Issue : 01 DOI : 10.5281/zenodo.8147277
INTERNATIONAL
JOURNAL
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AND
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Volume : 01
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Abstract
Today’s era of globalization has introduced Ayurveda on a global platform like never before. Ayurveda is
the ancient life science which aims at leading a healthy life but diseases form an inseparable part of life.
All these altered conditions are diagnosed most of the times on basis of clinical features as per Ayurveda
samhitas. With development of technology the contemporary science uses various biomolecules, imaging
techniques in addition to clinical features to diagnose a condition, understand its pathophysiology,
monitor the intervention or treatment outcome, these are called as biomarkers. It is necessary for
ayurveda scholars to get acquainted with this new glossary to face challenges of globalization. In this
review article the literature study of modern concept of biomarkers has been made and an attempt is made
to envision biomarkers examples mentioned in ayurveda literature. Owing to the vastness of Ayurveda
literature its relevance with modern classification of biomarkers is explained with only a few examples.
The article aims at giving ayurveda scholars scientific vision while studying ayurveda without losing the
core of ayurveda fundamental principles and willingness to incorporate contemporary biomolecular and
imaging techniques advances.
Keywords: Biomarker, Upamaan Praman, Pratyaksha pramaan, Anumaan pramaan,
Corresponding author: Dr. . Pallavi U. Chougule
Article Info: Published on : 15/07/2024
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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Critical Analysis of Concept of Biomarkers from Ayurveda Perspective
Dr.Pallavi U. Chougule
1
, Dr.Uday V. Chougule
2
1
Associate Professor and HOD, Dept. of Rognidan and Vikruti Vigyan, Aarihant Ayurvedic Medical
College & Research Institute, Gandhinagar, Gujarat- 382420, India
2
Associate Professor, Dept. of Ras Shastra and Bhaisajya Kalpana, Aarihant Ayurvedic Medical College &
Research Institute, Gandhinagar, Gujarat- 382420, India
Cite this article as: - Dr. Pallavi U. Chougule (2024) ; Critical Analysis of Concept of Biomarkers from Ayurveda Perspective
; Inter.J.Dignostics and Research 1(4) 20-26 , DOI: 10.5281/zenodo.12744091
G
A
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Introduction:
Diseases have been a part of life since time
immemorial and continuous efforts are being
made to understand the disease process in better
way aiming at better intervention and
theraupeutic results.Ayurveda the most ancient
science of life has explained the concepts of
disease and treatment in short as Trisutraviz.,
Hetu, Linga, Aushada skanda further elaborating
it into Nidan Panchak viz., Nidan, Purvarupa,
Rupa, Upashay and Samprapti
[1]
.
While the modern medical sciences describes the
diseases under four headings
[2]
:
1. The causative aetiological factors,
2. The developmental mechanism of
pathogenesis,
3. Structural morphological changes in the
cells and organs and
4. Functional changes.
Biomarkers are such entities that help to
understand the biological state of body, which
can be measured and help in diagnosing a
disease, monitoring its progress and assessing the
effectiveness of intervention and /or treatment.
Aim :
Understand the concept of biomarkers and
analyze its relevance from Ayurveda perspective.
Material And Method:
Classical texts and modern literature is reviewed
and critically analyzed to put forth logical
interpretation in context to biomarkers.
Review Of Literature :
The term “Biomarker” includes a wide range
subcategory of clinical signs and symptoms or
distinguished bio-molecule having an important
role in different biological and pathological
processes. These are objective indications of
medical state as observed from outside the patient
and tell about a specific pharmacological
response to a drug, giving appropriate
information about body’s actual condition that
can be reproduced and measured accurately
[3,4]
.
Thus biomarkers play an important role for
personalized medicine, disease diagnosis, and
prognosis.
Ideal biomarker: (‘Biological Marker’) :
An ideal biomarker must possess certain qualities
mentioned in figure.1
[5, 6]
.
Figure1: Ideal biomarker: Characteristics.
Classification of Biomarkers:
The biomarkers can be classified on various
parameters: figure 2.
Figure 2: Biomarker Types Based on Various
Parameters
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A. Biomarker Types Based on Genetic and
Molecular Biology Method:
a. Type 0 - Natural history markers: Represent
clinical indices. Examples -
i. Raised ESR value in Aamvata
[7]
.
ii. Bio-markers of Vardhakya (ageing) like
those which determine the biological age
i.e. skin elasticity and visual
accommodation, those which predict the
remaining life expectancy i.e. DHEA-S and
hand-grip power, those which determine
disease susceptibility, i.e. systolic BP and
glucose tolerance test. All these bio-
markers can be classified as laboratory tests
(eg. blood and urine tests) or as physical
tests carried out in a clinic
[8]
.
b. Type 1 - Drug activity markers: Used to
explain the effect of a therapeutic role. E.g.-
Use of Terminal Deoxynucleotidyl
transferase – mediated dUTP nick end
labeling assay (TUNNEL), aldehyde
dehydrogenase 1 (ALDH1) to analyze
breast cancer chemoprevention effect of
Ashwagandha (Withania Somnifera)
[9]
.
c. Type 2 - Surrogate markers: Used as
substitute for a clinical end point.
E.g.- Traditional Ayurvedic doctors used
ants for the identification of “sweet urine”
in patients
[10]
.
B. Based on characteristics: Figure 3
A. C. Based on disease related application –
B. Table 1.
Many of the biomarkers can fall in more than one
category based on its application made.
Table 1. Biomarkers classification based on
disease related application.
Sr.
No
Biomarker
Type
Examples
1)
Diagnostic
biomarker:
Diagnostic biomarker to
identify patients with
chronic kidney disease -
Glomerular filtration rate
(GFR) may be used
[11]
.
Pratyatmalakshanas of
diseases e.g Haridra
Netra Mutra Twak in
Kamala, Gudena
Atidravasaranam in
Atiasaara
[12]
.
2)
Monitoring
biomarker:
For assessing whether or
not the desired effect of
anticoagulation has been
attained in patients on
warfarin, monitoring
biomarkers used -
International normalized
ratio (INR) or
prothrombin time (PT)
[13]
.
Assessment of ESR
value in Aamavat
treatment
[7]
.
3)
Response
biomarker:
a.Pharmaco-
dynamic
biomarker
b.Surrogate
endpoint
biomarker
For evaluation of
warfarin treatment for
prevention of thrombosis
in a patient
pharmacodynamic
biomarker used - INR
may be used as a
[14]
.
Low-density lipoprotein
(LDL) cholesterol
reduction is a considered
surrogate endpoint for
decrease in
cardiovascular events and
has been used as the basis
for ayurvedic herbal anti-
hypercholestrolaemia
preparations
[15]
.
Figure 3:Biomarker Types Based on
Characteristics
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Sr.
No
Biomarker
Type
Examples
4)
Predictive
biomarker:
In evaluation of women
with platinum-sensitive
ovarian cancer predictive
biomarkers used -BReast
CAncer genes 1 and 2
(BRCA1/2) mutations
[4]
.
Kapha prakriti person
have increased
susceptibility to
respiratory disorders and
obesity
[16]
.
5)
Prognostic
biomarker:
In evaluation of women
with breast cancer, to
assess the recurrence of
breast cancer prognostic
biomarkers used- BReast
CAncer genes 1 and 2
(BRCA1/2) mutations
[17]
.
Taila Bindu Pareeksha
also helps in establishing
prognosis
[18]
.
Various arishta
lakshanas mentioned in
Charak Samhita Indriya
sthan
[19]
.
6)
Safety
biomarker:
In evaluation of patients
on drugs that affect
kidney function safety
biomarker used to
monitor for
nephrotoxicity- Serum
creatinine
[20]
.
Changes in myocardial
cytoarcitecture to
evaluate copper bhasma
toxicity
[21]
7)
Susceptibility/
risk
biomarker:
To scrutinize individuals
with a risk to develop
breast cancer
susceptibility/risk
biomarker used - BReast
CAncer genes 1 and 2
(BRCA1/2) mutations
[22]
.
Kaphaprakriti person
have increased
susceptibility to
respiratory disorders and
obesity
[16]
.
D.Based on biomolecule
[24]
-
DNA- based biomarker
RNA- based biomarker
Protien based biomarker
Lipid based biomarker
Sugar based biomarker
Discussion :
Ayurveda is a holistic science which has basic
principles like equilibrium in the components of
body like Dosha, Dhatu, Mala, Agni affect the
functioning of varioussrotasas(different systems)
and maintain health of an individual. Their
normal status or any deflection in the normal
status is manifestated in form of lakshanas
(clinical signs and symptoms). Trividhapariksha
(Darshan, Sparshana, Prashna), Shadvidha
Parikasha (panch jnanendriya pariksha and
prashna pariksha) have been explained in
bruhatrayeesto assess the status of a person and
disease.Selection of treatment is based on
samprapti (pathogenesis) occurred in patient and
cause for particular samprapti. Efficacy of
treatment is also evaluated in terms of samprapti
vighatana (reversal of disease condition) which is
evident by alleviation of the clinical features
manifested. These clinical features encompass
both clinical endpoints and biomarkers. Though
the term biomarker may be new, the concept isn’t
de nova to ayurveda - biomarkers mentioned are
in form of lakshanas and used as objective
criterias. Upamaan, Pratyaksha, Anumaan
pramaan are used for biomarkers explanation.It
has been observed that the ancient acharyas have
tried to explain the complex concepts of
pathophysiology and clinical features using
upamana pramana (similes used). We find
innumerable examples of similes given in
bruhatryees and laghutrayees to explain various
signs and symptoms too.
The bases of biomarkers in Ayurveda arepanch
arthas- Shabda, Sparsha, Rupa, Gandha, Rasa.
1) Shabda – (Sound as parameter)
Changes in voice of a patient like
Kapotiva kujanam (stridor) in apatantraka
patient. – can be used as diagnostic
marker.
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Abnormal sounds heard by physician in
patient – crepitus in joints of Sandhigata
vata patient– can be used as diagnostic
marker, monitoring marker, response
marker.
2) Sparsha –(Palpable parameters)
Kathina sparsha in case of Vataj Vrana -
can be used as diagnostic marker,
monitoring marker, response marker.
Vatapurna druti sparsha in Vatodar - can
be used as diagnostic marker, monitoring
marker, response marker.
3) Rupa –(Visible parameters)
Varna (colour) – yellowish discolouration
of nails, eyes in liver disorders - can be
used as diagnostic marker, monitoring
marker, response marker.
Sansthan (clinical features) -
Inflammation at joints in arthritic
conditions can be used as diagnostic
marker, monitoring marker, response
marker.
Rajijanma (caput medusae) in ascitis - can
be used as diagnostic marker, monitoring
marker, response marker.
Praman – liver and spleen enlargement in
yakrutodar (hepatomegaly) and pleehodar
(spleenomegaly) respectively etc. can be
used as monitoring marker, response
marker.
4) Rasa –(Taste as parameter) Use of various
animals is mentioned to interpret indirectly
the changes in body fluids of patient.
Use of ants to analyze urine sugar content
can be used as diagnostic marker,
predictive marker, and response marker.
Use of dogs and crow to differentiate
between shuddha rakta and Raktapitta can
be used as diagnostic marker, predictive
marker, prognostic marker.
5) Gandha –(Smell as parameter)
Various examples are given in Charak
Samhita, Indriya Sthan 2
nd
chapter
Related to smell emitted by patient used
for prognostic markers.
Ayurveda literature is full of clinical knowledge
and combined with integrated modern biomarker
vision will help enhance the scientificity of
research and practice. The proper interpretation
of these parameters in accordance with the basic
principles of Ayurveda can enrich understanding
and application of Ayurveda concepts.
The biomarkers can be used for:
Diagnosing stage of disease
Prognosis of a disease
Selection of treatment modality
Assess treatment efficacy
Assess ADRs, Toxicity
In clinical settings the disease often has
multifactorial etiology which can in turn have
innumerable various pathways to exhibit a
disease. Treatment outcomes also have variability
in respect to doctor- patient relationship, food
habits, lifestyle variations from person to person,
climate changes, demography, epigenetics posing
challenges to select a biomarker. Judicious
selection and assessment of appropriate
biomarkers will benefit overall patient care.
Conclusion :
The term biomarker includes objective
parameters in clinical setting along with
laboratory and imaging investigations.
Understanding the relationship between
measurable biological processes and clinical
outcomes is vital.
Limited information about the types of
processes involved in normal physiology of a
biological process or pathogenesis of diseases
makes constant reevaluation of biomarkers as
surrogate endpoints essential.
Use of biomarkers in Clinical practice &
Studies (at least for retrospective analysis of
biomarker correlation success) should always
have clinical outcomes as ultimate measures,
to maximize benefits to patients and reduce
harm.
Use of Clinical findings as Biomarkers and/ or
Laboratory and Imaging Biomarkers should be
made judiciously for person’s/ patient’s
benefit
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