Clinical toxicology

of
Ayurvedic medicines

Ruben Thanacoody
NPIS (Edinburgh)
 Ayurvedic medicine
• Comprehensive holistic medical system 4500BC
• “Knowledge or science of life”

• Kayachikitsa Internal Medicine

• Shalya Tantra General Surgery
• Bhutavidya Psychiatry
• Agada Tantra Toxicology
• Rasayana Tantra Nutrition, Detoxification and
Rejuvenation
• Kaumarabhrtya Paediatrics/Obstetrics/
Gynaecology
• Vajikarana Fertility and Virility
• Shalakya Otorhinolaryngology
 Ayurvedic medicines
• Individually prepared • Commercialisation

• Based on herbs and minerals

• Increasing use
• Classification in Caraka
Samhita (150BC-100AD) • Wider availability
– Elemental constituents – Health food stores
– Taste
– Ethnic shops
– Potency
– Postdigestive effect – Internet retailers
– Therapeutic action (50
groups) • Lack of Regulation
 THE MAKING OF
MADONNA

India drug gives

Alzheimer's hope

EXCLUSIVE:
Traditional medicine
takes on the world
MADONNA BABY BID
MADONNA is using old Indian
fertility remedies to try for a third
child at the age of 46.
She hopes a stash of Ayurvedic
medicines will help her conceive.
Source: BBC website
 Clinical Toxicology
• Contamination/Incomplete processing/
Adulteration
– Heavy metal poisoning

• Herb-drug interactions

• Genotoxicity

• Teratogenicity
 Case history
• 37 year old man admitted with weakness, dizziness and muscle pain. He
visited India and had bought several Ayurvedic medicines.

• Hb 7.8 g/dl
• Blood lead 58 μg/dl
• Urinary arsenic 24.1 μg/dl/L (normal<20)
• Lead content of Ayurvedic medicine 238 μg/gm .

Spriewald et al. Occup Environ Med 1999; 56: 282-283

 Heavy metal content
• England 1979: 30% (11/37) samples of “kushtay”
– Aslam M et al.Public Health. 1979;93:274-284

• India 1988: 64% contain lead and mercury,

41% arsenic and 9% cadmium.
– McElvaine MD et al. JAMA. 1990;264:2212-2213

• Boston USA 2003: 20% (14/70) of preparations

contain toxic concentrations of lead, mercury and
arsenic.
– Saper KB et al.JAMA 2004;292: 2868-2873.
Saper et al 2004
 Lead poisoning and anaemia

Kales SN et al. Med Sci Monit. 2007;13: 295-8

 Contaminant or incomplete processing?
• Medicinal properties • Vatsanabha (Aconitum sp.)
• Detoxification of aconite
• Toxicity well-known (samskaras)
• Crude aconite
• Detoxification process – 100% mortality at a
dose of 2.6 mg/mouse
– Complex oxidation
• Fully processed aconite
processes
– Bhasmas (Ash) – no mortality at 8x dose
crude aconite).
• Thorat S, Dahanukar S. J Postgrad
Med. 1991 ;37(3):157-9.
 Adulteration/Contamination
• Fake preparations containing steroids

• Organochlorine pesticide residues

– Rai V et al. Environ Monit Assess. 2007(in press)
 Herb-drug interactions
• Brahma Rasayana is beneficial for promoting mental clarity,
improved memory and cognition whilst improving resilience to
mentally demanding lifestyles.
Amla (Emblica officinalis), Haritaki (Terminalia chebula), Mandukaparni (Centella
asiatica), Pippali (Piper longum), Shankapushpi (Convovulus pluricalis),
Plava (Cyperus scariosus), Musta (Cyperus rotundus), Chandana (Santalum album),
Agaru (Aquallaria agolcha), Yastimadhu (Glycirrhiza glabra), Haridra
(Curcuma longa), Vacha (Acorus calamus), Nagakeshar (Messua ferrea), Ela
(Eletaria cardamomum), Twak (Cinnamomum zeylanicum), Bilva (Aegle marmelos),
Agnimantha (Clerodendrum phlomides), Syonaka (Orroxylum indicum), Patala
(Stereospermum suaveolens), Gambhari (Gmelina arborea), Shalaparni (Desmodium
gangenticum), Brihat (Solanum indicum), Prishniparni (Uraria picta), Kantakari
(Solanum xanthophylum), Gokshura (Tribulus terrestris), Punarnava (Boerhaavia
diffusa), Mudga parni (Phaseolus trilobus), Mashaparni (Teramnus labialis), Bala
(Sida cordifolia), Eranda (Ricinus communis), Jeevanti (Leptatenia
reticulate), Shatavari (Asparagus racemosus), Shara (Saccharum munja), Ikshu
(Saccharum officinarum), Kasha (Saccharum spontaneum), Darbha (Desmostachya
bipinnata), Kapikacchu (Mucuna pruriens), Sesame oil, Rock sugar, Honey
 Pharmacodynamic interactions

• Sarpaghandha (Rauwolfia serpentina)

• Datura (Datura metal)

• Yavani (Hyoscyamus niger)

• Kapikachchha (Mucuna pruriens)

 Phenytoin/Shankhapuspi Interaction

• Single dose of phenytoin and this herb did not

alter phenytoin serum levels in rats but
decreased antiepileptic activity.

• Multiple dose co-administration reduced both

antiepileptic activity and serum phenytoin levels.

• Dandekar et al. J Ethnopharmacol 1992;35: 285-288.

 Ashwagandha and Digoxin Assay

• Ashwagandha
(Withania somnifera)
contains withanolides
structurally similar to
digoxin

• Interferes with both

– FPIA digoxin
assay(falsely elevated)
– MEIA digoxin assays
(falsely low) .
Dasgupta et al.Am J Clin Path 2005;124:229-336
 Teratogenicity
• Asparagus racemosus roots
– Teratogenic in rats
– Goel RK et al.Indian J Exp Biol. 2006 ;44(7):570-3.

• Lead-containing preparations
– Congenital paralysis and sensorineural deafness
 Genotoxicity
• Birthwort (Isharmul, sunanda)
– Contraceptive
– Aristolochia indica
– Carcinogen banned in Europe and US
Gold LS. NEJM 2003;
349: 1576 (letter)

• Salacia oblonga roots

– Weak genotoxicity in vitro
– Flammang AM et al.Food Chem Toxicol. 2006; 44(11):1868-74.

• Arsenic-containing preparations
– Skin and haematological cancers
All substances are
poisons; there is
none which is not a
poison. The right
dose differentiates a
poison from a
remedy.”

Paracelcus 1493-1541
 Charaka samhita

• Sutra sthana 1/124-127

Type and dose of the drug as per the specification of every individual, if
done by a physician before the use of the medicine, he should be called a
quality physician

If processed and used properly, a deadly poison can become a life saving
medicine.
A lifesaving medicine medicine can become poison if not used properly

Rastogi et al. Int J Risk & Saf Med.2007;19:117-125

 Conclusion

• Ayurvedic medicines contain potent biologically

active ingredients.

• Risk of heavy metal poisoning

• Regulation of these products desirable.