Triphala: an age-old ayurvedic medicine
Dr R. Vatsyayan
No other herb, or group of herbs, finds such repeated mention in the Ayurvedic system of medicine as triphala. It has become a household name in our country. As the name suggests, triphala is a combination of three important herbal fruits — amla (emblica officinalis), harad (terminalia chebula), and baheda (terminalia bellirica).

AIDS vaccine is ready in Nairobi but...
John Kamau
AIDS drugs may become cheaper in developing countries, thanks to an about-face by pharmaceutical giants who tried blocking cheap drugs in South Africa. But a vaccine remains the holy grail in the fight against AIDS. And the most promising research for a vaccine continues to be plagued by controversy and bitterness.

Eat wisely to prevent cancer
Cancer is one of the most dreaded diseases and a lot of research is being carried out for its prevention and treatment. One’s eating habits can significantly reduce the risk of developing cancer.

The Heart Congress

Q&A
Food-borne illnesses
Dr J.D. Wig answers’ readers questions
We all are vulnerable to a number of food-borne illnesses. It is important to understand the risks of the outbreaks of food-borne diseases. We cannot wipe out such illnesses entirely but we can reduce them by using adequate control procedures.

The inner world of paranoid patients
Dr Rajeev Gupta

Baseless suspiciousness moving to the level of deep and firm conviction is the hallmark of the situation of paranoid patients. These patients keep harbouring and exhibiting strong beliefs against known and unknown people. They feel so strongly about their "beliefs" that they are not willing to budge even slightly from these or hear anything against these.

They have unshakable trust in the reality of their thoughts. Consequently, their life is completely governed by such beliefs. They develop many changes in their thought process, emotions and behaviour.

What constitutes paranoid symptoms?

Psychiatrists diagnose a patient paranoid (suffering from a psychotic disorder) when they find that they have lost contact with reality and live in their own world which is dominated by firmly held but completely false and baseless beliefs. Their beliefs may vary from the functioning of parts of their own body, the behaviour of other people or the control of natural and supernatural forces.

A few patients may have bizarre delusions and may feel that their heads have turned into stone or gold; the entire world is going to come to an end in a couple of months; they have been bestowed with special powers to change the world and God has specially selected them for such jobs.

Common psychiatric problems having paranoid symptoms: There is a wide range of psychiatric disorders which share paranoid symptoms: * schizophrenia, * depression, * reactive psychosis, * alcoholic paranoia, * drug-induced paranoid states and *secondaries to physical illnesses.

It is a major psychotic disorder and at any time about one per cent of the population can be found suffering from the disease. It is characterised by thinking, perceptual, emotional and behavioural disturbances. Schizophrenic patients show many behavioural abnormalities. Psychoanalystics consider them as suffering from the split personality syndrome.

Paranoid schizophrenia is a subtype which is dominated by paranoid symptomatology. These patients commonly believe that other people talk about them and criticise them. At times they may feel that others laugh or mock at them and hurt their feelings. Some patients may start believing that special TV programmes and newspaper items are produced about their lives only. They start giving special meaning to events happening around them. The feeling of persecution, during these patients strongly believe that others are after their lives and are planning to kill them, is commonly experienced by them. A schizophrenic patient may express serious concern about the character of his or her spouse and may keep on making allegations. Many patients may not accept food brought by their family members.

It is a common problem in clinical practice. Patients of endogenous depression may have paranoid symptoms. Depressed patients feel that since they are "bad", other are planning to harm or kill them. Such symptoms are common among old depressed patients.

C. Reactive psychosis:

It is a psychotic illness, which is precipitated by major psychosocial stress. Patients may become suspicious and harbour paranoid delusions.

Some may develop severe paranoid symptoms following acute stress like a loss in business, death of a family member or an accident. They may also become overexcited and require immediate psychiatric help. Reactive psychosis has a good prognosis and patients of this respond very well to treatment.

Chronic alcoholics often become suspicious or violent. They may also start having hallucinatory experiences. Many alcoholics express serious doubts about the character of their wives. Psychologists blame impotence, a common problem of alcoholics, for the underlying basis of the ideas of infedility. Chronic alcoholics also have many other paranoid delusions.

Chronic drug-addicts, too, experience paranoid symptoms. They generally use amphetamines, cocaine, cannabis (bhang and charas). Smack, heroin and codeine, containing enough syrups, are known to produce the typical symptoms.

They tend to become suspicious and distrust others. Under the effect of suspiciousness, they also tend to become violent and aggressive. They do not spare even their children.

Drugs like L-dopa, used against parkinsonism, can also induce such symptoms.

Many patients of cancer, hypothyroidism, head injury and limb-loss following major surgery may suffer from paranoid symptoms which need active psychiatric intervention along with adequate medical care.

Note: Patients with paranoid symptoms need urgent psychiatric help. Untreated or unattended patients are potentially harmful. Many of them do not accept medicines and may need urgent hospitalisation for a few days or even a few weeks. They are given antipsychotic drugs. Those suffering from a long lasting disease may need depot injections. Medicines have to be given only under the care of experts. Self-medication has to be discouraged.

It is important to remember that some patients may need prolonged treatment which may extend from a few months to a few years. My experience shows that drug treatment is highly effective and puts most of the patients back on the track.

The author is a Ludhiana-based psychiatrist. He heads "Manas", a psychiatric and deaddiction centre. (Ph 472822 and 472899).

Triphala: an age-old ayurvedic medicine
Dr R. Vatsyayan

No other herb, or group of herbs, finds such repeated mention in the Ayurvedic system of medicine as triphala. It has become a household name in our country. As the name suggests, triphala is a combination of three important herbal fruits — amla (emblica officinalis), harad (terminalia chebula), and baheda (terminalia bellirica). The popularly known Triphala Churna is the powder of dried fruits of these herbs without their seed part. Usually, these herbs are mixed in equal quantity but references are found when their ratio has been modified as harad one part, beheda two parts and amla three parts.

The first of these fruits, amla, is the richest source of Vitamin C. According to an old Indian saying, what gold is to the minerals, amla is to the herbs. It also contains tannic acid, resinous matter, glucose, protein, cellulose and calcium. Amla is useful as stomachic, antipyretic, hair tonic, alterative and nerve-brain tonic. Anaemia, hyperacidity, urine anomalies, haemorrhages, epistaxis and gynaecological disorders are among the indications where amla is prescribed as medicine and also as a preventive, restorative and curative.

The next among this traid, baheda or vibhitaka, is a pungent, acrid and bitter fruit. It is rich in Vitamin A and has astringent, digestive, laxative, anti-allergic, anthelminitic(killer of intestinal worms) and expectorant properties. Baheda, in fruit form, is used in a number of ailments like cough, bronchitis, billiousness, inflammatory conditions of the small intestines, problems of the eye, dropsy and in the enlargement of liver and spleen.

Finally, harad or haritaki which is also known as pathya in Sanskrit is also a very prestigious herb of Ayurveda. It is a carminative, a killer of intestinal worms, a laxative, and is not only a general tonic but also a protector of the lungs. Harad contains tannin up to 30 per cent, chebulinic acid and a sufficient amount of Vitamin B complex. The use of harad is beneficial in a number of diseases like asthma, constipation, piles and sinus allergies.

When these three fruits are mixed together, an excellent combination is achieved which can cure all the three vitiated doshas like, vata, pitta and kapha. Triphala is used as a medicine as well as a rejuvenating agent. Its use removes toxins and various other undesirable accumulations from the body. Triphala is known to nourish the tissues by increasing digestion and assimilation and, while regulating the metabolism, it strengthens all physiological systems. It also acts as a very good antioxidant.

Triphala helps one to recover from anaemia, indigestion, bowel toxicity and constipation. Its use is also beneficial in chronic lung disease, skin disorders, eye problems, hypertension and conditions where cholesterol is raised. Ayurvedic texts are replete with references where distinction is made according to disease and the use of triphala is prescribed with different anupaan or modes. However, if it is to be taken in the morning, one should mix it in honey. During daytime it should be taken with warm water and at bedtime with warm milk. Its average daily dose varies from two to five gms.

Dr R. Vatsyayan is based at the Sanjivani Ayurvedic Centre near the Rose Garden Main Gate, Ludhiana. Phones - 0161-423500, 431500; 
Email- sanjivni@satyam.net.in.

AIDS vaccine is ready in Nairobi but...
John Kamau

AIDS drugs may become cheaper in developing countries, thanks to an about-face by pharmaceutical giants who tried blocking cheap drugs in South Africa. But a vaccine remains the holy grail in the fight against AIDS. And the most promising research for a vaccine continues to be plagued by controversy and bitterness.

NAIROBI: As the world battles the pharmaceutical giants to cut the costs of AIDS drugs for poorer countries, the most promising research on a possible AIDS vaccine continues to be conducted amid acrimony over the issue of patenting.

"Ironically it is the most promising search for an HIV/AIDS cure," says Dr Alfred Nderitu of University of Nairobi in Kenya.

Months after it emerged that British scientists Dr Thomas Hanke and Prof Andrew McMichael applied to the British Patent Office as inventors of the vaccine and excluded the University of Nairobi team — Prof Jeckoniah Ndinya Achola, Dr Omu Anzala and the Microbiology Department's head Dr Job Bwayo — who collaborated with them, bitter Kenyan scientists agree on one thing: not to talk about the issue again. (Details next week)

Eat wisely to prevent cancer

Cancer is one of the most dreaded diseases and a lot of research is being carried out for its prevention and treatment. One’s eating habits can significantly reduce the risk of developing cancer. A number of scientific studies have shown that fruits and vegetables which we consume contain natural products that possess anticarcinogenic activities. The intake of fruits and vegetables is associated with the decreased incidence of cancer and mortality rate. The cancer chemopreventers present in our diet either belong to macronutrients or micro non-nutrient forms. Dr Rajiv Goel, Assistant Professor in the Department of Physiology at Dr Rajendra Prasad Government Medical College and Hospital, Kangra, at Tanda (H.P.) will explain these facts on next Wednesday.

The Heart Congress

The Heart Congress , which has chosen "Frontiers in Cardio-vascular Health" as its topic this year, has invited Dr Rajinder K. Suri, former Professor and Head of the Department of Cardiovascular and Thoracic surgery at the PGI, Chandigarh, to chair one of the major sessions on "Mechanical circulatory devices in the treatment of heart failure" at Winnipeg in Canada on July 1. There will be 500 speakers, 670 symposia and more than 3000 participants in the congress. Dr (Mrs) Sudha Suri has also been invited.

1. Happiness does not correlate with

(a) wealth

(b) privileges

(c) good health

(d) good looks

2. Happiness correlates positively with

(a) a loving spouse

(b) caring friends

(c) a low dose of religion and

(d) interesting, challenging work

3. There are very many ways of becoming instantly unhappy.

There are far fewer ways of becoming instantly happy.

The currently available drugs for instant happiness have unacceptably severe side-effects.

4. A deliberate pursuit of happiness is a good recipe for an unhappy life.

It seems that the best strategy (if you are very keen on happiness) is to let it slip in quietly as a byproduct of a life spent in chasing attractions other than happiness.

This write-up is based on evidence collected by Prof Steven Pinker.)

Dr Sharda Ranjan, FRCP, FIAMS, is an Ambala-based clinician and a former honorary Professor of Medicine (IMA College of General Practitioners).

Q&A
Food-borne illnesses
Dr J.D. Wig answers’ readers questions

We all are vulnerable to a number of food-borne illnesses. It is important to understand the risks of the outbreaks of food-borne diseases. We cannot wipe out such illnesses entirely but we can reduce them by using adequate control procedures.

Q. How are they caused?

A. Food-borne diseases may be the result of ingesting toxins produced by microbes that have grown on food (which is not handled or stored properly) prior to its consumption. Food-serving that carries an infectious pathogen into the body where it is able to gain a foothold can also be the culprit. The pathogen grows and produces various food-borne diseases.

Food may be contaminated during handling and preparation, often by infected food-handlers or by coming into contact with polluted water. There is a potential for fruits, vegetables and salad items being contaminated with water and sewage sludge during irrigation. Outbreaks arising from food contamination by infected food-handlers are common occurrences. Cold eatables such as salads and sandwiches which require much handling during preparation are implicated most frequently. Without meticulous attention to personal hygiene and thorough and frequent hand washing, faecally contaminated fingers can contaminate food and work surfaces.

Q. What are the symptoms?

A. Food-borne illnesses often show up with nausea, vomiting, diarrhoea or fever. Symptoms may begin as soon as one or two hours after eating. It is not uncommon for the symptoms to occur 24 hours or longer after eating. The symptoms may be severe such as high fever, bloody diarrhoea, excessive nausea and vomiting. Some have a severe illness that may require hospitalisation — especially infants, the elderly or the immunocompromised.

Q. What are the factors which make you vulnerable?

A. Eating raw, undercooked or unpasteurised foods (meat, dairy products, sauces) make you vulnerable. Even safely cooked foods can become cross-contaminated with bacteria transferred from one food to another during handling. Salmonella is one of the most prevalent types of food-borne illnesses. One of the common sources of infection happens to be in the kitchen — both commercial and domestic. Unless the highest standards of sanitation are applied by knowledgeable individuals during the preparation of food for human consumption, faecal material can contaminate the food. Such contamination can easily be spread to other foods via kitchen utensils, cutting boards, by contaminated hands or contact with contaminated work surfaces. These are hardy organisms which are able to survive for days or months in water or moist surfaces. Therefore, cursory measures will not protect you from dangerous organisms. A fatal type of food-poisoning may result from consuming products that have been subjected to improper home-canning methods. Bacteria that survive the canning process may grow and produce toxins. The symptoms include blurred vision, muscle weakness and headache.

Q. How to prevent such occurrences?

A. Prevention is difficult because of the nature of humankind. Elimination requires rigorous application of the basic rules of hygiene and sanitation that everyone learns in school but frequently fails to apply in everyday life. The best way to protect oneself is never to eat foods (meat, eggs, unpasteurised dairy products), raw or undercooked.

Wash your hands before preparing food after playing in the dirt, after coming into contact with animal faeces (dogs, cats) or after pooping. Do not eat dirty or spoiled foods, rotten fruits or vegetables. Do not eat off dirty dishes or utensils. Do not eat uncovered food. Keep your hands away from your nose, eye and mouth while handling or preparing food.

Q. What about kitchen habits?

A. Develop and practise good kitchen habits. Always assume that fresh food is contaminated. Wash all produce thoroughly removing all dirt. running water can remove many bacteria from fresh fruits and vegetables. Rinse for at least 30 seconds. Discard the outer leaves of the greens, and wash each leaf you use. Never leave food out of the refrigerator for more than two hours. Put away leftovers immediately after meals in small portions in the refrigerator. Use refrigerated meat within a day or two. Wash counters, sinks, refrigerator door handles, and the bottom shelf of the refrigerator regularly with a disinfectant.

Thoroughly reheat the leftovers before re-serving to destroy any bacteria.

Do not use or drink unchlorinated or any water not treated to remove bacteria. Use paper towels instead of sponges or cloth towels to clean up spills. Bacteria rapidly multiply in raw meat juice. Do not use the same plate for both raw meat and cooked meat unless you wash the plate carefully after removing the raw meat. Wash your hands well between working with meat and vegetables.

Q. What to do when one develops food poisoning?

A. Take a sample of suspected food. This will help in tracking the illness especially after attending a large congregation or eating a commercially prepared product.

Rush the individual to the hospital when the symptoms are very severe, or the individual is a high-risk person — very young or very old, diabetic, immunocompromised, or a pregnant woman. Watch for and treat early signs of dehydration. Drink plenty of clear liquids (water, weak tea or diluted juice) for 12 to 24 hours. Do not eat solid foods while vomiting persists. Replace the lost electrolytes. You can make your own electrolyte solution using salt and sugar to taste dissolved in water. When you feel better, begin eating clear soups and mild foods (dry toast, cooked rice, cereals, bananas). Avoid spicy foods, alcohol, coffee and dairy products until all symptoms are gone.

Conclusions: The key element in reducing the spread of food-borne diseases is continued surveillance and awareness. Meticulous attention to good food-handling practices and education is essential. Food-handlers need to be frequently checked and they should pay strict attention to good hygienic practice in the kitchen and serving areas. Salad items, fruits and raw vegetables should be washed thoroughly. Public health authorities need to educate the people on how to reduce the risk of food-borne illnesses and take greater responsibility for enforcing rigorous codes of practice for the preparation of safe food not only by permanent food serving establishments but also by street-vended food. Food safety has become a global issue.

Dr Wig is a concerned surgeon. He is based at the PGI, Chandigarh.