Concept Of Immunosuppression In Ayurveda

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Immunosuppression – Suppression of the immune system and its ability to fight against infections and other diseases is called immunosuppression.

Purpose

Now why would we want to suppress the immune system of our body?
To understand this we need to understand the meaning of immunity and autoimmune disorders.

Immunity – Body has a self-defense mechanism wherein it would identify its enemies and destroy them i.e. the system in our body which identifies and destroys anything which is harmful for our body is called the immune system. It is a natural existing phenomenon in all of us. These enemies may invade us in the form of bacteria, viruses, toxins, cancer cells and transfused or grafted tissues from another person or species. They are called antigens. The immune system would produce antibodies which destroy these harmful substances.

Read – Immunity In Ayurveda: Concept, Diet, Herbs, Medicines, Exercise

Auto-immune disorders – Autoimmunity is when the body fails in identifying self from non-self. The system fails in differentiating the antigens from the healthy body tissues. As a result of this masked and deceptive knowledge or lost-inbuilt-intelligence, the immune system attacks and destroys the healthy body tissues. This eventually leads to many disorders called auto-immune disorders. Apart from causing the autoimmune disorders, the defense system of the body which has become hostile to its own cells would cause destruction of one or more types of body tissues, cause abnormal growth of an organ or cause abnormal changes in organ functions. These are also the effects of autoimmune disorders. When not addressed at the proper time, these diseases will get deep rooted and damage the system.

Examples of autoimmune disorders include Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE), Multiple Sclerosis (MS), Myasthenia Gravis, Grave’s Disease, Type 1 Diabetes Mellitus (T1DM), Celiac Disease etc. The symptoms of autoimmune disorders are specific to the tissues, organs and manifested diseases. Symptoms may range from mild fever to severe arthritis. A given person may suffer from more than one autoimmune disorder at a time.

Examples of autoimmune disorders include Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE), Multiple Sclerosis (MS), Myasthenia Gravis, Grave’s Disease, Type 1 Diabetes Mellitus (T1DM), Celiac Disease etc. The symptoms of autoimmune disorders are specific to the tissues, organs and manifested diseases. Symptoms may range from mild fever to severe arthritis. A given person may suffer from more than one autoimmune disorder at a time.

Read – Early Stage Of Rheumatoid Arthritis: Ayurvedic Treatment, Remedies

Immunosuppression Types

When there is reduction of the activation or efficacy of the immune system, it is called immunosuppression. It may occur due to an adverse reaction to some treatment of other diseases.

It is of two kinds.
Deliberately induced immunosuppression –

1. Deliberately induced immunosuppression – Immunosuppressive medications or immunosuppressants are used. They suppress the hyperactivity of certain components of the immune system.

Immunosuppressive drugs can cause immunodeficiency. This will lead to increased susceptibility to hire opportunistic infections. They can be prescribed as remedies for autoimmune disorders such as RA, SLE, Crohn’s disease, Sjogren’s syndrome etc.

Immunosuppressants are also administered in order to prevent organ / tissue rejection in organ transplantations. This may in turn cause the body to become more vulnerable to infections and malignancy during the course of treatment.
Read – Doshas And Ayurvedic Immunology

It is used to treat graft-versus-host disease following bone marrow transplantation. This type of immunosuppression is achieved by using medications, surgery or radiation. People who are undergoing immunosuppression or those whose immune system is weak are said to be immunocompromised.

2. Non-deliberate immunosuppression – This is not achieved by administration of immunosuppressives. The immunosuppression is not intended and hence non-deliberate. It can occur as in –
Cancer
Chronic infections like HIV
Complement deficiencies
Ataxia-telangiectasia etc

These conditions are generally caused due to immunodeficiency. Immunodeficiency increases susceptibility to bacteria and viruses. A potential adverse effect of using many immunosuppressant drugs is immunodeficiency.

Therefore we can see that immunosuppression not only includes a beneficial perspective but also carries with it the angle of adverse effects which tends to decrease the functioning of the immune system.

B cell deficiency and T cell deficiency can also lead to immunodeficiency. They are the immune impairments which are present at birth or are acquired.
Read – Vitamins In Ayurveda – Sources, Functions, Deficiency Disorders

Ayurvedic Understanding

The concept of autoimmunity and autoimmune disorders is not new for Ayurveda. Dosha concept indicates the inborn preparedness of autoimmunity.

The term dosha itself suggests ‘something which contaminates the body components’. The balanced doshas are helpful in easy running of the body functions. But the same doshas tend to invade the body components when they get vitiated. So the human body is composed of the same components which are helpful as well as destructive. When the doshas attack the body’s defenses i.e. the tissues and organs and srotases, they cause many diseases.
Read – Tridosha Theory in Ayurveda

All Nija Rogas i.e. diseases caused by vitiation of doshas cannot be considered as autoimmune disorders. Only those diseases in which the tissues and channels and ojas are destroyed to the point of no-return or suggesting bad prognosis due to them being afflicted by the vitiated doshas can be considered as autoimmune.

The doshas invading the components of its own system can be seen as the autoimmune processes. We also need to see that the same doshas and dushyas have the ‘ashraya ashrayi sambandha’. So the residents i.e. doshas are destroying the residence i.e. tissues in spite of belonging to the same system.

The secret of understanding which diseases turn into autoimmune disorders lay in the concept of sadhyasadhyata i.e. curability and incurability of disorders (prognosis) mentioned for all the diseases. Asadhya i.e. incurable diseases and Yapya i.e. manageable but not curable diseases can be considered as autoimmune disorders so as some krichchrasadhya i.e. ‘difficult to cure’ diseases.
Read – How To Make Prognosis Of Disease According To Ayurveda?

Therefore the doshas which have a natural tendency to invade and the tissues which have a tendency to resist the invasion – both coexist in the same body without afflicting each other. Dosha-dushya sammurchana i.e. vicious amalgamation of vitiated doshas and susceptible tissues (key process in the pathogenesis of any disease) in which the disturbed doshas invade its own system i.e. weakened and susceptible tissues indicate the onset of autoimmune disorders. The earlier they are identified, the earlier they can be aborted. This also indicates the earliest and oldest explanation of autoimmunity.

‘Rogastu Dosha Vaishamyam – Dosha Samyam Arogata’ – which means ‘dosha imbalance causes diseases while their equilibrium keeps one healthy’, is a golden reference to tell that we live with friends which can turn foes at any time.

Doshas are masked missiles. Their intelligence is to attack but this intelligence is masked. When we change the programming and decode them, their masked intelligence gets exposed and they attack the system in which they are in. Otherwise they are programmed to protect our system.

‘Prakritastu Balam Shleshma, vikruto malam uchyate’ i.e. the balanced kapha is called as bala i.e. strength / immunity and when imbalanced the same kapha is called as mala i.e. waste product – too speaks about the same.

We also get clues from ‘Visarga Adana Vikshepa’ functions of doshas. The doshas are representative of external forces of the body.

Vata – represents air and does the function of vikshepa i.e. distribution and balance / transport / scattering / conveying etc like the air or wind

Pitta – represents the fire or Sun and does the function of adana i.e. transformation of energies just like the fire or Sun

Kapha – represents the water or Moon and does the function of visarga i.e. nourishment and building just like the water or moon

Protective wind, fire and water become all destroyed when they get aggravated and destroy the same universe which they create and guard by taking the form of tornadoes, volcanoes and tsunamis respectively. Same is the case with doshas.

Read – Nourishing, Depleting and Distributing Functions Of Tridosha (Visarga, Adana And Vikshepa)

So, when the doshas go berserk, not only our body components are destroyed but our immunity is compromised. In other sense, the body’s immunity powers are becoming autoimmune. ‘Samadosha Samagnischa Samadhatu Malakriayah, Prasanna Atma Indriya Manasascha Swastha Iti Abhidhiyate’

The definition of comprehensive health in Ayurveda suggests the balance between all its components, individual and related balance. Imbalance leads to diseases

Read – Balanced Doshas And Their Contribution To Comprehensive Health

What is the remedy?
Since the doshas are hyperactive, they are causing the diseases. Therefore their hyperactivity should be suppressed.

Vasti – therapeutic enemas
Virechana – therapeutic purgation and
Vamana – therapeutic emesis are the best remedies for expelling the hyperactive doshas.
Panchakarma are the best immunosuppressive therapies from Ayurveda perspective.

Rasayanas are said to be given after Shodhana as a mandatory rule. Rasayanas can be considered as immune modulators. So in the hyperactivity of doshas, purification therapies should be done first. This is immunosuppression.

Then we can find that the body components will come to a state of balance. Later we can enhance the immunity of the tissues by administration of Rasayanas. This is immunomodulation. Ayurveda immunotherapy i.e. immunosuppression or modulation or combination of both consists of cleansing and rasayana therapies as first hand and best options.
Read – Rasayana Therapy (Anti Ageing, Rejuvenation) Benefits, Meaning, Medicines

Modern science tells us that immunosuppression may cause immunodeficiency. Therefore samyak shuddhi lakshanas i.e. signs of proper cleansing should be looked for. Excessive cleansing or deficit cleansing may once again play with our immunity. Proper cleansing plus Rasayana therapy done with proper logic and effective administration can be seen as apunarbhava chikitsa i.e. treatments focusing on non-recurrence of diseases.

Modern science speaks about deliberate and non-deliberate types of immunosuppression.

Shodhana, shamana – palliative treatments, types of langhana – lightening therapies, rasayana, etc can be viewed as examples of deliberate immunosuppression wherein we are trying to suppress the hyperactive components of immune system and rejuvenate the tissues enhancing their defense mechanism and also trying to see that there are no recurrences.

Non-deliberate immunosuppression may occur due to immune-deficiency and endogenous factors leading to lowering of immunity and weakening immune system. Ayurveda understanding leads us to consider one or more of the below mentioned concepts –

– decrease of vyadhi kshamatva i.e. decrease of immunity / immune deficiency
– kapha kshaya – decrease of kapha
– vata-pitta vriddhi – abnormal increase of vata and pitta
– imbalance and various stages of ojus imbalance
– agni vaishamya – metabolic imbalances, errors and diseases caused by them (core metabolic and tissue fires included)
– srotodushti – contamination of channels of the body
– mala sanchaya – accumulation of waste products in the body
– formation and circulation of ama, sama doshas – doshas associated with ama etc
– dhatu kshaya – destruction of tissues

This type of immunosuppression may lead to the causation of many disorders or provide a platform wherein increased susceptibility to the diseases can be seen. These conditions may be treated on the principles of treating these conditions as mentioned in classics or on the basis of yukti – skilful understanding and situational treatment of disorders.

Read – Kapha Decrease Symptoms, Analysis, Treatment

Summary

There are some concepts of modern day medicine which are best left unaddressed or not translated or correlated from Ayurveda perspective. Immunosuppression is one such concept. Actually seeing any of the Ayurveda concepts in the treatment process cannot be said to be acting on the lines of immunosuppression. This is also because Ayurveda has a rich and proven concept of immunomodulators and Ayurveda or its principles do not try to suppress immunity, immune system or some components of the immune system. Many aspects of Ayurveda contribute towards explanation of the concept of immunity and immune system. There are many treatment concepts which contribute towards immunity enhancing and modulation but we can find no straight reference which can explain the concept of immunosuppression with respect to achieving dhatu samya i.e. equilibrium of body components or towards establishing health in an individual.

So why did I write this article on immunosuppression in terms of Ayurveda?
My explanation of immunosuppression in terms of Ayurveda is a hypothesis and my individual perspective. Nothing I have written is conclusive but intends to give a perspective to the topic if at all seen in that direction.

Few Ayurveda legends and stalwarts and scholars have appreciated this aspect of my explanation but few have differences about this. I agree that some concepts should be left alone but I contribute this concept of mine to innovative thinking.
Click to Consult Dr Raghuram Y.S. MD (Ayu) 

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