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=== Untoward effects of aushadha consumed in inappropriate doses ===
=== Untoward effects of aushadha consumed in inappropriate doses ===
<div style='text-align:justify;'>The aushadha, its potency and doses should be determined after evaluating dosha, the strength of the disease, and the person. Even the use of emergency aushadha, or the aushadha with mild properties in greater doses, or treatments such as use of alkali or surgical instruments, may cause harm to patients of poor physical strength and stamina. When aushadha with doses or potency greater than the strength of disease are used, this aushadha may relieve the patient from the existing disease, but soon may generate diseases of opposite qualities. These aushadha may cause exhaustion, fainting, toxicity, delusion, and a decrease in strength; those more potent than the digestive capacity will produce exhaustion and poor digestion.<ref>Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 6. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 424.</ref></br>The drug induced toxicity can be due to either of the four causes: hypersensitivity and related immunological reactions; off-target pharmacology; biological activation to toxic metabolites; and idiosyncratic toxicities.<ref>Liebler, D., Guengerich, F. Elucidating mechanisms of drug-induced toxicity. Nat Rev Drug Discov 4, 410–420 (2005). https://doi.org/10.1038/nrd1720</ref> For example, drug toxicity by drugs administered in high doses was observed in a study in which Lauha Bhasma and Mandura Bhasma were given five times (55 mg/kg) more than therapeutic dose (11 mg/kg) for a long duration (60 days) in albino rats. The signs observed in the rats were increase in body weight, blood sugar level, serum urea level, serum creatinine level, SGOT and serum alakaline phosphatase. Moderate fatty degenerative changes, diffuse necrosis, periportal necrosis, central vein congestion and sinusoidal dilatation was observed in Lauha bhasma treated group. Mild fatty changes and sinusoidal dilatation was observed in Mandur Bhasma treated group.<ref>Sarkar, Prasanta Kumar & Prajapati, Pradeep & Shukla, Vinay & Ravishankar, Basavaiah & Chaudhary, Anand. (2009). Toxicity and recovery studies of two Ayurvedic preparations of iron. Indian journal of experimental biology. 47. 987-92.</ref></div>
<div style='text-align:justify;'>The aushadha, its potency and doses should be determined after evaluating dosha, the strength of the disease, and the person. Even the use of emergency aushadha, or the aushadha with mild properties in greater doses, or treatments such as use of alkali or surgical instruments, may cause harm to patients of poor physical strength and stamina. When aushadha with doses or potency greater than the strength of disease are used, this aushadha may relieve the patient from the existing disease, but soon may generate diseases of opposite qualities. These aushadha may cause exhaustion, fainting, toxicity, delusion, and a decrease in strength; those more potent than the digestive capacity will produce exhaustion and poor digestion.<ref>Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 6. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 424.</ref></br>The drug induced toxicity can be due to either of the four causes: hypersensitivity and related immunological reactions; off-target pharmacology; biological activation to toxic metabolites; and idiosyncratic toxicities.<ref>Liebler, D., Guengerich, F. Elucidating mechanisms of drug-induced toxicity. Nat Rev Drug Discov 4, 410–420 (2005). https://doi.org/10.1038/nrd1720</ref> For example, drug toxicity by drugs administered in high doses was observed in a study in which Lauha Bhasma and Mandura Bhasma were given five times (55 mg/kg) more than therapeutic dose (11 mg/kg) for a long duration (60 days) in albino rats. The signs observed in the rats were increase in body weight, blood sugar level, serum urea level, serum creatinine level, SGOT and serum alakaline phosphatase. Moderate fatty degenerative changes, diffuse necrosis, periportal necrosis, central vein congestion and sinusoidal dilatation was observed in Lauha bhasma treated group. Mild fatty changes and sinusoidal dilatation was observed in Mandur Bhasma treated group.<ref>Sarkar, Prasanta Kumar & Prajapati, Pradeep & Shukla, Vinay & Ravishankar, Basavaiah & Chaudhary, Anand. (2009). Toxicity and recovery studies of two Ayurvedic preparations of iron. Indian journal of experimental biology. 47. 987-92.</ref></div>
=== Examination of aushadha ===
<div style='text-align:justify;'>Even if one aushadha is known to mitigate the existing disease, it should still be examined to compare its taste, potency, taste after digestion, qualities, nature of the substance, actions, special effects, place of growth, season of collection, method of preservation, correct method of using, prohibited mode of use, methods of processing combinations, procedure of use, dosage, the type of patient for whom its meant, time of use, the actions on dosha. The best aushadha should be selected for management of the disease.<ref>Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 8. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 425.</ref></div>
=== Features of undesirable aushadha ===
<div style='text-align:justify;'>The aushadha, whose potency is either less or more in regards to disease, dosha, strength and digestive capacity, which is new or not known, which is devoid of described properties, is not mitigating the diseases, have aversion towards mind that do not completely suppresses the aggravated dosha and do not subsides the disease completely should be avoided.<ref>Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 61-62. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 370.</ref> These are disqualifying criteria for medicines. </div>
=== Features of desirable aushadha ===
<div style='text-align:justify;'>Ideal aushadha for a person is the one that is grown locally in same climatic conditions or land as that of the patient.<ref>Tripathi R.D., (1 st ed.). Commentary Saroj on Astanga Sangrah of Vridhavagabhata, Sutra Sthana; Bheshajavacharaniya Adhyaya: Chapter 23, Verse 35. Delhi: Chaukhamba Sanskrit Pratishthan, 2015; 433.</ref> The aushadha growing in a region has the properties similar to that specific place. When the aushadha and the person are of same region, then the aushadha is nearly homogenous to the constitution of the persons. Hence the chances that the body of person being considered, the aushadha as foreign matter is more, so are the chances of immune reactions against the aushadha. The aushadha of hot regions like vindhya and shaila mountains have hot potency, whereas the aushadha of cold regions like mountain ranges of Himalayas have cold potency. Moreover the aushadha that does not destroy the strength of the patient but destroys the potency of the disease is the desirable aushadha.<ref>Satyapala, editor, (1st ed.). Commentary Vidyotini of Kashyap Samhita, Khila Sthana; Bheshajyopakramaniya Adhyaya: Chapter 3, Verse 63. Varanasi: Chaukhamba Sanskrit Sansthan, 2015; 370.</ref><br/>In current scenario, the ideal criteria for selecting a medicine are:<ref>WHO criteria for the selection of essential drugs, adopted by the forty-first World Health Assembly, Geneva, Switzerland, 2-13 May 1986, in resolution WHA39.27 https://healthydocuments.org/public/healthydocuments-doc21.pdf</ref>
<ul><li>Only those drugs for which adequate scientific data are available from controlled studies should be selected.</li>
<li>Each selected pharmaceutical product must meet adequate standards of quality, including bioavailability.</li>
<li>Those medicine should be selected whose concise, accurate and comprehensive drug information drawn from unbiased sources are available.</li>
<li>Drug selection should be based on the results of benefit and safety evaluations obtained in controlled clinical trials and/or epidemiological studies.</li>
<li>Cost represents a major selection criterion. In cost comparisons between drugs, the cost of the total treatment, and not only the unit cost, must be considered. In addition, the cost of non-pharmaceutical therapeutic modalities should be taken into account.</li>
<li>Local health authorities should decide the level of expertise required to prescribe single drugs or a group of drugs in a therapeutic category.</li>
<li>The influence of local diseases or condition on pharmackinetic and pharmacodynamic parameters should be considered in making the selection e.g. malnutrition, liver disease.</li>
<li>When several drugs are available for the same indication, then such a medicine must be selected which provides the highest benefit/ risk ratio.</li>
<li>When two or more drugs are therapeutically equivalent, preference should be given to:</li>
<ol><li>the drug which has been most thoroughly investigated.</li>
<li>the drug with the most favourable pharmacokinetic properties, e.g. to improve compliance, to minimize risk in various pathophysiological state.</li>
<li>drug for which local, reliable manufacturing facilities for pharmaceutical products exist.</li>
<li>drugs, pharmaceutical products and dosage forms with favourable stability, or for which storage facilities exist.</li></ol>
<li>Fixed ratio combinations are only acceptable if the following criteria are met: </li>
<ol><li>clinical documenttaion justifies the concomitant use of more than one drug.</li>
<li>the therapeutic effect is greater than the sum of the effect of each.</li>
<li>the cost of the combination product is less than the sum of the individual products.</li>
<li>compliance is improved.</li>
<li>sufficient drug ratios are provided to allow dosage adjustment satisfactory for the majority of the population.</li></ol>
<li>New drugs should be introduced only if they offer distinct advantages over drugs previously selected.</li>
</ul></div>
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