The Adaptive Medicine

Kaushal K. Srivastava and Ratan Kumar

In ‘Conservation, Cultivation and Exploration of Therapeutic Potential of
Medicinal Plants’
(Eds; Kumar, A; Padhi, M. M; Srikanth, N; Dhar, B; Mangal, A.K.)
Published by: Central Council for Research in Ayurvedic Sciences,
Department of AYUSH
Ministry of Health and Family Welfare, Government of India, 2014, p 405-
425.

The saga of evolution and development of civilization is the storey of enhancing

performance and efficiency of mankind. The methods for using muscle power either of
man or animals evolved gradually, accompanied with the discovery of wheel and levers.
This was followed with the arrival of mechanical machines. The source of power
gradually changed, from muscle power to steam and then to electricity. Controls also
evolved gradually, from mechanical to magneto –electrical and then to photo- electronics.
Each step points towards improvement in work performance and efficiency in doing
work. At the root of this process is Adaptation to Change.

The adaptation of any system either biological or otherwise involves interaction with the
internal and external environment. Since the latter is ever changing, the biological system
would be continuously changing to survive and reproduce. This change entails in itself
structural (morphological) and functional (Physiological and Biochemical) change/s
called Adaptation. It simply means that the man has limited capacity to work but it can be
enhanced. In addition; the capacity to work deteriorates as the man performs in time, he
ages, he is under mental distress and the environment in which the work is being done is
hostile to his well being. The latter may be due to high and low environmental
temperatures, atmospheric pressure such as in high mountains and deep sea, absence of
gravity and oxygen as in space, presence of noise and absence of sound and so on.
Increasing work performance played a key role in competitive sports all over the world.
Thus, there are many factors which affect the work performance and efficiency. The
methods and means to improve the work performance and overcome the adverse factors
are the part of Adaptive Medicine. These have played a key role in competitive sports and
the use of such Doping Agents had to be regulated by legislation. We shall briefly follow
the historical aspects of Adaptive Medicine.

The use of plants, animals and minerals for combating adverse effects of extreme
environment and malfunction by animals and man is as old as advent of mankind. This
becomes evident from the behavior of higher animals such as Chimpanzees in wild.
Evidence of the beginning of Medicine is seen some 6000 years back in the form of
Prescriptions found in Egypt. The “Ebers” papyrus contained the names of some 700
medicaments many of which are even familiar today. The Middle East medicine also had
the same beginning. Aesculapius, the son of Apollo, is the legendary father of Greek
medicine. Medicine was practiced in Aesculapian temples where priests diagnosed,
massaged, mixed medicine and offered musical and spiritual assistance to the body and
mind, though it was clouded with many strange and bizarre medicaments and procedures.
The ascetic Pythagorean brotherhood introduced the doctrine of physiological harmony.
The body was regarded as undifferentiated from the environment, and there was a flux
between them. The body, like the rest of the universe, was composed of fundamental
elements described metaphorically as earth, air, fire and water, together with affinities
between these elements.

Similar thoughts were expressed some 5000 years ago by Indian Medicine Sages; Chit,
jal, pawak, gagan, samira, Panch tatva yah rachit Sharira.

Disease arose, according to Alcmaeon, from a preponderance of one or other of the fiery
(hot), watery (fluid), earthy (solid) or airy (diffuse) elements. Medicines possessed
within them corrective powers to make adjustments to the internal balance. Some might
restore the fire or the dryness to the body, others drain the moisture. Indian and Chinese
systems of Medicine, some 5000 years old, embody the same principles, though perhaps
independently evolved. The Buddhists also believed that earth means the quality of mass
or solidity, air means motion, fire means energy and water means the binding quality.
They all move in space, or ether, sometimes called the fifth element the ‘akash’. The
four elements were later taken up by Aristotle, and through him transmitted to Europe
where they were a central dogma in life and medicine until the Renaissance in Sixteenth
Century
The equilibrium between the various elements in the organic body with the environment
described the health status of the individuals. The disease or the illness was considered to
be the disturbance in this equilibrium. If an ancient Greek or Indian practitioner described
that an organ is too ‘earthy’, he may be meaning that it is too dense and compact for its
own good. He was able to use this language to describe the way the body reacted to the
elements outside itself; the heat of the season generated ‘heat’ diseased, heavy foods
generated ‘solid’ diseases. The basic concept in these systems was that health was an
aggregate of elements, maintained in equilibrium with nature. The latter consisted of the
same elements.
Hippocrates, the father of modern medicine, criticized the Pythagorean four elements as
insufficient: Instead, he introduced the concept of ‘humours’ or fluid qualities of the body
which again needed to be in equilibrium – ‘crasis’ – for proper health. Every person had a
natural dominance of certain humors constituting his individuality. Disease arose when
the humors were diminished or strayed out of phase with a person’s natural dispensation.
In so far as the body was the cause of its own diseases, it could also heal itself by an inner
restorative process, the “medicatrix naturae”. Hippocrates always attempted to encourage
self-healing by designing a health regimen for a diseased person. This involved diet,
exercise, relaxation and other methods. These were supplemented by various drugs,
administered in order to correct those imbalances in the bodily secretions which produced
the weakness and susceptibility to disease. More or less, the Ayurveda, the ancient Indian
system of medicine and the Modern Medicine also believes the same way except that the
words or the symbols are different.
Galen, born in Pergamum in AD 130, the son of Nicon, the engineer in his fiery mission
to bring reason, logos, to bear upon medicine, emphasized once again the importance of
the humors and the Hippocratic concepts as a life force. The life force manifested itself
in the organism as various powers such as ingestion, expulsion and so on. These
balanced the humors, which Galen also saw as the arbiters of internal equilibrium, much
as we see hormones functioning in today’s physiology. Drugs could restore the inner
balance by regulating those self-same body powers. This would, according to the
Galenic system, restore the “physic” and the body would then throw off disease by itself.
Galen prepared many effective plant drugs and made the first attempts at standardization
of doses and of botanical sources. The systems of Galen and Pedanius Dioscorides, a
compiler of plant medicines, together with a smattering of Hippocratic naturalism, were
the legacy of Greek medicine and these systems also emphasized that divine design had
made physical resemblances between a medicinal plant and the disease or organ that the
plant could cure. This was preserved in a circuitous manner by the Arabs, spiced by the
return of some occult law.

Emergence of Science in Medicine

Paracelsus was the first to combine medicine with chemistry. As an alchemist his
method was the purification of the impure. He rejected the four humors theory of
Hippocrates i.e. blood, phlegm, yellow bile and black bile and the plant concoctions of
Galen, introducing instead poisons as medicines, compounds made of antimony, lead and
mercury. The medical establishment was universally Galenecists and hounded the
chemists as poisoners; the chemists fought back by describing the Galenecists as
purveyors of ‘filth, spittle, urine, flyes and the ashes of an owlets head’. However,
gradually there came the recognition that chemicals did sometimes work, and efforts
were made to control rather than attack the chemists. The next three centuries saw more
and more specific drugs introduced by the chemists. The transformation to modern
therapeutics occurred gradually during the course of the nineteenth century. New
substances were continually being isolated and proving immensely effective without any
theoretical basis at all. Quinine did cause fevers to come down, morphine did kill pain;
strychnine, brucine, atropine, codeine, and other compounds isolated from the old
vegetable drugs could be seen to work. They were strong. A spoonful of crystals had
such a massively amplified effect that it placed traditional doctors in the shadows.
Scientific medicine gathered strength from the artifice of the chemists, and from the
materialistic quantitative mode of thought of industrial man. It became a body of
knowledge. Each disease arose from a specific cause, and was a discrete entity that could
be cured by drugs which were applied only to that pathological condition. It was not
necessary to cure the patient, but the disease itself must be the focus of medical attention
with the patient as a kind of inert carrier of his condition. The doctor was not interested
in equilibrium. He was at war. Medicines were discovered by observation and
experiment, and they had to be tested in an objective manner to ascertain if they actually
worked. The centre of therapeutics became the laboratory, with assessment based on
weight of numbers, not weight of impressions. The humors, secretions, vital energy,
internal balance left medical jargon, never to return. The science of drugs, called
pharmacology, arose because the effective new drugs needed to be understood. Such
medicine horrified its critics because of its apparent lack of concern for the sick. The
chemical therapeutics became a rational system in its own right.
The presently available systems of medicine we find two ways of thinking. On the one
hand we have a naturalistic medicine in which the Diseases arise through imbalances,
health through equilibrium, and medicine and its drugs essentially help to adjust and are
restorative. On the other side is the reductionism view that disease is a specific physical
spanner in the works, arising from a certain cause and curable by attacking the origin of
the disease. It replaces harmony by specificity. In one, patient it is important while in the
other, the sickness and disease becomes the center of attack. The former is called the”
Holistic Medicine” in contrast to the latter. In fact, no medicine can afford to be other
than Holistic.

Concept of Health
There is a need to have an adequate understanding of the meaning of “health”. It is
difficult to give an honest answer. As difficult as the answer to the question – are you
happy? It is possible that there is no such thing as perfect health or sickness but a
spectrum of states, ranging from very fit to fit to healthy; to a bit off color to partly sick
to sick and so on. A man may be affected by subtle damage brewing inside him – a
cancer or clogged arteries – and still be called healthy due to inability of biomarkers to
detect such non critical changes. The person may be decrepit, debilitated, lethargic,
incapable, doped, with chronic aches, irritations, infections and itches; he would still be
classed as ‘not ill’. The modern medicine can provide many cures for detectable disease
state; it is difficult to deal with the states of chronic sub-health. Therefore, it is important
to revise our attitude to health, to add more subtle concepts of health to the already
advanced concepts of disease.
Health is not only absence of illness. It means the ability of the body and mind to quickly
adapt itself to constantly changing environmental conditions, and its ability to perform
every kind of activity at optimal levels. Health is that “state of the human body which
enables a person to carry out his social and biological functions with the highest possible
efficiency” At the same time it is a state of man’s complete equilibrium with nature and
his social environment.
We may consider as a useful minimal definition of health that was put forward by the
World Health Organization:
‘Health is a state of complete mental, physical and social wellbeing and not merely
the absence of disease.’
However, you cannot call a man healthy unless he is capable of fulfilling some of the
potential of man. Therefore one could improve the definition by adding something about
capacity. One could improve it even more by adding something about longevity. For
health is substantial if it can lead to resistance to the pathogen prevailing in that time.
One has to add the happiness of the individual as the harbinger of health. This brings the
spiritual aspect of life within the definition of health. Thus, we can define health as
‘Health is a state of complete mental, physical, social and spiritual wellbeing and not
merely the absence of disease.’
Though this definition undermines the current efforts at disease prevention, most of us
recognize that the chronic diseases are caused largely by environment and life-style. This
has led to a vociferous group of health and community medicine workers to put forward
programmes of preventive measures as solutions to the ills of modern man. They
formulate instructions on diet, cigarette smoking, blood pressure and physical fitness.
People would be tested for risk factors at regular intervals and legislation introduced to
reduce environmental contamination and improve foods. Health maintenance
organizations are being set up and the population is continuously screened to detect
diseases early. These health care efforts are going side by side with improvements in
clinical medicine and each would be given a more appropriate slice of the cake.
Such measures are steps in the right direction, but the whole problem is likely to be
postponed for some time until the health burden builds up again to the same levels.
Prevention is essential, but it must be tied to a more enlightened view of health. Cancer,
heart and circulatory diseases are primarily a long slow drift from harmony in the
workings of the body, aided and abetted by environmental stresses. As the societies
develop in different regions of the world, the pattern of diseases keep on changing. We
see it happening every now and then. The details are not at all understood at present.
Despite the application of colossal resources to the problem, it is only possible to state
that the causes are so subtle and diverse that none of the programmes currently available
are capable in preventing, controlling and treating ill-health in the world. To stop
smoking and reduce consumption of cholesterol will only, so to speak, cream off the top
of the chronic disease figures, but not bring them down to the level of simple agricultural
communities. It will extend the life-span, but not the quality of living and life. It will
relieve the health services, a little. It might improve the health of those surviving to old
age. If we want to achieve very much more than that, the subtle development of the
degenerative diseases needs to be dealt with by subtle measures.

The Available Drugs These Days

The modern drugs are discovered, tested in a certain way and approved for treatment by a
legislative body of scientists and medical fraternity. In 1932 Hildegarde Domagle pricked
her finger with a knitting needle. She developed septicemia and would have succumbed
but for the good fortune of having a father who worked for a German chemical company.
He gave his daughter one of his company’s red dyes called Prontisol and his daughter
recovered. The dye was found to contain sulphanilamide. This was the first of the
antibiotics and soon a multitude more were discovered and developed by industry.
Many new drugs were found by chemists who sought new uses for ranges of chemicals
which they had made for other purposes. This was particularly true of dye-stuffs. The
biggest drug companies in the world, Ciba, Geigy, Hoffman-La Roche and Sandoz, were
started to make dyes for the Swiss textile industry and then turned to drugs. Laboratory
research produced other drugs, such as Fleming’s discovery of penicillin through the
accidental contamination of a bacterial culture with spores of the bread mould. Another
source of material is still the plant and animal kingdom. Plants may be selected because
of their use in traditional medicine, folk lore and because it is known that certain classes
of plants make certain kinds of chemicals. Famous twentieth-century example is
ephedrine, derived from a Chinese medicinal plant. It revolutionized the treatment of
bronchial complaints, and reserpine, which revolutionized the treatment of Blood
Pressure Control and comes from a plant used in India for thousands of years. A
compound which is known to be effective is analyzed chemically and a range of slightly
different derivatives are made. This produces families of remedies with connected but
different pharmacological actions. Many new drugs such as antibiotics and anesthetics
are produced in this way. It is also common that biochemists propose chemicals with
pharmacological effects based on the actions/reactions in the metabolic sequences. When
it is felt that a certain chemical might produce an effect on a known biochemical reaction,
chemists are directed to go out and synthesize the key that fits the lock. Whatever kinds
of substances are discovered, they must go through a number of screens or filters to weed
out the harmful or ineffective remedies. They are tested in the laboratory to see
whether they have an effect first in the test-tube, then on animals, such as mice, rabbits or
guinea pigs. For example, a new stimulant will be tested on groups of mice to see if it
reduces their sleeping time, alter the behavior, ability to learn, metabolism and so on.
Tests will also be carried out on the way a drug is absorbed and excreted, or whether it is
converted to something else that is toxic, and what proportion of it goes in the body. In
the case stimulant, particular attention would be paid to the brain to see how much of it
ended up there and which sections of the brain were affected. Only least toxic and most
effective substances are given to human volunteers to try, and perhaps only the best one
considered safe and effective makes the mark. This is submitted to the health authorities
and permission is requested to carry out a study on the effects of the drug on patients; the
clinical trials.
The clinical trials judge the effect of the drug on people in a controlled situation, and
compare its effect to that of a completely inert substance that appears the same; the
placebo. Its effects are well known. An individual’s expectations and attitudes can easily
modify and over ride the effects of a drug. Someone taking a completely inert pill may
have all sorts of drug effects, while someone taking a drug, none and can be convinced
that it was useless. For example, dummy pills, can change states of mind, such as
anxiety, and might even assist in diseased such as asthma, coughing, diabetes, angina,
seasickness or arthritis. The clinical trial is intended to sort out the real from such
imagined effects of a drug. These trials are supposed to be double blind meaning that
neither patient nor the physician knows who is receiving placebo or the real drug. If a
drug gets through the clinical trial and is shown to be safe and effective, a license is
applied for. The licensing authorities will normally review all the evidence, including the
trials, and if they give the green light, the manufacturer can go ahead and make the drug,
market it and sell it. The whole process from discovery to the doctor’s prescription
seems sounds, a sensible and reasonable scheme for discovering effective new drugs and
getting them to people.
The system appears to be sensible, systematic and logical. This happens to be the only
legal way of accepting, producing and prescribing therapeutic drugs and procedures in
the health sector almost all over the world. But at times the problems with this
methodology become apparent when the drug once approved had to withdrawn, modified
and even banned for further use. Obviously, there are weaknesses in the system such as:
1. The toxicity trials on experimental materials such as animal models, tissues and cell
cultures are inadequate to represent their action on human beings especially on long term
usage.
2. The use of animal models of disease as a tool to evaluate efficacy of drug greatly
restricts the possibilities for the discovery/ development of new drugs for the emerging
new diseases as the search of a suitable animal is not always successful. The pace of drug
discovery is slowed down to the pace of discovery of new testing situations.
3. The enormous cost of trials also restricts many potential new drugs. Only few drugs
can be tested by placebo controlled double blind clinical trials. Pharmacologists will only
risk trying drugs that have a quantitatively large dramatic effect.
4. One has to set up a pharmaco-vigilance organization to test for any deleterious effect/
side effect of the drug especially on long term usage such as contraceptives and drugs for
metabolic diseases. It is not surprising to find that drugs were the root cause of many
disorders.
5. Many of the herbal preparations and therapeutic procedures such as yogic and life style
changes are not considered of therapeutic value only on the grounds that they have not
been tested by the modern drug testing system protocol as therapeutics modules are
extremely difficult to fit into the testing system.
The medical progress during this century has been spectacular especially in the field of
imaging technologies, diagnosis of maladjustments and disorders, surgical and life saving
procedures. But in the field of drug development and treatment of emerging new diseases
we are lagging behind. We have run headlong down the alley of ‘specificity’, and
‘affectivity’. Man has been stopped in our progress by a pandemic of metabolic and
degenerative diseases. To remedy this, we need a twofold strategy;
1. A health doctrine which deals with inner balance, disease resistance and vitality.

2. A science on how to maintain genuine health and human capacity for as many years
as possible now being called Geriatrics.

This means a marriage of traditional means to maximize health with modern means
to minimize disease.
There are living traditional medical systems which have such knowledge. These are in
India and China. The traditional Chinese medicine is now acceptable to a limited area.
The systems which we need now have been in daily use in India and China for more than
5000 years. China is running traditional Chinese medical system along with modern
medical system in their hospitals and clinics. In India too, the traditional Indian systems
like Ayurveda, Siddha, Unani and Yoga are being popularized and practiced in Modern
Hospitals and Clinics. This is considered not only to preserve the methods of traditional
medicine, but to fuse them with modern medicine.

Health in Ancient Indian and Chinese Medical Systems

In order to diagnose maladjustments, disorders and overt or hidden disease, the Chinese
and Indian physicians worked from the symptoms to the disharmonies which caused
them. Their goal was an assessment of the functional state of various organ systems,
following which an attempt was made to isolate the factors in the patient’s life-style or
environment which were causative.
The primary source of information was the pulse, which, if read with sensitivity, would
give many clues as to the nature of the internal disharmony. The pulse gave an indication
of the severity of the disease and the potential for a cure (prognosis). There were three
pulses on each hand and others scattered at various sites on the limbs. The physician had
to observe the rhythms, strengths, sounds and patterns of the pulses. The more finely
tuned and delicate his perception, the more information he could obtain about the inner
state of the patient. The sensitivity required as illustrated by instructions such as: ‘When
the pulse is slow and quiet, it acts as a protector and guardian. In days of spring the pulse
is superficial like wood floating on water. In winter it is sleepy, quiet and delicate like a
nobleman in his mansion.’ Though, it is rather difficult to find such physicians who
can read and interpret pulse. The physician will also derive valuable clues from
examining the color of the skin, the nose, tongue, mouth, teeth and the various colors of
the coating of the tongue. He will listen to the breath, the speech and the lungs. He
examines and smells the perspiration, urine and feces. He inquires about the patient and
his manner of life in great detail. The physician must be able to ‘see’ the functional state
of the body with such subtlety and insight that simple people credit him with almost
supernormal powers.
Chinese and Indian physicians generally did not classify health, aware of the basic
impossibility of the task. They recognized only an undivided spectrum running from
super vitality to death. Vitality with Longevity of life was considered to be the yardstick
of health. In both the systems 100 years of healthy life span was desired and prayed.
In China, the understanding of qi has literally shaped the worldview of Asian cultures for
thousands of years and the traditional medical training of its practitioners. Qi is a
complex concept that can be partly described as forming the basis of all life. Qi is
expressed in the strength of body and all its organs and tissues. The fundamental
principle of health and healing is dependent on the flow of qi (Huan & Rose, 2001). The
Physicians assessed the strength and vitality of the patient – his qi. They knew which
functions are affected and are to be cured. Their first concern was to bring the elements
in man into harmony with the environment. The healer also guided the patient to increase
his qi, for without a strong central life force the body will not have the power to return to
health. In some cases it is the qi which was increased first, the disease itself being
mopped up at a later stage. In Indian System of Medicine qi was more or less defined as
Life Force or Vitality. This has been expressed as Agni located all over the body.
The ancient medical systems taught that the primary activity should be to establish
harmony with the nature which would prevent disease. The art of disease prevention was
developed to an unparalleled degree. If the patient fell ill, it was considered partly the
physician’s fault. The Physician was and still is an instructor in living, since health and
disease arise from an appropriate or inappropriate way of life. The doctor is a sage, the
sage a healer, the healer a philosopher. These days, the Modern Physician, tends to be a
Specialist who is skilled at the examination of pathological symptoms of a particular
Physiological System rather than the patient as a whole. The system of Family Physician
prevalent earlier akin to Oriental practitioner has more or less disappeared. They
investigated the cause which might have resulted in disease state. The family physician
and the oriental one were tuned to every person’s basic make-up and characteristics, since
each individual is a walking record of his development.
It is difficult to estimate the success of traditional medical approach to health in an
objective manner. We know that there were many epidemics like plagues and cholera.
There were very healthy people too who survived these. The infantile mortality was very
high. There were a large number of mothers who died during child birth. The average life
span has been continuously rising with the development in modern medicine in
developed countries in comparison to the developing nations where traditional medicine
is still the way of life in large areas. However the traditional medical systems had made
some remarkable advances; The circulation of the blood, discovered 2000 years before
William Harvey; Total anesthesia discovered at the same time; Immunization against
smallpox by sniffing powder from pustules of cows with cow pox; The filling of teeth
with mercury-silver amalgam in the sixth century; And the discovery of hundreds of
unique remedies based on which many modern drugs have developed.
The real success of traditional medicines lay in its development of many kinds of
methods for preserving health for as long as possible, in accordance with its demanding
definitions of health. Its failure was its inability to remove the great risks associated with
illness once disease has gained a foothold.

Chinese Drugs
Shen Nung, the ‘Heavenly Cultivator’, was the father of both agriculture and herbal
medicine in China, the creator of the first Chinese pharmacopoeia, and mentor of Chinese
physicians and folk healers until today. He is supposed to have written the Shen Nung
Pen Tshao Teaching, or Pharmacopoeia of the Heavenly Cultivator. This work contains
365 remedies as well as the basic teaching of Chinese herbal medicine. Of the 365
remedies listed therein, 237 are botanical, 65 from animals, 43 mineral and the rest
unidentified. Shen Nung, according to some apocryphal sources, lived about 3000 BC.
Others say that he never existed. His book, Pen Tshao, was known at least as far back as
the second century BC.
The remedies are classified in a most interesting manner. They are placed in three
grades according to their toxicity, in an order. The most important group is the
‘kingly’, ‘superior’ drugs. They are characterized by being absolutely harmless, by being
used for a great variety of health purposes by the sick and the healthy, and by their ability
to increase vitality.
Superior healing herbs: They support at least one of the “three treasures”. The three
treasures according to traditional Chinese medicine, are known as qi (kinetic energy),
jing (essence or vital force), and shen (spirit or consciousness). Qi is the energy that
causes heart to beat, the lungs to breathe, and movement of blood throughout the body.
Furthermore, there are five categories within the superior class of Chinese herbs
(Winston and Maimes, 2007), and some herbs may fit in more than one category. These
categories include:
1) Qi tonics: Herbs that increase physiological energy production and are used to
treat the depletion of qi, examples include Asian ginseng (Panax ginseng, Chinese
name- Ren Shen), Eleuthero (Eleutherococcus senticossus, Chinese name- Ci
wujia), and licorice (Glycyrrhiza glabra, Chinese name- Gan cao).
2) Blood (xue) tonics: Herbs that nourish the blood and are especially useful for
woman, Example include lyceum.
3) Herbs that nourish the jing: these herbs helps conserve or strength the vital force,
Examples include Asian ginseng, cordyceps (Cordyceps sinensis, Chinese name-
Dong chong xia cao), reishi (Ganoderma lucideum, Chinese name- Ling zhi), and
schisandra (Schisandra chinensis, Chinese name- Wu wei zi).
4) Yin tonics: Herbs that nourish the fluids of the body, relieve dryness, and strength
the lungs, skin, stomach, and bowel, Examples include American ginseng, lyceum
and shatavari.
5) Yang tonics: Herbs that strength yang. They are especially used for deficient
kidney conditions and affect reproductive and adrenal functions; Examples
include Ashwagandha, Cordyceps, and Morinda roots.

Another quality that distinguishes the superior tonics is their ability to enhance normal
body functions. They help to establish homeostasis. They can strengthen the regulatory
mechanisms of the body and mind in such a way that body can maintain its balance
during stress. They increase inner vitality and energy and promote disease resistance.
They are ‘harmony remedies’.
In the second grade are the ‘ministerial’ herbs. These common drugs are more
powerful, are used against some diseases and are slightly toxic. For example:
Sophora angustifolia (k’u-shen)
Scrophularia oldhami (hsuan-shen) (a figwort)
Polygonum bistorta (tzu-shen) (bistort)
Angelica sinensis (tang-kuei) (type of angelica)
Fritillaria thumbergii (pei-mu)
Thirdly come, the inferior ‘assistant’ herbs, whose toxic dose is close to the
therapeutic dose. They are used to cure specific diseases. They are the last resort when
all other methods have failed. For example:
Aconitum Carmichael (aconite)
Platy Odon grandiflorum (chi-keng)
Adonis amurensis (pin-liang-hua) (pheasant’s-eye)
Veratrum nigrum (hellebore)
Strychonos nux vomica (vomit-nut tree)
There is also a subsidiary ‘servant’ class of drugs. They have the ability to conduct
other medicines to the place where they are intended to act in the body. Chinese
medicines largely follow the principle of ‘’noli nocere’’ (harmlessness). Few poisonous
plants are used, and if they are, the toxins are removed by processing. Almost all modern
medicines would be assigned to the assistant category by the Chinese pharmacologists
because of their toxicity and side effects.
All the herbs listed above are included in the Pharmacopoeia of the People’s Republic of
China (2000 English Edition).
In the two millennia since the first Pen Tshao, the principles of the Chinese use of drugs
have changed very little. They have only become somewhat more complex, and many
more remedies have been discovered. Chinese traditional medicine today is the result
of a continuous skein of evolution with occasional revisions along the way. Traditional
doctors still derive inspiration from the most ancient medical texts. However, Traditional
medicine suffered considerably, sinking in favor steadily in China with dominance of
Europeans during 15th to late 19th century. The intelligentsia of the Chinese urban was
won over by European ways including the health system. After the revolution in China all
physicians were urged to study traditional methods and incorporate them into their
modern training. Specialist hospitals using traditional methods and universities of
traditional medicine were established, as well as experimental institutes on acupuncture
and pharmacology. The Central Research Institute of Traditional Medicine in
Beijing,China coordinated the revival. Traditional medical experts joined with Modern
medicine-trained doctors in the Chinese medical association, and a flood of old books,
new compendia and reference works were published. Traditional physicians were no
longer the second-class experts dominated by imported foreign medical techniques.
Their procedures were no longer secret. They handed them over to a new generation of
professional traditional doctors. The traditional art again became the medicine of the
people. They included acupuncture, moxibustion, massage, physical culture and
medicines. These ancient techniques have been refined continuously. Their effectiveness
has also been demonstrated by modern methodology to entire world.
A long healthy life has been the cherished goal of man since antiquity. A number of
hymns and prayers are in Indian Scriptures including Vedic texts devoted to healthy
living and longevity. There are prayers to promote rejuvenation, healing and regeneration
of tissues i.e. Dhatus in the body. In addition to the rejuvenation of tissues, mention is
made to the important nature of the Jiva or Soul and its eternal transformation and rebirth.
The Vedic concepts of rejuvenation, longevity and immortality are the basic
philosophical concepts in Ayurveda. These concepts are embodied in Naithiki cikitsa,
Rasayana and Vajikaran; the procedures and the drugs meant for promotion of health in
otherwise healthy persons. The Rasayanam and Vajikaran seem to be the beginning of a
new branch of Medicine now being called Adaptive Medicine.
Rasayana is one of the eight clinical specialties of classical Ayurveda. It appears to have
been practiced in ancient times as an important specialty aiming at rejuvenation and
geriatric care. Rasayana is not a drug therapy but is a specialized procedure practiced in
the form of rejuvenative recipes, dietary regimen and special health-promoting conduct
and behavior i.e. Achara-rasayana. The focal basis of Rasayana is accelerated and
appropriated nutrition leading to improved biological competence of the body; the very
meaning of the word Rasayana (Rasa+Ayana) refers to nutrition and its assimilation in
the body. A state of improved nutrition is suppose to lead to a series of characteristics
like prevention of diseases, decreased ageing, improved immunity, mental competence,
vitality and luster of the body. However with the passage of time the importance of the
Rasayan and Vajikaran declined in popularity. This was an important part of Ayurveda
during the times of Charak, an important sage physician who lived and practiced about
three thousand years ago. Perhaps during his times, the diseases in the community were
controlled and not so common. With the passage of time, the diseases became more
common. It became necessary to deal with their cure and therapeutics of diseases.

Since Rasayan and Vajikaran seem to be the progenitor of Adaptive Medicine and
signatures for promotive aspect of modern Medicine, these are described in little detail.

The Rasayana promote health through one or all of the following three modes:
1. By the enrichment of nutritional quality of Food (Poshaka Rasa). A large
number of Rasayanas, both drugs and foods, contain in their bulk high quality of
nutrients and as such when administered, they are directly added to the pool of
nutrition and in turn, help improve tissue nourishment. Satavari, Dugdha, and
Ghrit are few such examples of Rasayanas.
2. By promoting nutrition through improving the Agnivyapara i.e. digestion and
metabolism. Several Rasayana drugs are known to promote digestion of food
and vitalize the metabolic activity resulting in an improved nutritional status.
Bhallataka is such an example.
3. By promoting the competence of Srotas i.e., the micro-circulatory channels in the
body leading to better bio-availability of nutrients and improved tissue
perfusion. Guggulu as mentioned by Sarngadhara is such an example. The
hypolipidemic and anti-atherosclerotic activity of Guggulu is in conformity with
the Rasayana effect of this drug.

The Rasayana are primarily of promotive value and are essentially meant to rejuvenate
the body and mind, to impart longevity against ageing and immunity against disease.
However, a rational classification of Rasayana into Ajasrika, Kamya and Naimittika has
been made (Mishra, 2011). Ajasrika is the nutrition which is taken regularly as food.
Kamya rasayana is suggestive in health to promote the vigor and vitality. Some
Rasayanas may be used in patients suffering from specific diseases in order to promote
their vitality. This is called Naimittika rasayana; Silajatu and Tuvaraka are the specific
examples of Naimittika Rasayana. In view of the contents, usage and purpose, the
Rasayana may be classified as given below (Charak Samhita, 1985):
A. As per scope of use:
1. Kamya Rasayana (promoter of normal health)
A. Pranakamya (promoter of life-vitality and longevity)
B. Medhakamya (promoter of intellect)
C. Srikamya (promoter of complexion and luster)

2. As per method of use:

1. Vatatapika Rasayana (outdoor regimen)
2. Kutipravesika Rasayana (indoor regimen)

B. As per contents of Rasayana:

1. Ausadha Rasayana (drug Rasayana)
2. Ajastrika Rasayana (dietary Rasayana)
3. Acara Rasayana (conduct Rasayana)

The use of Rasayana;

The Rasayana therapy is performed by two methods;
(1) Vatatapika (Out door)
(2) Kutipravesika.(In Hospital)
In Vatatapika procedure, the person remains in the society exposed to normal air and sun
and continues his normal work while under therapy. Vatatapika method is a routine
Rasayana procedure. It is convenient and cheap but is less effective. On the other hand,
the Kutipravesika procedure is a specialized indoor regimen of Rasayana therapy and as
such involves a rigorous procedure. The person has to be placed in a specially built
Trigarbha Kuti. He has to undergo systematic purificatory procedures i.e. Panchakarma.
A suitably chosen Rasayana in consideration of a number of factors dependent upon the
condition and nature of the patient, is administered in its full course. Samsodhana karma
(purification procedure) as a preparatory procedure before Rasayana Therapy has been
given special emphasis. The patient needs mental purification as well. Such a procedure
rejuvenates the individual. The kutipravesika procedure although difficult and
cumbersome, is claimed to yield highly effective benefits. It is advisable to select
Rasayana suitable for different age groups in relevance to the rate of ageing as individual
losses one of the ten important impacts of life processes every decade. Hence in
respective decade, one should select such a Rasayana which may supplement the specific
loss. At ages 1 to 10 years and after 80 years of age, Rasayan therapy has not been
advised. From 11 years to 30 years, growth promoting rasayana are advised to be taken.
Between 31 to 40 years, medhya Rasayan are to be given. Between 41 to 50 years, luster
of skin is desired to be improved. Between 51 to 60 years, Vision needs special attention
and beyond 61 years, virility needs to be augmented. However with change in desh and
kal, these requirements may be changed dependent on the needs.

The Medhya Rasayana (Higher Brain Function)

All Rasayana are supposed to promote both the body and the mind However, some
Rasayanas influence the mind or Medha and promote mental competence. Such
Rasayanas are called Medhya Rasayanas. These promote Prajna (Dhi, Dhriti and Smriti
i.e., intelligence, learning and memory). The four Medhya rasayanas namely
Sankhapuspi, Mandukaparni, Gudici and Yastimadhu are well known. In addition, a
number of other drugs have also been attributed with Medhya effect. Many such drugs
have been extensively and scientifically studied. These have been reported to posses
varying degree of anxiolylic activity and found to enhance intelligence and memory.
Naimittika Rasayana
The Naimittika Rasayana appears to be a later development in Rasayana-tantra. Specific
Rasayana were proposed for use in patients with specific disease. This concept emerges
in Susruta-samhita. Specific role of certain Rasayanas in the care and cure of specific
diseases such as Silajatu in Prameha and Tuvaraka in Kustha, gave a new dimension to
Rasayana-tantra.
Achara and Ajasrika Rasayana
Rasayan Therapy also includes specific dietary regimen, appropriate behavior and
conduct in addition to drugs. The Ajasrika rasayana refers to continued consumption of
nutritious diet such as milk, ghrita etc. Practicing proper social conduct and living with
clean and hygienic habits i.e., Achara such as worship of gods, respect to elders and wise,
holding on truth and non-violence, avoiding indulgence in alcohol, sex and excessive
physical activity, being self restrained, keeping peaceful attitude, speaking sweet words,
performing rituals including Japa, meditate, showing kindness to living being, being
humble, study of religious literature and respect for the believers of God. An aspirant
who lives such a life and practices Sadachara achieves the Rasayana effect i.e., longevity,
immunity and intellectual power. Probably the Achara Rasayana keeps the person free
from the emotional disturbances and stresses of everyday life, living and work. Ayurveda
highly appreciates the concept of Achara rasayana as the “Rejuvenating Method”.
The Rasayana drugs
The Ayurveda describe a large number of Rasayana drugs both herbs and minerals to be
used singly or as compounds. Many drugs are in use even today. Chyavanprasa and
Brahma rasayana are popular composites while Amalaki, Pippali, Amrta, Sankhapuspi,
Mandukaparni, Madhuyasti, Brahmi and Ashvagandha are popular single drug
Rasayanas. Certain Rasayana drugs are used in increasing dosage schedule with or
without special non-cereal dietary regimen popularly called Kalpa viz., Pippali-
vardhamana Rasayana, Bhallataka Rasayana, Ritu-haritakki etc. The Rasayana drugs
besides promoting nutrition at the level of Rasa, Agni and Srotas also possess anabolic
and virilising activities similar to Vajikarana agents which are essentially aphrodisiac and
mood-elevating agents besides their effect as Rasayana or anabolics.
Vajikaran
Since antiquity, perpetuations of one’s own species are a sign of life and living. One has
an instinctive desire to extend clan or race. Putraisana (desire for progeny) is one of the
primary desires of mankind mentioned in the Upanisads, the ancient scriptures of India.
Moreover, to make it more attractive it is synergistic with the pleasure derived from sex.
The Vaja means both speed and semen. Thus this branch of Ayurveda designed to
promote virility and power was crystallized, in the post-Atharv ved period, as Vajikarana.
The bull (Vrsa) is another animal which discharges semen copiously and as such it is also
known as vrsya. By comparing the little bird sparrow and the giant animal elephant in
terms of sexual power or sustenance, it was shown that the latter does not depend on the
bulk of the body but more on will and energy.
Human Prakrit (Nature) or innate personal qualities play important role; some are
stimulated by time factor, some by practice, some by other means (drug etc.) and some
are potent by nature. In the past, it was a routine procedure to take some aphrodisiac
before undertaking sexual intercourse. The idea was to promote, in this way, the quantity
and quality of semen along with sexual enjoyment.
The difference between Rasayana and Vajikaran is that the former promotes all the
Dhatus while the latter specifically increases semen and sexual potency. Of the two
aspects of Vajikaran, procreation and enjoyment, one or the other has been receiving
emphasis from time to time according to sociological condition. Many emphasized on
the former whereas Vatsyayana, the great sage and teacher of sexology in India during
medieval period, attached importance to the latter. He included this topic in his treatise.
But the physician’s role has been to look to both and maintain a balance between the two.
On the one hand, impotency was treated as a disease, on the other, excess of sex
supposed to causes loss of Dhatus and origin of other consequences like consumption.
Similarly, excess of progeny is not desirable but at the same time infertility was a curse.
In ancient compendia of Ayurveda, Vajikaran is described in a separate chapter after
Rasayana. In the cikitsasthana of Carak Samhita, the first two chapters deal with
Rasayana and Vajikaran. In fact, their role is promotive and as such they are parts of
Svasthavritta (health living) rather than of Cikitsa (therapeutics).
Classification of Vajikaran
The Vajikaran dravyas are divided into the following three groups:
1. Dehabalakara (or janaka) – promoting physical strength including semen quantity
and quality.
2. Manobalakara (or pravartaka) – enhancing psycho social aspects of sexual
activity)
3. Deha-manobalakara (or janaka-pravartaka) – Acting in both ways.

Again it is grouped, in terms of semen quality, as follows:

1. Sukravridhikara – increasing semen
2. Sukrasrutikara – promopting discharge of semen
3. Sukrasruti-vrdhikara – covering both the above aspects.

Vajikarana drugs:
According to the texts Vajikaran dravyas have been divided into five categories.
 Promoting production of semen: (milk, ghee, onion, vidari, musali, gokshura,
shatavari, yashtimadhu and semen from various other animals).
 Purifying action on semen: (kushtha, sugar cane, and bayberry).
 Promoting fertilization capacity in semen: (brahmi, shatavari, katuka, guduchi,
amalaki, bala).
 Herbs that increase libido: (akarakarabh, saffron, clove, garlic, pippali).
 Tonics to combat premature ejaculation: (nutmeg, ashwagandha, chandhan,
jatamansi, kapikachchu).

In addition to above substances of animal origin viz. eggs, semen of animals and birds,
testicles of goat etc. are also important ones. The use of Cannabis which is known to be
of use now as aphrodisiac was not used as such in early times. These drugs provide
pleasure, progeny and stamina.

References
Charaka, Caraka-samhita, Ed.P.V. Sharma, cikisasthana, ch.1, Chaukhamba orientalia,
Varanasi 1985.

Charak Samhita, 1998 Chaukhambha Orientalia Varanasi, Section 6 Chikitsasthanam,

Chapter 1, Qtr 1, pp 4-5.
Huan, Z.Y. and Rose, K. A Brief History of Qi, Paradigm Publications, 44 Linden Street,
Brookline, Massachusetts 02445, 2001
Mishra RN. Rasayan - The Ayurvedic Perspective. Res. J. of Pharmaceu. Biol. and
Chem. Sci. 2 (4): 270-282, 2011.
Pharmacopoeia of the People's Republic of China (English Edition) 2000; Pharmacopoeia
Commission: Published by: Chemical Industry Press

Sharadini Dahanukar and Urmilla Thatte, Ayurveda Unravelled, 1996, National Book
Trust, India
Singh R.H.: Ayuvediya Nidana Cikitsa-Siddhanta, Vol. 1, Chaukhamba Amarabharati
Prakshan, Varanasi, 1986.

Singh R.H.: The holistic principals of Ayurvedic Medicine. Chaukhamba Sanskrit

Prtishthan, Delhi, 1998, 117-127.
Stephen Fulder, The root of being; Ginseng and the Pharmacology of Harmony, Rider
and Company, London, 1980, 18-53.

Susruta, Susruta-samhita, Ed. Atrideo, Cikisasthana, chs. 27-29, Motilal Banarsidass,

Varanasi 1960.

Winston and Maimes (Eds.) Adaptogens: Herbs for Strength, Stamina, and Stress Relief,
Published by Healing Art Press, One Park Street, Rochester, Vermont 05767, 2007.