Provincial Government of Nepal, Province No 5,

Ministry of Social Development, Hospital Development and Curative Services Division.

Butwal, Nepal.

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Table of Contents

प्राक्कथन 1

PREFACE TO THE MANUAL 3

आयरेु्वदीय औषधि वर्वज्ञानमा प्रयोग हनेु प्रावर्वधिक शब्दार्वली 5

पारिभावषक शब्दहरूको नेपाली उच्चािण वर्वर्विण ताधलका 6

ABBREVIATED WORDS WITH THEIR SHORT INTRODUCTION 7

ASHWAGANDHA (अश्वगन्िा) 12

GUDUCHI (गडूुची) 15

HARIDRA (हरिद्रा) 18

TILA (धतल) 21

TULASI (तलुसी) 23

TRIKATU (धिकटु) 27

MARICHA (मरिच) 27

PIPPALI (वपप्पली) 29

SHUNTHI (शणु्ठी) 31

YASTIMADHU (यविमि)ु 33

GALLERY 37

REFERENCES 38

1

प्राक्कथन

आयरेु्वद चचवकत्सा वर्वज्ञान अनाददकालबाट यस शताब्दीसम्म मानर्व जगतको माि नभएि सम्पूणण चिाचि जगतको स्र्वास््य िक्षामा सततरुपमा लाधग परििहेको छ। समयको कालक्रमसँग सँगै अनेकौ जनपदोद्ध्रं्वश झेल्दै ि त्यसबाट पिीचक्षत, परिष्कृत हुँदै यो अर्वस्थामा आईपगुेको छ। यसिी आयरेु्वद शास्त्र चचवकत्सा वर्वज्ञान माि नभएि सभ्यताको परििक्षा गने ि जीर्वन चजउने कला धसकाउने मा्यम पधन हो। प्रकृधतमा आिारित प्राकृधतक धसद्धान्तबाट(Bio-mimicry) तलुनात्मक ज्ञानको वर्वकास गिी यो चचवकत्सा वर्वज्ञान अनादद ि शाश्वत छ।

वर्वशेषगिी यो चचवकत्सा वर्वज्ञान पञ्चमहाभतू, धिगणु ि धिदोषको धसद्धान्तमा आिारित छ। यसको िोग वर्वश्लषेणमा पञ्चधनदान, षचरक्रयाकाल, अिवर्वि ि दशवर्वि पिीक्षा प्रचलनमा छन ्भने चचवकत्सामा सामान्य- वर्वशेष धसद्धान्तको अहम ्भधूमकाछ। आयरेु्वद चचवकत्सा वर्वज्ञानमा औषधि धनमाणणका लाधग र्वनस्पधत, खधनज ि जान्तर्व बस्तहुरु मखु्य स्रोत हनु।्चचवकत्सा सफल हनु चचवकत्सकलाई िोग ि िोगीसँग सम्बचन्ित वर्वषयका साथै औषिीय-द्रव्यहरुको नाम,रुप एरं्व परिचयसवहत धतनको गणु, कमण,संयोग,प्रयोग,मािा आददका बािेमा पधन यथोचचत ज्ञान हनुपुदणछ।आयरेु्वदका औषधिको कमण बझु्न मखु्यतः सप्तपदाथण(द्रव्य, िस, गणु, र्वीयण, वर्वपाक, प्रभार्व ि कमण) बािे जानकािी हनुपुदणछ।हामीले आहाि र्वा औषधिका रुपमा प्रयोग गने सबै द्रव्यमा वर्वधभन्न वकधसमका िस, गणु, र्वीयण, वर्वपाक ि प्रभार्व हनु्छन।् द्रव्यको शिीिसँग संयोग भएपधछ र्वा शिीिधभि पगुेपधछ िस-र्वीयण-वर्वपाक आदद गणुकै आिािमा दीपन, पाचन, र्वमन, वर्विेचन,लङ्घन,बृंहण आदद वर्ववर्वि कमण र्वा परिर्वतणन गिाउँछन।्एउटै द्रव्यले गने कमणहरु पधन कुनै िसले, कुनै गणुले, कुनै वर्वपाकले, कुनै र्वीयणले ि कुनै प्रभार्वले हनेु हनुाले कुनै पधन द्रव्यको कमण त्यसमा स्र्वभारै्वले (प्राकृधतकरुपमा) िहने सबै पदाथणहरुले धमलेि देखाउने परिणाम हनु ्जसमा ती सबैको आ-आफ्नो भधूमका हनु्छ।

अतः कुनै धबचशिउद्देश्यले औषिीय-द्रव्य प्रयोग गदाण त्यसको तोवकएको अङ्ग/भाग नै प्रयोग गनुणपछण, अरु भाग र्वा त्यसको कुनै अंश (Isolated Single Constituent माि)प्रयोग गदाण त्यसमा हनुपुने सबै गणुहरु नहनुाले त्यसबाट अपेचक्षत प्रधतफल प्राप्त हनुसक्दैन। दूिको सबै काम 'lactose'ले, अमलाको 'vitamin-C' ले , अश्वगन्िाको 'withanolides' ले, गडूुचीको 'giloin' ले, हरिद्राको 'curcumin' ले, शणु्ठीको 'gingerol' ले वपप्पलीको काम 'piperine' ले गनणनसक्ने ि केही काम गिेपधन त्यससँगै अन्य अनपेचक्षत दषु्प्रभार्वहरु हनेु त्य अचेलका अ्ययन ि अनभुर्वबाट समेत प्रमाचणत भएका छन।् यसिी द्रव्यको प्रयोग गरिने भागको साथै स्रोत, काल/समय, संकलन, भण्डािण, संस्काि (धनमाणण), संयोग मािा आददको कािणले पधन द्रव्यको गणुमा फिक पने ि फलस्र्वरुप कमणमा स्र्वभार्वतः

2

फिक पने भएकाले आयरेु्वद औषधि-द्रव्यका सम्बन्िमा यी पक्षहरुकासाथै िोग-िोगीको प्रकृधत, अनपुान-सहपान, प्याप्यलाई समेत पूिै ् यान ददएि प्रयोग गिेमा आयरेु्वदीय औषधिहरु अवहलेभन्दा धनकै प्रभार्वकािी ि सिुचक्षत हनेुछन।्

आयरेु्वद चचवकत्सा वर्वज्ञानमा िोग ि िोगी पिीक्षालाई वर्वशेष महत्त्र्वका साथ हेरिएको हनु्छ। िोगबल ि िोगीबलमा आिारित चचवकत्सा सूि नै (Personalized evidence based medicine) यसको धबचशिता हो।आयरेु्वद चचवकत्सा वर्वज्ञानमा औषि सेर्वन काल,वर्विी, प्याप्य, अनपुान, सहपान ि मािा (Posology) िोगानसुाि ि िोगीबलानसुाि फिक छ। यसकािण चचवकत्सकको यचुि नै िोग शमन

गिाउने काममा अतलुनीय छ।

मूलभतू रुपमा सददयौदेचख यस चचवकत्सा पद्धधतमा प्रचलनमा ल्याएका श्रधुत पिम्पिा ि धलचखत रूपमा समेत स्थावपत आयरेु्वदमा प्रयिु केही जडीबटुीको आयरेु्वदीय ि आिधुनक चचवकत्सा सम्मत भएका अ्ययनलाई (Reverse Pharmacology)समारे्वश गिी यो पचुस्तका तयाि पारिएको छ। यसको मखु्य उद्देश्य हाम्रा घि आगँनमा पाइने यी बहमुलु्य जधडबटुी सभ्यता वर्वकासक्रमको कालखण्डमा आईपिेको वर्वधभन्न महामािी र्वा व्यािीबाट जु् न ि स्र्वास््य िक्षा गनण प्रमखु एरं्व सहायक धसद्ध भएका औषधिहरुको आिधुनक पसु्ताहरुमा धबना वहचवकचाहट अभ्यासमा ल्याउन वर्वधभन्न वर्विाका स्र्वास््यकमीहरुका लाधग उपयोगी बनाउन ुहो।यसबाट हाम्रो स्र्वास््य िक्षा ि िाज्यको आधथणक समवृद्धमा काँि थाप्ने कायणका साथै हालको पसु्ताले नचचनेका ि होच्याईएका जधडबटुीको ज्ञान ि प्रयोगका वहसाबले मूल्य अधभर्ववृद्धमा सहयोग पधन पगु्न सक्नेछ। यसिी आयरेु्वद मानर्व सभ्यताको प्रािम्भ देचख नै सम्पूणण प्राणीजगतको स्र्वास््य िक्षाको सािथी बनेको छ।यस औषधि-पचुस्तका तयाि पानण अनर्वित उजाण एरं्व हौसला प्रदान गनुणहनेु माननीय सामाचजक वर्वकास मन्िी सदुशणन बिालज्यू ि श्रीमान ्सचचर्व डा गोपीकृष्ण खनालज्यू प्रधत हाददणक आभाि व्यि गदणछौ। यो समग्र अधतवर्वचशिीकृत औषधि-पचुस्तकाको प्रािचम्भक खाकादेचख अचन्तम मस्यौदा तयाि पादाणसम्म सतत खवटनहुनेु आदिणीय अग्रज औषधिवर्वज्ञ चचवकत्सकहरु डा. पनेुश्वि केशिी, डा. कोवपला अधिकािी एरं्व चचवकत्सकहरु डा. प्ररे्वश श्रीर्वास्तर्व, डा. वर्वनोद चघधमिे, डा. मदन भण्डािी ि डा. प्रिेक िेग्मी प्रधत कृतज्ञ छौ।त्यसै गिी यो औषधि-पचुस्तकामा कसी लगाईददनहुनेु प्राज्ञ एरं्व समादिणीय गरुुर्वगणहरु प्रा. डा. श्याममचण अधिकािी, डा. ऋवषिाम कोईिाला ि डा. सम्मोदर्विणन कौचण्डन्यायनप्रधत हाददणक आभाि व्यि गदणछौ।

हामीले यो औषधि-पचुस्तकामा उल्लेचखत प्रामाचणक त्यको प्रयोगबाट हाल गचुििहेको वर्वश्वव्यापी महामािी वर्वरुद्ध जु् नेआम चचवकत्साकमीहरुलाई िेिै सहयोग धमल्नेछ ि कदठन परिचस्थधतमा हौसला प्रदान पधन गनेछ भन्न ेवर्वश्वास गिेका छौ।

अस्पताल वर्वकास तथा चचवकत्सा सेर्वा महाशाखा, सामाचजक वर्वकास मन्िालय

3

PREFACE TO THE MANUAL

Ayurveda Drug Manual for Health Care Workers in response to COVID 19 is forwarded by

the Provincial Government of Nepal, Province no. 5, Ministry of Social Development (MOSD)

- Hospital Development and Curative Services Division for all the Ayurveda Health Care

workers, service providers, contributors and scholars of the interdisciplinary fields. This

Manual consists of the drugs commonly used by Ayurveda in Province-5 for prevention and

management of Covid-19.

This work is an extension of the “Control and Management of the COVID-19 with Ayurveda

and Alternative Medicine Official Document” prepared by MOSD- Province 5 on 22 April

2020.

This drug manual is rational compilation of genuine scientific works that are intended to build

up the immunity of mankind to defeat the present Pandemic scenario. A tea fortified with

selected herbs (Ayurveda) mentioned in the document conducted two independent double-

blind intervention studies; their regular consumption has enhanced Natural Killer (NK) cell

activity, which is an important aspect of the (early) innate immune response to infections [Jyoti

Bhat et.al, 2010]. The working team mates contributing to draft this document considered such

researches, envisioned to make a document that supports the Ayurveda knowledge in Nepal.

This work credits to the publications of Central Council for Research in Ayurvedic Sciences

(CCRAS), Ministry of AYUSH, Indian Council of Medical Research (ICMR), and New Delhi,

India. Reviews were made from the journal articles available from Cochrane Library, Pubmed,

Hinari, Embase, Chinese Medicine Integrated Pharmacology Research Database, Scopus,

Nepjol, and other Nepalese Journal Publications. Opinion of Experts and Scholars associated

with the subject was considered to precise the content to the level of best.

This document always provides space for searching and extensive reviewing of research

activities for their rational choice of treatment. Additional references (systematic review/meta-

analysis) are provided related to the pharmacological actions on common signs and symptoms

of covid-19. Pharmacodynamic Basis of Herbal Medicine by Manuchair Ebadi, Scientific Basis

for Ayurvedic Therapies by Laxmi Chandra Mishra is recommended for further references.

Even the physicians have their own decision to select drugs based upon the stage of the disease,

symptom complex and availability of the medicines in his/her locality for proper management

of the covid-19 with their existing resources.

4

The references are indexed in Vancouver Style Reference (Author-date) at the end of the

booklet. Most of the abbreviations are mentioned at the beginning section with the short

introduction to it and the link is provided for the author in case of confusion to abbreviation or

its introduction part. Few abbreviations may be found in the text. For those it is mentioned with

their full form for its first time and accordingly the abbreviation is used in the following text.

The editorial team has tried their best for paragraphs proof reading and concise with simplest

language to understand. Transliteration from Devanagari to the Roman script is done for

Sanskrit words. Moreover, synonyms of the drugs are mentioned in Devanagari script too.

Basic terminology used in Ayurvedic Pharmacology (Dravya-Guna)

This document follows the fundamental concept of Rasapanchaka of respective drugs. Ayurveda prioritizes the concept of Rasapanchaka (five properties inherently associated with

every Dravya) - Rasa (taste) is the object of Rasanendriya (gustatory sense organ) which is the

taste perceived through the taste buds; Gunarefers to qualities that take shelter in a Dravya and

is inseparable from a Dravya. Guna is the responsible factor for any Karma (action) and is

inactive without the help of other factors. The property of a Dravya, which is responsible for

the therapeutic effects and without which no action can take place is termed as Veerya. Initial

Rasa when subjected to digestive fire brings about changes in the basic composition and the

transformed Rasa at the end of digestion under the influence of Jatharagni is known as Vipaka.

Each of the above factors is responsible for the net effect obtained from a drug, but if the

exhibited action cannot be explained on the basis of above factors, then it is referred to as

‘Prabhava’ (an unexplainable factor present in Dravya).

Editorial Team

01-08-2020

5

आयरेु्वदीय औषधि वर्वज्ञानमा प्रयोग हनेु प्रावर्वधिक शब्दार्वली ● क्र्वाथ (काढा)- Decoction: औषधिमा उपयोगी भागलाई िाम्रो सँग सफा गिी काटेि र्वा धथचेि/

वपसेि स-साना टुक्रा र्वा खस्रो िूलो बनाई चावहने जधत (आिा कप जधत) एउटा पकाउन धमल्ने सफा भाँडोमा िाख्न।े त्यसमा आठगणुा (चाि कप) सफा पानी धमलाएि पकाउने। पकाउँदा/ पकाउँदा एक कप जधत (एक चौथाई भाग) पानी बाँकी िहेपधछ उतािेि एउटा सफा भाँडोमा छानेि िाख्न।े यसिी तयाि भएको काढा त्यसै ददन प्रयोग गने।

● स्र्विस (झोल)- Fresh Juice: औषधिमा उपयोगी भागलाई िाम्रोसँग पखालेि अथर्वा सफा गिेि स-साना टुक्रा पाने। त्यसपधछ धथचेि र्वा वपसेि सफा कपडामा िाखी धनचोदाण आएको झोललाई सफा भाँडोमा िाखी ताजा अर्वस्थामा प्रयोग गने।

● चणूण (िूलो)- Powder: औषधिमा उपयोगी भागलाई िाम्रोसँग सफा गिेि सकुाउने ि मधसनो पािेि वपसेि /वपनेि सफा कपडाले अथर्वा जालीले छाने्न। छानेि आएको मधसनो िूलोलाई सफा भाँडोमा मखु बन्द गिी िाख्न ेि मािा अनसुाि प्रयोग गने।

● कल्क (लेदो)- Paste: ताजा( र्वा आद्रण) जधडबटुीको औषधिमा उपयोगी भागलाई िाम्रिी सफा गिी सफा धसलौटोमा (र्वा अरु सािनले) मधसनो हनेु गिी घोटेि/वपसेि लेदो बनाउने। सकेुको जधडबटुी भएमा िूलो पािेि बिाबि जस्तै मािामा पानी, दूि, आदद कुनै द्रर्व (िस र्वा झोल) पदाथणसँग धमसाई वपसेि चटनी जस्तो बनाउने। यसलाई प्रायः ताजा अर्वस्थामा खाने र्वा बावहि लगाउने अथर्वा अरु औषधि बनाउँदा धमसाउने।

● फाण्ट (चचया जस्तो िस)- Hot infusion: औषधिमा उपयोगी भागलाई िाम्रोसँग सफा गिी खस्रो िूलो बनाउने ि औषधिको ४ गणुा तातो पानी धमसाएि घोल्ने, धमच्ने, अथर्वा एकैधछन उमाल्ने। यसिी औषधिको सािभाग पानीमा धमधसएपधछ एक्लै अथर्वा अरु औषधिको साथमा आर्वश्यकता अनसुाि वपउने। यसिी प्रत्येक पटक ताजा बनाएि प्रयोग गने।

● वहम/ शीत कषाय (चचसो पाधनमा धभजाएको िस)- Cold infusion: औषधिमा उपयोगी भागलाई िाम्रोसँग सफा गिी धथच्ने/धमच्ने र्वा खस्रो िूलो बनाउने ि त्यसको ६ गणुा सफा, चचसो पानीमा बेलकुा देचख धबहानसम्म (र्वा धबहानदेचख बेलकुासम्म) धभजाईिाख्न।े त्यसपधछ िाम्रोसँग धमचेि, मसलेि स्र्वच्छ तरिकाले छानेको िस एक्लै र्वा अरु औषधिसँग वपउने।

● िस- (Taste): औषधि र्वा आहािको संगठन (वर्वशेष बनार्वट) अनसुाि प्रायः चजब्रोले थाहा पाउने स्र्वाद। यो मखु्यतः मििु(गधुलयो), अम्ल( अधमलो), लर्वण (नूधनलो), कटु (वपिो), धति (धततो) ि कषाय( टिो) गिी ६ प्रकािको हनु्छ।

● गणु- (Properties/ Qualities) : औषधि र्वा आहाि द्रव्यको भौधतक एरं्व कमणद्बािा थाहा हनेु गणु अथर्वा वर्वशेषता।

● र्वीयण (शचि)- (Potency): -औषधिको काम गने शचि अथर्वा बलर्वान/् असियिु गणुहरु।

● वर्वपाक- (Biotransformed active ingredients): आहाि र्वा औषधि द्रव्य शिीिमा पचेपधछ परिर्वतणन भएि अन्तमा बने्न िस र्वा गणु। यो कमणद्बािा पधछ थाहा हनु्छ।

● प्रभार्व( वर्वचशि कमण) -( Specific Potency): वर्वशेष खालको असि देखाउने औषधिको वर्वचशि शचि।

● दोषकमण (Effects on Dosas): शिीिका दोषहरु ( र्वात-वपत्त-कफ) माधथ पने औषधिको असि र्वा कमण।

6

पारिभावषक शब्दहरूको नेपाली उच्चािण वर्वर्विण ताधलका (Pronunciation of Romanized Ayurveda terms)

Romanized terms Pronunciation Romanized terms Pronunciation

Amala अमला Pipla वपप्ला

Amla अम्ल Pippali वपप्पली Ashwagandha अश्वगन्िा Pitta वपत्त

Balya बल्य Prabhava प्रभार्व

Churna चणूण Raktasodhaka ििशोिक

Deepana दीपन Rasa िस

Doshakarma दोषकमण Rasapanchaka िसपञ्चक

Guduchi गडूुची Rasayana िसायन

Guna गणु Sangrahi सङ्ग्ग्राही Guru गरुु Sattwa सत्र्व

Haridra हरिद्रा Sheeta शीत

Jwaraghna ज्र्विहि Shunthi शणु्ठी Kapha कफ Taila तैल

Karma कमण Tikta धति

Kashaya कषाय Tila धतल

Katu कटु Tridoshashamak धिदोषशामक

Kushtha कुष्ठ Tulasi तलुसी Kwatha क्र्वाथ Ushna उष्ण

Laghu लघ ु Vajikarana र्वाजीकिण

Lavana लर्वण Vata र्वात

Leha लेह Vatakaphapaha र्वातकफापह

Madhura मििु Vati र्वटी Maricha मरिच Veerya र्वीयण

7

Abbreviated Words with their Short Introduction:

● Mpro: main protease. [One of the best-characterized drug targets among corona

viruses is the main protease (Mpro, also called 3CLpro/ 33.8-kDa protease. (Link)]

● TMPRSS2: transmembrane protease serine 2 [TMPRSS2 (Transmembrane Serine

Protease 2) is a Protein Coding gene. Diseases associated with TMPRSS2 include

Influenza and Prostate Cancer (Link). Serine protease proteolytically cleaves and

activates the viral spike glycoproteins which facilitate virus-cell membrane

fusions.(Link) ]

● 5HT-receptors: 5-hydroxytryptamine receptors, or serotonin receptors. [5-

hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is

complex and multifaceted, modulating mood, cognition, reward, learning, memory, and

numerous physiological processes such as vomiting and vasoconstriction (Link)]

● BMI: Body Mass Index. [Body Mass Index (BMI) is a person’s weight in kilograms

divided by the square of height in meters. A high BMI can be an indicator of high body

fatness. BMI can be used to screen for weight categories that may lead to health

problems but it is not diagnostic of the body fatness or health of an individual. (Link)]

● TC: Total count. [TC or total count measures the number of WBCs or white blood

cells, which if high in number is indicative of bacterial or some other infections besides

other disorders. (Link)]

● DC: Differential Count. [DC expresses the types of WBCs in the blood.WBCs given

as percentage of basophils, eosinophils, neutrophils, monocytes and lymphocytes.

(Link)]

● RBC count: Red blood cell count. [An RBC count is a blood test that's used to find

out how many red blood cells (RBCs) you have. (Link)]

● ESR: Erythrocyte sedimentation rate test. [An erythrocyte sedimentation rate (ESR)

is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at

the bottom of a test tube that contains a blood sample.A faster-than-normal rate may

indicate inflammation in the body. Inflammation is part of your immune response

system. It can be a reaction to an infection or injury. Inflammation may also be a sign

of a chronic disease, an immune disorder, or other medical condition.(Link)]

● RAW 264.7: [RAW 264.7 cells are a macrophage-like, Abelson leukemia virus

transformed cell line derived from BALB/c mice. This cell line is a suitable transfection

host. This cell line is a commonly used model of mouse macrophages for the study of

cellular responses to microbes and their products.(Link)]

● MHC-II: Major histocompatibility complex II. [MHC class II can be conditionally

expressed by all cell types, but normally occurs only on "professional" antigen-

presenting cells (APCs): macrophages, B cells, and especially dendritic cells (DCs).

Class II MHC molecules are the only known ligands for LAG-3132; signaling through

8

which results in enhanced Treg function134 and abrogated CD8+ T cell effector

function. Link]

● CD-86: Cluster of Differentiation 86. [Cluster of Differentiation 86 is a protein

expressed on dendritic cells, macrophages, B-cells, and other antigen-presenting cells.

CD86 is a 70-kDa glycoprotein made up of 329 amino acids, a transmembrane region,

and a longer cytoplasmic domain than CD80.50 CD86 is constitutively expressed on

interdigitating DCs, Langerhans cells, peripheral blood DCs, memory B cells and

germinal center B cells, and macrophages. Link]

● IFN-γ: Interferon gamma: Interferon gamma (IFN-γ) is a cytokine critical to both

innate and adaptive immunity, and functions as the primary activator of macrophages,

in addition to stimulating natural killer cells and neutrophils. (Link)

● LPS: lipopolysaccharide. [Lipopolysaccharide (LPS) is an endotoxin derived from the

outer membrane of Gram-negative bacteria, detected in the portal venous blood153 and

in triglyceride (TG)-rich very low density lipoproteins (VLDL) in the systemic

circulation of normal humans,154 suggesting that dietary and microbial LPS is

consistently absorbed through the intestinal epithelia. (Link)]

● TLR4: Toll-like receptor 4.[Toll-like receptors (TLRs) belong to the pattern

recognition receptor (PRR) family, a key component of the innate immune system.

(Link)]

● DLC: Differential Leukocyte Count. [Differential blood count gives relative

percentage of each type of white blood cell and also helps reveal abnormal white blood

cell populations. (Link) ]

● TLC : Total leukocyte (white blood cells) count

● PBMC: Peripheral blood mononuclear cell. [Peripheral blood mononuclear cells

(PBMC) give selective responses to the immune system and are the major cells in the

human body immunity. (Link)]

● MCP-1: Monocyte chemo-attractant protein-1/ chemokine (C-C motif) ligand 2

(CCL2). [Monocyte chemoattractant protein-1 (MCP-1/CCL2) is one of the key

chemokines that regulate migration and infiltration of monocytes/macrophages Link ]

● TNF: tumor necrosis factor. [TNF, which stands for tumor necrosis factor, is a

substance in your body that causes inflammation.It is involved in systemic

inflammation and is one of the cytokines that make up the acute phase reaction. Link]

● IL-12: interleukin-12. [Interleukin-12 (IL-12) is a potent proinflammatory cytokine

that enhances the cytotoxic activity of T lymphocytes and resting natural killer cells.

Link]

● Cytochrome P450: Enzymes produced from the almost 60 genes cytochrome P450

genes are involved in the formation (synthesis) and breakdown (metabolism) of various

molecules and chemicals within cells. Cytochrome P450 enzymes play a role in the

9

synthesis of many molecules including steroid hormones, certain fats (cholesterol and

other fatty acids), and acids used to digest fats (bile acids), metabolize toxic substance

within cells. (Link) ].

● CYP3A enzymes: Cytochrome P450, family 3, subfamily A (Cytochrome P4503A).

[Members of the CYP family of enzymes, responsible for the metabolism of a large

number of pharmaceutical drugs and herbal drugs. It is the major such enzyme in critical

tissues such as the gastrointestinal tract and liver, and it is involved in the oxidative

biotransformation of numerous clinically useful therapeutic agents. Link ]

● P-gp: P-glycoprotein. [P-glycoprotein is one of the drug transporters that determine

the uptake and efflux of a range of drugs. It is a superfamily of efflux transporters that

are found in several regions of the body, including the GI tract and the blood-brain

barrier. (Link)]

● COX‐2: Cyclooxygenase-2. [The enzymes that produce prostaglandins are called

cyclooxygenase (COX).The cyclooxygenase isoenzymes, COX-1 and COX-2, catalyze

the formation of prostaglandins, thromboxane, and levuloglandins. prostaglandins are

autocoid mediators, levuloglandins act via irreversible, covalent attachment to

numerous proteins and Thromboxane is a potent vasoconstrictor and stimulus for

platelet aggregation. (Link)]

● FEV1: Forced expiratory volume in one second. [FEV1 is the maximum amount of

air you can forcefully blow out of your lungs in one second and is measured using a

spirometer. FEV1/FVC ratio, also called Tiffeneau-Pinelli index, is a calculated ratio

used in the diagnosis of obstructive and restrictive lung disease. (Link)]

● PEFR: Peak expiratory flow rate.[The peak expiratory flow rate (PEFR) test

measures how fast a person can exhale. The PEFR test is also called peak flow. This

test is commonly performed at home with a handheld device called a peak flow monitor.

These patterns can help you prevent your symptoms from worsening before a full-

blown asthma attack.(Link)]

● LC-MS analysis: Liquid chromatography–mass spectrometry. [Liquid

chromatography–mass spectrometry (LC-MS) is an analytical chemistry technique that

combines the physical separation capabilities of liquid chromatography (or HPLC) with

the mass analysis capabilities of mass spectrometry (MS). Coupled chromatography -

MS systems are popular in chemical analysis because the individual capabilities of each

technique are enhanced synergistically. (Link)]

● TNF-α: Tumor necrosis factor (TNF, cachexin, or cachectin; once named as tumor

necrosis factor alpha or TNFα. [is a multifunctional cell signaling protein (cytokine)

secreted primarily by macrophages, natural killer (NK) cells, and lymphocytes. (Link)]

● THP-1 cells: [THP-1 is a leukemia monocytic cell line, derived from an acute

monocytic leukemia patient, which has been extensively used to study

monocyte/macrophage functions, mechanisms, signaling. (link)]

10

● NF-κB-p65: p65 component of nuclear factor kappa-light-chain-enhancer of

activated B cells. [p65, also known as RelA, is one of the five components that form

the NF-κB. NF-κB p65 signaling pathway has been a pivotal point for intense drug

discovery. NF-κB is a protein complex that controls transcription of DNA, cytokine

production and cell survival. (link) ]

● CD14: Cluster of differentiation 14 [CD14 (cluster of differentiation 14) is a human

protein made mostly by macrophages as part of the innate immune system. It helps to

detect bacteria in the body by binding lipopolysaccharide (LPS), a pathogen-associated

molecular pattern (PAMP) (link)]

● NSAIDs: Nonsteroidal anti-inflammatory drugs.

● Lucigenin: Lucigenin is a chemiluminescent probe used to indicate the presence of

endogenously generated superoxide anion radicals in cells. (Link)]

● PMNs: Polymorphonuclear Leukocytes

● AHH: Hepatic aryl hydrocarbon hydroxylase. [Aryl hydrocarbon hydroxylase (AHH)

is a multicomponent, microsomal-bound enzyme system which converts a variety of

lipid-soluble compounds to water-soluble forms for subsequent elimination from the

body. It is used to induce hepatic aryl hydrocarbon hydroxylase (AHH) in vivo. (Link)]

● UDP-glucuronyltransferase: Uridine 5’-diphospho-glucuronosyltransferase. [A

liver enzyme essential to the disposal of bilirubin (the chemical that results from the

normal breakdown of hemoglobin from red blood cells).UDP glucuronyltransferases

(UGT1A) are responsible for the formation of glucuronides from a large variety of

cytotoxic and genotoxic compounds, including carcinogens and reactive oxygen

species. (Link)]

● GI tract: Gastrointestinal Tract.

● T lymphocyte/T cells: [T lymphocytes can be defined according to the profile of

cytokines they secrete—Th1 responses which drive cell mediated immunity are

predominantly composed of interferon γ (INFγ) and interleukin (IL)-2, while Th2

responses include IL-4 and IL-10, which control antibody mediated processes. (Link)]

● MAP kinases mitogen-activated protein kinase. [MAP kinases are activated within

protein kinase cascades (MAPK cascade :) that regulate cell proliferation,

differentiation, and death. Mitogen-activated protein kinases (MAPK) are proteins that

are serine/ threonine specific kinases which are activated by a wide range of stimuli

including proinflammatory cytokines, growth factors, mitogens, osmotic stress, heat

shock etc.(Link , Link 2)]

● SAPK: Stress-activated protein kinases. [Part of the cellular response to toxins,

physical stresses and inflammatory cytokines occurs by signaling via the stress-

activated protein kinase (SAPK) and p38 reactivating kinase pathways. This results in

modification of cellular gene expression. These stress-responsive kinase pathways are

11

structurally similar, but functionally distinct, from the archetypal mitogen-activated

protein kinases (MAPKs or ERKs). (Link)]

● ERK: Extracellular-signal-regulated kinase.[The ERK pathway is a hierarchical

cascade originating at the cell membrane with receptors for mitogens or growth factors,

which recruit, via adapter proteins and exchange factors, the small guanosine

triphosphatase (GTPase). The MAPK/ERK pathway is a chain of proteins in the cell

that communicates a signal from a receptor on the surface of the cell to the DNA in the

nucleus of cells. (Link)].

● p38 MAP kinases: P38 Mitogen-Activated Protein Kinases signaling

pathways.[p38 MAPK are proline-directed kinases and also calledRK or CSBP

(Cytokinin Specific Binding Protein)p38MAPK pathway is a key regulator of pro-

inflammatory cytokines biosynthesis at the transcriptional and translational levels,

which makes different components of this pathway potential targets for the treatment

of autoimmune and inflammatory diseases.(Link)]

● JNK: Jun amino-terminal kinases. [C-Jun N-terminal kinase (JNK) pathway is one

of the major signaling cassettes of the mitogen-activated protein kinase (MAPK)

signaling. They play a central role in stress signaling pathways implicated in gene

expression, neuronal plasticity, regeneration, cell death, and regulation of cellular

senescence. (Link)]

● SARS: severe acute respiratory syndrome-corona virus.[Severe acute respiratory

syndrome (SARS) is a viral respiratory illness caused by a corona virus called SARS-

associated corona virus (SARS-CoV). SARS was first reported in Asia in February

2003. (Link)]

● HSV: Herpes simplex virus. [HSV-1 and HSV-2 can be shed from normal-appearing

oral or genital mucosa or skin. (Link)]

● HMGB1: High Mobility Group Box 1.[It is a Protein Coding gene. Diseases

associated with HMGB1 include 13Q12.3 Microdeletion Syndrome and Rheumatic

Disease. The encoded non-histone, nuclear DNA-binding protein regulates

transcription, and is involved in organization of DNA. (Link)]

● 11βHSDH type 2 activity: 11β Hydroxysteroid dehydrogenase – 2 activities. [A

family of enzymes that catalyze the conversion of inert 11 keto-products (cortisone) to

active cortisol, or vice versa, and regulate the access of glucocorticoids to the steroid

receptors , hypertension, anorexia nervosa, old age, and female sex. (Link)]

12

ASHWAGANDHA

(अश्वगन्धा)

Nepali name: Ashwagandha (अश्वगन्िा) Sanskrit name: Ashwagandha –(अश्वगन्िा), Varahakarni (र्विाहकणी ) English name: Indian ginseng, Winter cherry

Latin name: Withania somnifera (L.) Dunal.

Parts Used: A mostly roots are used in Ayurveda practices. Leaves and berries are used

in traditional and folklore practices and modern phytochemistry.1,2

PROPERTIES AND ACTION2

Rasa: Tikta, Kashaya

Guna: Laghu

Virya: Ushna

Vipaka: Madhura

Doshakarma- Vatakaphapaha

Karma: Rasayana, Vata-kaphapaha, Balya, Vajikara.

Chief chemical ingredients: The main constituents of Ashwagandha are alkaloids and

steroidal lactones. Withanine is the main alkaloids; others are somniferine, somnine,

somniferinine, withananine. The aerial parts, specially the leaves of Ashwagandha are

rich in steroidal lactones collectively known as Withanolides.3Much of Ashwaganda’s

pharmacological activity has been attributed to two main constituents such as

withaferin-A and withanolide-D.1 Two acyl steryl glucosides viz.. Sitoindoside vii and

sitoindoside viii have been isolated from roots.3 Withaferin A4 Withanoside IV and

Withanolide A5are taken as standards for quantitative standard for its root.

Therapeutic uses: Stress, Anxiety, Insomnia, As Rasayana (Rejuvenate), Erectile

dysfunction, Arthritis, Rheumatoid arthritis, Immune-modulator, act as antibacterial,

Improves muscles mass, Enhances memory power, Acts as nervine tonic.

Drug Dose: Root powder 3-6 grams along with milk or water for adults.2,6

Mode of action: From the Ayurvedic perspective, Ashwagandha particularly balances

Vata and Kapha in excess because of its heating, unctuous, and building nature.

Pharmacological actions7 :

Major: Immune-modulator, Strength promoting2 and adaptogenic.

● Immunomodulatory activity- Investigation for Withania somniferaimmune

modulation mechanism identified five bioactive that are capable of regulating

15 immune system pathways through 16 target proteins by bioactive-target and

protein-protein interactions. The study also unveils the potential of withanolide-

phytosterol combination to achieve effective immuno-modulation and seven

13

novel bioactive-immune target combinations.8Sitoindosides IX alpha and X

alpha known to exhibit immune-modulator effects. 7 Aqueous suspension of

root powder has shown the immune-modulatory properties of both in-vitro and

in-vivo studies.9

● Latest research update on SARS CoV 2- A latest study about molecular

docking published online in Journal of Biomolecular Structure and Dynamics

showed Interaction and blockage of main protease (Mpro) with natural

compounds derived from Ashwagandha and honeybee propolis. It is discovered

that a natural compound Withanone (Wi-N) derived from Ashwagandha and

Caffeic Acid Phenethyl Ester (CAPE), an active ingredient of New Zealand

Propolis, has the potential to interact with and block the activity of main

protease (Mpro). Study showed that these bio-actives compounds have ability to

modulate the protein on the surface of human cells, to which SARS-CoV-2

binds and allows its entry into our cell - the transmembrane protease serine 2

(TMPRSS2), and selected Withanone.10

● Action on Central nervous system- Withaferin A, Withanolides and saponins

are responsible for different actions on central nervous system. It acts as

anxiolytic action due to alterations in 5HT. The anxiolytic action is mainly due

to glyco withanolides which reduces tribulin, which is endocoid marker of

clinical anxiety. Withania somnifera reduces stress by delaying the release of

cortisol by adrenal glands and also prevents negative effect of long term cortisol

production. It improves the cognitive capabilities of the brain by increasing the

cortical muscarinic acetylcholine capacity in lateral septum and frontal cortex,

which suggest their capacity to affect events in the cortical cholinergic-signal

transduction cascade.11, 12Aqueous suspension of the root extract prevented

stress produced by lipopolysaccharides in rabbit and mice.13

Important Formulations– Ashwagandha Churna, Ashwagandhaadyarishta,

Ashwagandhaadi Leha, Balaashwagandha Lakshaadi Taila.

Therapeutic safety: Different acute and subacute studies of extracts (hydroalcoholic,

alcoholic extracts) done in rats and mice have proven its safety.

In a study for acute and subacute toxicity, oral administration of LD50 of Withania

somnifera alcoholic extract standardized for Withaferin-A, in Wistar rats in dose greater

than 2000 mg/kg body weight did not show any toxicologically significant treatment

related changes in clinical observations, ophthalmic examination, body weight gain,

feed consumption, clinical pathology evaluation, and organ weight. Hematological and

serum chemistry parameters were within the normal limits and there were no treatment

related gross or histopathological findings14,15,16 Some pilot studies conducted on

efficacy and safety evaluation ofAshwagandha showed normal hepatic functions and

renal functions when given for 7 weeks.17

14

A study on healthy volunteers (12 Male &6Female, age: 18-30 years, and BMI: 19-30)

had shown normal organ function tests before and after the intervention. After baseline

investigations, they received WS capsules (Rx) (aqueous extract, 8:1) daily in two

divided doses with increase in daily dosage every 10 days for 30 days (750 mg/day ×10

days, 1000 mg/day × 10 days, 1250 mg/day × 10 days). Volunteers were assessed for

symptoms/signs, vital functions, hematological and biochemical organ function tests.

Majority of the volunteers did not show any noteworthy baseline symptoms. No

clinically significant change was found in pulse, temperature andblood pressure,

average mean body weight and BMI throughout the study's, DC, RBC count,

hemoglobin, platelets count, ESR, serum bilirubin, proteins, albumin, alanine

transaminase, aspartate transaminase, alkaline phosphatase,serum uric acid and fasting

blood sugar remained within normal range. However, average serum creatinine had

increased and blood urea nitrogen had decreased at visit 5 as compared with visit 1.

Only one volunteer showed increased appetite, libido and hallucinogenic effect with

vertigo.18

Food and drug interaction: As Ashwagandharoot has anxiolytic and is mild sedative

actions, it is known to potentiate the effect of sedatives and barbiturates when

administered simultaneously.7

Adulterants: Withania coagulans (Stocks) Dunal and widely growing W. Somnifera

(Linn.) Dunal are known substitutes/adulterants of the drug.2Roots of W. somnifera

(Linn.) Dunal,growing in the wild are thicker, curved or way, brownish in column with

strong pungent odour and extremely bitter in taste. Roots of W. coagulans (Stocks)

Dunal bear knotty crowns and show numerous scars, remnants of rootlets and

longitudinal wrinkles, exhibiting short fractures and yellow wood. The roots are dirty

brown, with bitter and astringent taste and characteristics odour.4

Precautions: Pregnancy,19 Diarrhea

Contraindications: Large doses (more than the therapeutic drug dose) must be given

under expert medicinal guidance during pregnancy. It is contraindicated in advanced

arterial congestion.7, 19

Toxicological Analysis: Crude extract for 180 days (100mg/kg per oral) in rats

increases in the catecholamine content of the heart and decreases in its content in

adrenal glands in rats.20 30 days dosing of LD50 = 1260mg/kg ip (alcoholic extract) in

mice at 100mg/kg caused a decrease in the weight of spleen, thymus and adrenal glands.

Additional References-

1. An Alternative Treatment for Anxiety: A Systematic Review of Human Trial

Results Reported for the Ayurvedic Herb Ashwagandha (Withania somnifera).

[Link]

2. Effects of Ashwagandha (Withania somnifera) on maximum oxygen

consumption (VO2max): A Systematic Review and Meta-Analysis. [Link|DOI]

15

GUDUCHI

-गुडूची_

Nepali Name: Gurjo (गजुो]{) Sanskrit Names: Guduchi (गडु्ची), Madhuparni (मिपुणी,), Amrita (अमतृा), Chhinnaruha

(धछन्नारुहा), Vatsadani (र्वत्सदनी), Chakralakshanika (चक्रलक्षचणका) English Name: Heart-leaved moonseed

Latin Name: Tinospora cordifolia (Willd) Hook. F & Thomson

Parts Used: Stem (mostly), Leaves.21

Properties and action21

Rasa: Tikta, Kashaya

Guna: Laghu

Virya: Ushna

Vipaka: Madhura

Karma: Tridoshashamak, Sangrahi, Balya, Deepana, Rasayana, Raktasodhaka, Jvaraghna21

Important formulations- Amritarishta, Amritottara Kwatha Churna, Guduchi Taila,

Guduchyadi Churna, Guduchi Sattwa, Chinnodbhavadi Kwatha Churna, GuduchighanaVati

Dose: 3-6g powder, 20-30g of the drug for decoction (decoction 40-80ml), Sattwa (cold water

extract)- 250-500mg.21

Chief chemical ingredients: Tinosporin, tinosporin, tinosporic acid, tinosporol, tinosporide,

tinosporidine, columbine, chasmanthin, palmarin, berberine, giloin, 1,2-substituted

pyrrolidine, a diterpenoid furanolactone, octacosanol, cordifolide, unosporin, cardifol,

cardifolon.22

Chemical constituents:

Terpenoids: Tinosporide, Furanolactone diterpene, Furanolactone clerodane diterpene,

furanoid diterpene, Tinosporaside, ecdysterone makisterone and several

glucosides isolated as poly acetate, phenylpropene disaccharides cordifolioside

A, B and C, cordifoliside D and E, Tinocordioside, cordioside, palmatosides C

and F, Sesquiterpene glucoside tinocordifolioside, Sesquiterpene tinocordifolin.22

Alkaloids: Tinosporin, (Stem), Magnoflorine, (Stem), Berberine, (Stem), Choline, (Stem),

Jatrorrhizine, (Stem), 1,2-Substituted pyrrolidine(Stem), Alkaloids, viz.

jatrorrhizine, palmatine, beberine, tembeterine, choline.

Lignans: 3 (a, 4-dihydroxy-3-methoxybenzyl)-4-(4- hydroxy-3-methoxybenzyl), (Stem)

Steroids: Giloinsterol, (Stem), ß-Sitosterol, (Stem), 20aHydroxy ecdysone, (Stem).

16

Others: Giloin, Tinosporan acetate, Tinosporal acetate, Tinosporidine,

Heptacosanol, Octacosanol, sinapic acid, Tinosponone, two phytoecdysones, an

immunologically active arabinogalactan.

Mode of action:

Vata shamak because of Ushna virya and Madhura Vipaka. Pittahara due to Madhura vipaka

and Tikta, Kashaya Rasa, Kaphashamaka because of Ushna Virya and Tikta, Kashaya Rasa,

Tikta Rasa is responsible of Aampachan and Jwarahar activity.23

The main phyto-constituents responsible for mode of actions and pharmacological activities

are as follows: 22

● Terpenoids: Stem: Respiratory tract infection, skin disease, Anti-hyperglycemic

property

● Alkaloids: Stem and root of plant: Anti-cancer property, Antioxidant activity.

Lignans: The root of plant: Anti-neoplastic property, Antioxidant activity.

● Steroids: Ariel part of stem: Anti-stress activity.

● Other: The whole part of Plant: Antidote to snake bite and scorpion sting, Analgesic

and Neuropharmacological activities, Diabetes, Rheumatoid arthritis, Gout, Cancer,

high cholesterol content, antipyretic, Antileprotic, Radioprotective .

Therapeutic uses - Kushtha, Vatarakta, Jvara, Kamala, Pandu, Prameha. 21

Pharmacological activities: Acts as Hypoglycemic,24anti-rheumatic, 25CNS depressant,

antibacterial,26 antimicrobial, immuno-stimulant, antipyretic, Antiviral, anti-inflammatory,

analgesic,27 Anti-stress, Anti-allergic, hepatoprotective, Anti-neoplastic, Anti-diabetic,

antitumor, antioxidant, Hypotensive.22

● Immune-modulatory activities: Macrophages are key innate immune cells of tissue

homeostasis with active involvement in primary immune response to the pathogens,

tumors, lifestyle associated diseases and neurodegenerative disorders. An experimental

study established that the plant polysaccharide, G1-4A, is rather safe for the

immunomodulation in various host systems. G1-4A promotes expression of pro-

inflammatory cytokines in RAW 264.7 and peritoneal macrophages of BALB/c mice

(BALB/c is an albino, laboratory-bred strain) through Toll-like receptor 4 (TLR4)-mediated

activation. G1-4A treatment augments the production of nitric oxide and up regulation of

expression of MHC-II and CD-86 in murine macrophages. It established that G1-4A as a

TLR4 agonist is having the potential to cause M1-activation of macrophages like Interferon

gamma (IFN-γ) and lipopolysaccharide (LPS).28 In the human subject also, it is considered

as an immune stimulator by increasing the killing capacities of neutrophils and

phagocytosis activities.29 Different extracts of Tinospora cordifolia also exhibit immune-

modulatory activity by splenocyte proliferation. N-formylannonain and 11-hydroxy

mustakone, gives significant splenocytepro- liferation.30

● Analgesic, Anti Inflammatory and Antipyretic activity: Tinospora cordifolia extract

exhibited significant analgesic effects in a dose-dependent manner in the three pain models

(acetic acid-induced writhing test, hot plate test and tail-flick test.) tested. The extract also

exhibited significant anti-inflammatory effects in the carrageenan-induced inflammation

test and antipyretic effects in the brewer’s yeast-induced pyrexia test in dose-dependent

17

manner compared to the effects observed in the control group animals.31 Its antipyretic

effect may be explained by its ability to inhibit cyclooxygenase in the brain, where peroxide

tone is low. Further, it does not inhibit neutrophil activation. In supra-pharmacologic doses

it inhibits NF-kB stimulation of inducible nitric oxide synthase.32

● Anti-rhinitis effect: The efficacy of Tinospora cordifolia extract (TC) in patients of

allergic rhinitis was assessed in a randomized double blind placebo controlled trial.

Seventy-five patients were randomly given either TC or placebo for 8 weeks. They were

clinically examined and Hb %, TLC (total leukocyte (white blood cells) count), DLC

(Differential Leukocyte Count) and nasal smear were done. Tinospora cordifolia

significantly decreased all symptoms of allergic rhinitis, like sneezing, nasal discharge,

nasal obstruction and nasal pruritus. After TC, eosinophil and neutrophil count decreased

the goblet cells were absent in nasal smear. Nasal smear cytology and leukocyte count

correlated with clinical findings. TC was well tolerated. Immune-stimulation is a known

pharmaco-therapeutic intervention in disease management The nasal smear cytology,

leukocyte count and clinical findings validated the efficacy of TC.33

● Antibacterial activity: The antibacterial activity of the aqueous, ethanol and chloroform

extracts from the stems of Tinospora cordifolia was studied using disc diffusion method

against Escherichia coli,34 Proteus vulgaris, Enterobacter faecalis, Salmonella typhi

(Gram-negative), Staphylococcus aureus and Serratia marcescens (Gram-positive).

Results of antibacterial screening of the stem extracts of Tinospora cordifolia were

measured in terms of inhibition. The zones of inhibition in diameter (cm) recorded and the

results suggested that among all extracts, the ethanolic extract has significant antibacterial

activity against all tested bacteria.26

● Antiviral Property - Tinosporin selectively inhibits virus from establishing infection to

target t helper cells.35

Therapeutic safety:

Guduchi is considered as safe even in higher dose than the therapeutic dose.36T. cordifolia is

considered as a safe drug. It is advocated in infants and children as a tonic to facilitate growth.

It is also a promoter of positive health.

Toxicological Analysis:

It is demonstrated in an acute toxicity study that up to 3 g/kg dose of aqueous extract of T.

cordifolia did not produce any adverse reaction and reported no death in the experimental rats.

It was also devoid of genotoxic effect under experimental conditions. In phase I study,

administration of T. cordifolia was found to be well tolerated and safe to healthy human

volunteers. 29,37

Safety in Pregnancy- As per animal studies Guduchi (Tinospora cordifolia) is considered as

safe. Due to its safety in pregnancy it is used in gestational diabetes,38its safety has also proven

by its use as supplementation in pregnant crossbred cows.39

Food and drug interaction: No drug interaction is found with Tinospora cordifolia and any

of the modern drugs or Ayurvedic medicine. 36

Precautions: To be used cautiously in patients with diabetes taking drugs likely to cause

hypoglycemia e.g insulin. The doses of Anti-diabetic drugs may need adjustment.

Contraindications: None. 36

18

HARIDRA

(हरिद्रा) Nepali name: Haledo (हलेदो), Besar (बेसाि) Sanskrit name: Haridra (हरिद्रा), Kanchani (काञ्चनी), Nisha (धनशा), Varvarnini ( र्विर्वचणणनी), Yoshitpriya (योवषतवप्रया) Latin name: Curcuma longa

PROPERTIES AND ACTION

Rasa: Tikta, Katu

Guna: Laghu, Ruksha

Virya: Ushna

Vipaka: Katu

Doshakarma: Kaphapittahara

Part Used: Rhizome

Chief chemical ingredients: Curcuminoids, oleoresin, ar-turmerone, α-turmerone, and β-

turmerone, curlone, ar-curcumene, α-santalene, santalenone, β-sesquiphellandrene, (Z)-β-

ocimene, β-bisabolene, β-caryophyllene, α-phellandrene, (Z)-β-farnesene, humulene oxide, β-

selinene, caryophyllene oxide, (E)-γ-atlantone, 1,8-cineole and essential oil (turmerone).40

Mode of action: From the Ayurvedic perspective: Haridra is Lekhaneeya, Kushthaghnaand

Vishaghna. Mechanism of action is considered as follows.41

● Curcumin has weak inhibitory synthesis, a strong stabilizing action on lysosomal

membrane and inhibitory action on leucotrine and thromboxane by synthesis without

any effect on prostacyclin synthesis.

● It sensitizes the tissue to endogenous corticoids as increase in adrenal steroidogenesis

has been reported.

● It possesses anti-thrombotic activity by inhibiting platelet aggregation.

● It has been found to increase fibrinolytic activity.

● It has free radical scavenging activity.

● Anti tumor, anticancer and anti proliferative actions have been suggested to be due to

induction of apoptosis, inhibition of adduct formation with DNA from bio activated

carcinogenic chemicals.

● Absorption of pure curcumin from GI Tract is about 60-65%.

Therapeutic use: Allergic Rhinitis, Conjunctivitis,42 Non healing wounds,43 Fungal

infection,44 Cancer,45 Acute tonsillitis,46 Bronchitis.47

Drug Dose: Powder 1-3 grams, Fresh juice 10-20ml.

19

Pharmacological actions:

● Anti-proliferative and immunomodulatory activities: Curcuma longa extracts

(including curcuminoids, volatile oil, curcumin, demethoxycurcumin and

bisdemethoxycurcumin, a-turmerone and ar-turmerone, Curcuminoids and a-

turmerone) significantly inhibited proliferation of cancer cells in a dose-dependent

manner. Both a-turmerone and ar-turmerone stimulated peripheral blood mononuclear

cell (PBMC) proliferation and cytokine production in vitro. It reports the anti-

proliferative effect of a-turmerone and immuno-modulatory activity exerted by ar-

turmerone. These findings revealed the potential use of as chemo preventive/antitumor

agent. 53

● Turmeric has been reported to increase the mitogenic response of splenic lymphocytes

in mice. Dietary turmeric in rats enhanced IgG levels. 41

● Anti-inflammatory activity: The laboratory studies have identified a number of

different molecules involved in inflammation that are inhibited by curcumin including

phospholipase, lipooxygenase, cyclooxygenase 2, leukotrienes, thromboxane,

prostaglandins, nitric oxide, collagenase, elastase, hyaluronidase, monocyte

chemoattractant protein-1 (MCP-1), interferon-inducible protein, tumor necrosis factor

(TNF), and interleukin-12 (IL-12).48

● Antiviral activity: Curcumin is found to act asstrong inhibitory effects on the

neuraminidases from two influenza viral strains, H1N1 and H9N2, as noncompetitive

inhibitors.49

● SARS COV 2: Curcumin has been found to interact with spike glycoprotein with a

high binding affinity (MolDock score − 141.36 kcal/mole and interaction energy

− 143.705 kcal/mole) and forms six hydrogen bond with Lys304, Gln314, Asn317,

Arg765, and Thr768. In addition, it has been found that the nimbin and curcumin have

better binding affinity toward spike glycoprotein as compared to nafamostat and

hydroxychloroquine50.

Therapeutic safety: Curcumin has been confirmed as a “generally recognized as safe”

compound by FDA, and it is stated not to have any toxic effect. According to Joint The Food

and Agriculture Organization of the United Nations (FAO) /World Health Organization Expert

Committee on Food Additives (JECFA) and European Food Safety Authority (EFSA) reports,

adequate daily intake (ADI) value of curcumin is 0–3 mg/kg। Lao et al. (2006) applied 500–

12,000 mg curcumin to healthy individuals so as to examine the maximum tolerance dosage

and safety of curcumin. As a result, up to 12 g/day intake of curcumin has been shown to have

no harmful effects on individuals.51

Food and drug interaction: Pre-treatment of both ginger and turmeric juice significantly

increased the tacrolimus blood concentrations. Curcumin, which is a component of turmeric,

has been reported to change both the function and expression of the P-glycoprotein (P-gp) and

the Cytochrome P450, (CYP3A) enzymes.52 When curcumin is co-administered with drugs

with a narrow therapeutic index, the level of such drugs could increase beyond the therapeutic

window, causing extremely unfavorable side effects. curcumin and doxorubicin co-delivery

20

because of the beneficial effects on antitumor activity and the ability to diminish the adverse

effects of doxorubicin.53

Precautions: As turmeric is having anti aggregatory effect and also known to reduce

thromboxane formation and reduces incorporation of arachidonic acid into platelet

phospholipids, it must be given with caution to the thrombocytopenia and platelets disorders.

It should also be given with caution with Aspirin and Warfarin. It is to be used with caution in

gall stone disease .53b

Additional References

1. Plant food supplements with anti-inflammatory properties: a systematic review

(II).[Link]

2. Turmeric (Curcuma longa): An Evidence-Based Systematic Review by the Natural

Standard Research Collaboration. [Link| DOI|]

3. Curcumin: Total-Scale Analysis of Scientific Literature. [Link]

21

TILA

(तिल)

Sanskrit name: Tila (धतल), Tailaphala (तैलफल), Snehaputaphala (स्नेहपूटफल)

Nepali name: Tila (धतल)

Latin name: Sesamum indicum Linn.

PROPERTIES AND ACTION54

Rasa: Madhura, Tikta, Kasaya, Katu

Guna: Guru, Snigdha

Virya: Ushna

Vipaka: Katu

Doshakarma: Kaphapitta nashak

Part Used: Veej (for oil), Panchanga (for kshar)

Drug Dose: For Kaval (Oil pulling): 10-20 ml55

Chief chemical ingredients:56

Major: Different parts of sesame contain Flavonoid, Alkaloid, Tannin, Phenol, Phytate, Fixed

oil, Carbohydrate, Protein. Chemical constituents mainly includesSesamin, Sesamol,

sesamolinol diglucosides,57 α -tocopherol, δ -tocopherol, γ -tocopherol , tocotrienols.

Mode of action: Fatty acid profiling of Sesame oil (SO) identified fatty acids that also showed

molecular binding with COX‐2, COX inhibition was a major pathway for its antiinflammatory

activity.58

Therapeutic use: In Ayurveda, therapeutic use of Sesame oil is done in several forms such as

Nasya (Errhine therapy), Abhyanga (Massage), Kavala/Gandusha (oil pulling), etc. It has

warming, grounding & calming effects on the nervous system. It is highly nourishing &

moisturizing, bringing deep relief to dry, irritated or congested nasal passageways. Sesame oil

also has anti-microbial, Anti-allergic properties.

Kavala Gandusha (oil pulling) with Sesame oil is found effective in

Halitosis,59Gingivitis.60Study shows that for oral hygiene oil pulling with Sesame oil (holding

in oral cavity or gargling) is equally effective as Chlorhexidine.61

Pharmacological actions:

● Antioxidant and Anti-inflammatory: Prevention and management of diseases

associated with oxidative stress,62 and inflammation. Topical usage of oil reduces pain

severity. Sesame oil has long been regarded as a daily nutritional supplement for

22

increasing cell resistance to lipid peroxidation (LPO). Sesame oil decreases LPO by

inhibiting the generation of reactive oxygen free radicals.

● It helps to regulate the body’s immune and balances autoimmune system .63 Sesamol

has shown protection against organ injury by decreasing NO associated LPO in

endotoxemic rats. 64

Analgesic and antipyretic: Sesame oil administered as dietary supplement produced

analgesic, antipyretic and anti-inflammatory activities in experimental animal models65.

Therapeutic safety: The external administration of this kind of sesame oil had not shown any

adverse effects. 66

Food and drug interaction: None

Additional References:

1. Effects of the Intake of Sesame Seeds (Sesamum indicum L.) and Derivatives on

Oxidative Stress: A Systematic Review. [Link]

23

TULASI

(िुलसी) Nepali name: Tulsi (तलुसी) Sanskrit name: Bhutagni (भतुघ्नी), Bhutapriya (भतूवप्रय), Gramya (ग्राम्य), Susasha (सिुसा), Surabhi (सिुभी), Bahumanjari (बहमुञ्जिी), Vishnuvallabha (वर्वष्णरु्वल्लभ), Apetarakshashi

(अपेतिाक्षसी) Latin name: Ocimum sanctum

English name: Holy Basil

Parts Used: Panchanga (whole plant)

Properties and action67

Rasa: Katu, Tikta, Kashaya

Guna: Laghu, Ruksha, Teekshna

Veerya: Ushna

Vipaka: Katu

Karma: 67 Vatahara, Kaphahara, Pittahara, Deepaniya, Hridya, Krimighna

Important formulations:67 Tribhuvanakirti Rasa, Muktapanchamrit Rasa, Mahajwarankush

Rasa.

Dose - 2-3 g of the drug in powder form. Fresh Juice 10-20 ml, Decoction 50-100ml, Seed

powder 3-6 gm. 67

Chief chemical ingredients:

Oleanolic acid,ursolic acid, rosmarinic acid, eugenol, carvacrol, linalool, β-

caryophyllene.68Ocimum sanctum revealed the presence of euganol 70% as major constituent.

Other components identified are nerol, methyl ether, caryphyllens, tripinine-4-ol, decaldehyde,

gammaselinene, alpha-pinene, beta-pinene, camphor and carvacrol. Leaves yield ursolic acid,

apegenin, leutolin, apigenin-7-o-glucuronide, leuteolin, 7-o-glucuronide, orentin and

molludistin. Older leaves contain 3.15% calcium.69

Leaves contain Tannins, coumarine derivative and stem contains Anthocyanoside,

Anthracenoside flavonic glycoside which are pharmacologically active.70 Ursolic

acidandeugenol is the quality standard ingredients.71Ocimum sanctum variety found in nepal

consist of the highest amount of ascorbic acid than other varieties of ocimum.72

Therapeutic use:

Swasa, Kasa, Pratishaya, Prasavshoola, Aruche, Hikka, Krimiroga, Kushtha.67

24

Dyspnoea,73 Pyrexia, Cough. Common cold, Urticaria, Sinusitis, Headache, Fever, Upper

Respiratory Tract Infection (URTI), Ring worm infestation .Stimulant, aromatic, anticatarrhal,

spasmolytic, diaphoretic, expectorant, insecticidal, antibacterial. 67

Mode of action:

According to Rasapanchaka it is Vatashamaka due to its Ushna virya and Kaphahara owing

to its Ushna virya, Katu vipaka and Katu Tikta rasa. Kaphanisaraka guna is responsible for

expulsion of cough. 74,75

Eugenol is one of the main phytoconstituents which is responsible for most of the therapeutic

effects on the immune system, reproductive system, central nervous system, cardiovascular

system, gastric system, urinary system, blood biochemistry and management of various

ailments.76

Pharmacological Action:

It has immune-modulatory activities,77,78, 79antioxidant activity,72 analgesic activity,

antipyretic activity, anti-inflammatory activity, anticancer activity, antihypertensive, cardio

protective activity, radio protective activity, chemo-preventive activity, antimicrobial activity,

central Nervous System (CNS) depressant activity, hepatoprotective activity, antidiabetic

activity, adaptogenic activity/anti-stress activity.80

● Immune-modulatory activities: Immune-modulatory effect of Tulsi leaves (300 mg

of ethanolic extracts) through a double-blinded randomized controlled cross-over trial

on healthy volunteers was done which revealed that statistically significant increase in

the levels of IFN-γ (p=0.039), IL-4 (p=0.001) and percentages of T-helper cells

(p=0.001) and NK-cells (p=0.017) were observed after 4 weeks in the Tulsi extract

intervention group in contrast to the placebo group. These observations clearly ascertain

the immune-modulatory role of Tulsi leaves extract on healthy volunteers.81

Regular use of herbal tea with Tulsi also helps as an immunomodulator. A study

conducted in India concluded this fact. The effect of a tea fortified with five herbs for

their putative immune enhancing effect (Withania somnifera, Glycyrrhiza glabra,

Zingiber officinale, Ocimum sanctum and Elettaria cardamomum) on innate immunity

was investigated in two independent double-blind intervention studies. Both studies

were conducted with healthy volunteers selected for a relatively low baseline NK cell

activity and a history of recurrent coughs and colds. In a pilot study (32 volunteers)

consumption of herbal tea significantly improved the NK cell activity of the volunteers

in comparison with a population consuming regular tea. These results were validated in

an independent crossover study with 110 volunteers. These two studies indicate that

regular consumption of the tea fortified with Ayurvedic herbs enhanced NK cell

activity, which is an important aspect of the (early) innate immune response to

infections.82

● Anti-inflammatory: A study is designed to evaluate the anti-inflammatory effect of

Ocimum sanctum and its phenolic compound and eugenol (EUG) in human monocytic

25

(THP-1) cells and validate its traditional use for treating cardiovascular diseases. The

LC-MS analysis revealed the presence of several bioactive compounds including

eugenol they showed marked inhibition on LPS induced TNF-α secretion by THP-1

cells and also inhibits gene expression of cytokines and chemokines (IL-6, TNF-α,

MIP-1α, MCP-1) and translocation of NF-κB-p65 to the nuclei. In addition, they also

showed significant inhibition on PMA induced monocyte to macrophage differentiation

and the gene expression of CD14, TLR2 and TLR4 markers.83

● Analgesic and anti-inflammatory, antipyretic activities: An animal study revealed

that ethyl acetate extract of Ocimum sanctum roots exhibit the anti-inflammatory,

analgesic and antipyretic activity. Ethyl acetate extract reduced the Brewer’s yeast

induced rectal temperature and exhibited antipyretic activity in a dose dependent

manner. Subcutaneous injection of Brewer’s yeast causes pyrexia by enhancing the

production of prostaglandin which ultimately increases the body temperature. This

production can be prevented by inhibiting the cyclo‑oxygenase enzyme. The extract

shows the presence of flavonoids. Flavonoids act as an anti-inflammatory agent by

inhibiting the chemical mediators of the inflammatory response in the same way as the

NSAIDs, that is, by inhibiting the enzymes that cause the synthesis of prostaglandins.84

● Antiviral Properties:

Crude aqueous extract of leaves found to enhance survival ratio and decrease the

incidence of residual neurological deficit in patients of viral encephalitis.85 Ethanolic

and aqueous extracts both inhibited replication of polio virus H-3 in vitro. 86

● Bronchodilator effect: Ocimum sanctum Linn. Exhibits bronchodilator effect. A

single-blind cross-over study of Capsules of Ocimum sanctum Linn. (200 mg, twice

daily) and Salbutamol sulphate (2 mg, twice daily) were administered in 41 patients.

Each drug was administered for a period of one week with a washout period of one

week between the two drug schedules. FEV1 and PEFR were recorded in these patients

to assess the bronchodilator activity before the drug administration, on 4th and on 7th

day of administration of Ocimum sanctum and the parameters obtained were compared

with that of the standard drug, salbutamol. The study concluded that Ocimum sanctum

200mg twice daily produced significant improvement in both FEV1 and PEFR values,

on 4th and 7th day and also produced improvement in symptoms of asthma and

suggested that Ocimum sanctum Linn. possesses significant bronchodilator activity in

mild and moderate bronchial asthma.87

Therapeutic safety:

The drug in 2 to 3 gm and juice 5 to 10ml is considered safe.

Dose: Powder: 2 to 3gm.67

Juice: 5 to 30ml. 67

Acute and subacute toxicity studies done in animals proved its safety. A study done for acute

and subacute toxicity of 50% ethanolic extracts (for acute toxicity -200, 600, and 2000 mg/kg

and for subacute toxicity 200, 400, and 800 mg/kg/day) which did not produce any hazardous

26

symptoms of CNS and ANS toxicities or death in the acute toxicity test. Sub acute treatment

did not show any change in body weight, food and water consumption, and hematological and

biochemical profiles. In addition, no change was observed both in macroscopic and

microscopic aspects of vital organs in rats. This result showed that Ocimum sanctum extract

could be safe for human use.88

Food and drug interaction: No studies on interaction of Ocimum sanctum are available. Seeds

may exert an additive effect with bronchodilators.

Precautions: In Pitta disorders (e.g. gastric ulcer) and burning sensation of the body

Additional references:

1. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the

Literature. [Pubmed| Link| DOI]

27

TRIKATU

(त्रिकटु)

Trikatu is the combination of three herbs: Pippali, Maricha and Sunthi. The details of drugs are

described below.

MARICHA

(मरिच)

Nepali name: Marich

Sanskrit name: Krishna (कृष्ण), Maricham (मिीचम)्, Ushanam (ऊषणम)्, Vellajam-

(रे्वल्लजम)्

Latin name: Piper nigrum L.

English Name: Black pepper

Parts Used: Dry fruits

Properties and action.89

Rasa: Katu, Tikta

Guna: Laghu, Ruksha, Teekshna

Virya: Ushna

Vipaka: Katu

Karma: Shleshmahara, Pittakara, Kaphavatajit, Vatahara, Chedana, Deepana, Ruchya,

Jantunghana, Medohara, Chedi, Hridroga, Vataroga.

Important formulations - Marichyadi Gutiki, Marichyadi Taila, Trikatu Churna.

Therapeutic uses - Swasa, Shoola, Krimiroga, and Tvakroga

Dose: 250 mg - 1 g of the drug in powder form.

Chemical ingredients: a-pinene, b-pinene, limonene, myrcene, sabinene, camphene, a-

thujone, piperitone, caryophyllene, pinocarveol, p-cymene, b-bisabolene, a-phellandrene, b-

farnesene, a-terpinene and linalool. Black pepper is also rich in minerals like iron, potassium,

zinc, magnesium, manganese and calcium along with antioxidant vitamins including Vitamin-

C and A.90

Mode of action: Fruits are used as aromatic, stomachic and carminative. It causes a feeling of

warmth and is used as a condiment. It also stimulates taste -buds, with an increase in gastric

juice. It is reported to enhance the bioavailability of certain drugs.91 Due to Uttejaka (stimulant

effect) it increases the urine output. Due to stimulation of mucosa of the respiratory tract,it

28

helps to expel coughs. Chhedana effect also helps to detach the adhered cough and Ushna virya

and Katu rasa helps to clear the tract by pacifying Kapha. 89,92,93

Therapeutic uses: Used as expectorant, febrifuge, diuretic, anti-arthritic, circulatory,

analgesic, stimulant, Anthelmintic, antiseptic, diaphoretic, antispasmodic, laxative,

aphrodisiac, anticatarrhal, rubefacient, and carminative. 90

Pharmacological actions: Immune-modulatory, Antiasthmatic, Antimicrobial, Antioxidant,

Anticancer, Anti Inflammatory, Hepatoprotective, Antidiarrhoeal, Digestive, Antidepressant,,

Anticonvulsant, Analgesic, Bioavailability enhancer.94,95

● Immune-modulatory activity: For macrophage cells, the Piper nigrum L extract

strong inhibitory activity on lucigenin-amplified oxidative burst of PMNs. The results

suggest ability to modulate the innate immune response of phagocytes at different steps,

emphasizing their potential as a source of new immune-modulatory agents.96The black

pepper and cardamom extracts significantly enhance the cytotoxic activity of natural

killer cells, indicating their potential anti-cancer effects and exert immune-modulatory

roles and antitumor activities. 97

● Antibacterial activity: Piper nigrum extract exerts significant inhibition on Gram

positive bacteria like Staphylococcus aureus, Bacillus cereus, Streptococcus faecalis,

and Gram negative strains like Pseudomonas aeruginosa followed by Salmonella typhi

and E. coli in-vitro. The mechanism of antibacterial action appears to be loss of control

over cell membrane permeability.98

Therapeutic safety: No toxic effects are reported. Chunlaratthanaphorn et al. found that a

single oral administration of the aqueous extract of the P. nigrum dried fruits (5,000 mg/kg

body weight) to male and female Sprague-Dawley rats did not produce signs of toxicity,

behavioral changes, mortality, changes on gross appearance or histopathological changes of

internal organs. In addition, the sub chronic toxicity was assessed by oral feeding daily at the

doses of 300, 600 and 1,200 mg/kg body weight continuously for 90 days. No abnormalities

were observed in the test groups as compared to the controls. 99

Food and drug interaction: Piper nigrum acts as enhancer of bioavailability.99Piperine from

black (Piper nigrum Linn) and long (P. longum Linn) peppers increased the phenytoin (an anti-

epileptic drug), propranolol and theophylline in healthy volunteers and plasma concentrations

of rifamipicin (rifampin) in patients with pulmonary tuberculosis.100

Precautions: Caution is necessary with Pitta dominant persons, active acid peptic disease, and

in summer (dose to be limited)

Contraindications: None.

Additional References:

1. A Systematic Review on Black Pepper (Piper nigrum L.): From Folk Uses to

Pharmacological Applications. [Link| Pubmed| DOI].

29

PIPPALI

(पिप्िली) Nepali name: Pipla (वपप्ला) Sanskrit name: Pippali (वपप्पली), Krishna (कृष्णा), Kanaa (कणा), Chapala (चपला), Magadhi

(मागिी), Upakulya (उपकुल्या), Shaundi (शौण्डी), Vaidehi (रै्वदेही), Tikshnatandula

(तीक्ष्णतण्डलुा). English name: Long pepper

Latin name: Piper longum Linn.

Parts Used- Fruits.101

Properties and action: 101

Rasa: Madhura, Katu, Tikta

Guna: Laghu, Snigdha

Virya: Anusna

Vipaka: Madhura

Karma: Deepana, Hridya, Kaphahara, Rucya, TridoÀahara, Vatahara, Vrishya, Rasayana,

Rochana.

Chemical ingredients : Piperine, Piper longumine, Lignans, Piperderidine Piplartine, Esters,

Triacontane, Sesamin, Volatile oil, Piper longuminine, Dehydropipernonaline Piperidine,

Trimethoxy Cinnamoyl-piperidine.102

Dose- Fruit powder- 1-3 gm.

Therapeutic uses:· Cough, Bronchitis, Respiratory diseases,103 Colic pain, Vomiting, Fever,

Worm infestation, Dysuria, Indigestion, Gout, Rheumatism.104

Probable mode of action- According to Rasapanchaka, it is Kaphaharadue to Katurasa, and

Vatashamakadue to Madhura vipaka. Due to its stimulatory effect (Uttejaka) on mucosal lining

of the urinary tract, it acts diuretic or Mutrala. Uttejaka action helps to secretes digestive

juices.105

Pharmacological activities -

● Anti-inflammatory: Fruits of Pippalisuppress the inflammation of both acute and

subacute phases.106 The petroleum ether extract has significant anti inflammatory

activity likes oxyphenbutazone or indomethacin. 104

● Immune stimulatory: The ingredient helps to activate the macro- phages, increases

macrophage migration index (MMI), and enhances phagocytic activity.107

● Anti-oxidant: Antioxidant activities of proteins isolated from boiling water extract of

Pippali (Piper longum) (long pepper) showed the lipid peroxidation inhibition.108

● Anti asthmatic activity- Piper longum did not show any significant effect on total

quantity of histamine in lungs. The petroleum ether extract of Piper longum produces

respiratory stimulant effects. The anti-asthmatic effect may be due to its

30

immunostimulatory activity as it can help in allergic bronchial spasm by increasing

immunoglobulin G levels. 104

● Other pharmacological activity: Piper longum also shows hepato-protective activity,

antitumor activity, Anti-diabetic activity, Hypocholesterolemic activity, Antioxidant

activity, Antiallergic activity, Analgesic activity.109

Important formulations: Trikatu Churna, Amritarishta, Ayaskriti, Chyawanprash Avaleha,

Gudapippali, Ashwagandhadyarishta, Kumarayasava, Chandanasava, Shiva Gutika, Kaishor

Guggulu.

Therapeutic safety: No side effects of Piper longum are reported up to date, however, under

certain conditions, such as pregnancy and lactation, the fruits of P. longum should be used

cautiously because of potential interactions.104,110

Precautions- Pregnancy,111 Lactation.104, 110

Food and drug interaction: Piper longum and its main constituent piperine is known to

enhance the action of many drugs by improving GI absorptions such as amoxicillin,

cefotaxime,nimesulide, pentobarbital and curcumin, rifampicin.104,111 Piperine might interfere

with enzymatic drug biotransformations resulting in the inhibition of hepatic aryl hydrocarbon

hydroxylase (AHH) and UDP-glucuronyltransferase and altered the pharmacokinetic

parameters of barbiturates and phenytoin.109It also increases plasma concentrations of

rifampicin (rifampin) in patients with pulmonary tuberculosis. 112

Additional References

1. A Systematic Review on Piper Longum L.: Bridging Traditional Knowledge and

Pharmacological Evidence for Future Translational Research. [Pubmed | Link| DOI]

2. A systematic review on black pepper (Piper nigrum L.): from folk uses to

pharmacological applications [Link| DOI]

31

SHUNTHI

(शुण्ठी) Nepali name: Sutho (सठुो)

Sanskrit name: Shunthi (शणु्ठी), Nagara (नागि), Vishvabheshaja (वर्वश्वभेषज), Katubhadra

(कटुभद्र), Mahaushadha (महौषि), Aardrika (आद्रणक), Shringabera (शृ्रङ्गरे्वि)

English name: Dry zinger

Latin name: Zingiber officinale Roscoe

Parts Used: Rhizome

Properties and action113

Rasa: Katu

Guna: Laghu, Snigdha

Virya: Ushna

Vipaka: Madhura

Karma: Anulomana, Deepana, Hridya, Pachana, Vatakaphapaha, Amadoshahara.

Chief chemical ingredients: Zingiberine, Zingiberol, Gingerol, Zingerone, Flavonoids,

Polyphenols, Ginger oleoresin, starch, Curcumen, Cyclo Hexan, 6-Shagole.114, 115

Therapeutic uses: Agnimandya (Indigestion), Swasa(Shortness of breath), Adhyamana

(Abdominal discomfort), Amavata (Rheumatoid arthritis), Pandu(Anaemia), Udararoga,

Vivandha (constipation), Vrishya (Aphrodisiac) Vaman (vomiting), Shool(Colic), Kas

(cough), Shleepad (elephantiasis), Shoth(Inflammation), Arsha (haemorrhoids),116 Stomachic,

carminative, stimulant, sialagogue,117 motion sickness.118

Mode of actions:

● According to Rasapanchaka, Ushna virya and Madhur rasa pacifies Vata dosha while

Ushna virya and Katu rasaare responsible for pacifying Kapha. Due to Ushna gunaand

vatahara properties it pacifies colic, inflammatory responses, ushna guna and katu ras,

laghu guna are responsible for kandle the digestive fire. Due to its Kaphahara

properties it pacifies cough, ushna guna and Katu rasa responsible for drying shleshma

in swasan tantra for ease the breathing. 116,117

● Ginger powder has been suggested that adsorbent, aromatic, and carminative properties

on GI tract cause adsorption of toxins and acid enhanced gastric motility. These may

have probably blocking effects of GI reactions and nausea, so useful in motion sickness.

Pharmacological actions:

● Immunomodulatory activity: Ginger essential oil recovered the humoral immune

response in immunosuppressed mice.119 In another study, volatile oil of ginger

influences both cell-mediated immune response and nonspecific proliferation of T

lymphocyte.120

32

● Anti-inflammatory: Various studies showed anti-inflammatory activity of zinger. 121,

122The mode of action as anti-inflammatory agents is described in a study done in

Lipopolysaccharide-Induced Mouse Model concluded that dry zinger inhibits LPS-

induced inflammation via regulation of NF-KB and MAP kinases. It significantly

inhibits the production of IFN-𝛼 and IL-6 and suppresses NF-𝜅B by degradation of I𝜅B-

𝛼. These activities appear to be mediated via down regulation of the extracellular signal-

regulated kinases (ERK1/2), Stress-activated protein kinases (SAPK)/Jun amino-

terminal kinases (JNK), and p38 MAP kinases (P38 Mitogen-Activated Protein

Kinases) signaling pathways and suppression of iNOS and COX-2. The data provided

evidence for a mechanism by which dry zinger acts as an anti-inflammatory agent. 123

● Antibacterial activity on respiratory tract bacteria: The pathogens Streptococcus

aureus, S. pyogenes, S. pneumonia, H. influenzaisolated from human respiratory tract

were sensitive with extract of Zingiber officinale. S.aureus was most susceptible

against extract of Zingiber officinale.124

● Antiviral activity: Ginger is effective against HRSV-induced plaque formation on

airway epithelium by blocking viral attachment and internalization. This study was

conducted with fresh zinger. 125

● Anti-tussive activity: A macromolecule glucan together with a small amount of poly

-galacturonan from Zingiber officinale, demonstrated significant antitussive effect in

guinea pigs. The observed biological effect provides a scientific basis for the past and

present use of this herb in traditional medicine. 126

● Other pharmacological activities: Zingiber officinale also shows analgesic,

antipyretic activity, anti inflammatory, antiulcerogenic, cytoprotective,127 antioxidant

and anthelmintic.128

Important formulations: Trikatu Churna, Shaubhagya-sunthipak, Shaubhagya vati,

Vaishvanara churna. 113

Therapeutic safety: Zingiber officinale is safe having no major side effects.129 U.S. Food and

Drug Administration have included ginger as a product that is generally regarded as safe

(GRAS). 118

Food and drug interaction: Long term use of zinger with Warfarin, phenprocoumon may

cause irregular bleeding.130

Precautions: Pregnancy, lactation.131

Contraindications: Bleeding disorders. 118 Fresh zinger (Adraka) is contraindicated in

Kushtha (Skin diseases), Pandu (Anaemia), Mutrakrichha (Dysuria), Raktapitta (Bleeding

disorders), Vrana (Ulcer), Jwar (Fever), Daha (Burning sensation), Grishma (Summer) and

Sharad (Autumn) ritu. 116

Additional References:

1. Cochrane Protocol - Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea:

A Systematic Review and Meta-Analysis. [Pubmed | Cochrane| DOI]

2. Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized

Controlled Trials. [Pubmed | Link | DOI]

33

YASTIMADHU

(यष्टीमध'ु)

Nepali name: Jethimadhu (जेदठमि)ु

Sanskrit name: Yastimadhu (यिीमि)ु, Klitanaka (क्लीतनक), Madhuka (मिकु)

English name: Liquorice root

Latin name: Glycyrrhizaglabra Linn.

Parts used: Stolon and Roots. 132

PROPERTIES AND ACTION: 132

Rasa: Madhura

Guna: Guru, Snigdha

Virya: Sheeta

Vipaka: Madhura

Karma: Balya, Chakshushya, Vrishya, Varnya, Vatapittajit, Raktaprasadana.132

Chief chemical ingredients: The constituent which it owes its characteristic sweet taste is

glycyrrhizin. Other constituents present are glucose (up to 3.8%), sucrose (2.4 - 6.5%),

mannite, starch (0.30%), asparagine, bitter principles, resins (2.4%), and volatile oil (0.03 -

0.035%) and colouring matter. The yellow colour is due to anthoxanthin glycoside, isoliquiritin

[C2H22O9, M.P. 185-86(decomp)] which undergoes partial conversion to liquiritin (M.P. 22)

during drying and storage of roots. Isoliquiritin gives a hydrolysis isoliquiritigenin (2, 4, 4'-

trihydroxy chalkone, C15H12O4, M.P. 2.2 - 4). Both isoliquiritin and liquiritin are bitter with

a sweet aftertaste and stimulate salivary glands. A steroid, estrogen probably estriol, is also

reported to be present in the liquorice.133

Therapeutic uses: Kasa, Kshaya, Svarabheda, Vatarakta, Vrana.132

Cough, bronchitis, ulceration of urinary tract, retention of urine, gastralgia, gastric ulcer,

cephalalgia, fever, skin diseases, ophthalmic diseases, pharyngitis, haemorrhoids , hoarseness

of voice, epilepsy, hiccough, erysipelas, anaemia, meno-metrorrhagia, intrinsic haemorrhage,

hemicrania, urticaria. 133

Drug Dose:

2-4 g of the drug in powder form.132

Dried root is dispensed at 1–4 g, three times daily to a maximum of 12 g.134 Small piece to be

sucked for sore throat.

Decoction made from the root

Mode of action-

● According to Rasapanchak it is Vata Shamak due to Madhura Rasa and Madhura

Vipaka, and Pittashamak due to Sheet veerya, Madhura Vipaka, Madhura Rasa. It also

acts as Raktaprakopashamak, which is useful in Vrana. Due to Soumaya and Sneha

34

Guna predominance it also acts as Kapha Nisharaka, so useful in Cough (Kasa),

Hoarseness of voice (Swarbhanga).135 ,136

● Carbenoxolone (Carbenoxolone (CBX) is a glycyrrhetinic acid derivative with a

steroid-like structure) and lieandane (white, crystalline, water-insoluble powder,

C6H6Cl6, the gamma isomer of benzene hexachloride) derivative prepared from

glycyrrhiza and possesses significant mineralocorticoid activity. It is used as anti-ulcer

drug. It changes the composition of mucous and increases the mucosal barrier for the

diffusion of acid. Carbenoxolone also inhibits the enzyme which inactivates

prostaglandins and suppresses the activation of pepsinogen, so it is useful as anti-

inflammatory, and employed commonly in treatment of gastric and peptic ulcer.137

● Isoliquiritin is flavanoids glycosides and its aglycone, part of glycoside has

antispasmodic effect. 137

● Due to natural mineralocorticoids (glycyrrhetinic acid) it is useful to treat rheumatoid

arthritis, inflammation and Addisions’s disease.137

Pharmacological actions-

● Anti-inflammatory activity- Glycyrrhizin suppresses proinflammatory

cyclooxygenase (COX-2), Inducible nitric oxide synthase (iNOS), and Tumor necrosis

factor alpha (TNF-α), and inhibits phosphorylation and secretion of high-mobility

group protein 1 (HMGP 1).It also suppresses NF-κB (NF-κB is a protein complex that

controls transcription of DNA, cytokine production and cell survival) via the PI3K

pathway (an intracellular signal transduction pathway that promotes metabolism,

proliferation, cell survival, growth and angiogenesis), inhibits the production of NO,

PGE2 (a potent inflammatory mediator that is generated by cyclooxygenase 2 (COX2)

conversion of arachidonic acid) , and Reactive oxygen species (ROS), and reduces the

protein and mRNA levels of iNOS and COX-2.138 Glycyrrhetinic acid also exerts a

direct anti-inflammatory effect by inhibiting 15-hydroxyprostaglandin dehydrogenase

and delta-13-prostaglandin reductase affecting the metabolism of inflammatory

prostaglandins.139

● Hepatoprotective activity- Glycyrrhiza glabra flavonoids provide protection to

hepatocytes exposed to CCl4 (Carbon tetrachloride) and galactosamine. The

hepatoprotective effect is due to the anti-lipid peroxidation effect.139

● Immune-modulatory activity - Licorice is known to increase the phagocytic activity

of macrophages, it helps macrophages to secrete interleukin-1. Glycyrrhetinic acid and

Glycyrrhizin potentially inhibits the classical complementary pathway (IC 50). Licorice

polysaccharides exhibited immune-modulatory activities in CT 26 tumor bearing

BALB/c mice. The polysaccharides significantly suppressed tumor growth and

increased immune organ index. Furthermore, the immune-modulatory effect was

evident with activation of CD4+ and CD8+ immune cells population.140

● Antimicrobial activity- Glycyrrhiza glabra extracts have displayed anti-microbial

activity in vitro against staphylococcus, S. mutans, M. smegmatis and Candida

albicans. The majority of antibacterial effects are due to isoflavonoid components. 137

Glabridin prevents the yeast-hyphal transition and is effective against C. albicans .

Licochalcone E reduces the production of α-toxin in S. aureus. Licochalcone A inhibits

35

the biofilm formation and prevents the yeast-hyphal transition shows antimicrobial

activity against C. albicans. Liquiritigenin decreases the production of α-hemolysin in

S. aureus. 138

● Antioxidant activity- Glycyrrhizin acts as free radical scavenger. An experimental

study showed that glycyrrhizin significantly decreases lipid peroxidation and

transaminase levels.138 ● Anti allergic activity- Licorice inhibits Prostaglandin E2, arachidonic acid release and

stimulates hydrocortisone. In vivo studies, it is established that licorice suppress

dexamethasone induces histamine release and mast cell degradation.139

● Antitussive and expectorant activity- Phytoconstituents of licorice i.e. liquiritin

apioside and liquiritin are the major antitussive and expectorant compounds. Their

antitussive effects depend on both peripheral and central mechanisms.141 Peripheral

expectorant effect is due to reflux expectorant action from the GI tract mediated by the

embryonic neural link between the mucosal membranes of the GIT and respiratory

tract.139

● Antiviral activity- Glycyrrhizin and glycyrrhetinic acid exhibits significant antiviral

activity by stimulating interferon. This interferon binds to the cell surface, stimulating

synthesis of intracellular proteins that block viral DNA. Glycyrrhetinic acid inhibits

herpes simplex type 1, Varicella zoster decreases hepatitis B surface antigen, inhibits

HIV-1.139 In recent years, many studies have shown that licorice extract has significant

antiviral activity against HIV, severe acute respiratory syndrome-coronavirus (SARS),

HSV, influenza virus (H3N2), rotavirus, respiratory syncytial virus, varicella zoster

virus, coxsackie virus, and enterovirus only two triterpenoids, Glycyrrhizin and 18β-

glycyrrhetinic acid, have been reported to possess antiviral activity. 138 The mechanism

of antiviral activities is different for different viruses for example; Glycyrrhizin reduces

endocytotic activity and reduces virus uptake of Influenza A virus. It reduces HMGB1

binding to DNA and inhibits influenza virus polymerase activity. It also exerts an effect

on the innate immunity to fight against a pathogenic virus H3N2. It weakens chemokine

ligand 10, IL-6, and CCL5 production and suppresses H5N1-induced apoptosis. 138

● Effect on SARS CoV- A study conducted in Germany the antiviral potential of

ribavirin, 6-azauridine, pyrazofurin, mycophenolic acid, and glycyrrhizin against two

clinical isolates of coronavirus (FFM-1 and FFM-2) from patients with SARS admitted

to the clinical center of Frankfurt University showed that glycyrrhizin was the most

active in inhibiting replication of the SARS-associated virus. The findings suggest that

glycyrrhizin should be assessed for treatment of SARS. The mechanism of

glycyrrhizin’s activity against SARS-CV is unclear. But it can be postulated that

Glycyrrhizin affects cellular signaling pathways such as protein kinase C; casein kinase

II; and transcription factors such as activator protein 1 and nuclear factor B.

Furthermore, glycyrrhizin and its aglycone metabolite 18 glycyrrhetinic acid up

regulate expression of inducible nitrous oxide synthase and production of nitrous oxide

in macrophages.142

Important formulations – Yashtimadhu Churna, Eladi Gutika, Yashtimadhuka Taila,

Madhuyashtdyadi Taila. 132

36

Therapeutic safety: Prolonged use of licorice may potentiate the cumulative toxicity of

cardiac glycosides due to potassium loss. > 40 Gram of Licorice candy per day for a prolonged

period has reported the 2 cases of Hypertensive Encephalopathy. 143 At 75 mg daily

glycyrrhetenic acid (derived from 50 G/day liquorices), a raising effect on blood pressure is

noted after 2 weeks. More than this, daily dose increases blood pressure proportional to

increased liquorice intake.144 Few studies show risk of toxicity after oral administration is

lowest, but risks of toxic effect are seen in IP or IV administration. Sub-acute exposure with

G. glabra and glycyrrhizin salts induces inhibitory effects on the adrenal–pituitary axis and

depletes the liver iron contents. The most important side effects by administration of licorice

and glycyrrhizin are hypertension and hypokalemia-induced secondary disorders. Some factors

may increase the risk of toxicity with licorice and glycyrrhizin, e.g. hypokalemia, prolonged

gastrointestinal transient time, decreased 11βHSDH type 2 activity (11β Hydroxysteroid

dehydrogenase – 2 activity) - a family of enzymes that catalyze the conversion of inert 11 keto-

products (cortisone) to active cortisol, or vice versa, and regulate the access of glucocorticoids

to the steroid receptors , hypertension, anorexia nervosa, old age, and female sex. G. glabra

and glycyrrhizin salts are not major teratogens and possess weak mutagenicity, genotoxicity,

carcinogenicity, and developmental toxicity effects.145

Precautions: Pregnancy, familial history of preeclampsia.145

Food and drug interaction: Glycyrrhiza glabra L. displaces serum bound cardiovascular

drugs such as diltiazem, nifedipine and verapamil.146 It increases potassium loss thiazide

diuretics, and should not be used simultaneously with either spironolactone or amiloride.

Contraindications- Licorice is contraindicated in severe renal insufficiency, high blood

pressure due to fluid retention, hypocalcaemia, overweight. 146Glycyrrhizin is contraindicated

for administration with oral contraceptives, hydrocortisone, and prednisolone.147

Additional Reference:

1. Metabolic Changes After Licorice Consumption: A Systematic Review With Meta-

Analysis and Trial Sequential Analysis of Clinical Trials. [Pubmed | Link | DOI]

37

Gallery

Ocimum sanctum Tinospora cordifolia (Willd)

Hook. F & Thomson

Curcuma longa

Sesamum indicum Withania somnifera (L.)

Dunal.

Glycyrrhiza glabra Linn

Piper longum Linn. Zingiber officinale Roscoe Piper nigrum L.

38

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PANEL OF EDITORS

Editors :

1. Prof. Dr. Shyam Mani Adhikari (BAMS, MD Dravyaguna). Campus Chief,

Patanjali Ayurveda Medical College, Dhulikhel, Kathmandu, Nepal.

2. Dr. Rishi Ram Koirala (BAMS, MD Kayachikitsa). Chief Medical

Consultant, Ayurveda Health Home, Kathmandu Nepal.

3. Associate Prof. Dr. Sammodavardhana Kaundinnyayana (MBBS, MD

Pharmacology).Department of Pharmacology, NAIHS, College of Medicine

(Affiliated to IOM TU), Sano Bharyang, Kathmandu, Nepal.

4. Dr. Pushpa Raj Poudel (BAMS, MS, Shalakya). Ayurveda Doctor, Ministry

of Social Development, Province no. 5. Government of Nepal.

List of Contributors:

1. Dr Puneshwar Keshari (BAMS, MD Dravyaguna). Ayurveda Materia

Medica Expert (Present designation: Ayurveda Doctor, Department of

Ayurveda and Alternative medicine, Government of Nepal).

2. Dr Kopila Adhikari (BAMS, MD Dravyaguna). Ayurveda Materia Medica

Expert, (Present designation Ayurveda Doctor, District Ayurveda Health

Center, Chitwan)

3. Dr Pravesh Srivastava (BAMS, IOM, TU). Ayurveda Doctor, Province No.

05 (Presently PG scholar of Panchakarma, National Institute of Ayurveda,

Jaipur, Rajasthan India).

4. Dr Binod Ghimire (BAMS, MD Yoga and Rehabilitation). Yoga Consultant

and Medical Doctor, Arogya Nepal, Lalitpur.

5. Dr. Madan Bhandari (BAMS, MD Shalya). Assistant Professor, Patanjali

Ayurveda Medical College and Research Center, Dhulikhel.

6. Dr. Prerok Regmi (BAMS, IOM, TU). Advisor, Integrative Medicine

Development Foundation Nepal (IMDF-Nepal), Kathmandu, Nepal.

50

SUGGESTION / FEEDBACK/ CORRECTION

This kind of work requires continuous editing to make it up-to-date. So, the editorial team

request for your continuous support in the form of suggestion, feedback and advice for the

correction to the errors committed in the document.

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