ROLE OF BALPUSHTIKARA YOG IN THE MANAGEMENT OF UNDERNUTRITION IN CHILDREN: EVIDENCE FROM AYURVEDA

ROLE OF BALPUSHTIKARA YOG IN THE MANAGEMENT OF UNDERNUTRITION IN CHILDREN: EVIDENCE FROM AYURVEDA

Ekta Sinha *, Kishan Gopal Choudhary and Nisha Kumari Ojha

Department of Kaumarbhritya-Balroga, National Institute of Ayurveda, Deemed to be University (DeNoVo) Jaipur, Rajasthan, India.

ABSTRACT: Introduction: Long life, good health, and healthy development are all dependent on proper nutrition. Well-fed children do better in school, develop into healthy adults, and offer their children a better start in life. Undernutrition, on the other hand, remains a major issue, particularly among children who are deprived of adequate food in developing countries. Childhood undernutrition is an underlying cause of an estimated 35% of all deaths among children under five and 21% of total global disability-adjusted life years lost among less than 5 children. Pathological alterations in the body arise as a result of various diseases or excessive indulgence in factors leading to emaciation, resulting in the emergence of undernutrition. In such cases, Deepana-Pachana (appetizer and digestive) Brimhana (Increasing muscle bulk), and Rasayana (Rejuvenizing) therapy is needed. Methods: This review is conducted using a complete and organized search of the available literatures in Ayurveda texts and published articles. The searches were performed using various databases, including PubMed, Scopus, MedLine, Google Scholar, and others. The keywords used for the search included Undernutrition, Deepana, Pachana, Brimhana, Balpushtikara yog. Result: Ayurveda drugs described for management of Karshya and Balshosha are completely formulated to meet all the deficiencies and cure the same. Balpushti karayog is an Ayurveda drug indicated as karshyaroghara for the management of emaciation (undernutrion). The purpose of this study is to evaluate the effect of the drug Balpushtikara yog in children. Conclusion: Balpushti karayog is a complete formulation to meet all the deficiencies of undernutrition.

Keywords: Brimhana, Deepana, Undernutrition, Pachana, Rasayana, Balpushti karayog

INTRODUCTION: The childhood stage is more prompt to growth and development than the other stage. Well-fed children do better in school, develop into healthy adults and offer their children a better start in life. Undernutrition, on the other hand, remains a major issue, particularly among children who are deprived of adequate food in developing countries.

Childhood undernutrition is an underlying cause in an estimated 35% of all deaths among children under five and 21% of total global disability-adjusted life years lost among less than 5 children. In India, the government has taken steps to combat undernutrition among school children by providing them one nutritious meal at school called “mid-day-meal.

And some other programs also running successfully include the National Health Mission (NHM), Rajiv Gandhi Schemes for Empowerment of Adolescent Girl (RGSEAG), also known as SABLA, RBSK, Poshana Abhiyan etc. Despite many efforts by government to mitigate this curse, no satisfactory results are gained. This needs to address many other issues apart from the availability of food. This includes safe drinking water, proper sanitation and waste disposal, regular deworming in children along with nutrition. Further, if food is made available, other factors like proper digestion, absorption and assimilation of food are equally important. Undernutrition is the result of the inadequacy of food in quality as well as quantity. Further, where nutritional rehabilitation is required at the same time, its digestion and proper assimilation is also equally important. Pathological alterations in the body arise as a result of various diseases or excessive indulgence in factors leading to emaciation, resulting in the emergence of undernutrition. Undernutrition in Ayurveda is similar to nutritional disorders like Balashosha, Phakka, Karshya, Parigarbhika, and Sushka Revati. In Ayurveda, the virtue of Deepana – Pachana (appetizer-digestive), Balya (strength promoting), Brimhana (increasing muscle bulk) and Rasayana (rejuvenizing) properties of drugs can be effective in undernutrition. Balpushti karayog is an Ayurveda drug mentioned in Sahasra Yogam in the reference to the management of Kshaya as Kshayarogahara Kashaya, mainly aspushtikaraka (nourishing) and kshayanashaka (correcting emaciation) ¹. Ayurveda drugs described for the management of Karshya and Balshosha are completely formulated to meet all the deficiencies and cure the same. Balpushti karayog is an Ayurveda drug indicated as karshyaroghara for the management of emaciation (undernutrion). This study aims to evaluate the effect of the drug Balpushti karayog in children.

MATERIAL AND METHODS: This review is conducted using a complete and organized search of the available literature in Ayurveda texts and published articles.

The searches were performed using various databases, including PubMed, Scopus, MedLine, Google Scholar, and others. The keywords used for the search included Undernutrition, Deepana, Pachana, Brimhana, Balpushtikara yog.

RESULTS:

TABLE 1: COMPOSITION OF BALPUSHTI KARAYOG

TABLE 2: NUTRITIONAL VALUE OF BALPUSHTIKARA YOG

TABLE 3: THERAPEUTIC PROPERTIES AND PHARMACOLOGICAL ACTIONS OF BALPUSHTIKARAYOG

TABLE 4: THERAPEUTIC PROPERTIES AND PHARMACOLOGICAL ACTION OF BALPUSHTIKARAYOG

Punarnava (Boerhavia diffusa):

Pharmacological Actions:

Immunomodulatory Activity:

In-vivo Studies: Mungantiwar and coworkers analyzed the immunomodulation by BD (aqueous extract, 50–200 mg/Kg/day orally) and showed remarkable leucocytosis and lowered mortality (50%) in pretreated mice using E. coli-induced abdominal sepsis stress model. The extract also reversed the elevation in the levels of glucose, cholesterol, SGPT, and BUN and reduction in triglycerides induced by cold and forced swimming stress in rats ³⁰. The alkaloidal fraction has shown a significant effect in leveling the increase in plasma cortisol and preventing the decrease in immune system performance in rats ³¹. The alkaloidal fraction (25–100 mg/Kg p.o.) considerably decreased and delayed hypersensitivity reactions in animals and it is due to metabolic alteration of the alkaloid to its active form ³².

TABLE 5: MINERAL ANALYSIS OF B. DIFFUSA ³³

Bala (Sida cordifolia):

Pharmacological Actions:

Anthelmintic and Antioxidant Activity: In-vitro studies were conducted on ethanolic and aqueous extract of whole plant S. cordifolia Linn. for anthelmintic and antioxidant properties. The antioxidant activities were evaluated by various antioxidant assays like α, α-Diphenyl-β-picrylhydrazyl free radical scavenging, total reducing power, nitric oxide scavenging, and hydrogen peroxide scavenging. The antioxidant activity of the ethanolic extract was almost quantitatively equivalent to that of the standards used, ascorbic acid. The anthelmintic activity of the whole plant, investigated using the Indian earthworm (Pheretima posthuma) showed that it is one of the most important local medicinal plants both for ritual and ethnomedical practices. Findings showed that S. cordifolia Linn. possesses potent antioxidant and anthelmintic activity ³⁴.

Hepatoprotective Activity: The powdered aerial and root parts of S. cordifolia showed a remarkable hepatoprotective activity against carbon tetrachloride followed by methanolic and aqueous extracts ³⁵. Malondialdehyde, hydroperoxides and conjugated dienes were significantly reduced in liver and protein carbonyls in the serum which was observed in the rats that were administered with ethanolic extracts of S. cordifolia. The mRNA level of cytochrome P450 2E1, nuclear factor-κB, tumor necrosis factor alpha and transforming growth factor-β were found to be increased in the alcohol treated rats and their expressions were found to be decreased in the S. cordifolia extracts treated rats ³⁶.

Chavya (Piper retrofractrum / P. chaba):

Pharmacological Actions:

Antibacterial Activity: The antibacterial assay was evaluated by the method of agar disc diffusion method. The media Mueller Hinton Agar No. 2 and the test microbial cultures were poured into Petri dishes. The test strain (200 ILL) was Inoculated into the media (inoculums size I O ^E cells mL ¯l) when the temperature reached 40-42 °C. I C) C) yg/20 ICIL of the test compound was impregnated in to sterile discs (7 mm, HiMedia). The disc was then introduced into medium with the bacteria. The plates were incubated ovemight at 37°C for bacteria. Antimicrobial activity was determined by measuring the diameter of the zone of inhibition. The experiment was performed in triplicates, and the mean values of the result are expressed as Mean ± SEM. Cefotaxime sodium (100 pg clisk¯l) was used as positive control, and Dimethylsulphoxide was taken as negative control ³⁷.

Bioavailability Enhancing Activity: Atal studied Piper chaba and suggested that piperine promotes the rapid absorption of co-drugs by increased absorption from the gastrointestinal tract or by protecting the drug from being metabolized/ oxidized in its first passage through the liver after being absorbed or by a combination of these two mechanisms ³⁸. Subsequently, Atal et al. studied the interaction of piperine with the biotransformation reaction of drugs in hepatic tissue both in-vivo and in-vitro. It was shown that piperine inhibits aryl hydrocarbon hydroxylation, ethyl morphine-N-demethylation, 7-ethoxy coumarin-o-de-ethylation, and 3-hydroxy benzo pyrene glucorodination in rats. The use of Piper longum as a powder or piperine crystals with drugs like vasicine and sparteine was found to increase their bioavailability 2.5 to 3.5 times, respectively ³⁹.

Shalparni (Desmodium Gangeticum)

Pharmacological Actions:

Anthelmintic Activity and Immunopotentiatory Activity: Crude ethanolic extract of Indian medicinal plant, Desmodium gangeticum (A001), and its three fractions-hexane (F002), n-butanol (F003), and aqueous (F004) were evaluated chemoprophylactically and chemotherapeutically against experimental visceral leishmaniasis in hamsters. Ethanolic extract showed 41.2+/-5.3% inhibition of parasite multiplication when administered at a dose of 250 mg/kgx² on days -7 and +7 of Leishmania donovani challenge.

Its n-butanol fraction exhibited better efficacy than the ethanolic extract to the tune of 66.7+/-6.1% inhibition when administered at a similar dose schedule. But the other two fractions failed to exert any action prophylactically. F003 also imparted significant (P<0.001) non-specific resistance to peritoneal macrophages against Leishmania infection. F003 also showed moderate antileishmanial activity when tested against established infection of Leishmania donovani in hamsters but the rest three fractions failed to show any significant inhibition of parasite multiplication activity ⁴⁰.

Antidiarrheal Property: Water decocted with Shalparni, Prishniparni, and Puga bark and mixed with honey pacifies three doshas and checks all types of diarrhea ⁴¹.

Pippali (Piper longum):

Pharmacological Actions:

Immunomodulatory Activity: The alcoholic extract of the fruits of the Piper longum and its constituent piperine was studied for their immunomodulatory activity. Administration of the alcoholic extract of Piper longum (10 mg/dose/animal) as well as piperine (1.14 mg/dose/animal) could prevent the solid tumor development in mice induced with DLA cells and increase the life span of rat bearing Ehrlich ascites carcinoma tumor to 37.3 and 58.8%, respectively. Also, administration of Piper longum extract and piperine increased the total WBC count to 142.8 and 138.9%, respectively, in Balb/c rat ⁴².

Bio-Availability Enhancing Effect: Piper longum constituentspiperine has been shown to enhance the bio-availability of structurally and therapeutically diverse drugs be modulating membrane dynamics due to its easy partitioning and increasing permeability. The effect of an ayurvedic compound Trikatu containing Piper longum, one of the major ingredients was tested in combination with another drug. The study reported that Trikatu had increased their bio-availability either by promoting rapid absorption from the gastrointestinal tract or by protecting the drug from being metabolized during its first passage through the liver after being absorbed or a combination of both mechanisms ⁴³. Possible mechanisms by which piperine caused bioenhancing effects to include alteration of membrane dynamics, inhibition of P-gp efflux and inhibition of gastrointestinal and hepatic metabolism 11, 83, 210 ^{44, 45, 46}.

Antimicrobial Activity: In-vitro antibacterial and antifungal screening were performed with petroleum ether, ethyl acetate, chloroform, and methanol extracts of root, stem and leaves of Piper longum against 13 pathogenic bacteria (5 gram-positive and 8 gram-negative) and 6 fungi by the standard disc diffusion method. Ethyl acetate extracts of Piper longum root, stem and leaves showed a relatively better anti-microbial effect against most tested organisms. Ethyl acetate, chloroform, and methanol extracts obtained from Piper longum root showed mild to moderate activity against most of the tested bacteria. But the inhibitory effect of petroleum ether was observed against only the bacteria. Of the four extracts, only ethyl acetate extract showed activity against gram-negative Klebsiella species. Ethyl acetate extract also displayed excellent activity against gram-positive Sarcina lutea (22 mm) and gram-negative Shigella sonnei (21 mm), whereas methanol extract showed strong activity against gram-negative Shigella flexneriae (17 mm). The organism Shigella boydii was resistant to all the extracts ⁴⁷.

Anti-oxidant Activity: The extract of the root of Piper longum Linn. and its major compound, Piperine exerts anti-oxidant activity and is protective in the myocardial ischemic condition. Piperine was isolated from the roots of the plant and by extracting with petroleum ether as solvent. Studies show that the petroleum ether extract and piperine show significant DPPH scavenging activity. The extract and piperine were also found to exert protective effect in the myocardial necrotic rats. They have protected myocardium from the harmful effects of lipid peroxidation and even maintained the glutathione levels to normal. Hence it can be concluded that the pet. ether extract as well as piperine are useful in exerting protective activity in case of myocardial ischemia in treated animals ⁴⁸.

Gokshura (Tribulus terrestris):

Pharmacological Actions:

Anthelmintic Activity: Successive extracts of Tribulus terrestris prepared using petroleum ether, chloroform, 50% methanol and water were tested for anthelmintic activity in-vitro using the nematode Caenorhabditis elegans. The activity could be detected only in 50% methanol extract, which on further bioactivity guided fractionation and chromatographic separation yielded a spirostanol type saponin, tribulosin, and β-sitosterol-D-glucoside. Both the compounds exhibited anthelmintic activity with ED50 of 76.25 and 82.50 μg/ml, respectively ⁴⁹.

In another study, the methanolic extract of T. terrestris was found to be more effective than the petroleum ether, chloroform and water extracts for in-vitro anthelmintic activity on the nematode Caenorhabditis elegans ⁵⁰.

Immunomodulatory Effect: Saponins isolated from the fruits of Tribulus terrestris (TT) demonstrated a dose-dependent increase in phagocytosis, indicating stimulation of non-specific immune response. An alcoholic extract of the whole plant of TT exhibited a significant dose-dependent increase in humoral antibody titer and delayed-type hypersensitivity response, indicating increased specific immune response ⁵¹.

Bioavailability Enhancing Effect: Gokhru extract, a popular plant extract used in Ayurvedic medicines, is derived from Tribulus terrestris Linn (Zygophyllaceae). One study investigated the effect of Gokhru extract on the absorption of metformin hydrochloride (HCl) in an everted sac model ⁵². Metformin is an anti-diabetic drug that is known to be highly soluble, but poorly membrane-permeable (BCS class III). The results showed increased absorption of metformin in the presence of the Gokhru extract, and the authors suggested the major saponin component in the extract may have contributed largely to this increase in drug transport. It can solubilize cholesterol while maintaining most of the structure of the cell membranes, thereby permeabilizing it to increase membrane permeability. The drug absorption enhancement properties of Gokhru extract were confirmed with increased metformin permeation across the chicken intestinal membranes from 29% to 54% ⁵³.

Jeevanti (Leptadenia reticulata):

Pharmacological Actions:

Immunomodulatory Effect: In a study, the whole plant aqueous extract of L. reticulata had proved to offer superior protection against immuno-suppression, which was induced by chromate (VI) thereby confirming the possibilities of therapeutic using L. reticulata for modulating and alleviating the chromate (VI)-induced immunosuppression ⁵⁴. Similarly, the immunomodulatory and antioxidant activity of the ethanolic leaf extract of L. reticulata was studied and proved that L. reticulata extract (100 and 200 mg/kg) significantly induced a delayed type of hypersensitivity reaction, increased Neutrophil adhesion (%) to nylon fibers, increased antibody titer values- dose-dependent manner and the rate of phagocytosis. Also, it showed to be a notable increase in the hematological profile ⁵⁵.

Antipyretic and Analgesic Effect: The antipyretic and anti-inflammatory effects of the aqueous whole plant Extract of Leptadenia reticulata (AELR) experimented in different animal models. In all the animal models Aqueous Extract of Leptadenia Reticulata (AELR) at the dose of 200 mg/kg b.w and 400 mg/kg b.w showed significant (P<0.01) antipyretic and anti-inflammatory activity ⁵⁶.

Hepatoprotective Activity: The stem’s extracts of L. reticulata on paracetamol-induced hepatic damage in albino rats. The hepatoprotective action of ethanolic extract of L. reticulata was evidenced by a remarkable reduction in the elevated serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and alkaline phosphatase level. The ethanolic extract of L. reticulata found significant hepatoprotective activity ⁵⁷.

Hematinic Property: The average content of Fe from three different parts of L. reticulata is 0.1173 ± 0.0046 ppm/100 gm. The highest amount of Fe is recorded in the root (0247 ± 0.007 ppm/100 gm) followed by leaf (0.213 ± 0.003) and stem (0.139 ± 0.004 ppm/100 gm) ⁵⁸. The normal tolerable range of iron is 15-20 mg/day; the amount of iron present in L. reticulata falls within the permissible range clearly indicate the use of the plant as medicine or food is safe to the criteria of WHO ⁵⁹.

DISCUSSION: Present review of the drug reveals that the drug Balpushtikarayog possesses a high value of nutrition Table 2, immunomodulatory, antioxidant, antipyretic, anti-bacterial, antifungal, hepatoprotective properties along with bioavailability enhancing properties Table 3. The bioavailability enhancing properties of the drug helps in proper absorption and assimilation of the drug to get the maximal effect. As there is undernutrition, the immune system also weakens, which further leads to frequent infections, which in turn worsens the health of the undernourished child. The immune-enhancing and antibacterial and antifungal effect may help in fighting the infections as well as combating the infections, if any by virtue of these actions. Intestinal worm infestation is one of the contributing factors of undernutrition. The drug also possesses anthelminthic properties.

Despite nutritional rehabilitation, if worm infestation is not treated, no promising result can be obtained. Chronic undernutrition leads to various pathological states in the body of a child, which includes the generation of free radicals and fever and also disruption in hepatic functions.

The antioxidant, anti-inflammatory, antipyretic and hepatoprotective properties of the drug may help in correcting these pathological conditions. The drug possesses Deepana, Pachana, Krimihara, Brimhana, Balya and Rasayana properties Table 4 which are key to correcting the undernutrition and promote proper growth and development in children. Therefore, it can be revealed that the drug Balpushtikarayog is a complete formulation to meet all the deficiencies of undernutrition and cure the same.

CONCLUSION: Undernourished children are more prone to infectious diseases like pneumonia and tuberculosis, which causes to higher mortality rate. Ayurveda has precisely explained the etiology, clinical features and treatment of undernutrition in terms of Kshaya and Karshya. Brimhana is the line of treatment in undernutrition but the concept of Agni in undernutrition and assimilation of the drug play significant role.

So, Brimhana and Rasayana drugs with Deepana- Pachana drugs can give a fruitful result in the correction of undernutrition in children. The present review indicates that Balpushtikarayog is a complete formulation to meet all the deficiencies of undernutrition.

ACKNOWLEDGEMENT: The authors are very much thankful to the National Institute of Ayurveda, Jaipur, for providing necessary support and facilities.

CONFLICTS OF INTEREST: The authors declare no conflicts of interest.

REFERENCES:

1. Sharma RN, Sharma S: SahasraYogam, Kashaya Prakarana, Kshayarogahara Kashaya, Chaukhambha Sanskrit Pratisthan Reprint 2019; 12.
2. Begum GRJ, Beevy SS and Sugunan VS: Nutritive and anti-nutritive properties of Boerhavia diffusa Journal of Pharmacognosy and Phytochemistry 2014; 2(6): 147-151.
3. Chandra K, Chaudhari BG, Dhar BP, Joseph JV, Mangal AK and Dabur R: Database on medicinal plants used in Ayurveda. Cent Counc Res Ayurveda Siddha 2007; 8: 42-58.
4. Jadidi N: Arraniry B.A. and all, Proximate composition, nutritional values and phytochemical screening of Piper retrofractum Fruits Asian Pacific Journal of Tropical Biomedicine 2018; IP: 10.232.74.23.
5. AOAC, 2016, Official methods of analysis of AOAC International. 20th edn. Rockville, Maryland.
6. Neelam and Kamala K: Nutritive value of Pepper, In: Pepper market review, National Institute of Nutrition, Hyderabad May 2001; 1-5.
7. Shail, Dwivedi M, Kumar N and Tripathi AD: nutritive estimation of tribulusterrestris, Gokshura Kseerapaka: A health supplement for pregnant women. International Journal of Home Science 2016; 2(2): 349-352.
8. George M and Christopher G: Nutritional value of selected wild edible leaves used by tribal communities of attappady, southern Western Ghats. International Journal of Food Science and Nutrition ISSN: 2455-4898.
9. Mishra B: BhavprakashNighantu, Indian Materia Medica, commentary by PadmashriChunekar K.C., Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Guduchyadivarga 231: 406.
10. Mishra B: Bhavprakash Nighantu, Indian Materia Medica, commentary by PadmashriChunekar K.C., Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Guduchyadivarga 144:351-353.
11. Mishra B:Bhavprakash Nighantu, Indian Materia Medica, commentary by PadmashriChunekar K.C., Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Haritkyadivarga 20.
12. Mishra B:Bhavprakash Nighantu, Indian Materia Medica, commentary by PadmashriChunekar K.C., Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Guduchyadivarga 31-33:273.
13. Mishra B:Bhavprakash Nighantu, Indian Materia Medica, commentary by PadmashriChunekar K.C., Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Haritkyadivarga 54-58:15.
14. Mishra B:Bhavprakash Nighantu, Indian Materia Medica, commentary by PadmashriChunekar K.C., Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Haritkyadivarga 45-46: 279.
15. Mishra B: Bhavprakash Nighantu, Indian Materia Medica, commentary by Padmashri Chunekar KC, Chaukhamba Bharati Academy Varanasi, C. 1500-1600, Haritkyadivarga 40-41: 282-283.
16. Sharma P: Dhanvantari Nighantu, Chaukhambha Orientalia, Varanasi Reprint Shatpushpadi varga 2008; 84.
17. Sharma P: Kaiyadeva Nighantu, PathapathyaVivodhakah, ChaukhambhaOrientalia, Varanasi Reprint, Aushadhi Varga 2009; 216.
18. Sharma P: Dhanvantari Nighantu Chaukhambha Orientalia, Varanasi Reprint 2008; 32.
19. Sharma P: Kaiyadeva Nighantu, Pathapathya Vivodhakah, Chaukhambha Orientalia, Varanasi, Reprint 2009; 12.
20. Sharma P: Dhanvantari Nighantu, Chaukhambha Orientalia, Varanasi Reprint Shatpushpadivarga 2008; 83.
21. Sharma P: Kaiyadeva Nighantu, PathapathyaVivodhakah, ChaukhambhaOrientalia, Varanasi Reprint Aushadhi Varga 2009; 216.
22. Sharma P: Dhanvantari Nighantu, Chaukhambha Orientalia, Varanasi Reprint 2008.
23. Sharma P: Kaiyadeva Nighantu, Pathapathya Vivodhakah, Chaukhambha Orientalia, Varanasi, Reprint 2009; 12.
24. Sharma P: Dhanvantari Nighantu, Chaukhambha Orientalia, Varanasi Reprint Shatpushpadivarga 2008; 83.
25. Sharma P: Kaiyadeva Nighantu, PathapathyaVivodhakah, ChaukhambhaOrientalia, Varanasi Reprint, Aushadhi Varga 2009; 216.
26. Sharma P: Dhanvantari Nighantu, Chaukhambha Orientalia,Varanasi, Reprint, Guduchyadivarga 2008; 65.
27. Sharma P: Kaiyadeva Nighantu, PathapathyaVivodhakah, Chaukhambha Orientalia, Varanasi Reprint AusadhiVarga 2009; 139.
28. Sharma P: Dhanvantari Nighantu, Chaukhambha Orientalia, Varanasi, Reprint 2008; 66.
29. Sharma P: Kaiyadeva Nighantu, Pathapathya Vivodhakah, Chaukhambha Orientalia, Varanasi, Reprint Aushadhi Varga 2009; 195.
30. Mungantiwar AA, Nair AM, Kamal KK Sharma Saraf MN: Adaptogenic activity of aqueous extract of the roots of Boerhaavia diffusa Indian Drugs 1997; 34(4): 184–189. [Google Scholar]
31. Muntgantiwar AA, Nair AM, Shinde UA, Saraf MN. Effect of stress on plasma and adrenal cortisol levels and immune responsiveness in rats: modulation by alkaloidal fraction of Boerhaavia diffusa. Fitoterapia 1997; 68(6): 498–500. [Google Scholar]
32. Mungantiwar AA, Nair AM Sharma Shinde UA: Studies on the immunomodulatory effects of Boerhaavia diffusa alkaloidal fraction. Journal of Ethnopharmacology 1999; 65(2): 125–131. [PubMed] [Google Scholar]
33. Subramanian R, Gayathri G, Rathnavel C Sharma Raj V: Analysis of mineral and heavy metals in some medicinal plants collected from local market. Asian Pacific Journal of Tropical Biomedicine 2012; 74-78.
34. Pawa RS, Jain A, Sharma P, Chaurasiya PK Sharma Singour PK: In-vitro studies on Sida cordifolia Linn for anthelmintic and antioxidant properties. Chin Med 2011; 2: 47-52.
35. Rao KS Sharma Mishra SH: Isolation and assessment of hepatoprotective activity of fumaric acid obtained for the first time from Sida cordifolia Indian Drugs 1997; 34(12): 702-6.
36. Rejitha S, Prathibha P Sharma Indira M: Amelioration of alcohol-induced hepatotoxicity by the administration of ethanolic extract of Sida cordifolia Br J Nutr 2012; 108(7): 1256-63.
37. Vaghasiva Y, Nair R and Chanda S: Investigation of Some Piper Species for Anti-Bacterial and Anti-Inflammatory Property. Intemational Joumal of Pharmacology 2007; 3(5): 400-405.
38. Dalvi RR and Dalvi PS: Differences in the effect of Piperine and Piperonyl butoxide on hepatic drug metabolizing enzymes in rats. Drug Metabolism and Drug Interaction 1991; 9(1): 23-30.
39. Atal CK, Zutshi U and Rao PG: Scientific evidence of the role of Ayurvedic herbals on bioavailability of drugs. J of Ethnopharm 1981; 4: 229-233.
40. Nasib Singh, Pushpesh Kumar Mishra, Aruna Kapil and Kamal Ram Arya: Efficacy of Desmodium gangeticum extract and it’s fractions against experimental visceral leishmaniasis. PMID 15763367, DOI:10.1016/j.jep. 2004. 12.032.
41. Trivedi HP: Vangasena Samhita, With ‘Hari’ Balaroga/39, Chaukhambha Sanskrita Series Office, Varanasi, Edition 2009; 1.
42. Suna ES and Kuttan G: Immunomodulatory and antitumor activity of Piper longum and piperine. J Ethnopharmacol 2004; 90(2-3): 339-46.
43. Bano G, Raina RK, Zutshi U, Bedi KL, Johri RK and Sharma SC: Effect of piperine on bioavailability and pharmacokinetics of propranolol and theophylline in healthy volunteers. Eur J Clin Pharmacol 1991; 41: 6157.
44. Khajuria A, Thusu N and Zutshi U: Piperine modulates permeability characteristics of intestine by inducing alterations in membrane dynamics: Influence on brush border membrane fluidity, ultrastructure and enzyme kinetics. Phytomedicine 2002; 9: 224–231. [CrossRef] [PubMed]
45. Shoba G, Joy D, Joseph T, Majeed M, Rajendran R and Srinivas P: Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med 1998; 64: 353–356. [CrossRef]
46. Bhardwaj RK, Glaeser H, Becquemont L, Klotz U, Gupta SK and Fromm MF: Piperine, a major constituent of black pepper, inhibits human p-glycoprotein and cyp3a4. J Pharmacol Exp Ther 2002; 302: 645–650. [CrossRef] [PubMed]
47. Antimicrobial Screening of Different Extracts of Piper longum M. Abbas Ali Research Journal of Agriculture and Biological Sciences 2007; 3(6): 852-857.
48. Jagdale SC, Kuchekar BS, Chabukswar AR, Lokhande PD and Raut CG: Anti-oxidant activity of Piper longum J Biol Chem 2009; 3: 119-125.
49. Deepak M, Dipankar G, Prashanth D, Asha MK, Amit A and Venkataraman BV: Tribulosin and β-sitosterol-d-glucoside, the anthelmintic principles of Tribulus terrestris. Phytomedicine. 2002; 9(8): 753-756.doi:10.1078/094471102321621395
50. Kiran B, Lalitha V and Raveesha KA: In-vitro Evaluation of Aqueous and Solvent extract of Tribulus terrestris leaf against Human bacteria. Int J Pharm Tech Res 2011; 3: 1897–903. [Google Scholar]
51. Tilwari A, Shukla NP and Devi U: Effect of five medicinal plants used in Indian system of medicines on immune function in Wistar rats. Afr J Biotechnol 2011; 10: 16637–45. [Google Scholar]
52. Ayyanna C, Mohan Rao G, Sasikala M: Somasekhar P, Arun Kumar N and Pradeep Kumar M: Absorption enhancement studies of metformin hydrochloride by using Tribulus terrestris plant extract. Int J Pharm Technol 2012; 4: 4119–4125.
53. Kumar A and Bansal M: Formulation and evaluation of antidiabetic tablets: Effect of absorption enhancser. World J Pharm Res 2014; 3: 1426–1445.
54. Girishkumar V, Sreepriya MS, Praveenkumar S, Bali G and Jagadeesh MS: Modulating effect of Leptadenia reticulate, Retz, Wight & Arn against chromate (VI)-induced immunosuppression and oxidative stress onmouse splenic lymphocytes and bone marrow derived macrophages. J Ethnopharmacol 2010; 131: 505–508.
55. Pravansha S, Thippeswamy BS and Veerapur VP: Immunomodulatory and antioxidant effect of Leptadenia reticulata leaf extract in rodents: Possible modulation of cell and humoral immune response. Immunopharm. Immunot 2012; 34: 1010–1019. [CrossRef] [PubMed]
56. Sneha B, Ganga RM and Divya N: Evaluation of antipyretic and anti–inflammatory activity of aqueous extract of Leptadenia reticulata in Animal Models. J Natural Remedies 2016; DOI: 10.18311/jnr/2016/468
57. Nema AK, Agarwal A and Kashaw V: Screening of hepatoprotective potential of Leptadenia reticulata stems against paracetamol induced hepatotoxicty in rats. Int J Res Pharm Biomed Sci 2011; 2: 666–671.
58. Chen KS, Tseng CL and Lin TH: Trace elements in natural drugs determined by INAA. Journal of Radioanalytical and Nuclear Chemistry 1993; 170: 265-280.
59. Sheded MG, Pulford ID and Hamed AI: Presence of major and trace elements in seven medicinal plants growing in the South Eastern Desert, Egypt. JAE 2006; 66: 210-217.
    

    ---

    How to cite this article:

    Sinha E, Choudhary KG and Ojha NK: Role of Balpushtikara yog in the management of under nutrition in children: evidences from Ayurveda. Int J Pharm Sci & Res 2022; 13(10): 3907-15. doi: 10.13040/IJPSR.0975-8232.13(10).3907-15.

    ---

    All © 2022 are reserved by International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.