TO THE EDITOR
We read with great interest the case report entitled “Ayurvedic drug induced liver injury” that was published in World J Hepatol 2017 November 8; 9(31): 1205-1209. Though the Case Report highlights a newer aspect of some Ayurveda formulations; there are few aspects that need to be addressed.
Both the formulations (Punarnava Mandura and Kanchanara guggulu) are well known in Indian parlance and are being used in therapeutics since centuries. No hepatic injury was noticed or reported till date with such usage and no such scientific data that can convincingly prove harmful nature of these formulations is available till date.
The Case Report mentions that the patient used three different herbal and homoeopathic formulations. Though identity of two herbal formulations is revealed; the nature of the third one is unclear. It also not known these drugs was procured and how they have been used for how much duration from where. A drug can be panacea or poison. Drugs fulfilling the criterion of a standard drug will always become panacea provided, if they are used properly. On the other hand, a poorly prepared or manufactured drug however used skilfully, will always prove to be a poison. Classics of Ayurveda do mention the hazards of drugs, which are not properly manufactured and not used judiciously. There is no sufficient evidence in the article to confirm the posological considerations of the formulations used. Ayurvedic formulations are not used in similar way as that of conventional medicines. Besides other basic requirements; understanding of digestive ability, metabolic capability, tolerability of a patient to a specific dose of the drug, psycho-somatic constitution, etc., of the patient is essential before starting treatment. After meticulous examination; suitable preparations are to be administered orally in specified quantities with great caution along with requisite vehicles like ghee, milk, honey, etc. In absence of a vehicle, adverse reactions are likely.
The Case Report also didn’t focus on how the drugs have been procured. These medicines are not OTC products and should be used under the supervision of any authorized Ayurveda/Homoeopathy physician, who are the registered authorities, have been trained in that specific field as per the syllabus provided by Ministry of AYUSH, Govt. of India. We are not sure about the identity of the healer referred in the current study. In addition; the nature of the third drug is also not known, in such case why to blame only Ayurvedic formulations for the manifested pathology. There is a possibility of drug-drug interaction too that was not considered in the current work.
As referred in the Case Report; Punarnava Mandura is not an extract of Boerhavia diffusa. Authors need to verify the validity of information being cited from the article. Besides this, editors also should be vigilant and prefer to restrict the authors from citing such articles from predatory journals. Similarly, Kanchanara Guggulu is not an extract of Bauhinia variegata. These two drugs are poly herbal combinations prepared by following standard guidelines explained in the classical text books of Ayurveda.
Punarnava Mandura is made-up of twenty ingredients which is familiar hematinic drug. Its efficacy has been well established in geriatric and gestational anaemias[3,4]. Kanchanara Guggulu is also a poly herbal formulation, whose efficacy has been well established. Traditional medicines, which usually have multi components are helpful in counteracting multi factors of any pathology. Different components of a traditional formulation act synergistically exerting various activities like metabolic enhancers, immuno-modulators, antioxidants, rejuvenators, increases bio-availability and help in countering toxic nature of other ingredients. All these activities indicate towards multi-variant nature of compound formulations that are actually need of the time.
Based upon a single and incomplete observation; inferring Ayurvedic drugs with liver injury is unwise. Authors have to understand that Ayurveda always advocate using drug as a whole and never prefer using extracts in a formulation except aqueous or hydro-alcoholic extracts.
This article indirectly clears the need of paying attention towards generating awareness on use of traditional medicines. The impact of such reports in a leading scientific journal like WJH is a serious matter as it may unnecessarily cause disrepute to herbal remedies and ultimately to the system of Ayurveda.