A REVIEW OF CLASSICAL, PROPRIETARY AND PATENTED AYURVED PRODUCTS AND THEIR INGREDIENTS IN LIVER / SPLEEN DISEASES

A REVIEW OF CLASSICAL, PROPRIETARY AND PATENTED AYURVED PRODUCTS AND THEIR INGREDIENTS IN LIVER / SPLEEN DISEASES

Narendra Bhatt ¹, Manasi Deshpande ^{* 2}, Prasad Namewar ² and Suryajeet Pawar ²

Consultant Ayurveda - Research & Industry ¹, 15, Bachubai Buliding J. Bhatankar Marg, Parel, Mumbai – 400012, Maharashtra, India.

Department of Dravyaguna Vigan ², Bharati Vidyapeeth (Deemed to be University), College of Ayurved, Pune - 411043, Maharashtra, India.

ABSTRACT: Liver disease is the tenth most common cause of death in India as per the World Health Organization and may affect every one in Five Indians. In spite of consistent human effort and drug discovery, modern drug has very little to offer. Nonetheless, Ayurved classical proprietary and patented formulations have shown promising results. The present study provides a general review of the Ayurved products along with pharmacological actions of herbal medicines. Arogyavardhini vati, Liv 52 are the highest prescribing medicines in liver disorders. Curcuma longa, Phyllanthus niruri, Tephrosia purpurea, Picrorrhiza kurroa, Swertia chirayata are the commonest single herb used by the herbalist and Ayurved physician in the treatment of various liver disorders. An attempt has been made to compile classical, proprietary and patented Ayurved products. This may be useful to the clinicians, professionals, scientists and scholars working in the field of Ayurved for new product development.

Liver disorders, Classical products, Proprietary, Patented, Product development

INTRODUCTION: The Liver is a vital organ involved in the maintenance of metabolic functions and detoxification of the exogenous and endogenous challenges like xenobiotic, drugs, viral infections and chronic alcoholism ¹. Liver disease is the tenth most common cause of death in India as per the World Health Organization and may affect every one in five Indians.  Around 10 lakh patients of liver cirrhosis are newly diagnosed every year in India. Liver cirrhosis is the 14^th leading cause of deaths in the world and could be the 12^th leading cause of deaths in the world by 2020. ²

Liver disorders like viral hepatitis, cirrhosis, alcoholic liver disease, fatty liver, jaundice etc. do not have specific treatment modalities in modern medicine even though they are the cause for death and secondary complications among the population of developed and developing countries. No any specific safe and no hepatic damage remedy has been found in conventional medicine. Medicinal products used are found to give only symptomatic relief to patient with hepatic disorder without managing the fundamental cause to the symptoms.

Ayurved herbal formulations are in great demand for primary healthcare because of their usefulness in various disorders and higher safety margins and lesser costs. These various formulations contain various plant drugs, and metals which could offer an opportunity to treat the various liver diseases and gives new hope for the future.

Various scientific research and review articles / papers are available on Liver diseases / Liver disorders. Two review articles on Indigenous drugs for liver and hepatoprotective Ayurvedic plants based on plant drugs gave idea about role of indigenous drugs as hepatoprotective drugs ^{3, 4}. In this paper, authors have reviewed all the available classical products, proprietary and patented products and their ingredients used for various liver diseases which may provide safe and cost-effective treatment modalities.

Liver- Ayurved and Modern Perspective: Liver and its dysfunctions are defined and well described in Ayurved in the context of blood as an important constituent of human biology. In Ayurved, the role of liver is explained in relation to pathogens (dosa), tissues (dhatu) and its development, muscle (mamsa), heart (hrid), blood (rakta), respiration (pranavaha srotas), and excretion (mala).

The liver may be affected in the diseases involving these systems. The liver is the largest organ of the body, contributing about 2% of the total body weight in the average human. It is connected with most of the physiological processes, which include growth, immunity, nutrition, energy metabolism and reproduction. Synthesis and excretion of bile, albumin, prothrombin and the production of the compliments which are the major effectors of the humoral branch of the immune system occur mainly in the liver ⁵.

Liver Disorders According to Ayurved: 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 function of the liver. This hepatotoxicity eventually leads to serious diseases like hepatitis, cirrhosis, alcoholic liver disease and ultimately results in hepatic cancers (liver tumors).

According to Ayurved, the accumulation of abnormal toxic fluids around the liver creates blockage (srotorodh) that inhibits the secretion of bile resulting in liver enlargement and various Liver disorders. Impaired digestive power (agni) has been considered the basic etiological factor ⁶.

Gulma: The meaning of Gulma is pindakara [round and hard mass]. It is the abdominal lump which is caused due to aggravation and encapsulation of Vata Dosha (kupita Anila moodhatwat) which does not give clue about its site of origin (Goodha Gulmodaya) and spreads widely like the shrubs (Gulmavat vishalatwaat). It is usually known as gaseous tumour of abdomen.⁷

Udarroga: Agnidosha [defective digestion strength] and Mala Vruddhi [increase in waste products / morbid matter] are the reasons for diseases like Udara (abdominal diseases including ascites). If there is suppression of Agni (power of digestion and metabolism), and if the person takes Polluted food, this leads to indigestion as a result of which Doshas get accumulated. This causes vitiation of Prana (a variety of Vata Dosha), Agni (digestive enzymes) and Apana (another variety of Vata, related to expulsion of faeces, flatus, urine etc.) and obstruction to the upward and downward channels of circulation. The vitiated Doshas get lodged between the skin and the muscle tissue and cause extensive distension of lower part of abdomen. This gives rise to Udara (obstinate abdominal diseases including Ascites) ⁸. Yakrutodara and Pleehodara are the types of eight Udarroga.

Panduroga: Panduroga is generally considered as anaemia. When the pitta predominant doshas get aggravated in the tissues, the tissues undergo inflammation and get weak and lax. Heaviness also develops in the tissues of the body. This pathological process leads to deterioration of varna (colour), bala (strength and immunity), sneha (unctuousness of the body, the protective fat buffer) and other qualities of ojas (ojas is the essence of all the tissues and hence represents immunity). The qualities of ojas go on deteriorating due to the complicated amalgamation of doshas and tissues (dhatus) in a disease complex. The person ultimately gets vaivarnya (discoloured, mainly pallor) and such a condition is called Pandu Roga ⁹.

Kamla: It is a term used in Ayurveda to describe a disease which resembles Jaundice. Pandu and Kamala are said to be the diseases which are interrelated. They are also said to be have common origin. When Pandu is not treated properly it can lead to Kamala. Thus, Kamala can be considered as an effect of untreated Pandu or Pandu which runs a chronic course.

Kumbha Kamala- Halimak, Alasa: When jaundice continues for more than one month and symptoms become serious with dark yellow colored urine, feces, deep yellow colored eyes, general swelling (edema) of the body, a crushing pain in the joints, it is called Kumbha-Kamala, which, when it develops in its course such symptoms as fever, aching pain in the limbs, vertigo, physical languor, drowsiness and emaciation comes to be known as Lagharaka. This, in its turn, when marked by an excessive preponderance of the deranged Vayu and Pitta is called Alasa, otherwise known as Halimaka ^{10, 11}.

Madatyaya: Madatyaya compromises of two words Madaa and Atyay. Mada means Harsh (Excitement) Atyay ¹² means Atikrama (excess). This over excitement is caused by excess consumption of Madya [alcohol]. Depending on the involvement of the Dosha, its toxic effects occur, due to ^{13, 14}. Due to excessive and the improper use of alcohol caused ‘Madatyaya’. It is Tridoshaja Vyadhi (disease caused by involvement of all three Doshas - Vata, Pitta and Kapha).

Granthi / Arbud specific to Yakrit / Pleeha: Granthi, [minor neoplasm] is a localized small swelling within the subcutaneous fat tissue, muscle or blood veins; it is round, erect, and knotted.

Arbuda [major neoplasm] is a spherical, stable, massive, painless swelling occurring at one site; it expands slowly with deeper roots.

It originates due to metabolic changes. Vata dosha is responsible for cell division. Aggravation of vata dosha and suppression of kapha doshas or both the doshas interacting with one another may result in proliferation of cells. However, the Ekadesavriddhi (growth at a specific part) is a part of abnormal cell division resulting in benign or malignant tumors.

Ayurveda Products / Herbs for Liver Diseases: In Ayurvedic classical texts, purification process (sodhana chikitsa including panchakarma) using internal and external medications which can eliminate pathogens (dosas), curative therapy (shamana chikitsa) pacifies pathogens (dosas), correction of metabolic defects (dhatwagni chikitsa), immunotherapy (rasayana), anticancerous drugs (vyadhipratyanika chikitsa) and symptomatic treatment (lakshanika chikitsa) and surgical treatment with herbal and mineral medicines (Shastra chikitsa), these are the general line of treatment for any type of liver disorders. The fundamental principles of Ayurveda are finding the cause of an illness and restoring the balance between the three major bodily systems by supplying deficient substances and by reducing the excessive ones (tridosa siddhanta).

The Indian Traditional Medicine like Ayurveda, Siddha and Unani are predominantly based on the use of plant materials and treating various types of Liver disorders. Plant drugs formulations have gained importance and popularity because of their safety, efficacy and cost effectiveness. Various formulations are prepared on the principle of synergetic actions as phenomenon of positive herb-herb interaction.

Nonetheless, some herbs and classical formulations have shown promising results. The present study provides a general review of the classical Ayurved products, patented Ayurved products along with pharmacological actions of herbal medicines.

Methodology: For the present review, A literature search was conducted for product and medicinal plants used for liver disorders from Ayurved classical texts, PubMed and Google Scholar. Various scientific research and review articles published from 2001 to 2017 were identified through PubMed and Google scholar websites using MeSH terms. The search included the following keywords: medicinal plants, formulations, liver diseases, Hepatoprotective, hepatic disorders.

Available formulations are classified in three categories; Ayurved classical products, patented products and Medicinal plants used in the formulations of Liver diseases. Details of pharmacological and clinical research profiles are summarized and tabulated.

Observations: After going through classical text and other literature, it is observed that Liver/ Spleen are directly or indirectly involved in the following diseases.

Liver Disorders and Comparison with Modern Science:

TABLE 1: VARIOUS TYPES OF LIVER DISORDERS AS PER AYURVED AND MODERN SCIENCE

Classical Ayurved Liver Products: A number of classical and significant formulations in the various dosage forms are mentioned in Ayurved classics for liver diseases. The basic approach is to formulate various compounds to select several herbs with properties that address key aspect of the individual case, such as involvement of Dosha, digestive power, symptoms, tissue, organs and channels involved. Single herb can have many properties; herbs can choose to address more than one particular element of the overall treatment.

All these herbal formations and Herbomineral formulations are compiled and classified in different disease categories as follows-

TABLE 2: CLASSICAL AYURVEDIC HERBAL FORMULATIONS FOR LIVER DISORDERS [SINGLE DISEASE CONDITION] ¹⁵

TABLE 3: CLASSICAL AYURVED PRODUCTS- CONDITION WHERE SYMPTOMS OF TWO DISEASES SEEN

TABLE 4: CLASSICAL AYURVED PRODUCTS- [COMBINATION OF THREE DISEASES CONDITIONS]

TABLE 5: CLASSICAL AYURVED PRODUCTS- [SYMPTOMS OF FOUR DISEASES CONDITIONS]

Proprietary Ayurved Products for Liver Disorders: ¹⁶ After searching on Google search, in the list of Ayruved manufacturers, more than 200 Liver products are available of various pharmacies. The popular description regarding ingredients and indications of products are selected for the review.

TABLE 6: AYURVED PROPRIETARY PRODUCTS FOR LIVER DISORDERS

AH- Alcoholic Hepatitis; ALD- Alcoholic Liver Disorders; CH- Cirrhosis; CCY- Cholecystitis; DIH- Drug induced Hepatitis; EL- Enlargement of Liver; FL- Fatty Liver; HT- Hepatotoxicity; JD- Jaundice; LD- Liver disorders; LF- Liver dysfunction; PLDT- Patients on long term drug therapy; SL- Sluggish Liver; TL-Tonic for Liver boosting; VH- Viral Hepatitis

Ayurved Patented products for Liver diseases: ^{17, 18} Review was also taken to find out the patented liver products. Following products listed as patented products for various Liver disorders.

TABLE 7: REVIEW OF PATENTED AYURVEDIC LIVER RELATED PHARMACEUTICAL PRODUCTS

Medicinal plants listed in Classical products, proprietary and patented products: Many of the medicinal plants have been mentioned in various formulations. They are scientifically proven and used for the treatment of liver disorders as ingredients for various products. After going through ingredients used for the preparation of various formulations, it is observed that total 74 plants drugs are used as ingredients in the various formulations.

TABLE 8: PLANT DRUGS USED FOR VARIOUS CLASSICAL, PROPRIETARY AND PATENTED LIVER PRODUCTS

Scientifically Proven Anticancer Activity of Plant Drugs: Following 23 medicinal plant drugs are important and widely used in various products out of above mentioned 75 medicinal plants. These plants have been scientifically proven and used for various conditions of liver disorders.

TABLE 9: LIST OF MEDICINAL PLANTS COMMONLY USED IN AYURVEDIC LIVER DISEASES WITH ACTIVITIES

DISCUSSION: The use of natural remedies for the treatment of liver diseases has a long history, and medicinal plants and their derivatives are still used all over the world in one form or the other for this purpose. Scientific evaluation of plants has often shown that active principles in these are responsible for therapeutic success.

Review suggested that more than 126 liver products are described in various Ayurvedic classical texts, more than 150 products are prepared as proprietary medicines by pharmacies and 18 are patented. More than 75 medicinal plants are used for the preparation of various Liver products. Amongst all, 23 plant drugs are used frequently in various products.

It is observed that maximum Ayurved classical products are used in liver disorders specifically in jaundice, hepatitis, alcoholism, cirrhosis and ascites conditions. These products are the combination of herbs and minerals. Arogyavardhini vati, Draksadi arkom, Gudapippali, Kumaryasava, Kumari Asava, Punarnava Mandoora, Udramrit vati are the common classical products which are used in various types of conditions related with Liver.

40 proprietary products are used in various Liver disorders such as alcoholic liver, ascites, cirrhosis, jaundice; Drug induced hepatotoxicity, fatty liver, viral hepatitis, sluggish liver.

Liv 52, Cytozen,  Kamilari  Livotrit Forte, Culiv , Vasuliv, Hepabex, Hepa Cap, Livotrit Forte, Livomyn are the patented products used in hepatitis, Jaundice, drug induced hepatotoxicity, Alcoholic liver, Cirrhosis, fatty liver.

Mode of Action of Some Products: Arogya-vardhini vati is a classical polyherbal-mineral formulation mentioned in Ayurvedic formulary. It has been used for centuries with excellent efficacy and safety in treatment of jaundice, liver disorders, and various skin disorders. An experimental study clearly demonstrated the protective effect of well-known Arogyavardhini vati against CCL₄ induced hepatotoxicity in rats ^{79, 80}. It has proven anti-oxidant properties. It is safe in use although contains copper and mercury. Argyavardini vati along with Bhumyamlaki leaves juice (Phyllanthus frataruns L.) and Triphla powder have a significant role of clearing; and normalizing liver transminase in hepatitis B infected patient within 45 days ⁸¹. It has good therapeutic utilities in nonalcoholic liver disorders also.

Roudra rasa is a novel Herbo-mineral product of Ayurveda mentioned to treat Arbuda [all types of Cancer]. This product is evaluated clinically and has shown highly encouraging results in the management of liver and G. I. cancer ⁸².

Navjeevan rasa can increase the functional efficiency of liver, increase enzyme efficiency and increase serum albumin. Thus, arouses appetite which builds up the body strong ⁸³.

Yakritplihariloha is used in the Ayurvedic treatment of all types of ascites, fever, edema, jaundice, bloating, anemia, anorexia, indigestion ⁸⁴.

Liv 52 is the important formulation used in liver diseases. Usage of Liv 52 can help regulate levels of enzymes and optimize assimilation and improve the functional efficiency of the liver. It helps restore the functional efficiency of the liver by protecting the hepatic parenchyma and assists in promoting hepatocellular regeneration. It facilitates rapid elimination of acetaldehyde, the toxic intermediate metabolite of alcohol metabolism, and helps ensure protection from alcohol-induced hepatic damage. It helps diminish the lipotropic activity in chronic alcoholism and prevents fatty infiltration of the liver. In pre-cirrhotic conditions, helps arrests the progress of the disease and prevents further liver damage ⁸⁵.

Amlycure D.S. helps in regeneration & repair of hepatocytes by increasing the nucleic acid content – RNA, DNA & Protein. It accelerates repair & regeneration of liver cells by assuring liver protection by acting as an anti-oxidant, accelerates repair and regeneration of liver cells from alcohol educed liver damage by increasing the level of alcohol metabolizing enzymes, thus benefits chronic alcoholic patients. It protects liver from toxins, boosts immunity, promotes & enriches hepato-biliary secretions thus accelerating fat digestion and retards fat deposits in Liver tissues, fights fatty liver condition ⁸⁶.

Heptovit SGC and syrup contain powerful and proven herbs to repair the damaged liver cells and restore the liver functions. It is a proven liver-protective, liver corrective and anti-viral herbal product. It efficiently lowers the raised levels of liver enzymes. It therefore stimulates appetite and improves the digestive functions.

Arkaliv is formulated as ‘Liver Protective’ with incorporation of drugs like Guduchi, Kutaki, Amalaki, Rohitaka etc. Guduchi is well known as hepatoprotective and it regulates bile flow. Kutaki is stomachic, bitter in taste and useful in infective and amoebic type of liver. Daruhalad is effective in treating hepatic spleenic enlargements and catarrhal jaundice. Rohitak is blood purifier and hepatic stimulant. Shankh and Kapardik bhasma acts as antacid. Arkaliv is useful in dyspepsia, peptic acid disorders, constipation, malnutrition and other digestive disorders. This is the drug of choice in epidemic jaundice (Hepatitis-A) caused by water pollution and liver protective for alcohol addicts.

Over all Mode of Action of Liver Products: The liver is a unique organ in body it can strengthen itself. However, when the damage is severe, scar tissue is formed causing cirrhosis at which point; the liver is unable to function effectively. Ayurvedic liver products help restores the effectiveness of the liver, protect the loss of functional integrity of the cell membrane, protect hepatic parenchyma against toxins, promotes regeneration of liver cells, control the progress of the disease and protect further liver damage and ensures early restoration of hepatic role in ineffective hepatitis. They help in the prevention and treatment of Alcoholic liver, viral hepatitis, Pre-cirrhotic conditions and early cirrhosis Protein energy malnutrition, less appetite, liver damage due to Radiation and chemotherapy-induced.

CONCLUSION: Today various liver diseases are one of the foremost health troubles worldwide, with liver cirrhosis and drug induced hepatotoxicity. liver cirrhosis is the 14^th leading cause of deaths in the world and could be the 12^th leading cause of deaths in the world by 2020. Conventional treatment modalities are limited, costly and risk of adverse effects seen. Various formulations prepared from herbal and minerals play important role for the treatment of Liver diseases.

In this review article, an attempt has been made to compile classical, proprietary and patented Ayurved classical products and may be useful to the clinicians, professionals, scientists and scholars working the field of Ayurved.

ACKNOWLEDGEMENT: Authors would like to thank authorities of Bharati Vidyapeeth Deemed to be University and College of Ayurved for providing all facilities to complete this review paper.

CONFLICT OF INTEREST: Authors affirm that they do not have any conflict of interest.

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    How to cite this article:

    Bhatt N, Deshpande M, Namewar P and Pawar S: A review of classical, proprietary and patented Ayurved products and their ingredients in liver/spleen diseases. Int J Pharm Sci & Res 2018; 9(10): 4056-70. doi: 10.13040/IJPSR.0975-8232.9(10).4056-70.

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