Essence of Chronopharmacology in Allopathy

It gives me great joy in placing Vol.9 (issue 3) of RJPS 2019 to our esteemed readers.

The word ‘chrono’ refers to ‘put in order by date’ and as we all are quite familiar with pharmacology, it deals with uses, effects and modes of action of drugs. The word Chronopharmacology deals with the variation in response to drugs depending upon the time of administration of drugs. The influence of drugs varies with season and time of administration which has been well appreciated and accepted in allopathy but not explored fully. Various factors that influence the effect of drugs are diurnal changes, circadian rhythm, seasonal changes etc. The concept of chronopharmacology can help in optimizing the therapeutic efficacy of drugs and can be adopted wherever possible in clinics for the benefit of patients. As we all are aware, every allopathic drug possesses side effects and a range of other unwanted effects hence, clinically practicing chronopharmacology can help in reducing the toxic effects of drugs, their dosage and treating patients effectively without compromising with beneficial effects.

Viz., treating the patients successfully with 1st generation antibiotics rather than highly potent and highly toxic 4th/5th generation antibiotics in appropriate season that is described below or treating arthritis patients with simple NSAID’s rather than with potent drugs like steroids, immunosuppressants etc., based on the appropriateness of the season for the same ailment(s). Further, this logic can be extended to other categories of drugs wherever applicable.

The concept of chronopharmacology is very well established in Ayurvedic system of medicine. A brief description of its principles in a nutshell will make the concept clearer for allopathy practitioners. The ayurvedic system of treating diseases is based on the 3 principles of ‘Vata’ ‘Pitta’ and ‘Kafa’ and ‘Ritucharya’ or seasonal influence of the year on the body. Any imbalance in these 3 principle constituents of the body is said to be the root cause of diseases based on the disturbed principle. These principles can be equated to air, bile/gastric juice, and phlegm in English respectively. In our almanac the year is divided into ‘6 Ritus’ (time periods). Viz., March-April Vasantharitu, MayJune Grishmaritu, July-Aug Varsharitu, Sept-Oct Sharadritu, Nov-Dec Hemanthritu and Jan-Feb Sishirritu each spanning 2 months.

According to the Ayurvedic theory (which is our own ancestral system), Shishir (Jan-Feb) and Vasanthritu (March/April) have predominance of ‘Kafa’ (phlegm) that gradually increase and then attain their peak and later gradually diminish giving way to next principle of ‘Pitta’. The above said ‘Kafa’ season can produce respiratory/lung related diseases Viz., cough, lung infections, throat infections etc. Later this starts diminishing and ‘Pitta’ principle starts predominating which attains its plateau and starts diminishing giving way for other principle. This season leads to imbalance in gastric acid/gastric juice secretions thereby producing GI related disorders Viz., hyperacidity, pharyngitis, chest burn, risk of peptic ulcers etc., (Varsha and Sharadritui.e.,July to Oct). This is followed by a gradual increase in ‘Vata’ principle that rises to its peak and starts diminishing in these 4 months once again giving way for ‘Kafa’. The influence of season on this ‘Vata’ principle will produce diseases related to bones and joints Viz., arthritis, joint pains etc. This will span from Nov. to Feb i.e., Hemanth and Shishirritu. Thus, the cycle repeats every year with slight difference in ensuing months and end period of each factor. Similarly, the period from Jan to June (6 months) is considered as the phase of descending energy and July to Dec (6 months) as ascending energy phase, which can be very well experienced by each one of us. Besides these factors, the predisposition of a person to these principles also plays an important role. This will generally depend upon the birth period of that person as to in which season he/she is born and even the time of birth and the dominance of the principle etc. Further details of this aspect can be unnecessary at this stage which is in the form of ‘karma’ or past deeds, their personal determination to overcome, discipline with reference to exercise, food, other habits inculcated etc.

Thus, if a patient has hyperacidity related disorders in its predominant season i.e., ‘Pitta’ season (June, July, Aug etc.) PPIs may be needed. However, during other seasons even simple antacids can do the job very well thereby reducing unnecessary drugging and reducing the toxic effects. If this is combined with diet modifications Viz, avoiding pungent, spicy food in this season and consuming sweets, bitter vegetables can benefit greatly (pathya/apathy concept).

The ‘Vata’ season is known to influence complications of arthritis and bitter principles aggravate the condition hence, they should be avoided Viz., bitter gourd and even medicines with bitter taste can aggravate instead of curing arthritis like disorders. However, the same bitter principles can be conducive in other seasons.

All the Ayurvedic practitioners believe in these theories and practice accordingly, however this concept of chronopharmacology is not explored in allopathy that can have a promising potential. Some of the examples in connection with chronopharmacology practiced in allopathy to a little extent can make the concept clearer.

• Asthamtic attacks are more severe during night compared to day time that may require higher dose of antiasthmatic at night and this very well falls in chronopharmacology concept.
• Jet lag experienced due to melatonin secretion because of day and night cycle is another example.
• The amount of sedative/hypnotics needed during night and during day can be different thus fits in the concept of chronopharmacology.
• Purgatives produce severe action during cloudy days than sunny days. 
• General weakness, weight loss experienced in harsh summer and general good health, weight gain experienced in winter explains the seasonal influence on the body 

Thus, the logic can be extended to all the categories of drugs and can be explored to its maximum potential with the help of Ayurvedic experts for the benefit of patients. This will reduce the cost, toxic effects, unwanted drugging and works in accordance to nature. Further addition of dietary principles in therapy will act as synergistic. Viz, avoiding oily food during ‘Kafa’ season can be of great benefit to patients and on the contrary they will benefit in ‘Vata’ dominant season.

Let us explore our own ancestral system of medicine and blend it with allopathy too wherever possible for leading a naturally bestowed healthy life. We have to become the torch bearers in this arena since we can understand our ancestral system better than outsiders and adopt innovative means by out of the box thinking.