Ayurveda in a time of Cholera

1. The Current Situation

The recent outbreak of cholera in Haiti’s capital and surrounding areas is according to authorities spreading far faster than predicted (as of November 25th, 2010, 57,000 have been infected and 1,344 have died) and has now spread to adjoining regions, having been reported in the Dominican Republic as well as Florida. Criticism of efforts to stem the tide of this killer have been widespread, from inefficiencies in the processing of needed materials and shortages of medical personnel to the United Nations deployment of staff from Cholera-plagued areas of Nepal (that saw a major outbreak the month before) to an especially vulnerable Haiti.

Sri Sushruta describes Visuchika (cholera) thus:

“Visuchika chiefly attacks those who are timid or immoderate in their living … along with convulsions the patient has intellectual torpor, vomiting, diarrhea, giddiness, thirst and restlessness, tenesmus, yawing, feeling of heat, lividity, shivering, pain in the head and at the praecordia. The belly is retracted. The patient, whose voice is lost, is in a state of extreme agitation. The gasses contained in the belly rise. When the feces and the air remain shut up in the belly the patient grows weak, loses power of moving, then come the hiccup and the eructations … when the patients gums are livid, his lips and nails pail, when he vomits abundantly and loses consciousness of his acts, when his voice has become hallow and his voice is lost, when his joints are all relaxed – then, one ought to have recourse to the instructions of the sacred books.”

As a teacher and practitioner of ayurveda (also known as ayurvedic medicine, a traditional lineage of natural therapeutics utilized since its elaboration in ancient India) I feel the need to point out the fact that over the course of many centuries, the elaborators of ayurveda have devised a number of protocols effective in preventing and treating cholera – protocols every bit as therapeutically effective today in Haiti as they were centuries ago in Vedic-era India. It is significant that all of these protocols involve the use of widely available, economically affordable foods and medicinal plants, an important fact when attempting to address a serious health issue in a country as economically marginal and resource-deprived as Haiti.

Given Haiti’s precarious economy and the unavailability in Haiti of the pharmaceutical drugs ordinarily used to treat cholera, it should be of interest to the global community and of immediate benefit to cholera sufferers in Haiti to be made aware of the existence of these “alternative” cholera protocols.

Ayurveda teaches that certain widely-available plant medicines as well as foodstuffs are often very effective in reducing the intensity of symptoms and ultimate destructive impact of this disease.

Surprisingly, the global community and those health workers most directly concerned with the outbreak have failed to take cognizance of the foregoing. Cholera is still one of the most violently devastating diseases known to humankind which, sadly, carries a very high mortality rate despite science’s best efforts to eradicate it and ameliorate its symptoms.

Cholera is an infection of the lower bowel area by the causative organism, Vibrio cholerae, a gram negative comma-shaped bacterium with a polar flagellum also known as Kommabacillus and is carried in contaminated water. It is particularly prevalent during the hurricane and monsoon seasons in those parts of the world affected. Cholera’s symptoms include an initially mild diarrhea followed by violent purging including profuse vomiting and a general nauseous feeling. Diarrhea and vomitus are comprised of clear fluid. Symptoms usually start very suddenly, one to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have a “fishy” odor. An untreated person with cholera may produce 10-20 liters of diarrhea a day. It is estimated that for every symptomatic case there are 3 to 100 individuals who are infected but remain asymptomatic. If the severe diarrhea and vomiting are not aggressively treated cholera can, within a matter of hours, result in dehydration and electrolyte imbalances soon followed by death. Dehydration is usually heralded by low blood pressure, poor skin turgor (e.g., wrinkled hands), sunken eyes, and a rapid pulse. The victim will also experience a raging thirst and will feel restless within themselves. The fall in blood pressure will usually also produce extremely painful cramps.

2. Ayurveda’s View of Cholera

Ayuveda teaches that a disease such as cholera is caused by a visitation of external forces (krimi, in this case the microorganism V. cholerae) into the body that causes a damage to all three doshas but involves vitiated pitta and vata as predominant factors.

V. cholerae goes through several phases after ingestion which alter the character of its exudates, but a critical point is reached when the organism has exited the stomach and reached the small intestine, at which point it will begin producing the toxic proteins that give the victim a watery diarrhea. The cholera toxin (CTX or CT) is a complex protein which binds to the surface of the intestinal epithelium cells. A portio of the protein gets inside the cell and once there secretes reactive toxins into the channel of the small intestine resulting in the rapid development of the several other symptoms associated with cholera. Pachak pitta and saman vayu respond to the introit of the organism by dysregulating pachak agni, the dysregulated pachak agni engendering the rapid formation of aam, and the relocation of the doshas with attendant aam travelling to the lower anavaha srotas and the purishavaha srotas, a process taking about five days and involving rasa, rakta, mamsa and medda dhatus in a process of dosha-dushya sammurchchana.

3. Managing Cholera: Dietary Protocols

A host of easily utilizable therapies are used by ayurveda to deal with the ravages of cholera. By way of example, in ayurveda’s experience the simple lemon or lime is highly effective in preventing cholera and ameliorating its symptoms.

Food remedies are plentiful and diverse.

A regular intake of lemon (C. limon) juice, either by itself or mixed with other liquids provides specific nutrients needed to disable and purge the causative micro-organism from the viscera, a fact attested to by contemporary (Western) biomedical research.

Cucumber (Cucumus sattivus) juice has also been demonstrated to help substantially alleviate the symptoms of cholera.

A daily intake of liquidized onion (Allium cepa), mint (menthe spp.) and vinegar has been of demonstrated effectiveness and is vital to recovery. The addition of freshly ground black pepper (Piper nigrum) enhances the speed and therapeutic efficacy of the foregoing. The frequent ingestion of onion, an effective remedy for cholera is highly recommended as it quells thirst and settles the patents, restlessness. It can also be kneaded into a paste and mixed with black peppers and taken 2 or 3 times daily. Conventionally, about 30 grams of onion and seven black peppercorns are finely pounded together and given to the patient. The mixture lessens the quantity of vomiting and diarrhea almost immediately. The addition of a small sugar to the recipe will increase its effectiveness and provide the victim with needed calories.

The juices of lime (C. aurantifolia or similar species), bitter melon (Momordica charantia), coconut water (Cocos nucifera) and cloves (Eugenia caryophyllata) have also been of proven effectiveness.

As the digestive system is compromised to such an extent that the victim is unable to tolerate solid food during an active outbreak, liquids are the only options available to the sufferer. It is important to revive acidity in order to purge the negative toxins exuded by V. cholerae and any liquid that gently accomplishes this goal is highly recommended. The drinking of pure fruit juices made freshly from acidic fruits, slightly mixed with boiled water if desired is to be encouraged.

Yoghurt, once the patient can tolerate it, is a useful food. In recovery, mashed ripe banana mixed with boiled water, salt and sugar is usually well tolerated and supplies much needed nutrients.

A strict diet – usually augmented with an herbal medical protocol - is the only practical way to combat the ravages of cholera as the sufferer will be too weak to undertake yoga asanas which would otherwise be of benefit. However meditation would be very useful in clearing the mind, allaying restlessness and giving inner strength to the sufferer.

4. Herbal Therapies

Useful herbs for the acutely destructive phase include Kushtha (Saussura lappa) and Gauriphal (red raspberry leaves, Rubus wallichii), which are specifics. Also found to be very useful are Daruharidra (Berberis aristata), Long Pepper (Piper longum), Bhunimba (Andrographis paniculata), Ajwain (Trachyspermum ammi), and Bilva (Aegle marmelos) as well as Marich (black pepper, P. nigrum) and Lavanga (clove, E. caryophyllata) which have already been discussed.)

Astringent herbs are also effective in the treatment of cholera. These cause a contraction of the surfaces with which they come in contact as a result of the tannins present, and reduced permeability. When consumed, they reduce the permeability of the internal lining of the intestines, which reduces the amount of toxins from the microorganisms assimilated into the blood. This reduces any harmful effects the toxins exuded by V. cholera may have, as well as the body's reaction to them, the diarrhea and dehydration. It also reduces the availability of nutrition for the microorganisms from the internal lining of the intestines. Tannins also cause contraction of the surface cell wall of the microorganisms, causing them to be disengaged from the internal lining of the intestines. Astringent herbs also reduce bleeding which may result when an individual has had cholera for some time.

Once detached from the internal lining of the intestines, the remaining microorganisms need to be ejected out through the bowel. Mucilaginous herbs are ideal for this, as they provide a physical mass (otherwise absent in the cholera victim) to carry them out without providing them with nutrition. Mucilaginous herbs also absorb and promote the emission of toxins through the bowel. Additionally, a victim who has had cholera for some time will also likely have experienced damage to the enteric mucosa and mucilaginous herbs promote the healing of such damage. Mucilaginous herbs used for this purpose include Isphagol (Psyllium, Plantago ovata) and Tila leaves (Sesame plant leaves, Sesamum indicum). Once into the recovery phase and capable of tolerating solid food, the patient may be fed Okra, a food containing a large proportion of mucilage, which must be thoroughly chewed.

As the effect of astringent herbs depends on their physical action, they should be taken in large amounts, with large amounts of water. This is normally only necessary for a short time, as patients ordinarily experience a significant improvement in their condition within one or two days, as the herbs, water and food, pass through their intestinal system.

After taking astringent herbs with water and the bulk of the same has passed through the stomach (usually a half hour or more), mucilaginous herbs (or high fiber, low calorie foods if tolerated) should be administered.

When using mucilaginous herbs doses should be sufficient to produce a reasonably large physical mass passing through the intestines to efficiently transport the microorganisms out. If consuming high fiber/ low calorie foods, one may eat until they feel satisfied.

One astringent herb, and one mucilaginous herb or high fiber/low calorie food, is normally adequate for the treatment of cholera. Dosages may be varied with the requirements of individual patients; however, the following doses are illustrative.

A suggested dose for an adult with cholera is 1 to 2 heaped dessert spoons full of a dried astringent herb, two or three times a day. This should be made into an infusion using 1 to 2 liters or more of hot water. depending upon the patient’s capacity. More water is salutary.

A suggested dose for an adult with cholera is half a heaped dessert spoon full of dried Isphagol (psyllium), mixed in 500 ml. room temperature water, two or three times a day.

Bibliography:

Barua, Dhiman & W. Greenough, eds.: Current Topics in Infectious Disease: Cholera. Plenum Publishing (New York) 1992

Rodrigues A: “Protection from cholera by adding lime juice to food - results from community and laboratory studies in Guinea-Bissau, West Africa,” Tropical Medicine & International Health. 2000 Jun;5(6):418-22.

Tirtha, Swami Sada Shiva: The Ayurvedic Encyclopedia. Ayurvedic Holistic Center Press (Bayville, NY) 1998

Williamson, M., ed.: Major Herbs of Ayurveda. Churchill-Livingstone/Elsevier (London) 2002