An Exploratory Study On Critical Analysis and Understanding of Medhya Rasayana (intelligence enhancer) in Dementia

Introduction

Lockdown was declared all over the globe at different time points according to the epidemic to break down the spread of the coronavirus disease- 2019 (COVID-19) infection. Social distancing was a critical means to break the cycle of infection. But it has caused severe threats to the physical and psychological health of the people around the globe. It causes loneliness and increases mental issues like anxiety, depression, and dementia.

Globally, the number of people with dementia is increasing. In 2013, the estimated number of people suffering from dementia was 44.35 million, which is expected to increase to 75.62 million in 2030 and 135.46 million in 2050 (Figure 1).¹ In Ayurvedic literature, impairment of memory is mentioned as Medhahrasa, which occurs due to vitiation of raja and tama doshas.

Medhya Rasayana drugs are beneficial for mental health of the healthy as well as the diseased. These drugs play an essential role in the treatment of psychiatric and psychosomatic diseases. Hence, since time immemorial, these drugs are being used in the management of many neuropsychiatric disorders. 

Dementia

Dementia is a cognitive condition associated with symptoms including memory loss, personality changes, and impaired intellectual functions that result from disease or trauma to the brain.² If these symptoms are not managed properly, the patients may become helpless, incapable of remembering the names of close relatives, wander into hazardous situations, and be unobvious of their surroundings. There are many types of dementia like Alzheimer’s dementia (AD), vascular dementia (VD), Pick’s disease, and dementia due to diseases such as stroke, acquired immunodeficiency syndrome (AIDS), and multiple sclerosis (MS). The most commonly found among these is AD.²

Concept of Prajna and Prajnaparadha

The equilibrium status of dhi, dhriti, and smriti are the three components that constitute Prajna. Chakrapani says Prajna is buddhi aparadha means offense.³ The term Prajnaparadha means faulty conception. A person whose dhi, dhriti, and smriti is impaired, subjects himself to prajnaparadha by his acts. Caraka mentions that Dhivibramsha (impairment of intellect), Dhritivibramsha (impairment of will), and Smritivibramsha (impairment of memory) are the main causative factors of the mental disorders, which lead to bad karmas. This stage is defined as a Prajnaparadha. It causes various types of physical and mental disorders i.e. kama, krodha, bhaya, moha, shoka, and udvega, etc.⁴

In dementia, the functioning of dhi, dhriti, smriti, and manas is impaired due to the vitiation of rajas, tamas, pranavayu, and sadhakapitta. Hence to correct these impaired doshas, the line of treatment should include the use of Medhya Rasayana drugs which can provide stability to the mental functions which are of prime importance in the management of dementia.

Dhi: Dhi refers to the acquisition of new information. The function of dhi is governed by vata dosha mainly pranavata, which in its normal state keeps the mind focused, thereby facilitating to acquire appropriate knowledge.⁵

Dhriti: In Charaka Samhita it is said that dhriti is the controlling factor that prevents the manas from indulging in harmful and non-beneficial objects. The association of dhriti with manas has been stressed under the function of manas in the context of “Swanigraha”, Dhriti Hi Niyamatmika.⁶ Dhriti refers to the regulation and processing of new information within the brain. The function of dhriti is governed by pitta dosha mainly sadhaka pitta, which in its normal state helps in regulating and processing the acquired information.⁷ Dalhana has mentioned that control over the mind is possible only on the basis of retained experiences whether that object is useful or not “Dhriti Manaso Niyamatmika Buddhi”.⁸

Smriti: According to Charaka Samhita, remembrance of tatvagyana due to the predominance of satvaguna is called smriti.⁹ Smriti is responsible for stabilizing the memory in the brain. The function of smriti is maintained by kaphadosha, mainly tarpaka kapha which is responsible for lubrication and nourishment of the brain tissue, thus helping in stabilizing the memory.¹⁰ Acharya Sushruta mentioned smriti as bhutartha vignana i.e. knowledge of past experience.¹¹ Vijayarakshita commentator of Madhava Nidan stated that remembrance of past experience is called smriti.¹²

Eight Factors For Good Memory¹³

1. Nimitta: For smriti, knowledge of cause and effect is very helpful. According to Chakrapani, one remembers karya (effect) by noticing karana i.e. cause.

2. Rupa Grahanat: Knowledge of form is also helpful in smriti. Chakrapani gives an example that after seeing any cow in the forest, one remembers his own cow because both are having a similar form.

3. Sadrushyat: Knowledge of similarity is also helpful for smriti. For example, on seeing a son, one remembers that his father is having similar features.

4. Saviparyaat: Knowledge of contrast in another factor of the smriti. For example, having seen an ugly form, one remembers a beautiful form.

5. Sattvaanubhandha: Concentration of the mind.

6. Abhyasat: By repetition, the smriti can be made sharp. If one reads a particular subject many times, it becomes memorized and one can remember it even for a longer period.

7. Jnanayogaat: Attainment of metaphysical knowledge may be called Jynana Yoga, This tatv jnananayogat is attributed to be one of the causes of recollection of the past.

8. Punah srutaat: Subsequent partial communication also helps in better smriti. It is said that memory is derived from atma, satva, and matrujadi shad bhavas, which are responsible for the formation of dhi, dhriti, and smriti of the foetus. In Charka Samhita, it is mentioned that memory is impaired due to a person being overpowered by rajas and tamas.¹⁴

If these factors are followed in one’s lifestyle, some of the possible etiological factors associated with dementia can be avoided, thereby reducing the risk of diseases such as AD.

There is a relation between mana, buddhi, medha, dhi, dhriti, and smriti. The power that determines the nature, merits, and demerits of an object of knowledge is buddhi.

Buddhi and mana are related with the cause and effect relation, dhriti is the power that controls the orientation of attitude. It is the regulator of the functions of mana. While smriti helps the mind in recollecting the entire percept or experimented objects based on the image formed by past experiences. The mind behaves accordingly by remembering the ethics tatva jnanayogat. Medha is the power that grasps and retains the knowledge which is impossible without the conjunction of the mind. Hence all these are interlinked with each other and the derangement of one of these will reflect on the other. Buddhi is defined as a phenomenon by which knowledge is gained. Chakrapani states that अवस्थानं स्थिरमतित्वम्” (avasthanam sthiramatitvam;¹⁵ avasthanam meaning centralization of the knowledge after grasping and sthiramatitvam is a function of dhi meaning retaining the knowledge for a longer period). Avibhram is the final stage of buddhi, where no more doubts and confusions arise and the facts are clear. Dalhana says, which बुद्धिर्निश्चयात्मिका(buddhi nischayatmika) means coming to the conclusion only after proper reasoning and logic.¹⁶

Dhi bhramasha: Perceiving the ayatarthagyna, incapable of deciding factor of nitya and anitya; hita andahita. Dhriti bhramsha -The mind cannot be restrained from harmful objects due to the impairment of dhriti (controlling power) and smriti impairment in recollecting knowledge due to avarana of the mana by rajo & tamodosha.

Causative factors for dhi, dhriti, and smriti bhramsha is prajnaapardha, kaala, satvabala, beeja dusti, vatakara ahara vihara, shoka, irshya, bhya, maan, krodha, and dvesha. They vitiate rajas and tamas dosha and involvement of rasavaha, majjavaha, manovaha, samjnavaha srotodusti that are considered for the manifestation of psychosomatic disorders like unmad and apasmara vyadhi’s. These are quoted as “Dhisatvasampalvat” by Acharya Charka.¹⁷

Cognitive process:

1. Indriya receives arthas when associated with manas-aanah punah aarani Indriyanyartha Grahana Samarthani Bhavanti. This perception needs a chain of artha, indriya, manas, and atma. This perception is called Uha.

2. After this, the process of actual analysis starts by manas, i.e. chintan, vichara, uha, samkalpa are performed. It gives the determination to perception. Hence, the journey from perception to determination, i.e. adhyavasaya or nischayatmaka buddhi is the first half of the physiology of manas.

3. The second half of the physiology of manas is related to karmendriyas. Manas being ubhayatmaka indriya, has to coordinate both jnanendriya and karmendriya to be in harmony with each other. After determination of the knowledge perceived by jnanendriyas, the essential desired reflex action is to be carried out, which is coordinated by manas with the help of determined knowledge, i.e. nischayatmaka buddhi. Further initiation of the action is carried out by karmendriyas.¹⁸

Prognosis of Dementia

Kalaja and swabhavika Smriti- Buddhi hrasa due to normal aging process is known as benign senescent forgetfulness or age-associated memory impairment and are yapya. Akalaja and aswabhavika Smriti- Buddhi hrasa is curable, but with difficulty (Kashtasadhya) and sometimes yapya and should be treated according to the dosha and the stage of the disease predominantly with Rasayana therapeutic measures.

Challenging Strategies for Management of Dementia

Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine are the drugs approved by US Food and Drug Administration (FDA). They act by inhibiting of cholinesterase and raising cerebral levels of acetylcholine. Memantine blocks overexcited N-methyl-D-aspartate channels. Antioxidants selegiline, and α-tocopherol (vitamin E) are also used for the management of dementia. Recently, the extract of the Ginkgo biloba has been found to cause modest improvement in cognitive functions in dementia.²¹

After the effects of the modern drug wear off, an individual will become depressed due to decreased probability of the neurotransmitter binding to a receptor, which leads to increased appetite, irritability, and aggression. Compulsive behaviors can take on any form; increased thirst, increased sleepiness, hyperacidity, obesity, cardiovascular disorders, and hypotension. Hence to overcome these complications and cure dementia, Medhya Rasayana, an ayurvedic treatment modality is adopted. It has multi-fold benefits, specifically in improving memory and intellect by prabhava. It also increases ayu, bala, varna, svara, agni, delays senility, and prevents other related diseases in old age.

Management of Dementia in Ayurveda

Ayurveda believes that manas and indriyas are panchbhautika as well as ahankarika (ubhayatmaka). Hence, both dravya and adravyabhootchikitsa should be applied in the management of smriti nasha. Sattvavajaya is a component of adravyabhootchikitsa.

As dhi, dhriti, smriti, and hrasa occurs due to old age and result in impairment of buddhi. This can be managed by Rasayana drugs (Rejuvenation therapy). Furthermore, before Rasayana therapy, shodhana is a prerequisite. Though samsodhana is a prerequisite before Rasayana treatment but in dementia due to old age and consequent dhatu kshaya, mridu, and snehayukta samsodhana such as mridu virechana in the form of haritakyadi churna can be adopted.

Acharya Charaka has mentioned four types of Medhya Rasayana viz. mandookaparni swarasa (Centellaasiatica Linn juice), yashtimadhuchoorna (Glycirrhizaglabra Linn powder) with goksheera (cow’s milk), guduchi swarasa (Tinosporacordifolia juice) and shankhapushpi kalka (paste Convolvulus pleuricaulis Chois).²² The properties ascribed to these formulations include medhya (memory promoting), ayushya (longevity enhancers), amaya nashana (eradicate diseases), bala, agni, varna, and samvardhana (enhances strength, digestive fire, complexion, and voice).²³

In Sushruta Samhita, more information about Medhya drugs can be found, such as different formulations with their mode of use, which are in the form of Kutipraveshikarasayan (indoor management).

Method of administration

According to Acharya Charaka, Medhya Rasayana can be administered in the form of vatatapikarasayana (rejuvenation therapy having no restrictions). As per Acharya Susruta, kutipraveshikarasayana (rejuvenation therapy involving specific rules) procedure is followed such as shodhana before administration of Rasayana.

Time of administration

Early morning before food, is the ideal time for the administration of Medhya Rasayana. In Yoga Ratnakar, ‘Prabhata’ is the word used for the time of administration of four Medhya formulations.²⁴

Discussion

Acharya Charak defined Rasayanas as the means of achieving the finest quality of rasadidhatus (body tissues), which increases the life span, improves medhya (intelligence), cures disease, stabilizes youthfulness, improves luster, complexion, voice, and makes body and senses strong and healthy.

Validation and Analysis of Mode of Action of Charakokta Medhya Rasayana in Ayurvedic Perspective

Charakokta Medhya Rasayana enhance intelligence. Yashtimadhu is sheeta that pacifies vata-pitta and maintains normal kapha. It controls rajoguna and increases sattva, resulting in boosting intelligence. Yashtimadhu also nourishes dhatus and ultimately increases shukra and oja. As explained by commentator Chakrapani, effects on indriya, mana, and buddhi are mediated through oja. Mandukaparni is sheeta and it specially pacifies pitta. It also controls rajoguna and increases sattva. Shankhapushpi is slightly ushna and it pacifies vata. Shankhapushpi also controls rajoguna and increases sattva. Shankhapushpi nourishes majja. Guduchi is also slightly ushna and it pacifies all three doshas, controls tama, and increases sattva. Keeping in mind such peculiarities, a specific Rasayana is chosen for a specific person.

Validation and Analysis of Mode of Action of Charakokta Medhya Rasayana in Modern Perspective

Mandukaparni (Centellaasiatica Linn.) being a neuroprotective brain growth promoter, inhibits the memory impairment induced by scopolamine through the inhibition of AChE.

Guduchi (Wild Miers Tinosporacordifolia )- possesses learning, memory enhancing, antioxidant, and anti-stress action, enhances the cognition in normal and cognition deficits animals in the behavioral test. It is useful for the treatment of bhrama (vertigo). It also helps in improving behavior disorders. Glycowithanolides isolated from Withania somnifera were reported to possess anxiolytic activity.

Yastimadhu (Glycirrhizaglabra Linn) increases the circulation into the central nervous system (CNS), and improves learning and memory in scopolamineinduced dementia

Shankhapushpi (Convolvulus pluricaulis) is reported to possess anxiolytic and memory enhancing and moodelevating effects. It retards brain aging and is also effective in chittodvega (anxiety disorders), reverses social isolation, stress-induced prolongation of onset, decreases pentobarbitone induced sleep, increases total motor activity, and stress-induced antinociception in the experimental model.

Medhya drugs act at the level of rasa, thus stimulating and improving the function of agni, improving circulation of rasa by opening and cleaning the microchannel, and improving Medhya functions.

Conclusion

Dementia is termed as a medha hrasa or loss of memory. Early detection and management are necessary for the prevention as well as the progression of the disease. Sadvritta, Aachar Rasayana, Medhya Rasayana, panchkarma therapy, yoga, pranayama, seems very effective and helps to improve the smriti. Conceptually, all the Medhya Rasayana drugs produce their effect by acting through the nutrition dynamics of rasa, agni, srotas, at the molecular level. Medhya Rasayana drugs work on the hypothalamus-adrenal axis (HPA axis) and normalize the secretion of neurotransmitters such as dopamine, serotonin, and acetylcholine and thus can improve the mental functions.

Acknowledgment

None

Conflicts of Interest

None