By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
One of the famous and frequently asked question to an Ayurveda doctor – ‘When to stop taking these medicines and treatment?’
This is a question which cannot be comprehensively answered by an Ayurvedic physician. This is because the answer is not the same for every patient. Just as the dose and number of days of medication differs from one person to the other, the time of stoppage of medicines too differ.
Read – How Is Time Of Medicine Administration Decided In Ayurveda?
When to stop medicines?
When should the medicines / treatment be stopped?
Modern medicine has specification of the maximum dose and stipulated time of taking the medicines.
Modern medicine has specification of the maximum dose and stipulated time of taking the medicines.
Did Ayurveda miss this out?
No, definitely not. Though it has not been detailed and explained anywhere in the Ayurvedic treatises, the knowledge of stoppage of medicines can be gained through inference. This comes only after having a thorough knowledge of Ayurveda basics.
Read – How Dose Of Ayurvedic Medicine Is Decided? 7 Factors
Why did Ayurveda not specify the stoppage time for medications?Ayurveda is a medical system wherein the medicines and treatment has been personalized rather than generalizing them. General principles too have been mentioned in terms of prescription of medicines, treatments and dietetic recommendations. But the theory of Prakriti i.e. individual constitutions and Vikriti i.e. specific pathological manifestations in specific individuals, mainly dependant on the ‘doshic theory’ will individualize and personalize the medications.
Read – Prakriti – Dosha Body Type Features As Per Master Charaka
The prescription is not universal. A particular line of treatment and particular set of medications are not applicable for everyone and for larger masses of people. The prescription and advices are moreover ‘one to one’ and more personal. Therefore the stoppage of medicines too is ‘one to one’ and not generalized. This may be the prime reason for the Ayurveda masters and authors of treatises not having standardised a ‘stoppage time for medications’.
In the early part of descent and evolution of Ayurveda, when there was transfer of knowledge from celestial to the mortal world, the knowledge of this divine medical science was not documented. The teaching was done from mouth-to-mouth and remained confined within the jurisdiction of teacher and his disciples.
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It was possible that the knowledge of ‘stoppage time for medications’ was also explained during this process and not documented. When there was a transit and evolution when the ‘orally preached Ayurveda’ got a shape of ‘documented Ayurveda’, most important concepts were recorded and brought into the shape of treatises.
The students who documented the teachings either wrote down the scriptures exactly in the way they were taught by their teachers, highlighting the concepts like ‘stoppage time of medication’ as and when narrated or missed out like their teachers thinking that the successive generation would be wise enough to understand this concept as per evolution and situation and get the clues from the unsaid part of Ayurveda, with whatsoever hints they have given about the concept.
Read – Ayurvedic Routes Of Medicine Administration
The Ayurvedic seers knew that with every generation, the physical constitution, the nature of diseases, the nature and quality of medicines, the immunity and tolerance of an individual to various medications would change with evolution. In that case, the physicians of those particular eras need to skillfully alter everything related to the medical practice, including the ‘stoppage time for medication’. Therefore they haven’t generalized it.
Since the treatises of Ayurveda were written for the usage of Ayurveda doctors and students. The information though in most of the contexts is synchronized and organized, it has been scattered through various chapters at many instances. Like, the most important medicine or a formulation for curing a particular disease might be explained in a different context or chapter.
Read – Ayurvedic Medicine: Introduction, Importance, Types and Myths
The intention of the authors was to make the students to read in between the lines rather than reading the texts formally. ‘Stoppage time for medications’ might also be one of the concealed concepts left out for the students and physicians of Ayurveda to understand as per situation and contextually.
Signs to observe
Clues of precise knowledge of ‘stoppage time for medications’ in Ayurveda treatises
We have many clues left out in the treatises of Ayurveda which point out towards the comprehensive knowledge of the then masters of ancient times about the ‘stoppage time for medications’.
Read – Ayurveda Is Best Medical System For You – 10 Strong Reasons
Few examples from Ayurveda treatises –
It is said that Long pepper, Kshara i.e. alkalis and salt should not be used for longer duration. This means that they should be used for small time duration and stopped, may be used after a time gap. This may just be an example. Long pepper probably depicts too spicy and pungent medicines; alkalis and salt depict wide range of medicines which impact alkaline or salt like action in the body, too harmful when used for prolonged durations.
Read – Importance Of Diet (Pathya) For Specific Diseases
I follow this principle from 20+ years of my medical practice. In between small schedules ranging from 3-4 weeks of medication, I give a small break of 5-7 days, ‘window period’ as I call it, to analyze the action of the medication. This I do in long standing chronic cases. The acute cases may not need this logic because they get addressed with small quantity of medication for small duration.
Read – Dosha And Vikriti, The Pathology Of Diseases
The window period has also helped me to access improvements in health of the patient and his or her immunity and tolerance levels to particular medications. This will enable me to re-work on the prescription, add or remove some medicines in the next schedule. This also gives a clue so as to which medicine works for what duration in people of different constitutions and pathological manifestations and also the possible time needed for the results to be seen.
Still we cannot sum-up the findings and declare them as common and generalised statements as far as medications, their doses and stoppage time is concerned. Age of the patient, immunity, metabolic status, efficacy of medicines and accuracy of preparation of the same (same medicines of different pharmacological companies give different type of results and in different time periods, in a same patient too), continuity of medications and seriousness on the part of the patient to use the medicines, stress, geographical and climatic impact, dietetic and lifestyle changes included or not, and many factors meddle into the concept of usage and stoppage of medicines, therefore cannot be generalized.
Read – How To Understand And Master Ayurvedic Medicines Easily
Pratimarsha type of nasal medication and Matra Vasti, a type of herbal enema is advised to be taken throughout the life. They are supportive to health and don’t produce any harm when used for longer durations. Therefore the stoppage time depends on whether the patient needs it or not at a point of time and the reasons for which he is undergoing these treatments.
Read – How To Do Ayurvedic Nasya Treatment At Home? Nasal Drops For Long Life
A famous preparation, ‘Kokilaksham Kashayam’ used in the form of herbal decoction is advised to be taken until the anger of the person comes down. It is known fact that the anger of the person is situational and cannot go away from one’s life forever. The clue for such indication is that it can be used throughout the life. The medicine is generally prescribed for joint and musculoskeletal disorders. It shall be taken until the symptoms are relieved. But it can still be continued even after relief of symptoms and disease. It doesn’t produce any complications. The medicine continued after relief will have supportive role and prevents recurrence of symptoms.
Read – Kokilaksha Kashayam – Benefits Dosage, Side Effects, Ingredients, Reference
Among the medicines which act as immune-modulators, rejuvenators and anti-aging inclusions, ghee and milk, which also happen to be daily food supplements, are advised to be taken for life.
Similarly herbal oil massage, powder massage, collyrium, gargles etc mentioned in the context of Dinacharya i.e. diurnal activities, shall be done on daily basis, throughout the life. There is no stoppage time for these maneuvers and shall be done throughout the life.
Cut off Criteria
Physician’s logic – If a doctor has specially mentioned the number of days or months in relation to a medicine or formulation to be used, in the prescription, the patient needs to follow it. There is definitely a logic, experience and wisdom behind such mention of stoppage time.
I generally put this part in my prescription. This makes the patient to report at the end of ‘stoppage or pause time’ to me so that I could have a follow up of the case, see the essential changes which had occurred during medication and to analyze the effect of medicines and also to implement changes in the prescription as and when needed, or to stop medicines when I feel it is enough.
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This also prevents the patients from using their wisdom to indiscriminately keep using the medication beyond prescribed and advised time duration. Many people still have a myth that Ayurveda medicines can be used for longer duration and they will not produce any side-effects.
Therefore they keep using the medications for lengthy medicines without taking a follow up of their condition with the doctor and without his consent.
Read – Ethics Of A Physician – Vaidya Vritti
Cure of disease and decrease in disease symptoms – The cure of disease and decrease in the symptoms of the disease are clues to stop the medication. Some medicines shall be used for extended periods even after the relief of symptoms and this need to be confirmed with the physician.
The chronic diseases may need an ‘add on time’ before the medicines are stopped for certain duration to see the improvements if any and also to see the time needed for the symptoms to recur, if at all they happen to do.
Recurrence of symptoms on non-recurrence indicates the immunity status of the patient. In either case a doctor will take the call. The patients should just keep away from decision making in these matters. This is applicable for all diseases including physical and mental.
Read – Chikitsa: Treatment Types, Ayurvedic classification
Appearance of undesired symptoms and signs, unrelated to the pathology of the disease being treated or the constitution of the patient – Many times, the symptoms of the disease will come down, even the intensity of the disease. The patient will feel healthy but at the same time some symptoms which were never a part of the disease being treated or which have never been experienced may surface.
The patient in such condition will panic. They should immediately consult the doctor. The doctor may ask the patient to stop the medication and review the case. This also happens with people who take the medicines beyond advised time i.e. beyond stoppage time.
Read – Upadrava: Complications of diseases, Definition, Examples
The medicines will act like medicines until the disease pathology exists. After the disease is cured, if the medicine is still used, it may cause damage of healthy tissues and cause fresh complaints. Appearance of such symptoms may indicate ‘action of medicines beyond point of saturation’ and this is a dangerous scenario.
It also makes the patient to think that these symptoms are side effects of the medications and also may blame the physician, but the reality is that they have used the medication beyond stipulated duration, even after the disease is cured.
This also may be a cutoff point which needs to be watched upon. Example, a pungent formulation like Trikatu Churna, prepared with long pepper, black pepper and ginger prescribed to bring down excessive coldness caused by kapha and related complaints in the body will induce heat, improvise the metabolism, combat morbid kapha and cure the cold related condition.
But when it is used even after the relief of cold, it may produce damage to the mucosa of stomach, produce burning sensation, inflammation and corrosion, headache, weakness of muscles etc conditions.
Read – Ayurvedic Hospital Management – Chikitsa Chatushpada
Signs of good treatment
Signs of proper, excessive and deficit use of medications / formulations / treatments – The signs of proper, excessive and deficit usage of certain treatments have been mentioned in Ayurveda texts. These symptoms are mentioned in the contexts of oleation, sudation, emesis, purgation, enema, nasal medication, lightening therapies (including appetite inducing, digesting medications etc), bloodletting, stoutening, constipating, nourishing etc therapies.
Read – Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation
Signs of proper usage indicate the saturation point of the medicine (in treatments like oleation) and cure of disease symptoms (in medications used for inducing appetite and correct metabolism etc). This also is the stoppage time for the related medications.
Read – Oleation – Snehakarma Dose, Benefits, Side Effects, Management
Signs of excessive usage hint at stopping the medications because they depict the tissue and organ damage due to excessive medicine use. Similarly, signs of deficit usage will hint at re-commencing the treatment after giving a gap, with proper dosage and properly planned time of administration.
Signs related to reactions of incompatibility of medicines – All medicines do not suit everyone. Some medicines may produce untoward reaction in the body. This is not essential due to an unsuitable or wrongly prescribed medication; it may be a reaction of the body to the medicine or response of disease pathology.
In some people, these symptoms will settle down with consequent doses. But when untoward symptoms occur when medicines are used, then it should be brought to the notice of the doctor. In some people, the symptoms may not come down even after the medication has been used for a week or so. This is also a clue for the physician that the medicine may be stopped and replaced with some other effective medication.
Read – Dangers Of Self Treatment With Ayurvedic Medicines – Two Live Examples
No response or relief from medication – Sometimes there will be no relief from medication, in a disease or symptoms of a disease. Again this happens due to many causes. When, in spite of taking medicines for many days or months, there is negligible change or no change in the symptoms or severity of a disease, it shall be reported to the physician. In fact absence of response of a medication should be reported in quick time, may be couple of weeks after taking the medication. This may hint the physician to stop the medication.
Read – Ayurveda Is Not A Granny Medicine
Aversion to medicines – Aversion to a compound or an herb may occur in some cases, may be from day one of medication. Medicines take time to adjust in the system. Once there is compatibility, there should not be any problem. But if there is constant aversion to the medications, or if the body is constantly rejecting the medicines and if there are symptoms of rejection like nausea, vomiting etc, the medicines shall be stopped and brought to the notice of the doctor.
Read – How To Make A Remedy With Any Ayurvedic Herb?
Aversion also may start after a certain period of usage of medicines or after the disease gets cured. This implies to the saturation of the medication and that no more medicine is needed to the system. Generally the palatability comes into the route of aversion.
Now days the physicians can make an alternative suggestion like using tablets prepared by solidifying herbal decoctions in place of traditional decoction. The tablets can be gulped without tasting them and it is easy to use. In spite of change of form and method of usage suggested by physician, if there is aversion to those medications, they shall be stopped with the permission of the physician.