“ROLE OF INDIGENOUS DRUGS IN PSYCHIATRY”
Dr. B.S. Kale, DPM (Dublin)
Supdt. Mental Hospital Gwalior (M P.)
Paper before Scientific Session of the 14th Annual Meeting of the Indian Psychiatric Society at Ranchi (Bihar), March 1961
INTRODUCTION:
HIPPOCRATES, the father of medicine, wrote twenty-three centuries ago:
“No man can be a good doctor unless he loves the art of healing, loves mankind, loves his patients.”
“Clear grasp of theoretical knowledge, wide practical experience, skill and purity of body and mind: those are to be known as the tetrad of desiderata in a physician” according to Charaka5
Truth is science and science is search for truth. Research is essence of life. Life is growth. Growth of science is perpetual.
History of mental diseases is as old as man himself as Psyche and Soma are inseparable. When Psychology was considered as part of philosophy, metaphysics, theology etc. mental diseases were considered as haunting or possession of man by some spirits, holy or evil. Naturally, the treatment was left to visits to Holy places, Priests, and Witchcraft. Science has advanced tremendously since then. Now mental diseases are considered as separate disease entity like that of any other somatic disease.
The modem era of the care and treatment of mental illness dates from the end of the eighteenth century and is divided into three periods: viz: (i) The period of humane reform; (ii) The introduction of non-restraint; and (iii) The hospital period. In twentieth century much advance is made in its theory and management, especially so, after the Second World War.
Psychoanalytical approach to psychoneurotic cases and Physical methods of treatment like Chemical and Electro Convulsive Therapies, Insulin Therapy, Leucotomy, Hypnotic and Sedative Drugs, Tranquillizers, Antidepressant drugs etc have been widely used. During last decade or so, much advance is made in neurology, neurobiology, neuro-biochemistry, neuro-pathology and psychopathology and with it in psycho-pharmacology too. As the working of the Brian and Central and Autonomic Nervous system is becoming clearer, more and more drugs are coming in vogue which act at different levels of the nervous system like Spinal Cord level, synapse level, brain stem, basal, ganglion, thalamus and hypothalamus and Cortical level. With this advance, physical methods of treatment are losing their ground and control of mental diseases by drugs alone is the hope of near future, it is a good sign.
For the present more and more drugs are being imported from the west and raw materials exported. Fortunately, after the independence, the things are improving and Government is keeping strict watch on exports and imports of drugs. However, it affects our economy. We should therefore give more attention to our Indigenous herbs and drugs. A man of science should be open minded and not biased or prejudiced to any party.
Healing is not only Science but also an Art. To make it perfect, one must take best from every party after careful study and scientific trial.
In our country-Indian Medicine-Ayurveda is as old as Vedas. Mental diseases-Un-mad or Insanity is mentioned in detail in Ayurvedic literature.
Charka describes general etiology etc. of Insanity as follow:
- Diet that consists of articles that are incompatible, vitiated and un-clean.
- Disrespect towards the gods, teacher and the twice born;
- Mental shock resulting from excess of fear or joy; and
- Faulty bodily activity.Due to any or all these factors “ The humors in the body of the weak-minded, getting morbid by the above factors, and in their turn, vitiating the brain, the seat of intelligence, become localized in the channels of the nervous system and soon derange the function of the mind.And the general symptoms are confusion of intellect, extreme fickleness of mind, agitation of the eyes, unsteadiness, the incoherence of speech, mental vacuity.’ An imbecile, who is thus afflicted, is unable to know pleasure from pain and right behavior or duty. Needless to say, he knows no mental ease. Deprived of memory, understanding and his wits, he keeps his mind wavering restlessly.It is classified into five main varieties i.e. due to vata, pitta, kapha, all-together or exogenous (due to spirit).Treatment vary according to type, endogenous (Vata, Pitta, Kapha, etc.) or exogenous (Spirit), Various types of herbs and medicines are advocated which include different types of medicated ghee and other medicaments.Preventive side is also described as “The man of strong mind, who abstains from flesh and alcohol, observes a wholesome diet and is always dutiful and pure will never fall a victim to insanity, whether exogenous or endogenous.”Thus we see that, though in its own way and according to knowledge of that time mental diseases and its treatment are very well described in Ayurveda.Therefore if we make re-search of that literature and put the old remedies to test of the modern times and concepts, we may be able to contribute a remedy to mental diseases which will be cheaper, easily available and procurable, effective, less toxic and within the means of the poorest.With this idea in view and encouraged by the works of Dr. Hakim1Soni,30 Rana,27 Dhairyam, I have been using Indian medicines in my cases during last eight years. In this paper, l shall attempt to put before you my method and observations. In this series I have used Indigenous drug combinations singly or with other therapies in 388 cases and put before you my observations with inferences. I must admit and frankly say that I had no proper facilities to try it in more scientific manner. I had no laboratory facilities, no proper follow up or up-to-date record. I have not been able to use a double-blind method or placebo method. They are purely clinical observations and based on little experience of ten years of practice in this line. For scientific approach chances of erring are many but as the results obtained were encouraging, I make bold to put this before you so that it may serve as an incentive to our younger and junior colleagues for more scientific research in indigenous drugs for management of mental diseases.According to Chopra “ The indigenous drugs have great importance both from the professional and economic points of view. Medicine is very ancient art, and drugs have been used in days of antiquity as far back as history can take us. It is impossible to think of medicine as something not connected with treatment and drugs have formed an integral part of treatment from the commencement of human memory.” Captain Johnston Saint, mentioned the extraordinary advance made both in surgery and medicine in India when Europe was groping for light in her cradle in Greece; says he : If then this is what we found in surgery, what may we not find in Medicine from India – that vast and fertile country which is a veritable encyclopaedia of the vegetable world. The Material Medica of the ancient Hindu is a marvel from which both the Greeks and the Romans freely borrowed.A system which has survived to such an extent, the ravages of time, cannot be entirely brushed aside as unscientific. History shows that many of our important pharmacological drugs were also used in some form or other possibly long before they were introduced into Western medicine and before their actions were investigated on scientific lines. Medicine is a progressive science; in every department, an attempt is being made to replace empiricism by rationalism and nowhere is this more evident than in the science of pharmacology and therapeutics.MATERIAL USED:
From ancient times the roots of an indigenous plant Rauwolfia serpentina, has been widely used in India and Malaya, as an antidote to insect and snake bites,as a febrifuge, as a stimulant to uterine contratcion, and as a sedative. Dr. R.J Vakil investigated its use in hypertension and found it to have a marked hypotensive action. Recently the drug has attained prominence as a remedy for insomnia, hypochondria etc. The hypnotic action of the drug appears to have been known to the poorer classes in Bihar and the practice of putting children to sleep by this drug is stated to be still presented in certain parts of province. In Uttar Pradesh and Bihar, the drug is sold as “Pagal-ka-Dawa” (Insanity specific) and its use is common amongst the practitioners of the indigenous medicines. But sometime it produces congestion of nose, eyes, diarhoea, dizziness, excessive salivation bradycardia, rigidity of the hands and parkinsonism like syndrome. The major side-effect of the drug is reduction in blood pressure.
Dhairyam used Sanku-pushpi and triple salt (Muppu) intrathecaly and also Neermuly and mukia intrathecaly and in cistern in mental cases. He also used injection of Brahmi subcutaneously and was satisfied with the results.
Hakim, Soni, Rana used combination of Indigenous drugs. As the drugs of this combination appears to have synergistic action and counteracts the side effects fairly well I have also used the same combination.
Drug used is, therefore, a combination of:
- Chandrika-Sarpagandha (Rauwolfia- Serpentina) 200 Mg. (3 Gr.)
- Shankhushpi (Evolvulusalsinoides) 67 Mg. (1 Gr.)
- Bhringaraj – Bhangro (Eciipta alba) 50.25 Mg. (3/4 Gr.)
- Brahmi (Monniera cuneifolia or Herpestis monniera) 33.05 Mg. (1/2 Gr.)
- Jeevanti (Leptadenia reticulata)33.05 Mg (1/2 Gr.)
- Ugragandha (Acorus calamus) 16.75 Mg. (1/4 Gr.)
400.10 Mg. (6 Grs.)
It is crude Power sold in tablet form under the name of ‘SILEDIN’ manufactured by ALARSIN – Post Box No. 14, Bombay 1.
Clinical material used was indoor and outdoor cases at Mental Hospital, Gwalior, (M.P.) since 1954 to 1960. The series consists of 388 cases and 100 Control cases. They include males and females of varying age groups ranging from 4 to 70 years.
Cases included married and unmarried and of different educational and social status, from Housewives and Cultivators to Professors. Cases were of various diseases viz: Mental deficiency, Epilepsy, Psychoneurosis and behavior disorders, Manic Depressive Psychosis, Schizophrenia, Toxic and Senile Psychosis and Dementia.
IMPORTANT PHARMACOLOGICAL ACTIONS OF INDIVIDUAL DRUGS:
1. Rauwolfia Serpentina Benth (Sarpagandha-Chandrika) Chopra6 Nadkarni .
On account of its popularity much work is done on this.
Sen and Bose (1931) found two alkaloids in the root. Siddiqui and Siddiqui (1931) have found five new alkaloids and divided in two groups. A-Ajmaline groups and B-Serpentine group and other constituents like phytosterol, Oleic acid and unsaturated alcohols. Schlittler and Co-workers (1952) isolated from the Oleoresin fraction of the root extract a new alkaloid reserpin. m. p. 262°OC in crystalline form. This is supposed to be one of the hypnotic principles of the drug.
According to Palmer “there are about three dozen Rauwolfia alkaloids of which four-reserpine, deserpidine, rescinnamine, and syrosingopine, – are clinically used as hypotensive agents, as well as the whole root of Rauwolfia serpentina and the alueroxylon fraction. Rauwolfia apparently depletes tissue stores of serotonin and also catecholamines. There is evidence that serotonin is important in cerebral function although its precise role is not known (Sioerdsnna, 1959). Clinically the most important action is hot its weak hypotensive one, but its tranquillizing one which may be devastating, producing severe prolonged depression sometime requiring electro-shock treatment. Happily, this is rare and therefore less important than mild suppression of mental alertness which in my experience, is quite common and may be very serious in brain workers.”
Rauwolfia and its derivatives are weakly hypotensive, but powerfully tranquillizing, diminishing alertness and intellectual function. The latter is far more serious in brain workers because far more common than the occasional serious depression, peptic ulcer, weight gaining, salt retention, and unexpected bleeding.
Ajmaline group acts as a general depressant to the heart, respiration and nerves and the Serpentine group paralyses the respiration and depresses the nerves but stimulates the heart. Reserpine has been found to be a strong and long duration central sedative. In small doses the animals are put to sleep for a long period. In higher doses the effect is reversed.
The drug has been tried by Sen and Bose (1931) in cases of Insanity with violent maniacal symptoms. Gupta and Co-workers (1943) treated fifteen patients suffering from various types of mental disorders.
According to Vahia the drug is not a hypnotic but it potentiates the action of other hypnotics. The E. E. G. studies show that patients do not show sleep patterns like other hypnotics. The drug does not seem to act on Cerebral Cortex. It probably acts through the hypothalamus by reducing sympathetic activity. It is probably this action that is responsible for reducing the tension state without disturbing the mental activity. Pletscher and others have suggested that reserpine acts by releasing serotonin from the intestine. Probably serotinine and reserpine exert a common central potentiating action, according to Shore and others. Some workers have reported that atleast in the treatment of mental cases the total alkaloids are more efficacious than its principle active alkaloid reserpine. Kothari in his preliminary report suggests that probably other alkaloids potentitate the action of reserpine. If this impression is found to be ultimately correct, then a standardized product, containing all the alkaloids would be a drug of choice. The drug does not seem to cause addition nor does it seem to produce tolerance.
Datey and Josh have also found that the powdered root of Rauwolfia serpentina the crude extract of the root act better than reserpine alone. Locket (1955) also report favorably with crude extract. Fortunately, a wide margin of safety exists between the therapeutic and toxic doses of the Rauwolfia serpentina group. Some unpleasant effects, such as nasal congestion, and dryness of the mouth and throat are very common, but severe reaction did not appear even when doses were high e.g. Serpasil 10 mg. or Serpina 48 mg. a day. It seems curious but the toxic effects of Rauwolfia serpentina are not necessarily associated with the higher doses of the drug.
2 Evolvulus alsinoides (Shankha-pushpi) – Chopra6 Nadkarni22
Constituents – A yellow neutral fat, an alkaloid, an organic acid and saline substances.
Action – Tonic, alterative and febrifuge; also an- thelementic and antiphlogistic.
Uses – It is used in fever, nervous debility and toss of memory.
Dhairyam9 has used Shankha-pushpi in some mental cases with good results.
3. Eclipta alba (Bhrungraj)6 – Chopra – Nadkarni.22Constituents – Alkaloid ecliptine.
Action – Tonic, Roots and leaves are cholagogues.
Uses – Roots and leaves are largely used alone or in combination with ajowan seeds in derangement of the liver and gall bladder.
They have been used as substitutes for Taraxacus a reputed and popular liver tonic.
4. Herpetis Monniera (Brahmi) – Chopra, Nadkari, Malhotra, Aithal and Sirsi
It is considered to be nerve tonic and useful in insanity and Epilepsy.
The Alkaloid obtained from Herpestis Monniera for which the name Brahmi is suggested has been studies by Bose and Bose (1931).
The dose of 0.05 mg per kilobody weight of cat produces a fall of blood pressure. In smaller doses, however there is slight rise of blood pressure due to vasoconstriction and stimulation of the cardiac muscles. The respiration is stimulated in small doses. Plain muscles like that of small intestines, uterus etc.are stimulated in dilution of 1 in 200,000 to 1 in 500,000.
Malhotra – The crude total extract have been found to have cardiotonic, vasconstrictor, sedative and neuromuscular blocking actions. LD 50 frogs was 43.15 mg/100 G. body weight when injected into the ventral lymp sac.
LD 50 in albino Rats was 30.1 mg/ 100 G body weight by intra-peritoneal route.
The pure glycocide – Saponin principle was found to have cardio tonic action in normal and hypodynamic frogs heart, sedative action in Rabbits and guinea – pigs ileum and rats Uterus.
LD 50 in albino rats was 2.51 mg/ 100 G body weight by intra-peritoneal route.
Aithal and Sirsi2 – Both the leaves and stems of the plant are used in the indigenous system of medicine for a variety of clinical disorders like asthma, rheumatism and kidney dysfunction, of particular importance are its therapeutic claims in disorders of the central nervous system and affections of the higher centres of the brain. Epilepsy, insanity, general mental retardation are some of the affections where the drug is considered to act beneficially. The plant is also considered astringent, bitter, cooling and is believed to improve the intellect.
The alkaloid ‘brahmine’ in therapeutic doses raises and in higher doses reduces the blood pressure. A glycoside – saponin principle isolated from it exhibits sedative and cardiotonic actions. The alcoholic extract has a tranquilizing effect in rats and dogs. This is evident from the general behaviour which is dissimilar to those observed with hypnotics. The psychotropic actions of the drug in facilitating ‘the motor learning’ in rats has now been established.
5. Leptadenia Reticulata (Jeevanti) – Chopra, Nadkarni, Agarwal
The plant is used in Ayurvedic medicine as a tonic, restorative and stimulant (Kirtikar and Baow -1933) and in combination with other indigenous drugs for sexual neurasthenia and sedation. Agarwal et al (1960) find that:-
- Aqueous extract of L.reticulata has a prolonged and pronounced hypotensive effect both intact aswell as spinal dogs.
- It does not block the Carotid sinus reflex and intracisternal administration causes marked and prolonged rise in arterial pressure.
- It does not possess parasympathomimetic or adrenalytic actions but blocks the pressure response to nicontine.
- It does not possess parasympathomimetic or adrenalytic actions but blocks the pressure response to nicontine.
- It has got negative ionotropic effect in dog’s heart which is transient.
- It causes significant vasodilatation in the dog’s hind limbs.
- It causes initial stimulation followed by depression of the respiration and slight constriction of bronchial muscle.
- It does not show any acute or chronic toxicity in rats in dose upto 6 cc/kg.6. Acorus Calamus (Ugragandha) — Chopra, Nadkarni,2 Agarwal et al.
Action — Root and rhizom are stimulants, emetic, nauseant, Stomachic, aromatic, expectorant, Carminative, antispasmodic and nervine sedative. Improves Agni, clears urine and stools. Beneficial in hysteria and neuralgia used also in epilepsy and insanity.
Agarwal et al (1961). Lately, the powder of roots and rhizomes of Acorus calamus has been used along with other indigenous drug powder like Ruwolfia serpentina and has been claimed to be of value in neurosis, insomnia, Melancholia, hysteria, and also indicated in neurasthenia and epilepsy. Action of an extract of Acorus calamus roots and rhizome on experimental animals has shown the drug to possess potent sedative and analgesic properties. This justifies its historical use in ayurvedic system of medicine for various mental diseases. Experiments have shown Acorus calamus to be a potent drug possessing significant Pharmacological action.
Dandiya et al – The steam volatile fraction of the roots and rhizomes of Acorus calamus prolongs the sleeping time of mice when used with pentobarbithe, hexobarbitol and ethanol. It reduces body temperature of mice. The maximum reduction of body temperature and the potentiation of the hypnotic activity is observed one hour after its administration. It exacerbates tonic seizure provoked by convulsive doses of Metrazol in rats and potentiates the action of reserpine in reducing amphetamine toxicity in aggregated mice.
Madan et al – Essential oil of Acorus calamus, has been investigated for its antiarrhythmic, antiveratrinic and anticonvulsant actions. It exhibits guinidine like activity. In addition protective action of Acorus calamus against maximum electro-shock seizure in rats has been elucidated.
TOXICITY TEST ON SILEDIN’ TABLETS:
Herd and Mundy18 (1953) report as follows: Preliminary Test-
In these tests male mice each received 100 milligrams of the crushed tablets orally, that is by stomach tube, in aqueous suspension on four consecutive days. Thus, each animal received 400 milligrams or about 16 gms per kilogram. This huge dose produced no deleterious effect.
Toxicity of Extracts:-
Two types of extracts were made – a lipoid extract (Petroleum either and benzene) and water-soluble extract. The lipoid extract was a golden brown oil and represented about 1.4 per cent of the material.
The acqueous extract represented 28.9 per cent of the material.
The extracts were then tested for toxicity by subcutaneous injection into groupings of mice. Each mouse received the equivalent of 100 milligrams of the original material on three consecutive days. Thus each mouse received the equivalent of 300 milligrams or about 12 grams per kilogram.
No toxic effects were produced after 12 days.
RESULTS:
These experiments show that the material has a very low toxicity.
Toxicity Report by the Panray26 Corporation, New York, 1953.
We have just completed a study embracing ten (10) albino rats in order to determine the LD 50 in rats viz: stomach implantation of the drug. All the rats employed in the study survived the test period of two weeks and at no time was there any interference in food or water intake or in the excretions of the animals. No irregularities or abnormalities were noticed in the coats of the living animals. All the animals were sacrificed and autopsies were performed on each rat. All organs appeared normal. In as much as the rats tolerated the dose of 1350 Mg. per kg. of the drug, we found ourselves limited by the bulk of the drug which could be put into the stomach of the test animal. Under the circumstances, it was impossible to establish an LD 50 in rats. In any event, these early findings clearly illustrate that this drug is non-toxic.”
METHOD AND PROCEDURE:
388 Cases were treated with this indigenous drug combination in some form or other as detailed below and 100 cases were used as Control. (Table No. I)
These cases were divided sex-wise, age- wise, disease-wise, group combination-wise. (Table Nos. II, III and Iv).
TABLE NO. I
| Control Cases | Indigenous Drug and Combination | Total |
| 100 | 388 | 488 |
TABLE No. II
CASES: Disease and Sex-wise
| SR.No. | Disease Group | Control Cases M. F. T. |
I.D. and Combination M, F. T. |
Total | ||||
| 1 | Affective Reaction Type | 34 | 36 | 70 | 115 | 91 | 206 | 276 |
| 2 | Schizophrenic Reaction Type | 25 | 5 | 30 | 101 | 11 | 112 | 142 |
| 3 | Mental Deficiency | — | 16 | 5 | 21 | 21 | ||
| 4 | Psychoneurosis | — | — | 10 | 10 | 20 | 20 | |
| 5 | Toxic Psychosis | — | _ | — | 7 | 3 | 10 | 10 |
| 6 | Senile Psychosis | — | 6 | 2 | 8 | |||
| 7 | Dementia | __ | 4 | 1 | 5 | 5 | ||
| 8 | Epilepsy | — | — | — | 3 | 1 | 4 | 4 |
| 9 | Hyperkinesis | — | __ | __ | 1 | 1 | 2 | 2 |
| Total | 59 | 41 | 100 | 263 | 125 | 388 | 488 | |
TABLE No. III
CASES: Disease, Age and Sex-wise.
| SI. | Disease Group | Age Group | Age Group | Age Group | Age Group | Total | ||||||||||
| No. | 1 to 20 | 20 to 40 | 40 to 60 | 60 & above | ||||||||||||
| M. | F. | T. | M. | .F | T. | M. | F. | T. | M. | F. | T. | M. | F. | T. | ||
| 1 | Affective Reaction Type | » | ||||||||||||||
| a) Control | 2 | 3 | 5 | 20 | 25 | 45 | 11 | 8 | 19 | 1 | — | 1 | 34 | 36 | 70 | |
| b) Drug and | 23 | 15 | 38 | 74 | 62 | 136 | 18 | 14 | 32 | — | — | — | 115 | 91 | 206 | |
| Combination | ||||||||||||||||
| 2 | Schizophrenic Reaction | |||||||||||||||
| Type a) Control | 7 | 2 | 9 | 17 | 3 | 20 | 1 | 1 | _ | 25 | 5 | 30 | ||||
| b) Drug and Combination | 29 | 2 | 31 | 70 | 9 | 79 | 2 | 2 | — | — | — | 101 | 11 | 112 | ||
| 3 | Mental Deficiency | 13 | 4 | 17 | 3 | 1 | 4 | 16 | 5 | 21 | ||||||
| 4 | Psychoneurosis | 1 | 2 | 3 | 5 | 7 | 12 | 4 | 1 | 5 | — | — | — | 10 | 10 | 20 |
| 5 | Toxic Psychosis | 1 | — | 1 | 5 | 3 | 8 | 1 | — | 1 | — | — | — | 7 | 3 | 10 |
| 6 | Senile Psychosis | 5 | 2 | 7 | 1 | — | 1 | 6 | 2 | 8 | ||||||
| 7 | Dementia | 4 | 1 | 5 | — | — | — | 4 | 1 | 5 | ||||||
| 8 | Epilepsy | 2 | 1 | 3 | 1 | — | 1 | 3 | 1 | 4 | ||||||
| 9 | Hyperkineses | 1 | 1 | 2 | 1 | 1 | 2 | |||||||||
| Total | 79 | 30 | 109 | 195 110 305 | 46 | 26 | 72 | 2 | — | 2 | 322 166 488 | |||||
Table IV:
Cases: Diseases – Drug Combination- Wise
| Sr. No | Disease Group | Control | I.D. Alone | I.D.+Cardizol | I.D+E.C.T | I.D+ other Drugs | I.D & Other Treatments | Total |
| 1 | Affective reaction type | 70 | 21 | 9 | 128 | 13 | 35 | 276 |
| 2 | Schizophrenic Reaction Type | 30 | 7 | 10 | 48 | 10 | 37 | 142 |
| 3 | Mental Deficiency | 6 | 1 | 4 | 9 | 1 | 21 | |
| 4 | Psychoneurosis | 7 | 3 | 7 | 3 | 20 | ||
| 5 | Toxic Psychosis | 1 | 7 | 2 | 10 | |||
| 6 | Senile Psychosis | 1 | 4 | 1 | 2 | 8 | ||
| 7 | Dementia | 2 | 1 | 2 | 5 | |||
| 8 | Epilepsy | 4 | 4 | |||||
| 9 | Hyperkinesis | 2 | 2 | |||||
| 100 | 47 | 20 | 195 | 44 | 82 | 488 |
All cases were classified in Nine sub-groups of Adolf Meyer as per Henderson.17
Indigenous Drug combination was used in five different combinations:
- Indigenous Drug Alone
- Indigenous Drug with Cardiozol Shock
- Indigenous Drug with E.C.T.
- Indigenous Drug with other Drugs like — Chlorpromazine, Meprobamate, Trifluopromazine,Trifluperazine, Amphetamine, etc.
- Indigenous Drug with several treatments combined viz: other Drugs – oral or parenteral, hormones, Insulin, E.C.T. and Cardiozol. These were chronic cases.
For control, cases where indigenous drug was not used but other methods of physical treatment were used are taken.
Results were classified in three groups as cured, improved and not-recovered. Cured includes those cases who were relieved of all their symptoms and went back home in normal condition and did not turn back again. Follow up was possible only in few cases and they showed no relapse. Improved included all cases who were relieved of their symptoms but few showed relapse and those that were not normal but manageable at home. Those that did not benefit by treatment were termed as not- recovered.
Results of different groups and disease-wise is shown in Table Nos. V to XVI
TABLE NO. V
AFFECTIVE – REACTION – TYPE (M.D.P.) – A 206 CASES B 70 CONTROL
| SI. | Group | Cured | Improved | Not-recove red | Total | |||
| No. | No. | % | No. | % | No. | % | ||
| 1 | Indigenous Drug Alone | 10 | 47.6 | 10 | 47.6 | 1 | 4.8 | 21 |
| 2 | Indigenous Drug with Cardiazol | 5 | 55.6 | 3 | 33.3 | 1 | 11.1 | 9 |
| 3 | Indigenous Drug with E.C.T. | 74 | 57.8 | 53 | 41.4 | 1 | 0.8 | 128 |
| 4 | Indigenous Drug with other Drugs only. | 5 | 38.5 | 7 | 53.8 | 1 | 7.7 | 13 |
| 5 | Indigenous Drug with other Combinations. | 3 | 8.6 | 26 | 74.3 | 6 | 17.1 | 35 |
| A Total | 97 | 47.09 | 99 | 48.6 | 10 | 4.85 | 206 | |
| B Control | 26 | 37.10 | 35 | 50.0 | 9 | 12.90 | 70 | |
TABLE VI
SCHIZOPHERENIC – REACTION – TYPE -A 112 Cases B 30 Cases Control
| SI. | Group | Cured | Improved | Not-recovered | Total | |||
| No. | No. | % | No. | % | No. | % | ||
| 1 | Indigenous Drug Alone | 4 | 57.1 | 3 | 42.9 | 7 | ||
| 2 | Indigenous Drug with Cardiazol | 6 | 60.00 | 4 | 40.00 | – | – | 10 |
| 3 | Indigenous Drug with E.C.T. | 30 | 62.00 | 17 | 36.90 | 1 | 1.1 | 48 |
| 4 | Indigenous Drug with other Drugs | 6 | 60.00 | 4 | 40.00 | – | – | 10 |
| 5 | Indigenous Drug with other Combinations E.C.T. Cardiazol Insulin Drugs etc. | 19 | 51.3 | 12 | 32.40 | 6 | 16.3 | 37 |
| A Total | 65 | 58.9 | 40 | 35.7 | 7 | 5.4 | 112 | |
| B Control | 10 | 33.4 | 17 | 56.6 | 3 | 10.0 | 30 | |
TABLE No. VII
MENTAL DEFICIENCY – 21 CASES
| SI.No. | Group | Cured | Improved | Not-recovered | Total |
| 1 | I.D. Alone | – | 6 | 6 | |
| 2 | I.D. with Cardiazol | – | 1 | _ | 1 |
| 3 | I.D. with E.C.T. | – | 3 | 1 | 4 |
| 4 | I.D. with other Drugs | – | 9 | 9 | |
| 5 | I.D, with other Combinations | – | – | 1 | 1 |
| TOTAL | – | 19 | 2 | 21 |
TABLE No. VIII PSYCHONEUROSIS – 20 CASES
|
Sr. No. |
Group | Cured | Improved | Not-recovered | Total |
| 1 | Indigenous Drug Alone | 3 | 4 | _ | 7 |
| 2 | Indigenous Drug with Cardiazol | — | – | ||
| 3 | Indigenous Drug with E.C.T. | 2 | 1 | — | 3 |
| 4 | Indigenous Drug with other | ||||
| Drugs | 5 | 2 | — | 7 | |
| 5 | Indigenous Drug with other | ||||
| Combinations | 1 | 2 | 3 | ||
| TOTAL | 11 | 9 | – | 20 |
TABLE No IX
TOXIC PSYCHOSIS – 10 CASES
|
SI. |
Group | Cured | Improved | Not-recovered | Total |
| No. | |||||
| 1 | Indigenous Drug Alone | — | 1 | — | 1 |
| 2 | Indigenous Drug with Cardiazol | – | — | — | |
| 3 | Indigenous Drug with E.C.T, | 3 | 4 | “ | 7 |
| 4 | Indigenous Drug with other | ||||
| Drugs | — | — | — | — | |
| 5 | Indigenous Drug with other | ||||
| Combinations | 1 | 1 | 2 | ||
| TOTAL | 4 | 6 | __ | 10 |
TABLE NO X
SENILEPSYCHOSIS – 8 CASES
| SI. | Group | Cured | Improved | Not-recovered | Total |
| No. | |||||
| 1 | Indigenous Drug Alone | 1 | – | 1 | 1 |
| 2 | Indigenous Drug with Cardiazol | – | — | – | — |
| 3 | Indigenous Drug with E.C.T. | 2 | 2 | – | 2 |
| 4 | Indigenous Drug with other | ||||
| Drugs | 1 | — | — | 1 | |
| 5 | Indigenous Drug with other | ||||
| Combinations | — | 1 | 1 | 2 | |
| TOTAL | 4 | 3 | 1 |
8 |
TABLE NO. XI
DEMENTIA – 5 Cases
| Sr. No | Group | Cured | Improved | Not- Recovered | Total |
| 1 | Indigenous Drug Alone | – | 1 | 1 | 2 |
| 2 | Indigenous Drug with Cardiazol | – | – | – | – |
| 3 | Indigenous Drug with E.C.T | – | 1 | – | 1 |
| 4 | Indigenous Drug with other Drugs | – | – | – | – |
| 5 | Indigenous Drug with other combinations | – | – | 2 | 2 |
| TOTAL | – | 2 | 3 | 5 |
- In four cases of Epilepsy Siledin (Indigenous Drug) was tried with other drugs and all improved.
- In two cases of Hyperkinosis Siledin (Indigenous Drug) was tried alone and one was cured and one
improved.
TABLE No XII
Indigenous Drug Alone
| Sr. No | Disease | Cured | Improved | Not- Recovered | Total |
| 1 | A.R.T | 10 | 10 | 1 | 21 |
| 2 | S.R.T | 4 | 3 | – | 7 |
| 3 | M.D | – | 6 | – | 6 |
| Psychoneurosis | 3 | 4 | – | 7 | |
| Toxic Psychosis | – | 1 | – | 1 | |
| Senile Psychosis | 1 | – | – | 1 | |
| Dementia | – | 1 | 1 | 2 | |
| Epilepsy | – | – | – | – | |
| Hyperkinosis | 1 | 1 | – | 2 | |
| Total
% |
19 40.42% |
26
55.31% |
2
4.27% |
47
|
TABLE NO. XIII 2 Indigenous Drug with CARDIOZOL – 20 Cases
| Sr No | Disease | Cured | Improved | Not-Recovered | Total |
| 1 | A.R.T | 5 | 3 | 1 | 9 |
| 2 | S.R.T | 6 | 4 | – | 10 |
| 3 | M.D | – | 1 | – | 1 |
| Total | 11
55.00% |
8
40.00% |
1 5.0% |
20 |
TABLE NO XIV
3 Indigenous Drug with E.C.T –
195 Cases
|
Sr.No |
Disease | Cured | Improved | Not-Recovered | Total |
| 1 | A.R.T | 74 | 53 | 1 | 128 |
| 2 | S.R.T | 30 | 17 | 1 | 48 |
| 3 | M.D | 3 | 1 | 4 | |
| 4 | Psychoneurosis | 2 | 1 | 3 | |
| 5 | Toxic Psychosis | 3 | 4 | 7 | |
| 6 | Senile Psychosis | 2 | 2 | 4 | |
| 7 | Dementia | 1 | 1 | ||
| 8 | Epilepsy | ||||
| 9 | Hyperkionsis | ||||
| 111
56.92% |
81
41.58% |
3
1.50% |
195 |
TABLE NO XV
4 Indigenous Drug with other Oral Drugs – 44 Cases
| Sr. No | Disease | Cured | Improved | Not-Recovered | Total |
| 1 | A.R.T | 5 | 7 | 1 | 13 |
| 2 | S.R.T | 6 | 4 | – | 10 |
| 3 | M.D | – | 9 | – | 9 |
| 4 | Psychoneurosis | 5 | 2 | – | 7 |
| 5 | Toxic Psychosis | – | – | – | – |
| 6 | Senile Psychosis | 1 | – | – | 1 |
| 7 | Dementia | – | – | – | – |
| 8 | Epilepsy | – | 4 | – | 4 |
| 9 | Hyperkionsis | – | – | – | – |
| 17
38.63% |
26
59.09% |
1
2.28% |
44 |
TABLE NO XVI
Indigenous Drug with Other
Therapies – 82 Cases
| Sr. No | Disease | Cured | Improved | Not-Recovered | Total |
| 1 | A.R.T | 3 | 26 | 6 | 35 |
| 2 | S.R.T | 19 | 12 | 6 | 37 |
| 3 | M.D | – | – | 1 | 1 |
| 4 | Psychoneurosis | 1 | 2 | – | 3 |
| 5 | Toxic Psychosis | 1 | 1 | – | 2 |
| 6 | Senile Psychosis | – | 1 | 1 | 2 |
| 7 | Dementia | – | – | 2 | 2 |
| 8 | Epilepsy | – | – | 4 | |
| 9 | Hyperkionsis | – | – | ||
| 24
29.26% |
42
51.21% |
16
19.53% |
82 |
Table XVII-XVIII show comparison of control group and Indigenous Drug Group
TABLE NO XVII
Comparison in A.R.T and S.R.T with control group
| Sr. No | Cured | Improved | Not-Recovered | Total | |
| Control Group | |||||
| 1 | No of Cases | 36 | 52 | 12 | 100 |
| 2 | % | 36% | 52% | 12% | |
| Indigenous Drug
(All Five groups combined) |
|||||
| 3 | No of Cases | 162 | 139 | 17 | 318 |
| 4 | % | 50.94% | 43.71% | 5.35% |
Indigenous drug was given in tablet form. Each tablet was of 400 mg or 6 Gr and dose used varied from 3 tablets per day to 12 tablets per day in divided doses. Usually 2 Tablets three times a day was given for first 15 days, then reduced or increased according to condition and continued for two months. In acute excited cases, those who cooperated to take tablet, 3 Tablets were given Q.I.D for first few days and then the dose reduced to 2 T.D.S and later 2 B.D. Usually I asked them to take with milk and I prescribed Yeast Tablets with it.
When patients are discharged, I usually prescribed ‘Siledin’ Tablet and Yeast and ask them to take 2 B.D each for four to six months. Usually their reports were satisfactory. In few cases they were used for one to two years.
TABLE No. XVIII
COMPARATIVE PERCENTAGE IN CONTROL AND INDIVIDUAL GROUP WHERE INDIGENOUS DRUG IS USED
| Sr.
No. |
Group | Cured | Improved | Not-recovered | Total |
| 1 | Control | 36% | 52% | 12% | 100 |
| 2 | Indigenous Drug Alone | 40.42% | 55.37% | 4.27% | 47 |
| 3 | indigenous Drug with Cardiazol | 55.00% | 40.00% | 5.00% | 20 |
| 4 | Indigenous Drug with E.C.T. | 56.92% | 41.58% | 1.50% | 195 |
| 5 | Indigenous Drug with other oral Drugs |
38.63% | 59.09% | 2.28% | 44 |
| 6 | Indigenous Drug with other treatments |
29.26% | 51.21% | 19.53% | 82 |
| TOTAL | 488 |
OBSERVATIONS:
Results seen are given in above tables. V to XVI are self-explanatory.
Table XVII shows that percentage of cure in group Indigenous drug combination was used in Affective-Reaction Type and Schizophrenia Reaction Type, was 50.94% while in control cases it was 36%. Not recovered percentage in Indigenous drug group was only 5.35% while in control group it was 12%.
Table XVIII shows that percentage of cure in Indigenous drug group increased as compared to control group except in last group of chronic cases where it was used with other treatment and showed no advantage. Percentage of improvement also increased when the Indigenous drug was used alone and with other drugs or with other treatment but as percentage of cute was better with Cardiozol and E.C.T. percentage of improvement was naturally less in these groups. Except in last chronic case group percentage of Not-recovery decreases substantially as compared to control groups.
Two female cases where SILEDIN was used for long time complained of uterine bleeding (Menorrhagia) but whether it was due to use of this drug or any other cause could not be ascertained. They, however improved on discontinuing the drug. Palmer has mentioned such unexpected bleeding.
Except this no side or toxic effect was seen when this drug was used. In Chlorpromazine, meprobamate, triflupromazine, in some cases marked drowsiness, giddiness, weakness, constipation, insomnia, excessive salivation or dryness was noticed. This was not noticed with Indigenous drug group. Amnesia or disturbances of memory, irritability, apprehension, sexual weakness which usually followed with convulsive therapy was less marked or absent in Indigenous drug group.
Duration of treatment with or without indigenous drug group did not vary much, but with Indigenous drug group they showed good response, they were more cooperative and manageable and there were few or no adverse side effects.
SUMMARY.
- Indigenous drug combination was used singly or in combination in 388 cases and 100 control cases were used.
- Results of Indigenous drug group are better than control group.
- There were few or no side or toxic effects with Indigenous drug group as with other
- Action of Indigenous drug group is synergistic with other therapies specially with other drugs, Cardiozol and E.C.T.
- Indigenous drug alone has given very satisfactory results in 47 cases.
- It has shown no memory disturbances, no sexual weakness, no insomnia, no liver
damage or gastric upset. - It could be freely used, without any side-effect. In General Practice or when the patient
is not under observation and becomes controllable with this or other treatment and is
discharged and sent home. - It is economical and easily procurable being indigenous drug.
CONCLUSION:
Indigenous drugs show great promise in the treatment and management of mental diseases. It, however, needs further studies, investigations and researches about the combinations, proportions, actions of individual drug and doses, etc.
Pharmacological Action of many Indigenous drugs are now being studied and more work is being done on them.
As said in the beginning my observations are purely clinical and these may vary and differ from person to person. Facilities for me were practically nil except the clinical material. But all the same, they substantiate the findings of my predecessors like Hakim,16 Soni,30 Rana2‘’ etc. and if this can prove as incentive for further research work on Indigenous Drugs in Mental diseases my purpose is well served.
ACKNOWLEDGEMENTS:
Here I must acknowledge with great thanks help received from “MANTHAN” Research Division of ‘ALARSIN’, Bombay-1, in providing me free samples for clinical trial and making available to me the references asked for by me.
My thanks are also due to Shri Manu Desai of ‘ALARSIN, for helping me to compile this paper – which I have been contemplating since last few years but could not put in action for some reason or other.
I must thank staff of my hospital for their kind help specially to Dr. S. B. Mathur, Dr. P, C. Gumasta and Dr, B. Banerjee.
I must also mention the invaluable help rendered by my son, Dr. P. B. Kale, in preparing the tables and which was a very arduous task.
Last, but not the least, the thanks are due to all my patients and guardians who cooperated with me in this work.
In the end, I must mention that in order that more and more scientific work be done on indigenous Drugs I had suggested the “MANTHAN” Research Division of ‘ALARSIN Bombay-1 to offer a research scholarship to the Indian Psychiatric Society for research on Indigenous Drugs and I am Glad to say that they have accepted my proposal and offered the same to the Secretary. I hope this will offer our Society an opportunity to promote research on Indigenous Drugs, especially for Mental Diseases. `