Clinical toxicology of Ayurvedic medicines
اسلاید 1: www.tabaye.ir
اسلاید 2: Clinical toxicology of Ayurvedic medicines Ruben ThanacoodyNPIS (Edinburgh)
اسلاید 3: Ayurvedic medicineComprehensive holistic medical system 4500BC“Knowledge or science of life”Kayachikitsa Internal Medicine Shalya Tantra General Surgery BhutavidyaPsychiatry Agada TantraToxicologyRasayana Tantra Nutrition, Detoxification and Rejuvenation KaumarabhrtyaPaediatrics/Obstetrics/ GynaecologyVajikaranaFertility and VirilityShalakyaOtorhinolaryngology
اسلاید 4: Ayurvedic medicinesIndividually preparedBased on herbs and mineralsClassification in Caraka Samhita (150BC-100AD)Elemental constituentsTastePotencyPostdigestive effectTherapeutic action (50 groups)CommercialisationIncreasing use Wider availabilityHealth food storesEthnic shopsInternet retailersLack of Regulation
اسلاید 5: THE MAKING OF MADONNA Traditional medicine takes on the world India drug gives Alzheimers hope EXCLUSIVE: MADONNA BABY BID MADONNA is using old Indian fertility remedies to try for a third child at the age of 46.She hopes a stash of Ayurvedic medicines will help her conceive.Source: BBC website
اسلاید 6: Clinical ToxicologyContamination/Incomplete processing/ AdulterationHeavy metal poisoningHerb-drug interactions GenotoxicityTeratogenicity
اسلاید 7: Case history37 year old man admitted with weakness, dizziness and muscle pain. He visited India and had bought several Ayurvedic medicines.Hb 7.8 g/dlBlood lead 58 μg/dlUrinary arsenic 24.1 μg/dl/L (normal<20)Lead content of Ayurvedic medicine 238 μg/gm .Spriewald et al. Occup Environ Med 1999; 56: 282-283
اسلاید 8: Heavy metal content England 1979: 30% (11/37) samples of “kushtay”Aslam M et al.Public Health. 1979;93:274-284 India 1988: 64% contain lead and mercury, 41% arsenic and 9% cadmium. McElvaine MD et al. JAMA. 1990;264:2212-2213 Boston USA 2003: 20% (14/70) of preparations contain toxic concentrations of lead, mercury and arsenic.Saper KB et al.JAMA 2004;292: 2868-2873.
اسلاید 9: Saper et al 2004
اسلاید 10: Lead poisoning and anaemiaKales SN et al. Med Sci Monit. 2007;13: 295-8
اسلاید 11: Contaminant or incomplete processing?Medicinal propertiesToxicity well-knownDetoxification processComplex oxidation processesBhasmas (Ash)Vatsanabha (Aconitum sp.)Detoxification of aconite (samskaras)Crude aconite100% mortality at a dose of 2.6 mg/mouse Fully processed aconite no mortality at 8x dose crude aconite).Thorat S, Dahanukar S. J Postgrad Med. 1991 ;37(3):157-9.
اسلاید 12: Adulteration/ContaminationFake preparations containing steroidsOrganochlorine pesticide residuesRai V et al. Environ Monit Assess. 2007(in press)
اسلاید 13: Herb-drug interactionsBrahma Rasayana is beneficial for promoting mental clarity, improved memory and cognition whilst improving resilience to mentally demanding lifestyles. Amla (Emblica officinalis), Haritaki (Terminalia chebula), Mandukaparni (Centella asiatica), Pippali (Piper longum), Shankapushpi (Convovulus pluricalis), Plava (Cyperus scariosus), Musta (Cyperus rotundus), Chandana (Santalum album), Agaru (Aquallaria agolcha), Yastimadhu (Glycirrhiza glabra), Haridra (Curcuma longa), Vacha (Acorus calamus), Nagakeshar (Messua ferrea), Ela (Eletaria cardamomum), Twak (Cinnamomum zeylanicum), Bilva (Aegle marmelos), Agnimantha (Clerodendrum phlomides), Syonaka (Orroxylum indicum), Patala (Stereospermum suaveolens), Gambhari (Gmelina arborea), Shalaparni (Desmodium gangenticum), Brihat (Solanum indicum), Prishniparni (Uraria picta), Kantakari (Solanum xanthophylum), Gokshura (Tribulus terrestris), Punarnava (Boerhaavia diffusa), Mudga parni (Phaseolus trilobus), Mashaparni (Teramnus labialis), Bala (Sida cordifolia), Eranda (Ricinus communis), Jeevanti (Leptatenia reticulate), Shatavari (Asparagus racemosus), Shara (Saccharum munja), Ikshu (Saccharum officinarum), Kasha (Saccharum spontaneum), Darbha (Desmostachya bipinnata), Kapikacchu (Mucuna pruriens), Sesame oil, Rock sugar, Honey
اسلاید 14: Pharmacodynamic interactionsSarpaghandha (Rauwolfia serpentina)Datura (Datura metal)Yavani (Hyoscyamus niger)Kapikachchha (Mucuna pruriens)
اسلاید 15: Phenytoin/Shankhapuspi Interaction Single dose of phenytoin and this herb did not alter phenytoin serum levels in rats but decreased antiepileptic activity.Multiple dose co-administration reduced both antiepileptic activity and serum phenytoin levels.Dandekar et al. J Ethnopharmacol 1992;35: 285-288.
اسلاید 16: Ashwagandha and Digoxin AssayAshwagandha (Withania somnifera) contains withanolides structurally similar to digoxinInterferes with both FPIA digoxin assay(falsely elevated)MEIA digoxin assays (falsely low) .Dasgupta et al.Am J Clin Path 2005;124:229-336
اسلاید 17: TeratogenicityAsparagus racemosus rootsTeratogenic in ratsGoel RK et al.Indian J Exp Biol. 2006 ;44(7):570-3.Lead-containing preparationsCongenital paralysis and sensorineural deafness
اسلاید 18: GenotoxicityBirthwort (Isharmul, sunanda)ContraceptiveAristolochia indicaCarcinogen banned in Europe and USSalacia oblonga rootsWeak genotoxicity in vitroFlammang AM et al.Food Chem Toxicol. 2006; 44(11):1868-74.Arsenic-containing preparationsSkin and haematological cancers Gold LS. NEJM 2003; 349: 1576 (letter)
اسلاید 19: All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy.”Paracelcus 1493-1541
اسلاید 20: Charaka samhitaSutra sthana 1/124-127Type and dose of the drug as per the specification of every individual, if done by a physician before the use of the medicine, he should be called a quality physicianIf processed and used properly, a deadly poison can become a life saving medicine.A lifesaving medicine medicine can become poison if not used properlyRastogi et al. Int J Risk & Saf Med.2007;19:117-125
اسلاید 21: ConclusionAyurvedic medicines contain potent biologically active ingredients.Risk of heavy metal poisoningRegulation of these products desirable.
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