A Review on Personalized Medicine - An Ayurvedic Perspective withCase Reports

Introduction

Personalized medicine is about making the treatment as individualized as the disease. It involves identification of genetic, genomic and clinical information that allows exact predictions to be made about a person’s susceptibility of developing or acquiring the diseases, the course of disease and its response to treatment. Single nucleotide polymorphism (SNP) and epigenetic factors are that factors which influence the drug response and forms the basis of personalized medicine.

Single nucleotide polymorphism is defined as variation in a single nucleotide that occurs at a specific portion in the genome (complete set of DNA) where each variation is present to some appreciable degree within the population. Epigenetics is the study of cellular and physiological phenotype trait variations that result from external or environmental factors that switch genes on and off and affect how cell express genes. Epigenetic factors are compounds that attach to or mark DNA. These factors interact with genetic material but do not change the underlying DNA. For example, when a person is afflicted with disease change in phenotype is seen, not genotype.¹

Ayurveda is successfully demonstrating its ability in managing a considerable number of diseases, particularly chronic disorders, not only in terms of internal and external medicines but also with the application of Shastra, Kshara and Agnikarma. Ayurveda emphasizes the treatment of disease in highly individualized manner as it believes that every individual is unique. This is evident by various references mentioned all over the text by Ayurveda Acharyas.

Personalized medicine in Ayurveda

The reference quoted by Acharya Charaka is as follows: “Every individual is different from one another and hence should be considered as a different entity. As many variations are there in the universe, all are seen in human beings.”² Incongruent to the above quotation, we do get good number of references to emphasize on personalized approach. They are as follows-

• In Sutra Stana first chapter, Acharya mentions that an exquisite physician should have the knowledge of nomenclature of medicine and its identification along with the ability to treat the disease according to place, time and individual variation. Only then he is regarded as Uttama Bhishak.³

• In the context of internal administration of Sneha, the dose of Snehapana are three types- Pradhana, Madhyama and Avara; but again, it is specified further that dosage and type of Sneha should be selected according to individual needs.⁴

• Even after successful administration of Snehana and Swedana, every individual should be assessed properly before the administration of Vamana. ⁵

• The dose of Vamana Dravya and all the other drugs used for purification therapy is determined according to the individual capability.⁵

• All the drugs mentioned in Samshodha Samshamaniya Adhyaya should be administered after considering the Vyadhi, Agni and Bala, which varies in every individual.⁶

Deha Prakriti represents the psychological and physical make up of an individual which is formed at the time of conception. Proportion of Dosha which is present at the time of conjugation represents the Deha Prakriti;⁷ this makes the person unique. The concept of Prakriti is helpful in maintaining health, understanding disease and its management. This has been accepted worldwide and made evident through various researches. But it is not just Prakriti which plays a major role in the management of disease, there are few more. This has been enumerated by our Acharya under the heading of Dasha Vidha Pareeksha.

These Pareeksha are helpful in understanding the disease, planning the treatment, selection of medicine, its dosage, time of administration, adjuvants etc. according to the individual.⁸

Source of data

Patients who fulfilled the criteria of Gridrasi were selected. They were analyzed and treated on the basis of Dashavidha pareeksha.

Observation and Results

Discussion

The discussion on personalized medicine appeared in published articles in 1999. However some core concepts have been referred since the early.¹⁹ With the advent of new technologies researchers are able to provide a link between an individual’s molecular and clinical profiles.²⁰ The discoveries of single nucleotide polymorphism (SNP) genotyping and microarray have led to progress in the field of personalized medicine.¹⁹ These tools have been used in segregating patients in a multitude of studies, clinical trials susceptible to various disease processes and drug therapy responsiveness ultimately allowing for development of protein based diagnostics and therapeutics.²¹ Personalized medicine can help predict a patient’s susceptibility of developing particular illness. For example, mutations of the BRCA1 and BRCA2 genes that have been implicated in familial breast cancers and loss of APC gene function in familial Adenomatous Polyposis. Ginsburg and McCarthy stated that personalized medicine intersects with the course of the patient’s disease at six major points: predisposition, screening, diagnosis, prognosis, pharmacogenomics and monitoring.²² Personalized medicine can identify protein markers of disease long before clinical manifestations, which helps us to plan earlier treatment thereby resulting in decreased morbidity and mortality. It can precisely diagnose and aid in prognosis based on specific gene characteristics unique to a patient rather than depending on data collected from a diverse population with a wide array of genetic variables.²¹

This type of approach towards patient was evident long before in Ayurveda and importance is given to every individual because all are different in terms of Prakriti, Sara, Satva, Bala etc. Diseases are managed by an individualistic approach using different modalities of treatment suitable to the patient. Ayurveda aims at not only curing the diseases but also preventing the illness;²² it is done by following diet and regimen according to the seasonal variation along with purificatory therapies,²³ daily regimen according to one’s own capacity and also consumption of rejuvenating medicines.

It is recommended that the phenotyping or the Prakriti analysis alone is not sufficient. The physician has to closely examine the ten factors i.e Dushya, Desha, Bala, Kala, Anala etc which represents the Roga bala and this is interdependent on Prakrithi, Vaya, Satmya and Satwa which represents the Rogi bala.⁹

While coming to the aspects of Chikitsa in many of the chapters, we have the Chikitsa Sutra mentioned. It can be taken as a guideline but before treating any disease every individual is considered as they differ from one another. The physician should observe the Lakshanas in the patient, then only Upakrama should be adopted according to Dosha Bala Kala Vishesha.²⁴

These guidelines were followed in analysis of patient, and different modalities of treatment were planned. In the clinical trial, there was highly significant difference between before and after treatment in all subjective parameters. Because the obtained ‘t’ values were greater than the table value at 95% confidence interval with respect to p value of <0.05 at degrees of freedom=3. This shows that the patients had appreciable improvement.

Each person must be treated with a unique approach which is evident all over the text. For example: Nityameva Virechanam²⁵ is mentioned for Udara but if patient is Sukumara Durbala, treatment plan should be changed according to the patient. It is said that Takrapayoga in Arshas is done for 7, 10, 15 days, but the physician should observe the Bala of the Rogi and according to Kala then administer the takra.²⁶ In the cases of Rajayakshma, if patient becomes Shushka, administration of Mamsa is very important. Even though he is not used to Mamsa of other animals, it should be administered in such a way that patient likes it because Mamsa does Brimhana which is necessary in that condition E.g. meat of carnivorous animals in the name of deer.²⁷

When a variety of treatment modalities are mentioned for a disease, not all can be adopted in the patient; physician must observe keenly and then plan the treatment. Variety of treatment modalities such as Abhyanga, Parisheka, Avagaha, Sheetagruha Basti etc. are mentioned and they should be adopted according to Kala and Matra.²⁸ By Dashavidha Pareeksha, we have complete knowledge of patient’s condition and stage of the disease. Thus along with the Prakrithi, other factors like Saara, Samhanana, Pramana, etc. play a major role for personalized approach.

Conclusion

Ayurveda plays a major role in not only disease prevention but also promotion of health towards longevity with a better quality of life, which is similar to the aims of personalized medicine. By overall assessment of Purusha, Vyadhi was understood, then treatment was planned according to the individual and was adopted in the case study which showed significant improvement.

Dashavidha Pareeksha is an important tool to understand and examine the patient individually to plan the treatment. The physician should examine by all means, in all possible ways and then conclude the disease. Once he is aware of the innermost meaning of the treatment principle, there will not be any delusion and the treatment will be fruitful. One who does not make use of intellect, by examination of patient when he is not able to understand the inner soul of the diseased or not able to gain the confidence of patient, then treatment will be unsuccessful. Hence the physician by his knowledge and intellect should understand the patient individually for the treatment to be fortuitous.

Acknowledgement

This study was supported by Late Dr. Mallika KJ, Former Professor, Shree Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Tanneruhalla, B M Road, Hassan, who provided insight and expertise that greatly assisted the study. We would like to show our sincere gratitude to her for sharing her pearls of wisdom with us during the course of this research. We are also grateful for her comments on an earlier version of the manuscript, although any errors are our own and should not tarnish the reputations of this esteemed person.

Conflicts of Interests

None.