ISSN : 2693 6356 2018 | Vol 1 | Issue 4 Uramarunnu: Pediatric Care in the Ayurvedic Tradition B .Buvana , R .Chaithu ,N . Samyoutha Assistant Professor 1,2,3, Badruka Pharmacy College and Institution ABSTRACT BACKGROUND: Appropriate development of children is a prime necessity for a health future of a country. Uramarunnu (medicines administered after rubbing) is one of the traditional practices in Southern part of India which is a modification of Lehana (drugs administered in lickable form) and Prasana (small quantity of food or medicine which is contained in between the thumb and the index finger when taken). AIM: To explore the scientific aspect regarding the use of Uramarunnu. MATERIALS AND METHOD : Data from various Ayurveda classics, Ayurveda Pharmacopeia of India and online database was reviewed for the work. OBSERVATIONS: The drugs of Uramarunnu were found to be possessing digestive stimulant, immunmodulator and nervine tonic properties. Thus practise of Uramarunnu covers a three dimensional aspects in health care of a child i.e. Gastrointestinal protection; Stimulation of the central nervous system and immunomodulation. CONCLUSION: The review suggests that the Uramarunnu is having positive relation with Gut-Brain axis and can be used for safe and effective baby care under proper guidance of a physician. Keywords: Children, Digestive Stimulant, Immunmodulator, Nervine Tonic, Uramarunnu Introduction Every child should be able to achieve their optimal development at various stages of their life. In order to achieve that appropriate childhood development is of prime importance, it includes not only physical but also socio -emotional, cognitive as well as motor development between the age of 0-8 years. So every health care system gives utmost importance to the prevention of illness and promotion of health of children. Health problems as well as treatment should be dealt with great caution in the case of children, as they are Soukumarya (tender), Alpakayatwa (small in size) and Sarva anna anupasevana (not used to intake of different kinds of medicine as well as food) [1] In this paper a traditional practice - Uramarunnu that is being practised in various parts of India has been reviewed with respect to commonly used drugs, their posology, mode and frequency of administration, their action on the GI Tract, CNS and immunity. Materials and Methods A thorough search was done in the Ayurveda classics, Ayurveda Pharmacopeia of India and database of Google Scholar; Pubmed, NCBI for getting relevant data from literature and research papers. Mostly the research articles published in English language was considered. A detailed review of the common drugs used in Uramarunnu in various parts of South India were reviewed in parlance with the Classical texts. Observations Uramarunnu is one of the traditional practices prevailing in the southern part of India, especially in Kerala, Karnataka and Tamil Nadu. Uramarunnu has derived its name from the method in which it is administered i.e. Ura refers to rub and Marunnu - medicine. Thus it represents a wide range of drugs which are administered to infants by rubbing. They include drugs possessing digestive stimulation (Deepana and Pachana), promoting proper movement of tissues inside the body (Vatanulomana), producing strength (Balya) and that which promotes the intellect (Medha). Uramarunnu is a traditional therapeutic modification of Lehana and Praasana (variety of licking) explained by Acharya in various Samhithas. The drugs in Uramarunnu are rubbed one by one (with honey/breast milk/cow’s milk/butter generally as the medium) on a flat stone called Chaana. The resultant fine paste is applied to the tongue of the infant or to the nipple of the mother (Sthanalepanam) and the child is allowed to feed. The time gap between two doses is usually once in a week, but in case of any ailments the frequency of administration and the number of rubs of each ingredient can be modified. Common examples that are practised by traditional paediatric practitioners are; in case of constipation Hareethaki (Terminalia chebula); in abdominal pain and flatulence Lasuna (Allium sativum) are given in more proportion or given more number of rubs. Age of administration: Usually administered after 28 days from birth till 1- 2years. Dose: Given in a dose of 1 pinch or 1 Vidangaphala dose and increased as per age to a maximum dose of size of an Amalaki (Embilica officinalis) [2] Discussion While dealing with Uramarrunu there are three important aspects that needs to be taken into consideration with respect to its action. They are, 1. Gastro-intestinal tract protection 2. Central Nervous System stimulation 3. Immunomodulation The infants and children are mentioned as possessing tender constitution and the age is Kapha Dosha predominant. Children’s diet is predominantly sweet and unctuous as they are mostly fed with breast milk, ghee, butter etc. [3] There is always probability for derangement in the digestive fire (Agnimandya) which can lead to Gastro Intestinal Tract dysfunctions (Grahaneedooshana) and production of Undigested metabolites (Ama). As a child is unable to perform all activities as adults; derangement in the function of Vata Dosha (Vatavaigunya) is another concern as the movement (Gati) of Vayu is not always downwards (Anuloma), so there are symptoms like frequent vomiting, abdominal pain. [4] There is a primary need for maintaining a healthy gastro-intestinal tract by the administration of Deepana-Pachana-Vatanulomanadravya. The nervous system in a child is in the phase of development. It can be stimulated in the stage of infancy and childhood for better levels of intelligence and cognitive functions as well as to prevent neuro degenerative disorders in future. Ayurveda aims at development of all aspects of intellect viz Grahana Shakti [5] (grasping power), Dharana Shakti [5] (retention power), Vivechana Shakti [5] (discrimination power) and Smriti [5] (recollection). So there is a need for the administration of drugs that promotes the intellect (Medhya) with suitable medium or vehicle (Anupana) that promotes the development of the Central Nervous System. Children and new-born have only passive immunity which has been obtained from the maternal immunoglobulins and colostrum. As children are in a stage of under developed body tissues (Aparipakva Dhathu), there is a need to boost the neuro-endocrine- immune axis of the body which can be called as Innate strength (Bala) / Vitality (Ojus) / Immunity (Vyadhikshamatwa), so as to help children and neonates resist and overcome the attack of diseases.[6] Some of the most common Ingredients used in Uramarunnu and their properties are listed in the table 1. Table 1:- Common Ingredients of Uramarunnu and their properties Sanskrit Name Botanical Name Family Part used Rasa Guna Veery a Vipaka Karma Vacha [7] Acorus calamus Araceae Rhizome Katu- Thiktha Laghu-Theekshna (Light-sharp acting) Ushna Katu Deepana, Medhya & Kantya (Voice promoters) Hingu [8] Ferula Asafoetida Apiaceae Resin Katu Theekshna Ushna Katu Deepana-Pachana, Ruchya (Promotes taste) Harithaki [9] Termnalia chebula Combretaceae Seeds; fruits Pancha Rasa (Five tastes) Laghu-Ruksha (Light- Dry) Ushna Madhura Vata-pittaharra, Rasayana (Rejuvenating), Anulomana Lasuna [10] Allium sativum Liliaceae Bulb Katu-Madhura Guru-Snigdha- Theekshna Ushna Katu Deepana, Balya, Medhya Haridra [11] Curcuma Longa Zingiberaceae Rhizome Thiktha -katu Ruksha Ushna Katu Kapha-Pittahara, Vishaghna (cures poisonous effect), Varnya (Improves complexion ) Jathiphala [12] Myristica fragrnas Myrtaceae Seed Thiktha -katu Laghu-Theekshna Ushna Katu Deepana, Grahi (Absorbing) Bakuchi [13] Quercus infectoria Fabaceae Seed Thiktha -katu Ruksha Seetha Katu Kapha-Pitta, Grahi Chandana [14] Santalum album Santalaceae Heart wood Thiktha - Madhura Laghu-ruksha Seetha Katu Piita-Kaphaghna Ela [15] Eletteria cardamomum Zingiberaceae Whole fruit Katu-Madhura Laghu Seetha Madhura Rochana (Promotes taste), Deepana, Anulomana Jyothishmathi [16] Celestrus paniculatus Celastraceae Seed Katu-Thiktha Ushna-Theekshna Ushna Katu Vathaghna, Deepana Yastimadhu [17] Glycerrhiza glabra Fabaceae Root Madhura Guru -Snigdha Seetha Madhura Vata-Pitta,Balya Vidanga [18] Embelia ribes Myrsinaceae Fruit Katu -thiktha Laghu-ruksha Ushna Katu Deepana, Anulomana, Krimighna Sunti [19] Zingiber officinale Zingiberaceae Rhizome Katu Laghu-Snigdha Ushna Madhura Deepana, Pachana, Anulomana Pippali [20] Piper longum Piperaceae Fruit, Root Katu Laghu-Theekshna Ushna Katu Vataghna, Deepana, Pachana Maricha [21] Piper nigrum Piperaceae Fruit Katu-Thiktha Laghu-ruksha Ushna Katu Kaphaghna, Ruchya, Deepana Mustha [22] Cyperus rotendus Cyperacae Rhizome root Katu-Tikta Laghu -ruksha Ushna Katu Kapha-Vatahara, Deepana, Pachana, Grahi Probable mode of action: On a closer evaluation of the drugs that are used in Uramarunnu the drugs are bitter and pungent (Tikta- Katu Rasa) predominant, light in nature (Laghu Guna), Pungent in post digestion phase (Katu Vipaka) and a combination of hot and cold (Ushna -Seetha) potency. Tikta Rasa is Akasa + Vayu (Space + Air) Mahabhuta predominant and Katu is Agni +Vayu (Fire + water) Mahabhuta predominant there by making the drugs Laghu by their nature. Being Laghu Guna predominant it will be easy to digest for the children and the combination acts as Agni Deepana, [23] Pachana, Vatanulomana. Thus the Agni in proper state and Vayu in its Anuloma Gathi (moving in its normal course) they promote the smooth functioning of the entire system of the child. Among the six Rasas, Tikta is said to be Medhya [24] in nature thereby acting on the brain and neurological tissues and promoting the CNS development in children. Once the system is corrected it help in the production of Prakrutha (with all normal qualities ) Doshas - Vata, Pitta, Kapha. This Prakrutha Avsatha of Doshas itself is Bala (immunity), [25] which in turn develops a good immune system in children to fight and prevent diseases. On analysing the Rasa, Guna, Veerya, Vipaka and Prabhava of the drugs used it is clear that the combinations direct site of action is Gastro intestinal tract thereby on Agni which further improves the innate strength and further immunity and the wellbeing of the human body. Table 2 :- Drugs in Uramarunnu and their action on GIT and CNS Name Of The Drug Action On GIT Action On CNS Vacha It iscarminative, stomachic, laxative, anthelminthic, [27] abdominal colic, dysentery. Promotes Intellect, anticonvulsant, nerve tonic, tranquilizing, sedative. It is used in epilepsy, delirium.is anti- inflammatory, immunomodulatory and neuro-protective.[27] Hingu It is antispasmodic, carminative, laxative, digestive, anti- helminthic, used in flatulence, dyspepsia. It is anti- hepatotoxic,anti-inflammatory [28] Nervine tonic ,used in hysteria, epilepsy, psychopathy. Harithaki It is carminative, digestant, laxative, anthelminthic. Used in stomatitis, anorexia, flatulence. Used in cephalgia, neuropathy, debility [29] Lasuna Digestive, carminative, laxative, anti-helminthic. Used in colic, flatulence, constipation. It shows antimicrobial activity against gram positive and negative bacterial. [30] CNS stimulant, tonic, in facial paralysis, hysteria and weakness of brain. Haridra Appetizer, carminative, stomachic, laxative, anti-helminthic. It is used in constipation, flatulence and dyspepsia. CNS stimulant and used in epilepsy, debility [31] Jathiphala Digestive,carminative,stomachic,laxative,antihelminthic,antispas modic.It is used in dyspepsia, flatulence, diarrhea, vomiting CNS stimulant, used as an anticonvulsant and used in insomnia [32] Bakuchi It is anti-helminthic, antipyretic, used in management of skin diseases and it is immunostimulant.[33] -- Chandan It is antifungal, antibiotic, antiviral and a potent antioxidant It produces a sedative effect [34] Ela It is gastro protective, anti-inflammatory, analgesic, antispasmodic and used as an antioxidant [35] -- Jyothishmath i It is an analgesic, anti-inflammatory and antioxidant. nervine tonic, enhances cognitive function, hearing and memory[36] Vidanga It has analgesic, antihelminthi, antibiotic and antioxidant property. It is an anticonvulsant [37] Sunti It is anti-inflammatory, antiemetic, antioxidant. It is GIT protective, improves Gastro Intestinal mobility and Immunomodulatory. [38] -- Pippali It is anti-inflammatory, antioxidant, anti -asthmatic, immunomodulatory and hepatoprotective in nature.[39] -- Maricha It is anti-inflammatory; antimicrobial, antidiarrheal, antispasmodic and antipyretic in nature [40] -- Mustha It is astringent, diuretic, analgesic, antispasmodic, carminative, antitussive, vermifuge, antiemetic, gastroprotective. It inhibits gastric mobility, anti-diarrheal. It acts as a tranquilizer, anticonvulsant. [41] According to Ayurveda, Agni is the basis of strength of all human beings which in turn promotes the Bala. This principle is like the recent theory of Gut Brain Axis in the body. The concept of the Gut-Brain axis, is used to describe the complex bi-directional communication system that exists between the central nervous system and the gastrointestinal tract and which is vital for maintaining homeostasis of human body. [26] As children are more susceptible to Agnimaandya, which is the root cause for all disease, the drugs of Uramarunnu by virtue of their property improves Agni, promote Amapachana and the Anulomagathi of Vayu, which in turn helps in proper movements or circulation of Dosha, Dhathu etc. and thus maintaining homeostasis of various body tissues. The pharmacological studies already reported on the individual drugs also favours the effect on Gastro Intestinal tract and Central Nervous System as listed in table 2. Enteric nervous system is a subdivision of autonomic nervous system. It is embedded in the mucosal lining of the gastro intestinal lining and is described as the second brain. The enteric nervous system communicates with the CNS through sympathetic and parasympathetic nervous system. The support cells of the enteric nervous is like astroglia of brain. The capillaries surrounding the ganglia is similar to blood brain barrier The enteric nervous system can alter its response depending on the bulk and nutritive content of the food materials and medicaments. This bidirectional gut-brain axis is a communication that integrates the gut and central nervous system activities. Gut-brain axis influences a range of diseases, influence the behaviour, links the emotional and cognitive centres of the brain with the intestinal function. Moreover, the enteric nervous system influences the central nervous system via neural, endocrine and metabolic pathways by producing inhibitory, inflammatory and anti-inflammatory cytokines. [26] Thus the drugs of Uramaruunu, clearly promotes the gut health of the children and thereby improve overall growth both physically and mentally. The healthy gut thus helps the body to develop a strong immune system to fight and resist diseases. It covers multiple positive aspects of the gastro intestinal tract, such as the effective digestion and absorption of food, the absence of gastro intestinal illness, normal and stable intestinal microbiota, effective immune status and a state of well-being itself. Conclusion Uramarunnu is a traditional practice which acts primarily on the Gastro intestinal tract. It has a three dimensional impact i.e. Gastro Intestinal Tract protection, Immunomodulation and Central Nervous System stimulation. Uramarunnu also acts on Gut- Brain Axis and satisfies the concept of native vaccine to a greater extent. The number of drugs used can be increased or decreased or modified according to the condition of health and disease. The study concludes that Uramarunnu can be used for safe and effective baby care under proper guidance of a physician. Research works to promote and establish scientifically these traditional health care practices are to be done in future. References 1. 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