INDIGENOUS
DRUGS IN THE TREATMENT OF
MENTAL DISEASES
By
Dr. R. A. HAKIM, Hon. Psychiatrist
B.J. Medical College, The Civil Hospital & The Mental Hospital, Ahmedabad
Paper before: 6th Gujarat
& Saurashtra Medical Conference, Baroda 1953
History of mental diseases and
their treatment is as old as the history of medicine. The therapies have
changed from time to time along with our concepts of the etiologic factor of
the diseases. Even though we are highly advanced in many fields of medicine
today, we still find a great handicap in the treatment of mental diseases.
However, we are better equipped than the past generation in promptly handling
and treating such illnesses.
Freud 5, Adler1,
Jung7 and
other pioneers in the psychoanalytical school by their work were able to give
us insight into the psyche of the mentally ill persons. This progress was welcomed
with great enthusiasm. Exposing thenaked psyche from the well - garbed super
ego helped us. With further investigations, various other theories of the causation
of mental illness came up. Mott 11, Pickworth12 Stockings1'1
and other contemporaries are of the opinion that the mental diseases are
the outcome of neurometabolic disorder of the brain celts. Pickworth in his
great work "New Outlook on Mental Diseases" has shown that the patterning of
blood flow in the cerebal tissues determines the pattern of association of
somatic tissues, and this conditioning of reflex pathways for sensorimotor
activities proves a satisfactory basis for correlating mental and organic
phenomena.
I was given a proprietary drug
put up by a pharmaceutical concern to try on mental illnesses. It was a
combination of Ayurvedic drugs. In view of the recent theories of metabolic
disturbances of brain cells! thought of trying the drug. These drugs were used
in the past in our country and they are even now prescribed by persons
practicing Ayurveda. My aim was to find out whether the drugs of bygone days,
which are being utilized up to the present time, have any effect on curing or
in ameliorating the diseases of mental origin. I had neither any bias nor any
prejudice for this indigenous product. I tried it on some of my patients in
1950. The response to this treatment was good. Then I prescribed this drug as
an adjuvant to other treatment from the beginning of 1951. I could not take
the risk of treating my patients with this drug only, so I used electric
convulsion therapy as well. Some patients refused the electric convulsion
therapy, but tried the drug only. Checking up my results I had a pleasant
surprise that many of them had recovered without taking electric convulsion
therapy.
The results made me more
inquisitive. I tried to find the action of each individual drug according to
the Ayurvedic pharmacology. Each drug was acting practically on all the organs
of the body. Sometimes, the emphasis was on one and sometimes on the other
organ.
PHARMACOLOGY: The
combination per tablet is -
Brahmi (Monniera cuneifolia or Herpestis monniera) Gr 1/2
Shankhavali (Evolvulus
alsionides). Gr. 1
Chandrika (Rauwolfia
serpentina). Gr. 3
Jeevanti (Leptadenia
reticulata), Gr. 1/2
Ugragandha (Acorus calamus). Gr.1/4
Bhringaraj-Bhangro (Eclipta
alba). 3/4
Total Grs. 6
PHARMACOLOGICAL ACTION OF EACH DRUG
(Only selected action is taken into
consideration)
1 BRAHMI8 {Monnieracunefolia or Herpestismoniera)
There are two varities of this
herb. Kaviraj of Bengal differs from Vaidraj of Bombay.
The plant is bitter, pungent,
heating, emetic, laxative (Ayurveda).
The plant is bitter,
aphrodisiac, maturant. (Yunani).
It is considered by the Hindu
physicians as a nervine tonic useful in insanity, epilepsy and hoarseness.
In Pondicherry, the plant is
considered an aphrodisiac.
Brahmi-ghritha or a medicated
ghee whose chief ingredient is Monniera cunei folia was administered in cases
of epilepsy and hysteria and in one case of chorea. Cases of epilepsy were
considerably benefited by its use, the attacks coming on at longer intervals.
Hysteria cases were completely cured. The cases of chorea did not derive any
benefit from it (Kaman).
The leaves contain an alkaloid
which produces toxic symptoms similar to those of strychnine. The alkaloid
raises the blood-pressure through vaso-constriction and stimulation of the
cardiac muscles, and it always produces stimulation of the respiration. (K. C.
Bose and N. K. Bose, Journ. Ind. Med. Ass. October 1931)
2. SHANKHAVALI8
(Evolvulusalsinoides)
The herb is used as a whole, i.e. roots, stems,
leaves, flowers and fruits. The plant is bitter, pungent, useful in epilepsy,
brightens the intellect, improves complexion, appetite.
The Mohammedan physicians believe that this plant has the power to strengthen
the brain and memory.
3. CHANDRIKA4 (Rauwolfia Serpentina)
The root contains the following alkaloids (1)
Ajmaline, (2) Ajmalinine, (3) Ajmalicine, (4) Serpentine, (5) Serpentinine and
(6) Rauwolfine in addition to a resin and other miscellaneous plant principles.
Bihar sample is rich in Serpentine group whereas Dehradun variety is rich in
Ajmaline group.
Recently the drug has attained prominence as remedy
for insomnia, hypochondria and insanity. The hypnotic and sedative action of
the drug is not mentioned in the ancient Sanskrit literature. In Bihar the
poorer classes make use of the hypnotic property of the drug in putting the
children to sleep.
Pharmacological investigations showed that an alkaloid
obtained from the roots of Rauwol- fine Serpentine and presumed to be identical
with Ajmaline had pronounced effect on the central nervous system and on
account of its cerebral depressant properties it would prove to be a valuable
sedative drug.
3. JEEVANTI8 (Leptadenia
reticulata)
The plant is stimulant and tonic.
4. UGRANGANDHA8 (Acorus
calamus)
The rhizome is pungent, bitter, heating, improves
appetite, voice, throat, useful in epilepsy, delirium, hysteria, loss of
memory. (Ayurveda)
The rhizome has very bitter, sharp taste, tonic to the
brain, useful in general weakness. (Yunani).
The root has been employed in medicine since the time
of Hippocrates.
The root is supposed by the Chinese to affect the
heart and lungs. In general, it is taken as a restorative for the body and
spirit.
As an emetic it is more nauseant and depressant than
Ipecauanha. It is one of the two vegetable drugs in this country which act
efficiently as emetics in so small a dose as 30 grs. 40 grs. Its action is very
violent and obstinate.
Among other diseases which aremost benefited by this
drug are bronchial catarrh, neuralgia and some forms of dyspepsia. (Mooden
Sheriff).
6. BHR1NGARAJ8 (Eclipta alba).
The plant has bitter, sharp taste, tonic,stomachic,
good for pain in the liver, cures vertigo. (Yunani).
It is principally used as a tonic and deobstruent in
hepatic and splenic enlargements.
When used in large doses, it acts as an emetic. The
juice of the leaves is given in one teaspoonful dose in jaundice and fevers.
There are two varieties of the plant, the yellow
flowered and the white flowered. The former variety has thicker leaves which
are extensively used in catarrhal jaundice.
From these pharmacological actions it is apparent that
these four drugs, viz. Brahmi, Shan- khavali, Ugragandha and Chandrika have action
on the nervous system. Out of these Brahmi has aphrodisiac action.
Ugragandha appears to have the action of stabilizing
the emotional stress on Thalamus. Probably the effect can be compared to that
of Mephasine Hydrochloride.
Jeevanti is added as a general stimulant.
Bhringaraj has corrective action on the liver.In the course
of schizophrenic attacks there is disturbed detoxicating function of the liver.
By means of Quick's test a pathological decrease in hippuric acid elimination
is shown during such attacks. Schizophrenic process is the manifestation of an
endogenous metabolic disorder leading to slight reversible liver parenchymal
damage which, for its part, disturbs detoxication of the toxin.
CLINICAL
STUDY:
The sample of this study includes 146 patients. These
were treated by (1) Electric Convulsion Therapy (E.C.T.), (2) The Ayurvedic
Drug (A.D.) and (3) The Ayurvedic Drug and Electric Convulsion Therapy. The
electric convulsion therapy group was selected at random from the patients
treated at the Mental Hospital, Ahmedabad and were used as a control group.
The following table gives the disease and the number
of patients in each group of treatment for the years 1951-1952 :-
Table 1:
|
Disease |
Electric
Convulsion Therapy |
Ayurvedic
Drug |
Ayurvedic
Drug and E.C.T. |
Total |
|
|
Schizophrenia |
23 |
19 |
23 |
65 |
|
|
Mania
Depressive Psychosis |
14 |
23 |
16 |
53 |
|
|
Paranoid
State |
1 |
1 |
1 |
3 |
|
|
Senile
Psychosis |
1 |
1 |
1 |
3 |
|
|
Puerperal
Insanity |
2 |
2 |
|
4 |
|
|
Schizo
Affective Psychosis. |
4 |
4 |
|
8 |
|
|
Vitamin
Deficiency Psychosis |
|
2 |
|
2 |
|
|
Anxiety
State ., |
|
4 |
|
4 |
|
|
Hysteria |
|
2 |
|
2 |
|
|
Hypochondriasis |
|
1 |
|
1 |
|
|
Epilepsy |
|
1 |
|
1 |
|
|
Grand
Total |
45 |
60 |
41 |
146 |
Table 2
RESULTS
Schizophrenia – 65 Patients
|
Group |
E.C.T. |
A.D. |
A.D. & E.C.T. |
||
|
I |
II |
Ill |
|||
|
Sex. |
Male |
Female |
Male |
Female |
Male Female |
|
Total |
14 |
9 |
10 |
9 |
14 9 |
|
Recovered |
2 |
3 |
3 |
5 |
6 7 |
|
Fair recovery |
1 |
|
1 |
1 |
5 1 |
|
Improved |
|
1 |
3 |
3 |
.. |
|
Not recovered |
8 |
4 |
3 |
.. |
2 .. |
|
Relapsed |
3 |
1 |
|
|
1 1 |
|
% recovered |
21.43 |
33.33 |
40 |
66.66 |
78.57 88.88 |
|
Total % recovered
26.08 |
52.63 |
82.6 |
|||
In group I, 23 patients were
treated with E.C.T. and the total percentage of cure was26.08.In group II, 19
patients were treated withA.D. and the total percentage of cure was 52.63.In
group lII, 23 patients were treated with A.D. and E. C. T. and the total
percentage ofcure was 82.60.
TABLE
3
|
Maniac Depressive Psychosis — 3 Patients A: MANIA |
||||||
|
Group |
E.C.T. |
A.D. |
VD. & E.C.T. |
|||
|
A l |
A ll |
A III |
||||
|
Sex. |
Male |
Female |
Male |
Female |
Male |
Female |
|
Total |
7 |
6 |
13 |
6 |
7 |
6 |
|
Recovered |
2 |
1 |
7 |
4 |
6 |
5 |
|
Fair recovery |
|
|
2 |
|
|
|
|
Improved |
3 |
2 |
3 |
2 |
|
1 |
|
Not recovered |
2 |
2 |
1 |
|
|
|
|
Relapsed |
|
1 |
|
|
1 |
•• |
|
% recovered |
28.55 |
16.66 |
69.2 |
66.66 |
85.7 |
83.33 |
|
Total% recovered
23.07 |
68.42 |
84.61 |
||||
In the group A-1, 13 patients were treated with E.C.T.
and the total percentage of cure was 23.07. In the group A-ll, 19 patients were
treated with A.D. and the total percentage of cure was 68.42. In group A-Ill,
13 patients were treated with A.D. and E.C.T. and the total percentages of cure
was 84.61. In
this group the condition of mania and hypomania was combined, the difference
being of degree in psychomotor activity rather than the disease identity.
CASE
HISTORIES:
(1)
Female, 11 years, duration 3 months.
She was self-absorbed, mute negativistic, did not take meals unless forced to,
dirty in habits. She was a good student.
She was given A. D. Tablets, one T.D.S., with
multivitamin Syrup orally, glucose injection intravenously and hypnotic at
night. She started showing gradual improvement within 15 days treatment and
recovered completely after a month. Now she attends her school regularly.
(2)
Male, 18 years, duration 6 months.
He had 30 insulin comas at the K.E.M. Hospital, Bombay, and cardiazol
convulsions at the J.J. Hospital, Bombay. Both times he showed slight recovery
and relapsed in 15 days time.
Examined on 22-6-51. He was self-absorbed, mute,
negativistic, did not co-operate for the examination, apprehensive. He was
impulsive, destructive and dirty in habits. Disturbed sleep.
He was given A.D. tablets, 2 T.D.S. and ten E.C.T.
sittings. After four E.C.T, he started showing improvement. He recovered
completely, joined I. M.T.S. "Duffrin", passed his examination and now he
is on a mercantile ship.
CASE
HISTORIES:
(1)
Female, age 56 years, duration 2
months, 4th attack.
She was treated at C.M.H. Yarvada in 1950 as she was
very violent and unmanageable at home. She had diabetic mellitius proved by
blood sugar curve and urine examination. She had high blood pressure and a
rheumatic heart. In 1951 she was highly excited, talked freely, had feeling of wellbeing,
shown ideas of grandeur, she was highly emotional and her emotions were in
keeping with her talks, she was very irritable, she did not sleep at night,
was eating every now and then and wasted lot of food and money.
She was given A.D. Tablets, 2 T.D.S., with tuinal grs.
3, morning and noon, and grs. 6 at bed time. She was treated at home though
there were attacks of excitement, but she was not unmanageable except on two
occasions when she was given injections for sleep. She recovered completely.
She had a mild attack of depression in summer 1952.
She was put on A.D. tablets for a week and she recovered without any
furthertrouble.
(2)
Male, 30 years, duration 15 days, 4th
attack. He was highly excited, talked and shouted at the top of his voice, was
aggressive violent and destructive, had a feeling of well-being. He was
deluded, he had ideas of grandeur, his emotions were in keeping with his talk
and action, he had no sleep and did not take his meals properly. He was given
E.C.T. 10 sittings and A.D tablets 2 T.D.S. He recovered completely in 15 days'
time.
Table 4
B:
DEPRESSION
|
Group |
E.C.T. |
A.D. |
A.D. 8 E.C.T. |
||||
|
BI |
Bll |
Bill |
|||||
|
Sex. |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
Total |
1 |
•• |
3 |
1 |
1 |
2 |
|
|
Recovered |
1 |
|
3 |
1 |
1 |
1 |
|
|
Fair recovery |
|
|
|
|
|
|
|
|
Improved |
|
|
|
|
|
|
|
|
Not recovered |
|
|
|
|
|
|
|
|
Relapsed |
|
|
|
|
|
1 |
|
|
% recovered |
100 |
|
100,0 |
100 |
100 |
50 |
|
|
Total % 100.0 |
100 |
66.66 |
|||||
In the group B-l, there was one patient. He recovered
with E.C.T.
In group B-lI, 4 patients were treated with A.D. and
all recovered.
In group B-lll, 3 patients were treated with A.D. and
E.C.T. All recovered, but one female patient had a relapse after three months.
E.C.T. gives best results in any type of de-pression
10, In these cases Ayurvedic drug also has given very good result.
CASE
HISTORIES:
(1) Male,
26 years, duration 6 months, 3rd Attack.He was depressed, could not attend to
his work, was crying while giving history, feeling of guilt present, felt like
committing suicide, could not take interest in anything, sleep disturbed.He was
given six E.C.T. and A. D. tablets 2 T.D.S. He recovered completely and went
back to his clerical job at the end.
(2) Female,
28 years, duration one year. 7th attack. She had such attacks every year in
sum-mer.She had sad and anxious expressions, apprehensive, ideas of devils
coming to her, feelingof Impurity, reaction time was increased, movements slow,
sloop disturbed.
She was given A.D. tablets, 2 T D S. She recovered
and had no relapse in the year 1952.
PARANOID
STATE:
One patient was treated with E.C.T. and another with
Insulin Coma, neither of them were cured, One with 60 comas showed slight
improvement, but he was not fit enough to be discharged from the mental
Hospital. One patient was treated with A.D., he showed improvement. He had
auditory hallucination and that disappeared. His emotional tension was less.
One patient was treated with A.D. and E.C.T. and he recovered.
SENILE
PSYCHOSIS:
In this group one was treated with E.C.T. and he did
not recover. One patient was treated with A.D. he showed slight improvement,
while another male patient who was given A.D. and E.C.T. did not recover.
PUERPERAL
INSANITY:
Two patients were given E.C.T. and both recovered
while two of my patients had taken A.D., one recovered and another showed improvement.
SCHIZO-AFFECTIVE
PSYCHOSIS:
Out of the two males and two females in the control
group treated with E.C.T., one male and one female recovered giving 50% rate
for recovery. Two males and two females were treated with A. D. Out of these
patients only one female recovered and another female showed improvement. Both
males did not recover.
VITAMIN
DEFICIENCY PSYCHOSIS:
This is a group where the psychotic symptoms were due
to Vitamin deficiency13. The patients were given vitamin B complex
parenterally and multivitamin preparation orally. One male and one female were
given A.D., both recovered. In these cases, I cannot give any definite view
regarding the effect of A.D. as I have no control group to compare with.
PSYCHONEUROSIS:
In this group those patients who were not found
suitable for psychotherapy were given A.D. Those patients whom I took for
psychotherapy were not given any drug.
ANXIETY
STATE:
Four male patients were treated with A.D. one recovered,
two had fair recovery and one showed improvement.
HYSTERIA:
One male and two females were treated with A.D. Male
did not recover. He was also given five E.C.T. One female had fair recovery and
another showed improvement.
HYPOCHONDRIASIS:
One male was treated with A.D., showedsome
improvement.
EPILEPSY:
A boy, aged 10 years, was getting fits for the past
eight years. He had a number of fits per day. He was given mesantoin tablets,
gradually increasing to one T.D.S. This stopped his fits, but he was still
getting jerks every now and then. He was given Glutamic Acid tablets, gm.
I.T.D.S. This brought up his fits again. He was then put on A. D. tablets, one
T.D.S. and he has no fits and no jerks.
OBSERVATIONS:
(1)
The patients who were taking A.D. required
a small dose of barbiturates for sleep. Some of them did not take any hypnotic
drug as they found they had good sleep by taking the A.D. alone. This sedative
action is due to Chandrika.
(2)
Chandrika (Rauwolfia serpentina) is
administered to reduce blood pressure 6. It is included in the
combination, but I have not observed any marked fall of blood pressure in the
patients who were treated with this A.D. It is the action of Brahmi which
counter-balances the effects of Chandrika.
(3)
Usually there is a disturbance of
memory for recent events after E.C.T.3. This change gradually clears
up in about two months' time. The patients who had A.D. and E.C.T. did not
complain of this disturbance of memory. The patients who were given intensive
E.C.T. with A.D. complained of memory disturbance but it cleared up within a
month's time. Ugragandha and Shankhavali have action in minimizing the memory
disturbance.
(4)
Dr. S. T. Michael has found in his
male patients that they complain of Impotency after E.C.T.10. The
period varies from one to twomonths and the patient gradually regains his
potency. I had tried to find out complaint regarding the impotency in my
patients who had been treated with A.D and E.C.T, but no such disorder was
noticed. Brahmi has got aphrodisiac action and jeevanti's stimulant and tonic
action prevents this condition.
(5)
In neurosis the A.D reduces emotional
tension stress on the autonomic nervous system. This gives the patient a marked
feeling of well being and somatic disturbances lose their intensity. Ugragandha
helps to reduce the emotional tension and gives the feeling of well being.
(6)
The duration of treatment with E.C.T
is reduced when combined with A.D. The average recovery period is 5 weeks with
this combined treatment as compared to eight weeks or so with E.C.T alone.
CONCLUSION:
The clinical studies show the following results:
The various types of psychotics treated with electric
convulsions therapy give a recovery rate of 31.11%. Those treated with
Ayurvedic drug alone show a recovery rate of 51.66%. Those treated with
combination of Ayurvedic drug and electric convulsion therapy show a recovery
rate of 80.48%.
The above mentioned results show that the indigenous
drug stated herein have got a better action in ameliorating and curing mental
disease than the use of electric convulsion therapy alone. The use of A.D and
E.C.T combined gives better results than either of them used individually.
In psychoneurosis the drug ameliorated the tense
condition of the patient. This is a blessing where the patient cannot take
psychotherapy.
At this stage I would like to point out that it is too
early in cases of mental illness to study the relapse rate and to confirm the
stabilizing action of these drugs.
I am putting up
this work to the medical profession to confirm or to contradict my findings in
a purely scientific manner. This work will be an impetus for doctors to look
into the neglected Indian indigenous drugs.
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1940.
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New Delhi, Govt. of India, Bullet No. 1 of 1950, 85.
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