Rasayana and its relevance in the new millennium: A multimodal translational approach for generating scientific evidence

Background Ayurveda, one of the oldest traditional systems of medicine, has a unique approach to maintaining health and well-being. It emphasizes achieving equilibrium and harmony between the mind, body, and soul through systematic daily regimens, seasonal regimens, codes of conduct, dietary and therapeutic interventions, lifestyle practices, and bio-cleansing purificatory measures. In Ayurveda, Rasayana (rejuvenation therapy) is one of the eight branches that broadly deals with the longevity of life, delayed aging, rejuvenation of body tissue elements of healthy individuals, and management of age-related disorders. Ayurveda literature states that through Rasayana therapy, one can attain longevity, intelligence, freedom from disease, youthful vigor, complexion, voice, physical strength, and good sensory functions.[1] Rasayana in Ayurveda Rasayana therapy is a unique approach of Ayurveda intended to regulate/slow down/arrest the aging process in human beings during the degenerative phase. A holistic health care system like Ayurveda tackles the aging process through twofold methods[2]: one is a radical approach that recharges the whole body’s metabolic process by eliminating the toxins from the system in a rigorous and organized process of 3–4 months, known as Kutipravesika Rasayana.[3] However, this process is seldom practiced due to the extreme intricacy of the process involved and the need for utmost care to be taken by the physician and individual, including the environment where the treatment is done. Hence, this Kutipravesika remains a textual marvel of Ayurveda rather than a practical process of contemporary relevance. The second approach, called Vatatapika Rasayana, is quite popular and can accompany normal day-to-day life. This type of Rasayana is essential in the current scenario as it has a relatively easy mode of administration without any restrictive pre-conditions. Similarly, there are different types of Rasayana based on benefits, method of use, and type of substances. For example, Medhya Rasayana,[4] which acts as a nerve tonic for example, use of Sankhapuṣpi (Convolvulus pluricaulis), Mandukaparni (Centella asiatica), Yastimadhu (Glycyrrhiza glabra), or Vardhamāna Rasāyana meaning administering the medicine in a gradual step-up dosage, from minimum to maximum dose and then followed by tapering back for example, Vardhamana Pippali[5] and Vardhamana Shilajatu[6] or Kamya Rasayana that comprises of medicines, which promotes good health, and Naimittika Rasayana, that is, Rasayana for specific diseases. Ayurveda considers good conduct (Achara Rasayana) also a part of rejuvenation therapy highlighting the importance of mental health and self-discipline. Sharangadhara Samhita, a thirteen-century text on Ayurveda, narrates the sequential loss of biological qualities viz., childhood, growth, beauty, intellect, skin health, visual acuity, virility, physical endurance, wisdom, and motor activity in each decade of human life. Thus Rasayana drugs on respective characteristics are generally advised from forties to counter the effects of said loss during the further decades of life.[7] Relevance and Concept of Rasayana The twenty-first century is witnessing a gradual decline in fertility with an increase in life expectancy. Society will need to grapple with longevity issues. The cause of morbidity and mortality across the globe is shifting from communicable diseases to noncommunicable diseases. The leading causes of mortality among aged people comprise respiratory problems, heart diseases, cancer, and stroke. Significant causes of morbidity among this group are chronic inflammatory and degenerative conditions such as arthritis, diabetes, osteoporosis, Alzheimer’s disease, depression and psychiatric disorders, and Parkinson’s disease. Moreover, the recent coronavirus disease 2019 pandemic also emphasized the need for an alternative approach and adjuvant therapies to boost an individual’s immunity and play an active role in disease prevention. Thus, Rasayana therapy offers a promising option for combating and preventing disease conditions. Preventive and therapeutic relevance Rasayana therapy is a multi-faceted approach that involves preventive and therapeutic effects. The unique healing approach of Ayurveda focuses on diet, lifestyle, and medicines that address Dhatusamya (achieving the state of homeostasis) and not merely managing the symptoms of a disease. Ajasrika Rasayana The quality and quantity of food play a significant role in health preservation. Agni (capacity of digestion and metabolism) and individual favorability of food items as per Prakriti (body constitution), also play an important role in the effect of food intake on the body. Healthy and nutritious food habits and the inclusion of nourishing, favorable, and healthy food items are crucial in Ajasrika Rasayana (Rasayana in the form of food).[8] Thus, awareness among society about the role of healthy food and food habits has to be reintroduced, considering the present lifestyle of the people. Human life has been affected by drastic environmental changes in the present era. Thus, the biggest challenge of humankind is endurance to match the pace of speedy transformation in diet and lifestyle. Furthermore, newly emerging infections/communicable diseases and metabolic disorders have posed challenges to healthcare systems. To meet these challenges, public awareness of the preventive use of Rasayana can be introduced. Naimittika Rasayana Certain Rasayanas are disease-specific that is, Naimittika Rasayana addresses the clinical symptomatology and pathology of particular disease. Haridra, Shilajatu, and Amalaki for Prameha (diabetes mellitus); Khadira, Tuvaraka, Triphala, and Bhallatak for Kushtha (skin disorders); Gokshuru, Punarnava, and Shilajatu for Mutravahasrotas Vyadhis (urinary tract ailments); Triphala and Madhuyashti for Chakshuroga (eye diseases); Pippali, Shirisha, and Chyawanprasha for Swasaroga (respiratory diseases); Ashwagandha, Shankhpushpi, and Brahmi for Manasikaroga (psychiatric disorders). For therapeutic purposes, Dhatu (tissue) specific Rasayana drugs can be administered along with treating the underlying disease to enhance tissue strength for expedited effect of the treatment and to avoid recurrences, thus, offering radical cure to the patients.[9] Achara Rasayana A person can achieve psychological and social harmony, which is essential for healthy living. Achara Rasayana is a nonpharmacological way of acquiring the benefits of Rasayana through good personal, moral, and social behaviors. There is immense scope for this area of Rasayana in the present era where mental health is of grave concern for the policymakers in the whole world. The rules for good conduct and focus on the three pillars of health viz., Ahaar (food), Nidra (sleep), and Brahmacharya (self-control) can lead to self-discipline and a harmonious and healthy society for sustainable global health. Certainly, Rasayana is a critical perspective articulated in traditional treaties and should be a major research area due to its multi-faceted benefits. Diversified effect of Rasayana multimodal approach A review of the literature about published studies on herbs and formulations used as Rasayana reveals anti-oxidant, free radical scavenging, immune-modulatory, and adaptogenic activities. Recently, published works encompass the anti-cancer, neuro-protective, anti-Parkinson, radio-protective, aphrodisiac, and anti-dementia activity. Glimpses of scientific evidence Several experimental and clinical studies have demonstrated the safety and therapeutic effect of Ayurvedic interventions as potential immunomodulators and in age-related disorders, longevity, and degenerative disorders. Scope of research and way forward Based on various experimental and clinical studies, it can be said that Rasayana therapy in Ayurveda can reinforce innate and cell-mediated immunity. It can act competently in the biosystem and microcirculation stratum to rejuvenate the body and mind. Rasayana might make the body so well-built that it can defy various infectious agents. Numerous medicinal herbs and plant-based formulations treasured as Ayurvedic Rasayana for their restorative potential have been scientifically documented with potential outcomes. It has therapeutic potential in combating many dreadful diseases of present times, like tuberculosis, diabetes, atherosclerosis, dyslipidemia, stroke, Alzheimer’s, and cancer. Different studies on Rasayana drugs have proven their efficacy in treating epilepsy, convulsive disorders, and psycho-somatic stress. Rasayana has also shown positive results in alleviating anxiety and apprehension and keeping the mind quiet and pleasant. Rasayana drugs have been reported to treat generalized weakness and afford protection from cyclo-phosphamide-induced leukopenia. The pharmacological attributes of Rasayana can be correlated in terms of modern scenarios—anti-oxidant, immunomodulatory, hemopoietin effect, adaptogenic action, anti-aging, nutritive function, neuro-protective, and detoxification actions [Figure 1].Figure 1: Possible mechanism of action of RasayanaResearchers have concluded that Rasayana regulates the immunological and endocrine systems without damaging the auto-regulative functions of the organisms. However not much could be explored about the possible mechanisms of these effects of Rasayana. Postulations are that the Rasayana medicines may be acting by immune modulation, quenching free radicals, enhancing cellular detoxification mechanisms, repairing damaged nonproliferating cells, inducing cell proliferation and self-renewal of damaged proliferating tissues, and replenishing them by eliminating damaged or mutated cells with fresh cells. Therefore, though a lot has been described in the theory, good quality evidence that can endorse the benefits of Rasayana on aging-related conditions and, preventing and effective management of health ailments, is still awaited. Financial support and sponsorship Nil. Conflicts of interests There are no conflicts of interest.