|Year : 2021 | Volume
| Issue : 1 | Page : 21-27
Ayurveda perspectives and research updates on factors influencing the immunity: A review
Rinky Thakur1, Raghavendra Naik2, RC Mythrey3, Sulochana Bhat2
1 Central Council for Research in Ayurvedic Sciences, New Delhi, India
2 Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Bengaluru, Karnataka, India
3 Government Ayurveda Medical College, Mysuru, Karnataka, India
|Date of Submission||21-Jan-2021|
|Date of Decision||22-Feb-2021|
|Date of Acceptance||08-Mar-2021|
|Date of Web Publication||16-Apr-2021|
Dr. Rinky Thakur
Central Council for Research in Ayurvedic Sciences, 61-65, opp. D’ Block, Janakpuri Institutional Area, Janakpuri, New Delhi.
Source of Support: None, Conflict of Interest: None
The basic concept of immunity is well explained under the heading Vyadhi-kshamatva in classical texts of Ayurveda. A clear and comprehensive understanding of the relationship between immunity and lifestyle such as daily activities, seasonal regimens, diet, emotional factors, and psychological factors is documented in ancient literature. According to Ayurveda, the most important contributing factors for the normal immune functioning of the body include Agni (digestive factors), Ahara (food), Nidra (sleep), Vyayama (physical activity/exercise), Satva (mental stability), and Rasayana (rejuvenators). In the present work, these factors influencing immunity were compiled from classical texts of Ayurveda and presented systematically with the help of published scientific literature. It is observed that good immunity in an individual will be due to effect of active and healthy functioning of the digestive system. It depends mainly on the type of food consumed. Higher diet quality is associated with the positive health of the body. Quality diet, required quantity and balanced food, is the base for the proper digestion and in turn for the development of a strong immune system. Exercises improve metabolic health which in turn provides a good immune system. Even sleep affects the immune system. Good sleep provides strong immune responses; it results in the formation of antibodies which along with white blood cells cellular immune system of body and fight against the disease. A significant relationship is also reported between mental resilience and perceived immune functioning and health. Psychological well-being also can increase living comfort. Rasayana provides a defense mechanism against diseases (Vyadhi) in the body. Proper understanding and application of these concepts in clinical practice can be a preventive strategy for a number of diseases.
Keywords: Ayurveda, Bala, immunity, Oja, Vyadhi-Kshamatva
|How to cite this article:|
Thakur R, Naik R, Mythrey R C, Bhat S. Ayurveda perspectives and research updates on factors influencing the immunity: A review. J Indian Sys Medicine 2021;9:21-7
|How to cite this URL:|
Thakur R, Naik R, Mythrey R C, Bhat S. Ayurveda perspectives and research updates on factors influencing the immunity: A review. J Indian Sys Medicine [serial online] 2021 [cited 2021 Jul 29];9:21-7. Available from: https://www.joinsysmed.com/text.asp?2021/9/1/21/313700
| Introduction|| |
Humanistic and social measures like health and education are key indicators in assessing the condition of a society and the country at large. Societal health is extremely critical in the well-being of a country and hence greater emphasis and investments are made by the state to improve these parameters which clearly reflect in Social Progress Index. Human diagnostics, in today’s time and age, is critical to assess the individual, community, and overall health of the society. In the times of COVID-19, a great emphasis has been laid on the need for immunity of an individual in his/her resistance to the virus and its ill effects. Hence, identifying and quantifying the immunity levels of an individual are the first step in disease management. As the onus of maintaining health, across different strata of society/different age groups/gender, the governments across the world are giving more thrust on monitoring and control in factors influencing the immunity.
Ayurveda, a system of medicine, works on the principle of life and lifestyle, has a great potential to become an effective public healthcare delivery system. Ayurveda is one of the oldest, tested, and proven forms of P4 (predictive, preventive, personalized, and participatory) medicine.
In Ayurveda, the concept of immunity can be related to Vyadhi-kshamatva (power of the body to arrest the occurrence and progress of diseases). Immunity can also refer to Bala (strength) and Ojas (essence of all seven Dhātu). Bala denotes the strength of the body and this strength is provided by Prakruta Kapha. Bala is considered as ojas by Charaka., Factors responsible for Bala (Balavṛudhdikara bhavas) are people who have good immune system who are born in a geographical region (Balavat Purushe Deshe), born with strong genes (Janma), born during the period of the season when strength is naturally strong (Balavat Purusha Kaale), healthy sperm and ovum (Beeja) and uterus (Kshetra) qualities, proper digestion of food, compact physique (Aharasampat) (Sharīrasanpat), strong natural constitution (Satmya), natural tendency (Swabhava), youth (young adult and middle-aged status) exercise, cheerfulness. Any variation in normal functioning of Bala, Kapha, and Ojas leads to disturbance in the immune system which may lead to some of the diseases. Description of this concept in ancient classical texts of Ayurveda is comparable with the current understanding of immunology. Ayurveda has meticulous information under the concept of Vyadhikashmatva which signifies an individual’s immune status, health and measures for prevention of diseases.
Different concepts of Ayurveda related to modulation of immune response have now become a subject of scientific investigation. Although the scientific understanding of immunology is related to enhancement of immune responsiveness against a pathogen by nonspecifically activating the immune system, Ayurveda clearly appreciated the role of diet, lifestyle, seasonal variations, emotional, and psychological factors, for the proper functioning of body’s defense mechanism.
The same concepts are outlined in modern science through recent advances in understanding the neuro-endocrine-immune axis and influence of circadian rhythm etc. which proves that Ayurveda principles such as Vyadhi-kshamatva, Oja, and Bala are comparable with the immunology of modern science.
In the recent past, it has been observed that, in diseases, conditions with disturbed immune response can be preserved with Ayurveda concept of immunity. Therefore, in the present article, the factors influencing immunity as mentioned in the classical texts of Ayurveda were compiled and critically analyzed.
| Materials and methods|| |
The concepts like Agni (digestive factors), Ahara (food), Nidra (sleep), Vyayama (exercise), Savta (mental stability) and their role in immunity were compiled from the classical texts of Ayurveda like Charaka Samhita,,,,, Sushruta Samhita,,, Ashtanga Hridaya,Ashtang Sangraha, Sharera kriya Vijyana, Ayurveda vikriti, and rog vigyana. The research update on the immunity parameters was collated from AYUSH research portal, PubMed, DHARA, Google Scholar. The data obtained during this search have been discussed and are presented in this article.
| Observations and results|| |
The classical information narrated by ancient seers clearly highlight that they were well aware of the defense system of the body. However, as the ancient way of expressing physiology is different than modern physiology, immunity-related knowledge is narrated under the concept of Vyadhipratoridhaka Bala and factors influencing it such as Agni (digestive/metabolic factors), Ahara (diet/food/nutrients), Vyayama (physical activity/exercise), Nidra (sleep) and Satva (mental strength)/psychological well-being etc. The detail of the literature is discussed onward. The researches conducted on the correlation between the aforementioned factors and immunity also vividly represent the ancient awareness regarding immunity, factors affecting it, factors enhancing it as well as factors that can maintain and initiate specific immunity. All such modalities are termed as Rasayana and are also reviewed in this work [Table 1].
| Discussion|| |
Ayurveda Concept of Immunity
The basic concept of immunity and immunology is existed and well-practised in Ayurveda for centuries. The basic concept in Ayurveda is to prevent the disease and cure the disease condition with different treatment modalities. This concept gives importance to prevention rather than the curative aspect. Although the term Vyadhi-kshamatva is generally correlated with the term immunity, this concept has much wider implications. The term Vyadhi-khsamatva has been described under the term Vyadhi bala Virodhitwa, Vyadhiyutpada Pratibandhakatwa by Chakrapanidatta which it means the strength in a person which waves off the strength of the disease and which inhibits the manifestation of the disease.
According to Ayurveda, Ojas is the final essence of all the Dhatus (structural components of the body) and seat for the Bala (strength), which is provided by Prakruta Shleshma of an individual that helps to fight against a disease. If Ojas get vitiated or decreased, there manifests three kinds of immunity-compromised patterns, i.e., if failure of host defense occurs, then the immune status fall into three divisions i.e., Ojavisramsa (dislodged immune strength) such as autoimmunity, Ojavyapat (aberrant immune function brought about by morbid Dosha and Dushya interaction) such as hypersensitivities and Ojakshaya (decrease in its normal quantity)—immune deficiencies and causes many disease manifestation and over a period of time leads to death of a person as well. Although these three states of Oja are different, all of them indicate an immune deficiency. In all these cases, the aim is to enhance Bala. Oja is vital energy that infiltrates into all tissues and cells and is also an element of our immune health and resistance to disease.
Factors Influencing the Immunity
Classical texts of Ayurveda very clearly identified and explained the role of daily activities, seasonal regimens, diet, emotional and psychological factors in the proper functioning of the immune system. The most important factors that contribute to Vyadhikashamatva include Agni (digestive factors), Ahara (food), Nidra (sleep), Vyayama (exercise), Satva (mental stability), Vyadhi and Vaya patency of Srotas (structural or functional channels) normal Dosha (bodily humors), and balanced condition of Dhatu (Physiological parameters) and Rasayana. These factors oscillate around holistic perpetuity under Ayurveda biology and contribute to assessing the immunity of an individual. The rasayana are rejuvenating and health-promoting agents which support the body to build resistance against diseases. Oja is responsible to boost immunity and Rasayana are used since ancient time as oja promoting herbs in Ayurveda. All these factors are now being increasingly recognized by researchers based on the evidence of the various experimental and clinical studies. The relation of all the components (Agni, Ahara, Vyayam, Nidra, Satva and Rasayana) with immunity was interpreted and research studies accompanying these components were collated and discussed below.
Agni (Digestive/metabolic factors)
Agni is the entity in the body that is responsible for digestion, metabolism, and the assimilation of nutrients. As per Acharya Charaka classical text of Ayurveda, Agni is the fundamental causative agent for longevity, health, good strength, normal Ojas, resistance against infection, motivation, and skin lusture. The cause of all diseases is Mandagni (hypometabolism) and the treatment protocol of any diseases in Ayurveda begins with normalizing the Agni. Even the existence of an individual is said to be because of Agni. Among all Agni, Jatharagni (metabolic factors located in the digestive tract) is the base for the normalcy of Bhutagni and Dhatavagni. Jataragni. All the responsible for all the physiological and vital functions occurring in the body. This shows if one wants strength, good immunity, and longevity, one should consume a wholesome diet with a healthy lifestyle and contrary to that if one consumes an unwholesome diet, suffer from the disease with vitiation in Grahani (disturbance in the gastrointestinal tract).
The digestive system of human has a lot to do with our immune system; it reflects our immunity and overall health. The human gut encounters many viruses, germs, and bacteria present in food items on a daily basis which is observed by the immune system in the gut. Our gut microbiome shapes our immune system. The gut bacteria functions contradictory to damaging microorganisms that cause disease. The imbalance in the composition of microbiome disturbs the relation between gut microbiome and immune system, which triggers many disorders like inflammatory bowel syndrome (IBS). Also, TLR (Toll-like receptors) is a major factor of the immune system, which act as a guard against foreign attack in their cross-talk with microbiota. The TLR signaling recognizes the problems related to colon like inflammation and even cancer. This depicts the relation between immune system and digestive system. There are some studies that complement the claims of immunity relation with agni (digestive system). Nichole A. Broderick has analyzed the connection between digestive and immune component. Many enzymes which help in digestion also participate in immune response. The adaptive immune system allows the diversification of microbes within the gut. According to one of the hypotheses, there are many similarities in the origin and functioning of the digestive and immune system.,
Ahara (food) is composed of Panchmahabhuta and is said to be Prana (life), which means that homeostasis of our body and mind is dependent upon the compatible diet, i.e., our diet has a direct impact on our immune system. Eating correctly is the most important aspect. Ahara, despite being a basic thing for life, is also destructive of life. A person should consume a balanced diet to keep one’s self healthy and leave longer without any risk of diseases. Ahara (food) is the most important aspect as food contributes to building of body cells and enables to fight off disease. Yuktikrit Bala (acquired immunity) is achieved with a proper diet. One of best way to enhance Bala and Ojas is through consuming proper food. Wholesome food is one of the important measures for strength, longevity, happiness. Food consumed should be Pustivardhak (nourishing), Medhya (increasing intellect) and Balya (increasing strength and immunity). Nutritious diet supports the body throughout the life for healthy growth and development.
The role of nutriments in immune system function cannot be taken for granted. The body requires appropriate food and nutrition for any cells to function and the same goes with cells of the immune system as well. A balanced diet that includes all the food groups builds the immune system and protects against infections and many other diseases. During the infection, a balanced diet containing all the essential nutrients helps to enhance the immune system and initiate an effective response against pathogens. Nutrients have an impact on the immune system causing changes in functions of immune cells and gut micro-biome. Lack of appropriate diet and nutrients impairs the immune cells and antibodies. Diet and its effect on the gut microbiome and autoimmune disease cannot be ignored. Due to molecular mimicry of food items sharing the sequence homology with human tissue can induce the autoimmune disorder. Due to lack of absorption and improper intake of food which ultimately weakens the immune system in older adults have been identified to be more prone to infections. Micronutrients deficiencies have been identified in deterioration of immunity. In a study, the relation of diet with gut microbiome and immune cells has been discussed. Diet has been targeted to gut micro-biome which includes probiotics and prebiotics when consumed in adequate amount afford the health benefit to host. Prebiotics enhances the barrier function and act as substrates for bacterial metabolism. In condition of gut inflammation in prebiotics bacteria of animal models, the reduction in pro-inflammatory Th1 and Th 17 cytokins such as IL-17 and IFN- and increases the production of resolving cytokines IL-10 was observed. Breast milk is the ultimate food for infants, and development of the immune system is influenced by feeding, its immuno-active components are active component in immune system maturation. Studies also show that the newborn rats when provided with supplement as oral gavage the fibroblast growth factor-21, epidermal growth factor and transforming growth factor-2 can change lymphocyte phenotypes. Polyphenols (present in some of the naturally occurring vegetables, fruits, cereals, dry legumes and spices such as turmeric, apples, avocadoes, apricots, spinach blueberries etc.) acts as immunomodulatory and anti-inflammatory agents. The link between the nature of diet adopted and autoimmunity is also reported. The relation between food and disorder is also related to the increased IgM, IgA, and IgG against food protein such as milk, fish, pork, wheat, lectins, and agglutinins. Studies suggest that adopting Mediterranean diet have a useful effect on rheumatoid arthritis which affects the immunity of an individual.
Vyayama (Physical Activity/Exercise)
Vyayama is any physical activity that enhances the strength of body. Any Karma (action or movement) which brings Ayasa (exhaustion) is called as Vyayama.Vyayama which will be called as physical activity has to be done in proper measure. As per the classical text of Ayurveda physical activity, not only maintains health but also reflects its ill effects if done excessively and inadequately. The balance has to be stuck in both which stimulates the rejuvenation and immunomodulation of the body. It helps in maintaining the balance between three Dosha (regulatory functional factor of the body- Vata, Pitta, Kapha) enhances Ojas, stimulates Agni (digestive and metabolic strength) and maintains homeostasis in general. It maintains a healthy weight, bones, muscle strength, psychological well-being and strengthens the immune system. It is also said that anyone who performs daily exercise, can digest any kind of food. According to Ayurveda treatises, lack of exercise leads to Prameha VyadhiSthoulya. All of this shows how it helps in preventing the disease. Acharya Charaka defined Vyayama as Balavridhikarbhava i.e immune enhancer. Acharya Susruta has said that the function of Oja is Sthirupachitamansata (well-nourished compact muscle) and assessment of Bala (strength) is done by Vyayama Shaktipariksha (evaluation of body strength). This indicates the link between physical exercise or activity and immune mechanism.
Scientifically, the individual variations in response to exercise have been recorded. The genetic variation in response to exercise, stamina in relation to Prakriti and immunity of individual can be inferred. The immune response of exercise in health is like an increase in the number of leucocytes, catecholamine’s and later by cortisol during exercise. There are indications that those who exercise regularly develop a strong defense mechanism. It has also been reported that adopting a habit of daily physical activity produce neuro-immunoendocrinological modulations causing a change in metabolism of various tissue which can also be related to balancing nature of exercise on Tridosha (three fundamental energies or principles which governs the function of our body). The study was conducted on sedentary obese women suffering from upper respiratory tract infection in two groups, it was observed that those who took regular exercise were less prone to infection than those who remain inactive. The randomized controlled study of 36 sedentary females underwent 45 minutes/session walking of 15 days for a duration of 6 weeks, 57% increase in NKCA (Natural killer cell activity-innate lymphocyte important for an early and effective immune reaction against infection)was observed compared to control group. Published literature of human studies has also shown significant improvement in NKCA with exercise training.
Nidra (sleep) is one of Trayopastambhas (three great subsidiary pillars) on which a person’s health is firmly balanced. As per Ayurveda to determine the basic function of sleep Dosha plays a very important role. The dominance of Vata Dosha creates a disturbance in sleep quality and Kapha helps in quality sleep. Sleep is essential factors responsible for a healthy life, provides nutrition to maintain good health. Quality sleep is a reflector of a good health-supporting good immune system and stress reliever. The body and nervous system convalesce in a condition of sleep. It improves digestion, restores the natural equilibrium of body tissue. In a condition of sound sleep, the hormone that controls appetite, energy metabolism and glucose metabolism is secreted by the body and less sleep disrupts these and other hormones. The quality of sleep has a strong relation with immunity and strength of the body. Nidra increases the Kapha Dosha and Kapha means Bala. The word Vyadhikashamatva is attributed to Kapha Dosha in Ayurveda. In the condition of Nidranasha, Bala is reduced. This shows a strong association between the immune system and Nidra (sleep).
The body’s health and immune function is maintained by sleep as well and is the master co-coordinator between body, mind health and immunity. There is a relation between Dosha, Nidra (sound sleep) and immunity. The unique thing in Ayurveda is that major Dosha involved in the Prakruti of an individual determines the quality sleep and immune system. The concept of sleep is being used in different diagnostic criteria’s including different scales for diagnosing a variety of disorders. It is observed that individual with increased Vata Dosha takes more time to fall asleep and individual with imbalanced Vata Dosha are likely to be more prone to infection and weak immune system. Good sleep is essential for an individual to enhances longevity. According to a new highlight homeostasis of the immune system is regulated by the circadian system and sleep. 11 pairs of identical twins were studied for different sleep patterns through blood samples collection and a depressed immune system was observed in twin with shorter sleep duration compared to sibling with sound sleep and also had a strong immune system. It is also reported that, when sleep-deprived people were given vaccine, a low antibody response was noted. The likelihood of getting an infection is more in sleep-deprived people who were exposed to rhinovirus. In another study, the CNS along with other systems like respiratory, endocrine is infected by infectious diseases related to sleep disorders under immune response. Few studies establish the relation between sleep and circadian rhythm and its effect on the human immune system. Production of pro-inflammatory cytokines (IL-2) and naïve T-cells are at peak during night time, whereas cytotoxic effectors leukocytes and anti-inflammatory cytokine (IL-10) producers are at spike during the daytime. Thus the circadian system and sleep evoke an endocrine array, beneficial in convincing changes in leucocytes and shift in pro-inflammatory cytokines during the night period of sleep.
Satva (Mental Strength)/Psychological Well-Being
A new branch of medical sciences known as—“Psychoneuroimmunology” is developing, which studies the interrelationship of psychological factors, nervous system and immune system. According to Ayurveda, Satva is one among three distinct categories called Triguna and is an integral component of mind and energy requirement for creation. The mental characteristics of an individual are determined by the predominance of one or another Triguna (three primary attributes) Satva of the human being is significant to maintain the homeostasis within the body. Ayurveda describes three types of Satva i.e superior (Pravara), medium (Madhyam) and inferior (Avara). Among all those with superior Satva or Pravara Satva, Sara Purusha (a person with strong mental strength) is able to withstand physical and psychological stress and these patients show a good response in treatment. In Ayurveda by following Sadvritta for positive health and control of senses, if practiced simultaneously fulfills two objectives—maintenance of positive health and control over sense organs. And also explained the forbidden codes of conduct and Achara Rasayana which helps in maintaining proper Satva. To combat any disease condition, the mental well-being is given utmost importance for early recovery which directly or indirectly shows a strong immune response. According to Ayurveda, Yoga helps in the development of Satva Guna which heals the body, brings happiness, positive approach towards life and determines the strong Satva of an individual.
Satva i.e. mental strength/psychological well-being increase the immune response and enhance resistance towards diseases. The immune response depends upon the psychological status of an individual. Cohen et al. in the immunization course gathered information about the connection of antibody response and psychological stress. Some literature also supports the hypothesis that individual with emotional affective style is at risk to develop diseases. Another study evaluated the level of phagocytes shows immune reaction on inflammatory response and later on, a lot of additional phagocytes might have accelerated wound healing. As a result, for preschool kid development the time required for hospital stay became shorter. Another adequate way to induce psychological well-being is by educating the primary caregiver. It was reported that in the subjects of human immunodeficiency virus/acquired immuno deficiency syndrome (HIV/AIDS), spiritual coping and communal hold as an effort towards mental stability /psychological well-being showed to boost the immune responses, increased health quality of life (HRQoL). A study conducted on three populations of cancer subjects and studied the effect of singing on immune responses, mood and stress. As sign cortisol, oxytocin, beta-endorphin and 10 cytokines obtained from saliva and results showed a positive response. All these studies suggest the good impact of mental well-being on the immune system.
Rasayana shows its effect on prevention and curative purpose. Immunomodulation may be taken as a prime mechanism to be related to effect of Rasayana therapy. As per Ayurveda, the aging and environmental factors may be a prime cause of most of the disease while the other cause may be very well avoided only by having healthy living styles. Ayurveda is the ancient science that has an answer for slowing down the process of aging successfully. Rasayana drugs provide a defense mechanism against diseases (Vyadhi) and decelerate down the aging process (Jara) and in the body. Rasayanas progress the host resistance of an individual and keep the physical and mental status of an individual in a healthy way and helps the individual to cope up effectively and place oneself efficiently in the society. The diets and lifestyle as per body system are advised in Rasayana therapy. The study also claims the effect of Rasayana use in boosting the immune system of AIDS subjects. AIDS is due to the infection of HIV virus, which has the capacity to kill the T-helper cells that have a significant function to preserve the immunity of the body. After the infection with HIV virus, immunity looses, due to which pathogenic organisms invade and gradually the health deteriorates. Rasayana drugs have an important role in improving the immune system of the body, that way they may be supportive to promote the health of the person suffering from AIDS. Many such studies support the role of Rasayana in enhancing the immune system in disease conditions where immunity has major role to play. Different classification of Rasayana as per Ayurveda is depicted in [Table 1].
| Conclusion|| |
Ayurveda is a holistic science with a multi-dimensional approach and constitutes special methods to formulate good immunity. Ultimately the focus falls on Rasayana which is having immunomodulatory activity, antistress, antiaging, antioxidant, adaptogenic effect which is of extensive benefits for the present living standards. The effect of Rasayana drugs can be seen provided if there is a healthy contribution from all the other factors mentioned above. These can be considered as a set of parameters that influence the immunity of an individual as per the classical texts of Ayurveda. Quantification of these parameters is the first step in identifying and managing diseases. Further this can help the government to formulate its policies and corresponding action especially to plan and deliver efficient health care to millions of individuals who have poor nutrition and immunity levels. This can also serve as a preventive strategy as invariably lower immunity levels are an ideal recipe for contraction of diseases.
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| References|| |
Flores M, Glusman G, Brogaard K, Price ND, Hood L P4 medicine: How system of medicine will transform the health care sector and society. Pers Med 2013;306:640-3.
Sastry VLN Kaumarabhrtyam (Paediatrics in Ayurveda) Chapter-7-Immunity and Immunization (Vyadhi ksamatvaka Sakti-Tat Prakriyas). Chaukhambha Orientalia Varanasi. Edition 2009, p. 131.
Gowda S Ayurvedeeya Shareera Kriya Vijnyana. Revised ed. Rhotak: Nath Pustak Bhandar; 1993. p. 29.
Shastri R, Upadhyaya Y, Pandeya GS, Gupta B, Mishra B, editors. Charaka Samhita of Charaka, Sootra Sthana; Kiyantashiraseeya Adhyaya. 25th ed. Ch 17 Verse 117. Vol. 1. Varanasi: Chaukhambha Bharati Academy; 1995. p. 366.
Tripathi JS, Singh RH The concept and practice of immunomodulation in ayurveda and the role of rasayanas as immunomodulators. Anc Sci Life 1999;19:59-63.
Agnivesha, Charaka Samhita with Ayurveda Dipika Commentary, Ed. Acharya YT, reprint. Varanasi: Chaukhambha Surbharti Prakshan; 2009. p. 178.
Sharma RK, Das VB. Editor Charaka Samhita of Agnivesa, Chikitisa Sthan; Grahani Dosa Adhyaya: Chapter 15, Verse 3, Varanasi: Chaukhamba Krishnadas Academy, 1 ed. Vol. IV, 2009. p. 1-2.
Brahmanand Tripathi, Ganga Sahay Pandey, editor, Charak Samhita, Charak Chandrika Hindi commentary, Chaukhamba Surbharti Prakashan, 2007. p. 355.
Acharya YT Charaka Samhita, repr., Sutrasthana, Chapter 21, Sootra 50, Chaukhamba Orientalia, Varanasi, 2007, p. 119.
Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 4, edited by Singhal et al
., 2nd ed. Varanasi: Choukhambha Surbharati, 2002.
Ambikadutta Shastri, editor, Sushruta Samhita, Chaukhamba than, Varanasi, 2007. p. 107.
Acharya YT, Ram N Acharya Kavyatirtha Sushruta Samhita, repr., Chikitsasthana, Chapter 24, Sootra 88, Chaukhambha Surabharati Prakashana, Varanasi, 2008. p. 491.
Tripathi B, editor, AshtangaHridaya, Vidyotini Hindi commentary Chaukhambha Prakashan, Varanasi 2009. p. 175.
Sharma S Asthanga Samgraharepr., Chapter 9, Sootra 33, Chaukhambha Sanskrit Series Office, Varanasi, ISBN: 978-81-7080-186-9, p. 92.
Byadgi PS Vyadhiksamatwa. Parameshwarappa’s Ayurvediya Vikriti Vigyan & Roga Vigyan, 1st ed. Volume 1. Varanasi: Chaukhambha Sansktit; 2007. p. 292-305.
Divya K, Tripathi JS, Tiwari SK Exploring novel concept of agni and its clinical relevance. Altern Integr Med 2013;02.
Masram P, Chaudhary S, Patel KS, Kori VK, Raja Gopala S A brief review on Ayurvedic concept of immunity and immunization. Ayurpharm Int J Ayur Alli Sci 2014;3:230-40.
Vighi G, Marcucci F, Sensi L, Di Cara G, Frati F Allergy and the gastrointestinal system. Clin Exp Immunol 2008;153(Suppl 1):3-6.
Round JL, Mazmanian SK The gut microbiome shapes intestinal immune responses during health and disease. Nat Revi Immunol 2009;9:313-23.
Cario E Toll-like receptors in inflammatory bowel diseases: A decade later. Inflamm Bowel Dis 2010;16:1583-97.
Sipos F, Fűri I, Constantinovits M, Tulassay Z, Műzes G Contribution of TLR signaling to the pathogenesis of colitis-associated cancer in inflammatory bowel disease. World J Gastroenterol 2014;20:12713-21.
Broderick NA A common origin for immunity and digestion. Front Immunol 2015;6:72.
Tauber AI Metchnikoff and the phagocytosis theory. NatRevMolCellBiol 2003;4:897-901.
McFall-Ngai MJ Adaptive immunity: Care for the community. Nature 2007;445:153.
Matarese G, La Cava A The intricate interface between immune system and metabolism. Trends Immunol 2004;25:193-200.
Thakur R, Kumar N, Nanda GC Role of Gudadi Modak in the management of Amlapitta W.S.R to diet and lifestyle. Int J Ayurveda Pharm Res 2017;5:14-9.
Byadgi PS Vyadhikshamatwa: Parameswarappa’s Ayurvediya Vikriti Vigyan & RogaVigyan, Varanasi, India: Chaukhambha Sanskrit Sansthan; 2007. p. 292-313.
Childs CE, Calder PC, Miles EA Diet and immune function. Nutrients 2019;11:1933.
Vojdan A, Gushgari LR, Vojdani E Interaction between food antigens and the immune system: Association with autoimmune disorders. Autoimmun Rev 2020;19:102459.
Maggini S, Pierre A, Calder PC Immune function and micronutrient requirements change over the life course. Nutrients 2018;10:1531.
Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al
. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics Consensus Statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11:506-14.
McKeen S, Young W, Mullaney J, Fraser K, McNabb WC, Roy NC Infant complementary feeding of prebiotics for the microbiome and immunity. Nutrients 2019;11:364.
Santiago-Lopez L, Hernandez-Mendoza A, Mata-Haro V, Vallejo-Cordoba B, Wall-Medrano A, Astiazaran-Garcia H, et al
. Effect of milk fermented with lactobacillus fermentum on the inflammatory response in mice. Nutrients 2018;10:1039.
Donovan SM, Comstock SS Human milk oligosaccharides influence neonatal mucosal and systemic immunity. Ann Nutr Metab 2016;69(Suppl 2):42-51.
Torres-Castro P, Abril-Gil M, Rodríguez-Lagunas MJ, Castell M, Pérez-Cano FJ, Franch À TGF-β2, EGF, and FGF21 growth factors present in breast milk promote mesenteric lymph node lymphocytes maturation in suckling rats. Nutrients 2018;10:1171.
Yahfoufi N, Alsadi N, Jambi M, Matar C The immunomodulatory and anti-inflammatory role of polyphenols. Nutrients 2018;10:1618.
Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P The gut-joint axis: Cross reactive food antibodies in rheumatoid arthritis. Gut 2006;55:1240-7.
Nielsen SM, Zobbe K, Kristensen LE, Christensen R Nutritional recommendations for gout: An update from clinical epidemiology. Autoimmun Rev 2018;17:1090-6.
Pedersen BK, Toft AD Effects of exercise on lymphocytes and cytokines. Br J Sports Med 2000;34:246-51.
Nash MS Exercise and immunology. Med Sci Sports Exerc 1994;26:125-7.
Nieman DC, Nehlsen-Cannarella SL, Markoff PA, Balk-Lamberton AJ, Yang H, Chritton DB, et al
. The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 1990;11:467-73.
Nehlsen-Cannarella SL, Nieman DC, Balk-Lamberton AJ, Markoff PA, Chritton DB, Gusewitch G, et al
. The effects of moderate exercise training on immune response. Med Sci Sports Exerc 1991;23:64-70.
Fiatarone MA, Morley JE, Bloom ET, Benton D, Solomon GF, Makinodan T The effect of exercise on natural killer cell activity in young and old subjects. J Gerontol 1989;44:M37-45.
Acharya YT Charaka Samhita, repr. Sutrasthana, Chapter 11, Sootra 35, Chaukhamba Sanskrit Orientalia, Varanasi, 2007, p. 74.
Chen M-Y, Wang EK, Jeng Y-J Adequate sleep among adolescents is positively associated with health status and health-related behaviors. BMC Public Health 2006;8:59.
Division of Sleep Medicine at Harvard Medical School. Sleep and Disease Risk.http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk [Last accessed 2013 Aug 29].
Bhushan P, Kalpana J, Arvind C Classification of human population based on HLA gene polymorphism and the concept of Prakriti in Ayurveda. J Altern Complement Med 2005;11:349-53.
Thakur R, Nanda GC, Pratibha CK, Pattnaik J Prospective approach on diagnosis and management of Nidravikara (sleep disorder/insomnia) in Ayurveda. Int J Res AYUSH Pharmaceut Sci 2017;1:46-51.
Telles S, Pathak S, Kumar A, Mishra P, Balkrishna A Ayurvedic doshas as predictors of sleep quality. Med Sci Monit 2015;21:1421-7.
Coogan AN, Wyse CA Neuroimmunology of the circadian clock. Brain Res 2008;1232:104-12.
Watson NF, Buchwald D, Delrow JJ, Altemeier WA, Vitiello MV, Pack AI, et al
. Transcriptional signatures of sleep duration discordance in monozygotic twins. Sleep 2017;40:zsw019.
Spiegel K, Sheridan JF, Van Cauter E Effect of sleep deprivation on response to immunization. JAMA 2002;288:1471-2.
Ibarra-Coronado EG, Pantaleón-Martínez AM, Velazquéz-Moctezuma J, Prospéro-García O, Méndez-Díaz M, Pérez-Tapia M, et al
. The bidirectional relationship between sleep and immunity against infections. J Immunol Res 2015;2015:678164.
Lange T, Dimitrov S, Born J Effects of sleep and circadian rhythm on the human immune system. Ann N Y Acad Sci 2010;1193:48-59.
Tawalare K, Hedaoo G, Kothekar M, Tawalare K Use of assessment of Satva Sarata (Essence of Psyche) in prognosis of female patient of breast cancer receiving chemotherapy. Int J Complement Alt Med 2017;9:00295.
Cohen S, Herbert TB Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annu Rev Psychol 1996;47:113-42.
Cohen S, Miller GE, Rabin BS Psychological stress and antibody response to immunization: A critical review of the human literature. Psychosom Med 2001;63:7-18.
Barak Y The immune system and happiness. Autoimmun Rev 2006;5:523-7.
Wu CH, Gau BS Nursing care of a preschool-age child with cellulites induced by phagocyte deficiency. Hu li Za Zhi. J Nursing 2010;57(2 Suppl): S16-21.
Dalmida SG, Koenig HG, Holstad MM, Wirani MM The psychological well-being of people living with HIV/AIDS and the role of religious coping and social support. Int J Psychiatry Med 2013;46:57-83.
Fancourt D, Williamon A, Carvalho LA, Steptoe A, Dow R, Lewis I Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. Ecancermedicalscience 2016;10:631.
Sharma H, editor. Sharngadhara Samhita of Sharngadharacharya. Varanasi: Chaukhambha Orientalia; 2008. p. 37.
Das Banamali, Kori VK, Baghel MS Concept of Rasayana therapy with special references to AIDS. AYU 2009;30: 238-42.
Lai PK , Roy J In: Mishra LC, editor. Scientific Basis for Ayurvedic Therapies. New York: CRC Press; 2004; p. 1-15, 68.