EFFECTS OF AYURVEDIC THERAPY FOR THE MANAGEMENT OF AUTISM IN CHILDREN: A REVIEW

EFFECTS OF AYURVEDIC THERAPY FOR THE MANAGEMENT OF AUTISM IN CHILDREN: A REVIEW

Nitu Sinha * and Nisha Kumari Ojha,

Department of Kaumarbhritya, National Institute of Ayurveda, Deemed To Be University (De Novo), Jaipur, Rajasthan, India.

ABSTRACT: Introduction: Autism is a group of psycho-neuro-developmental diseases in which children fail to acquire social interaction and other regular motor and verbal milestones, and some developmental issues are suspected. According to recent reports, prevalence rates have risen drastically from 4-6/10,000 in the early 1960s to 40-60/10,000 now. According to Ayurvedic literature, Unmada is a term for psychotic issues that encompasses many mental conditions, including autism. Aims and Objectives: Critical review and analysis of the effects of various conventional Ayurveda treatment modalities in the management of Autistic children. Material and Methods: Various Ayurveda classics and studies published in journals, as well as PubMed, and Medline databases related to effect of Ayurveda drugs, therapeutic process, and supportive therapy in management of Autistic children, are reviewed and appraised. Review Results: Multimodal management approach of an Ayurveda comprising the herbal supplements, Ayurveda Compounds, Abhyangam, Shiropichu, Shirolepa and a very specific, controlled and wholesome diet and Sattvavajaya chikitsa (Psychotherapy) with supportive therapy. These Ayurveda therapeutic approaches are used to manage autism with respect to psychosomatic disorder Unmada. Discussion: These treatments benefit autistic children by a different mechanism of action and improve their quality of life. Conclusion: The children with autism can become functional with the help of Ayurveda medicine supplementation, contributing members to their families and communities and their lives become better than before.

Keywords: Autism, Psycho-neurodevelopmental diseases, Herbal supplements, Sattvavajaya chikitsa

INTRODUCTION: Autism is a heterogeneous set of psycho-neurodevelopmental disorders that persists throughout the longevity of the individual whose definite etiology is still unknown. These developmental disorders are first suspected when the child fails to develop social interaction and other typical motor and language milestones.

With little variations, children present with cognitive impairment, socialization skills with typical behavioral peculiarities and speech and language deficits ¹. Autism spectrum disorder (ASD) is a multifactorial disorder resulting from genetic and non-genetic risk factors and their interaction.

There is a high recurrence risk (2-19%) for autism among siblings and a higher concordance rate (37-90%) in twin studies. Other risk factors are closer spacing of pregnancies, advanced maternal or paternal age, extremely premature birth (<26 weeks gestational age) and family members with learning problems, psychiatric disorders and social disability.

The male-female ratio is estimated to be 4:1. ASD is more common in males, but in a recent meta-analysis, the true male-to-female ratio is closer to 3:1 than the previously reported 4:1 ². The incidence of ASD may be higher in immigrant populations ³. According to recent reports, prevalence rates have changed dramatically from 4-6/10,000 in the early 60s to 40-60/10,000 according to recent reports ⁴. Due to these main reasons, i.e., awareness and diagnosis are much more prevalent and sophisticated, more than ever, the fetus and developing infants are exposed to chemicals, women have children later in life, and genetics, this prevalence has increased more than tenfold over the past 20 years ⁵.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders. The current edition of the DSM, the fifth revision (DSM-5) ⁶, was published in May 2013. The DSM-5 classification also adds new clinical signs of stereotypical speech and also hyperreactivity or hyporeactivity to sensory input or interest in sensory aspects of the environment. According to different causes, autism is of two types: primary autism with an unknown cause and secondary autism.

In primary autism with unknown cause, diagnosis is made when there are impairments in reciprocal social interaction, communication, repetitive behaviour/restricted interest, and stereotyped patterns of behaviours or interests prior to the age of 3 years. But in secondary autism, there are found many causes which are associated with perinatal disorders (like rubella, encephalitis, cerebral palsy) and also with known genetic causes/metabolic errors (like fragile x syndrome, congenital infections secondary to rubella and cytomegalovirus, phenylketonuria, tuberous sclerosis) ^7-13.

As per Ayurveda literature, Unmada is a term for psychotic problems that include many mental illnesses and covers autism. The symptoms of Unmada are the derangement in the Manas (mental functioning), Buddhi (application of acquired knowledge), Samjna (perceptions), jnana (experiences), Smriti (memory), Bhakti (emotional adhesions), Seela (conditioned activities), Chesta (behaviour) and Achara (socio-cultural activities) ¹⁴. The clinical features of autism merge well with that of Unmada.

Causes of Autism ¹⁵: As per Ayurveda, the causes of Autism (Unmada) are Beejadosha (Genetic alteration, mutation), Aharadosha (Indulgence in highly Vata vitiating diet and deeds immediately after conception) such as Viruddhahara (incompatible foods), Viharadosha (Inappropriate schedules), Manaabhighata (Injury to cerebrum during delivery may result in cerebral palsy), Vaikarikabhava such as Bhaya, Kopa, Shoka and Harsha (Emotional factors such as fear, anger, sorrow, pleasure etc.), unfulfilled desires in Dauhrida may hurt the mind in fetus.

Pathophysiology: According to the fundamentals of Ayurveda, Samprapti (pathogenesis) of any disease comprises the vitiated Dosha-Dushya (union) Sammurchhana. These vitiated components are manifested in full flown disease, when they exacerbate with already existing ‘Khavaigunya’¹⁶ (structural and functional alteration of body tissues/ system etc.). The aggravated Dosas become Unmargami (leave their place and reach the upper channels of the body) i.e., produce symptoms¹⁷. Vitiation of Tridoshas and Rajas and tamas lead to vitiation of Manovaha Srotas, which disturbs mental emotions and produce Unmada. When prominence of Kapha Dosha, then it is called Kaphaja Unmada. Symptoms of Kaphaja Unmada are staying in an unchanged position, silence, least movements, loss of appetite, liking of loneliness, disliking for cleanliness, excessive sleep, white colour, and stickiness in eyes ¹⁸, which is specifically similar to Autism symptoms.

AIMS AND OBJECTIVES: Critical review and analysis of the effects of various conventional Ayurveda treatment modalities in the management of Autistic children.

MATERIAL AND METHODS: Various Ayurveda classics and studies published in journals and PUBMED, MEDLINE database related to the effect of Ayurveda drugs, therapeutic process, and supportive therapy in the management of Autistic children are reviewed and appraised.

Review Results: Ayurveda has a lot of potential for training psychiatric and behavioural disorders with plant-based medications and Panchakarma therapies that don’t harm the body’s growing condition ¹⁹.

All these objects can be achieved by multimodal management approach of an Ayurveda comprising the Drug therapy (Shamana therapy and Shodhana therapy) and Sattvavajaya chikitsa (Psychotherapy). These Ayurveda therapeutic approaches are used in the management of autism with respect to psychosomatic disorder Unmada.

Drug Therapy: Autism is a complex neurodevelopmental disorder where Ayurveda drug preparations are used in Shamana therapy and Shodhana therapy.

Shamana Therapy: Shamana therapy of autism (Unmada) includes Deepana, Pachana (Drugs and procedures that promote digestion), and Snehapana (internal oleation use of medicated ghee). The Ghrita preparations most commonly used in the management of Autism are Kallyanaka Ghrita, Mahakallyanaka Ghrita, Jivanthyadi Ghrita, Siddharthak Ghrita, Mahapaishachika Ghrita, Lashunadda Ghrita ²⁰. Essential fatty acids (EFAs) are beneficial in nearly 30% of children with autism ²¹. The consumption of EFAs for autism spectrum disorder designates a relationship between neuron function improvement and regeneration. It gives satisfactory outcomes and quantifiable improvements in the language and learning skills of autistic children ²². In autistic children, several herbs are recommended, including Guduchi ²³, Aamalaki ²⁴, Pippali ²⁵, Trikatu ²⁶ which provide digestive support. It is well recognized that bidirectional communication between the gut, the immune system, and the brain. For example, psychological stress can induce changes in gastrointestinal microbes. However, intestinal bacteria can directly communicate with the central nervous system through the vagal sensory nerve fibers and the peripheral immune system. The drugs which act as probiotics can be useful to restore the microbial balance in the intestine, relieve gastrointestinal problems and attenuate immunological abnormalities ²⁷. According to their Pharmacological properties, some drugs which can be used in Autistic children are given the following.

TABLE 1: PHARMACOLOGICAL PROPERTIES OF THE SINGLE HERBAL DRUGS USED IN AUTISM AS PER AYURVEDA

TABLE 2: PHARMACOLOGICAL PROPERTIES OF THE DRUGS USED IN AUTISM AS PER AYURVEDA

Shodhana Therapy ¹⁰⁶: Shodhana therapy is used in autistic children and Shamana therapy provide very significant effects. It consists of Abhyangam (oil massage), Mridushodhana (mild body purification by emesis or purgation), Siropichu (overhead application of special oil), Sirodhara (continuous pouring of specific oil over the forehead), and Sirolepam(medicinal paste application overhead region). The application of Abhyangam early in the morning can have massive health benefits (both physical and mental in the case of Autistic children) ¹⁰⁷. Mridu Shodhana (mild body purification by purgation) helps flush out toxins from the body and improves the whole functioning of all organ systems in the body. It also has a curative effect on the vitiated Doshas of Pitta and Kapha, thus secondarily affecting the Rajo and Tamo Mano Doshas. This leads to improved psychological aptitude in a person’s approach to dealing with stressful conditions ¹⁰⁸. Shodhana therapy in the form of Basti preceded by Snehana and Swedana is used to manage the Rasadusti in the body, which is present throughout the body ¹⁰⁹.

In autistic children, Shiropichu has a greater effect. It's one of the most effective ways to relieve stress and anxiety. Taila is used in Shiropichu because it has a high density and a longer contact time.Due to Sukshma, Ushna & Vyavayi properties of Taila ¹¹⁰ it penetrates easily into Manovahasrotas, correcting vitiation of Manas Doshas (Raja & Tama). Brimhana, Balya, Vata Shamana, and Medhya qualities of Taila simultaneously correct all Manas Vikaras.

Sattvavajaya Chikitsa (Psychotherapy): Sattvavajaya chikitsa is thought to be working on enhancing cognitive abilities in regularizing emotional discrepancy. Different methods used in the achievement of Sattvavachaya in Autistic children include ¹¹¹ Bandhana and Tamogriha Rodhana (Detention in dark rooms- those who are attacking in nature), Tarjanam (admonishment), Trasanam (frightening), Danam (rewards, reinforcement), Harshanam (delighting), Santwanam (pacification), Vismayam (mystic). These methods are useful to get back these different mental abilities like Gyana (True knowledge of self-behaviour), Vigyana (Specific Knowledge), Dhairya (Patience), Smriti (Memory), Samadhi¹¹² (Mental equanimity), Dharaniya Vega Dharana ¹¹³ (Mental urge control), Ahitanam Anupasevana and HitanamUpasevana¹¹⁴ (withdrawal of unwholesome regimens and adoption of wholesome regimens) deranged in Autistic children to normalcy. The factors that help the mind make a stable, firm and right decision with interest in having a healthy body status that is Samyak Artha Grahana are Dhee, Dhriti, and Smriti. The factors that help the mind make a stable, firm and right decision with interest in having a healthy body status that is Samyak Artha Grahana are Dhee, Dhriti, and Smriti.

Supportive Therapies ¹¹⁵: Supportive therapies should be focused on (in young kids) language, speech, special education, parent education, training, and support. In an older child / Adolescent (with relatively higher intelligence) but poor social skills. So, psychotherapy and behavioural therapy are required. Working with families of Autistic children is vital. In general, services/care for the autistic child are the following:

1. Early (started before 3 years age child) intensive behavioural and educational rehabilitation.
2. Use of visual structures for optimal education.
3. Childhood Autism Rating Scale (CARS),
4. Multidisciplinary training for all professionals.
5. Methods are adapted for spontaneous language improvement.
6. Hold in a language increases communication, increases communication, and decreases the tendency of autism.
8. Social skill training.
9. Vigorous aversion therapy
10. Auditory integration training is also hopeful.

Pathya and Apathya (Wholesome & Unwholesome diet and habit) for Autism (Unmada) ¹¹⁶: The foods indicated for Autism (Unmada) are Cow’s milk, Goghrita, Good sleep, Puran Shali (old rice paddy), Shashtik (Rice), Draksha (Grapes), Yava (Barley), Lajasaktu (roasted parched paddy powder) etc. and are contraindicated for autism are alcohol, pungent and spicy food, penetrative and irritant food, irritating, insulting incidences and activities, suppression of natural urges, incompatible and polluted food, sleeplessness.

DISCUSSION: Autism is a pervasive developmental disorder that impairs the ability to communicate and interact or form relationships with other people. With the help of Ayurveda management, patients with autism can become functional, contributing members to their families and communities. According to Ayurveda, the management of autism is based on the motive to reduce the effect of ‘Khavaigunya’ by restoring the functions of other pathological markers. Vitiated Sharira Doshas and Manas Doshas, which in turn, may be helpful in reducing problematic behaviour that would be adaptive at lower rates and maintain this adaptive behaviour for longer duration. In addition, it may help acquire new skills of learning and communication.

Drug therapy (Shamana therapy and Shodhana therapy) and Sattvavajaya chikitsa (Psychotherapy) are used for management of autistic children. Shamana therapy pacifies Doshas of the body and does not expel them from tissues, similar to vomiting or purging. Herbal supplements are used to improve cognitive function, language, and learning skills. Medicated Ghrita preparations are used in autism which absorbs and readily enter the brain through the blood-brain barrier.The selection of a particular Ghrita preparation is decided based on two things. Primarily you have to decide whether the selected Ghrita is indicated for psychological Disorders. Secondly, the selected ghee should improve the foremost humor of the specific clinical subtype of autism. Managing the immune system needs of autistic children by using Ayurvedic theories requires a constant focus on sustaining proper immune function. Probiotics have been shown to support immune system function and digestive support.

This is critical for autistic people because many have shown signs of impaired or reduced immune systems. Shodhana therapy expels Doshas from tissues and cells (at the micro-level), similar to emesis or purging or by both actions. The Doshas are metabolized by the liver and excreted from the body. Ayurveda also proceeds into a description of autism caused by microbial infestation, which can give rise to endotoxins in the child’s body. When the microbial infestation reaches the brain, then disruption of the brain functions is done by attacking nerve cells and causes deterioration of the child's developmental skills ¹¹⁷.

With the help of Shodhana therapy, the endotoxin produced by microbial infestation is removed, and autistic children are improved their brain function. Abhyangam (Oil massage) provides significant relief to patients suffering from anxiety and depression because these therapies have a smoothening effect on the nervous system, relax the tensed muscles, and increase blood circulation. Shiropichu (Pouring of specific oil over the forehead) and Shirolepa (medicinal paste application overhead region) are done to enhance the concentration of the mind continuously in autistic children by the proper functioning of the nervous system. In comparison to other body regions, the skin over the scalp is thin, and absorption is faster and more from the scalp. Shiropichu's local effect is determined by the type of medicine utilized during the operation and drug cellular absorption via the transdermal route. According to modern medicine, local application, such as ointment, passes through the stratum corneum into the blood artery and reaches the proper organ.

Similarly, the oil on the forehead is rapidly absorbed and reaches the brain's cortex. It increases circulation by rectifying cerebral circulation, which is critical in times of stress. Therefore, Abhyanga, Shiropichu and Shirolepa, and Shamana therapy are very useful in autistic children.

Sattvavajaya chikitsa (Psychotherapy) mainly aims to control the mind, regularize the functions of the mind, and prevent the mind from those factors that disturb its functions. The mind should be educated and trained to avoid and desensitize unwholesome factors to the self (mind and the body) and society. Therefore, the mind has to decide which is good and bad as soon as it gets exposed to the external environmental hazards and takes a decision within no time by keeping interested in the body's health status.

Children with autism have difficulty and lack interest in interacting and communicating with other people. Hence, proper function with the integrity of these three cognitive elements (Dhee, Dhriti, and Smriti) enables the mind to work at its best. Direct knowledge is provided by a consequence of the conjunction of soul, mind, sense organ, and their objects, but merely after the mediation of Buddhi ¹¹⁸. Memorization (Smriti) is a function carried out by Udana Vayu. However, in an older autistic child, working memory functions are realized extensively upset, while long-term memory may remain intact due to repetitive maintenance practice. This may be suggestive of the ongoing degradation of Udanavayu. Derangement of Udana Vayu is responsible for speech impairment also ¹¹⁹. As cognitive function represented by Sadhaka Pitta 120 can be denoted in the form of Buddhi and Medha, the function of emotional and social cues is represented as Bhaya, Shaurya, etc. Along with Ayurveda management, it is more beneficial for autistic children when we give supportive therapies. These supportive therapies improve cognition, communication, IQ, language, academic performance, adaptive and social functioning and decrease inappropriate behaviours such as aggression, hyperactivity, and temper tantrums.

Pathya Aahara and Vihaara (Wholesome & Unwholesome diet and habit) are invariably a part of management. Specific types of food, i.e., dairy products, nightshade vegetables (tomatoes, eggplant, potatoes, and peppers), citrus fruits, peanuts, preservatives, colours, food additives, insecticides, pesticides and heavy metals are thought to contribute to the significant impact on symptoms associated with autistic children. Autistic children are also more expected to suffer from food sensitivities resulting from improper digestion of foods, frequently resulting from weakened digestive and immune systems. This often causes incompletely digested food to move into the bloodstream, causing an autoimmune attack and a response comparable to an allergic reaction. Naturally occurring probiotics have demonstrated the ability to promote healthy digestion and strong immune system function ¹²¹.

CONCLUSION: Present review study shows that ayurvedic management with supportive therapies provides a good response in autistic children. Autism disturbs normal brain functions, impacting brain areas responsible for social interaction and aggression. Currently, in modern medicine, a permanent cure for autism does not exist; research has provided several useful findings to assist with managing the symptoms associated with autism. Through the strategic practice of Ayurveda medicine supplementation like Herbal supplements, Ayurvedic Compounds, Abhyangam, Shiropichu, Shirolepa, and a very specific, controlled, and wholesome diets, patients with autism can become functional, contributing members of their families and communities and their life become better than before. Hence, traditional approaches in the form of drug therapy (Shamana & Shodhana) and Sattvavajaya Chikitsa (Psychotherapy) and supportive therapies like intensive behavioural and educational rehabilitation are highly beneficial in the management of autistic children.

ACKNOWLEDGEMENT: The authors are thankful to the institute for providing the necessary facilities.

CONFLICTS OF INTEREST: The authors declare no conflict of interest.

REFERENCES:

1. Kliegman and Stanton: Nelson, Textbook of Pediatrics. First South Asia Edition 2015; 30: 176.
2. Hodges H, Fealko C and Soares N: Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Transl Pediatr 2020; 9(1): 55-65. Doi: 10.21037/tp.2019.09.09
3. Kliegman and Stanton: Nelson, Textbook of Pediatrics, First South Asia Edition; 2015; 30:177.
4. Nair MKC, Menon PSN, Kundu R, Gupta P and Nedunchelian K Choudhury J: IAP Textbook of Pediatrics, Sixth Edition 2016; 6.16: 468.
5. Jutel A: Sociology of diagnosis: a preliminary review. Soc Health Illness 2009; 31: 278–99.
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association 2013.
7. Khan NZ, Gallo LA, Arghir A, Arghir A, Budisteanu B, Budisteanu M and Dobrescu L: Autism and the grand challenges in global mental health. Autism Res 2012; 5: 156–59.
8. Bauman ML and Kemper TL: Neuroanatomic observations of the brain in autism: a review and future directions. Int J Dev Neurosci 2005; 23: 183–87.
9. O’Reilly C, Lewis JD and Elsabbagh M: Is functional brain connectivity atypical in autism? A systematic review of EEG and MEG studies. PLoS One 2017; 12: 0175870.
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edi Washington, DC: American Psychiatric Associa Pub 2013.
11. Lord C, Petkova E, Hus V, Gan W, Lu F and Martin D: A multisite study of the clinical diagnosis of different autism spectrum disorders. Arch Gen Psychiatry 2012; 69(3): 306–313.
12. Maenner MJ, Rice CE, Arneson CL, Cunniff C, Schieve LA and Carpenter LA: Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates. JAMA Psychiatry 2014; 71: 292–300.
13. Weitlauf AS, Gotham KO, Vehorn AC and Warren ZE: Brief report: DSM-5 “levels of support:” a comment on discrepant conceptualizations of severity in ASD. J Autism Dev Disord 2014; 44: 471–76.
14. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: (editors), Vaidyamanorama Hindi Commentary, Nidanasthana 7/5,Varanasi: Choukhambha Sanskrit Sansthana 2012; 565.
15. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: (editors), Vaidyamanorama Hindi Commentary, Chikitsasthana 9/4, Varanasi: Choukhambha Sanskrit Sansthana 2012; 305.
16. Sushruta, Sushruta Samhita and Shastry Ambikadut: (editors), Ayurvedtatvas and ipikahindi Commentary, Sutrasthana 24/10, Varanasi: Choukhambha Sanskrit Sansthana 2012, 133.
17. Yogaratnakar, Tripathi Indradev and Tripathi Daya Shankar: (editors), Vaidyaprabha Hindi Commentary, Unmadadhikar verse 2013; 386.
18. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: (editors), Vaidyamanorama Hindi Commentary, Chikitsasthana9/5, 13-14, Varanasi: Choukhambha Sanskrit Sansthana 2012; 305-308.
19. Shinde RV, Patil S and Jha RK: Ayurvedic intervention for autism – a case study. European J of Molecular & Clinical Medicine 2021; 8(1):380.
20. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: (editors), Vaidyamanorama Hindi Commentary, Chikitsasthana 9/23-76, Varanasi: Choukhambha Sanskrit Sansthana 2012; 315-24.
21. Bruisten SM: "TOXBASE. Emerg Med J. 2006 Aug; 23 (8): 614-7. [PubMed-in process], Team V, Markovic M. Internet advertising of artificial tanning in Australia." Oncol Nurs Forum 2006; 249-54.
22. Bent S, Bertoglio K and Hendren RL: Omega-3 Fatty Acids for Autistic Spectrum Disorder: A Systematic Review. J autism Dev Disord 2009; 39(8): 1145–1154.
23. Upadhyay AK, Kumar K, Kumar A and Mishra HS: Tinospora cordifolia (Willd.) Hook. f. and Thoms. (Guduchi) – Validation of the Ayurvedic pharmacology through experimental and clinical studies. Int J Ayurveda Res 2010; 1(2): 112–121.
24. Thilakchand K, Mathai R, Simon P, Ravi R, Baliga-Rao M and Baliga M: Hepatoprotective properties of the Indian gooseberry (Emblica officinalis Gaertn): A review. Food & Function 2013; 4(10): 1431.
25. Sharma L, Saini D, Ajmera P, Singh M, Therapeutic Benefits of Long Pepper (Pippali). Int J Creative R Thoughts (IJCRT) 2018; 6: 468-477.
26. Singh B, Upadhyaya S and Nuna S: Critical Review of Trikatu in Ayurvedic classics. Dev Sanskriti Interdisciplinary International Journal 2014; 4: 73-78.
27. CritchfieldW, Hemert SV, Ash M, Mulder L and Ashwood P: Gastroenterology Res and Practice 2011; 161358: 1-8.
28. Ayurvedic Pharmacopeia of India API, Government of India, ministry of Health and Family welfare Department of Health 2001; 1(4): 69-71.
29. Veerendra Kumar MH and Gupta YK: Effect of Centella asiatica on cognition and oxidative stress in an intracerebroventricular streptozotocin model of Alzheimer's disease in rats. Clin Exp Pharmacol Physiol 2003; 30: 336–342.
30. Chen Y, Han T, Qin L, Rui Y and Zheng H: Effect of total triterpenes from Centella asiatica on the depression behaviour and concentration of amino acid in forced swimming mice. Zhong Yao Cai 2003; 26: 870–873.
31. Chen Y, Han T, Rui Y, Yin M, Qin L and Zheng H: Effects of total triterpenes of Centella asiatica on the corticosterone levels in serum and contents of monoamine in depression rat brain. Zhong Yao Cai 2005; 28: 492–496.
32. Somchit MN, Sulaiman MR, Zuraini A, Samsuddin LN, Somchit N and Israf DA: Anti-nociceptive and anti-inflammatory effects of Centella asiatica. Indian J Pharmacol 2004; 36: 377–380.
33. Almas Taranum: A Clinical Comparative Study On The Efficacy Of Mandukaparni And Guduchi On Intelligence Quotient In School Going Children. International AyurvedicMedical Journal {online} 2017 {cited September 2017}
34. Bruisten SM: "TOXBASE. Emerg Med Wang Xs, Dong Q, Zuo JP and Frong JN., Structures and potential immunological activity of a pectin from Centella asiatica (L.) Urban, Carbohydr Res 2003; 338 (22): 2393-2402.
35. Jayathirtha MG and Mishra SH: Preliminary immunomodulatory activities of methanol extracts of Eclipta alba and Centella asiatica, Phytomedicine 2004; 11(4): 361-365.
36. Ayurvedic Pharmacopeia of India API. Government of India, ministry of Health and Family welfare Department of Health 2001; 1(1): 168-169.
37. Martins N, Dueñas L, Santos-Buelga C and Ferreira ICFR: Characterization of phenolic compounds and antioxidant properties of Glycyrrhiza glabra L. rhizomes and roots. RSC Adv 2015; 5: 26991–26997. 10.1039/c5ra03963k. [CrossRef] [Google Scholar]
38. Chen G, Zhu L, Liu Y and Zhou Q: Isoliquiritigenin, a flavonoid from licorice, plays a dual role in regulating gastrointestinal motility in-vitro and in-vivo. Phytotherapy Research 2009; 23(4): 498-506.
39. Genovese T, Menegazzi M, Mazzon E, Crisafulli C, Paola RD and Bosco MD: Glycyrrhizin reduces secondary inflammatory process after spinal cord compression injury in mice 2009; 31(4): 367-375.
40. Berezin VE, Bogoyavlenskiy A, Tolmacheva VP and Makhmudova NR: Immunostimulating Complexes Incorporating Eimeria tenella Antigens and Plant Saponins as Effective Delivery System for Coccidia Vaccine Immunization. J of Parasitology 2008; 94(2): 381-385.
41. Cui YM, Ao MZ, Li W and Yu LJ: Effect of glabridin from Glycyrrhiza glabra on learning and memory in mice. Planta Med 2008; 74(4): 377-380.
42. Parle M, Dhingra D and Kulkarni SK: Memory-strengthening activity of Glycyrrhiza glabra in exteroceptive and interoceptive behavioral models. J Med Food 2004; 7(4):462-466.
43. Dhingra D and Sharma A: Evaluation of antidepressant-like activity of glycyrrhizin in mice. Indian J Pharmacol [serial online]. 2005 [cited 2021 Jul 29]; 37: 390-394.
44. Dhingra D and Sharma A: Antidepressant-like activity of Glycyrrhiza glabra L. in mouse models of immobility tests. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2006; 30(3): 449- 454.
45. Adamyan TI, Gevorkyan ES, Minasyan SM, Oganesyan KR and Kirakosyan KA: Effect of Licorice Root on Peripheral Blood Indexes upon Vibration Exposure. Experimental Biologiii Meditsiny 2005; 140(8): 164-168.
46. Wan X, Luo M, Li X and He P: Hepatoprotective and anti-hepatocarcinogenic effects of glycyrrhizin and matrine. Chem Biol Interact 2009; 181(1): 15-19.
47. Ambawade SD, Kasture VS and Kasture SB: Anticonvulsant Activity of Roots and Rhizomes of Glycyrrhiza Glabra. Indian J of Pharma 2002; 34: 251-255.
48. Ayurvedic Pharmacopeia of India API, Part 1, Volume 1, Government of India, ministry of Health and Family welfare Department of Health 2001; 53-55.
49. Singh SS, Pandey SC, Srivastava S, Gupta VS, Patro B and Ghosh AC: Chemistry and medicinal properties of Tinospora cordifolia (Guduchi) Indian J Pharmacol 2003; 35: 83–91.
50. Singh J, Sinha K, Sharma A, Mishra NP and Khanuja SP: Traditional uses of Tinospora cordifolia (Guduchi) J Med Aromat Plant Sci 2003; 25: 748–51.
51. Bairy K, Rao Y and Kumar KB: Efficacy of Tinospora cordifolia on learning and memory in healthy volunteers: A double blind, randomized, placebo-controlled study. Iranian J Pharmacol Therap 2004; 3: 57–60.
52. Agarwal A, Malini S, Bairy KL and Rao MS: Effect of Tinospora Cordifolia on learning and memory in normal and memory deficit rats. Indian J Pharmacol 2002; 34: 339–349.
53. Prince PS, Kamalakkannan N, Menon VP. Restoration of antioxidants by ethanolic Tinospora cordifolia in alloxan-induced diabetic Wistar rats. Acta Pol Pharm 2004; 61: 283–7.
54. Prince PS, Padmanabhan M and Menon VP: Restoration of antioxidant defence by ethanolic Tinospora cordifolia root extract in alloxan-induced diabetic liver and kidney. Phytother Res 2004; 18: 785–787.
55. Wesley JJ, Christina AJ and Chidambaranathan N: Effect of alcoholic extract of Tinospora Cordifolia on acute and subacute Inflammation. Pharmacology 2008; 3: 683–687.
56. Ayurvedic Pharmacopeia of India API, Part 1, Volume 2, Government of India, ministry of Health and Family welfare Department of Health 2001; 155-157.
57. Nahata A, Patil UK and Dixit VK: Effect of Convulvulus pluricaulis on learning behavior and memory enhancement activity in rodents. Nat Prod Res 2008; 22: 1472 1482.
58. Amin H, Vyas HA, Vyas MK and Harisha CR: A comparative pharmacognostical and phytochemical study of Shankhapushpi (Convolvulus pluricaulis) tablet with bhavana and without bhavana. Inter J Res Ayu Pharm 2011; 2: 1457 1460.
59. Amin H, Vyas HA and Vyas MK: Philosophical and applied Ayurvedic aspects of Mana w.s.r. to Smriti. MD dissertation. IPGT and RA Jamnagar 2012.
60. Nahata A, Patil UK and Dixit VK: Anxiolytic activity of Evolvulus alsinoides and Convulvulus pluricaulis in rodents. Pharm Biol 2009; 47:444 451.
61. Dhingra D and Valecha R: Evaluation of the antidepressant like activity of Convolvulus pluricaulis in the mouse forced swim and tail suspension tests. Med Sci Monit 2007; 13: 155 161.
62. Dhingra D and Valecha R: Screening for antidepressant like activity of Convolvulus pluricaulisChoisy in mice. Pharmacol Online 2007; 1: 262 278.
63. Sharma K, Arora V, Rana AC and Bhatnagar M: Anxiolytic effect of convolvulus pluricaulis petals on elevated plus maze model of anxiety in mice. J Herb Med Toxicol 2009; 3: 41 46.
64. The Ayurvedic Pharmacopoeia of India, Part- I Volume – II, Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 25-27.
65. Dev RDO: Comparison on cognitive effects of Centella asiatica in healthy middle age female and male volunteers. 2009; 55: 709.
66. Wattanathorn J, Mator L and Muchimapura S: Positive modulation of cognition and mood in the healthy elderly volunteer following the administration of Centella asiatica 2008; 116(2): 325–332.
67. Chatterjee M, Verma P and Palit G: Comparative evaluation of Bacopa monniera and Panax quniquefolium in experimental anxiety and depressive models in mice. Indian J Exp Biol 2010; 48(3): 306-313.
68. Mannan M: Anxiolytic Effects of the Methanolic Extract of Bacopa monniera in Mice. Pharmacology & Pharmacy 2019; 10: 298-308. doi: 10.4236/pp.2019.106024.
69. Pase MP, Kean J, Sarris J, Neale C, Scholey AB and Stough C: The cognitive-enhancing effects of Bacopa monnieri: a systematic review of randomized, controlled human clinical trials. J Altern Complement Med 2012; 18(7): 647-652.
70. The Ayurvedic Pharmacopoeia of India, Part- I Volume – II, Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 177-179.
71. Jayaraman R, Anitha T and Joshi VD: Analgesic and anticonvulsant effects of Acorus calamus roots in mice. Int. J. Pharm Tech Res 2010; 2: 552–555.
72. Pushpa VH, Padmaja SK, Suresha RN, Vaibhavi PS, Kalabharathi HL, Satish AM and Naidu S: Antidepressant Activity of Methanolic Extract of Acorus calamus Leaves in Albino Mice. Int J Pharm Tech 2013; 5: 5458–5465.
73. Naderi GA, Khalili M, Karimi M and Soltani M: The effect of oral and intraperitoneal administration of Acorus calamus L. extract on learning and memory in male rats. J Med Plant 2010; 2: 46–56.
74. Bahukhandi A, Rawat S, Bhatt ID and Rawal RS: Influence of solvent types and source of collection on total phenolic content and antioxidant activities of Acorus calamus Natl. Acad Sci Lett 2013; 36: 93–99.
75. The Ayurvedic Pharmacopoeia of India, Part- I Volume – I, Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 105-106.
76. Butola JS and Samant SS: Saussurea species in Indian Himalayan Region: diversity, distribution, and indigenous uses. Int J Plant Kulsoom Zahara et al./Asian Pac J Trop Med Biol 2014; 7(1): 60-69.
77. Kumar N and Kumar A: Durlabhhoti chamatkari caushadhi-Kuth. Sachitra Ayurveda 1989; 1: 25-29.
78. Kang JS, Yoon YD, Lee KH, Park SK and Kim HM: Costunolide inhibits interleukin-1beta expression by down-regulation of AP-1 and MAPK activity in LPS-stimulated RAW 264.7 cells. Biochem Biophys Res Commun 2004; 313: 171-177.
79. Hsu YL, Wu LY and Kuo PL: Dehydrocostus lactone, a medicinal plant derived sesquiterpene lactone induces apoptosis coupled to endoplasmic reticulum stress in liver cancer cells. J Pharmacol Exp Ther 2009; 329: 809-819.
80. The Ayurvedic Pharmacopoeia of India, Part- I Volume – I, Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 19-20.
81. Dnyanraj Choudhary, Sauvik Bhattacharyya and Sekhar Bose: Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J Diet Suppl 2017; 14(6): 599-612.
82. Chengappa KNR, Bowie CR, Schlicht PJ, Fleet D, Brar JS and Jindal R: Randomized placebo-controlled adjunctive study of an extract of Withania somnifera for cognitive dysfunction in bipolar disorder 2013; 74(11): 1076-1083.
83. Kuboyama T, Tohda C and Komatsu K: Effects of Ashwagandha (roots of Withaniasomnifera) on neurodegenerative diseases. Biol Pharm Bull 2014; 37(6): 892-7.
84. The Ayurvedic Pharmacopoeia of India, Part- I Volume – II, Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 65-66.
85. Younus M: Ethno botanical study and traditional uses of Celastrus paniculatus. International Journal of Innovative Science, Engineering & Technology 2015; 2: 139-143.
86. Valecha R and Dhingra D: Behavioral and Biochemical Evidences for Antidepressant-Like Activity of CelastrusPaniculatus Seed Oil in Mice. Basic and Clinical Neuroscience 2016; 7: 49-56.
87. Kumar MH and Gupta YK: Antioxidant property of Celastruspaniculatus Wild.: a possible mechanism in enhancing cognition. Phytomedicine 2002; 9(4): 302- 311.
88. George L, Kumar BP, Rao SN, Arockiasamy I and Mohan K: Cognitive enhancement and neuroprotective effect of Celastrus paniculatus seed oil (Jyotishmati oil) on male wistar rats; Journal of Pharmaceutical Science and Technology 2010; 2(2): 130-138.
89. Praful M and Sushil K: Neuroprotective effect of Celastrus paniculatus seed oil against glutamate- induced toxicity. Planta Med 2004; 21 (2): 44-47.
90. Jadhav RB and Patwardhan B: Anti-anxiety activity of Celastrus paniculatus Indian J Nat Prod 2003; 19 (3): 16-19.
91. Rajkumar R, Prem Kumar E, Sudha S and Suresh B: Evaluation of anxiolytic potential of Celastrus oil in rat models of behavior. Fitoterapia 2007; 78: 120-124.
92. The Ayurvedic Pharmacopoeia of India. Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 1(4): 62-63.
93. Chandre R, Upadhyay BN and Murthy KN: Clinical evaluation of Kushmanda Ghrita in the management of depressive illness. AYU. 2011 [cited 2021 Oct 31]; 32: 230-233.
94. Mandana B, Russly AR, Farah ST, Noranizan MA, Zaidul IS and Ali G: Antioxidant activity of winter melon (Benincasa Hispida) seeds using conventional soxhlet extraction technique. Int Food Res J 2012; 19(1): 229-234.
95. The Ayurvedic Pharmacopoeia of India. Government of India Ministry of Health and Family Welfare Department of Ayush 2001; 1(1): 67-68.
96. Joshi H and Parle M: Nardostachysjatamansi improves learning and memory in mice. Journal of Medicinal Food 2006; 9(1): 113-118.
97. Ran Li, Zhi-Mei Wang, Yan Wang, Xueqi Dong, Li-Hua Zhang, Tao Wang, Yan Zhu, Xiu-Mei Gao, Hong-Hua Wu and Yan-Tong Xu: Antidepressant activities and regulative effects on serotonin transporter of Nardostachysjatamansi DC. J Ethnopharmaco 2021; 268: 113601.
98. Lyle N, Bhattacharyya D, Sur TK, Munshi S, Paul S, Chatterjee1 S and Gomes A: Stress modulating antioxidant effect of Nardostachysjatamansi. Indian Journal of Biochemistry & Biophysics 2009; 46: 93-98.
99. Khan MB, NasrulHoda Md, Tauheed Ishrat, Saif Ahmad, MohdMoshahid Khan, Ajmal Ahmad, Seema Yusuf and Fakhrul Islam: Neuroprotective efficacy of Nardostachysjatamansi and crocetin in conjunction with selenium in cognitive impairment. Neurol Sci 2012; 33(5): 1011-20.
100. Tiwari R, Tripathi JS, Gupta S, Reddy KRC. Pharmaceutical and Clinical Studies on Compound Ayurvedic Formulation, Saraswata Churna. IRJP 2011; 2(6): 77-84.
101. Rajopadhye BD and Sahasrabudhe RA: Memory Enhancing Activity of Saraswatarishta in Mice. Biomed Pharmacol J 2020; 13(4): 2033-2039.
102. Shihabuddeen EM, Jithesh M and Gayal RR: A randomized controlled trial on the efficacy of Panchagavya in the management of obsessive-compulsive disorder. Int J Res Ayurveda Pharm 2014; 5(2): 140-144.
103. Sinimol TP: Probable Mode of Action of Kalyanaka Ghrita in Unmada (Insanity) Based on Analysis of Rasa Panchaka of Ingredients- A Review. International Journal of Ayurveda and Pharma Research 2019; 7(2): 19-30.
104. Patil V, Samant C and Baragi U: Suvarnaprashana therapy in children; concepts, practice and prospects. J of Ayurveda and Hol Med JAHM 2014; 2(7): 1-3.
105. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: (editors), Vaidyamanorama Hindi Commentary, Chikitsasthana9/25-26, Varanasi: Choukhambha Sanskrit Sansthana 2012; 316.
106. Joseph CR, Cherian A and Joseph CT: Role of Abhyanga (oil massage) to lead a healthy life. Ayurpharm Int J Ayur Alli Sci 2012; 1: 163-167.
107. Chandrashekar D: Dealing with Stress with the holistic approach of Ayurveda, Keva Ayurveda 2016.
108. Lekshmi MK: Ayurvedic Interventions in Autism Spectrum Disorders- A case Series. International Journal of Ayurveda and PHarma Research 2016; 4(12): 64-67.
109. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: (editors), Vaidyamanorama Hindi Commentary, Sutrasthana 27/286, Varanasi: Choukhambha Sanskrit Sansthana 2009; 559.
110. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Chikitsasthana 9/79-86, Varanasi: Choukhambha Sanskrit Sansthana Editors 2012; 324-325.
111. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana1/58, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2012; 35.
112. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana7/26, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2012; 160.
113. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana11/46, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2012; 235.
114. Eikeseth S: Outcome of comprehensive psycho-educational interventions for young children with autism. Res Dev Disabil 2009; 30: 158–78.
115. Sushruta, Sushruta Samhita and Shastry Ambikadut: (editors), Ayurvedtatvas and ipikahindi Commentary, Uttartantra 62/22, Varanasi: Choukhambha Sanskrit Sansthana 2012; 587.
116. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana 18/51, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2012; 385.
117. Agnivesha, Samhita C, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana 12/8, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2012; 250.
118. Agnivesha, Samhita C, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana 11/20, Varanasi: Choukhambha Sanskrit Sansthana. Edis 2012; 217.
119. Vagbhatt, Ashtanga hridayam and Tripathi B: Nirmala Hindi Commentary, Sutrasthana 12/5, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2009; 120.
120. Agnivesha, Charaka Samhita, Shastri K and Chaturvedi G: Vaidyamanorama Hindi Commentary, Sutrasthana 12/8, Varanasi: Choukhambha Sanskrit Sansthana. Editors 2012; 250.
121. Critchfield JW, Hemert SV, Ash M, Mulder L and Ashwood P: Gastroenterology Research and Practice 2011; Article ID 161358: 1-8.
     

     ---

     How to cite this article:

     Sinha N and Ojha NK: Effect of ayurvedic therapy in the management of autism in children: a review. Int J Pharm Sci & Res 2022; 13(8): 3007-17. doi: 10.13040/IJPSR.0975-8232.13(8).3007-17.

     ---

All © 2022 are reserved by International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.