Ayurvedic Routes Of Medicine Administration

By Vd. Ranga Prasad Bhat
Various surfaces of the body possess different degrees of vascularity (blood supply) as well as different capabilities of absorption; hence the medicine entry and absorption rate into the human system varies with the route of administration adopted. 

Routes of administration

1. The unbroken skin – tvak mārgena – snehana, svedana, lepa, abhyaṅga etc.,
2. The mucous membrane – as in nasyaṃ, gaṃḍūṣaṃ, basti, āścotana, pichu etc.,
Read related: Lepa Kalpana: Ayurvedic Dosage Forms For External Application

3. Diseased surfaces – eg.,
a) Applications – pralepa, pradeha, ālepa, abhyaṅga etc.,
b) Lotions – kaṣāya for vraṇadhāvana, pariṣeka etc.,
c) Dusting powders – ropaṇa and śodhana cūrṇa
d) Collyrium – añjanaṃ
e) Plugs – varti, vikeśikā,, pichu.
f) Poultices – utkārikā, piṇḍikā

4. Inhalations through the nose, larynx – Dhumapana
Read related: Herbal Smoking – Benefits, Rules, Side Effects, Blends To Try

The alimentary canal : –
5. a) The Oral route – The drugs are administered through the oral route either for their local action happening through the rasā or for the means of absorption by the alimentary tract through the vīrya, vipāka and prabhāva of the drugs. Sometimes certain drugs produce a systematic effect, by getting absorbed through the mucous membrane of the oral cavity like śūtaśekara, hemagarbha, nāgavalli etc., Some yogas are used as lozenges and held locally in mouth to be chewed until they get completely dissolved to produce viable clinical result as in – khadirādi, yaṣṭi.

5. b) The stomach and intestines : The frequently employed route for ingesting the medicines. The medicinal yogas are either popped or swallowed so as to reach the stomach, where in the ingetsed medicines gets digested and pass through the walls of the gastro intestinal blood vessels and lacteal to enter into the general circulation. The crystalloids in the solution pass more steadily than the colloidals substances like the fat, gum, gelatine etc, which require to be emulsified or pre-digested before getting absorbed.

The vamana dravyas, kṣāras and amladravyās are at times used for their sthalīya aka local actions over the gastric mucosa. Others like virecanīya exert much of their influence upon intestines than the stomach. The absorption rate gets influenced by the solubility and the form of the drug. the guṭikās take a longer time to get absorbed in comparison to the kaṣāya, hima, phānṭa
In general the drugs act more efficiently when administered in empty stomach compared to post prandial.

5.c) The rectum : In case of वात व्याधिs the drugs are at times administered through the rectal route. The enema prepartion of Ayurveda apart from local action do provide clinical effect in systemic diseases too. The biomedicine uses the rectal route mainly to wash off the contents of the bowels and in certain occasions to pass the glucose or saline solutions into the human system. At certain other circumstances the emollients, astringents and anthelmentics too are administered.
Read related: Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

In Ayurveda, on contrary, bastis are used not only for the purpose of noursihment or cleansing but for the therapeutic effect over the वात, पित्त and कफ diseases. Charaka devotes one special section for elucidating the clinical therapeutics of the basti karma.
“बस्तिर्वय:स्थापयित्वा सुखायुर्बलाग्नि मेधास्वरवर्णकृच्च ।
सर्वार्थकारी शिशुवृध्दयूनां निरत्यय: सर्वगदापहश्च ॥ २६॥ विट् श्लेष्म मूत्र अनिलपित्तकर्षी दार्ढ्यावह: शुक्रबलाप्रदाश्च । च.सि.१/ ॥
“bastirvaya:sthApayitvA sukhAyurbalAgni medhAsvaravarNakRRichcha |
sarvArthakArI shishuvRRidhdayUnAM niratyaya: sarvagadApahashcha || 26||
viT shleShma mUtra anilapittakarShI dArDhyAvaha: shukrabalApradAshcha | cha.si.1/ ||

Basti increases the life span, provides physical strength, improves memory;voice and digestion. Brightens the complexion. It exhibits uniform clinical effect in all the categories of life – the children, adult & old people. It eliminates the feces, aggravated vata, pitta and kapha doshas from the system and controls the process of excretory system of mutra and mala. In toto it provides stability to the human physique and increases the virility of the person.

शाखागता: कोष्ठगताश्च रोगा मर्मोर्ध्व सर्व अवयव अन्गगाश्च ।
ये सन्ति तेषाम् न तु कश्चिदन्यो वायो: परम् जन्मनि हेतुरस्ति ॥
विण्मूत्र पित्तादि मलाशयानाम् विक्षेप संघातकर:स यस्मात् ।
तस्य अतिव्रुद्धस्य शमाय नान्यद्वस्तेर्विना भेषजमिति किंचित् ॥३८।
तस्मात् चिकित्सार्धमिति ब्रुवन्ति सर्वां चिकित्सामपि बस्तिमेके ।
shAkhAgatA: koShThagatAshcha rogA marmordhva sarva avayava angagAshcha |
ye santi teShAm na tu kashcidanyo vAyo: param janmani heturasti ||
viNmUtra pittAdi malAshayAnAm vikShepa saMghAtakara:sa yasmAt |
tasya ativruddhasya shamAya nAnyadvastervinA bheShajamiti kiMcit ||38|
tasmAt cikitsArdhamiti bruvanti sarvAM cikitsAmapi bastimeke |

There can be no other causative factor other than the vAyu which can be accounted for afflicting the extremities, stomach, intestines, head or any other anga pratyanga in the body with disease. As the main function of the vAyu is to eliminate the toxins from the digestive tract and improve the circulation by removing all the impeding obstacles or congestions, it becomes necessary to see to it that the vAta do not get deranged at any cost. And to maintain the normal status of vAta as status quo, there can be none of the treatments on par with the basti chikitsa. The basti chikitsa occupies almost half the percentatge of the fields of the treatment in Ayurveda. Hence it gets denoted many times as ardhacikitsA. Quite at times, some other physicians go to the extent of claiming basti as the whole chikitsa (sarvāṃ cikitsām).

Factors influencing dosage

Factors influencing or modifying the dosage :-
There is no fixed rule for determining the generalized dosage pattern, and it differs from individual to individual with due consideration of the following factors.

Stithi: nAstyeva mAtrAyA: kAlamagniM vayo balam | prakrutiM desha doShau cha druShTvA mAtrAM prayojayet.
The specific  instructions regarding he dosage of drugs are missing to be seen in a single given context. But, hitherto the references related to general pattern of dosages  could be traced in the samhithās. They are,-
Age
Physical strength
Status of strength of Digestive fire
Constitution of the patient
The involvement of the deranged doṣās
Habitat of the patient
Season at the time of dispensing the medicine.

2. alpamAtraM mahAvegaM bahudoShaharaM sukham| laghupAkaM sukhAsvAdaM prINanaM vyAdhinAshanam||15|| avikAri cha vyApattau nAtiglAnikaraM cha yat| gandhavarNarasopetaM vidyAnmAtrAvadauShadham||16|| cha.si.6/ ||

The medicinal dosage should be small but potentful in providing ease to the patients from the aggravated doShAs (bahudoṣaharaṃ). The dosage should be easy for digestion and assimilation and should be pleasant in appearance and nourishing to the mind so as to enact the vyādhināśanam (cure from the disease). The dosage selected should in no way cause any complications neither should it cause exhaustion or weakness in the body of the patient.

3. mAtrAkAlakriyAbhUmidehadoShaguNAntaram |
prApya tattaddhi dRRishyante te te bhAvAstathA tathA||46||
tasmAt svabhAvo nirdiShTastathA mAtrAdirAshrayaH|
tadapekShyobhayaM karma prayojyaM siddhimichChatA||47|| cha. sU.25||

It has been observed that the dose and effect of the medicine gets influenced by the form of medicine, the time of administration and the method of adminstering the medicine along with the habitat and living conditions of the patient. Hence, the wise physician should conisder all these factors before administering the medicine for begetting success in the treatment.

Age

according to Dalhana in Su.sU 35th chapter – In first month of the infant 1 raktikā dosage gets adviced. An electure (avalehya) be prepared of the cūrṇam by mixing it either with the madhu or milk or sitā or ghrta. The dosage be increased by one raktikā for each consecutive months until the infant attains one year of age. When child attains 1 year dosage be fixed as i māṣhā, which be increased by one in quantity for each consecutive years until the child attains sixteen years of age. After completion of 16 years, whenceforth the dosage mentioned for adults can be started to be given.

In biomedicine, there used to be a formula named ‘Young’s formula’ to determine the dosage of medicines for children under twelve years of age.
The rule states, “divide the age inh years by the age in years plus twelve. The resulting quotient is the proper fraction of the adult dosage.” Considering ‘N’ to be the age of the child, the formula gets denoted as follows,- N / (N + 12) = fraction of the adult dose. Thus the dose for a four year old child the dose will be ¼ th of the adult dosage { 4 / (4+12) =1/4 }.

Sex: Women require comparatively smaller dosage than men due to their sukumAra nature. Their menstrual period too should be considered at times. Drastic purgatives are not adviceable during rtukAla & garbhini stages.

Size and body weight: Differentiation should be made between thin and robust.

Prakruti

Prakruti – constituition:-
tasmAdAturam parIkSheta – prakrutitashcha vikrutitashcha sAratashcha saMhananatashcha pramANatashcha sAtmyatashcha sattvatashcha AhAra shaktitashcha vyayAmashaktitashcha vayastashceti balapramANa visheSha grahaN heto: | cha.vi.8/105 |

Individuals of Vata prakruti can bear sedatives and antispasmodics. The pitta persons can bear depressants but not the stimulants. Like wise the kapha prakruti persons can bear purgatives and bitter tonics.

Tolerance

The sātmya aka tolerance to the drugs or pain can be of two types innate or inborn and acquired tolerance. Certain medicines when taken for a longer time duration, fail to produce the required therapeutic effect at times. This is due to the patient getting accustomed to the medicine and getting tolerant to the medicine. Since this is not inborn tolerance but acquired it gets denoted as acquired tolerance.

Habit

The craving for a particular medicine due to addiction making them feel that life gets impossible without that medicine falls under this category. Laxatives taken by patients is one best example for this category.