Vijaya (Bhanga) or Cannabis sativa L. is a reputed plant ascribed in traditional system of medicine since centuries. Ayurveda enumerates the therapeutic use of Vijaya in the management of Shool (pain), Grahani rog (Irritable bowel syndrome), Nidra-naash (Insomnia), Jwara (Fever), Agnimandya (loss of appetite), Prameha (Diabeties) etc. Due to certain illegalities and drug abuse, the same has never received any recognition in the past decades despite hundreds of benefits. Recent studies suggest that the appropriate and ethical use of cannabis can help in treating number of diseases i.e. IBS, Epilepsy, multiple sclerosis, insomnia, anxiety and degenerative diseases. It has been found that various phytochemicals mainly cannabinoids are responsible for the therapeutic activity of Bhanga. Thus the salient observations of Bhanga are gathered from classical Ayurvedic and contemporary researches to highlight the therapeutic potential of the novel drug, Cannabis sativa in management of few important ailments, i.e. IBS, epilepsy and cancer and associated symptoms of ailments i.e. pain, insomnia etc.
BHANGA IN AYURVEDA LIERATURE:
Bhanga is one of the plant origin drug which has found its place in Ayurveda classics from medieval period due to its exceptional properties and actions. Since then, the detailed aspects of Bhanga has been explored including purification methods, therapeutic uses and contra-indications. Around 40 synonyms of Vijaya has been mentioned owing to its morphological characteristics i.e, Samvidmanjari (the drug having potent inflorescence), pharmacological properties i.e. Bahuvadini (it causes verbosity), Madini, Mohini, Ganja, Matulani (excessive use may cause delirium), Ananda (having soothing effect) and many more. Bhanga, Charas and ganja are three forms of its usage being Bhanga (dried leaves of plant) the most common (Acharya R. et al., 2015). It has tikta rasa, ushna virya, laghu tikshna gunas and katu vipaka. It alleviates kapha and vata doshas, increases pitta having dipana, pachana, ruchya, grahi, madkari and vyavayi properties. Rasshastra texts describes Vijaya as Upavisha vargaas the excessive use of the herb manifests toxic effects on the CNS. Sharangdhar also mentions this drug under madkaari dravyas which affects the buddhi (CNS) due to virtue of its tikshna, ushna properties and prabhav. It also increases agni (digestive fire) and pitta because of tikta rasa and ushna virya. It has been described for the treatment of various diseases which includes Nidranasha(insomnia), Atisara (diarrhea), Grahani rog (IBS), Mandagni(loss of appetite) (B.P.Ci.1.325), Kushtah(skin disorders) (VM.51.56-57 also SB.4.832), Prameh(Diabeties mellitus), Unmada( anxiety neurosis), Ardavabhedak(hemicrania), Nadi daurbalya (neurological weakness), Shosh (emaciation) and Dhanusthambha (stiffness of back). Besides its wide range of therapeutic utility, highest number of formulations is advised in Grahani (30), followed by Jwara (17), Atisara (9), Agnimandya (7) and Prameh (6) (Acharya R. et al., 2015).
CONTEMPORARY VIEW ON BHANGA:
Cannabis sativa is a dioecious and occasionally monoecious plant which belongs to cannabinaceae family and is found in regions ranging from sea level to the temperate and alpine foothills of the Himalayas. In the last few years, use of cannabis or medical marijuana is gaining momentum due to its wide range of therapeutic potential. According to WHO, it is the most commonly cultivated, trafficked and abused drug globally. Cannabis has bad reputation as it is the common psychotic and recreational drug. However, it has been used in folklore practices since ages as medicine, fuel source, source of paper, building materials and textiles (Small and marcus,2002). Marijuana is prepared from the dried flowering tops and leaves; hashish consists of dried cannabis resin and compressed flowers (Ashton, 2001) which are consumed by humans. Wide range of complex phytochemicals namely cannabinoids, terpenes and phenolic compounds have been found in cannabis which are responsible of its multipurpose therapeutic applications as well as psychotropic effects. Carbohydrates, fatty acids and their esters, simple amides, amino acids, phytosterols, phenolic compounds are also identified. Antibacterial (G. appendino, 2008), antimicrobial (Esra M. M. ali et al. 2011), analgesic and anti-inflammatory activities (formukong EA et al 1988) have also been reported. It is also used in the management of pain, chemotherapy-induced nausea and vomiting among cancer patients (Machado Rocha et al., 2008), post-traumatic stress disorder, epilepsy, cachexia, degenerative neurological conditions (CDPHE,2016; OHA-2016). and for relief of spasticity in multiple sclerosis patients (Sastre-Garriga et al., 2011) Pre-clinical and clinical studies conducted in recent era suggest its efficacy and medicinal importance, which is mainly due to the presence of cannabinoids. The Endocannabinoid system (eCBD) which consists of endogenously produced cannabinoids, receptors and metabolizing enzymes have been found in the various part of the human body including central nervous system, gastrointestinal system, connective tissues and immune cells. (M.B. Bridgeman,2017) plays an important role in the physiological and pathological processes. It acts as protective system against the pathology of certain diseases like IBS, migraine, anorexia, multiple sclerosis and schizophrenia. Lack or abnormalities in eCBD system ramificates these diseases. Hence, exogenous cannabinoids derived from cannabis sativa can act as potent medicine.
Delta 9 tetrahydracannabinol is the primary active cannabinoid present in cannabis sativa which is responsible for its pyschotic effects. It is a potent analgesic, antiemetic, anxioltic, appetite stimulant, hypnotic, antipyretic and anti-spastic agent (Jeffrey K Aronson 2014). The other important cannabinoid constituent of current interest is cannabidiol (CBD)The extract of Cannabis sativa contains more than 60 terpeno-phenolic compounds namely phytocannabinoids, cannabidiol and cannabinolic acid. Non-cannabinoid compounds are also found which are 30 times more efficacious than aspirin in pain. Proteins, amino acids, glycoproteins, sugars, ketones, aldehydes, fatty acids, steroids, flavonoids and vitamins are also identified. (Asati A. et al, 2017)
FUTURE PROSPETCS OF BHANGA FOR MEDICAL SCIENCE:
Pain is a crucial aspect of the body’s defence mechanism and it is a part of a rapid warning relay instruction the motor neurons of the central nervous system to minimize physical harm. (Emanuel LL et al, 1999; 1-37). In pathophysiology of neuropathic and inflammatory pain, receptors CB1 and CB2 along with prostaglandins, serotonin, bradykinin and epinephrine get involved in the mediation of inflammatory response. Cannabinoids present in cannabis are CB1 and CB2 agonist whereas Non cannabinoid compounds inhibit the release of prostaglandins and is 30 times more potent than aspirin. Preclinical and clinical studies have also been conducted which proves cannabis to be a promising analgesic. Thus, for quick and effective pain management, Bhanga may be used. The references for use of Bhanga in pain management can be retrieved from medieval Ayurvedic classics. Its rational use as a single or adjuvant drug candidate may be done in present scenario to relieve agony in a wide spectrum of diseases.
Irritable bowel syndrome or disease is characterized by abdominal pain, diarrhoea, constipation or a combination of both diarrhoea and constipation, mucus discharge along with stools and changes in the form (appearance) of stools. (Azpiroz F, Dapoigny M,2000). It is one of the most prevalent gastrointestinal problem affecting globally. Inflammation and hypersensitivity of the colon in response to stress, food, physical stimulant and idiopathic factors are of primary concern in the pathogenesis of IBS. Receptors CB1 and CB2 are found in all the layers of intestinal sections, including the mesenteric and sub mucosal plexus and the epithelium responsible for inflammatory response mediation. Cannabinoids by their agonist effects on CB1 and CB2 have proinflammatory effects and helps in the reduction of inflammation of intestinal mucosa which helps relieve the disease (Waseem Ahmed ,2016). In Ayurveda, Bhanga is the key plant for effective management of troublesome disease IBS.
Epilepsy affects about 50 million people throughout the world and is especially common in childhood and in elderly people. “Epilepsy” is the condition of recurrent, unprovoked seizures which has numerous causes, each reflecting underlying brain dysfunction (Shorvon et al. 2011). Root cause of epilepsy may either be at circuit level primarily abnormal synaptic transmission or at the receptor level. It has been found that cannabinoid receptors CB1 and CB2 are present in the central nervous system and are termed as endogenous cannabinoids. Control in Synaptic transmission and regulation of the rate of neuronal firing are vital role of CB1 and CB2 receptor respectively. Activation of these receptors with cannabinoids results in the inhibition of synaptic transmission along with glutamate release (Zou S. et al,2018). Various studies suggest that the therapeutic use of cannabinoids targets the signalling pathway which results in epileptic seizures.
WHO defines cancer as the uncontrolled growth and spread of cells which can affect almost any part of the body. The growths often invade surrounding tissue and can metastasize to distant sites. The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. Inflammatory conditions and carcinogenesis share same common pathways such as proliferation, increased survival of cells and migration where cytokines and growth factors play an important role. In the formation of tumour, inflammatory mediators regulate a number of proinflammatory responses through inhibition of protective immune response. (F. pellati et al ,2018). The presence of CB1 and CB2 receptors on immune cells suggests their important role in the regulation of the immune system. By targeting the ECS, cannabinoids affect many essential cellular processes and signalling pathways which are crucial for tumour development. Experimental studies using cancer cell lines and genetically engineered mouse models reveals that the activation of CB receptors by cannabinoids is antitumorigenic in most cases mainly breast, prostate and glioma cancer cell lines. it inhibits tumour cell proliferation, induces apoptosis in vitro, blocks angiogenesis and tumour invasion/metastasis in vivo (Darris et al, 2019). Derivatives from Bhanga, cannabinoids and cannabis-based pharmaceutical drugs have been the subject of intensive research for their potential antitumor activity.
Bhanga or Cannabis sativa L. has tremendous potential in the field of medicine which was described hundreds of years ago in Ayurvedic scriptures. The use of Vijaya is described in the management of Shool (pain), Grahani (IBS) and Apasmar (Epilepsy) in different Ayurvedic texts. The pharmacodynamics of the drugs may be explained on the basis of pharmacodynamics attributes i.e. Rasa, Guna, Veerya, Vipaka and Prabhava of the plant. The dosha dominance in Shool (pain) is Vata which get alleviated by Ushna virya of Bhanga. One of the important properties of the drug is Grahi, deepana and pachana due to its tikta rasa and ushna virya. Due to this activity, it is very beneficial in the management of Grahani and Sangrahani (vata-kaphaj). Ushna, tikshna and vyavayi gunas helps it to get absorbed efficiently in the body specially Srotas. As Apasmar is a disease of Manovaha-srotas, these Gunas help pacifies the doshas infiltrated in these srotas. The contemporary researches reveal that the various phytochemicals or cannabinoids mainly delta 9 tetrahydrocannabinol and CBD (cannabinol) are the most promising compound present in Cannabis sativa which are responsible for its therapeutic potential. Cannabinoids derived from cannabis acts as CB1 and CB2 agonists and activate these endocannabinoid receptors where the pathology exists whether in the Gastrointestinal system, CNS or Immune system. Anti-inflammatory, Anti-oxidant, Anti-bacterial and anti-microbial activities have also been identified. Bhanga (Cannabis sativa) can be a promising drug in future however few issues regarding its legalization, availability, quality and safety should be in consideration. Moreover, further extensive research should be done in order to enlighten about the use and implication of cannabis in diseases described in Ayurveda along with its pharmacokinetic and pharmacodynamic studies.
Acharya R. et al. (2015) ‘Vijaya (Cannabis sativa Linn.) and its therapeutic importance in Ayurveda; a review’ J.D.R.A.S. Vol.1 No.1 pp 1-12.
Ahmed W. et al. (2016) ‘Therapeutic use of cannabis in Inflammatory Bowel Disease.’ Gastroenterology & hepatology volume 12, issue 11
Ashton, (2001) ‘Pharmacological and effects of cannabis: A brief review’ British Journal of Psychiatry 178,101-106
Appendino G., (2008) ‘Antibacterial cannabinoids from Cannabis sativa:A structure-activity study’ J. Nat. Prod. 71,1427-1430
Asati A. et al, (2017) ‘Pharmacological and phytochemical profile of Cannabis sativa L.’ Int. J. Ind. herbs drugs, Vol-2, Issue 2
Azpiroz F, Dapoigny M (2000) ‘Nongastrointestinal Disorders in the Irritable Bowel Syndrome’ S. Karger AG, Basel Vol.62, No.1
Bhavprakash Samhita 1.325
Darris et al, (2019) ‘Cannabinoids in cancer treatment: Therapeutic potential and legislation’ Bosnian Journal of Basic Medical Sciences
Esra M. M. ali et al. (2011) ‘Antimicrobial Activity of Cannabis sativa L.’ Chinese Medicine, 2012, 3, 61-64
Formukong EA et al (1988) ‘Analgesic and Anti-inflammatory activity of constituents of Cannabis sativa L.’ SpringerLink pages361–371(1988)
F. Pellati et al (2018) ‘Cannabis sativa L. and Non-psychoactive Cannabinoids: Their Chemistry and Role against Oxidative Stress, Inflammation, and Cancer’ Hindawi BioMed Research International Journal
Jeffrey K Aronson (2014) ‘Plant Poisons and Traditional medicines’ Elsevier manson’s tropical infectious diseases (23rd edition)
M.B. Bridgeman (2017) ‘Medicinal Cannabis: History, Pharmacology,And Implications for the Acute Care Setting’ P & T Vol. 42 No. 3
Sastre-Garriga et al. (2011) ‘THC and CBD oromucosal spray (Sativex®) in the management of spasticity associated with multiple sclerosis’ Expert Review of Neurotherapeutics Volume 11, 2011
Shorvon et al. (2011) ‘The etiologic classification of epilepsy’ Epilepsia journal
Small and marcus (2002) ‘Hemp: A new crop with new uses for North America’ p. 284–326. In: J. Janick and A. Whipkey (eds.)
Zou S. et al (2018) ‘Cannabinoid Receptors and the Endocannabinoid System: Signalling and Function in the Central Nervous System’ Int. J. Molecular Science
Trailokya Vijaya Vati: Providing relief in multiple joint pains
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.
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.
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.
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.
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.
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.
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.
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.
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
Published by Hempstreet
How Ayurveda can help to manage long-term pain in Osteoarthritis?
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.
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.
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.
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.
- 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
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.
Within a week, she began to notice a distant difference in her pain.
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.
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
How Ayurveda helps 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.
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.
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.
A twenty-one-year-old girl was a known case of polycystic ovarian syndrome(PCOS) with bilateral renal calculus.
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.
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.
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.
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.
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
Published by Hempstreet
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