An overview of certain Āyurvedic herbs in the management of viral hepatitis

Āyurveda

An overview of certain Āyurvedic herbs in the management of viral hepatitis

Dr. Martha Bhaskar Rao

Editor's Note

Long before modern medicine came into existence, there existed in all countries a knowledge of herbs that helped in various ways. The very fact that humanity has survived critical transitions, wars and famines is itself empirical proof of the value of these herbs. Now that we are realising that modern medicine pays a heavy price, there is an attempt the world over to dig into the lost secrets. This search is not without difficulty. It is like learning an entirely new language. Our present knowledge sometimes becomes a bar. The ancients saw the world differently: they felt and experienced it in another way, a way we have lost but whose trail still lingers in our memory, energising us to undertake the same journey from our present point. This article tries to bridge a gap that is the need of the hour.

(This article was presented at the Japan Society of Hepatology http://www.jsh.or.jp/english/index.html ,in 2007).

India is the third richest source of plant species after Brazil and China with over 1,500 species and occupies the highest position in the use of herbal drugs, utilising 500 plant species for various ailments. Following an increasing awareness and interest in nature cure, a large percentage of the Indian population at present consult traditional Āyurvedic physicians for various ailments.

Never in the history of mankind has the liver been exposed to so many hepatotoxic chemicals as now. Indiscriminate use of synthetic drugs like tetracycline, paracetamol, anti-tubercular drugs, oral contraceptives of a hormonal origin, chemicals used as food preservatives and agro chemicals are causing damage to the liver. Addiction to alcohol and other drugs have further aggravated the problem. Under-nutrition and malnutrition are other important causes of damage to the liver in developing countries. Despite its extraordinary capacity to regenerate, a slight injury may lead to fatal complications. Hepatocellular damage too can be caused by various viruses, bacterial toxins and hepatotoxic chemicals. There is no effective treatment available in modern medicine as such for the cure of liver diseases, especially hepatitis. Usually, supportive measures are prescribed. So our attention is drawn to Āyurveda, the ancient system of medicine, for the eradication of this dreadful disease. Traditional Āyurvedic physicians such as Caraka (1000 B.C), Suśruta (800 B.C) and Vāghbata (400 A.D) have recommended a large number of herbal and herbo-mineral preparations in the management of this disease. Nearly 30 drugs like kutiki, amalki, bhringarāja are mentioned in this paper. An attempt has been made to brief their clinical evaluations on viral hepatitis with special reference to hepatitis B.

Literary review

What is viral hepatitis according to Āyurveda?

Viral hepatitis is considered as a variety of kāmala in the Āyurvedic classics. Kāmala has been clinically described in four ways.

1.Koṣṭhāśraya kāmala

2.Śākhāśraya kāmala

3.Kumbha kāmala

4.Halimaka

Caraka says that if a person suffering from pāṇḍuroga indulges in pitta prakopakara āhāra and vihāras (factors vitiating pitta), he may get kāmala. Kāmala can also occur individually without any previous history of pāṇduroga. Āchārya Harita describes koṣṭhāśrita kāmala, śākhāśrita kāmala and halimaka under pāṇḍuroga. Cakrapani interpreted less involvement of pitta in śākhāṣraya and more in kośṭāṣraya kāmala, The lakshanas (signs and symptoms) of different varieties of kāmala are below:

SL. No.	Āyurvedic terminology	Modern equivalent
1.	Aruchi	Anorexia
2.	Ajīrṇa	Indigestion
3.	Dourbalya	Weakness
4.	Aṅga glāni	Tiredness
5.	Haridrā netratvam	Eye, coloured turmeric yellow
6.	Haridrā varṇatvak	Skin, coloured turmeric yellow
7.	Haridrā varṇanakha	Nails, coloured turmeric yellow
8.	Haridrā varṇamukham	Face, coloured turmeric yellow
9.	Haridrā varṇaśarīram	Body, coloured turmeric yellow
10.	Rakta pītavarṇamūtrā pūriṣa	Urine and faeces coloured reddish yellow
11	Indriya dourbalya	Weakness of organs
12	Dāha	Burning sensations all over the body

2. Śākhāśraya kāmala

Tila piṣṭa — faeces coloured like varṇa purīṣa — seasamum paste

The above mentioned symptoms of koṣṭhāśrita kāmala may also be present in this variety.

3. Kumbha kāmala

SL. No.	Āyurvedic terminology	Modern equivalent
1.	Arochakam	Anorexia
2.	Chardi	Vomiting
3.	Hṛullāsa	Nausea
4.	Jvaram	Fever
5.	Klama	Tiredness
6.	Kāsa	Cough
7.	Śvāsa	Difficulty in breathing
8.	Vitbheda	Loose movement of bowels

The above mentioned symptoms have been enumerated under asādhya (incurable) lakshanas of kumbha kāmala.

4. Halimaka

SL. No.	Āyurvedic terminology	Modern equivalent
1.	Jvara	Fever
2.	Aṅgamarda	Body ache
3.	Aruci	Anorexia
4.	Balakṣayam	Debility or loss of strength
5.	Utsāhakṣayam	Lack of enthusiasm
6.	Harita/syavavarṇa śarīra	Body discoloured green or dark
7.	Triṣṇā	Thirst
8.	Bhrama	Dizziness
9.	Tandrā	Drowsiness

Asādhya kamala lakshanas (symptoms of incurable kāmala)

SL. No.	Āyurvedic terminology	Modern equivalent
1.	Kṛṣṇā, pīta rakta varnna mutra/purissa	Urine and faeces discoloured black, yellow and bloody
2.	Sodha	Anasarca
3.	Sarakta viṇmūtratā	Blood in faeces and urine
4.	Dāham	Burning sensations all over the body
5.	Tandrā	Drowsiness
6.	Moham	Swooning or fainting
7.	Mūrchā	Loss of consciousness

Line of treatment

In the management of kāmala, recana karma (purgation treatment) has been given prime importance. Snehana (intake of medicated ghee) should be given prior to recana karma.

Āchārya Caraka prescribes the following ghrrtas (medicated ghee) for snehana karma.

1. Pañcagavaya ghṛtam
2. Mahatktaka ghṛtam
3. Kalyaannaka ghṛtam

Among the single and compound preparations described in Āyurveda for the treatment of kāmala, some of the drugs have been found to be effective. A scientific study of the following drugs was carried out and significant response observed.

Single drugs

SL. No.	Āyurvedic terminology	Modern equivalent
1.	Bhūmyāmalakī	Phyllanthus niruri, Linn.
2.	Kaṭūkarohiṇī	Picrorhiza kurroa Royle, ex Benth.
3.	Bhṛṅgarājā	Eclipta alba, Linn. Hassk.
4.	Punarnavā	Boerhaavia diffusa, Linn.
5.	Guḍuci	Tinospora cordiafolia, Willd.Miers ex Hook. F, & Thoms
6.	Bilva	Aegle marmelos (Tinn.), Corr.
7.	Haritakī	Terminalia chebula (Gaetn.), Retz.
8.	Śuṇṭi	Zingiber officinale Roscoe
9.	Haridrā	Curcuma longa, Linn.
10.	Amlika	Tamarindus indica, Linn.
11.	Harita manjarī	Acalypha indica, Linn.
12.	Eraṇḍa	Ricinus communis, Linn.
13.	Atibala	Abutilon indicum, Linn.
14.	Trivṛt	Operculina turpethum, Linn.Silva Manso
15.	Aragvadha	Cassia fistula, Linn.
16.	Indra varuṇi	Citrullus colocynthis, Schard.
17.	Nimba	Azadirachta indica, A.Juss.
18.	Bhūnimba or kālamegha	Andrographis paniculata (Burm. F.), Wall ex Nees.
19.	Karpāsa	Gossypium herbaceum, Linn.

Recent research observations

Recent observations on some of the above mentioned plants are given below:

1. Kaṭūkarohiṇī (Picrorhiza kurroa Royle, ex Benth.)

The alcoholic extract of the drug caused significant decrease in the S.G.O.T. and S.G.P.T. concentrations in rabbits whose livers were damaged by carbon tetracycline injections. Improvements in B.S.P Clearance test was also noted in those animals. The total biliary output in the treated groups of animals showed appreciable increase compared to the controlled group (Pandey & Chatruvedi 1968, 1970). The total extract of roots revealed marked hydro-chloretic and anti-bacterial properties, suggesting its potential value in infective hepatitis and urinary tract infections (Vohr. et al ,1972).

2. Bhūmyāmalakī (Phyllanthus niruri, Linn.)

A study conducted by the Noble Laureate, Dr. B.S. Blumerg of Philadelphia, U.S. in association with the institute has shown that the Phyllanthus niruri, Linn. (bhūmyāmalakī) inhibited the synthesis of viral D.N.A. in jaundice caused by the hepatitis B virus.

3.Kālamegha (Andrographis paniclulata (Burm. F.), Wall ex Nees.

Kālamegha was given to patients having infective hepatitis in decoction form. The results were assessed on the basis of clinical and biochemical parameters. In this study, 80% of the patients in this series were cured while 20% were relieved. Therefore, Kālamegha appears to be a useful remedy for the treatment of infective hepatitis. Many researchers have attempted to isolate the active principle of this plant. A few reports are cited below.

Phytochemistry of kālamegha

Dymock et al (1895) were the first to report the presence of a non-basic, intensely bitter substance which fails to give any test of alkaloid in Andrographic paniculata. Gorter (1911) chalked out its formula C20 H30 O5, M.P. 2170 and he has ascribed the name andrographolide to it. Later Bhaduri (1914) reported the presence of two non-basic principles from the leaves of A. paniculata, besides andrographolide (C19 H28 O5) M.P. 206 and kālamegha (C19 H51 O5) M.P. 195. The presence of andrographolide in the roots has been reported by Govindachari et al (1969) while Chan et al (1971) have shown the structure and stereochemistry of neoandrographolide, a diterpine glucoside from A.paniculata. Efran et al (1972) mentioned that the roots of A.Paniculata contains the flavones andrographin (I.R. = Mc R1) panicolin (II, I R = H) and apigenin 4, 7 diemthylethers (II). Wahi (1973) reported that no andrographolide is detected in the underground system of A. paniculata as was shown by Govindachari et al (1969).

Bhasmas (mineral preparations – calces)

1. Abhraka bhasma
2. Loha bhasma
3. Mandoorā bhasma
4. Svarṇa makṣikā bhasma
5. Kaseesa bhasma
6. Yasada bhasma
7. Suddha bhasma
8. Pravala bhasma

Compound preparations of medicinal drugs

1. Ārogya vardhinī rasa
2. Dhātrī loham
3. Punarnavaadi mandoora
4. Tapyādi loham
5. Navayasam cūrṇam
6. Lakṣmī vilāsa rasa
7. Amṛtāriṣṭa
8. Navasadara cūrṇam
9. Rajaha pravartinī vaṭī
10. Kaṇṭavallabha rasa

(Dr. Nisteswar and et al )

Material methods

Sixty patients with viral hepatitis were selected for a study. All were treated with 1 gram Phyllanthus amarus, Ocimum sanctum and Andrographis paniculata for a period of one month at T.T.D’s S.V. Āyurvedic Hospital, Tirupati, A.P. India. Patients, both male and female, were randomly selected. The clinical data of the patients were recorded and a detailed enquiry was also made about the onset of jaundice. Out of 60, 6 patients were HbsAg positive patients. The diagnosis was made on the basis of clinical and biochemical findings. Patients were followed up every week for a period of 2 months with clinical and biochemical parameter assessment. They were divided into:

1. Cured
2. Improved
3. Unchanged

Cured
Complete relief from signs and symptoms and liver function tests approximately within normal range.

Improved
Either marked improvement in the signs and symptoms or in the liver function tests.

Unchanged
No marked improvement either in the signs and symptoms or in the liver function tests.

Results

Aruchi (loss of appetite) was present in all 60 patients. An initial improvement after about 4-5 days of treatment with kalamegha was noticed. The appetite of all patients was restored to a normal within 14 days. The deep yellow colour of urine gradually changed and became normal within 3 weeks of treatment in all cases. The yellow colour of the conjunctiva gradually diminished and completely disappeared in all the cases (100%). Tender hepatic enlargement was observed in 85% of patients and this was relieved in 96% of them within 20 days of treatment. The data is given in table 1below.

Table I

SL. No.	Group response	Number of cases	Percentage
1.	Cured	54	90
2.	Imporoved	6	10
3.	Unchanged	-	-

Total response from the compound drug (60 cases)

Table II

SL. No.	Symptoms	Number of Cases (Before Treatment)	Percentage of improvement (After Treatment)
1.	Aruchi	60 (100%)	100
2.	Yellow conjunctiva	60 (100%)	100
3.	Hepatic enlargement	51 (85%)	100

Clinical improvement

Conclusions

Based on the available data, the following conclusions can be drawn:

1. Out of 60 patients, 54 (90%) were cured. 6 cases (10%) showed mere relief. There was no case without response or mortality.

2. The combination of Phyllanthus amarus, Ocimum sanctum and Andrographis paniculata is effective in viral hepatitis and can be used without any side-effects. This is a valuable contribution of Āyurveda in the treatment of viral hepatitis.

3. An interesting observation from this clinical trial is that out of 6 HbsAg positive patients, 3 cases became negative after the treatment.

4. The possible mode of action of this compound drug is shown to be HbsAg binding, inhibition of DNA polymerase, immunomodulation and antihepatotoxic potentials.

5. Further multi-centric trials are to be made to re-evaluate and to reproduce the results.

Bibliography

1. A Nidanam. Mumbai, Niranaya Sagar Press, 1955.

2. Caraka Samhitā. Mumbai; Nirmaya Sagar Press, 1941.

3. Chaturvedi, G.N., Tomar, G.S., Tiwari, S.K., Singh K.P. Clinical Studies on Kalamegha (Andrographis) paniculata (Burm, f.) Wall ex Nees in infective hepatitis. Ancient Science of Life April 1983.

4. Cikitsa Pradeepik. Pune.

5. Current Medical diagnosis and treatment. California, 94023; Lange Medical. Publications, 1986

6. Motilal Benarasi Das. Rasa tarangini. Delhi;1979.

7. Nisterwar, K., Arunee Kumar. Dravyaguua Prayoga Vignan. Vijayawada; Indian Medicine Industries, 1987.

8. Rasatantra Sarva Siddha Prayoga Sangrah, Vol. I. Krishna Gopal Ayurveda Bhavan Ajmeer, 1973.

9. Siddha Yoga Sangraha. Kolkata; Bhaidyanada Ayurveda Bhavan, 1957.

10.Uttara Lakshmi, C.V.S., Nisterwar, K. Kamalahara Yogamulu. Indian Medicine Industries, September 1986.

Dr. Martha Bhaskar Rao, MD in Āyurveda, is Assistant Professor at the Department of Shalya, SV Āyurvedic College and Hospital, Tirupati.

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