient from these regions may be suspected as filarial. Epidemics also exhibit regional preferences due to various factors. Now that people travel a lot, a patient who was exposed to a disease in a region may manifest the disease in another remote region when the incubation period is over. Hence in such disease the regions visited by the patient in near past are to be enquired. Ayurveda has classified geographical region into three viz. arid (dhanva, jaangala), marshy (aanoopa) and common (saadhaarana). Such a consideration is also important in diagnosis as well as prescribing drug, diet and regimens.
Strength (bala) should be understood in four con-texts. The physical strength of the patient is one. Weak patients cannot be given strong medicines. They may not be subjected to surgery and dangerous diagnostic procedures. Ayurveda states that physical strength of a patient can be assessed by the ability to perform exercise. Strength also implies immunity as it is stated categorically that it is the strength (bala) that combats the disease. Hence it is important to consider the immunity status especially the history of allergic reactions in prescribing. The strength of the disease also is to be considered. A disease may be mild or severe. Both require different medication. In very mild cases even drugs may not be necessary. For example, a mild headache may vanish with rest or sleep. Here prescribing drugs is a sin unless the headache is a regular phenomenon. Now the strength of the drug also is to be considered. There are strong medicines and mild drugs. We consider this in prescribing and proper precautions are to be taken during administration of very potent drugs to avoid side effects and adverse reactions. Thus under the head of strength we should examine the physical strength, immunity status, strength of disease and the strength of the drug.
Time is yet another multifaceted factor. The time of onset or augmentation of a disease is important. We know that humors have diurnal and seasonal cycles. Thus vaata is more in the evening and at the last phase of night. This humor gets accumulated in summer, gets aggravated in the rainy season and subsides in the falls. Hence diseases due to vaata also may exhibit such changes in intensity of the disease. For example an evening (afternoon) headache is essentially with vaata predominance. Diseases due to vaata show a tendency to aggravate during the rainy season. Another consideration of time is the time of medication (aushadha-kaala). It is of two types – by the clock (kshanaadi) and condition of disease (vyaadhyavasthaa). When a doctor prescribes a drug sixth hourly he is following the clock. But when he prescribes a drug to be consumed 'when there is pain' he is prescribing by condition of the disease. Prescription of medicines also may be in relation with food such as before food, after food etc. This also implies time as we have specific times for food. Time of collection of drugs is also important. For example the latex of cactus for preparing caustic thread (kshaara-sootra) is to be collected before sunrise. After sunrise the active principles in the latex will be less. Specific seasons are stipulated for collection of specific drugs and parts of herbs.
This is to ensure optimal effectiveness of herbal drugs. Relative period of collection of drugs of animal origin also is specified. Period of storage of raw materials and prepared drugs are also important. Generally raw herbal materials stored more than one year lose their potency. Prepared drugs have date of expiry. These things are to be remembered during prescription
Another important factor is the strength of the bio-fire of the patient. When the bio-fire is weak heavy drugs that require strong bio-fire to digest should not be prescribed. Many diseases involve the undigested factor called aama. Aama is the product of weak bio-fire. Here medication is usually contraindicated. Attempts for removing aama such as fasting are to be done first. Only after attaining the digested stage (niraama-avasthaa) drugs are to be administered. This factor overlaps with another factor namely the condition of the disease.
The constitution of the patient is another important factor in treatment. There are various constitutional considerations in Ayurveda. Yet the humoral constitution is the most important one as it embraces other constitutional criteria too. For example the constitution by the five existents (bhoota-prakrti) can be included in the humoral constitution. The earthy and watery constitutions come under kapha constitution, the fiery constitution comes under pitta constitution and the airy and ethereal constitutions come under vaata constitution. Mental constitutions also come under the humoral constitutions as each humoral constitution has specific temperamental traits. Identification of the constitution of persons has gained popularity recently among people, as the importance of constitution is stressed in recent ayurvedic literature especially in English. Patients now request the ayurvedic doctors to identify their humoral constitution so that they can regulate their regular diet and activities. Drugs, diet and activities suited for one constitution may not be suited for another. Certain drugs and food materials may cause allergy to people with pitta constitution. Formulations containing garlic and marking nut are not suitable for people having pitta constitution. As constitutions have a say on bio-fire (agni) and the condition of the gut (koshtha) and both these factors are to be considered in prescribing. For example those who are having pitta constitution will have soft gut (mrdu-koshtha) and they will tend to have loose motions even with milk. On the other hand persons with vaata constitutions are with cruel gut (kroora-koshtha) and they require strong and unctuous purgatives to effect purgation. Hence it is evident that the doctor should consider the constitution and nature of the gut while prescribing a purgative or laxa- tive. Not only purgatives, actions of other drugs also are modulated by these factors.
Needless to add, age of a patient is an important factor in diagnosis and prescribing. Age deter- mines the dose, type, course and strength of the drugs and procedures. Some diseases are specific for infants and chil- dren. Some diseases are specific to youth and there are diseases occur in old age. For example measles is uncommon in adult males. Maturity onset diabetes manifests after reaching the age of forty years even though the genetic predisposition is right from the beginning. Cataract usually affects the old age. Though there is physiologic change in the refractive index in the crystalline lens of the eye throughout life, the change reaches a threshold affecting near vision by surpassing the level of accommodation resulting in presbyopia only by the age of forty years. Small doses and mild drugs are preferred in children and old age. On the other hand certain drugs well tolerated by children may not be tolerated by the adult.
Mental strength is yet another factor to be considered. Though it can be included under the head of physical strength, it is mentioned separately because of its practical significance and clinical application. Persons are broadly classified into three viz. weak minded, strong minded and mediocre. It is an identified fact in Ayurveda that mental diseases occur mostly to weak-minded persons. Again, patients with a prominent psychic factor might confabulate or exaggerate their version about the disease. It is the duty of the doctor to find out the real needle of disease from the presented haystack of verbosity. Weak-minded persons are reluctant to accept treatment and follow long courses of treatment. Hence a wise doctor should be strategic in prescribing medicines and procedures to weak-minded persons.
Habituation- is of prime importance in Ayurveda. Anything that goes smoothly with the person is habituated (saatmya). If anything reacts unfavorably and denies going smoothly with the person it is not habituated (asaatmya). For example, when we consume certain food, if it is digested, absorbed, metabo- lized and finally thrown out from the body without any difficulty that food is wholesome and habituated to us. If the material is not readily digested, absorbed, metabolized and eliminated it is not habituated. All diseases are caused by substances which are not habituated or cannot be habituated. They are considered as toxins. All the diseases have a toxicological bearing as they involve intrinsic or extrinsic toxic substances which cannot be habituated. This aspect is repeatedly mentioned in Ayurvedic treatises and hence the doctor has to find out what are habituated and not to the patient on prescribing.
Diet of the patient is very important. Formerly ayurvedic physicians were meticulous in detailed prescription of the diet for the patient and this has been instrumental for the unpopularity of Ayurveda among people who preferred a fast life. Hence physicians too changed tune and became almost liberal in prescribing dietary restrictions to maintain clientage. Both the traits are wrong. The diet should be optimal. Unwanted restrictions should not be insisted. For example a patient taking the powder of the three acrids need not be prescribed a non-spicy bland diet. Treatment has three modes – drugs, diet and activities. Hence it should be ensured that the diet of the patient is supplementing and agreeable to the drugs and activities and is conducive to cure.
In Ayurveda, treatment is according to the condition of the disease. It is not fair to make a fixed protocol for treating any disease. Systematized protocol is the style of modern medicine. If we make rigid protocols for treatment of diseases, invariably there will be no difference between the approaches of Ayurveda and modern medicine and the goodness and independence of Ayurveda will be lost. Hence treatment according to Ayurveda should be very flexible in tunes with the condition of the disease. One could easily understand that how treatment should change with condition of the disease from the treatment of fever itself. Instead, a tablet or decoction for all conditions of fever will be the most unscientific thing according to Ayurveda. But unfortunately this is what the researchers and authorities of Ayurveda are attempting. The equation, Disease + Drug = Cure or Health is not applicable in the case of Ayurveda. The Ayurvedic physician should be able to appreciate this and should change his prescriptions whenever necessary. In Kerala, there was a practice of prescribing decoctions to patients for very long courses such as six months or one year. This may have its merits. But it cannot be considered very scientific as during the course of a long treatment the condition of the patient may change consider- ably and the doctor should make appropriate amendments in his prescription.
Similarly even when a material used as medicine, it is not to be considered as a medicine unless it is prescribed in a specific dosage form. For example ginger is a herbal material used as drug. But it can be considered as medicine only when there is medical instruction to consume it as a whole drug, juice, paste, jam, medicated ghee etc. or in combination with other materials.
Ayurvedic concept of a drug is primarily based on herbal drugs. But in Ayurveda we use drugs of herbal, mineral and animal origin. In many formulations all these three types of materials are incorporated. All these are materials.
The action of the drug is the most important factor. It is for the pharmacological action that we utilize materials as drugs. Drugs with drastic action are mostly preferred as medicines whereas slow acting materials are generally used as food materials. It is stated that materials with importance of taste (rasa- pradhaana) are used as food materials and materials with importance of potency (veerya-pradhaana) are used as medicines. Always this is not true. Bland or sluggish materials (manda- dravya) are also used as medicines. Similarly potent substances such as ginger and black pepper are used as food materials.
In a drug there are five pharmacological principles namely taste (rasa), property (guna), potency (veerya), metabolic effect (vipaaka) and special potency (prabhaava). The action (karma) of the drug depends on these five principles. Including the drug and action we may concisely enumerate seven pharmacological principles. Much is talked about these principles in the ayurvedic field but it seems that not only ayurvedic students and the lay public but also ayurvedic elite are rather confused about these principles. Because of this confusion these principles demand a closer observation for clarity.
Kerala Ayurveda Ltd.
Kerala Ayurveda Ltd.
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