|Year : 2020 | Volume
| Issue : 2 | Page : 127-131
Concept of cumulative dose in Ayurveda with special reference to metallic Bhasma
Pravin Jawanjal1, Bishwajyoti Patgiri1, SS Savrikar2
1 Department of Rasa Shastra and Bhaishajya Kalpana, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Professor and Head, Department of Rasa Shastra and Bhaishajya Kalpana, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat; Scientific Advisory Board Member, CCRAS Vice-Chancellor (Ex)- Gujarat Ayurved University, (Ex)- Professor and Head, Department of Rasa Shastra, RA Podar Ayurvedic Medical College, Worli Mumbai, India
|Date of Submission||07-Mar-2020|
|Date of Decision||22-Jun-2020|
|Date of Acceptance||03-Jul-2020|
|Date of Web Publication||18-Dec-2020|
Dr. Pravin Jawanjal
Department of Rasa Shastra and Bhaishajya Kalpana, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat
Source of Support: None, Conflict of Interest: None
BACKGROUND: Metals and minerals are an integral part of Ayurvedic therapeutics. Many cases of metal toxicity caused by the administration of Ayurvedic drugs are being reported every now and then. It has been observed that in most of these reported cases, the Ayurvedic drugs were used in inappropriate dose and duration. In view of this observation, an attempt has been made in this article to bring forth the appropriate therapeutic and cumulative dose of metallic Bhasmas as described by Ayurvedic classics. The concept of the cumulative dose appears to be the most ignored part by Ayurvedic practitioners.
AIMS AND OBJECTIVES: To search and find out the references of cumulative dose with special reference to metallic Bhasma and to explore the concept of cumulative dose in Ayurveda.
METHODS: Ancient Ayurvedic classics and other available translations in various languages, published books, and other topic-related material available online were viewed and compiled references to elaborate on the concept of cumulative dose with special reference to metallic Bhasma.
STATISTICAL ANALYSIS: The cumulative frequency method is used to determine the cumulative dose.
RESULTS: Total 2 references found out of the one reference in Ayurved Prakasha and one in Sharangadhara Samhita with the commentary of adhamallas dipika.
DISCUSSION: According to Sharangadhara Samhita, with the commentary of Adhamallas Dipika therapeutics dose of metallic Bhasma for Swarna 2 Yava (62.5 mg), whereas 1 Yava according to Ayurveda prakasha but the cumulative dose is same.
CONCLUSION: As per Sharangadhara Samhita, with the commentary of Adhamallas metallic Bhasma can be used for 16 days and as per Ayurveda Prakasha 32 days. It needs to be determined in accordance with the status of Agni, Dosha, Desha, Kaala, Prakruti, and other factors.
Keywords: Ayurveda, cumulative dose, maatra, metallic bhasma, therapeutic dose
|How to cite this article:|
Jawanjal P, Patgiri B, Savrikar S S. Concept of cumulative dose in Ayurveda with special reference to metallic Bhasma. BLDE Univ J Health Sci 2020;5:127-31
The term “Cumulative dose” is the sum of all administered Doses/Cycles (usually in mg). In modern medicine, the term “Cumulative dose” is explained in relation to the management of cancer. For example, the total amount of a drug administered in a patient over a period or the total dose of radiation given in a series of radiation treatments or the total dose of radiation resulting from repeated exposures of a specific part of the body or the whole body. The term “Cumulative” means an increase in quantity, degree, or force as a result of successive additions. The term “Dose” is used to indicate the amount of drug in weight, volume, moles, or international units that is necessary to provide a desired effect. In clinical practice, it is called “therapeutic Dose.”  In Ayurveda, the term Maatraa ?can be correlated with “therapeutic dose.” Maatraa anapaayiparimaanam / Amount of drug which produces expected therapeutic effect without causing any harm to the body is known as “Maatraa” . Bheshaja maatraa vyaadhi aatura bala apekshani / The dose of the drug depends on the severity of the disorder and the strength of the patient. Maatraa pramaana can be correlated with dose measurement. In this context, consideration of Madanaphala Kashaaya Maatraa will prove exemplary. The dose of the Madanaphala decoction and also of all the expurgative drugs needs to be determined in accordance with the requirements of the individual being treated. The quantity of the drug required to eliminate abnormal dosha should be considered as the dose for the person being treated. This dose should not produce any effects of underuse or overuse.
Bhasma, an Ayurvedic dosage form, prepared by using complex procedures like Shodhana (purification), Marana (designed cyclic incinerations), possesses broad-spectrum therapeutic utility in disease prevention and treatment. Metals; Gold (Swarna), Silver (Rajata), Copper (Tamra), Iron (Lauha), Tin (Vanga), Lead (Naga), and Zinc (Yashada); are used in therapeutics in the form of Bhasma for different durations. Bhasma, when used in the larger dose and for longer duration, may cause various untoward effects. Bhasma needs to be administered in a patient in appropriate dose, with suitable adjuvant and appropriate duration, such administration of Bhasma will not produce any untoward effect. The purpose of this study is to bring forth the appropriate dose and duration of Bhasma formulations and the concept of cumulative dose as described by Ayurvedic classics. This paper also underlines the significance of adherence to the advice of these classics with reference to the dose and duration of Bhasma. This is particularly important in view of reports of a large number of cases of toxicity said to be caused by the administration of Bhasma formulations. The study of most of these cases reveals that ignoring the advice of Ayurvedic classics, the dose, and duration of Bhasma administered in the victim was exceeded considerably, which resulted in toxicity. Under this background, the present paper becomes most important.
Aims and objectives
To search and find out the references of cumulative dose with special reference to metallic Bhasma and to explore the concept of cumulative dose in Ayurveda.
| Methods|| |
For the present study, Ancient Ayurvedic classics and their main commentaries were viewed and compiled references to elaborate the concept of cumulative dose with special reference to metallic Bhasma and other available translations in various languages, published books and other topic related material available online were referred to compile, analyze, organize and describe this concept. Published research papers in only the English language were included in the review. The references were critically reviewed and sorted on the basis of relevance to the topic. In inclusion criteria, selected references talk not only about anyone metal like Swarna but also about Rajata and other Loha (means all metals). Some other references like Vardhamana Pippali also included those help to explore the concept of cumulative dose in Ayurveda. The focus of the manuscript is clear on the cumulative dose of metallic Bhasma so that reference is not related in the context of the topic are excluded. Classical terms have been thoroughly explained on the basis of the classical Ayurvedic texts in Samskrit.
The cumulative frequency method is used to determine the cumulative dose.
| Results and Discussion|| |
A total of two references describing the cumulative dose of Bhasmas are found in Ayurvedic classics. The first one is found in Ayurveda prakasha, and the other is found in Sharangadhara Samhita with the commentary ” Dipika” by Adhamalla.
Adhamalla, the author of Dipika commentary on Sharangadhara Samhita and the other famous classic Ayurveda Prakash, has described the therapeutic dose and cumulative dose of Metallic Bhasmas in detail. It is not only two texts describing two types of doses, but also the message to practicing clinician has to be made clear. The concept of the cumulative dose is specifically noteworthy in this respect; in this context Vardhamana Pippali and Bhallataka Rasayana are also considered in this article. No, any research published research paper was identified as exclusively focused on this concept.
According to Ayurveda Prakasha the following quotation describes the dose of Metallic Bhasma.
According to Ayurveda Prakasha, the cumulative dose of Swarna Bhasma is described as follows [Table 1]:
On the 1st day, 31.25 mg (1yava) should be administered. This dose should be repeated daily until a cumulative dose of 1000 mg (8 Gunja) is reached. Four Yava is equal to one Gunja. Therefore, Swarna Bhasma is to be administered in the dose of 31.25 mg daily for 32 days?. Thus, the cumulative dose of Swarna Bhasma becomes 1000 mg.
According to Ayurveda Prakasha for Rajata Bhasma and Tamra Bhasma, therapeutic dose and cumulative dose were found to be twice that of Swarna Bhasma. It means, Rajata Bhasma and Tamra Bhasma can be used in a therapeutic dose of 62.50 mg daily for 32 days and the cumulative dose for Rajata Bhasma and Tamra Bhasma becomes 2000 mg. According to Ayurveda Prakasha for Loha Bhasma, Naga Bhasma, Yashada Bhasma?, Vanga Bhasma?, Pittala Bhasama, the following cumulative doses were found. Therapeutic dose and cumulative dose were found to be thrice that of Swarna Bhasma. Therefore, Loha Bhasma, Naga Bhasma, Yashada Bhasma, Vanga Bhasma, and Pittala Bhasma need to be administered in a therapeutic dose of 93.25 mg daily for 32 days making their cumulative dose 3000 mg.
The second reference was found in Sharangadhara Samhita with Adhamalla's ” Dipika” and Kashiram's ” Gudhartha Dipika” commentaries in Dhatu upadhatu shodhana mararanam adhyaya.
According to Sharangadhara Samhita, with the commentary of Adhamalla's ” Dipika,”  the therapeutic dose and cumulative doses of Swarna Bhasma are 2 Yava (62.5 mg) and 8 Gunja (1000 mg), respectively. Therefore, Swarna Bhasma is to be administered in a therapeutic dose of 62.50 mg daily for 16 days making its cumulative dose 1000 mg.
Adhamallas Dipika further describes the therapeutic and cumulative dose of Rajata bhasma, which is observed to be double that of Swarna Bhasma. Thus, Rajata Bhasma is administered in a therapeutic dose of 125 mg daily for 16 days making the cumulative dose 2000 mg. Further, the therapeutic and cumulative dose of Loha Bhasma and other Bhasmas are found to be tripled with reference to doses of Swarna Bhasma. Loha Bhasma and other Bhasmas are to be administered in therapeutic dose of 187.5 mg daily for 16 days making the cumulative dose 3000 mg.
Ayurved Prakash further mentions the dose of Metallic Bhasma as
The maximum daily therapeutic dose of Metallic Bhasma is 1 Gunja (125 mg) whereas its cumulative dose is 9 Ratti (1125 mg). This appears to be the dose of Swarna Bhasma to be used as Rasayana (rejuvenation).
Some other references for cumulative dose are also found. However, these references are not related to Bhasma. These references are being described in this paper to elaborate the concept of cumulative dose. In this context the description of the dose of Vardhaman Pippali (Piper longum Linn.) is illustrative. The dosing schedule of Vardhamaana Pipplai Rasaayana is as follows: On the 1st day ten? Pippali (Piper longum Linn.) fruits are administered with milk. From the 2nd day onwards up to the tenth day; an increment of ten fruits is introduced daily. Further from 11th day onwards deduction of ten fruits from the dose is introduced every day till the last dose of ten Pippali fruits is administered. Thus, the cumulative intake of Pippali (Piper longum L.) fruits becomes 1000 spread over the duration of 19 days. Gangadhara Roy in Jalpakalpataru commentary describes three courses comprising ten, six, and three Pippali fruits, which are completed in 19, 25, and 36 days. Thus, the total number of fruits comes to 1000, 1014, and 1026, respectively. Sushruta describes this formulation in Maha vatavyadhi chikistita adhyaya. The dose of Pippili (Piper longum Linn.) is mentioned as 5 and 10 fruits in accordance with the strength of the patient. Bhoja Samhita has also mentioned the same dose of Pippali. However, the lower dose is mentioned as three Pippali (Piper longum L.) fruits. In the case of Bhallataka (Semecarpus anacardium Linn. f.) Rasayana, Charaka describes a gradual increase in the dose. The number of Bhallatka fruits is gradually increased up to thirty. Thereafter the dose is gradually decreased. In this way, the total number of fruits administered in a patient comes to one thousand. In Nagabala (Sida Veronicaefolia Lam) Rasayana Kalpa, the root of Nagabala is administered with the initial dose of 6 gm. The dose is then gradually increased by 6 g daily till it reaches 48 gm. Nagabala is to be taken with milk continuously for a month. In the same manner, Mandukaparni, Shunthi, and Madhuka may be also used.
This article will be incomplete unless the therapeutic and cumulative dose of the most popular and widely used or misused? drug Guggulu (Commiphora wightii Arn.) prescribed by Vagbhata, is mentioned.
The maximum therapeutic dose of Guggulu is one Pala (48 g) per day, whereas its cumulative dose is one Tula, i.e., 100 Pala (4.8 kg), which spreads over 100 days. Vagbhata further warns about the untoward effects of the overuse of Guggulu.
If Guggulu is administered in overdose, it will produce following untoward effects:[? 17]
Timira (Blindness), Vadana Shosha (Dryness in mouth), Klaibya (Infertility), Kaarshya (Emaciation), Moha (Drowsiness), and Shamala shithila bhava described by Indu as “Druta Purishatvam” (Urgency in the passage of stools) and dryness in the whole body. Further, Vagbhata states that Guggulu should never be used in all these conditions.
The difference in therapeutic dose of Bhasma as described by Adhamalla in his Dipika commentary of Sharangdhara Samhita and as described in Ayurved Prakash, is observed. Adhamalla prescribes 2 Yava (62.5 mg) as a therapeutic dose of Swarna Bhasma, whereas Ayurved Prakasha mentions 1 Yava (31.25 mg) as therapeutic dose of Swarna Bhasma. However, the cumulative dose of Svarna Bhasma, as described by both the authors is same, which is 8 Gunja (1000 mg). Variation in the initial dose of Bhasma leads to variation in the duration of the period of administration. According to Adhamalla, the duration of administration of Bhasma is 16 days, whereas according to Ayurved Prakash, this duration is 32 days.
In continuation of the above discussion, the authors also emphasize the significance of various factors such as Kala (age of patient), Agni (digestive power), Prakriti (Constitution), Dosha, and Desha (Habitat); in determining the therapeutic dose of Bhasma and other drugs. The Maatraa (dose) of every drug needs to be determined with Yukti (skill). The success of treatment depends on the determination of the appropriate dose of drug and duration of treatment. Every wise physician gives importance to two factors Maatraa and Kaala, where Matra is the principal one.
Prayoga samasad gunyad dosha na bhavanti/
Jejjata says that Pippali, if administered in appropriate dose, manner, and duration does not produce any harmful effect.
Excessive use of Piper longum Linn. (Pippali) like salts (Lavana) and alkali (Kshara) is prohibited, but their such use in Rasayana is an exception; because these drugs are used in combination with other substances and for a definite duration, which comprises gradual increasing and decrease of the dose. Potency (Shakti) of drugs is specific to action, which can be known through scriptures only. It is not subjected to human reasoning. Thus, they are beneficial only if combined with specific substances; otherwise, they are harmful. Besides, Rasayana, if administered in a person in a specific order, following proper preparations, with specific expurgation therapies, they are beneficial; otherwise, their inappropriate use will lead to the accumulation of Dosha. Administration of metallic Bhasma in the dose and duration above the prescribed dose and duration will definitely lead to their accumulation in body organs causing cumulative toxicity. Therefore, every clinician should consider the cumulative dose prescribed in the Ayurvedic classics to avoid their toxicity.
According to Chakrapani commentary Bhallataka Rasayana if appears harmful in view of the Prakruti of the patient, it may be discontinued in between the treatment period. The number of Bhallataka fruit need not be completed in one course. The cumulative dose of the number of Bhallataka fruits can be completed by repeating the course as required in view of patient tolerance?.
One should modify the potency of drugs from lower to higher and vice versa, by combination, elimination, timing, processing, and method of administration. The time of administration is also equally important in the administration of drugs. These factors should be considered during the administration of drugs in the patients in routine clinical practice.
| Conclusion|| |
It has been observed that Ayurvedic drugs, particularly metallic Bhasmas are being reported recently as a major cause of toxicity in the number of cases. This has been observed true in some cases, but a detailed study of these cases has revealed that the real culprit is the administrator of the drug and not the Ayurvedic drug. On this background, it is necessary on the part of all Ayurvedic practitioners to know the appropriate dose, duration, and method of administration of these drugs as described by the classics. In the above discussion, it has been appropriately explained that the maximum daily therapeutic dose of Swarna, Raupya, and Tamra and other Bhasmas should not exceed 62.5, 125, and 187.5 mg, respectively. The cumulative dose of Swarna, Raupya, and Tamra and other Bhasmas should never exceed 1000, 2000, and 3000 mg, respectively. However, the therapeutic and cumulative dose is not constant and varies with every individual. It needs to be determined in accordance with the status of Agni, Dosha, Desha, Kaala, Prakruti, and other factors. If the practitioner follows all these directives, there is no chance of toxicity following administration of any Ayurvedic drug.
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