Ayurvedic Prevention & Management of Lyme Disease

Introduction

With the onset of spring and summer and with increasing amounts of time spent outdoors in those seasons, the issue of Lyme disease is a timely one.

Lyme disease is a bacterial infection caused by any one of three gram-negative bacteria of the spirochete class: Borrelia burgdorferi causes most cases of the infection seen in the United States, while B. afzeli and B. garini are responsible for most European incidences and 20 further Borrelia species have been identified as carriers and vectors. First identified in 1975 in the town of Lyme, Connecticut (USA) the disease is the most common tick-borne infection in the northern hemisphere.

Ayurveda & Infectious Diseases

The study and treatment of infectious disease is not an exclusive property of contemporary biomedicine. In ayurveda, millenia before the invention of microscopy, the Rshis adduced the origins, courses and treatments of infectious diseases, and these have long been the subjects of ayurvedic interest, and research and clinical activity. By way of introduction, ayurveda categorizes all microorganisms – whether microbes, viruses, rickettsiae or parasites - as Krimi (from the Sanskrit, meaning worm). All krimi divided into two main categories, viz., external and internal.

External krimi refers to microorganisms either emerging out of the human body (enteric parasites) or living on its surface (vermin or infectious microorganisms living on the skin). Internal krimi includes micro-organisms that reside within the human body and are categorized by habitat, yielding 3 types: those generated in or residing in the mucus – Kaphaja; those generated or residing in the blood – Raktaja; and those generated in the stool or rsiding in the lower digestive tract - Purishaja.

Kaphaja krimi includes bacteria that multiply in the internal organs. Their environment is aam-laden kapha - mucus. Their ordinary introit into the body is via the respiratory tract, and along with kapha they are spread throughout the body.

Raktaja krimi includes organisms that enter the bloodstream, as in the case of a insect bite or penetration of the flesh with a contaminated object, causing the blood to act their vehicle to all organs and body systems. This category would include smallpox, measles, furunculosis, strep infections of the blood, etc.

Purishaja krimi are generally the agents of gastrointestinal diseases, including the most severe epidemics such as cholera and dysentery. These generally enter into the body with contaiminated food or liquid and breed in decomposing fecal matter in the colon. Infectious diseases caused by purishaja krimi generally do not rise above the stomach. If by any reason purishaja krimi do enter into the esophagus, there is a very characteristic symptom of the fecal-smelling breath.

Lyme Disease falls into the last of these categories.

Epidemiology

The infection is spread by the bite of the Deer Tick (genus Ixodes). Borrelia inhabits the lumen of a tick's digestive tract. The disease is transmitted when the bacteria migrates up to the ticks salivary glands, and through the opening in the skin created by the tick's bite. Ticks increase salivation while feeding, prompting the migration of the saliva from the digestive tract. Because migration from the gut takes a few days, transmission of the disease usually does not happen until after the first 24 hours of attachment. As it requires a minimum of 24 hours of attachment by a tick to the potential host for transfer of the organism to occur, making regular "tick checks" of the skin's surface is a helpful preventive measure.

Lyme disease is endemic in several regions in the United States, Canada and temperate Eurasia and accounts for more than 95% of all reported cases of vector-borne illness in the United States. More than 62,000 cases were reported by states to the US Centers for Disease Control from 1993 - 1997, and the national mean annual rate in this 5-year period was 5.5 cases per 100,000 population. Although cases of Lyme disease have been reported by 48 states, only 13 states are considered to be either highly or moderately endemic, and risk is thought to be low or non-existent in the remaining 37 states and the District of Columbia.

Persons of all ages are thought to be equally susceptible to infection, although the highest reported rates of Lyme disease occur in children aged greater than 15 years of age, and in adults aged 30-59 years Both under-reporting and overdiagnosis are common.

Most infections are thought to result from periresidential exposure to ticks during property maintenance, recreation, and leisure activities. Thus individuals who live or work in residential areas surrounded by woods or overgrown brush infested by vector ticks are at risk of getting Lyme disease. In addition, persons who participate in recreational activities away from home such as hiking, camping, fishing and hunting in tick habitat, and persons who engage in outdoor occupations, such as landscaping, brush clearing, forestry, and wildlife and parks management in endemic areas may also be at risk of getting Lyme disease.

Stages & Symptoms

Lyme disease is described in 3 phases:

(a) the early localized disease stage with fever, headaches, fatigue, depression, skin inflammation, and a characteristic circular skin rash called erythema migrans;

(b) an early disseminated disease stage with heart and nervous system involvement, including nerve palsies and meningitis; and

(c) a late disease stage featuring motor and sensory nerve damage, brain inflammation and arthritis, including cranial neuropathy (specifically facial palsy), and meningitis (abnormal cerebrospinal fluid) and psychological symptoms.

Erythema migrans, which is present in about 80% of cases, can appear anywhere from one day to one month after a tick bite. This rash does not represent an allergic reaction to the bite, but rather an actual skin infection with the Lyme bacteria, and is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation. The erythema migrans rash is classically 5 to 6.8 cm in diameter, with a bullseye pattern of one or more concentric rings of irritation and is sometimes confused with the rash indicating the presence of ringworm (Dermatophytosis).

Left untreated, later symptoms may involve the joints, heart, and central nervous system. In most cases, the infection and its symptoms are eliminated by antibiotics, especially if the illness is treated early. Delayed or inadequate treatment can lead to the more serious symptoms, which can be disabling and difficult to treat.

Ayurvedic Herbal Management

The Ayurvedic treatment of Lyme disease is aimed at alleviating or eliminating the symptoms, preventing complications and boosting the immune status of the body.

Immunoaugmentative and antimicrobial medications which may also allay skin inflammation and should thus be utilized in the early stages of the disease include the following multiherbal formulations:

Chandraprabha-Vati
Gandhak-Rasayan
Mahamanjishthadi-Qadha
Panch-Tikta-Ghrut-Guggulu
Sukshma-Triphala

Lyme Disease can create inflammation of the heart muscle, resulting in arrhythmia or abnormal heart rhythm, and heart failure. Inflammation of the heart muscle can be treated using the following single herbs and multiherbal formulas:

Amalaki (Emblica officinalis)
Draksha (Vitis vinifera)
Haritaki (Terminalia chebula) (see 'Chronic Lyme disease' below)
Kutaj (Holarrhina antidysentrica)
Musta (Cyperus rotundus)
Nimba (Azadirachta indica)
Patol (Tricosanthe dioica)
Arjunarishta (formula)
Dashmoolarishta (formula)
Punarnavadi-Guggulu (formula)
Saarivasava (formula)
Triphala-Guggulu (formula)

Dr. John Douillard, DC has suggested an initial formula comprised of Ashwagandha, an adaptogren, Manjishtha, a lymphatic detoxification agent and Nimba (Neem) as a microbicidal agent used complementarily with conventional antibiotic therapy.

The following multiherbal formulations are useful in preventing and treating the cardiac arrythmias sometimes associated with the disease:

Bruhat-Vat-Chintamani
Ekang-Veer-Ras
Maha-Vat-Vidhwans-Ras
Tapyadi-Loh

Nervous system involvement can be treated with:

Nirgundi (Vitex negundo)
Prushnaparni (Uraria picta).
Shalparni (Desmodium gangeticum)
Yashti madhu (Glycerrhiza glabra)
Bruhat-Vat-Chintamani (formula)
Ekang-Veer-Ras (formula)
Kaishor-Guggulu (formula)
Maha-Vat-Vidhvans-Ras (formula)
Tapyadi-Loh (formula)
Vishtinduk-Vati (formula)

Involvement of the joints can be treated with the following single herbs:

Deodar (Cedrus deodara)
Erandmool (Ricinus communis).
Guduchi (Tinospora cordifolia)
Nirgundi (Vitex negundo)
Rasna (Pluchea lanceolata)
Vishwa (Zinziber officinalis)

as well as the following multiherbal foormulas:

Gokshuradi-Guggulu
Maha-Rasnadi-Guggulu
Maha-Yograj-Guggulu
Yograj-Guggulu

Symptoms resulting from this disease sometimes persist even after eradication of the Lyme bacterium (See 'Chronic Lyme Disease' below).

This is usually because of an ongoing auto-immune response in the body and is treated using herbal medicines including:

Tulsi (Ocimum sanctum)
Bhringaraj (Eclipta alba)
Shatavari (Asparagus racemosus)
Mandukparni (Centella asiatica)
Ashwagandha (Withania somnifera)
Bala (Sida cordifolia)
Abhrak-Bhasma (formula)
Suvarna-Bhasma (formula)
Suvarna-Malini-Vasant (formula)

Lyme protocols often include items that can create constipation, giving rise to subsequent doshic vitiation and the accumulation of aam. To avoid constipation, gentler laxatives can be indicated to enhance elimination, and the multiherbal formulation Triphala is ideal for this purpose. Additionally, urinary and bladder symptoms are amenable to treatment with Shilajit.

Prevention

Since Lyme disease is transmitted by ticks attaching to the body, it is important to use protective clothing and adopt other techniques for the prevention and avoidance of tick bites while staying in, or visiting tick-infested areas. Adequate hygiene should be maintained in order to prevent transmission of this disease.

Chronic Lyme Disease

There is increasing evidence that some patients treated for Lyme Disease have symptoms that persist for years afterward, despite having received the recommended standard antibiotic treatments resulting in the active bacterial infections having been eradicated. The main symptoms of fatigue, musculoskeletal pain, and neurocognitive difficulties are attributed to a post-infection syndrome, also known as post-treatment or Chronic Lyme Disease. Some practitioners question whether such symptoms are or can be a direct consequence of Lyme disease, believing the symptoms are simply from depression following an acute infection. They are skeptical owing to the long-term, indistinct nature of the symptoms and because some studies did not show a statistically significantly greater prevalence of symptoms in patients who have had Lyme Disease. All studies so far have been relatively small, so the issue awaits clarification.

Ayurveda & Chronic Lyme Disease

One theory supporting the existence of Chronic Lyme Disease relies on the fact that when threatened, Borrelia spirochetes are capable of secreting a protective biofilm. This biofilm renders the bacteria invulnerable to antibiotics, anti-Lyme herbs, and antibodies that would ordinarily destroy it. Thus enshrouded, Borrelia are believed to lie dormant in their biofilm for months or even years. After such a period, the bacteria can re-emerge and aggravate symptoms of pain, fatigue, and mental and emotional disorientation and dysphoria. Such patients may end up receiving an extremely wide variety of antibiotics over the course of several years, antibiotics that are believed to stimulate the production of the bacteria's biofilm. When the bacteria re-emerges, symptoms can flare intensely.

A promising advance occurred in 2006, when a 17 year old participant in a Mississippi student science fair utilized Terminalia chebula (Haritaki, one of Ayurveda's most widely used herbal drugs) to infiltrate the biofilm of Pseudomonas aeruginosa, a bacteria often responsible for deaths from pulmonary infection in individuals with cystic fibrosis. Haritaki appears to exert a similar effect on the Borrelia's biofilm, with current patients reporting a reduction in their symptoms when taking this herb with other anti-Lyme herbs and treatment methods. In patients that have been infected for a year or less, symptoms are reportedly reduced in their intensity by as much as 90% in as short a period as eight weeks. In some cases, biofilm penetration appears coincident with an increase in your symptoms due to greater numbers of bacteria being released into physiological activity. Some patients have reported an increase in symptoms of fatigue and joint pain when starting to take T. chebula, and it seems initially that the herb ought to be administered at a very low dose so as to minimize any possible flaring of symptoms.

John Douillard, DC, a leading teacher and practitioner of Ayurveda discerns an emotional context to the treatment of Lyme Disease and has said “I have never had success with a patient with Chronic Lyme who hasn't been willing to unravel the emotional traumas that seem to manifest as deeply seated molecules of emotion and are held on to for dear life. Lyme is a fat soluble bacterium and the toxins released are fat soluble neurotoxins that can challenge the body's ability to maintain stable mood, energy and neurological function. Therefore, one of the keys to treating Lyme is to help the body detox the toxic fat cells. Stress chemically tells the body to store fat and crave sugar. Energy goes high and then low and we self medicate with more toxic sugars.”

As there has been reticence on the part of some medical authorities to validate claims of victims of Chronic Lyme Disease, the issue has become laden with political acrimony, and many practitioners for this reason seek to avoid having Lyme patients. Many patient advocates (notably an advocacy organization, the International Lyme And Associated Diseases Society), individual patients, and some physicians who support the concept of chronic Lyme disease have organized to promote the recognition of this diagnosis, as well as to argue for insurance coverage of long-term antibiotic therapy, which most insurers deny as it is at odds with the guidelines of major medical organizations.

Article provided by William Courson, BVSA, D. Ayur., an Ayurvedic Practitioner, faculty member and the College Dean of Institutional Development at Sai Ayurvedic College & Ayurvedic Wellness Center.

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