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1 PG scholar, Department of Gunapadam, National Institute of siddha, chennai 600047, India;
2 Assistant Professor, Department of Gunapadam, National Institute of siddha, chennai 600047, India
Corresponding Author: Swathi T, Department of Gunapadam, National Institute of siddha, chennai 600047, India. E-mail: swathiabi1497@gmail.com.
Running title: Williams-Beuren syndrome diagnostics
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ABSTRACT |
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INTRODUCTION |
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MATERIALS AND METHODS |
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PROFILE OF INDIVIDUAL DRUGS |
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DISCUSSION |
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CONCLUSION |
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ACKNOWLEDGMENT |
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CONFLICT OF INTEREST |
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REFERENCES |
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ABSTRACT
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The Siddha system is one of the traditional systems which provide healthy life to humans through the natural sources in the form of herbals, minerals and animal products. Lavaņa kuḻambu is a Siddha herbo-mineral formulation mentioned in the Siddha text Aņupõka Vaittiyanavaṉītam. Kuḻambu is a semi solid preparation with the shelf life of 5 years. The drug is indicated for Pīlīkai kaṭṭi, Kavitai kaṭṭi, Pāņṭu, Kāmālai, Peruvayiṟu, Makōtaram All these symptoms are related to the dysfunction of the vital organ Liver. Liver inflammation and oxidative stress are commonly associated with development and progression of chronic liver disease. It is evident that the natural products with anti inflammatory and anti oxidant activities posses therapeutic effect against inflammation, fibrosis and metabolic disorders. This review is aimed to bring out scientific evidence for the therapeutic usage of Lavaņa kuḻambu and focused on the Hepato protective activity for the curative nature of the drug. It is unambiguous that the ingredients in the Lavaņa kuḻambu have Hepato protective activity as per the Siddha literature and scientific evidence.
KEY WORDS: Siddha medicine, Lavaņa kuḻambu, Hepato protective, liver disorder|
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INTRODUCTION |
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Siddha system is one of the oldest traditional systems practiced in southern regions of India mostly in Tamil Nadu. It provides healthy life to the humans through the natural sources in the form of herbals, minerals and animal products. Siddhars have classified diseases in to 4448 and treated the same by 32 internal and 32 external medications. The mineral objects can be classified into four kinds, Metals (Ulōkam), salts (Kārasāram), Arsenic compounds (Pāṣāņam), Secondary minerals (Uparasam). Kārasāram (salts) is one of the type of mineral which are twenty five in number as per the text Pōkar 2000 and they are classified as Natural salts and synthetic salts. The ancient sage Tērāyar considered ‘ Kāram ‘ as the manifestation of God ‘ Sivā ‘ and ‘ Sāram ‘ as the manifestation of Goddess ‘ Sakti’(1).
Liver disease accounts for over 2 million deaths annually (cirrhosis, viral hepatitis, and liver cancer) and accounts for 4% of all deaths worldwide. Cirrhosis is the 15th leading cause of disability adjusted life years (DAILYs) globally (2). Liver cirrhosis is a consequence of chronic liver damage and inflammation and it is characterized by diffuse hepatic fibrosis and normal liver structures being replaced by regenerative liver nodules (3). Cirrhosis is an important cause of morbidity and mortality among patients with chronic liver disease which can lead to hepatocellular carcinoma, hepatic decompensation including ascites, hepatic encephalopathy and varicel bleeding (4).
Lavaņa kuḻambu is a Siddha herbo-mineral formulation mentioned in the Siddha text Aṉupōka Vaittiyanavaṉītam. Kuḻambu is a semi solid preparation with the shelf life of 5 years. The drug is indicated for Pīlīkai kaṭṭi (disease of the spleen), Kavisai kaṭṭi (a tumor in the stomach arising from dropsy), Pāņṭu (Anaemia), Kāmālai (Jaundice), Peruvayiṟu (Ascites), Makōtaram (Abnormal collection of serous fluid in the peritoneal cavity, due to inflammation of the peritoneum or obstruction of venous circulation). All these symptoms are related to the dysfunction of the vital organ Liver. The major symptoms of liver dysfunction are abdominal pain and swelling, loss of appetite, jaundice, swelling in the legs, nausea, vomiting and chronic fatigue (5, 6). The drug review of “Lavaņa kuḻambu “, a Siddha herbo mineral formulation gives evidence for its therapeutic actions mentioned in the literature. This review is focused on the pharmacological activities of each ingredient which supports the traditional claim for the effectiveness in treating Liver disorders and the literature search is confined to that area. The search was made from the textbooks in the library of national Institute of Siddha, journals, internet database.
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MATERIALS AND METHODS |
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Standard operating procedure for preparation of Lavaņa kuḻambu
Drug details
Study drug: Lavaņa kuḻambu
Reference: Hakim Mohammed Abdullah Sahib, Aṉupōka Vaittiyanavaṉītam(part - 3) 2001 - December edition, Pg. no 47, 48.
Purification of raw drugs (1)
Purification of raw drugs is described in Table 1.
Preparation of the drug – Lavaņa kuḻambu (5)
The ingredients and quantity for the preparation of Lavaņa kuḻambu were mentioned in Table 2 (Figure 1).
The palm jaggery is dissolved in sea water, the purified and powdered drugs are allowed to dissolve in the water, boiled in a low flame to attain thick consistency (meḻukupatam) and it is stored in a glass vessel.
Dose - 1 to 1 ½ Varākaṉ (4.1 – 6.6gm) Bd – 1Maņṭalam (48 days)
Indications
Pīlīkai kaṭṭi, Kavitai kaṭṭi, Pāņṭu, Kāmālai, Peruvayiṟu, Makōtaram
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PROFILE OF INDIVIDUAL DRUGS |
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Veṭiuppu (Potassium Nitrate) (7)
Formula: KNO3
Color: White to dirty grey.
System: Trigonal
Potassium nitrate is the inorganic nitrate of salt potassium, naturally occurring mineral source of nitrogen. It appears as a white to dirty gray crystalline solid. It is water soluble, noncombustible, but accelerates the burning of combustible materials.
Siddha literature (1)
It has coolant, diuretic, demulcent and diaphoretic properties as per Siddha literature.
“Mallāṟum aṭṭakuṉmam māntar utarakatti
Kalla amthaippu nīr kaņḍuraka - ellām”
It is indicated for eight types of gunmam, uterine fibroids, anemia, urinary tract infection, abdominal distension, Hepatomegaly, spleenomegaly and Ascites.
Toxicity studies (8)
In acute and sub-acute oral toxicity study, Veṭikāra cilācattu paṟpam and Neruñcil kuṭinīr at the dose level of 2000 mg/kg and 500 mg/kg was administered to Wistar albino rats did not show any pathological changes and mortality. The histopathological examinations of heart, liver, kidney also showed no abnormalities. Hence that VSP and NK is safe to be widely used for clinical application.
Scientific validation
Anti-inflammatory activity (9)
Veṭiuppu is one of the ingredients in Vedikara silasathu parpam.
Anti-inflammatory activity of Veṭikāra cilācattu paṟpam was done in Wistar Albino rats using Carragenan Induced Paw Edema method with dose 500 mg/kg Veṭikāra cilācattu paṟpam and Neruñcil kuṭinīr showed reduction in the paw diameter when compared to control groups.
Analgesic activity (9)
Analgesic activity of Veṭikāra cilācattu paṟpam was done in Wistar Albino rats using a Tail Flick method with dose 500 mg/kg Veṭikṟra cilācattu paṟpam and Neruñcil kuṭinir showed increase in the reaction time at 30 minutes when compared to the control group.
Hepatoprotective activity (10)
In veṭi-aṉṉapēti centūram (VABC), veṭiyuppu is one of the ingredients.
Hepatoprotective activity of VABC was carried out by CCl4 Induced Hepato toxicity in Wistar Albino rats. The group which administered with veṭi-aṉṉapēti centūramat 23.4 mg/kg along with CCl4 shows reduction in the serum enzyme levels and reversed the elevated levels of ALP, SGPT, SGOT, Total bilirubin which indicate the healing of damaged hepatic cells.
Anti-oxidantactivity (11)
Formula: NaCl
Color: Colorless to brown pink
System: Face centered cubic structure.
Sodium chloride also known as rock salt, halite - is an ionic compound with the chemical formula NaCl, in a ratio 1:1 of sodium and chloride.
It has a perfect cleavage and readily soluble in water. It has a pure saline taste and burns with a yellow flame (13).
Natural occurrence (14)
Himalayan salt is a rock salt (halite) is mined from the salt range mountains, the southern edge of a fold and thrust belt that underlines the pothohar plateau south of the Himalayas in Pakistan.
Siddha literature (1)
It is taken out from earth especially in the Northwest regions of Punjab and Sind. The salt is a form of earth element.
Taste: saline (Uppu)
“Aṭṭakuṉmam māntam acirkarasuram cītapittam
tuṭṭa aiyam naṭi puņṣaṅkaḻ”
It relieves eight types of gastric ulcer, vaatha pain, and throbbing pain.
It is laxative, purgative, carminative, and diuretic, stomachic.
Scientific validation
Toxicity study (15)
Intuppu pāvaṉai is Herbo-mineral formulation used to treat pitta kunmam.
In acute and sub-acute oral toxicity study with dose of 2000 mg/kg, 1800 mg/kg, the experimental animals showed no significant changes in hematological parameters, renal parameters, Liver function test , Lipid profile and blood glucose level. The histopathology study was normal. Thus, the toxicological study of the test drug greatly establishes the safety and gives the justification for long time administration.
Analgesic activity (15)
Analgesic activity of Intuppu pāvaṉai was done in Swiss Albino mice using Eddy’s Hot plate method at the two doses 200 mg/kg and 400 mg/kg, showed analgesic activity at 90 min and120 min.
Anti-inflammatory activity (15)
Anti-inflammatory activity of Intuppu pāvaṉai was done in Wister Albino rats using cotton pellet granuloma with doses of 200 mg/kg, 400 mg/kg. Among the two doses 400 mg/kg showed slight reduction in weight of granuloma than the standard drug and concludes the anti-inflammatory activity in Cotton pellet granuloma model of inflammation in rats.
Anti-oxidant activity (16)
Intuppu is one of the ingredients in camuttira cūraņam. The antioxidant activity was carried out by DPPH Radical Scavenging assay. At the dose of 200 μg/ml level camuttira cūraņam has 91.80% of inhibiting the free radical production and oxidative degeneration and proves to be a rich anti-oxidant drug.
Kaṟiyuppu (Sodium chloride) (17)
Formula: NaCl
Color: Colorless
System: Face centered cubic structure.
Sodium chloride is the salt responsible for the salinity of seawater and of the extracellular fluid of many multicellular organisms. In its edible form known as table salt or common salt commonly used as condiment and food preservative.
Natural occurrence (1)
Sodium chloride is obtained when the sea water evaporates by insolation. It is being cultivated in eastern coasts of Tamil Nadu. It has white, pale and ash color according to the cultivated land.
Siddha literature (1)
It is salty in taste and easily dissolves in water. It is not soluble in alcohol.
It is laxative, emetic, anthelmintic, stomachic and febrifuge.
“Alattil-urai nallu aṉal vātam māṟum kalattuṉai taṉṉai kalayuṅ kilaittakapam ākaṭaiya villai nōy aṣṭakuṉmam”
It is used in the treatment of liver disorders, distended abdomen, tumor, eight types of gunmam, lymphadenitis, and retention of urine.
Scientific validation
Toxicity study (18)
Kaṟiyuppu paṟpam is a Siddha mineral formulation used to treats kunmam.
In acute oral toxicity test, the limit dose of 4000 mg/kg Kaṟiyuppu paṟpam am did not cause any mortality or any signs of toxicity. Histo pathological and gross pathology also showed no abnormalities in vital organs. It can be concluded that it is non-toxic or non-lethal after an acute exposure of 4000 mg/kg.
Anti ulcer activity (18)
Anti-ulcer activity of Kaṟiyuppu paṟpam was done in Wistar Albino rats using Pyloric ligation method. In pylorus ligated rats, Kaṟiyuppu paṟpam shows partial decrease in the acid secretion and enhancement of mucin activity when compared to control group.
Anti-inflammatory activity (19)
Kaṟiyuppu is one of the drugs in kāḻamēkanārāyaņa centūram.
Anti-inflammatory activity of kāḻamēkanārāyaņa centūram was done in Wistar Albino rats using Carragenan Induced Paw Edema method. The animals treated with 400 mg/kg of kāḻamēkanārāyaņa centūram have significant anti-inflammatory effect in rats with p<0.01 when compared to control group.
Analgesic activity (19)
Analgesic activity of kāḻamēkanārāyaņa centūram was done in Swiss Albino mice using Eddy’s Hot plate method. The animals treated with 400 mg/kg of KMNC showed the analgesic activity with the latent period of 90 min possess significant effect.
Paṭikāram (Alum) (20, 21)
Formula: KAl (SO4).12H2O
Color: White crystal
System: octahedral structure
Potassium aluminum sulphate is a metal sulphate with a ratio of 1:1:2. Potassium alum or potash alum is the potassium double sulphate of aluminum. It is an astringent, styptic and antiseptic used commonly in water purification. It is a colorless white vitreous isometric crystal.
Natural occurrence
It is available in nature and found in combination with certain special form of clay in places such as Nepal, Kathiawar, Punjab and Bihar. The alum is separated from the clay.
Siddha literature (1)
Alum appears like crystal, white in color. It acts as astringent, antiseptic, anti-spasmodic.
Suvai: sweet, sour and astringent.
“cīṉameṉuṅ kāra madu ceṟivu palliranai āṉaikkāl kaņņoy aṉilamoṭu māṉilattiṉ”
It is indicated for vaayu., tumor, gingivitis, elephantiasis, gastric ulcer.
Toxicity studies (22)
In acute oral toxicity cīṉalavaņa paṟpam with the starting dose of 50 mg/kg and the subsequent doses 100,250,500,1000,2000,4000 was administered to Wistar albino rats. The animals did not show any major and significant changes in general behavior or other physiological activities till the maximum of 4000mg/kg dose. The LD50 (p.o.) of cīṉalavaņa paṟpam was found to be greater than 4000 mg/kg body weight in mice.
Scientific validation
Anti spasmodic activity (22)
Paṭikāram is one of the ingredients in cīṉalavaņa paṟpam.
Antispasmodic activity of cīṉalavaņa paṟpam was done in acetylcholine induced specific spasm as well as barium chloride induced nonspecific spasm of guinea pig ileum method. It was concluded that the antispasmodic activity of cīṉalavaņa paṟpam on guinea pig intestinal smooth muscle (Ileum) was found to block cholinergic spasm as well as non-specific spasm induced by barium chloride.
Anti-inflammatory activity (23)
Paṭikāram is one of the ingredients in ārātara paṟpam.
Anti-inflammatory activity of ārātara paṟpam was done in Wistar Albino rats using Carragenan Induced Paw Edema method with doses of 25 mg/kg, 70 mg/kg showed significant anti-inflammatory activity p<0.01 at 3rd hour when compared to control group.
Analgesic activity (23)
Analgesic activity of ārātara paṟpam was done in Swiss Albino mice using Eddy’s Hot plate method at the two doses 25 mg/kg and 80 mg/kg. Among the two doses of ārātara paṟpam 80 mg/kg at 150 minutes have shown significant analgesic activity.
Anti-oxidant activity (24)
Tacalaṉatirāvakam contains Paṭikāram, Veṭiuppu, Intuppu, Navāccāram, Veṅkāram, Kaṟiuppu, Kalluppu, Pūnīṟu, Turucu, Annapēti. The antioxidant activity was done in DPPH assay. The percentage inhibition of DLD ranges from 68.75 to 91.3% has shown promising anti-oxidant activity.
Navāccāram (Ammonium chloride) (25)
Formula: NH4Cl
Color: White solid
System: Body centered cubic.
Ammonium chloride is an inorganic chloride having ammonium as the counterion. It has a role as a ferroptosis inhibitor. It helps to maintain pH and exerts a mild diuretic effect.
Natural occurrence (26)
Ammonium chloride occurs naturally in volcanic regions, forming on volcanic rocks near fume releasing vents (fumerols). The crystals deposit directly from the gaseous state and tend to be short lived as they dissolve easily in water.
Siddha literature (1)
Navāccāramis available in small quantities in brick stone furnace. It is also obtained by sublimation of coal, salt and dung ashes of camel. It has no smell, solid in state, fiber in nature, it is hard to powder.
Taste: bitter, sour taste and smells like urine
Its actions are diuretic, stimulant, rubefacient.
“Kunmam kudarsoolai kollum Mahotharam Vanmaiyurum kalladaipu matrumkaan”
It is indicated for abdominal pain, distended abdomen, renal calculi, Hepatomegaly, hepatitis, splenomegaly.
Toxicity studies (27)
In sub-acute toxicity study, Navacharachunam (NC) with dose of 25, 50, 100 mg/kg were administered daily for 28 days. Gross pathological examination did not show any abnormality. In histopathological examination, liver showed marked dilatation of sinusoids, degeneration of Hepatocytes, necrosis. Kidney shows renal tissue with tubular epithelial damage. It was concluded that NC has toxic effect 50 mg/kg onwards for 28 days. The therapeutic use in human with dose of 25mg/kg is safe. It is not recommended for long term usage.
Scientific validation
Hepatoprotective activity (28)
Hepatoprotective activity was carried out by Paracetamol Induced Hepatotoxicityin Wistar Albino rats. In the acute liver damage induced by different hepatotoxins, Pañcākkiṉi centūram 5 mg/kg and 10 mg/kg significantly reduced the elevated serum levels of Aspartate Aminotransferase, Alanine transferase, Alkaline phosphatase and Bilirubin.
Veṅkāram (Borax) (29)
Formula: Na2-B4-O7
Color: Colorless to white crystal
System: Octahedral
Borax also known as sodium borate, tincal and tincar is a salt, a hydrated or anhydrous borate of sodium. It is a colorless crystalline solid that dissolves in water to make basic solution.
Natural occurrence
Borax occurs naturally in evaporate deposits produced by the repeated evaporation of seasonal lakes. The most commercially important deposits are found in Turkey, California and Searles Lake, California. Also, borax has been found at many other locations in the Southwestern United States, the Atacama Desert in Chile, newly discovered deposits in Bolivia, and in Tibet and Romania.
Siddha literature (1)
Taste: Sweet and astringent
Veṅkāram has coolant, diuretic, lithotriptic activities when taken internally. On external use it has emollient, antiseptic and astringent activities.
“Veṅkārañ cēttamattai vēṟupaṭṭu mēkaṟuku taṅku cila nīr māṟiyat tāṉ vāṅgum”
It is used to treat abdominal diseases, indigestion, gastric ulcer, Kapam, urinary tract infections, and infective disease.
Toxicity study (30)
Acute oral toxicity study of boron compounds, in male Sprague Dawley rats, LD50 was 4.50 g/kg for borax and 3.45 g/kg for boric acid. The LD50 for female Sprague Dawley rats was 4.98 g/kg for borax and 4.08 g/kg for boric acid. Hence borax and boric acid are relatively nontoxic by the po route.
Scientific validation
Anti-inflammatory activity (31)
Veṅkāramis one of the ingredients of veḻḻai paṟpam.
Anti-inflammatory activity of veḻḻai paṟpam was done in Wistar Albino rats using Carragenan Induced Paw Edema method with doses of 200 mg/kg and 400 mg/kg showed significant inhibition of paw edema in indomethacin treated and drug veḻḻai paṟpam treated group. The drug veḻḻai paṟpam treated rats showed the more potent anti-inflammatory activity.
Hepatoprotective activity (32)
Hepatoprotective activity of Veṅkāracuņņamwas carried out by CCl4 Induced Hepatotoxicity in Wistar Albino rats. The liver damage was induced by CCl4 intraperitoneal injection in a suspension of liquid paraffin in the ratio of 1:2 at the dose of 0.1 ml CCl4/100 mg/kg, Veṅkāracuņņam with the dos 130 mg/kg+CCl4, 390 mg/kg+CCl4 for treatment period 9 days except the control group.
Veṅkāracuņņam induced accelerated regeneration of liver cells, reduction in the serum enzyme levels and reversed the elevated levels of Transaminase, ALP and total Bilirubin which indicate the healing of damaged hepatic cells.
Appaḻakāram (Sodium carbonate) (13, 33)
Formula: Na2CO3
Color: White solid
System: Monoclinic, orthorhombic
Sodium carbonate is an organic sodium salt and a carbonate salt. It is the disodium salt of carbonic acid with alkalinizing property. When dissolved in water, sodium carbonate forms carbonic acid and sodium hydroxide. As a strong base, sodium hydroxide neutralizes gastric acid thereby acting as an antacid. It is a colorless crystal which decomposes on heating by CO2.
Siddha literature (1)
Impure sodium carbonate is known as Appalakaram. It is obtained from the soil of alkaline earth. It is a pale-yellow color.
Its actions are antacid, diuretic, anti-flatulence, and carminative.
“kuṭalvātañ cūlai koṭitāṉa vātam aṭalpuriya maiya maṭukkum neṭuvayiṟṟiṉ”
It is effective in the treatment of throbbing pain, abdominal distension, and gastric ulcer.
Toxicity study (34)
In acute and sub-acute oral toxicity, the animals did not show any changes in the general appearance during the observation period. The animals treated with test drug shows normal growth pattern and body weight when compared with control group. Hence it was concluded the Appaḻakāra sūraņam are non-toxic to the hematopoietic and leucopoietic system.
Scientific validation
Analgesic activity (34)
Analgesic activity of Appaḻakāra sūraņam was done in Wistar Albino rats using Acetic acid induced writhing test model with doses 100 mg/kg and 200 mg/kg which exhibited mild analgesic activity (53.39%) compared to the standard drug diclofenac (79.82%).
Anti-inflammatory activity (34)
Anti-inflammatory activity of Appaḻakāra parpam was done in Wistar Albino rats using Carragenean Induced Paw Edema method with doses of 100 mg/kg, 200 mg/kg had significant reduction in the paw edema with the percentage of 56.96% and 58.78% on oral administration of 100 and 200 mg/kg as compared to the standard control group (59.09%).
Kaṟpūram (Cinnamomum camphora) (35)
Formula: C10H16O
Color: Colorless to white
System: Orthorhombic
Camphor is a cyclic monoterpene ketone, a naturally occurring monoterpenoid. It has a role as a plant metabolite. It has strong mothball-like odor. It emits flammable vapors above 150°F.
Natural occurrence (1)
Natural camphor is present in the plant Cinnamomum camphora. The natural crude camphor may be obtained by steam distillation of chips of the camphor tree; the crude camphor so obtained is purified by sublimation.
Siddha literature (1)
It is white in color, waxy in nature and has pleasant smell. It is not soluble but floats in water, and dissolves in air. It can be powdered. It is soluble in oil, arrack and gum.
Taste: Salty and pungent
Potency: Hot
Its actions are carminative, anti-spasmodic, anodyne, anti-convulsant.
“Kirumi calatōṭaṅkaḻ Kiḻai VippuruthCaṉṉi PorumuṁMāntamAṅkippaṭṭa Puṉcaraṅkaḻ”
It cures worm infestation, rhinitis, convulsions, delirium, and dyspepsia due to vatham, burns, cardiac arrest, and dysmenorrhea.
Scientific validation
Hepatoprotective (36)
Hepatoprotective activity of camphor was done in female rats. The animals in control group received no injection, the sham group received olive oil as camphor dissolver, and the experimental groups received 25, 50,100 mg/kg of camphor for 14 days. The results suggest that camphor has a stimulating effect on liver enzymes on higher doses.
Kaṭalnurai (Sepiolite) (37)
Formula: Mg4Si6O15 (OH)2. 6H2O
Color: Grey, cream
System: Orthorhombic
Sepiolite also called Meerschaum, (German: sea foam), a fibrous hydrated magnesium silicate.
Siddha literature (1)
It is known as Akkiniḵai, Vāriṯi nañcu, Mīṉ nañcu. Pōkar has mentioned about the formation of this foam as following, when the aged crocodile who has lived in the sea for long period becomes debilitated, fire is formed in its abdomen; because of this crocodile will bring out mucus and die. The mucus which fell in the sea is brought to the seashore by the sea water; this gets dried by the hot sun, and this should be taken out without touching by hand.
It cures eye diseases, ulcers, Kapam, and gastric ulcer.
Peruṅkāyam (Ferrula asafoetida) (38)
Botanical name: Ferrula asafetida
Family: Umbelliferae
Taste: Bitter
It is an oleo resin obtained from the rhizome and root of the plant. The gum resin is antispasmodic, carminative, and laxative, expectorant. In Siddha literature, it is known for its carminative, analgesic, anti-spasmodic, diuretic activity.
Effect of Ferrula asafoetida on gastrointestinaltract (39)
Colloidal solution of gum resin powder is administered orally to rats at a dose of 50 mg/kg, 60 minutes before experiment, produced significant protection against gastric ulcers induced by 2 hours cold restraint stress, aspirin and 4 hours pylorus ligation methods.
Scientific validation
Hepatoprotective activity (39)
A mixture of the methanol insoluble fraction of the dried resin, fresh garlic, curcumin, ellagic acid, butylated hydroxytoluene and butylated hydroxyanisole, administered by gastric intubation to ducklings at a dose of 10 mg/kg, shown anti Hepatotoxic activity in aflatoxin B1 – induced Hepatotoxicity.
The pharmacological actions of ingredients in Lavaņa kuḻambu comparison with scientific evidence were noted in Table 3.
Classical Siddha Formulations for treatment of various chronic liver diseases (Table 4) (45).
1. Aṣṭakuṉma lēkiyam
2. Iñci vaṭakam
3. Jalamañcari
4. Kānta cenduram
5. Karisālai kaṟpam
6. Kum maṭṭi meḻuku
7. Piṭaṅkunāri kuṭinīr
8. Cāmbirāņi pataṅkam
9. Saṅka tirāvakam
10. Ulōka maņṭalam
11. Viṣņu cakkara
Some of the formulations are broad-based being used in variety of liver disorders whereas others are specific to a liver disease. These all are aimed towards normalizing the functions of pittam and repairing the affected udalthathukkal namely Saaram (Nourishing fluid) and Kuruthi (Blood).
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DISCUSSION |
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Liver cirrhosis is a chronic disease resulting from fibrosis formation, hepatic encephalopathy, hepatic cellular carcinoma and an increased risk of organ failure. In cirrhosis scar tissue development replaces normal parenchyma and blocks the portal flow of blood to organ and affects normal function. Hepatic parenchyma damage due to the inflammation, activate stellate cell and it increases fibrosis in which the fibrous tissue bands separate Hepatocyte nodule and replace the entire liver architecture (3).
In Siddha system, liver disorders are known as Valappaṭṭīral noy, Mānta kaṭṭi, Kal māntam, Yakkutam. It is caused due to the vitiated Pitta tōṭam which is associated with other humors Vatham and Kapam along with the Vāyu Viāṉaṉ which is known for its spreading nature. The Pitta tōṭam affects the body physical constituents mainly Cāram (plasma - water), Cennīr (blood - fire + water) (40).
Liver inflammation and oxidative stress are commonly associated with development and progression of chronic liver disease. However, there are no currently available treatments for Alcoholic liver disease, non-alcoholic fatty liver disease, and liver fibrosis except the preventive strategies, such as changes in exercise, diet and alcohol use. Patients with advanced ALD and NAFLD require liver transplantation. It is evident that the natural products with anti-inflammatory and anti-oxidant functions display therapeutic effects against inflammation, fibrosis and metabolic disorders (41).
The Veṭiuppu is one of the ingredients of the formulation Veṭi annapēti centūram which reversed the elevated levels of Transaminase, Alkaline phosphatase and Total bilirubin which indicate the healing effect of damaged hepatic cells and supports for Hepatoprotective activity.
Navāccāram in one of the ingredients of the formulation Pañcākkiṉi centūram - possess Hepatoprotective activity by reducing the elevated serum levels of AST, ALT, ALP, bilirubin and prevented the increase in liver weight by supporting the liver tissues.
Veṅkāracuņņam maintains the normal functioning of the hepatic cells by preventing cellular accumulation of calcium. It maintains the normal fragility in the structure of liver. It helps in the structural maintenance of membrane integrity in the liver cells. It can induce accelerated regeneration of liver cells, reducing the leakage of the ALT, AST, ALP enzymes into the blood.
Cinnamaldehyde is one of the most important compounds in camphor which significantly decreases the AST, ALT, tumor necrosis factor and interleukin levels in serum. This suggest that the cinnamaldehyde acts as Hepato protection against lip polysaccharide/ D- galactosamine induced liver damage and their Hepatoprotective effects may be due to modulation of anti-inflammatory activities.
Ferrula asafoetida administration causes significant restoration in SGOT and SGPT while bilirubin and alkaline phosphate were restored more effectively. It restores the cellularity of the hepatocytes. The resin portion is known to contain asaresinotannols ‘A’ and ‘B’, ferulic acid, umbelliferone which plays the vital role to compat the arsenic induced Hepatotoxicity in mice.
Tacalaṉatirāvakam contains Paṭikāram, Veṭiuppu ,Intuppu, Navāccāram, Veṅkāram, Kaṟiuppu, Kalluppu, Pūnīṟu, Turucu, Annapēti. The antioxidant activity was done in DPPH assay.
Siddha Herbo mineral drug kāra veṭiyuppu paṟpam which shows the presence of alkaloids, phenols. Phenol groups are essential part of many antioxidant compounds.
Hence the antioxidant therapy, mainly using natural and synthetic anti-oxidants represents a reasonable therapeutic approach for the prevention and treatment of liver disease due to the role of oxidative stress in contributing to initiation and progression of hepatic damage (42).
In the Siddha Herbo mineral formulation Lavaņa kuḻambu, the ingredients such as Veṭiuppu, Navāccāram, Kaṟpūram and Peruṅkāyampossess Hepatoprotective activity as per the scientific evidence. Kaṟiuppu, Paṭikāram, Intuppu, Navāccāram, possess antioxidant activity.
As per Siddha pathology, liver disorder is caused due to aggravated Pittam. To alleviate the Pitta tōṭam drugs which have bitter (Kaippu), sweet (Iṉippu), astringent (Tuvappu) tastes are preferred (43). The taste of the ingredients Veṅkāram-Kaippu; Paṭikāram – Iṉippu, Tuvappu; Navāccāram – Kaippu; Peruṅkāyam – Kaippu are evident to reduce the aggravated Pitta tōṭam. The tastes of the ingredients of Lavaņa kuḻambu directly reduces the Pitta humor and hence useful in alleviating the Liver disorders. It is also evident that the pharmacological activities, indications as per the Siddha literature support the same. Moreover, the scientifically validated studies also indicate that the ingredients of Lavaņa kuḻambu have potent Hepatoprotective activity.
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CONCLUSION |
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Lavaņa kuḻambu is a Siddha Herbo mineral formulation which is indicated for Jaundice, Ascites and Liver disorders. This review highlights the potency of the ingredients of the drug in treating the Liver disorders as per Siddha pathology and by modern pharmacological activities.
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ACKNOWLEDGMENT |
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I would like to acknowledge my mentor, Dr. S. Sudha Revathy, for guiding me through this paper and providing insightful resources and ideas.
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CONFLICT OF INTEREST |
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The authors disclose no conflict of interest.
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REFERENCES |
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