Abstract
Polyherbal drugs have been regarded as the most advantageous results of Ayurveda as they consist of numerous phytoconstituents with ameliorative effects on body metabolism. The resultant synergistic effect of these formulations has been remarked with pharmacological efficiency as well as minimal toxic effects. In the context, Shiva Gutika proves to be an effective treatment against some uncommon health maladies like spondyloepiphyseal dysplasia tarda (SEDT), HIV-AIDS and dyslipidemia. The phytochemical profiling of Shiva Gutika depicts the uncommon combination of phytochemicals extracted from different medicinal plants. However, much the pharmacological effect of Shiva Gutika on diseases like cancer and diabetes mellitus are poorly understood and still needs to be elucidated. The present commentary highlights the importance of Shiva Gutika by emphasizing on its phytochemical profile and pharmacological activity on some uncommon morbidities as mentioned above. The commentary also projects the essential factors that need to be concerned to use Shiva Gutika as an efficient replacement to the conventional therapeutic agents.
Introduction
Ayurveda is an ancient, well-organized traditional Indian culture for medicine that has been in practice in the past 300 decades. It is referred to as the amalgamation of senses, body, mind, and spirit, comprehended as the life (Sharma Citation2016). Ayurveda is purely based on plants that are associated with numerous medicinal properties which help in curing and prevention of several health maladies. As a result, Ayurvedic medicines have sought a profound baseline with the usage of plants as the source of medicines (Altemimi et al. Citation2017). The association of Ayurvedic medicines with the modification in lifestyle and diet helps in restoring the imbalance in between the mental and physical elements, which is acknowledged as improvising the innate immunity (bala) (Mahesh and Shreevidya Citation2014). Even though the present obsession with synthetic drugs is unbudgeable, the input of plants and their supplements to disease management, treatment and prevention is rapidly gaining interest (Veeresham Citation2012; Anquez-Traxler Citation2011).
Ayurvedic medicines are mainly based on the concept of either a single plant source or the combination of more than one plant source (polyherbal). The efficacy of the polyherbal medicine is comparatively higher than the single herb medicine. However, many potent phytochemicals could be used to get a synergistic effect, which is greater than the individual effect of a single compound. Most of these medicines available in the markets are the combination of herbs with desirable therapeutic effect following the mechanism of synergism (Parasuraman et al. Citation2014). Unlike conventional drugs which follow single-drug-single-target action, Ayurvedic drugs are expected to perform diverse pharmacological functions, at least to the extent of relieving symptoms. Besides, polyherbal medicines eliminate the necessity of more than one type of formulation at a time, which could benefit in the development of better therapeutic effect. Ayurvedic medicines have been the center of discussion over their negligible adverse effects over conventional allopathic drugs. Allopathic medicines have been reported with adverse effects like vomiting, fatigue, diarrhea, hair loss, and confusion, whereas the polyherbal medicines are reported to cause mere and negligible side-effects, without altering the human metabolism. Although one cannot simply oversight the toxicity issue of herbal medicines, people are intriguing the efficacy of these plant-based therapeutics (Parasuraman et al. Citation2014; Karimi and Majlesi Citation2015).
Despite several beneficial effects over conventional allopathic medicines, polyherbal medicines are sometimes considered to be incompatible (viruddha). The incompatibility may be due to energetic incompatibility, quantitative incompatibility or functional incompatibility. For instance, Kalmegh is an extract of Andrographis paniculata (Burm.f) Nees (Acanthaceae), which is known to possess hepatoprotective ability, degraded the active markers (kutkoside and picroside-I) of kutki or Picrorhiza kurroa Royle ex Benth. (Scrophulariaceae) that has similar pharmacological significance. However, active marker (andrographolide or AGD) of Kalmegh was found to be undamaged (Bhope et al. Citation2011). This served as the best example of functional incompatibility.
Several polyherbal drugs have been formulated and have been used to treat various diseases till date. For example, Dihar is prepared using the extracts of Syzygiurn curnini, Mornordica charantia, Ernbelica officinalis, Gyrnnerna sylvestre, Enicosternrna littorale, and Azadirachta indica. This drug is principally designed to treat hyperlipidaemia and hyperglycemia (Patel et al. Citation2009). Another drug termed Arthosansar is formulated with the extracts of Corniphora wightii, Bosvvellia serrata, Pluchea lanceolata, Ricinus cornrnunis, Zingiber officinale, and Withani sornnifera against rheumatoid arthritis (Sumanth and Swetha Citation2012). Furthermore, Kutajarista was prepared with the extracts of Madhuca longifolia, Holarrhena antidysenterica, Grnelina arborea, Woodfordia fruticose, Vitis vinifera, honey, and jaggery to treat gastrointestinal aberrations like sprue, dysentery, and diarrhoea (Dinesh et al. Citation1988). These polyherbal drugs do not address multiple infections or diseases. In fact, they fail to exert a ‘network pharmacology’ (multi-drug-multi-target mode of action) effect, despite possessing variable amount of phytochemicals. This may be due to the presence of phytochemicals below the minimum effective concentration. Unlike monoherbal therapy which is expected to give higher concentration of phytochemicals with more potential pharmacological action, these polyherbal drugs sometimes may witness incompatibilism (Parasuraman et al. Citation2014; Karimi and Majlesi Citation2015). Moreover, none of the above-mentioned polyherbal formulations have cleared the clinical trials. This sets up a drawback in their line of manufacturing as a phytochemical-based polyherbal medicine.
In this context, herein we discuss about a polyherbal drug known as Shiva Gutika, whose multi-directional pharmacological actions have been unnoticed in the world of Ayurveda in the recent past. Our intuition is to highlight the available literature on pharmacological activities of Shiva Gutika and to create room for the further discussion of such aspects. Unlike other polyherbal drugs, Shiva Gutika has cleared a clinical trial and we also keen on highlighting our perspectives on the same. With respect to the incompatibilism, there appears to be no issues with Shiva Gutika, which makes it to be the standalone medication with unmatchable pharmacological significance.
Phytochemical and pharmacological profile of Shiva Gutika
Mythologically, Shiva Gutika is believed to be a formulation that Lord Shiva has given to his son Lord Ganesh to cure Premeha, a syndrome with clinical conditions involves obesity, metabolic syndrome, and diabetes. Apart from this, there have been no mention about the folk uses of this polyherbal formulation. The main constituent in the Shiva Gutika is Shilajathu, without which is believed enhance the immunity by alleviating the three humors, including health aberrations related with air and aether (Vata), aberrations related with fire (Pitta), and aberrations related with water (Kapha) (Shilpa and Venkatesha Citation2011). The phytoconstituents of Shiva Gutika are listed in Table . These phytochemicals have been derived from different medicinal plants and are combined into a single polyherbal formulation. There are no selectable plants from this combination which can give a better result than Shiva Gutika. This polyherbal formulation can cure the morbid factor with oral medicine, nourishment and enhance the immunity (Ojas). It acts as an antibiotic, anti-diabetic, anti-venomous, anti-hypolipidaemic, anti-inflammatory, analgesic, immuno-modulatory, antiviral, antimicrobial and antioxidant agents (Vishwesh and Bhat Citation2014). In addition, it is also believed to increase the skin tone (Varna Prasadana), strengthen the body (Balya), scrapes off unwanted tissues, splits and expels the morbid matters from the body. Shiva Gutika is also responsible for the gain in body weight, counter-acting the symptoms and improvisation of the blood. It further ameliorates the body from maladies like tuberculosis, gout, diarrhoea, jaundice, piles, anaemia, and fever. Furthermore, it is also believed to have a positive effect on reproductive system diseases, fever, splenic disorders, vomiting, distension of abdomen, cough, dyspnoea, tastelessness, weakness, and diseases related with mouth, eyes, and head (Mishra Citation2018).
Table 1. Phytochemical constituents of Shiva Gutika (Mishra Citation2018).
Effects of Shiva Gutika on uncommon morbidities
Apart from the health aberrations listed above, there exist few of them which have been categorized as uncommon. The literature survey depicted the positive effect of Shiva Gutika on those diseases as well. For example, spondyloepiphyseal dysplasia tarda (SEDT) is a rare, infrequent, X-linked genetic disease where patient suffers different types of body deformities including scoliosis and arthropathy (Gedeon et al. Citation2001). It was efficiently treated with Shiva Gutika by prescribing panchakarma, along with a combination of Shiva Gutika (500 mg), Trayodashanga guggulu (500 mg), Dashmool kvatha (40 ml), Eranda paka (10 g), and Dashmoolarista (20 ml). As a result, a reasonable reduction of spinal disorders and the scoliosis was observed (Singh and Rajoria Citation2016). Shiva Gutika here acted as a Rasayana, reducing imbalance in the blood vessel, headache, and dyspnoea. This formulation helped in combating the complications of SEDT and improved the patient’s health. Therefore, early diagnosis of SEDT with Ayurveda treatment supplemented with Shiva Gutika could enhance the chances of survival of SEDT patients.
The pharmacological action of Shiva Gutika further extends to be effective against human immuno deficiency virus-auto immune deficiency syndrome (HIV-AIDS). The increase in the CD4 count in the patients treated with the 12 g of Shiva Gutika was found to be statistically significant in comparison with the ART treated patients, where administration of Shiva Gutika increased the CD4 count from 391 to 567. Whereas the antiretroviral therapy (ART) could increase it to 447.6 from 417.6 (Anil and Acharya Citation2013).
Despite considerable pharmacological amelioration of rare and detrimental aberrations like SEDT and HIV-AIDS, Shiva Gutika effect on cancer remains unassessed. Conventional therapeutic options like chemotherapy, radiotherapy, and surgery are not completely reliable in terms of adverse effects as well as efficient removal of tumours. In this context, polyherbal medications could edge over the conventional therapeutics. Although few bioactive compounds like withaferin A from Ashwagandha (Withania somnifera) have reached pre-clinical stage (Hassannia et al. Citation2020), they are yet to be cleared for the human consumption. Another approach known as Shatkriyakala is believed to be under development, which removes Doshas (impairments) from Dhatus (tissues) in a six-stage program (Chauhan et al. Citation2017). Furthermore, Ayurvedic drugs like Mauktikyukta Kamdudha (MKD) and Mauktikyukta Praval Panchamruta (MPP) have been administrated, yet with the combination of chemotherapy (Deshmukh et al. Citation2014). Therefore, there is much room for the analysis of polyherbal drugs like Shiva Gutika to make them usable against different types of cancers, without referring the chemotherapeutics. Studies could embark with in vitro approach using different cancerous cell lines, in vivo approach with animal models, and in silico approach using molecular docking to assess the anticancer potential of Shiva Gutika. This would truly benefit the patients suffering from cancer.
Clinical trials
There is much room left for the clinical trials on Shiva Gutika to explore the pharmacological significance on humans to confirm the ameliorative effects. However, there has been only one clinical trial conducted on humans using Shiva Gutika. A single blind randomized clinical study was conducted by Hegde et al. (Citation2018) to evaluate the efficiency and safety level of Shiva Gutika in dyslipidaemia. 60 patients diagnosed with dyslipidaemia were randomly selected irrespective of their age and sex were treated with a herbal drug Navaka Guggulu (group A; control; 2 g double dose) and Shiva Gutika (group B; test; 2 g double dose) orally for 45 days. Despite significant results from group A, patients from group B were found with more reduced components of lipid profile like triglycerides, low-density lipoproteins (LDL), high-density lipoproteins (HDL), very-low-density lipoproteins (VLDL), total cholesterol (TC), and cholesterol: HDL ratio. Apolipoprotein levels were also found to be decreased, which are said to be essential in binding of lipids with proteins. In these results, Shiva Gutika had an edge over the Navaka Guggulu drug. Safety evaluation also resulted in statistically significant results, which imply the efficacy of Shiva Gutika as an anti-obesity drug (Hegde et al. Citation2018). As the obesity and overweight are linked with type-2 diabetes mellitus, Shiva Gutika could be effectively used to control the former disorders to reduce the risk of getting diabetes. However, clinical trials on different health aberrations including cancer, HIV-AIDS, herpes, diabetes, and tuberculosis need to be conducted.
Conclusion
Ayurvedic management of the disease is found to be most effective and safe with promising results. Shiva Gutika is the formulation enriched with vast herbal ingredients which must be considered as a rich source of bioactive components to treat diseases. Phytochemical constituents of Shiva Gutika prove to be the richest source of antioxidant activities, which could manage oxidative stress in the body. Decreasing oxidative stress could truly aid in the amelioration of body tissues and organs, which in turn benefits with the betterment of metabolic activities. However, clinical studies are warranted to further provide the scientific evidences for the useful effects of Shiva Gutika. The action mechanism of Shilajathu in improving the immunity could be further studied in detail. As the effects of Shiva Gutika on different types of cancers remain unachieved, it could be focussed using suitable approaches. In total, polyherbal drugs like Shiva Gutika need to be focussed as the natural, traditional therapeutic remedies to the disease, thus safer in comparison with the conventional medicine.
Data availability
Data sharing is not applicable to this article as no new data were created or analysed in this study.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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