|
 
 |
| SHORT COMMUNICATION |
|
| Year : 2016 | Volume
: 35
| Issue : 3 | Page : 176-179 |
|
Treatment of infective hepatitis: Where biomedicine has no answers, Ayurveda has!!
Pradyumna R Raval1, Ramchandra M Raval2
1 Department of Orthopaedic and Trauma Surgery, Tayside Orthopaedic Rehabilitation Technology Centre, Division of Postgraduate, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, Scotland, UK
2 Department of Health, Integrated Child Development Scheme, Government of Maharashtra, Karjat Taluka, Raigad District, India
| Date of Web Publication | 8-Apr-2016 |
Correspondence Address:
Pradyumna R Raval
56, The Fairways, Bothwell, South Lanarkshire, Glasgow G71 8PA
UK
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0257-7941.179861
Background: Infective hepatitis is a major health hazard in the Indian sub-continent with a large population and improper sanitation adding to the malady. Water-borne or infective hepatitis has no treatment in modern medicine. However, there are multiple accounts of how infective hepatitis can be successfully cured by Ayurvedic medicine.
Aim: To review relevant studies in Ayurveda claiming to treat hepatitis.
Materials and Methods: A comprehensive PubMed search was conducted using 'Treatment of Hepatitis' and 'Ayurveda' as the primary search criterion.
Results: 27 articles were revealed by the search. 16 of these 27 articles were selected after reading all abstracts. All 16 articles were reviewed in detail and thereafter the current article was written.
Conclusion: Ayurveda definitely has a lot to offer in terms of the treatment of hepatitis. However, a mass awareness of this potential of Ayurvedic medicine is desirable to achieve a larger impact on the society. Keywords: Hepatitis, treatment, Ayurveda
How to cite this article:
Raval PR, Raval RM. Treatment of infective hepatitis: Where biomedicine has no answers, Ayurveda has!!. Ancient Sci Life 2016;35:176-9 |
| Introduction | |  |
Infective hepatitis is primarily caused by the Hepatitis A and the Hepatitis E viruses. Both of these viruses are RNA (ribonucleic acid) viruses.[1],[2] Hepatitis A infection is caused largely due to faeco-oral transmission. Contaminated food including milk, some fruits such as raspberry and even shellfish has been implicated as the causative agents. Improper personal hygiene of people living in a congested, overcrowded locality only compound the problem.[1]
Hepatitis E also has a similar mode of spread as that of Hepatitis A, however a person to person contact is rare in the case of Hepatitis E.[1] It is generally known to occur in those individuals who are immune to a Hepatitis A infection, since they had it in the past. Another issue of concern is that an infection of Hepatitis E during pregnancy can lead to acute liver failure. This has disastrous consequences with such patients having a high rate of mortality.[2]
There is no specific treatment available for infective hepatitis in biomedicine. There are no antiviral drugs which can alleviate a patient's symptoms, and since this condition is self-limiting, most physicians advocate rest to their patients.[1],[2]
The primary author of this article had the misfortune of getting affected by both the variants of Infective hepatitis over a short span. On both occasions he was advised rest by his physician colleagues. The immense nausea, discomfort and the overall agony experienced by him was the trigger to the present article.
| Hepatitis and Ayurveda | | |
A comprehensive PubMed search was conducted employing the following search terms: (Treatment of hepatitis) AND (Ayurveda). There were no restrictions on the date of publication. The search was performed on 16th June 2015. A total of 27 articles were revealed by the search. The abstracts of these 27 articles were studied and 16 relevant papers were selected which commented specifically upon the treatment of hepatitis. These 16 papers were reviewed in detail and the following short report was written.
Chturvedi et al., in their clinical study on Kalmegh (Skt. Bhūnimba, Andrographis paniculata Nees) have reported an 80% cure rate in the study population suffering from infective hepatitis. A significant decrease in the liver enzymes was noted in all these patients who were administered Kalmegh in the form of a decoction.[3]
Keche et al., conducted a randomised double blind placebo controlled clinical trial. This was undertaken to evaluate the efficacy of a polyherbal preparation called Livwin, in patients suffering from acute viral hepatitis. They have stated that this drug gives good results in those patients who suffer from uncomplicated cases of hepatitis. Adverse effects of epigastric distress and diarrhoea were reported with this drug treatment.[4]
Naturally occurring substances such as fruits or by products of certain insects such as honey produced by bees have also been shown to have therapeutic effects in the treatment of hepatitis.[5],[6],[7] Eugenia Jambolana (Skt. Jambu, Jamun), is commonly found in the tropical countries such as India. It has anti-oxidant properties. Donepudi et al., report a study conducted on mice with hepatic damage induced in them following bile duct ligation. They were thereafter administered an extract prepared from the Jamun fruit. Subsequently the authors have documented that the hepatic inflammation induced in rats due to the bile duct ligation was reduced by the Jamun fruit extract (JFE). Suppression of lipid peroxidation was postulated to be the main hepatoprotective effect. Other important findings noted were reduction of macrophage infiltration, pro-inflammatory cytokines, and reactive oxygen substances found after bile duct ligation.[5]
The fruit extract of Long pepper (piper longum) has been shown to have hepatoprotective action. In a study conducted on rodents with carbon tetrachloride (CCl4), induced liver damage, the extract was shown to restrict ongoing liver fibrosis. This action resulted in stimulation of regeneration of the cells. However there was no protective effect against cirrhosis of liver or acute liver damage. The most abundant component isolated from this plant is called Piperine. It's mechanism of action is reduction of lipid peroxidation, by which it offers a hepatoprotective effect.[7]
The medicinal value of bee's honey has been vividly mentioned in ancient texts. The Caraka Saṃhitā mentions four different types of honey viz. mākşik a, bhrāmara, kşaudra and paittaka, whereas the Suśruta Saṃhitā mentions eight different types of honey namely pauttika, bhrāmara, kşaudra, mākşika, chatra, arghya, auddālaka and dala madhu. Of these, the best type is mākşika which is produced by the honey bee which is of red colour. A mixture of 15 ml of honey with 120 ml of Adhathoda vasica, given twice daily has been recommended as a treatment for jaundice.[6]
The medicinal importance of Tulasī (Ocimum sanctum Linn) has been well documented in ancient Indian literature. This amazing plant has a substance called adaptogen, which is known to counteract multiple nonspecific stresses. Mondal et al., in their study noticed enhanced physical endurance and improved healing in rodents that were fed with an ethanol extract of Tulasī. The extract was prepared by drying the whole plant. This ethanol extract was also shown to have a hepatoprotective effect at a dose of 100 mg/kg body weight.[8]
Dange et al., studied the efficacy of an Ayurvedic medication called Arogyavardhini, on rats that had CCl4 induced hepatic damage. Arogyavardhini consists of the following ingredients in a 200 mg tablet, 1 part each of mercury, sulphur, lohabhasma, tāmrabhasma and abhrakabhasma; 2 parts of Triphalā cūrṃa (Terminalia chebula, Terminalia bellerica and Phyllanthus emblica); 3 parts of Shilajit (Skt. Śilājatu); 4 parts of Guggulu (Commiphora mukul); 18 parts of Kuṃakī (Picrorhiza kurroa) and 72 parts of the decoction of Azadirachta indica. They noted that the group treated with Arogyavardhini not only had a less marked rise in the liver enzymes but also had a much subdued histopathological picture with less severity of degenerative and necrotic tissue. The authors of this study could not conclusively state as to which ingredient of Arogyavardhini was hepatoprotective but postulated that it could be Picrorhiza kurroa.[9]
Vaidya et al., in their study on the hepatoprotective effect of Picrorhiza kurroa have shown significant results in the rats that had galactosamine induced liver injury. This study emphasises the need of standardization of the active agent picroside in the medications prepared from Picrorhiza kurroa.[10]
Liv. 52 is a commonly available over-the-counter medication for liver ailments. This drug is prescribed by almost all Ayurvedic physicians at some point in their practice. Mandal and Roy studied the role of Liv. 52 in cases of acute viral (infective) hepatitis. Among the patients treated by them, 73% had good results, 23% had fair and only 3% had poor results.[11] In a recent placebo controlled study, Katiyar et al., state that the polyherbal formulation, New Livfit ® (NLF) has been shown to clear the viral load of Hepatitis B (HBV-DNA) sooner in patients suffering from End Stage Renal Disease (ESRD). This drug however had no effect on the kidney disease of the patients.[12]
Buwa et al., in their study on Abhraka Bhasma, attribute the hepatoprotective property of this compound to it being a derivative of mica. Silica which is known to be a free radical scavenger is one of the constituents of mica. Abhraka Bhasma is supposedly thought to exert free radical scavenging and hepatoprotective effect because of its peculiar composition.[13]
As the saying goes, 'There are two sides to every story'. We also find a recent study which has criticised Ayurvedic medicines. Bunchorntavakul and Reddy in their study state that a high content of metals in Ayurvedic medicines is a major causative factor for drug-induced liver injury (DILI). Liv. 52 which was reported by Mandal and Roy to have a good effect in their patients,[11] has been reported to have a higher rate of mortality in patients suffering from alcoholic cirrhosis. Surprisingly enough, while on one hand this study criticises Ayurvedic medicine, its authors also acknowledge the fact that the reported prevalence of hepatotoxicity is extremely less, about 1.3% in India, where these drugs are used the most.[14]
A recent study done by Manvar et al., on Eclipta Alba (Bhṃṃgarāja), evaluates the action of this traditional compound on Hepatitis C virus (HCV). Their study identified three active phytochemical compounds in Eclipta Alba. These were Wedelolactone, Luteolin and Apigenin. These potent compounds inhibited HCV replication in vitro and in cell culture. Moreover when these compounds are combined, they show a synergistic activity in inhibiting HCV replication.[15]
Hepatocellular carcinoma as a long term complication of hepatitis is well documented. A recent study has revealed that Tridham (TD) might have a role to play in the treatment of Hepatocellular carcinoma. This medication has been known for years by the practitioners of the Siddha system of medicine. 'Tri' means three and as the name implies, Tridham consists of three plant ingredients viz. seed coat of Terminalia chebula (T. chebula), fruit of Elaeocarpus ganitrus (E. ganitrus) and leaves of Prosopis cineraria (P. cineraria) in equal proportions. Tridham is believed to bring about a programmed cell death, so called 'apoptosis' in the cancer cells responsible for Hepatocellular carcinoma. The mechanism of action is via the action of the caspase cascade. This act is independent of the expression of the p53 gene.[16]
| Conclusion | | |
Ayurvedic medicine definitely has a lot to offer to the society by way of improving liver health and this is quite evident from the various studies reported in literature. However certain studies have raised questions as to whether Ayurvedic medicines are worthwhile. We believe that apart from conducting more evidence based clinical research in Ayurvedic medicine, the need of the hour is to educate the masses about the rich heritage of Ayurveda. That day may not be too far away when Ayurvedic medication might answer some of the most difficult questions faced by the modern day physician.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Dienstag JL. Acute viral hepatitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison's Principles of Internal Medicine, 18 th ed. Printed in the United States of America: The McGraw Hill Companies Inc.; 2012. p. 2537-57.  |
| 2. | Anstee QM, Jones DEJ. Liver and biliary tract disease. In: Walker BR, Colledge NR, Ralston SH, Penman ID, editors. Davidson's Principles and Practice of Medicine. 22 nd ed. London, United Kingdom: Elsevier Health Sciences; 2014. p. 948-55. |
| 3. | Chturvedi GN, Tomar GS, Tiwari SK, Singh KP. Clinical studies on kalmegh (andrographis paniculata nees) in infective hepatitis. Anc Sci Life 1983;2:208-15. |
| 4. | Keche Y, Badar V, Hardas M. Efficacy and safety of livwin (polyherbal formulation) in patients with acute viral hepatitis: A randomized double-blind placebo-controlled clinical trial. Int J Ayurveda Res 2010;1:216-9. |
| 5. | Donepudi AC, Aleksunes LM, Driscoll MV, Seeram NP, Slitt AL. The traditional ayurvedic medicine, Eugenia jambolana (Jamun fruit), decreases liver inflammation, injury and fibrosis during cholestasis. Liver Int 2012;32:560-73. |
| 6. | Ediriweera ER, Premarathna NY. Medicinal and cosmetic uses of Bee's honey – A review. Ayu 2012;33:178-82. [ PUBMED]  |
| 7. | Kumar S, Kamboj J, Suman, Sharma S. Overview for various aspects of the health benefits of Piper longum linn. fruit. J Acupunct Meridian Stud 2011;4:134-40. |
| 8. | Mondal S, Mirdha BR, Mahapatra SC. The science behind sacredness of Tulsi ( Ocimum sanctum Linn.). Indian J Physiol Pharmacol 2009;53:291-306. |
| 9. | Dange SV, Patki PS, Bapat VM, Shrotri DS. Effect of 'Arogyavardhini' against carbon tetrachloride induced hepatic damage in albino rats. Indian J Physiol Pharmacol 1987;31:25-9. |
| 10. | Vaidya AB, Antarkar DS, Doshi JC, Bhatt AD, Ramesh V, Vora PV, et al. Picrorhiza kurroa (Kutaki) Royle ex Benth as a hepatoprotective agent – Experimental & clinical studies. J Postgrad Med 1996;42:105-8. [ PUBMED] |
| 11. | Mandal J, Roy B. Studies with Liv. 52 in the treatment of infective hepatitis, chronic active hepatitis and cirrhosis of the liver. Probe 1983;22:217-42. |
| 12. | Katiyar CK, Arora D, Mehrotra R, Nandi AR, Dutta A, Jain AK. Management of chronic hepatitis B with New Livfit in end stage renal disease. Indian J Physiol Pharmacol 2005;49:83-8. |
| 13. | Buwa S, Patil S, Kulkarni PH, Kanase A. Hepatoprotective action of abhrak bhasma, an ayurvedic drug in albino rats against hepatitis induced by CCl4. Indian J Exp Biol 2001;39:1022-7. |
| 14. | Bunchorntavakul C, Reddy KR. Review article: Herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther 2013;37:3-17. |
| 15. | Manvar D, Mishra M, Kumar S, Pandey VN. Identification and evaluation of anti hepatitis C virus phytochemicals from Eclipta alba. J Ethnopharmacol 2012;144:545-54. |
| 16. | Jaganathan R, Ravinayagam V, Panchanadham S, Palanivelu S. Potential therapeutic role of Tridham in human hepatocellular carcinoma cell line through induction of p53 independent apoptosis. BMC Complement Altern Med 2013;13:323. |
|
Search Pubmed for