Kala- Azar in Ayurveda

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I am very much glad to write foreword to the book entitled "Kala-Azar in Ayurveda". I have gone through the contents of the book entitled "Kala-Azar in Ayurveda". He is my student when he was pursuing his Ph.D from Banaras Hindu University and did his work on Kala-Azar and submitted thesis for the award of Ph.D and he successfully completed the same. Since he is a post graduate in Ayurveda hence I decided to give topic related to management of visceral leishmaniasis by Ayurvedic drugs. Ayurvedic system of Medicine is sophisticated holistic systems of medicine have been handed down from generation to generation. This system met the needs of local communities for many centuries. It is one of the potentially important resources for the delivery of health care in many ways like protection of health in healthy individual, prevention of disease and cure of the disease. Medicinal plants are oldest known health care products and their importance to the health of individuals and communities was widely accepted and was recorded since many decades. Medicinal plants are also important for pharmacological research and drug development. Keeping the scope of finding safe drug from Ayurveda this study has been designed and he did a experimental work and observed significant results in the experimental work. I completely browsed the whole book. The title of this book includes the word Ayurveda. This reflects the fact that the sourcebook draws from Ayurveda. Selected experimental work using Ayurveda as well as herbal medicines from various corner are reproduced to give you some of the latest information available to date on leishmaniasis related to natural products and Ayurvedic drugs. This book is nicely arranged in eight different sections with scientific approach, preceded with introduction and appended with bibliography. Visceral leishmaniasis patient presents at a late stage, with persistent but fluctuating low-grade fever, weight loss giving the appearance of severe starvation, spleno-or hepatosplenomegally. The skin is some times said to be muddy, pale or dark. Non-specific laboratory tests will show marked leucopenia (Pancytopenia, mainly neutropenia), anemia, and raised serum proteins, with reversal of albumin/globulin ratio. Ayurveda described certain diseases which mimics Indian Kala-azar namely Visamajwara (Satatajwara), Krimi (Raktaja) and Plihodara/Pliha roga are seems to be suitable correlation depending on their etiology, symptomatology, prognosis and treatment. Raktaja Krimi is also responsible for the manifestation Raktaja vyadhi, out of which Pliha roga is one. That's why selection of drug for the present study was done on the basis of their actions acting on liver, spleen and parasites. The existing situation demands the effective, affordable, safe, cheaper and oral leishmanicidal agents to curb the problem of treatment. This may be possible by inventing a drug from Ayurvedic Drugs. In this direction effort has been made to understand the concept of Indian kala-azar as per Ayururveda and compiled references from various texts. It is the stepping stone for the understanding of concept kala-azar from ayurvedic point of view. In this direction Dr.Parameswarappa.S.Byadgi meticulously tried his level best for the understanding of concept of kalaazar from Ayurveda and has conducted some novel experiments in his work and screened several herbal compounds both in vitro in promastigotes aswell as amastigotes in macrophages and conducted experiments using five plants in several combinations. Multiple combination group exhibited better interest nominal activity than single drug. There is good scope of taking this study further with aim to develop clinical drug.

I appreciate the work of Dr.P.S.Byadgi for his excellent work to publish this book, which is a useful addition to the understanding of kala-azar from ayurvedic perspective. I wish him the bright future and expect more such useful books from his talented brain for the benefit of Ayurvedic fraternity.

The term "Traditional Medicine" refers to ways of protecting and restoring health that existed before arrival of modern medicine (WHO 1996). Ayurvedic system of medicine is sophisticated holistic systems of medicine have been handed down from generation to generation. This system met the needs of local communities for many centuries. It is one of the potentially important resources for the delivery of health care in many ways like protection of health in healthy individual, prevention of disease and cure of the disease. Medicinal plants are oldest known health care products and their importance to the health of individuals and communities was widely accepted and was recorded since many decades. Medicinal plants are also important for pharmacological research and drug development, not only when plant constituents are used directly as therapeutic agents, but also when they are used as basic materials for the synthesis of drugs or as models for pharmacologically active compounds. (WHO 1996).

Leishmaniais is an important disease in terms of morbidity and mortality. Which is caused by infection with intracellular protozoan parasite belonging to genus leishmania and family trypanosomatidae. The organism is transmitted to human by the bite of insect called sandfly (Phlebotomus old world and Lutzomia new world).

Visceral leishmaniasis patient presents at a late stage, with persistent but fluctuating low-grade fever, weight loss giving the appearance of severe starvation, spleno-or hepatosplenomegally. The skin is some times said to be muddy, pale or dark. Non-specific laboratory tests will show marked leucopenia (Pancytopenia, mainly neutropenia), anemia, and raised serum proteins, with reversal of albumin/globulin ratio. Ayurveda described certain diseases which mimics Indian Kala-azar namely Visamajvara (Satatajvara), Krimi (Raktaja) and Plihadara/Pliha raga are seems to be suitable correlation depending on their etiology, symptomatology, prognosis and treatment. Raktaja Krimi is also responsible for the manifestation Raktaja vyadhi, out of which Pliha raga is one. That's why selection of drug for the present study was done on the basis of their actions acting on liver, spleen and parasites.

Plihodara is a syndrome characterized by splenomegally, debility, anorexia, indigestion, retention of stool and urine, thirst, bodyache, lassitude, cough, mild fever, emaciation, pain in belly, reddish or abnormal tinge or appearance of blue, green or yellow streaks on abdomen, severe anaemia etc.

Emergence of resistance to antileishmanial agents pose a growing challenge to medicine and it has played havoc with various ongoing national programmes related to control of infectious diseases like leishamnia, malaria etc. The problem is that a switch from normally less expensive first line drugs to second or third line involves a dramatic escalation in the price of treatment and presently available antileishmanial agents must be administered under medical supervision, require extensive hospitalization and are not affordable by individuals. New drugs for human diseases have also originated from alternative sources over the decade. The Chinese herb artemisine derivative ginghaosu, is widely available in South East Asia and Africa for malaria treatment. This prompted the researchers to invent a safe, cheap, effective oral antileishmanial agent from medicinal plants/Ayurvedic drugs. In this connection many efforts are undergoing worldwide for the development of drug from traditional system of medicine. With this background certain medicinal plants were selected for the present study to prove their efficacy in experimental models as well as in human beings. Many single and compound formulations were described in Ayurvedic texts for the management of Plihodara/Pliha roga, Udara and Krimi. Medicinal plants were chosen depending on their therapeutic action on liver, spleen, abdominal disorders, parasites, and fevers. The, selected plants namely Parijata (Nyctanthes arbortristis), Sarapunkha (Tephrosia purpurea), Latakaranja (Caesalpinia bonducella), Saptaparna (Alstonia scholaris), Rohitaka (Amura rohitaka) screened for their antileishmanial activity in accepted experimental models. All are well known for their therapeutic efficacy acting on liver, spleen, abdominal disorders, parasites. In one group combination of Parijata + Sarapunkha + Latakaranja + Saptaparna + Rohitaka + Guduci (Tinospora cordifolia) a cock-tail i.e. drug 6 was taken for the present study. Guduci is well known for its therapeutic action as immunomodulator. A cocktail was prepared to check the leishmanicidal activity in suitable experimental models. This was done with a view to investigate the efficacy of the drug when the immune status is suppressed due to infection. It has been well documented that resultant cure is a combined effect of drug action and immune system. Besides cock-tail group multiple combination of 1+2 (Parijata + Sarapunkha); 3+4 (Latakaranja + Saptaparna); 2+5 (Sarapunkha+Rohitaka); 1+3 (Parijata + Latakaranja); 1+5 (Parijata + Rohitaka); 1+4 (Parijata + Saptaparna) was done to check their efficacy in infected golden hamsters. Both cocktail group and multiple combination groups exhibited better efficacy than single extracts. Though, the selected plants extracts could not exceed the positive control drugs SAG and Miltefosine efficacy wise, but adverse events associated with prolonged use of latter puts severe restrictions on its use. The present study provided a clue for further research in the field of leishmaniasis research in relevance to Ayurvedic drugs.

**Contents and Sample Pages**