Abstract

Excellent memory, extraordinary intelligence, great academic achievement, and successful career are the dreams of every individual in this era of competition and professionalism. A good memory power acts as a catalyst in all walks of life, be it academic success or maintenance of personal relationships. It is observed that an average man uses only 10% of his natural memory. Remaining 90% is left unused in a haphazard manner. As per the American psychologist Carl Emil Seashore, if one is alert and makes systematic attempts to awaken and use the natural memory properly, his/her natural memory would be activated creatively and would offer benefits of higher order. A comparative study was conducted comprising 90 subjects to know the efficacy of Medhya Rasayana and Yogic practices in short-term memory of school-going children. The study was conducted over a period of 3 months. It was an open, prospective, and randomized clinical study. The subjects of group A formed the control group and they were observed silently for 3 months without any intervention. The subjects in group B were administered with Choorna (powder) of four Medhya Rasayanas, Mandukaparni (Centella asiatica Linn.), Yashtimadhu (Glycyrrhiza glabra Linn.), Guduchi [Tinospora cordifolia (Willd.) Miers ex Hook. f. and Thoms.], and Sankhapushpi (Convolvulus pluricaulis Choisy), at a dose of 2 g twice daily with milk. Subjects belonging to group C were advocated regular Yogic practices of Asanas, Pranayama, and Dhyana. Further study revealed that among the three groups, group B treated with Medhya Rasayana showed highly significant and most effective changes with respect to objective parameters in the tests, i.e. (1) short-term memory test pictures and (2) serial recall effects test using memory scope. Among the three groups, group C treated with Yogic practices showed highly significant and most effective changes with respect to subjective and objective parameters in mini mental status scale i.e. test 3. The treatment is cost effective and devoid of side effects, which can be beneficial for the community. Mean increase after first follow-up in group B was higher as compared to group C. This shows that Medhya Rasayanas are quick in action and bring about improvement in memory faster when compared with Yogic practices. So, on the whole, group B can be considered to be the most efficient among the three groups.

1. Introduction

In the present era, individuals are overloaded with stress, tension, anxiety, and lack of sleep, which adversely affect the memory of most individuals. It is very common even in children. The prevalence of attention-deficit hyperactivity disorder (ADHD) among children of age group 11-17 years was 2.1%, anxiety disorders was 6.9%, and depression was 2.1% in the US in 2007.^[1] Also, the prevalence of overall mental illnesses is 12.5% in 0-16 year age group, prevalence of anxiety disorders in developed countries is on an average 8% (2-24%) and in India, it is 4.1% among 4-16 year olds.^[2] The prevalence of attention-deficit hyperactivity syndrome is 1.7-17.8% in India. Hence, it very essential to manage these mental faculties affecting the short-term memory of children by advocating Medhyna Rasayanas and Yogic practices as mentioned in our ancient classics.

Daily use of Medhya Rasayana is not only good for memory but also good for promotion of mental health. Yogic practices reduce stress in life and enhance lifespan along with increasing memory. Hence, the present research work has been designed to know the relation between Prakritiand Sara of children with short-term memory of school-going children, to evaluate the effect of Medhya Rasayana on the improvement of short-term memory and maintenance of health and to evaluate the effect of Yogic practices in the improvement of short-term memory among school-going children.

2. Materials and Methods

Approval was obtained from the departmental research committee and ethical committee of the institute. This study was conducted at a school, and subjects attending the OPD in an Ayurvedic institute were the participants. Consent was obtained from the school authorities and parents of the children participating in the study.

Research design

The study involved intragroup comparison as well as intergroup comparison of three groups A, B, and C. It was an open, prospective, and randomized clinical study.

Inclusion criteria

Age, 10-16 years; sex, both sexes.

Exclusion criteria

Age below 10 years and above 16 years, mental retardation, epilepsy, any systemic disorder.

Study design and treatment schedule

In this study, 90 subjects were selected after taking consent from school authorities and parents. The 90 subjects were divided into three groups with each having 30 subjects. General history, general physical examination, and systemic examinations were done to rule out any illness. Selected questions from Hamilton's Stress Index questionnaire were also used to rule out any major stress among the subjects. The groupings were as follows:

Group A: Control group

Group B: Medhya Rasayana

Group C: Yogic practices.

Group A: This was the control group. No treatment was given to this group.

Group B: Subjects treated with Medhya Rasayana. Medhya Rasayana consists of Mandukaparni (Centella asiatica Linn.) (Panchanga), Yashtimadhu (Glycyrrhiza glabra Linn.) (root), Guduchi [Tinospora cordifolia (Willd.) Miers ex Hook. f. and Thoms.] (stem), and Sankhapushpi(Convolvulus pluricaulis Choisy) (Panchanga).^[3] These four raw drugs were identified by the experts in the Department of Dravyaguna. After identification, they were taken in equal proportion and made into Suksmacurna (fine powder). Subjects of this group were advised to take Medhya Rasayana 2 g twice daily with milk for 3 months. The combination comprised of fine powder of the above-mentioned four MedhyaRasayana drugs, milk powder, and sugar powder in the ratio 2:1:1. Totally 4 g of medicine (Medhya Rasayana 2 g, milk powder 1 g, and sugar powder 1 g) was given in one dose. These drugs were mixed with milk powder and sugar powder to increase the palatability of the drug, so that children could consume it easily. This combination was used as the subjects were school-going children. Medhya Rasayana was given in the morning and evening with milk.
Group C: Subjects treated with Yogic practices. They were asked to practice Yogic practices regularly in the following order.

General schedule for yoga

a.Joint movements: 5 rounds each/day Toes- flexion and extension, foot- flexion and extension, ankle- rotation, knee- rotation, hip- rotation, finger- flexion and extension, wrist- rotation, elbow- flexion and extension, shoulder- rotation, neck- rotation

b.Standing Asanas: 5 rounds each/day Tadasana, Tiryaka Tadasana, Vrukshasana, Virabhadraseana, Trikonasana

c.Pranayama- Anuloma-Viloma- 15 rounds/day, Bhramari- 10 rounds/day, Omkar Dhyana- 15 min/day

d.Shatkarma- Kapalabhati- up to 100 rounds/day.

Assessment criteria

The following criteria were used to evaluate the improvement:

1. Short-term memory test - Pictures
2. Serial effects test - Words
3. Mini Mental State Scale.

Short-term memory test - pictures (test 1)

A sheet containing 20 pictures was provided to the subjects. A 2-min time schedule was provided to memorize the pictures and the sheet was collected back. The subjects were then asked to write down the names of pictures on a blank sheet within 2 min. A sheet containing a new set of 20 pictures was provided at each follow-up so as to avoid remote memory effect. Test 1 was done manually and scoring was out of 20.

Serial recall effect test - words (test 2)

This test was done with the help of Digital Memory Scope MD-100, a microprocessor-based instrument designed primarily for testing the memory of subjects. A set of 10 words was shown to each subject and he/she was asked to reproduce the words in the same order as it was shown at the same time duration. For every wrong answer, the esc key was pressed. At the end of the test, the screen displayed the score. For each follow-up, a new set of 10 words was used to avoid repetition. Test 2 was scored out of 20.

Mini mental status examination (test 3)

This test, designed by Folstein, assesses the mental status of a subject through a questionnaire, regarding orientation about date, time, place, season, and factors, along with mental stress if any, which directly affects the short-term memory and performance at the school. Some questions regarding reproducing of numbers in the same and reverse order also help to assess the recollection capacity or memory of an individual. Some questions also analyze the writing skills of an individual. Test 3 was scored out of 30.

3. Observations and Results

The collected data were computed in Microsoft Excel sheet showing various variables, and analysis was done using statistical software SPSS version 16.0. The demographic profile and personal characteristics were collected. Intragroup comparison was done by paired t-test to compare initial and various follow-ups. Independent sample t-test was done and difference of means of two independent groups was calculated for intergroup comparison. Increase in mean values in test 1 in group B was 2.53 and 5.30 after the 1^st and 2^nd follow-ups, respectively, compared to the initial value, and was statistically highly significant, whereas the mean increase in group C at 1^st follow-up was 1.63 and was statistically not significant; however, the difference in a mean score of 2^nd follow-up was 4.93, which was statistically highly significant. As the mean values in groups B and C were higher compared to group A, groups B and C may be considered to be better than the control group [Table 1].

Table 1: Within-group comparison by paired t test

Increase in mean values in test 2 in group B was 1.67 and 2.27 after 1^st and 2^nd follow-ups, respectively, compared to the initial value, and was statistically highly significant. Similarly, mean increase in group C at 1^st follow-up was 0.60 and was statistically insignificant. However, the difference in a mean score at 2^nd follow-up was 1.73, which was statistically highly significant. As the increase in mean values in groups B and C was higher compared to group A, groups B and C may be considered to be better than the control group [Table 2].

Table 2: Within-group comparison by paired t test

Increase in mean values in test 3 in group B was 1.17 and 3.73 after 1^st and 2^nd follow-ups, respectively, compared to the initial value, and they were statistically significant and statistically highly significant, respectively. Whereas increase in mean values in group C at 1^st follow-up was 1.90 and 4.10 after 1^st and 2^nd follow-ups, respectively, compared to the initial value, and was statistically highly significant [Table 3]. However, when the difference between initial and 2^nd follow-up values was compared between group A and group B as well as between group A and group C, statistically highly significant results were obtained [Table 4]. Group C was considered better than the control group as the increase in mean values in C was higher.

Table 3: Within-group comparison by paired t test 

Table 4: Intergroup comparison on difference of initial and follow-up

Deterioration and weakening of memory process can be delayed by the intake of Medhya Rasayanas^[4] and by the regular practice of Yoga since childhood. Majority of children (i.e., 87.78%) belonged to 10-12 age group [Table 5]. About 51.11% subjects were males and rest were females [Table 6]. Maximum number of subjects (i.e., 83.33%) belonged to Hindu religion, followed by Muslims (i.e., 16.67%). This signifies Hindu-dominant population in and around Varanasi. About 62.22% subjects belonged to middle class, 20% to upper class, and 17.78% to lower class.

Table 5: Distraction according to age

Table 6: Distraction according to sex

In this study, maximum number of subjects had Kapha-Pittaja Deha Prakriti (i.e., 36.67), followed by Vata-Pittaja Deha Prakriti (33.33%) [Table 7]. Basically, Pitta Prakriti persons are blessed with excellence of memory,^[5] but practically, finding Eka Doshaja Prakriti persons is very difficult. Retention of the perceived object is brought about by Kapha as it is the normal function or Kapha. Pitta, having Ashukari (fast spreading) and Tikshna qualities, stimulates the mind and helps in perception of the object and recollection of previous expression. Further, people with Raktasarata and Satvasarata are naturally gifted with good memory.^[6] Regarding Samhanana, maximum subjects (54.44%) had MadhyamaSamhanana and 45.56% had Pravara Samhanana. This indicates the proper development of body due to proper intake of food and good Vyayama. Regarding Satmya, maximum subjects (62.22%) came under the Madhyama Satmya category, followed by 32.22% in PravaraSatmya. This indicates that the children consumed more than four Rasas regularly in the diet. About 61.11% subjects belonged to MadhyamaSatva, whereas 24.44% belonged to Pravara Satva and only 14.44% belonged to Avara satva. This shows that proper Satva leads to good memory. Maximum subjects were not under major stress, which was assessed by means of selected questions from Hamilton's Stress Index. Majority of subjects (i.e., 65.56%) were having Pravara Abhyavaharanashakti, while 27.78% subjects were having MadhyamaAbhyavaharanashakti. Jaranashakti was also found to be Pravara in majority of subjects (61.11%). This indicates that children are basically physically active, and because of it, their Agni is increased. Hence, they need good amount of energy through food. Majority of subjects (i.e., 55.56%) were having Madhyama Vyayamashakti. This also indicates that subjects were physically fit for doing Yoga. In this study, the effect of four Medhya Rasayanas, Mandukaparni, Yashtimadhu, Guduchi, and Sankhapushpi, was studied. These are easily available, and they are very beneficial for memory and also help in the prevention of many diseases. Medhya Rasayana was given to group B subjects at a dose of 4 g twice daily for 3 months.

Table 7: Distribution according to Deha Prakriti/i>

Mode of action of Medhya Rasayana

Medhya Rasayanas strengthen the body and maintain normal body function. Pitta Dosha maintains the intelligence and Kapha sustains the body with intelligence and Dhriti (courage) by its Sthira Guna.^[7] Pranavata performs the intellectual function and it is the main factor involved in grasping and fast recall, especially because of its Chala (mobile) and Vishada (fast-spreading) properties. Sadhaka Pitta performs functions like discrimination between right and wrong by the Nishchayatmaka Buddhi and Medha (intelligence).^[8] Medhya Rasayanas help to maintain vata, pitta, and Kapha Doshas normal functions. According to Ayurveda, Mandukaparni is Medhya by Prabhava (special effect). Mandukaparni present in Medhya Rasayana improves learning and memory processes by modulating dopamine, 5-Hydroxytryptamine receptor, and noradrenaline systems, which was also reported in a study on rats.^[9] It is also effective in preventing the cognitive deficits as well as oxidative stress.^[10] It also reduces stress which is one among the factors leading to memory impairment by reduction in raised circulating corticosterone. It also shows immune-modulatory activity and strong antioxidant activity as revealed by increased level of superoxide dismutase (SOD), glutathione peroxidase, and glutathione in mice. Ce. asiatica extract and powder may ameliorate H ₂ O ₂ -induced oxidative stress by decreasing lipid peroxidation via alteration of the antioxidant defense system in rats.^[11] Thus, it is a general health promoter. It has neuronal dendritic growth-stimulating property.^[12] This may help in enhancing concentration power, thus improving short-term memory. Asiaticoside, an active principle present in Ce. asiatica, imparts anxiolytic activity,^[13] and thus, it helps in reducing the anxiety which is one of the factors affecting the memory. Aqueous extract of Ce. asiatica Linn. is reported to be effective in preventing the cognitive deficits as well as oxidative stress caused by intracerebroventricular streptozotocin in rats.

Madhura and Shita qualities and Vatapittashamaka and Rasayana effects of Yashtimadhu bring about soothing effect, and probably this helps in bringing about Stairya and Dhriti to establish stability of mind and for enhancing memory [Table 8]. The root of G. glabra Linn. contains the active principles, glycyrrhizin, glycoside, isoliquritin, liquiritin, steroid estrogen, hispaglabridin B, isoliquiritigenin, and paratocarpin B. ^[14] Experiments showed that G. glabra Linn. increases the blood circulation to the central nervous system and balances the sugar levels in the blood. ^[15] The isoflavones glabridin and hispalglabridins A and B of G. glabra Linn. have significant antioxidant activity. The antioxidants protect susceptible brain cells from the oxidative stress, resulting in reduced brain damage and improved neuronal function, thereby enhancing the memory. ^[16]Ethanol extract of G. glabra Linn. possesses cerebroprotective effect in hypoxic rats, which may be mediated by its antioxidant effects. According to a study improvement in learning and memory of mice was observed when they were administered aqueous extract of liquorice in a dose of 150 mg/kg. This is probably due to facilitation of cholinergic transmission in mouse brain. ^[17]

Table 8: Properties of plants as per Bhavaprakash Nighantu

Guduchi, another component of Medhya Rasayana, has Katu, Tikta Rasas which help in keeping the mind alert, so that things can be remembered properly. By Tridoshahara property, it helps to establish a balance and a good coordination of grasping, retention, and recall of memory. Further, Rasayana Prabhava helps in retaining things. T. cordifolia has active principles such as tinosporone, tinosporic acid, cordifolisides A-E, syringen, berberine, giloin, gilenin, crude giloininand, arabinogalactan polysaccharide, picrotene, gilosterol, tinosporol, tinosporidine, sitosterol, cordifol, and glucan polysaccharide. The root extract of T. cordifolia was found to possess normalizing activity against stress-induced changes in norepinephrine, dopamine, 5-hydroxytryptamine, and 5-hydroxyindoleacetic acid levels. T. cordifolia enhances cognition (learning and memory) in normal rats. Cyclosporine-induced memory deficit was successfully overcome with T. cordifolia.^[18] T. cordifolia, at a dose of 500 mg daily, enhances verbal learning and memory and logical memory (of immediate and short-term type) compared to placebo in healthy volunteers.^[19] According to Burton, T. cordifolia has found a place in natural and herbal treatments of ADHD. Guduchi is shown to have antioxidant activity and amelioration.^[20] This helps in health promotion as well as preventing forthcoming diseases.

Sankhapushpi is the most effective among the four Medhya Rasayana drugs mentioned by Acharya Charaka.^[21] It has Kashaya Rasa and Ushna Guna, which may enhance the alertness and quick understanding and retention of experiences. It has Tridoshahara property. C. pluricaulis contains many phytonutrients like convolidine, convolvine, convolvidine, convoline, confoline, phyllabine, subhirsine, and scopoline. These compounds help in brain stimulation and increase the ability to concentrate.^[22] C. pluricaulis reduces anxiety and stress by controlling the production of body's stress hormones, adrenaline and cortisol. It is reported to possess anxiolytic and memory-enhancing and mood-elevating effects, and is claimed to retard brain aging.^[23] Neuroprotective role of C. pluricaulis has been proved in the study by Bihaqi et al. on aluminum-induced neurotoxicity in rat brain. The psychotropic effect of C. pluricaulis was studied by Singh and Mehta on 30 outpatients of anxiety neurosis in 1976. After 1 month of treatment, a significant reduction in the neurotic features was observed and immediate memory span was significantly improved.
Mode of action of Yoga

Due to short-term memory loss, the individual faces many problems and overall poor performance in work. Yoga can help humanity in a major way by making individuals overcome the challenges posed by loss of memory. An integrated approach to Yoga is necessary for the holistic development of memory. Tadasana develops physical and mental balance. Tiryak Tadasana balances the body as well as the mind. ^[24]Vrukshasana gives sense of balance and poise. Virabhadrasana develops concentration power. Trikonasana stimulates the nervous system and alleviates nervous depression. Kapalabhati energizes the mind for mental work and removes sleepiness,^[25] thus brings about alertness needed for the improvement of short-term memory. While performing Anuloma-Viloma, breathing through the left nostril tends to activate the right hemisphere and breathing through the right nostril activates the left hemisphere. It has calming effect and relieves anxiety, improves concentration, and stimulates Ajna cakra. The brain centers are stimulated to work nearer to their optimum capacity. Bhramari relieves stress and cerebral tension, and thus helps in alleviating anger, anxiety, and insomnia. Omkar Dhyana produces benefits at many levels of life. It simultaneously influences body, emotions, mental functioning, and relationships. Meditation also improves brain functioning, enhances the ability to focus, improves perception and memory, promotes development of intelligence, decreases craving for cigarette, alcohol, and drug abuse, along with decreasing the withdrawal symptoms, induces relaxation, and decreases stress. Meditation is an inherent ability of the human body. Meditation is an activity whereby the nervous system, brain, and senses get tuned themselves for best functioning. During meditation, the concentration on different Cakras like on Muladhara Cakra enhances health and Vidya, Manipura Cakra enhances Vidya and capacity, and on Vishudha Cakra brings about improvement in speech and knowledge. The Satvasarata state leads to excellence of memory; this state can be brought about by the regular practice of Yoga, so as to improve short-term memory.

Objective assessment

In test 1 (short-term memory test - pictures), the intergroup comparison showed that group B treated with Medhya Rasayana was most effective as the increase in mean values in the group was higher. A similar study conducted also showed marked improvement in visual reproduction of Wechsler memory scores after the practice of Yoga.^[26]

Intergroup comparison showed that group B (Medhya Rasayana) was most effective in test 2 (serial recall test). This shows that MedhyaRasayana enhances the Granthagrahana Samarthya of students.^[27] Intergroup comparison showed that in test 3, group C with Yogic practices was the most effective as the increase in mean values in the group was higher. This shows that the Yogic practices help in the improvement of mental status like relief from day-to-day stress and also help in the improvement of memory. When group B was compared with group C in test 1, the difference between the 1^st follow-up values was found to be significant. Increase in mean values after 1^st follow-up in group B was higher as compared to group C. This shows that Medhya Rasayanas are quick in action and bring about improvement in memory faster when compared with Yogic practices. So, on the whole, group B can be considered to be the most efficient among the three groups.

5. Conclusion

Medhya Rasayana helps in improvement of memory power. Yogic practices help to improve the concentration and calm the mind, resulting in memory improvement. Among the three groups, group B treated with Medhya Rasayana was highly significant and most effective with respect to objective parameters in tests 1 and 2. Further, the treatment is cost effective and devoid of side effects, so it can be applied in the community. Among the three groups, group C treated with Yogic practices was highly significant and most effective with respect to subjective and objective parameters in test 3. It is also a cost-effective, non-pharmacological intervention; so, everyone can adopt it to enhance memory as well as prevent many lifestyle disorders. Group B treated with Medhya Rasayana is most effective in improving short-term memory of school-going children among the three groups.

Acknowledgements

We are very much thankful to Prof. C. B. Jha, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi and all the teachers, staff, and junior residents of our department. Our special thanks to Shri Subhash Chandra Sharma, Principal, Kendriya Vidyalaya, BHU and Smt. Savita Jain, Principal, Malaviya Shishu Vihar, BHU for granting permission to conduct the study in their school. We heartily thank all school children and their parents for their kind co-operation, without which this work would not have been possible.

References

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About Authors:  Atul Shankar Sarokte, Mangalagowri V Rao. Atulji is Junior Resident III, Department of Swasthavritta and Yoga, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. Mangalaji is Assistant Professor, Department of Swasthavritta and Yoga, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Article available online/offline on: AYU, Vol. 34, Issue 4, Oct-Dec 2013, Page no.383-89, for more details please visit: www.ayujournal.org

Address for correspondence: Mangalagowri V Rao, Department of Swasthavritta and Yoga, Faculty of Ayurveda, IMS, BHU, Varanasi - 221 005, Uttar Pradesh India. 

No part of this article may be reproduced in full or part without written permission of the Ayu Journal who can be contacted at ayujournal@yahoo.com