Scientific Basis for
Ayurvedic Therapies
edited by
Brahmasree Lakshmi Chandra Mishra
Hepatic Disorders
Premalatha Balachandran and Rajgopal Govindarajan
14.1 Introduction
In Ayurvedic texts (or Ayurveda), the liver is called
yakrut
or
yakruta
or
yakrit.
The word
yakrut
has two verbs, “ya” and “krut.”
Ya
denotes activity and
krut
denotes several
meanings such as “to breakdown” or “to be instrumental”
in performing any activity. The
liver is an organ that is continuously engaged in the
activity of breaking down various
stimuli (e.g., food, water, air, or other sensory
stimuli) and is instrumental in sustaining
the process of life. In some instances, the word
yakrut
is also used as a synonym to the
word “restoration” because it helps bring back damaged
body tissues to a normal physiological
state.
1
Ayurveda describes the liver as a center of origin (
mula sthana)
of the
circulatory system (
raktavaha srotas
).
In Ayurveda, the role of liver is explained in relation
to pathogens (
dosa
), tissues (
dhatu
)
and its development, muscle (
mamsa
), heart (
hridroga
), blood (
rakta
), respiration (
pranavaha
srotas
), and excretion (
mala
). The liver may be affected in the diseases involving
these systems.
In conventional medicine, the liver is known to play a
central role in the maintenance
of metabolic homeostasis by its involvement in
carbohydrate, lipid, and protein metabolism.
It converts sugar into glycogen, carbohydrates and
proteins into fats, toxic ammonia
into nontoxic urea, etc. It produces bile, blood
coagulating and anti-coagulating factors,
proteins, and enzymes. It stores critical trace elements
and vitamins and is responsible for
detoxification and elimination of various toxins,
carcinogens, nitrogen-containing waste
products, and alcohol.
The maintenance of a healthy liver is vital to overall
health and well-being. Unfortunately,
environmental toxins, poor eating habits, alcohol
consumption, and therapeutic
drug use often abuse this vital organ, and as a
consequence there is an overall decline in
metabolic functions of the liver. This hepatotoxicity
eventually leads to serious diseases
like hepatitis, cirrhosis, alcoholic liver disease, and
ultimately results in hepatic cancers
(liver tumors).
Hepatic diseases like acute or chronic hepatitis and
cirrhosis are some of the major
causes of significant human mortality, which may result
from a wide variety of viral
infections and a range of toxins including alcohol.
Although the etiology and pathology
of hepatic disorders are not clearly defined in detail in
Ayurvedic texts, symptoms of
hepatic diseases are well described. The symptoms include
increased serum bilirubin
(
pittavriddhi
), decreased hepatic uptake (
yakruta dhatwagni manya
), decreased hepatic conjugation
(
saman vikruti
), hepatocellular damage (
yakruta shotha
), biliary stasis (
sang
), steostasis
(
medomay, yakrut medoj siragranthi
), and cirrhosis (
yakrutshosh
).
2
Modern diagnostic
accurate and speedy diagnosis of hepatobiliary disorders
and to understand the underlying
mechanisms of the diseases.
The aim of this chapter is to provide information on the
Ayurvedic treatment of hepatitis,
hepatic coma, ascities, cirrhosis, and liver cancer.
Scientific information available on
Ayurvedic treatments is summarized.
14.2 Hepatitis (
Kamala
)
According to Ayurveda, hepatitis is a disease of the
circulatory system and is categorized
under biliary (
pitta
) diseases;
ranjaka pitta
is the type of biliary fluid involved in this
tools presented in Table 14.1 are widely used by
Ayurvedic practitioners currently for
© 2004 by CRC Press LLC
Hepatic Disorders
233
pathogenesis.
3
The liver secretes
Pachaka pitta
(more than 500 cc in a day) and is stored in
the gall bladder (
pittashaya
). The stored bile gets reabsorbed and leaves a fraction
of original
bile (
tyakta drava pitta
). The concentration of original bile in the circulation
is critical and
any derangement leads to diseases arising out of weak
digestive and metabolic activity
(
agni vaishamya
). The more dilution of bile in the gall bladder results
predominantly in
symptoms like nausea, vomiting, and fever. When the
concentration is too high, it leads
to symptoms like burning sensations, thirst, profused
sweating, giddiness, and hemor-
1
TABLE 14.1
Tests for Hepatobiliary Disorders
Test
(Reference Range) Diagnosis
Biochemical Analysis
Alanine aminotransferase
(up to 35 IU/l)
Aspartate aminotransferase
(6–38 IU/l)
Elevation indicates degree of inflammation and possible
causes for
the disease
Alkaline phosphatase (53–128 IU/l)
Gamma glutamyl transpeptidase
(
<
50 IU/l)
Elevation suggestive of obstructive liver diseases and
liver cancer
g
-GT is an indicator of alcohol usage
Total bilirubin (0.2–1.0 mg/dl)
Direct bilirubin (0–0.2 mg/dl)
Elevation indicates diseases of the liver and bile ducts
Albumin (3.5–5.0 g/dl) Decreased level suggests chronic
liver disease and liver cancer,
particularly worse cases, though a decrease is also
noticed in
generalized protein deficiency conditions (e.g.,
kwashiokar and
marasmus)
Alphafetoprotein (up to 10 ng/ml) Specifically rises to
500 ng/ml during hepatocarcinoma
Abnormal clotting studies Suggestive of worsening chronic
liver disease
Antibody test (blood sample) Indicates hepatitis A, B, or
C
Hepatitis B DNA (blood sample) Indicates hepatitis B
Hepatitis C RNA (blood sample) Indicates hepatitis C
Bile duct imaging Indicates primary biliary cirrhosis
HFE gene analysis for C282Y
mutation
Indicates hemochromatosis
Liver biopsy Indicates nonalcoholic steatohepatitis,
chronic hepatitis B or C,
primary biliary cirrhosis, autoimmune hepatitis,
alcoholic liver
disease
Imaging Modalities
a
Plain abdomen x-ray Detects gallstones, calcification
Oral cholecystography Gives size, shape, position, and
function of gall bladder
IV cholangiography Visualizes bile duct
Percutaneous transhepatic
cholangiography
Detects obstructive jaundice
Endoscopic retrograd
cholangiography
Confirms obstructive jaundice
Ultrasound scanning Diagnoses cysts, abscesses, neoplasm,
degenerative changes, and
metastatic deposits
CT scanning Diagnoses malignant tumors, focal nodular
hyperplasia,
hemangioma, cysts, and abscesses
Radionucleotide or isotope scanning Detects and estimates
metastatic lesions
MRI scanning Produces images of gall bladder and biliary
duct
a
Dole, V.A.,
Ayurved and Hepatic Disorders
, Sri Satguru Publications, Delhi, 2001, 71.
rhagic conditions (Figure 14.1).
Ayurveda classifies two basic types of hepatitis:
hemolytic jaundice
(kostashakhasrita kamala,
paratantra kamala,
or
bahupittaja kamala
) and obstructive jaundice (
shakhasrita kamala).
Hepatitis
could also be intrahepatic (
swatantra
) or extrahepatic jaundice (
paratantra
).
The other
minor types of hepatitis are chronic hepatic failure (
kumba kamala
), fulminant hepatic failure
(
halimaka
), and hepatorenal syndrome (
panaki
).
3
Hemolytic hepatitis is associated with moderate
to severe anemia. Accelerated destruction of red blood
cells and hemoglobin (increased
malaroopa ranjaka pitta
),
due to the diet and lifestyle that increase
pitta
(
pittavardhaka ahara
and
vihara
), leads to enhanced bilirubin formation. The obstructive
hepatitis is due to the
obstruction in the biliary flow. Water (
kapha
) or fluid accumulation obstructing the passage
channels of biliary system results in this manifestation.
The stools will be clay colored
(
tilapista nibha
) until bile comes to the intestine (
kosta
).
3
Conventional medicine considers hepatitis as one of the
most common liver diseases.
Hepatitis is caused by agents like viruses (hepatitis A,
B [HBV], C [HCV], D, E, G,
cytomegalovirus [CM virus], Epstein-Barr virus [EB
virus], yellow fever), parasites (
E.
histolytica
), bacteria (leptospirosis, cholangitis, septicemia),
drugs, and toxins. Although
these agents can be distinguished by their antigenic
properties, clinically they all are
generally manifested as jaundice along with some
associated constitutional symptoms.
Hepatitis may be contacted through the intake of viral
contaminated food stuff, virusinfected
blood, serum, saliva, sexual contact, urine or feces,
blood transfusion, or fecalcontaminated
food stuff.
Viral infection in liver causes destruction of
parenchymal cells at the deoxyribonucleic
acid (DNA) level, which leads to hepatocellular failure,
disturbances in nitrogen metabolism,
inflammation, necrosis, and cirrhosis resulting in the
obstruction of bile-canaliculi.
This obstruction leads to resorbtion of bile into the
peripheral bloodstream through the
hepatic vein and lymphatics.The process then causes the
serum bilirubin level to rise above
2 mg% and is sufficient to be termed clinically as
jaundice.
4
14.2.1 Treatment
Removing biliary tract blockade during hepatitis by
purgatives forms the basis for its
treatment. The elimination of vitiated pathogens (
shodana
approach of
panchakarma)
, preceded
by curative along with liver regenerative therapy (
snehana
), forms the primary
treatment protocols. Supplementary treatment includes the
administration of a daily dose
of purgatives, chologogue drugs like
katuki
, and medicated ghees.
Samprapti vighatana
treatment strikes at the root of the disease process by
destroying and neutralizing the
inflammation, removing the obstruction, and bringing the
pathogens to the intestine. Viral
hepatitis patients were treated with
pancha gavyam ghritam
(5 g B.D.) and
Katuka
rohini
(1
g) daily in the morning with milk and
bhumi amla swarasa
(50 ml/day). For nasal infiltration
(
nasya karma
),
katu tumbi jal
was used.
Netranjan
has been used as
jyotishmati swarasa.
After
4 to 6 weeks of treatment, encouraging results were
obtained and clinical symptoms of
jaundice completely disappeared.
4
This
panchakarma
treatment is more appropriate for hemolytic jaundice than
hepatocellular
jaundice. This is because a patient with a poor appetite
and general disability would
not be able to tolerate the above-mentioned exhaustive
procedures.
3
In such cases, hepatoprotective
drugs would be beneficial.
14.2.2 Herbal Treatment of Hepatitis
Two reviews have been published so far on
hepatoprotective Ayurvedic drugs. The
first one gives extensive review of the experimental and
clinical research on the
© 2004 by CRC Press LLC
Hepatic Disorders
235
hepatoprotective effects of medicinal plants and their
preparations.
5
The second review
gives a compilation of the information on various studies
on these plant medicines.
6
The herbs with their scientifically proven
hepatoprotective property are discussed in
one or more properties, including antiviral, cholerectic,
regeneration of hepatocytes,
antifibrotic, etc.
7
Individual treatment profiles for various types of
hepatitis presented
Classical Ayurvedic formulations for diseases related to
circulatory system, liver ail-
14.3 Ascites (
Udaram, Jalodhar, Asadhya
)
According to Ayurveda, the accumulation of abnormal toxic
fluids around the liver creates
blockage (
srotorodh
) that inhibits the secretion of bile resulting in liver
enlargement.
Impaired digestive power (
agni
) has been considered the basic etiological factor for
this
disease and clinical features include abdominal
distension, weakness, sluggish passage of
feces, and flatus. The successful treatment depends on
the treatment of underlying causes.
Phalatrikadi kasaya
formula
has the potential to remove a toxic blockage of the
liver. The
herbs
triphala,
katuki,
and
chira
have the properties to clear off the abnormal pathogens.
Constipation associated with ascites may be relieved by
Katuki.
Necessary detoxification
TABLE 14.2
Hepatoprotective Ayurvedic Herbal Therapies
Botanical Name Liver Disorders Type of Study Ref.
Acacia catechu Viral
hepatitis Clinical 47
Adhatoda vasica Liver
diseases Clinical 47
Aegle marmelos Hepatitis
B Clinical 7
Aloe vera Hepatoma
Yoshida AH-130 ascite
hepatoma cell line
48
Anacardium occidentale Hepatoma Hepatoma 129 cell line 49
Azadirachta indica Hepatitis B Clinical 47
Bacopa monnieir Viral
hepatitis Clinical 7
Chichorium intybus Chronic hepatitis Clinical 50
Citrullus lanthus Viral hepatitis Clinical 7
Emblica officinalis Hepatomegaly
hepatitis C
Clinical 51
Fummaria parviflora Hepatitis C Clinical 52
Glycyrrhiza glabra Hepatoma In vitro
53
Gynandropis pentaphylla Hepatoma Hepatoma 129 cell line 49
Phyllanthus niruri Hepatitis B In vitro 54
Plumbago zeylanica Hepatoma Animal studies 55
Saussurea lappa Hepatoma
HepG2 cell line
(human hepatoma cell line)
56
Solanum nigrum Viral
hepatitis Clinical 47
Sphaeramthus indicus Viral hepatitis Clinical 7
Tephrosia purpurea Viral hepatitis Clinical 7
Vitex nigundo Hepatitis
B Clinical 50
Withania somnifera Hepatoma In vitro
49
the end of the chapter and also listed in Tables 14.2 and
14.3. These herbs also possess
in Table 14.4 will help practitioners choose a better
drug for these dreadful diseases.
ments, and jaundice are listed in Table 14.5. The
Ayurvedic formulas commercially
available for the treatment of hepatic disorders are
presented in Table 14.6.
© 2004 by CRC Press LLC
236 Scientific
Basis for Ayurvedic Therapies
TABLE 14.3
Ayurvedic Herbs Shown to Have Antitumor Activity
Research Protocol Therapeutic Hepatoprotective Properties
Ref.
Andrographis paniculata (Kalmegh)
Active constituent: Andrographolide
Paracetamol-induced toxicity on isolated
rat hepatocytes
Increases the viability percentage of the hepatocytes;
antagonizes the toxic effects of paracetamol on liver
function enzymes
57
Carbon tetrachloride (CCl4) and
galactosamine toxicity in rats
Stimulates hepatic regeneration and increases
resistance to damage by toxins; activates
reticuloendothelial system
58
Animal tumors Antihepatocarcinogenic and enhances
carcinogen
detoxification by the regulation of antioxidant defense
system and microsomal drug metabolism
59
Annona atemoya/muricata (Sitaphala)
Active constituent: Bullatacin
In vitro studies
in 2.2.15 cells, human
hepatocarcinoma cell line
Induces cell death due to apoptosis, preceded by cell
blebbing, chromatin margination, and condensation
60
Animal studies Inhibits mitochondrial electron transport
and NADH
oxidase activity; arrests abnormal cell growth by
inhibiting oxidative phosphorylation and lowering
ATP levels
61
Boerhavia diffusa (Punarnava)
Active constituent: Punarnavine alkaloid
CCl4 -induced toxicity in rats Shows strong choleretic
activity and increases normal
bile flow
62
Animal studies Pharmacological potency depends on the
morphological features and time of collection of herb;
plant roots of 1–3 cm diameter, collected in the
summer, exhibited very high hepatoprotective effect
63
Eclipta alba (Bhringaraj)
Active components: Wedelolactone and
demethyl-wedelolactone
In vitro studies
in rat hepatocytes Anti hepatotoxic and stimulates liver cell regeneration 64
CCl4-induced hepatotoxicity in rats Regulates GSH levels,
hepatic drug metabolism, and
activities of lysosomal enzymes
54
Clinical trials — hepatitis patients Used as a cholagogue
and as deobstruent; down
regulates HBAg
Piper longum (Pippali)
Active constituent: Piperine
CCl4-induced toxicity in animals and
culture
Reduces lipid peroxidation by increasing glutathione
levels
59
Terminalia chebula (Haritaki)
Active constituent: Tannins
Cholesterol-induced hypercholesterolemia
in rabbits
Hypocholesterolemic effect 65
Clinical trials Used in many anticancer formulations for
the treatment
of liver enlargement
and blood purification are carried out by nimba and vasa because
they have the detoxification
properties and often are used as blood purifiers. Guduchi and triphala are used
to
restore health.8
14.4 Hepatic Coma
Ayurveda does not have a clear description and diagnosis
of hepatic coma except that it
resembles an advanced stage of kumbha kamala. Viral-,
toxic-, or drug-induced hepatocel-
TABLE 14.3 (continued)
Ayurvedic Herbs Shown to Have Antitumor Activity
Research Protocol Therapeutic Hepatoprotective Properties
Ref.
Semecarpus anacardium Linn. (Bhallataka)
Animal studies — Aflatoxin-induced
hepatocellular carcinoma in rats
Gradual increase in body weight; decreases bilirubin
and abnormal nucleic acid content; normalizes cancer
marker activities, lysozomal enzymes, glycoprotein
content, immunosuppression, and hyperlipidemia;
reduces alpha-fetoprotein to normal range and
regulates abnormal mineral metabolism; cures
hypoglycemia by activating gluconeogenic enzymes,
thereby increasing the synthesis of glucose; controls
abnormal lipid peroxidation and maintains
antioxidant defense status of the host; as a bifunctional
inducer induces both phase I and phase II
biotransformation enzymes and causes carcinogen
detoxification; prevents tumor initiation by the
metabolic activation of carcinogens; replaces necrotic
tissues by newly regenerated hepatocytes
66–73
Clinical trial — Anacartin forte an
Ayurvedic
preparation containing Semecarpus
anacardium nuts
and seeds in the
proportion of 1:200 (90 g/day of divided
doses for 3 months)
Gives subjective and objective improvement, alleviates
troublesome symptoms, increases survival time and
causes complete regression of hepatocarcinoma;
patient recovers by gaining weight and appetite;
normalizes liver abnormalities like tenderness and
enlargement; blood count and liver function tests
become normal
74
Ayurvedic formulation containing
Semecarpus anacardium nuts, Amura
rohitaka, Glycyrrhiza glabra Linn., and
Tamra bhasma
75
Animal studies — C3H jax strain breast
tumor-bearing mice
Inhibits tumor development and increases survival
period; tumor specific g-amino butyric acid level
decreases to normal
Clinical studies — cancer patients
(1.5 g of divided doses)
Response to this formulation was higher than
conventional chemotherapy and combined chemoand
radiotherapy; reduces the toxic effects of other
chemotherapeutic agents, prolongs the drug efficiency,
and increases the body’s resistance to cancer;
normalizes g-aminobutyric acid levels and glutamic
acid decarboxylase activities
lular necrosis results in a hepatic coma — a clinical
syndrome due to neuropsychiatric
complications. This kind of hepatocellular failure and
portal systemic shunts contributes
to the genesis of hepatic encephalopathy. This process
occurs by allowing nitrogenous
products of bacterial fermentation in the colon (e.g.,
ammonia) to reach the brain, which
is sensitive to their toxic actions. The aromatic amino
acids formed from the conversion
of branched chain amino acids act as weak
neurotransmitters and may displace normal
neurotransmitters (adrenaline and dopamine) in the brain,
producing hepatic coma. It is
accompanied by jaundice, gynecomastia, hepatomegaly,
splenomegaly, and ascites.
Because hepatic coma is not a single disease but a
complication resulting from various
TABLE 14.4
Therapeutic Modalities for Hepatitis
Disease Comment and Treatment Ref.
Hemolytic jaundice Bilirubin seldom exceeds 6 mg% and
more than 80% is indirect bilirubin
Treatment modalities include antibiliary measures,
internal oleation,
virechana,
hepatoprotective drugs, ghritha, and rasayana
drugs (e.g.,
Brahmarasayana, Indukantha ghritha, Panchathiktha ghritha,
Rohitakarista,
and Suvarnamalini
vasantha)
3, 50
Hepatitis B Annual incidence in U.S.: 140,000–320,000
Mild cases: Virechaka like Phalatrikadi kashaya and viricidal agent,
Phyllanthus niruri
Moderate: Arogyavardhini
with viricidal and virechaka drugs
Severe cases (serum bilirubin exceeds 20 mg%): Kamalihara rasa (0.3
g),
Tapyadi lauha (0.25
g), Arogyavardhini (0.5 g), Nirgundi
sallaki (3 g), and
Guduchi (3 g) are
used in three divided doses/day for 3 to 4 weeks;
minerals like tapyadi lauha and srothoshodhaka drugs
like shilajithu,
nirgundi, and Semecarpus anacardium are additionally used
10, 50
Acute viral hepatitis
(HBAg negative)
Arogyavardini (500
mg), hepax (500 mg), valiliv (250 mg), kamalahar
forte
(250 mg) and Liv.52 (275 mg); Arogyavardini and
hepax are more
beneficial
Decrease in total serum bilirubin was evident from the
4th day of
treatment; stimulates either hepatic or extra hepatic
clearance of
bilirubin; normalizes HDL cholesterol and other lipid
levels
76
Acute viral hepatitis
(HBAg positive)
Swarasa composed
of P. kurroa, Azadirachta indica, Amrita, Eclipta
alba,
and P.
niruri is beneficial in 17/20
patients in 30 days
Suvarnamalini vasantha, P.
niruri, and R. emodi (100 mg 2
times/day for
3 to 6 months)
50, 77
Hepatitis C Complicates into hepatic cirrhosis followed
by liver failure
N. stellata seeds
(250 mg), abhrak bhasma (250 mg), P.
longum (100 mg),
Fummaria parviflora (100 mg), Tinospora
cordifolia (100 mg), Boerhavia
diffusa (100 mg),
Emblica officinalis (100 mg) (total 1 g three times/day
dose)
52
Amebic hepatitis Combination of Shankhabhasma vati, Laghusutshekhar vati, Indrayav vati
(250 mg 3 times/day for 15 days)
Shankhabhasma vati has the property of ushna, laghu, ruksha, and teekshna
and described as Grahanirognashan
Indrayav vati is
a combination of tridoshaghna, sangrahi, and katu; it acts
as deepan, shoolnashak, jwarnashak, atisarnashak,
and krumighna
78
Drug- or alcoholinduced
hepatitis
Eclipta alba,
Andrographis paniculata, P.
kurroa, Tephrosia purpurea, and
trikatu in
combinations or Liv.52 (275 mg twice daily)
Chronic hepatitis Hepatoprotective drugs (Arogyavardini,
E. alba, Solanum
nigrum,
Chichorium intybus, P.
kurroa), anti-inflammatory drugs (Vitex nigundo,
P. longum,
sallaki, Tephrosia purpurea), rasayani
drugs (Vardhamana,
P.
longum, rasayana), and
immunomodulators (Amritha, Semecarpus
anacardium,
Punarnava mandoora) are used in combinations
50
TABLE 14.5
Classic Ayurvedic Formulations for Diseases Related to Raktavaha srotas (e.g., Liver Ailments, Jaundice
[Kamala])
Formulation, Manufacturer, and Ingredients
Indications
and Dose Ref.
Abhrak bhasma (UNJHA,
UAP Pharma Pvt. Ltd.)
Abhra, Ravi ksira, Vata ksira, Snuhi ksira, Kakamaci,
Goksura, Kharamanjari,
Vata praroha, Gomutra, Tulasi, Kadali sipha
Viral hepatitis
(250 mg)
52
Bhallataka vati (Imis
Pharmaceuticals Pvt. Ltd.)
Bhallataka, tila bija, Haritaki, Guda
Cancer (1–3 pills after
food)
Brahmarasayana (Nagarjuna
Herbal Concentrates Ltd.)
Pathya, Dhatri, Bilva, Ganikarika, Salaparni,
Prasniparni, Brhati, Kantakari,
Goksura, Bala, Punarnava, Eranda, Masaparni,
Mudgaparni, Satavari, Meda, Jivati, Jivaka, Rsabhaka,
Sali, Kasa,
Sara, Darbha, Iksu, Tvak, Ela, Musta, Rajani, Pippali,
Agaru, Candana,
Mandukaparni, Kanaka, Sankhapuspi, Vaca, Plava,
Yastyahvaya, Vidanga,
Sitopala, Sarpi, Taila, Ksaudra
Hemolytic jaundice
(12 g)
50
Candanabalalaksadi taila (Dabur Ayurvedic Specialties Ltd.)
Candana, Bala mula, Laksa, Lamajjaka, Taila, Usira, Nisa
Madhuka, Satahva,
Aguru, Katurohini, Devadaru, Bala, Kustha, Manjistha,
Balaka, Asvagantha, Darvi, Murva, Musta, Mulaka, Ela,
Tvak, Naga kusuma,
Rasna, Laksa, Sugundhika, Campaka, Pitasara, Sariva,
Sauvarcala, Saindhava,
Ksira
Hepatitis (6 g)
Draksadi arkom (Nagarjuna
Herbal Concentrates Ltd.)
Vitis vinifera, Madhuca latifolia, Glycyrrhiza glabra,
Symplocos racemosa, Cyperus Rotundus
Liver diseases
(15–30 ml)
79
Gudapippali (SRI
Dhanwantari Matam Ayurvedics Pvt. Ltd.)
Embelia ribes, Piper longum, Zingiber officinale, Piper
nigrum, Plumbago rosea,
Nigella sativa,
salt, and mineral additives
Liver diseases 79
Indukantha
ghritha (Nagarjuna Herbal Concentrates
Ltd.)
Ptia, daru, Bilva, Agniatha, Syonaka, Gambhari, Patala,
Salaparni, Prsniparni,
Brhati, Kantakari Goksura, Ksira, Ghrta, Pippali,
Pippalimula, Cavya, Citraka,
Sunthi, Saindhava
Hemolytic jaundice
(12 g)
50
Kutajavaleha (Zandu
Pharmaceutical Works Ltd.)
Kutaja tvak, Guda, Rasanjana, Mocarasa, Sunthi, Marica,
Pippali,
Haritaki, Bibhitaka, Amalaki, Lajjalu, Citraka, Patha,
Bilva, Indrayava, Vaca,
Bhallataka, Prativisa, vidanga, Balaka Ghrta, Madhu
Hepatic diseases
(6–12 g)
Laghusutshekhar vati (Gary and Son, U.S.A.)
Svarna gairika, Sunthi, Nagavalli svaras
Amebic hepatitis
(1 to 2 tablets)
78
Pancha Gavyam Ghritam (Imis Pharmaceuticals Pvt. Ltd.)
Gomaya svarasa, Dadhi, Gomtra, Goghta
Hepatitis (12 g) 4
Panchathiktha ghritha (Vyas Pharmaceuticals)
Nimba, Patola, Vyaghri, Guduci, Vasaka, Haritaki,
Bibhitaka, Amalaki, Ghrta
Hemolytic jaundice
(6 g)
50
Patolakaturohinyadi arkom (Nagarjuna Herbal Concentrates Ltd.)
Trichosanthus cucumarina, Picrorrhiza kurroa, Santalum
album, T. cordifolia,
Chonemopha fragrans
Liver diseases
(15–30 ml)
79
Phalatrikadi kasaya (Rajashree Ayurvedic Pharmacy)
Haritaki Bibhitak, Amalaki, Amruta, Vasa, Katuki, Nimb,
Kirattikta
Cirrhosis, ascites
(20 ml)
80
Punarnavasava (Nagarjuna
Herbal Concentrates Ltd.)
Sunthi, Marica, Pippali, Haritaki, Bibhitaka, Amalaki,
Darvi,
Svadamstra, Brhati, Kantakari, Vasa, Eranda mula, Katuki,
Gajapippali, Sothaghni, Picumarda, Guduci, Suska mulaka,
Duralabha, Patola, Dhataki, Draksa, Sita, Maksika
Hepatic diseases
(12–24 ml)
Rohitakarista (UNJHA,
UAP Pharma Pvt. Ltd.)
Rohitaka, Guda, Dhataki, Pippali mula, Cavya, Citraka,
Sunthi, Tvak,
Ela, Patra, Haritaki, Bibhitaka, Amalaki
Hemolytic jaundice
(12–24 ml)
50
disorders, the choice of treatment depends on symptoms of
individual patients. Treatment
profile includes the combination of the following drugs
and a vegetarian diet:
1. Nasya of
haridra and daru haridra quath reduce ammonia saturation in encephalopathy.
2. Basti (a type of enema) with dashmool quath and
saindhava can reduce toxicity in
guts.
3. Sugarcane juice maintains electrolyte balance.
4. Vasa prevents gastrointestinal bleeding.
5. Guduchi is an antibiotic.
6. Triphala
and katuki manage constipation.
7. Bhunimb and nimb help in regeneration of liver cells.9
14.5 Cirrhosis
Ayurveda does not have a clear description and diagnosis
of cirrhosis. According to
conventional medicine, the etiology of the liver
cirrhosis is due to the diffuse degeneration
and infiltration of parenchyma that results in the
structural alteration of fat lobules, dense
perilobular connective tissue formation, and development
of regeneration areas. Cirrhosis
is the seventh leading cause of death in the U.S., with
4000 annual deaths.10 Advanced
cirrhosis leads to ammonia toxicity, hepatic coma,
gastrointestinal hemorrhage, and kidney
failure. It is not a primary disease but the end result
of a diffuse liver injury secondary to
poor nutrition, anorexia and action of toxins,
alcoholism, hepatitis C, or biliary obstruction.
As liver cells are destroyed, they are systematically
replaced by scar tissue. Hepatic
cirrhosis occurs following one or more clinical manifestations
such as the loss of appetite,
hepatomegaly, splenomegaly, ascites, edema of the legs,
fever, diarrhea, hematemesis,
jaundice, portal hypertension, and anemia.
TABLE 14.5 (continued)
Classic Ayurvedic Formulations for Diseases Related to Raktavaha srotas (e.g., Liver Ailments, Jaundice
[Kamala])
Formulation, Manufacturer, and Ingredients
Indications
and Dose Ref.
Shankhabhasma vati (UNJHA, UAP Pharma Pvt. Ltd.)
Sanka, Kanjika
Amebic hepatitis
(250 mg)
78
Suvarnamalini vasantha (UNJHA, UAP Pharma Pvt. Ltd.)
Mauktika bhasma, Hingula, Marica, Kaphari, Svarna bhasma
Hemolytic jaundice
(10 g)
50
Tapyadi lauha (Vyas Pharmaceuticals)
Haritaki, Amalaki, Vibhitakaki, Sunthi, Marica, Pippali,
Vidanga,
Citraka mula, Musta, Pippalimula, Devadaru, Daruharidra, Dalcini,
Cavya,
Silajitu, Svarnamaksika bhasma,Raupya bhasma, Lauha
bhasma, Mandura bhasma
Viral hepatitis
(250–500 mg)
50
Vasagulu chyadi kvatha (Vaidyaratnam Oushadhasala)
Adhatoda vasica, T. cordifolia, Glycyrrhiza glabra,
Strychnos
potatorum, Melia azadirachta
Liver diseases
(15–30 ml)
79
TABLE 14.6
Patent Ayurvedic Formulas for Hepatobiliary Disorders
Formulation, Manufacturer, and Ingredients
Indications
and Dose Ref.
ARKA LIV Tablet (Ayurvedeeya Arkashala Ltd.)
Guduchi, Rohitaka, Daruharidra, Amalaki, Katuki, Shankha,
Karpardika,
Dagadiber bhasma
Hepatitis, jaundice,
hepatoprotective (2–3
tablets two times/day
with honey)
Arogyavardhini (Zandu
Pharmaceutical Works Ltd.)
Mercury, Sulfur, Lohabhasma, Tamrabhasma, Abhrakbhasma,
Triphala
churna, Shilajit-, Guggul, Chitrakamal Churna, Kutaki
churna, decoction
of A.
indica
Hepatitis (500 mg/day) 80
Ayu Liv Tablet (AYUDRUGS)
Kalamegha, Sharpunkha, Chitraka, Punarnava, Triphala,
Kakmachi, Senai
leaves,
Arjuna, Rohitakarishta, Kutaja tvak, Mandoora bhasma, Ajamoda,
Khus-Khus, bile
salt
Liver diseases, sluggish
liver, jaundice (1–2
tablets/day)
Hepabex (Swastik Formulations Pvt. Ltd.)
Solanum nigrum, Tephrosia pupurea, Picrorrhiza kurroa,
Ipmoea tupethum,
Eclipta alba, Phyllanthus niruri, Tecomella undulata,
Boerhaavia diffusa,
Tinospora cordifolia, Glycyrrhiza glabra
Hepatoprotective,
hepatitis B, and jaundice
(2 tsp two times/day)
Hepa Cap (Capro Labs Exports India Ltd.)
Zizyphus jujuba, Terminalia chebula, Aegle marmelos,
Calcium oximum,
Berberis aristata, Vitis vinifera, Ipomoea digitata,
Emblica officinalis
Jaundice, cirrhosis,
infective hepatitis (2
capsules two to three
times/day)
81
Hepajun (Phyto Pharma Pvt. Ltd.)
Bhringaraja, Madayantika, Daruharidra, Kalamegha,
Punarnava, Nimba,
Chitraka, Mandura bhasma, Shankha bhasma, Kasamarda,
Pathari,
Nishothara, Katuki, Kharavath, Kapardika
Impaired liver function,
hepatitis, hepatobiliary
disorders (2 capsules/
day)
Hepatovit (Millenium Herbal Care Ltd.)
Phyllanthus niruri, Terminalia chebula, Terminalia
belerica, Embilica
officinalis, Eclipta alba, Berberis aristata, Fumaria
parviflora, Boerhaavia
diffusa, Zingiber officinale, Plumbago zeylanica,
Tinospora cordifolia,
Andrographis paniculata, Picrorrhiza kurroa, Piper longum
Hepatitis, hepatobiliary
dysfunction, enlarged
liver, cirrhosis (1–2
capsules/day)
Hepax (Anglo-French Drugs and Industries Ltd.)
Chitraka, Katuki, Maricha, Ardraka, Sarjikakshara,
Amalaki, Yavakshara,
Chuna, Haritaki
Chronic hepatitis,
cirrhosis, infective
hepatitis (2 tablets three
times/day)
76
Hepin (Nupal Remedies Pvt. Ltd.)
Yashthimadhu, Daruharidra, Pippali, Bhumyamalaki,
kakamachi,
Gudardrakam, Musali, Ela, Tripadi, Kandasari
Hepatitis A and B, non-A
and non-B hepatitis (2
tablets three times/day)
82
Herboliv (Vyas Pharmaceuticals)
Arogyavardhini vati, Punarnava mandura,Bhumyamalaki,
Bhringaraja,
Punarnava,Vidanga, Haridra, Haritaki, Guduchi, Rohitaka,
Nishothara,
Mehandi, Varuna, Arjuna, Parpata Sugar
Anemia, hepatitis,
hepatomegaly, anorexia
(1–2 tablets/day)
Liv.52 (The Himalaya Drug Company)
Himsra, Kasani, Mandur bhasma, Kakamachi, Arjuna,
kasamarda,
Biranjasipha, Jhavuka; processed in Bhringaraja,
Bhumyamalaki,
Punarnava, Guduchi, Daruharidra, Mulaka, Amalaki,
Chitraka, Vidanga,
Haritaki, parpata
Viral hepatitis, cirrhosis,
hepatotoxicity (2–3
tablets/day)
76
Livotrit (Zandu Pharmaceutical Works Ltd.)
Arogyavardhini rasa, Eclipta alba, Mandura bhasma,
Boerhaavia diffusa,
Andrographis paniculata
Infectious hepatitis, liver
dysfunctions (2 tablets
two times/day)
Livshield syrup (Bajaj Consumer Care Ltd.)
Bhumyamalaki, Bhringaraja, Guduchi, Gokshura, Kasamarda,
Chitraka,
Kantakari, Krishna tulasi, Palasha pushpa, Punarva,
Arjuna twak, Triphala,
Karanaja, Maricha, Methika beeja, Nagavalli, Trivrut,
Pippali, Ativisha,
Ajamoda satva
Liver dysfunction,
jaundice (2 tsp three
times/day)
In a case report of early hepatic cirrhosis due to
biliary obstruction, patients with moderate
jaundice and anorexia with a tender, enlarged liver were
treated with arogyavardhini and
phalatrikadi kasaya with milk on empty stomachs for 3 months. No other food
was allowed.
Om Tat Sat
(Continued...)
(My
humble salutations to H H Maharshi ji, Brahmasri
Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and
doctors for the collection)
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