Recently I came across a message which was forwarded to me about a case of severe alcoholic liver disease in a patient due to consumption of Dasamoolarishta, an Ayurvedic Formulation. It was forwarded in the name of Dr Cyriac Abby Philips, a gastroenterologist from Kochi, Kerala. When I checked his Face book page for the details of the message, I came across and the post about the case report published in American Journal of Gastroentrology – “Severe alcoholic hepatitis in a Teetotaler” and his interview at Janam TV where he has narrated the experience mentioned in the message. I appreciate doctor for highlighting the issue with details. But post in social media may create certain misconceptions among the Public which I believe was not the intention of Dr Cyriac Abby Philips. I am an Ayurvedic Doctor, a Faculty for Muniyal Institute of Ayurveda Medical Sciences, Manipal and also the Technical In-charge for Muniyal Ayurveda Pharmacy. Being a native of Kerala I am aware about the Tradition of Ayurveda in Kerala and would like to mention a few points
1. As mentioned in the message Dasamoolarishtam is an Ayurvedic medicine very popular in Kerala for centuries (years before electric mosquito killer bat) and people are aware that Arishtas are products containing alcohol. The author himself has revealed about the increase of sale of Arishtas when there was a ban on Alcohol which evidently supports the argument. The alcohol content ranges from 3-9% depending upon the product and the limit is regulated by the government to 12%. A few formulations where the alcohol content exceeds the limit of 12% are sold only in 25ml bottles. The production of Arishtas with Alcohol content above the prescribed limit is a violation of law. The sale of medicines against the specification of government is a crime either it is Traditional or modern medicine.
2. The dose recommended for the product is 12-24 ml once or twice a day and depending on the condition of the patient sometimes up to 48ml is used (for limited period of time). So maximum dose per day is 96ml. The Patient cited in the case was consuming almost 350-450ml per day which is 4-5 times the recommended therapeutic dose. Hence it was a clear case of drug abuse. We have seen similar cases of Codeine cough syrup addictions and the Nigerian Government even had to ban the product to prevent an Addiction epidemic. Many medicines which are available for over the counter sales will result in similar complications if used in doses exceeding therapeutic dose. The Problem is not with the Medicine, but with the irrational usage. Ayurveda doesn’t advocate the daily use of Aristas or any other Alcohol and similar properties are attributed to Alcohol and Poison in Ayurveda classics. Many it may act as medicine in certain conditions when used in prescribed dose. Hence dose determines whether it is Toxin or Medicine.
3. Dasamoolaristhta is a medicine which has multiple therapeutic benefits, one among which is a digestive action mentioned by the author. As doctor has stated the body know how to digest food and doesn’t need any medicine for that and I agree to that statement. However traditionally we used several ingredients in our diet that stimulates digestion like spices, Ginger and garlic which are accepted to have medicinal value. People having certain health problems need an additional support of medicine in the process of digestion. Most of the Ayurvedic medicines are administered as kashayas (decoctions), choornas (powders) etc which are prepared from crude drugs unlike isolated active constituents in modern medicine. For the absorption of the active constituents these medicines needs to be digested and absorbed in the stomach. That is the reason Ayurveda gives so much emphasis to digestion of the Patient irrespective of the disease. If a person is healthy, he need not take any medicine for digestion. Most people use Paracetamol during fever to bring down the body temperature. One purpose of a fever is thought to be to raise the body’s temperature enough to kill certain bacteria and viruses sensitive to temperature changes. Should we really reduce fever if it is helping body to get rid of infections? But on the other hand, people sometimes die due to fever. So the logic is if fever is not severe let body fight against the infection and provides adequate rest and no need of medication. But if the fever is high, definitely take medicine to control fever. Same law is applicable for all system of medicine. First give your body a chance for self- healing and then take the help of medicine as prescribed by a doctor. Any medicine consumed in excess dose will cause complications either it is Dasamoolarishta or it is Paracetamol. But that doesn’t mean those medicines are harmful.
4. Doctor has described the use of a flower Woodfordia fruticosa in the preparation of Dasamoolarishtam as a fermenting agent for generating alcohol. It is not just a fermenting agent intended to generate alcohol but has got many therapeutic benefits including hepatoprotective activity. It has proven anti-asthmatic, anti-inflammatory, anti-hyperglycemic and antioxidant properties. A few links to the research papers are
https://www.ncbi.nlm.nih.gov/pubmed/24405177
https://www.ncbi.nlm.nih.gov/pubmed/24772949
https://www.ncbi.nlm.nih.gov/pubmed/26342523
https://www.ncbi.nlm.nih.gov/pubmed/21771673
https://www.ncbi.nlm.nih.gov/pubmed/21501038
https://www.ncbi.nlm.nih.gov/pubmed/20731559
5. In his interview doctor explained about the genetic predisposition of individuals to side effects of medicine citing the example of Paracetamol. He has stated Paracetamol is not something which we need to be afraid of, if prescribed in therapeutic doses and it is safer than many other commonly used medicines. He has also explained about the genetic predisposition of individuals to side effects of certain medicines which may cause complications even in therapeutic dose. The human body reacts in the same way whether the medicine is Ayurvedic or Allopathic and rules of genetic predisposition are equally applicable to both. In fact Ayurveda is a system which decides the predisposition and prognosis to disease status and also the treatment for disease and lifestyle regime based on Prakriti (individual’s basic constitution). The Institute of Genomics and Integrative Biology, a premier institute under CSIR (Council of Science and Industrial Research) engaged in research in the areas of genomics, molecular medicine, bioinformatics and proteomics is working on a Project named Ayurgenomics based on the concept. A Few links to research findings in connection with that is attached below
https://www.ncbi.nlm.nih.gov/pubmed/26009644 https://www.ncbi.nlm.nih.gov/pubmed/26047609 https://www.ncbi.nlm.nih.gov/pubmed/23049851 https://www.ncbi.nlm.nih.gov/pubmed/27019453 https://www.ncbi.nlm.nih.gov/pubmed/26587393 https://www.ncbi.nlm.nih.gov/pubmed/21923095
Hence we can’t generalize the result based on a single case study and conclude Dasamoolarista will cause the same effect in everyone since there could be many reasons including genetic predisposition for the adverse effect seen in that particular patient. We should check about the possibility of interaction of alcohol and the toxic pesticides mentioned in the case which may result in such dangerous outcome.
Drug abuse is a major issue in all systems of medicine which needs to be addressed. No Ayurvedic qualified practitioner will support the use of irrational use of medicine. Whether it is Modern or Traditional medicine, anything which benefits mankind is good and anything which causes harm is bad. Being an Ayurvedic Professional I am aware of the merits and problems of the system. It is a traditional medicine evolved through centuries and hence like any other traditional knowledge it is bound to culture, belief and Philosophy that co-existed with that. The treatment modalities and concepts have evolved in a different era when compared to modern medicine, observation was the best methodology for research and hence certain details are subjective. Unfortunately many researchers consider numbers and objective data as the ultimate truth. But now that concept is changing and qualitative research is gaining more importance which will be a better approach for traditional medicine research. It is difficult to produce quantifiable data for everything. A famous quote comes to my mind which is credited to William Bruce Cameroon and Albert Einstein (source not confirmed but words matters)
“Not everything that counts can be counted and not everything that’s counted truly counts” Hope one day will come when doctors from different system will work together with mutual respect for each other with a single aim- For the greatest benefit to mankind.
Dr Divya P
Associate Professor
Muniyal Institute of Ayurveda Medical Sciences
