Qamaruddin Barakzai ( Deptartment of Pharmacology, Ziauddin Medical University, Karachi. )
The history of use of herbal medicine dates back to more than 4000 years1. A wide range of plants have been utilised for treatment of multiple disorders of the liver2. The utilisation has been as extracts of single plants and also compound preparations of more than one-plant types. The era when scientific methodologies started developing to explain the phenomena of positive outcomes of herbal medicine in curing liver disease, a vast research started throughout the world and now plenty of data is available showing encouraging results.
The research on herbal remedies for liver disease is so much broad based that nearly every advanced country has held basic experimental work followed by clinical trials. The use of herbal medicine for liver disease is continuing since centuries in India and China where majority of the work is unpublished. The use of herbal medicine has led to new trends in therapeutics and a couple of new disciplines. have evolved such as Phytopharmacology and Ethnopharmacology. Many countries are now exposing their flora as their cultural contribution towards medicine.
Herbal medicine has been categorically employed for a variety of medical problems and modem trends have even helped in extracting the active principles which have been classed into many chemical groups such as alkaloids, glycosides, resins and tannins3. It is a fact that earlier use of plants as medicines was devoid of any scientific explanations. The reason for this may be that even there was little known about the aetiology and pathology of disease. Now because tremendous advances had been made regarding many unanswered questions pertaining to the development of disease state, herbal medicine is also being explored by scientific protocols.
As is evident from old literature, liver disease in Greece-Arab era was recognised only by the symptomatic jaundice4. This even was classed as green and black depending on the colour which was imparted to the exposed parts of the patients. Liver disease under this description was treated by different types of herbs obtained from indigenous plants with promising healing effects. Presently with the help of newer advanced diagnostic methodologies, liver disease has a strong basis of labelling clearly defined categories. This gives a very strong base to relaunch the use of herbal medicine to study their tremendous healing qualities in well-defined liver disorders.
It is a very surprising fact that since the establishment of aetiology of infectious hepatitis during the decade 1930-19405, the use of herbal medicine for liver disorder took an upward surge which culminated to extremes when infectious hepatitis was found to have the viral aetiology (1960). This was obviously due to the fact that in viral hepatitis the role of allopathic medicine was not much encouraging. The problem of drug use in liver disease is that this organ is responsible for handling of all foreign chemicals (Including drugs). In discased state the power of liver to perform this important function of degrading toxic substances is much reduced and the increased half life of the chemicals could not only damage the liver itself but could also effect other important organs of the body such as kidneys. It is an established fact that in liver disease it is only the supportive treatment which is instituted, as nature has given a tremendous power of regeneration to the hepatic tissue.
The role of antiviral drug treatment for viral hepatitis is also limited. Use of these, agents requires a close monitoring and the results are also not so appreciable. Use of herbal medicine in several trials has revealed promising results in viral hepatitis. Not only has the recovery been documented in acute stages but also their role in chronic liver disease has been observed to be much encouraging.
The research on hepatoprotective herbs have been done not only in vitro but also in vivo6,7. The herbs have shown a potential of reversing liver damage caused by a number of hepatotoxic compounds. Invitro studies include regenerating effects of the herbs on isolated hepatocytes and in vivo hepatoprotection studied in animals exposed to hepatotoxic poisons.
Human studies have also shown encouraging results in the clinical trials carried out in different parts of the world. There had been efforts of doing such studies in human subjects in Pakistan. but enough data has not been framed. There still is a need of exploring this important field of herbal medicine.
As majority of the medicinal plants are indigenous to Pakistan being one of the developing countries. Modern life saving drugs are beyond the reach of nearly three-quarters of the third world population. ‘As part of the strategy to reduce the financial burden in developing countries, it is likely that the increased use of traditional medicine be considered. If such a common medicine could be made available for a plethora of liver disorders it will help the common poor man who cannot afford costly therapies which too have a limited role8.
1. St Oo. Pharmacologically active compounds in current use which arc derived from medicinal plants. Asia Paci. J. Pharmacol., 1991;6:S21-S28.
2. Tammana SA. National Seminar on Unani Medicine, Aligarh: Faculty of Unani Medicine, Aligarh Muslim University, 1990.
3. De Smet PA. The role of plant derived drugs and Herbal Medicine in Healthcare Drugs, 1997;54;801-40.
4. Samuelson G. Nature as source ef new drugs. Acta. Pharin. Nord., 1989;1:111-16.
5. Micheal C. Viral Hepatitis: Diagnosis. Therapy and Prevention. Quoted in New Eng. J. Med., 1999;341 :770.
6. Gilani AH. Esculctin prevents liver damage induced by paracetamol and CCL 4. Pharmacol. Ret., 1998;37:l.
7. Thyagarajan SP. Effect of phyllanthus amarus on chronic carriers of Hepatitis B virus. Lancet 1988;17:764-66.
8. Philipson JD. Natural products as basis for new drugs. Trends in pharmacology scienccs, 1980; 1:81-85.