Is the Soul Real? A Scientific, Philosophical, and Spiritual Reflection

 

Is the Soul Real?

I have received this video three times sent to me though WhatsApp 

https://youtu.be/41bIJ7hYbLs?si=ruvw9_cqohtieoHS

I was asked for my opinion if the soul exist? Actually I have written many articles about life and its mysteries here in this blog. But I shall give my comments based on the above video link by Dr. Michael Egnor.  

In the above video, Dr. Michael Egnor, a neurosurgeon e explores the evidence (2025 Dallas Conference on Science & Faith)

Since many people have asked the same question, let me independently write my personal view once again on this subject. 

The question of whether the human soul is real lies at the intersection of science, philosophy, and theology, a topic both ancient and ever-evolving. In modern times, voices like Dr. Michael Egnor, a neurosurgeon and professor at Stony Brook University, have reignited this debate, particularly within the framework of neuroscience. His provocative position, often discussed at events such as the Dallas Conference on Science and Faith, challenges materialist assumptions and asserts that evidence from neuroscience points toward the existence of a non-material soul.

The article explores the central arguments made by Dr. Egnor and others in defense of the soul’s reality, contrasts them with materialist views, and reflects on how current scientific understanding might be harmonized with a belief in the immaterial soul.

1. What Is Meant by "The Soul"?

In classical philosophy, especially as articulated by Aristotle and later by Thomas Aquinas, the soul (psyche or anima) is the form of the body, the organizing principle that gives life and unity to a living being. It is not a ghostly entity trapped inside the body, but rather its animating essence.

There are traditionally three types of souls:

Vegetative soul – present in plants (growth, reproduction)

Sensitive soul – present in animals (perception, movement)

Rational soul is unique to humans (reason, abstract thought, free will)

In religious frameworks (e.g., Christianity), the human soul is considered immaterial, eternal, and capable of surviving bodily death. The key issue is whether this view is consistent, or even supported by scientific findings.

2. Dr. Michael Egnor’s Core Argument: Consciousness Is Not Material

As a neurosurgeon, Dr. Egnor brings a rare blend of clinical expertise and philosophical insight. His central thesis is that consciousness, intellect, and will cannot be reduced to physical processes in the brain.

a. The Intellect Is Immaterial

Dr. Egnor draws heavily from Thomistic dualism. He argues:

Human beings engage in abstract thought (e.g., mathematics, justice, infinity).

Abstract concepts have no physical properties; they are not located in space, weightless, and not made of matter.

Since the brain is entirely physical, it cannot produce or contain abstract thoughts.

Therefore, abstract reasoning must be rooted in an immaterial intellect, a faculty of the soul.

b. Split-Brain Patients and the Unity of Self

Some neuroscientists argue that "split-brain" experiments (where the corpus callosum is severed) suggest a divided consciousness. Dr. Egnor counters that:

Despite some differences in motor or linguistic processing, patients retain a unified sense of self.

This supports the idea that the mind (or soul) is not strictly tied to brain hemispheres.

c. Free Will and Moral Agency

Materialism implies that all thoughts and actions are the result of deterministic brain chemistry. Dr. Egnor argues:

Free will cannot arise from deterministic material causes.

Humans experience moral agency, which presupposes the ability to choose, this points to a non-material will.

3. Scientific Challenges to the Soul’s Existence

The mainstream neuroscience view remains materialist or physicalist:

Consciousness emerges from complex neural networks.

Damage to specific brain areas (e.g., the prefrontal cortex) impairs personality, memory, or decision-making, suggesting mental processes are brain-based.
Neurological conditions like Alzheimer’s or stroke are often seen as refutations of soul-based cognition.

Materialists argue:

If a soul exists independently, why does brain damage affect memory or personality?

The "soul hypothesis" adds no explanatory power and is not falsifiable.

But proponents like Dr. Egnor respond:

The brain may be more like a radio receiver: damaging the receiver doesn’t prove the signal is gone, only that the brain is no longer properly receiving or expressing it.

The soul remains intact, but its earthly expression is disrupted.

4. Near-Death Experiences (NDEs) and Transcendent Reports

Some argue that NDEs, including verified out-of-body perceptions, offer evidence that consciousness can exist apart from the physical body. While skeptics attribute these to brain hypoxia or hallucinations, others believe they indicate:

A non-local consciousness

The possibility of conscious survival beyond death

Dr. Egnor is open to these lines of evidence as suggestive, though he primarily focuses on philosophical and neurobiological grounds.

5. Reconciling Science and Soul

Though empirical science cannot “prove” the soul, just as it cannot “disprove” it, many argue that the limits of neuroscience actually point beyond itself.

Key philosophical support includes:

Descartes’ dualism: Mind and body are distinct substances.

Kant’s noumenal self: The inner agent behind perception is unknowable but real.

Popper and Eccles’ dualist interactionism: The mind can affect the brain, suggesting a bidirectional relationship.

In Christian theology, the soul is not merely immaterial, but also created in the image of God, capable of love, creativity, and eternal communion.

The Soul Is Real and Reasonable?

While neuroscience has illuminated much about the brain’s structure and function, it has not eliminated the mystery of consciousness, free will, or personal identity. Dr. Michael Egnor’s contribution lies in demonstrating that materialist explanations fall short, and that the soul remains a philosophically coherent and even scientifically respectful hypothesis.

Rather than pitting faith against science, the soul bridges them. It acknowledges our embodied nature while affirming that we are more than neurons, we are rational, moral, and transcendent beings.

In this light, the soul is not merely a theological relic but a vital key to understanding human nature itself.

 In my personal belief, the soul is the breath of God. It is always there when a person is still alive. The breath of God does not die. It lives in your body and mine. It only leaves when the physical body dies and returns to the soil or dust. Without the soul the body cannot live. The body just dies There are many instances when a person who was born blind who has no clue what the world looks like who returned from death to describe how the world looks like and their relatives look, and although still blind after returning from the other world. How could he now "see" to describe after his soul returns to the body after death? 

How could neuroscientists claim that a dying brain was just hallucinating, But how could a brain hallucinate to see something it has never seen or experienced when he was blind since birth when he died temporary? If he was born blind how could he describe exactly what a sighted person saw even if it was due to changes in the chemistry of the brain? How could the chemistry of the brain "saw" or "see" something it has never seen or recorded before? Only a living soul can do that even if the physical body was blind. If a person was blind since birth the brain just cannot register any images. 

But on death the soul is liberated and it sees, returns to the physical body to tell exactly what he saw. When neuroscientists say they hallucinate when the brain was dying, then how could a person born blind since birth and totally has no idea what the physical world looks like, and neither the brain has any record of such images, but could now describe what he saw on returning to this world even though he was still physically blind? He couldn't have hallucinated with such a clear description of what he saw on death. When you challenge neuro scientists to explain they went dumb. I believe the soul is life to the body, and life itself is the soul - the soul of life. In the Bible, specifically Ecclesiastes 12:7, it is stated that when a person dies, the body returns to the dust from which it was made, and the spirit returns to God who gave it. 

Furthermore, when a brain is dying, it continues to die due to lack of perfusion of oxygen and perfusion of blood to the brain till it decompose, because the soul that controls its chemistry has left it unattended. But when the soul returns to the body all the chemistry of death reverses and the dead brain and dead body become a living soul once again. 

In other words it is the unseen soul within our body that makes us alive and living. We clearly see that in Genesis 2:7, and also how Jesus brought the soul of Lazarus back to his body after he was already dead for 4 days as given in John 11:39 

Let me put my personal thoughts on this age-old question from the dawn of human consciousness when people have pondered the mystery of life and asked: What is it that animates us? Are we merely the sum of our biological processes, or is there something more, something unseen, yet intimately essential to who we are?

At the heart of this age-old question lies the concept of the soul. While materialist science often attempts to explain human consciousness as the product of neurons and chemistry, a growing number of thinkers, both scientists and philosophers, are beginning to challenge that narrow view. Among them is Dr. Michael Egnor, a neurosurgeon who argues compellingly that the evidence for the soul is not only compatible with modern science, but in many ways, demanded by it.

The Soul as the Breath of God

As I put it: “The soul is the breath of God. It is always there when a person is still alive.” This poetic and profound view is deeply rooted in Scripture. In Genesis 2:7, when we read that God formed man from the dust of the ground, and “breathed into his nostrils the breath of life; and man became a living soul.” The soul, then, is not a by-product of the brain, it is the divine animating essence. Without the soul, the body lies inert, a mere shell. With it, we live, think, feel, and choose.

When a person dies, “the dust returns to the ground it came from, and the spirit returns to God who gave it” (Ecclesiastes 12:7). This passage captures the intimate relationship between the human soul and its divine origin. The soul does not perish with the body; it departs, returning to its source.

The Neuroscientific Challenge, and Its Limitations

In the modern scientific world, especially in neuroscience, many attempt to explain all human thought, emotion, and experience as arising from the brain. According to materialism, the brain is the mind, and nothing more. Consciousness is merely an emergent property of neurons firing in complex patterns.

But Dr. Michael Egnor, among others, disagrees. Drawing on both classical philosophical reasoning and clinical neurological experience, he argues that this materialist view cannot account for:

Our ability to engage in abstract thought (such as mathematics or justice), which have no physical form,

Our free will, which cannot arise from deterministic chemical reactions

Or our unified self-awareness, which persists even when parts of the brain are impaired.

The intellect, will, and consciousness, according to Dr. Egnor, are not reducible to the brain. Rather, they point to an immaterial soul, which uses the brain much like a pianist uses a piano, not the instrument itself, but the player behind it.

When the Blind "See", A Window Into the Soul

Perhaps the most striking evidence in favor of the soul’s reality comes from near-death experiences (NDEs), especially those reported by individuals who were blind from birth.

There are documented cases where such individuals, having been declared clinically dead, return to life and report vivid visual experiences. These experiences include detailed descriptions of their surroundings, of people they had never seen, and even of events occurring during their medical resuscitation. Yet upon recovery, they remain physically blind.

How is this possible?

A brain that has never processed visual information cannot "hallucinate" visual imagery. If a blind person has no concept of what “seeing” is like no retinal inputs, no occipital visual memory, then how, could they generate a hallucination of something they never experienced?

We should wisely questioned, “How could the chemistry of the brain ‘see’ something it has never seen or recorded before?”

The answer points beyond biology. The most coherent explanation is that the soul sees, even when the body cannot. In death, when the soul momentarily departs from the body, it is no longer limited by physical organs. It perceives reality as it is, clearly, vividly, and truly. When the soul returns, even to a body still blind, the experience remains and is described in astonishing detail.

These cases defy materialist explanation. They imply that our essence, our self, our consciousness, is not confined to the brain, but survives outside it.

Death and the Chemistry of Life

From a medical perspective, the brain depends on a constant supply of oxygen and blood. When the heart stops beating, perfusion ceases, and the brain begins to die. Yet, if the soul returns, there are recorded instances where death is reversed, the chemistry of decay is undone, and the body lives again.

This is not mere metaphor. In the Gospel of John, chapter 11, Jesus raises Lazarus from the dead after four days. The body had begun to decay, yet with a word, Jesus calls his soul back:

“Lazarus, come forth.” 

And he does. Life is restored, not because the body generated it, but because the soul returned.

The soul, then, is not a bystander in the drama of life, it is the director. It sustains the body, animates it, and gives it meaning. Remove the soul, and the body dies. Return the soul, and death is reversed. 

The Soul of Life: 

In light of both spiritual truth and scientific humility, we come to a powerful conclusion that the soul is real - at least to me. It is the breath of God, the spark of consciousness, the root of our identity. It transcends matter and survives the body.

The soul sees when the eyes cannot, chooses when neurons fail, and lives even when the body dies. Whether glimpsed through Scripture or revealed through the mystery of near-death experience, its presence is unmistakable. And though science may never fully capture it, the soul remains the most intimate reality we possess.

In the words of Jesus: “What shall it profit a man if he gains the whole world but loses his soul?” (Mark 8:36)

May we cherish this divine breath within us, and seek always to live with reverence for the immortal soul that makes us truly alive.

This sums up my view. 

Auscultation: A Clinical Perspective

 

Auscultation and the Stethoscope: A Clinical Perspective

by: lin ru wu alias 

lim ju boo

Introduction:

Auscultation is one of the most venerable and fundamental clinical skills in medicine, denoting the act of listening to internal bodily sounds to evaluate physiological processes and discern potential pathology. Since René Laennec's invention of the stethoscope in 1816, this technique has remained indispensable in the bedside examination of patients, particularly in the assessment of the respiratory and cardiovascular systems, as well as in the identification of vascular abnormalities such as bruits. Despite the emergence of advanced diagnostic technologies, auscultation continues to maintain a pivotal role due to its immediacy, non-invasiveness, and capacity to yield vital diagnostic insights (1,2).

Auscultation of the Respiratory System  

When appraising the thorax, auscultation enables the clinician to evaluate airflow dynamics within the lungs and detect abnormal or adventitious sounds. The primary normal respiratory sound is the vesicular breath sound, which is audible over the majority of lung fields. These sounds are characterized by their soft and low-pitched quality, reminiscent of a gentle rustling. They manifest during active inhalation as air traverses into the bronchi and alveoli, persisting through passive exhalation driven by alveolar elastic recoil. The phases of these sounds can be broadly delineated as the tubular component, succeeded by the alveolar phases during both inspiration and expiration (3).

Any deviation from this normative pattern may signify underlying pathology. For instance, bronchial breath sounds, if detected in peripheral lung fields, may indicate consolidation, as seen in pneumonia, while adventitious sounds such as crackles, wheezes, or rhonchi may reflect conditions such as pulmonary fibrosis, asthma, or chronic obstructive pulmonary disease (3,4).

Auscultation of the Cardiovascular System  

Cardiac auscultation entails the act of listening to the heart using a stethoscope to assess valve functionality and identify abnormal blood flow patterns. Both the diaphragm and the bell of the stethoscope are employed: the diaphragm for high-pitched sounds such as the first (S1) and second (S2) heart sounds, and the bell for low-pitched sounds such as the third (S3) and fourth (S4) heart sounds, or certain diastolic murmurs (5).

A systematic approach is imperative. The examination typically commences at the apical impulse and progresses to the lower left sternal border, the right and left upper sternal borders, and ultimately to the axilla when indicated. Various patient positions, including supine, sitting forward, and left lateral decubitus, are often utilized to accentuate specific sounds (6).

The normal heart sounds comprise S1, produced by the closure of the mitral and tricuspid valves, and S2, resulting from the closure of the aortic and pulmonic valves. Physiological splitting of S2 during inspiration is commonplace and generally benign. Abnormal sounds encompass S3, associated with rapid ventricular filling and often suggestive of heart failure, and S4, which arises from atrial contraction against a stiff ventricle, potentially indicating left ventricular hypertrophy or ischemia (7).

Murmurs represent additional sounds generated by turbulent blood flow across valves. They are described by their timing within the cardiac cycle, intensity, pitch, location, and radiation. Systolic murmurs occur between S1 and S2 and may be further classified as midsystolic, holosystolic, or late systolic. Diastolic murmurs transpire between S2 and S1, while continuous murmurs extend across both systole and diastole. Noteworthy examples include the holosystolic murmur of mitral regurgitation radiating to the axilla, the pansystolic murmur of tricuspid regurgitation accentuated during inspiration, the harsh pansystolic murmur of a ventricular septal defect at the left sternal border, and the Austin Flint murmur indicative of severe aortic regurgitation (8,9). Innocent murmurs, such as Still’s murmur in children, may also be encountered and must be differentiated from pathological murmurs.

To standardize assessment, systolic murmurs are classified from I to VI, with grade I being scarcely perceptible and grade VI audible without the stethoscope in contact with the chest. Murmurs graded IV or higher are typically associated with a palpable thrill (5). The early identification of abnormal heart sounds is of paramount clinical importance, as it enables timely intervention, mitigates morbidity, and enhances patient outcomes (7).

Auscultation of Blood Vessels: Bruits

Beyond the examination of the lungs and heart, auscultation proves invaluable for evaluating major blood vessels. A bruit is an aberrant, blowing or whooshing sound discerned over an artery, resulting from turbulent blood flow through a narrowed or partially obstructed vessel. In contrast to heart murmurs, bruits are extracardiac and generally signify vascular pathology.

Common sites for the auscultation of bruits encompass the carotid arteries in the neck, the abdominal aorta, the renal arteries, as well as the iliac and femoral arteries. Etiological factors include arterial stenosis, often attributable to atherosclerotic plaque, or other obstructive lesions. Clinically, the identification of a carotid bruit holds particular significance, as it may indicate carotid artery disease and herald an elevated risk of stroke (10). Similarly, abdominal or renal bruits can denote aneurysm or renovascular hypertension, conditions necessitating further imaging and prompt intervention.

Auscultation and the utilization of the stethoscope remain foundational elements of clinical examination. Whether assessing vesicular breath sounds, differentiating complex cardiac murmurs, or detecting vascular bruits, auscultation yields critical insights into the underlying physiology and pathology of the patient. While contemporary imaging and diagnostic techniques provide enhanced precision, the art of attentive listening remains indispensable for bedside evaluation, early diagnosis, and clinical decision-making. Mastery of this skill not only augments diagnostic accuracy but also sustains the essential doctor–patient rapport that is central to medical practice. The significance of auscultation extends beyond immediate diagnostics; it embodies a symbiotic relationship between clinician and patient, fostering a deeper understanding of the patient's unique health narrative. Engaging in this intimate process allows for the exploration of subtle shades that may escape more mechanized assessments.

Moreover, the ability to discern minute variations in sound can unveil a myriad of conditions, from valvular heart diseases to systemic ailments, where the implications of timely recognition can be life-altering. This diagnostic skill transcends routine practice and becomes an art form, one that demands both patience and profound attentiveness.

As the landscape of medicine evolves, integrating technological advances with traditional methodologies, the role of auscultation should not be relegated to obsolescence. Rather, it should be viewed as an essential complement to innovative diagnostic tools, serving to enrich the clinician’s toolkit. The harmony between advanced imaging and the time-honored technique of auscultation ensures a holistic approach to patient care, empowering practitioners with a comprehensive understanding of health dynamics.

In conclusion, while the complexities of modern medicine continue to expand, the fundamental principles of clinical assessment remain steadfast. The mastery of auscultation, with its capacity to provide immediate feedback and understanding, is an invaluable asset in the clinician's repertoire. It not only enhances the precision of diagnoses but also reinforces the humanistic aspects of medical practice, ensuring that care remains not only effective but deeply empathetic. Thus, embracing and refining the art of auscultation will continue to be paramount as we navigate the intricate interplay between health and healing in the evolving landscape of healthcare.

Summary Table: Auscultation Findings

System	Normal Sounds	Abnormal Sounds	Clinical Significance
Respiratory	Vesicular breath sounds: soft, low-pitched, rustling, heard across most lung fields	Bronchial breath sounds in periphery; Adventitious sounds (crackles, wheezes, rhonchi)	Consolidation (pneumonia), asthma, COPD, fibrosis
Cardiac – Heart Sounds	S1: closure of mitral & tricuspid valves; S2: closure of aortic & pulmonic valves (physiological splitting in inspiration)	S3: rapid ventricular filling (HF); S4: atrial contraction against stiff ventricle (LVH, ischemia)	Heart failure, hypertrophy, ischemic heart disease
Cardiac – Murmurs	None	Systolic, diastolic, or continuous murmurs, described by timing, pitch, intensity, radiation	Valvular disease (e.g., MR, TR, VSD, AR, AS)
Cardiac – Murmur Examples	Innocent murmurs (e.g., Still’s murmur in children)	Austin Flint (severe AR); Graham Steell (pulmonary regurgitation); Holosystolic MR/TR murmurs	Differentiates benign vs. pathological murmurs
Vascular	No bruit	Bruit: blowing/“whooshing” sound over artery	Carotid bruit (stroke risk), renal bruit (renovascular HTN), abdominal bruit (aneurysm)

Clinical Pathway of Auscultation: 

Step 1: Preparation

Ensure a quiet environment.

Patient positioned appropriately (supine, sitting, left lateral, etc.).

Use diaphragm and bell of stethoscope correctly.

Step 2: Systematic Listening

Respiratory system: Listen over multiple lung fields (anterior, posterior, lateral).

Cardiovascular system: Listen systematically over the four valve areas (aortic, pulmonic, tricuspid, mitral) and axilla if needed.
Vascular system: Listen over carotids, abdominal aorta, renal, femoral, and iliac arteries when indicated.

Step 3: Identify Normal vs. Abnormal

Respiratory: Vesicular vs. bronchial/adventitious sounds.

Cardiac: S1, S2 normal; presence of S3, S4, murmurs.
Vascular: Presence or absence of bruits.

Step 4: Characterization of Abnormal Sounds

Respiratory: Type of adventitious sound (crackles, wheezes, rhonchi).

Cardiac murmurs: Timing (systolic, diastolic, continuous), pitch, intensity (I–VI), location, radiation, quality.
Bruits: Site, intensity, duration.

Step 5: Correlate with Clinical Context
Match auscultatory findings with symptoms (dyspnea, chest pain, syncope).
Integrate with physical signs (cyanosis, edema, pulse quality, BP changes).

Step 6: Clinical Decision

Normal findings → reassurance and routine monitoring.

Abnormal but benign (e.g., Still’s murmur) → observation.

Pathological findings → further investigations:

Respiratory: Chest X-ray, CT, spirometry.
Cardiac: Echocardiography, ECG.
Vascular: Doppler ultrasound, CT angiography.

Step 7: Management and Follow-up

Use auscultatory findings as early diagnostic evidence.

Guide medical/surgical treatment decisions.
Monitor progression or resolution during follow-up.

A Medical Psalm: The Shepherd’s Auscultation

“The Lord is my Shepherd; I shall not want. He makes me lie down in green pastures; He leads me beside still waters; He restores my soul.” 

(Psalm 23:1–3)

So too, the physician with stethoscope in hand becomes a shepherd of the patient. To auscultate is to pause, to lean in, and to listen, not only to the rhythms of heart and lung, but to the unspoken fears and silent hopes of the one who suffers.

1. The quiet room is the green pasture.

2. The still diaphragm of the stethoscope is the still water.

3. The sounds of the heart and lungs are the voice of the flock, calling for guidance.

When the physician listens with humility, wisdom, and compassion, auscultation becomes more than a diagnostic tool, it becomes a ministry of healing. As the Good Shepherd restores the soul, the attentive clinician restores the trust, dignity, and hope of the patient.

Conclusion:

 
Auscultation remains a vital pathway, uniting clinical science with the healing art of listening. Its practice, structured, disciplined, and compassionate, reminds us that medicine is not only about discovering pathology but also about shepherding life with care. In the stillness of auscultation, the voice of both body and soul can be heard.

References

1. Laennec RTH. De l’Auscultation Médiate. Paris: J.-A. Brosson & J.-S. Chaudé; 1819.

2. Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees: a comparison of diagnostic proficiency. JAMA. 1997;278(9):717–22.

3. Vukanovic-Criley JM, et al. Competency in cardiac examination skills in medical students, trainees, physicians. Arch Intern Med. 2006;166(6):610–6.

4. Shaver JA. Cardiac auscultation: a glorious past—and it does have a future! Circulation. 1995;91(4):1256–9.

5. Roy D, Sargeant J. The disappearing art of auscultation: a call to action. Med Teach. 2012;34(7):568–70.

6. Chizner MA. Cardiac auscultation: rediscovering the lost art. Curr Probl Cardiol. 2008;33(7):326–408.

Is Cukur Manis or Mani Cai Safe for Consumption?

 Nutritional Anaemia and Hypotension Among Rural Malaysian Women: Investigating the Role of Sauropus androgynus (Cekur Manis)

by  Lim Ju Boo alias Lin Ru Wu

Abstract: 

This paper explores the relationship between dietary patterns in rural Malaysian villages and the prevalence of nutritional anaemia and hypotension among young women, with a specific focus on the widely consumed vegetable Sauropus androgynus (cekur manis). Through field studies and chemical analyses, a potential link was established between frequent consumption of this vegetable and observed low blood pressure. The phytochemical component papaverine, a vasodilator, was identified in the plant. This paper discusses the dual nature of S. androgynus as both a nutritional and potentially toxic plant, citing documented outbreaks of bronchiolitis obliterans in Taiwan and Japan from the raw consumption of the plant in large quantities. Recommendations for safe consumption and further public health implications are provided.

1. Introduction:  During medical research and health surveys conducted by my medical and nutrition team from the Institute for Medical Research from 1970 till mid 1990's in the villages of Malaysia, a recurring health problem among young women was observed, namely, frequent complaints of giddy spells, later correlated with nutritional anaemia and consistently low blood pressure. These women, often on nearly meatless diets, experienced chronic iron deficiency worsened by monthly menstrual blood loss.

Upon deeper investigation, it was discovered that many of these villagers consumed large quantities of a local leafy vegetable known as cekur manis (Sauropus androgynus), valued for its affordability, taste, and traditional health benefits, and easy to plant in their own village fields and compounds. 

Intrigued by the potential physiological effects of this plant, samples of cukur manis were collected by one of my colleagues from the National University of Malaysia (UKM), and sent  to the Dept. of Nutrition at Queen Elizabeth College (QEC), University of London where we once studied -  for chemical analysis. There at QEC they used their mass spectrometers and nuclear magnetic resonance (NMR) spectrometers to identify the  compound present. It turned out to be papaverine, a smooth muscle relaxant that has hypotensive properties. Of course we can also use other analytical procedures such as spectroscopy (UV-Vis, FTIR) and chromatography (GC-MS, HPLC-MS), but magnetic resonance (NMR) spectrometers is better, and we did not have that analytical instrument.  

An NMR spectrometer is huge and a complex instrument, not easily visualized without prior knowledge, nor is it easy to use,  but it's essentially a huge machine  that uses strong magnetic fields and radio waves to analyze the magnetic properties of atomic nuclei within a sample. 

NMR (Nuclear Magnetic Resonance) spectroscopy is a powerful tool for elucidating and identifying the molecular structure of a compound. It provides detailed information about the connectivity of atoms within a molecule, as well as their chemical environment, which helps in determining the overall structure.

While not  simple to use, modern benchtop NMR spectrometers have become more user-friendly, with integrated consoles and software to aid in data acquisition and interpretation.

We did not have an NMR spectrometer in Malaysia then in the 1970's, so we sent samples of cukur manis to scientists at the Department of Nutrition and in the Department of Chemistry at Queen Elizabeth College, University of London to help us identify the unknown compound that causes hypotension. The scientists at QEC identified it as papaverine.

2. Nutritional Composition and Traditional Use S. androgynus is commonly consumed in Southeast Asia, known locally as cekur manis (Malay), mani cai (Chinese), or sweet leaf. Rich in iron, protein, vitamins A, B, and C, calcium, potassium, and carotenoids, it has been used traditionally to:

• Promote lactation

• Support skin and eye health

• Improve vitality and digestion

3. Field Observations and Clinical Correlation In the studied villages, the majority of women consumed cekur manis in cooked form, often stir-fried. No cases of respiratory distress or lung disease were reported, but hypotension was consistently noted. This prompted the hypothesis that a phytochemical component in cekur manis might be acting as a vasodilator.

4. Phytochemical Analysis: As already mentioned, laboratory analysis confirmed the presence of papaverine, an opium-derived but non-narcotic alkaloid known for its ability to relax smooth muscle tissues, particularly those of blood vessels. Papaverine’s pharmacological actions include:

• Dilation of cerebral and coronary arteries

• Smooth muscle relaxation in the gastrointestinal and genitourinary tracts

• Temporary blood pressure lowering effects

Although once used in the management of vascular diseases, papaverine is no longer widely prescribed for hypertension due to its:

• Short duration of action

• Potential hepatotoxicity

• GI and CNS side effects

• Unpredictable pharmacokinetics

The naturally occurring papaverine in cekur manis likely explains the consistent hypotension observed in the villagers, compounded by anaemia from poor iron intake.

5. Toxicity Concerns and International Incidents Between the 1990s and early 2000s, Taiwan and Japan saw multiple cases of bronchiolitis obliterans, a rare and irreversible lung disease, linked to the excessive raw consumption of S. androgynus. Young women consumed large quantities of raw cekur manis in juices or smoothies, often for weight loss or to enhance lactation.

Over 100 cases in Taiwan required long-term oxygen therapy, some requiring lung transplants [Chen et al., 2000].

The suspected mechanism involves certain alkaloids and non-protein amino acids that induce immune-mediated inflammation and fibrotic scarring of bronchioles.

The specific compound in raw Sauropus androgynus (cukur manis) that causes bronchiolitis obliterans has not been definitely identified. However, it is believed that certain compounds within the plant, particularly in the aqueous fraction, may be responsible for inducing lung inflammation and tissue damage. Studies suggest that the aqueous fraction of S. androgynus may play a significant role in the development of the disease. 

Several compounds have been isolated from S. androgynus, including nucleosides,  flavonols, and lignan glycosides, none have been definitively pinpointed as the sole cause of bronchiolitis obliterans.

T-cell Mediated Immunity:

Research indicates that T-cell mediated immunity might be involved in the pathogenesis of lung damage, suggesting an immune response is triggered by the plant's compounds.

Crucially, no cases were associated with cooked cekur manis, suggesting the  toxic compounds is destroyed during cooking (heat-labile).  

6. Recommendations and Public Health Implications Given the dual nature of S. androgynus ,  as a nutrient-dense vegetable and a potential source of toxicity, public education is essential:

Encourage consumption in moderation and only in cooked form, bear in mind cekur manis is  known to be rich in beta-carotene, which is a precursor to vitamin A (retinol). This means that the body can convert the beta-carotene found in cekur manis into vitamin A. Studies have shown that cekur manis contains a high level of total carotenoids, which are converted to retinol equivalents (RE). 

Avoid large quantities of raw cekur manis, especially in juice or smoothie form. Continue research to identify the exact causative toxic compounds

7. Conclusion:

The study highlights how local diets, when examined in conjunction with phytochemical analysis, can reveal both therapeutic and harmful health effects. The vasodilatory property of papaverine in cooked S. androgynus may explain low blood pressure among rural Malaysian women, especially those also affected by anaemia. However, international cases of bronchiolitis obliterans from raw consumption underscore the need for caution. Traditional wisdom and modern science must work hand-in-hand to ensure safe dietary practices.

References:

1, Chen CH, Shih CL, et al. (2000). Sauropus androgynus-induced bronchiolitis obliterans in Taiwan: a review of epidemiology, clinical presentations, and pathogenesis. Am J Respir Crit Care Med, 161(4): 1241–1246. PMID: 10764302

2. Ismail A, et al. (2000). Nutrient composition of selected indigenous vegetables in Malaysia. Food Chemistry, 68: 51–59.

3. Wong KC, Tan GL. (1995). Chemical constituents and biological activities of Sauropus androgynus. Natural Product Communications, 2(6): 199–204.

4. Wu CC, et al. (1997). Obliterative bronchiolitis associated with consumption of Sauropus androgynus in Taiwan. Lancet, 349: 1306.

5. Liu GY, et al. (2006). Papaverine and its pharmacological applications: past, present and future. International Journal of Clinical Pharmacology and Therapeutics, 44(9): 480–488.

The Medicinal Values of Garlic - from Clove to Circulation

 Title: The Biochemistry and Pharmacology of Garlic: From Clove to Circulation

by: Lin Ru Wu alias Lim Ju Boo

 

In the mid 1960's I was doing my postgraduate in Nutrition at the University of London when one of my professors mentioned about the medicinal values of garlic. Today, I like to share further knowledge I gained  there about this valuable medicinal  clove 

Abstract:

Garlic (Allium sativum) has been revered since antiquity for its culinary and medicinal properties. This paper explores the biochemical transformation of garlic's sulfur compounds, particularly allicin and ajoene, through mechanical processing, digestion, and hepatic metabolism. It discusses the pharmacologically active derivatives of garlic, their bioavailability, and the evidence-based therapeutic doses. By synthesizing findings across food chemistry, enzymology, and clinical pharmacology, this work aims to serve as a concise but comprehensive resource for doctors, nutritionists,  healthcare enthusiasts and scholars

1. Introduction:

Garlic is widely recognized for its diverse medicinal applications, including antimicrobial, cardiovascular, and anticancer effects. These properties are attributed to sulfur-containing compounds formed upon cellular disruption of garlic tissues. While traditional knowledge praises garlic's benefits, understanding the journey of its bio-actives from raw clove to systemic circulation requires a multidisciplinary approach.

2. Allicin Formation: The Moment of Activation

Allicin is not present in intact garlic cloves. Upon mincing or crushing, the enzyme alliinase converts the stable compound alliin into allicin within 5 to 10 minutes. This enzymatic reaction is highly sensitive to:

• Heat (>60°C), which denatures alliinase

• Acidity, which can reduce enzyme efficiency

Reaction Pathway: Alliin (S-allyl-L-cysteine sulfoxide) + Alliinase → Allicin (diallyl thiosulfinate)

Waiting 10 minutes after crushing allows maximal allicin formation before further cooking or ingestion.

3. Stability and Degradation of Allicin

Allicin is unstable, reactive, and decomposes quickly into secondary sulphur compounds, including:

• Ajoene (anti-platelet, antifungal)

• Diallyl disulfide (DADS)

• Diallyl trisulfide (DATS)

• S-allyl cysteine (SAC) (stable, bioavailable in aged garlic)

Heat, time, and pH conditions all influence the breakdown pathway.

4. Oral Processing vs Mechanical Mincing

Chewing garlic activates alliinase, but swallowing too quickly reduces time for full allicin conversion. Saliva does not appear to inactivate alliinase significantly, but the enzymatic activity is more reliable in a controlled setting (e.g., mincing and waiting 10 minutes).

5. Gastrointestinal and Hepatic Fate

In the digestive tract:

• Allicin is mostly degraded in the stomach
• Derivatives like DADS, DATS, ajoene, and SAC survive and are absorbed

In the liver:

• Some compounds are metabolized but retain activity

• SAC is especially bioavailable and used in standardized supplements

6. Pharmacological Activity and Effective Doses

Compound	Effective Dose	Activity
Allicin	20–50        mg/day	Antimicrobial,                       antihypertensive
Ajoene	~10–25         mg/day	Antithrombotic,                   antifungal
SAC	Varies	Antioxidant, anti-                 inflammatory

Garlic supplements are typically standardized to 1.3% allicin content or 3.6 mg per 600 mg tablet. But this value may not be stable on storage as for garlic pills. I shall talk on this later.  

7. Preparation Guidelines for Maximum Medicinal Value

Method	Allicin Yield	Notes
Mince + wait 10 min + consume raw	Maximum	Best for medicinal use
Chewing raw garlic	Moderate	Faster ingestion limits yield
Cooking after 10 min rest	Mild	Low heat preserves some value
Aged garlic extract	High (SAC)	Ideal for long-term supplementation

8. Conclusion

While allicin itself is ephemeral, its derivatives may or may not persist and contribute meaningfully to garlic's therapeutic potential. For instance, from the very beginning I mentioned that in the mid 1960's when I was doing my postgraduate in Nutrition at the University of London when one of my professors mentioned about the medicinal values of garlic. But he also told us that they took over two dozens different types of garlic pills manufactured by various companies from various parts of the world and analyzed them for the presence of ajoene, the derivative of allicin since allicin is not stable. What the researchers at London University found was, even ajoene which was supposed to be more stable was not present in any of those hundreds of garlic pills. This implied that even the derivatives of allicin - ajoene is not stable when the garlic was processed into pill form or when stored in a bottle for sales. Probably garlic pills were  just oils - like any vegetable oil with no medicinal values in them?  

My strong advised is, when raw garlic has been minced or crushed, wait for at least 10 minutes for the enzyme alliinase to release the allicin and consume immediately - not longer than a few hours later. We are unsure if storing the minced raw garlic in a refrigerator will retain its medicinal values - allicin and its derivatives - DADS, DATS, ajoene, and SAC, since as far as I know, no study has been done on this. 

Understanding garlic as a sequence of biochemical transformations, from mechanical activation to hepatic metabolism, enables more effective use of this ancient botanical medicine.

References

1. Amagase H, Petesch BL, Matsuura H, Kasuga S, Itakura Y. Intake of garlic and its bioactive components. J Nutr. 2001 Mar;131(3s):955S-962S.

2. Lawson LD, Wang ZJ. Allicin and allicin-derived garlic compounds increase breath acetone through allyl methyl sulfide: Use in measuring functional allicin in garlic. J Agric Food Chem. 2005;53(6):1974-1983.

3. Dirsch VM, Kiemer AK, Wagner H, Vollmar AM. Effect of allicin and ajoene, two compounds of garlic, on inducible nitric oxide synthase. Atherosclerosis. 1998;139(2):333-339.

4. Rahman K. Effects of garlic on platelet biochemistry and physiology. Mol Nutr Food Res. 2007;51(11):1335-1344.

5. Iciek M, Kwiecien I, Wlodek L. Biological properties of garlic and garlic-derived organosulfur compounds. Environ Mol Mutagen. 2009;50(3):247-265.

Acknowledgments:

 Special gratitude to my friend and colleague, Professor Sage for his additional inputs that has inspired me to write this paper