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| EDITORIAL |
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| Year : 2013 | Volume
: 32
| Issue : 3 | Page : 131-133 |
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Papaya, dengue fever and Ayurveda
P Ram Manohar
Director and Chief Scientific Officer, AVP Research Foundation, Coimbatore, Tamil Nadu, India
| Date of Web Publication | 17-Dec-2013 |
Correspondence Address:
P Ram Manohar
Director and Chief Scientific Officer, AVP Research Foundation, Coimbatore, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0257-7941.122994
How to cite this article:
Manohar P R. Papaya, dengue fever and Ayurveda. Ancient Sci Life 2013;32:131-3 |
In recent times, there have been heated discussions and debates on the efficacy of papaya leaves in management of dengue fever especially in increasing platelet count in dengue patients with low platelet count and those who develop hemorrhagic dengue fever.
There has been widespread reporting on the efficacy of the use of papaya leaves in dengue fever, at times appearing in the media in India and especially the state of Kerala. There have also been reports of untoward effects after ingestion of papaya leaves by some patients.
The reaction from the biomedical community been mixed, with some advocating for its use and others contending that there is no evidence for the efficacy of the use of papaya leaves in management of dengue fever. In principle, for a drug to be formally accepted in biomedicine, adequate pre-clinical and clinical researches are expected to be done, the active principles are expected to be screened and a more active and purer version of papaya as a drug is to be developed. There is also the question as to whether the natural increase in platelet counts seen in many dengue patients is being mistaken as the effect of papaya leaves.
It is difficult to judge what the overall response has been from the Ayurvedic community. However, since papaya is a plant and it is used in a natural form, it appears that most of the Ayurvedic physicians may not find it difficult to advocate its use. On the other hand, some Ayurvedic physicians are likely to raise the doubt as to whether papaya has been understood adequately in Ayurvedic terms so as to be used as part of Ayurvedic interventions.
Be that as it may, in states like Tamil Nadu, Siddha physicians have come forward to promote the use of papaya, Andrographis paniculata and other herbs to combat dengue fever and this paniculata? move is reportedly being promoted by the Government of Tamil Nadu.
In these circumstances, it is important to make sense of the situation. Should we dismiss papaya as just another story that will disappear like a few other spurious claims in the medical field that surface from time to time? Or is there something in papaya can be of use in the current clinical practice? Or is it necessary for the Ayurvedic community to explore the potential clinical benefits and uses of Papaya?
The claim that there have been no studies on the therapeutic efficiency of Papaya in dengue fever doesn't stand the trial of truth. Search on the PubMed database returns details of five studies including pre-clinical and clinical research on the therapeutic effects of papaya leaves.
One study found that the papaya seed was toxic to the Aedes aegypti mosquito, which is a vector for the etiologic agents of both yellow and dengue fever. [1] Another study reported that in in vitro models, papaya leaves demonstrated significant inhibition of hemolysis. [2] A third study in mice revealed significant increase in thrombocyte counts compared to the controls. [3] There is one clinical study, which is a randomized controlled trial in 228 patients that reported significant increase in platelet production in patients with dengue and dengue hemorrhagic fever after administration of papaya leaves. [4] The fifth study is a case report on a single patient with dengue fever showing significant increase in platelet count after administration of papaya leaves. [5]
From the point of view of biomedicine, these studies may not represent substantive evidence. It can be argued that the phytochemistry and pharmacology of papaya has not yet been satisfactorily understood. It can be pointed out that double blind placebo controlled studies have not been conducted and trials need to be done in larger number of patients. However, all this does not mean that papaya should be dismissed altogether. It only shows the need for more studies before a final verdict can be passed. If we go by the guidelines issued by Oxford Centre for Evidence-based Medicine, the current usage of papaya is supported by evidence levels 5 (Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles") and 2b Individual cohort study (including low quality randomized controlled trial; e.g., <80% follow-up). And the grade of recommendation for clinical use would be D or C at the most. [6] So, we cannot say there is absolutely no evidence supporting the use of papaya.
While papaya is "a study in progress" as far as biomedicine is concerned, the situation in Ayurveda must be examined in its own right. What do the modern studies and findings mean for Ayurveda? Is there enough justification and rationale for Ayurvedic physicians to use papaya leaves for dengue fever?
We cannot consider that the reported studies on papaya alone give sufficient ground for its use as an Ayurvedic medicine. At the outset we must realize that papaya is not mentioned in the classical Ayurvedic texts. The plant itself is not of Indian origin. However, that does not mean that there can be no basis for Ayurvedic practitioners to use papaya. The classical texts assert emphatically that there is no substance in the world that does not have medicinal properties and that we must search in all corners of the earth to discover medicinal plants. Therefore, if adequately understood, papaya can be used in Ayurveda. However, modern studies cannot be the ideal method to evaluate papaya from an Ayurvedic perspective. According to the classical texts a plant or any other drug source that has not been adequately understood in terms of its nomenclature, identity, properties and applications has a great chance of being wrongly used and hence leading to untoward effects. [7] Therefore, the question arises as to whether papaya has been understood adequately in these Ayurvedic terms. If we look at the early modern writings of Ayurveda, we can see that attempts have been made to incorporate and describe papaya from an Ayurvedic perspective. It has been named as Eranda Karkati, which literally means the "Castor Cucumber" because the leaves resemble that of the castor plant and the fruit that of cucumber. [8] Its properties and applications have been described in a limited way but there is no mention of its potential use in conditions like dengue fever. It is not just enough to give a name and describe the properties of papaya from the Ayurvedic perspective. The incorporation of a plant as a drug source becomes complete in Ayurveda only when its applications are well developed and described. For example, we need to have a clear understanding on which dośa (functional principles) and dhaātu (tissues) will it work, what are the desirable and undesirable effects, with which other herbs it should be combined to make a balanced formulation and in which dosage form should it be administered as well as the ways in which it has to be formulated. Apart from this, it is also important to find out as to which stages of diseases and on what types of patients can it be administered. At this point of time, we have to admit that this complete knowledge in case of papaya has not been fully developed from an Ayurvedic perspective. Yet another important point to be considered is the possibility of different parts of the papaya plant having different properties. For instance, the ability to increase the platelet count has been attributed only to the leaves and not the fruits or seeds. There could also be a difference in the properties of unripe and ripe papaya, which is important from an Ayurvedic perspective.Further studies to isolate active principles will not be very helpful to expand the understanding and uses of papaya, though they may lead to valuable clues. While modern drug development takes the route of isolating active alkaloids from the crude plant, Ayurveda takes the route of developing complex formulations including simple extracts by combining it with other herbs and subjecting it to complex processing methods.
In sum, we conclude that whether it be from the biomedical point of view or from the Ayurvedic perspective, there is a need to conduct more studies, observations and investigations to gain a thorough understanding of the uses of papaya in not only dengue fever but perhaps other diseases also. In the meantime, its empirical use may continue in a limited way as physicians continue to explore more safe and effective ways to tackle epidemic diseases like dengue fever and its complications.
| References | |  |
| 1. | Nunes NN, Santana LA, Sampaio MU, Lemos FJ, Oliva ML. The component of Carica papaya seed toxic to A. Aegypti and the identification of tegupain, the enzyme that generates it. Chemosphere 2013;92:413-20. 
[PUBMED] |
| 2. | Ranasinghe P, Ranasinghe P, Abeysekera WP, Premakumara GA, Perera YS, Gurugama P, et al. In vitro erythrocyte membrane stabilization properties of Carica papaya L. leaf extracts. Pharmacognosy Res 2012;4:196-202.
[PUBMED] |
| 3. | Sathasivam K, Ramanathan S, Mansor SM, Haris MR, Wernsdorfer WH. Thrombocyte counts in mice after the administration of papaya leaf suspension. Wien Klin Wochenschr 2009;121 Suppl 3:19-22.
[PUBMED] |
| 4. | Subenthiran S, Choon TC, Cheong KC, Thayan R, Teck MB, Muniandy PK, et al. Carica papaya leaves juice significantly accelerates the rate of increase in platelet count among patients with dengue fever and dengue haemorrhagic fever. Evid Based Complement Alternat Med 2013;2013:616737.
[PUBMED] |
| 5. | Ahmad N, Fazal H, Ayaz M, Abbasi BH, Mohammad I, Fazal L. Dengue fever treatment with Carica papaya leaves extracts. Asian Pac J Trop Biomed 2011;1:330-3.
[PUBMED] |
| 6. | Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, et al. Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Oxford Centre for Evidence-Based Medicine. Available from: http://www.cebm.net/index.aspx?o=5653. [Last accessed on 2013 Jul 12].
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| 7. | Yadavji TA, editor. Caraka Samhita. New Delhi: Munshiram Manoharlal Publishers; 1992. p. 13.
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| 8. | Linn CP, Nambiar PK, Nambiar VP, Ramankutty C. Indian Medicinal Plants a Compendium of 500 Species. Vol. 1. Chennai: Orient Longman Private Limited; 2003. p. 383-5.
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