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Cannabis in Treating Depression, Anxiety and PTSD syndromes

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Anxiety and PTSD

Cannabis. The sound of it triggers widely different reactions from people across the world. This is primarily a consequence of the idea of it being a ‘drug’ coupled with the long ongoing debate over the legalisation of it, in different parts of the world. Although many countries have legalised it, it will not be wrong to say that they have not accepted it. The driving cause behind it has been the fact that, while intensive research has been conducted to draw the ills of the cannabis plant, there has been a dissipated approach towards gathering evidence about the benefits of it. Hence, in a country like India, cannabis otherwise known as weed, marijuana, ganja, etc can be easily passed as a ‘sign of danger’. Any person associated with it, in any manner, either needs to face stern action or needs to be kept away from. In order to combat this mentality and establish a balanced opinion about the plant, it is paramount that the general public be made aware of the working of cannabis, as a drug, in one’s body.

Cannabis Constituents


Medicinal Cannabis, a much lesser known term in the country, is made up of over 400 chemical compounds ranging from cannabinoids, terpenoids, etc. to fatty acids. The research into medicinal cannabis, still being at a nascent stage, has distinctly identified only two of the 61 cannabinoids, delta-9 tetrahydro-cannabinol or THC and Cannabidiol or CBD, respectively. THC, recognised for its intoxicating effects, has been proven to act on CB1 receptors, that are present throughout the body. CB1 receptor is one of the many cannabinoid receptors that is most sufficiently present in the brain. It’s effect is thus, felt significantly in the brain as THC, being an active constituent of cannabis, binds to the CB1 receptors in the brain and activates them, giving the much hyped ‘high’ to individuals who consume it. Contrary to the effects produced by THC, CBD, the only other constituent of cannabis that has been studied, is known to contain no pyshcoactive element in it, whatsoever. Hence, does not produce any intoxicating effects.

How Cannabis works in the body


While CB1 receptors are mustered in the brain and the central nervous system of the body, CB2 receptors are spread throughout the body including our heart, kidney, liver, blood vessels, etc. CB1 and CB2 receptors, the only classified receptors among the many other receptors present in the body, form the core of the Human Endocannabinoid System(ECS). Cannabinoids are known for their brisk interaction with this system. Hence, it is necessary to have a brief discussion and understanding about this system.

The Human Endocannabinoid System


The Human Endocannabinoid System, is a complex and crucial system in the body, responsible for maintaining biological balance of the body, when things go awry. ECS, literally, produces molecular cannabinoids endogenously in the body, as and when required, to sustain the body in its ideal conditions. This phenomenon of sustaining the body in its ideal conditions is known as homeostasis. ECS and homeostasis go hand-in-hand, making ECS, an integral part of the body.

CBD and it’s significance


Shifting our focus back to CBD, which is widely recognised for it’s therapeutic potential, apart from having no intoxicating effects, it is also proven to counter the effects of THC on the body. Unlike THC, CBD’s binding affinity to the CB1 receptors, is abysmally low. This is where a line can be drawn between THC and CBD when it comes to these constituents affecting the behavioral mannerisms of an individual, who is a frequent consumer of cannabis. While THC’s psychoactive effects include euphoria, relaxation when taken in lesser dosage, it also leads to anxiety, short term memory impairment when the dosage intake is high and consistent. CBD due to it’s poor binding affinity with CB1 receptors produces the opposite effect of decreasing anxiety and short term memory impairment. In today’s world, where anxiety and depression lead the charts with maximum number of people of suffering from it, cannabis, otherwise considered a stigma, it being useful in contributing towards the cure of anxiety and depression, has come out as a significant revelation.

In addition to this, there has also been scientific proof, discovered recently, about how lower dosage of THC can even lead to inhibition of anxiety. This is because, varying dosage of THC has differring effects on the neural activity of the brain and the nervous system, due to its variation in the capacity of bonding with the receptors.

Cannabis for Therapeutic Purposes


Such discoveries have been potential reasons for encouraging researchers across the world to delve deeper into the use of CPT, i.e, Cannabis for Therapeutic Purposes. Studies have found that the use of cannabis does not contribute to any individual indulging either in self-harm or in harm to others. Experiences in medical practice have substantiated that Dronabinol, a synthetic form of THC, has been effective in uplifting moods and developing a sense of well-being in individuals, when appropriate dosage is taken regularly. When it comes to the use of cannabis as a treatment for PTSD, i.e, Post Traumatic Stress Disorder, evidence mainly consists of success stories of patients. Clinical trials and scientific research is yet to be done in this regard.


Keynote


While Canadian government offers remuneration to its military officers for cannabis use pertaining to treatment of PTSD, U.S has started begetting ways for combined CBT and medication treatment for anxiety and depression patients. Other countries like Czech Republic, Spain, Uruguay, Netherlands have not only initiated their journey but have also recognised important results about the potential of medicinal cannabis. It’s high time, India breaks out of its conventional and conformist mindset and takes steps towards discarding the label of stigma, off cannabis.

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Trailokya Vijaya Vati: Providing relief in multiple joint pains

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pain relief medicine

Abstract: This is a clinical case study of a 72-year-old female with multiple joint pains and Rheumatoid arthritis in both upper and lower extremities and how Trailokya Vijaya Vati helped her cope with the condition and add quality to her life.

Ayurveda Perspective 

The description of AMAVATA dates back to 1500 BC in Rigveda. The main pathogenic event in RA is the formation and deposition of AAMA which is the causative factor for inflammation.
Restoration of AGNI and management of SHOOLA are the two basic principles in the treatment of AMAVATA. The TIKTA rasa and USHNA guna of Vijaya makes it is choice of drug for the treatment of RA and multiple joint pains.

 Introduction

Rheumatoid Arthritis is a long-term, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and other body organs.
RA usually affects the hands and feet first but it can occur in any joint. It usually involves the same joints on both sides of the body.

The symptoms of RA tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe. The joint damage that occurs with RA can make it difficult to perform daily activities.

Case Report

Patient description

This patient with the age of 72 Years had rheumatoid arthritis and multiple joints pain in both upper and lower extremities. She was walking with a tremendous amount of pain, and her gait could quickly tell how excruciating the pain was there for her to bear. She also complained of digestive disturbances and disturbed sleep.

Case history

This old lady was on potent pain killer as Voveran 50mg and Ultracet daily. The adverse side effects of these pain killers were visible on her body with her gut became acidic as she presented with severe gastritis pain whenever she took chemical pain killers to combat her pain issues. To beat gastritis and pain, she also started to take modern anta acids that troubled her digestion.

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with TrilokayaVijayaVati with one tablet three times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain, inflammation, improve digestion, and that the patient should get a sound sleep. 

Actual outcome

Even this small duration of a week was sufficient enough in this case to witness the painkilling effects of Cannabis or Vijaya. The one week use of ‘TrilokayaVijayaVati’ helped her not to consume synthetic pain killers, her quality of sleep improved with no pain induced nights, her digestion got enhanced during the process. She presented with an improved gait and walk when she walked into the clinic after a period of one week.

Discussion

As mentioned in Ayurveda the line of treatment was decided with an aim of restoration of AGNI and management of SHOOLA. 
The patient got relief from most of her complaints within a week of starting with the treatment.

Conclusion

In the last 50 years, extensive research has been done on RA and multiple joint pains associated with it by modern medicine but the etiology and a standard line of treatment are still developing. New research has revealed various biological agents that have provided relief to a significant number of patients. However, these agents are very expensive, require close monitoring, have side effects, and need to be used indefinitely. 

A result from several small studies suggests that in people with RA, Cannabis has helped to curb morning pain, improve sleep and lower inflammation in joints. Hence the use of Cannabis in the treatment of RA and Multiple Joints Pain can be further promoted as it is also a cheaper and an effective alternative to the other available drugs.

Case study shared by Dr. Preeti Chhabra, Consultant Ayurvedacharya

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How Ayurveda can help to manage long-term pain in Osteoarthritis?

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pain relief

Abstract: Osteoarthritis commonly referred to as OA is the most common joint disease and one of the most widespread of all chronic conditions managed in General Practice. Whilst its prevalence increases with age, a significant number of adults experience symptoms of OA earlier in life. Most cases of OA are not extraordinary, yet the individual experiences of the affected can help a health practitioner to fully understand the impact of the diseases in the overall population.

This case report was triggered by a patient who was eager to tell her story and also reach out to the others suffering from OA- as to how a simple Ayurveda drug helped her to manage her long term pain effectively. As the importance of narrative medicine is increasingly being recognized to have a positive impact on patients and also helps clinicians to strengthen their practices, a summary of this case highlighting the use of Trailokya Vijaya Vati was made.

Introduction

Osteoarthritis occurs when the cartilage that cushions the ends of our bones in our joints gradually deteriorates.

OA has often been referred to as a “wear and tear” disease. But besides the breakdown of cartilage, OA affects the entire joint. It causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone. It also causes inflammation of joints.  

The pain and limited mobility in OA occurs as a result of destructed cartilages. Left bare of their padding, bones rub painfully against each other – particularly in the hands, spine, knees and hip. 

For years, there have been very limited treatment options available for OA. The treatments include pain management, steroidal injections, physiotherapy and surgery as a last resort. Out of these pain management is the best sought treatment as PAIN itself is a major symptom in this condition.

 Case Report

Patient description

A 48 yr old female was presented with complaints of pain in both knees for 8 years, since the last 3 months the pain had aggravated from moderate to severe to highly intolerable which was leading to increased anxiety and also restless sleep. The pain would increase on an activity like walking or climbing up the stairs and would be relieved by rest. 

Case history

The patient has no history of fall or trauma. She walked without a walking aid but requires support when there is a peak in pain. 

She has been on analgesics since when she doesn’t exactly remember, taking periodic physiotherapy sessions as advised by the doctor. She took Intra-articular injections a couple of times but the relief was temporary (6-8 months).  She was recently advised bilateral knee replacement by her doctor and she decided to give it a last go through an alternate option! The pain was her only concern.

Recently the severity of the pain was so intense that it was impossible for her to use stairs and she is sedentary most of the time. 

Physical Examination

  • BMI – 30 (Obese)
  • Gait – Antalgic
  • Fell – Mild crepitus is felt upon moving both knee joints.
  • ROM – Restricted and Painful
  • Blood Results – ESR and CRP raised

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with Trilokaya Vijaya Vati with one tablet two times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain and that the patient should get a sound sleep. 

Actual outcome

Within a week, she began to notice a distant difference in her pain.

Discussion

The treatment was focused on effective pain management as that was the only factor troubling the patient at this given point. The patient was not ready to undergo surgery thou she was counseled that she might need one over a period of 5 years or so. 

She was also prescribed other drugs effective on OA and mild exercises. Trailokya Vijaya Vati not only helped the patient with pain but also gave her a sound night’s sleep. The patient also reported being less cranky throughout the day. 

Conclusion

For years, treatments for OA have majorly being planned on physiotherapy, steroidal injections, and joint replacement surgery. But as pain management is now emerging as an individual branch, there has been an increased focus on pain management in the treatment of OA. 

Unlike Rheumatoid Arthritis, OA hasn’t had any major breakthroughs that have dramatically improved its medical treatment. Drug development for OA has been slow because the disease itself follows a slow process. 

Dr. Anirudha  Mohite, Consultant Ayurvedacharya

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How Ayurveda helps in managing menstrual cramps

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Ayurveda in managing menstrual cramps

Abstract: This case study assesses the use of Trailokya Vijaya Vati highlighting cannabis in the pain treatment during periods (menstrual pain/cramps) medically termed as Dysmenorrhoea. 

Menstrual cramps or period pain is caused largely by hormones called prostaglandins which are released from the lining of the uterus, the hormone also causes inflammation which aggravates the pain. Recent studies suggest that the female reproductive system has cannabinoid receptors and hence cannabis can prove effective in the treatment of menstrual pains, also that Cannabis has anti-inflammatory properties.

This is a case of a 21 yr old female with a known case of polycystic ovarian syndrome (PCOS) with bilateral renal calculus and how Trailokya Vijaya Vati helped her assuage the pain in a matter of just 7 days of treatment.

Ayurveda Perspective 

According to Ayurveda, during the menstrual cycle, the APANA VAYU which is connected to the VATA DOSHA and is responsible for the downward flow of the energy and mass to the pelvis aggressively works to cleanse uterine lining.  The increased VATA DOSHA hence causes SHOOLA (RAJASHOOLA)

Vijaya is having Tikta Rasa Ushna Virya it has laghu Tiksnha Guna and Katu Vipaka. Hence it pacifies the Vata Dosha and helps in the treatment of VATAJA SHOOLA. Ayurveda Rasatarangini has attributed 29 pharmacological indications for Vijaya in which RAJASHULA is included.

 Introduction

Cannabis is believed to have therapeutic uses for a variety of illnesses, including but not limited to chronic pain, headache, epilepsy, symptoms of multiple sclerosis, and gastrointestinal disorders. 
The science around cannabis and its ability to relieve menstrual pain are scarce but strongly promoted. 

The diversity of approaches for the consumption and use of cannabis might help increase its popularity. Ideally, as more people use cannabis for period pain, researchers will produce more science about the risks and benefits in hopes that we learn all about the amazing herb. And the possibility cannot be denied that Cannabis might be the only preferred drug/herb available worldwide for Dysmenorrhea in the mere future. 

Case Report

Patient description

A twenty-one-year-old girl was a known case of polycystic ovarian syndrome(PCOS) with bilateral renal calculus. 

Case history

She was also suffering from dysmenorrhea (excessive painful menses) and metrorrhagia (excessive bleeding).  Adding to all these troubles were her mood swings and anxiety episodes, making her health a subject of concern to her parents and directly impacting her studies. Her menstrual cycle was extending up to seven days a month with an entire week going in this pain every month. 

Sonography results

Her whole abdomen ultrasonography revealed hemorrhagic cysts in her bilateral ovaries. 

Treatment plan/ Medicines to be used – Trailokya Vijaya Vati

To overcome the pain and get the cysts removed naturally, she started her treatment at ‘The Ayurvedic Thyroid Clinic’ Pune, in the month of August 2020.  To beat her pain issue, she was kept on ‘TrilokayaVijayaVati’ in the month of October 2020, with a dose of one tablet two times a day. 

Expected outcome of the treatment plan

It was expected not immediately but gradually that the patient would find relief with her pain and also that she should be able to carry out her daily activity with some ease.

Actual outcome

Within a week of administering her ‘TrilokayaVijayaVati’, she started to feel relieved in terms of her menstrual cramps and pain like never before. Although the patient is still on the medication for PCOS, her immediate concern was this menstrual pain unbearable for her. The use of ayurvedic pain killer in the form of the classical formulation of ‘TrilokayaVijayaVati’ her pain reduced considerably, and she was motivated to continue with further treatment as her faith strengthened in the process. She believed firmly with the evidence as what ‘TrilokayaVijataVati’ did for her, even Meftal-Spas could not do.

Discussion

The treatment was decided on the basis of the predominance of VATA DOSHA involvement and pain management. The Vijaya as mentioned has anti-inflammatory properties and is also an effective VATAGHNA herb. It helps in reducing the pain gradually but effectively.

Conclusion

Cannabis is believed to have therapeutic uses for illnesses and pains, including menstrual discomfort. Researches are still scarce, but some studies show the effectiveness of cannabis on the relief of menstrual pain. 

Dr. Vikrant Patil, Consultant Ayurvedacharya

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