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Introduction

THE liver is one of the vital organs that regulates the physiological process of the body to maintain homeostasis. Liver disease has become a serious public health problem in today's era. It affects more than 10% of the world's population, and is also the fifth most common cause of death worldwide. Approximately 1.5 billion cases of chronic liver disease (CLD) are reported worldwide which is a slow progressive process of inflammation, destruction, and degeneration of liver parenchyma leading to Liver fibrosis and Liver cirrhosis. Also, it is noted that one of the major causes of ascites in most patients. It involves varied liver pathology such as fatty liver, hepatocellular carcinoma, cirrhosis, fibrosis, chronic hepatitis, etc. Approximately 50% of patients with CLD progress toward ascites within 10 years. The causes of CLD include viral infections such as Hepatitis B, Hepatitis C, metabolic cause (nonalcoholic fatty liver disease [NAFLD]), the use of toxic substances and drugs, that is, excessive alcohol consumption (alcoholic liver disease), and autoimmune factor (causing primary sclerosing cholangitis and primary biliary cholangitis). Symptoms of CLD include poor appetite, jaundice, ascites, peripheral edema, itchy skin, decreased weight, small spider angioma, anemia, and splenomegaly. In Ayurveda, some disease conditions are described that enumerate the earlier-mentioned stages of CLDs and their treatment. Udar, Yakrut Vruddhi, Plihavruddhi, Kamala are explained in Ayurveda. The treatment for liver diseases in contemporary medicine is very limited. Several Medicinal plant preparations either single or combination drugs, have been used in Indian Traditional Ayurvedic Medicine for the treatment of liver diseases. Herbal medicines are effective drugs for the treatment of Liver diseases. The safety and efficacy of various herbal drugs in the treatment of liver diseases have been reported in clinical trials. In present review article, tries to compile information on Medicinal plants used in Liver diseases according to Ayurved.     

Materials and Method: The literature review was done from Ayurveda Samhita, Nighantus, compendia, clinical medicine texts & related websites for the present work.

Literature review from Ayurveda Samhita, Nighantus.

Ayurveda classics have described various formulations for the management of liver disorders, among which the most abundant and prescribed ones are Kutaki (P. kurroa Royle ex Benth), Guduchi (Tinospora cordifolia (willd)Miers), Bhunimba (A. paniculata Nees.), Bhumiamalaki (P. niruri Linn.), Kakmachi (S. nigrum Linn.), Yashtimadhu (Glycyrrhiza glabra Linn.), Guduchi(T. cordifolia [Willd.] Hook. F. and Thoms.), Bhringraj (E. alba [L.] Hassk.), Pippali (Piper longum L.), Rohitaka (Tecoma undulate G. Don.), Nimba (Azadirachta indica A. Juss.), Sharapunkha (T. purpurea Pers. Linn. Pers.), Ashwagandha (W. somnifera Linn.), Vasa (Adhatoda vasica Nees.), Paarijata (N. arbor-tristis Linn.), Bharangi (C. serratum Linn. Moon.), Haridra (C. longa), Nimba (A. indica A. Juss.), Apamarga (A. aspera Linn.), Daruharidra (Berberis aristate DC) etc.

The Mode of Action and Properties of Hepato-protective Drugs—Ayurveda Perspective:

The mode of action of these drugs are described in terms of functions such as Anulomana (carminative or correcting the movement), Rechana (cause increased bowel movement and cleanse the body of deposited wastes, toxins, and bile juices), Pittasaraka (excrete the bile and other inflammatory markers), Yakrituttejaka (stimulates the liver), Pleehahara or Pleehaghna (reduce the size of spleen),  and Shothahara (reduces swelling, oedema inflammation, and clears the body channels), which are described for these drugs . The drugs are described to have hepato-protective potential on the basis of choleratic and cholegogue action, antioxidant effect, antiviral effect, antiedemic, anti-inflammatory, diuretic, antioxidative, rejuvenative, and hepato-splenoprotective, metabolism-promoting actions, and immune-modulating effects. In Ayurveda, drugs which explained in the management of liver diseases stimulate the digestive and metabolic processes, remove obstruction (caused due to undigested metabolic waste), purify the blood, clear the flow of bile, stimulate bile flow, and thus reduces inflammation, resulting in the clinical relief associated with significant changes in biochemical and radiological parameters.

Discussion

Most of these drugs have Tikta (bitter), Katu (pungent), and Kashaya (astringent) Rasa, and Katu Vipaka. The drugs shows Deepana-Pachana, Yakridottejaka,blood-purifying properties along with digestive stimulant action and Pitta pacification, which is helped by their Laghu property, Katu Rasa, and Katu Vipaka. Due to improved digestion, it helps to decrease the vitiated Kapha and Ama, and clears the obstruction of channels, restoring the natural flow of Pitta. Being Pitta-Saraka, once the passages are clear, they facilitate bile flow and clear inflammation and swelling. Yakridottejaka action stimulates the liver cells to function properly. Further, due to their Deepana-Pachana,

Yakridottejaka, and Rasayan properties, they cause the regeneration of liver cells and protect them from damage caused due to toxins and chemicals. Most of these drugs, with drugs such as Yastimadhu (G. glabra (L.) and Ashwagandha (W. somnifera (L.) having sweet (Madhura) tastes. They are light to digest (Laghu, except Glycerriza and Tinospora which are heavy to digest) and produce properties similar to pungent taste in the body after digestion (Katu Vipaka except for Pippali (P. longum), Yastimadhu (G. glabra), Guduchi(T. cordifolia), Bhumyamalaki(P. niruri), and Ashwagandha) W. somnifera), which develop sweet properties after digestion, and hence are used as nourishing [Rasayan] drugs).Kutaki, Guduchi shows hepatoprotective properties. Rohitaka,Sharapukha, Kutaki , and Daruharidra described to have hepato-protective potential on the basis of choleratic and cholegogue action, antioxidant effect, antiviral effect, antiedemic, anti-inflammatory, diuretic, antioxidative, rejuvenative, and hepato-splenoprotective properties.

Conclusion

In this article, a detailed description of medicinal drugs is explained and used for CLD due. In this review, the Collection of drugs that show hepato-protective properties, Yakrut plihaghna properties.

It helps to reduce oxidative stress that damages the liver by their hepato-protective property. Also helps to preventing fibrogenesis, inhibition of oxidative damage, tumour growth, and antiviral effect of formulations. All medicinal plants mentioned in present article are very useful to treat Liver disease.

Need of scope: There is a need of more randomized, multicentric clinical trials to develop evidence-based therapeutics for CLD treatment. Further research is also needed for some medicinal plants to identify, isolate, confirm, and standardize the active components or molecules.