World TB Day: Expert Article On Tuberculosis And Ayurveda

24th March is declared as World Tuberculosis Day and the theme for the year 2022 is "Invest to end TB. Save Lives" - investing and applying the Ayurvedic management approach as complementary medicine, i.e. using ayurvedic drug & management methods with conventional methods or using Ayurveda as an alternative medicine for managing tuberculosis patients with or without traditional management.

Tuberculosis is a chronic infection that primarily affects the lungs and respiratory system, and extrapulmonary tuberculosis is also not uncommon. Tuberculosis is basically believed to be a bovine infection; in the previous century, a sharp decline in incidence & death due to tuberculosis has been observed. Still, in the last decade, there has been an increase in the number of tuberculosis cases. The more severe and alarming is the rise in multidrug resistance tuberculosis and complete drug resistance tuberculosis.

There is a rise of resistance in the microbe, and antimicrobial and anti-tuberculosis drugs seem to be lesser effective. This may be due to superbugs. The status is even worse for India as India has approximately one-fourth of the global burden; As per reports published by the ministry of health and family welfare, there has been a rise in cases of TB from 2015; there has been a decline in 2020 (as of covid -19 year). As per WHO, the estimated death due to tuberculosis in 2020 (covid - 19 years) was 1.5 million. Moreover, WHO has projects much higher deaths due to tuberculosis in the current year.

Drug Resistance In Tuberculosis Management

It has been observed that tuberculosis death has increased since 2020 (covid-19 year); WHO has raised serious concern about the surge in TB cases and TB deaths. India is the worst hit with approx. 40% of the global burden of total cases of TB has been identified in India. The surge may be probably due to poor sanitation, the unhealthy environment at home & work, insufficient water, living in crowded, nutritional deficiency, working in closed areas, having little exposure to sunlight, compensated ventilation, etc., over and above these factors, the serious problem is developing drug resistance.

Drug resistance is increasing is believed to be occurring due to improper management and discontinuing medication without medical advice. It has been opined that discontinuing medicine before 6-8 months is a primary reason for developing drug resistance. The other probable cause for drug resistance is natural selection (which is not widely accepted publicly, but scientifically this may be a more valid reason as now a day, the infective agent may be the resistant strain only). According to the theory of natural selection, only the fittest organism would survive, and the rest will be destroyed. This can be explained by the two examples below.

Mosquito - this is considered the most suitable example for understanding the phenomenon of natural selection and human intervention. The DDT, though synthesised in the late nineteenth century (1874), the first use of DDT was made possible in mid of twentieth-century (in October 1945). In the first few years, there was a great success in controlling malaria as it controlled the growth of the vector - mosquito. After about one and half decades, the effect of the DDT was not observed to be promising, and the mosquito growth has not controlled the effectiveness of DDT was decreasing. Moreover, it has adverse environmental effects and reduces the impact of the use of DDT has been reduced. Before the use of DDT, the mosquito population has a majority as DDT sensitive. A few resistance specie (as there was no merit for the people to have DDT resistance) after the first use of DDT exposed mosquito population reduced, and the majority of mosquito population was of DDT resistance strain. This change was due to the phenomenon of survival of the fittest, i.e. the theory of natural selection. The second example was of the moth of Oka tree of London.

Invest In Ending TB - Save Lives

WHO (world health organisation) has given the theme to raising funds and investing more to manage the disease and reduce tuberculosis's burden. However, there is also a need to invest knowledge of ancient Ayurveda wisdom to manage chronic infective disease.
Ayurveda can be employed as adjuvant therapy (with conventional medical management), complimentary management, and alternative management (only managed by Ayurveda management).

Tuberculosis is narrated in Ayurveda classic Charaka Samhita in detail before 3500 years. The disease though a microbial disease, but the environmental factors favour successful parasitism. It has been opined that there is the rule of 10 in tuberculosis, i.e. approx.. 10% of the population gets exposed to tuberculosis exposure, out of that 10% gets invasion of microbe, out of that population 10% of the population gets invasion of microbe in body tissue, out of this 10% population has changes of primary complex, out of these 10% population gets the disease, out of these patients 10% gets severity of disease, out of the 10% met with complications and out of the 10% eventually ends up in death. The environmental factors favour microbial growth, increasing virulence and decreasing immunity in the disease. These four factors were excessive depletion of body tissues (Dhatu Kshya), suppression of natural urges, excessive execration (performing tasks beyond individual strength) and improper diet. These factors act as an environmental factor and favour microbial to invade lodge and manifest illness. Understanding the impact of these factors on a microbial illness would help craft the management protocol that can give promising effects in treating the illness and reducing the burden on the health care system.

Ayurvedic classics narrated to use of goat products; this means that by some means, ancient Ayurvedic scholars knew the bovine relationship of disease and innate immunity of goats. For example, goats have innate immunity against tuberculosis, and thus they were not infected by the pathogen. Moreover, they don't serve as a reservoir of infection, and thus using goat milk goat meat would help combat the disease. Therefore, the reduction of cow milk is advocated.

Management Options Of TB

Ayurveda provides holistic health care through medicinal management and diet management. The primary goal of treatment is to improve host defence, improve digestion principle, improve Agni (vital fire), nourishing body tissue (nutritional principle). The important herbs used for treating tuberculosis are Pippli (piper longum), Lasuna (garlic), metals like mica, gold, goat meat, flesh, milk, etc. Polyherbal compounds commonly used for treating tuberculosis were Sitopaladi churna, Talisadi Churna, Abhrak Bhasma, suvarna Bhasma, Chyavanprasha, Kansaharitaki, Lakshmi Vilas rasa, Vasant Malti rasa, Hemgarbha potli, abhragarbha potli, etc.

There is a short course of medicated milk known as Pippli prayoga or Lasuna (garlic) prayoga. In this therapy, three long pippers are boiled with 1 cup of milk and 1 cup of water until the mixture is reduced to 1 cup, followed by eating the pipper and drinking the milk. This is done preferred in the morning time and on an empty stomach. In the case of Lasuna, one can drink milk. This can be done under the supervision of an Ayurvedic physician or his advice. As long pipper can't be consumed for long, the maximum duration of the therapy can be fortnight to four weeks. It may be done as 4 - 6 courses for managing the condition.

It has been observed in clinical trials that the use of pippli enhances the effects of anti-tuberculous drugs by increasing their bio-availability. Thus, using the Ayurveda drug as an adjuvant with conventional AKT therapy may show more promising effects.

Diet ought to include the use of goat products in food. Cow milk or buffalo milk should be replaced with goat milk for vegetarians, and goat flesh can be used as a food supplement for non-vegetarians. Mansa rasa - meat soup ought to be taken in accordance with one's digestive strength (starting with a small quantity and then increasing the quantity).

Dates are good nourishment for TB patients. Dates can be taken in breakfast with ghee, or they can be taken with dried black grapes. Ensuring proper digestion and metabolism is the key for getting success in treating TB. Hence, one needs to ensure that food ought to be taken in a quantity that can be easily digested. Food can be reduced if a person gets digestive problems, irregular bowel, and other GI symptoms.

Road Map for Planning Comprehensive Management of TB

Governmental agencies, non-government organisations, private organisations were working for managing the morbid condition. Ayurveda diet and supplements - like chyavanprasha, chyvanprasha candy, or chyvanprasha biscuits can be given as diet & health supplements. Chyavanprasha is believed to contain micronutrients that improve immunity and thus helps in managing the disease. Ayurveda medicine can be used as nutraceuticals that may prove synergetic in action and thus reduce the burden of drug-resistant tuberculosis. Adjuvant and follow-up therapy of herbal medicine and therapeutic purification (to be evaluated properly on case to case basis before employing - classically not advocated but classics narrates them in details - for details one may see in Charaka Samhita) in treated cases so that reoccurrence or relapse can be arrested.

Disclaimer: These are opinions based on knowledge from the ancient Ayurvedic classics and using them for the benefit of mankind. This information increases awareness about Ayurveda medicine in chronic microbial illness, and readers are advised to consult Ayurveda physicians or Ayurveda hospitals for more details and consultations.