A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine – PubMed Black Hawk Supplements

BLACK HAWK: High quality lions mane supplement for inflammation

Published article

Complementary and alternative medicine-related liver injuries are increasing globally. Alternative medicine, as an inclusive healthcare practice, is widely accepted in developing and underdeveloped countries. In this context, the traditional systems of medicine in India have been at the forefront, catering to the preventive and therapeutic spectrum in the absence of conclusive evidence for benefits and lack of data on safety. Contrary to popular belief, it is evident that apart from adverse…
Black Hawk Supplements, best supplements in the UK

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine - PubMed

Review

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine

Cyriac Abby Philips et al. Medicine (Baltimore). .

Abstract

Complementary and alternative medicine-related liver injuries are increasing globally. Alternative medicine, as an inclusive healthcare practice, is widely accepted in developing and underdeveloped countries. In this context, the traditional systems of medicine in India have been at the forefront, catering to the preventive and therapeutic spectrum in the absence of conclusive evidence for benefits and lack of data on safety. Contrary to popular belief, it is evident that apart from adverse events caused by contamination and adulteration of alternative medicines, certain commonly used herbal components have inherent hepatotoxicity. This narrative review updates our current understanding and increasing publications on the liver toxicity potential of commonly used herbs in traditional Indian systems of medicine (Ayush), such as Tinospora cordifolia (Willd.) Hook.f. & Thomson (Giloy/Guduchi), Withania somnifera (L.) Dunal (Ashwagandha), Curcuma longa L. (Turmeric), and Psoralea corylifolia L. (Bakuchi/Babchi). This review also highlights the importance of the upcoming liver toxicity profiles associated with other traditional herbs used as dietary supplements, such as Centella asiatica (L.) Urb., Garcinia cambogia Desr., Cassia angustifolia Vahl (Indian senna), and Morinda citrofolia L. (Noni fruit). Fortunately, most reported liver injuries due to these herbs are self-limiting, but can lead to progressive liver dysfunction, leading to acute liver failure or acute chronic liver failure with a high mortality rate. This review also aims to provide adequate knowledge regarding herbalism in traditional practices, pertinent for medical doctors to diagnose, treat, and prevent avoidable liver disease burdens within communities, and improve public health and education.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.

Summary of Tinospora cordifolia (Willd.) Hook.f. & Thomson (Giloy) related liver injury.

Figure 2.
Figure 2.

Summary of Withania somnifera (L.) Dunal (Ashwagandha) related liver injury.

Figure 3.
Figure 3.

Summary of Curcuma longa L. (Turmeric/curcumin) related liver injury.

Figure 4.
Figure 4.

Summary of Psoralea corylifolia L. (Bakuci/babchi) related liver injury.

Figure 5.
Figure 5.

Summary of hepatotoxicity of other herbs. (A) Centella asiatica (L.) Urb. (Gotu kola), (B) Cassia angustifolia Vahl (Indian senna), (C) Garcinia cambogia Desr. (Malabar tamarind), and (D) Morinda citrofolia L. (Noni fruit).

Figure 6.
Figure 6.

Hepatic sinusoidal obstruction syndrome due to ingestion of Ayurvedic herbs containing pyrrolizidine alkaloids. A 56-year-old man was prescribed herbal formulations for anxiety by an Ayurvedic healer. Two weeks later, he developed abdominal pain, swelling of legs, ascites, pleural effusion and worsening hepatocellular jaundice. Conservative treatment did not improve his condition, culminating in liver transplantation. Explant liver was enlarged, bluish, with capsular stretching, and visibly sclerosed hepatic venules (A, B, arrows). Biopsy revealed central vein occlusion (C), sinusoidal hemorrhage and hepatic necrosis, suggestive of veno-occlusive disease. The healthy living-donor liver is shown for comparison (D).

Figure 7.
Figure 7.

Algorithmic approach to a person with complementary and alternative medicine-related liver injury.

Similar articles

References

    1. Jaiswal YS, Williams LL. A glimpse of Ayurveda: the forgotten history and principles of Indian traditional medicine. J Tradit Complement Med. 2016;7:50–3. – PMC – PubMed
    1. Patwardhan K. Confessions of an Ayurveda professor. Indian J Med Ethics. 2023;VIII:61–4. – PubMed
    1. Neelavathi A. A brief introduction of Siddha system of medicine. Bull Indian Inst Hist Med Hyderabad. 1979;9:38–40. – PubMed
    1. Siddiqi T. Unani medicine in India 1524 to 1605 A.D. Indian J Hist Sci. 1981;16:22–5. – PubMed
    1. Grams N. Homeopathy-where is the science? A current inventory on a pre-scientific artifact. EMBO Rep. 2019;20:e47761. – PMC – PubMed

Publication types

MeSH terms

BLACK HAWK: Best lions mane supplement for men

Read the original publication:

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine – PubMed