LivPro®
Natural liver energizer with potent anti-hepatotoxic activity, repairs damage. Stimulate appetite & growth.
Indication:
Adjunctive therapy for liver diseases. Acute, chronic & persistent hepatitis.
Liver energizer, Cirrhosis of liver, Anti-hepatotoxic, Help in Fatty liver.
Repairs damages to liver. Stimulates appetite & growth.
The Role of Unani vs. Western Medicine in the Treatment of Hepatitis C:
Irfan Shahid:
Introduction:
Hepatitis C is a recently discovered disease. Until 1989 medical science was unaware that it even existed. Earlier than the discovery of Hepatitis C, it was called as Non A, Non B Hepatitis. There was no name for it and people that had it and actually had symptoms, either went undiagnosed or the liver problems were labeled as other diseases.
Once they discovered that it was a different and unique form of hepatitis, they named it hepatitis C. It has been called the silent killer. Doctors quickly realized that this new form of hepatitis was particularly deadly because patients often had little or no symptoms other than flu like aches and pains, fatigue and occasionally, elevated liver enzymes (ALT and AST) until their liver failed due to cirrhosis or cancer. Although this was particularly troubling, they soon realized that because the disease had only recently been discovered, that infected people had unknowingly been donating blood and that the disease had been transmitted through blood transfusions. The U.S. Centers for Disease Control estimates that over the coming decade the death toll from hepatitis C will triple, surpassing that of AIDS. Four times as many Americans are infected with the hepatitis C virus as with HIV. In Pakistan over 10 million Pakistani’s are infected with Hepatitis C virus. Hepatitis C is caused by many viruses, which are extremely small germs that can mutate and multiply after invading a host. It invades through the blood or other bodily fluids causing infection and inflammation of the liver, which leads to complications or death. Liver enzyme tests sometimes reveal high levels of bilirubin, which causes jaundice, severe itching and yellow urine and can lead to cirrhosis causing coma or death. There is a higher risk of liver cancer with Hepatitis C infection, statistics reveal that 35% Hepatitis C patients get into Liver cirrhosis. It is responsible for more than one-third of all liver transplants. The disease is not casually spread. It can be transmitted through the transfer of infected blood either by sharing intravenous drug or hospital workers accidentally being stuck with a needle used on an infected patient, an actual blood transfusion, Alum or used razors by the barbers, tattooing and other sources of potential blood to blood contact. What is particularly frightening about the disease is that those who have the disease seldom realize they are sick when they first become infected. They may remain symptom free for decades and pass the virus through needles or shared toothbrushes and razors. HCV is not a fragile organism. No one knows how long it can survive in microscopic traces of dried blood; after 3 months, it is still active and infectious. Fortunately, person-to-person infection is rare even through sex but what is even more worrisome is that for 10 percent of people with the disease, the route of infection cannot be determined. Most people don’t think about their liver. They are unaware of the functions taking place within their body by this important organ. When a doctor tells them there is a problem with their liver they are usually shocked. The liver can slowly start to fail for a variety of reasons such as viruses, bacteria, cirrhosis, or cancer with little or no outward symptoms.
Function of the Liver
Unlike other organs in the body the liver has many functions. The stomach digests, the heart beats, the brain thinks but the liver performs multiple duties. Unlike other organs it can actually “regenerate” itself by expanding to fill the empty space if part of it is damaged or removed! One exception to this would be if it were permanently scarred with cirrhosis. A person can live without a gallbladder or spleen, a kidney or lung but they cannot live without a liver. Everything that enters the body through any method must pass through the liver. Besides being a very efficient filter, the liver plays a role in many other areas of the body. It helps to build muscles by metabolizing proteins. It regulates energy by storing glucose in the form of glycogen for use when needed. It maintains hormonal balance by regulating hormonal production. It helps to process vitamins and minerals as well as any ingested drugs. The liver being the most active gland of the body secretes about 600-800ml of bile daily. The metabolic functions of the liver include metabolism of fats, proteins, minerals, and carbohydrates. It also has secretory and excretory functions. In Western medicine the liver functions as the gatekeeper and regulator of nutritional health and provides a purifying system as well. It weighs about 3 pounds and contains four sections called lobes. Within each lobe, lobules contain liver cells and passageways for blood circulation, called sinusoids. It is within the lobules that the specialized liver cells transform chemical substances into nutrients the body can use or neutralizes potential toxins to protect the body from damage. Because the liver plays a major role in the circulation and the composition of blood, its health has an impact on all body systems, from hormone regulation to thinking and even moods.
Tests
Liver function tests are performed that determine the way the liver is performing. These are for AST, SGOT, ALT, GGT, AP, bilirubin, and albumin. These letters are acronyms for enzymes – proteins inside of cells. AST for example stands for aspartate amino transferase. This enzyme used to be called serum glutamic oxalacetic transaminase (SGOT), hence the two names. ALT = amino alanine transferase, GGTP= gamma glutamyl transpeptidase, and AP= alkaline phosphatase. Different cells have different enzymes inside them, depending on the function of the cell. Liver cells happen to have lots of AST, ALT, and GGTP inside them. When cells die or are sick the enzymes leak out causing the blood level of these enzymes to rise, which is a way of determining if the cells in question are sick. Serum total bilirubin is increased in hepatocellular damage (infectious hepatitis, Liver disease, kidney disease, and malnutrition are the major causes of low albumin). A diseased liver produces insufficient albumin. Additionally, if hepatitis is suspected then an HCV-RNA test will be run to test for evidence of HCV antibodies and if present then a PCR test will be run to test the viral load of HCV present in the blood.
Western Medical Treatment of Hepatitis C
There are currently three drugs on the market that are used to treat hepatitis C. These are interferon and sofosbuvir, which are supposed to boost immunity, and ribavirin, which attacks the virus. There are, unfortunately many side effects associated with the drugs including fever, aches, pains, flu-like symptoms, hair loss and severe depression just to name a few. These drugs are not effective against many of the genotypes associated with the virus. They are not effective in 100% patients. These genotypes are mapped globally.
Genotype patterns
It is believed that the hepatitis C virus has evolved over a period of several thousand years. This would explain the current general global patterns of genotypes and subtypes:
1a – mostly found in North & South America; also common in Australia
1b – mostly found in Europe and Asia.
2a – is the most common genotype 2 in Japan and China.
2b – is the most common genotype 2 in the US and Northern Europe.
2c – the most common genotype 2 in Western and Southern Europe .
3a – highly prevalent in Australia (40% of cases) and South Asia including Pakistan.
4a – highly prevalent in Egypt
4c – highly prevalent in Central Africa
5a – highly prevalent only in South Africa
6a – restricted to Hong Kong, Macau and Vietnam
7a and 7b – common in Thailand
8a, 8b & 9a – prevalent in Vietnam
10a & 11a – found in Indonesia
Genotype and treatment
Current scientific belief is that factors such as duration of a person’s HCV infection, their HCV viral load, age, grade of liver inflammation or stage of fibrosis may play an important role in determining response to interferon or sofosbuvir treatment. Recent studies have suggested that a person’s HCV subtype (or subtypes) may influence their possible response to their treatment. Genotype 1b appears to be at the greatest risk for increased risk of development of hepatocellular carcinoma (HCC) in cirrhosis.
Western Holistic Treatment of Hepatitis
Several herbs and supplements are used to treat hepatitis currently. These are as follows:
Milk Thistle
Picorhiza
Licorice
Vit C
Vit E
Phyllanthus
Burdock
Danbdelion
Reishi mushrooms
Turmeric
Schizandra
Alpha Lipoic Acid
N-Acetylcysteine
Selenium
Zinc.
Unani & the Liver:
In Unani medicine the liver is the seat of safra along with the spleen. The definition of Safra literally means bile. Safra Zangari gives color to all the tissues. Safra Zangari is responsible for erythrogenesis, the creation of red blood cells in the bone marrow, which are mixed with the plasma. Thus, Safra Zangari is responsible for giving color to the blood. The function of safra zangari in the liver is the disintegration of hemoglobin, which produces heme and globin. From heme, bile is produced, and that bile is safra zangari. Its’ job is to give color to the urine, feces and sweat. Safra Zangari in the stomach is intrinsic factor, which is responsible for production of blood in the bone marrow. Safra Zangari in the spleen kills bacteria and parasites as well as produces some white blood cells, so its job is more protective. There is a functional integrity between the liver, stomach, spleen, and bone marrow. If the function of the liver is affected the bone marrow will also be affected. If the function of the stomach is affected, it will affect the liver. In a way, the spleen is to filter the blood and to send unwanted heavy, old red blood cells to the liver; the liver destroys them and separates the hemoglobin from the blood. Then the liver utilizes the hemoglobin that is liberated for the production of bile salts, pigment and enzymes. Therefore, when the spleen is enlarged the liver may also be enlarged and vice versa. The Unani word for liver is “Jigar”. Jigar is an important seat of fire – the seat of anger, hate, envy, and jealousy. These emotions need to be processed and metabolized. These emotions want to come out but, if we suppress them, they accumulate in the tissues and lead to disease. Unani does not separate emotions from the organs. We cannot separate body from mind and mind from consciousness. Disorders of Safra include hepatitis, anemia, chronic fatigue syndrome, and mononucleosis. Excessive bile production or a blockage in the flow of bile usually indicates high safra, which in turn affects the fire or enzyme activities responsible for absorption, digestion and metabolism. Safra can be aggravated by many factors of diet and lifestyle. These would include alcohol abuse, eating red meat, eating too much spicy or oily, heavy foods, lack of sleep, too much direct exposure to the sun and smoking. When safra becomes aggravated liver diseases can result such as hepatitis and cirrhosis. Although viral type hepatitis such as hepatitis C is not mentioned in the classic Unani texts, similar symptoms are described under “safra zangari”.
Unani describes two basic types of Yarqan (hepatitis or jaundice).
1. Pila Yarqan: is caused by the minimal aggravation of safra and balgham, and is easily curable.
2. Kala Yarqan: results from very high safra and is difficult to cure. It can become incurable if not attended to immediately.
Pathogenesis due to the aggravation of safra by excessive alcohol intake, too much heavy, oily, spicy food, etc. the liver can become diseased. When safra is out of balance and disease begins in the liver this can result in disease of the blood, muscle tissue, and biliary system. The symptoms of “kala yarqan” include:
•Loss of appetite and taste
• Generalized weakness
• Yellowish discoloration of the eyes, nails, oral cavity, and urine
• Vague body pains
• Burning sensation
• Weakness in all sensory organs
Once hepatitis is advanced and the immune system is highly comprised emaciation will be present as well. Unani teaches us that hepatitis involves all systems in the body including musculoskeletal, cardiovascular, and the gastrointestinal system as well as the skin. Symptoms of hepatitis such as generalized edema (swelling), excessive thirst, bloody stools, vomiting blood, red eyes, dizziness, drowsiness, total loss of appetite and hepatic coma indicate that the liver disease is at an incurable stage, and the patient is believed to be terminally ill. Usually liver disease will present itself with certain signs and symptoms. These may include fatigue, jaundice, loss of appetite, mild fever, joint aches and pains, occasional nausea and or vomiting. The eyes may appear yellowish and burn; the skin may have hives or rashes. The tongue will have a deep redness indicating the heat of safra. Palpating the abdomen may reveal a swelling or tenderness in the upper left quadrant where the liver resides. There will be other information available as to the type of lifestyle the person has lived, their constitution and physical strength. Out of balance safra, and poor heat play important roles in the symptoms of hepatitis and other liver disorders. In addition, low ojas is the essence of the immune system. Ojas is the biological energy that represents the most subtlest form of khilt balgham and the water element of the body. This vital essence plays a direct role in our energy, strength, immunity, libido and vitality. Therefore if we are lacking in any of these areas, it is likely that the Ojas in the body may be depleted or disturbed. Healthy Ojas is needed in the body to reduce signs of aging and protect against disease. A person with “good” Ojas, tends to have a healthy, luminous glow. They are patient, compassionate and rarely become sick. Low ojas makes a person more vulnerable to immune system dysfunction or infections such as hepatitis.
Unani Treatment of Hepatitis C
Any diet or lifestyle activity that aggravates safra can be a contributor to hepatitis. These would include:
1. Alcohol abuse
2. Red meat
3. Spicy, oily, heavy foods
4. Lack of sleep
5. Too much sun exposure
6. Smoking
Treatment would be to balance khilt safra and should be individually based for each person’s imbalances. Herbs, meditation, diet and bodywork would all play an important role in the treatment. Diet should consist of the following:
1. sweet and bitter vegetables
2. sweet, ripe fruits
3. mung dahl, lentils
4. grains – oats, basmati rice, barley
5. dairy – butter, buttermilk, milk, cream
6. spices – coriander (fresh and dried), fennel, cardamom, dill, turmeric
Light exercise can be very helpful in recovering from liver disorders. This should be performed early in the morning or evening. Avoid hot showers or baths. Breathing exercises are also effective. Meditation in a quiet place is important as well. Walks in nature or gazing at the moon are balancing for pitta as well. The herbs that are important and effective for treating liver disorders are:
Bhumi Amla
Turmeric
Oont Katara
Afsanteen
Neem
Mulathi
These therapies are important for liver ailments and excess safra. Apart from medication patients should follow the diet and lifestyle that will establish the balance of safra. This would include avoidance of afternoon sleeping, exposure to hot sun, exertion, anxiety, alcohol abuse, smoking and irregular eating habits. Diet should be mainly fresh vegetarian food as outlined above.
Red pepper should be replaced with long pepper or black pepper for fever fatigue, inflammation, liver and spleen enlargements. The dose would be 1 tablespoon twice a day.
Also asghand, zeera would be given in powder form for fatigue, immune enhancer and rejuvenator and to decrease the viral load. The dose would be 1 tablespoon twice a day.
Summary
Western medicine at present offers little in the way of treatment or cure of Hepatitis C. The drug treatments have many side effects and almost no effectiveness in eradicating the virus and even if undetected lots of patients got reoccurrence. Western holistic medicine offers some positive therapies for protecting the liver and supporting the immune system. Unani offers a total approach to support and treatment of people with hepatitis. Long term studies for LivPro® are in progress in the treatment of hepatitis C for its anti-inflammatory properties along with its anti viral benefits, Unani explained diet patterns and lifestyle changes. Additionally, Unani emphasizes disease prevention as well as achieving a goal of total health being holistic in its approach.
Research Paper
LivPro® (tablets)
Total No. of papers: 1
(Research papers based on Indications and clinical markers)
Pro. Dr. Naseer A. Chaudhry (M.B.B.S, Ph.D) Muhammad Usman Bhatti (B.Pharm, M.Phil Pharmacognosy) Ameer Hamza Shaheed (Doctor of Pharmacy), Irfan Shahid (Research Associate).
