Treatment of viral hepatitis by an indigenous drug

Prof. Mukerjee, A.B., M.D. (Cal.), F.R.C.P. (Lond.), Professor and Head of the Department of Medicine, Calcutta National Medical College & Hospitals, Hon. Consultant, Department of Medicine, Ramakrishna Mission Seva Pratishthan, Calcutta, and Dasgupta, M., M.D. (Cal.), Resident Physician, Ramakrishna Mission Seva Pratishthan, Calcutta, India.

Since World War II the diagnosis of infectious hepatitis in adults has been made from various parts of the globe with increasing frequency. The course of the disease varies in duration and severity. Being viral in origin its treatment is not laid down in specific terms but the same becomes imperative when it affects an appreciable percentage of the population in a country like India every year. Unlike western countries the disease as recorded in India is more often a prolonged affair with a likelihood of complications, including hepatic failure and post-hepatic cirrhosis, developing. As such, though most of the patients might usually get clinical cures with relief of symptoms the prevention of hepatic failure and assessment of residual hepatic cell damage must guide the clinician in his choice of therapy.

A scientific approach to the problem of therapy of infectious hepatitis in adults thus assumes importance and the criteria of success should be rapid recovery and convalescence without residual liver cell damage. An attempt has been made in the present instance to carry out treatment of infectious hepatitis with an indigenous drug combination in an adult group of cases attending a general hospital.

The drug, ‘Liv.52’ (The Himalaya Drug Co.), is a herbal preparation and is claimed to have diuretic, aperient, stomachic, anabolic and choleretic effects. Each tablet contains processed extracts of several plants in varying proportions, viz.:

Capparis spinosa	23%
Cichorium intybus	23%
Solanum nigrum	12%
Cassia occidentalis	6%
Terminalia arjuna	12%
Achillea millefolium	6%
Mandur bhasma	12%
Tamarix gallica	6%

Experimental studies have been reported for substantiating the therapeutic properties of the combined formula in respect of protection of liver cells from permanent damage by various noxious agents (Northover, 1960; Joglekar et al., 1963; Patel et al., 1963; Karandikar et al., 1963; Murkhibhavi and Sheth, 1957 and Captain et al., 1966).

It has also been tried clinically in cirrhosis of the liver and viral hepatitis and reasonable success claimed (Mathur, 1957; Patrao, 1957; Sheth et al. 1960; Sule et al., 1956, 1957, 1968; Vyas, 1963; Menon and Ravindran, 1966; Arora, 1969; Joglekar and Leevy, 1970).

In view of these observations it was decided to study the effects of ‘Liv.52’, and compare the same with those of a placebo and of combined ‘Liv.52’ and steroid therapy.


MATERIAL AND METHODS

Twenty five cases were selected for this study. After clinical diagnosis liver function tests were determined in each of them. Needle biopsy of the liver was done, when required, before and after the treatment.

The patients were followed-up either in the hospital indoors or in the O.P.D. and the progress was noted on the basis of jaundice, hepatomegaly, anorexia, colour of urine, etc. At the same time biochemical investigations were repeated at intervals.

The clinical assessment of recovery of the patient was not based on the single criterion of disappearance of jaundice but the persistence or otherwise of hepatomegaly and the return of liver function tests to normal values were also taken into account.

After the therapy was over, the overall residual liver damage in each case was assessed by means of B.S.P. (Bromsulphthalein) tests (45 mts. value). This Bromsulphthalein test was carried out by following the method of Mateer et al. (1942) with a dose of 5 mgm. Of the dye per kg. of the body weight. Our laboratory normal value varied from 0-5% retention at the end of 45 mts. Values above 5% were indicative of liver cell damage and more than 25% indicative of advanced degree of liver cell damage. The results thus obtained are presented below.

RESULTS

Of the 25 cases, 13 received treatment only with ‘Liv.52’ tablets (2 tablets thrice daily); 4 were treated with placebos (2 tablets thrice daily) only and the rest (8 cases) were treated with ‘Liv.52’ and steroid combined. The overall results of each of these groups are given as follows:

Group I — Treated with ‘Liv.52’ alone: Out of 13 cases treated, 9 were entirely from the O.P.D. The average period of therapy was 6 weeks in this group, but two were followed-up to a maximum period of 14 weeks.

The residual liver damage, when assessed by B.S.P. test at the end of therapy, was found to be within normal limits showing thereby excellent degree of response with the drug. Table I shows the details of the therapy and its results.

Table I: Cases treated with ‘Liv.52’ (alone)
Sl. No.	Name, age/sex	Period of treatment (weeks)	Place of treatment	Clinical diagnosis	B.S.P. 45 mts. result at the end of therapy	Body weight changes	Liver biopsy	Results
1.	P.D. 21/F/H	12	Hosp. & O.P.D.	Pregnancy with viral hepatitis	2.8%	Gained by 4 kgs.	Done I-Picture of icteric hepatitis with cholestasisII-Normal liver (See Figs. 1 & 2)	Good
2.	S.R. 20/M/H	6	O.P.D.	Viral hepatitis	1.2%	Loss by 2 kgs.	Not done	Good
3.	P.K.D. 25/M/H	6	O.P.D.	“	1.8%	Loss by 1 kg.	“	Good
4.	P.K. 10/M/H	14	O.P.D.	“	0.6%	Loss by 1 kg.	“	Good
5.	A.K. 13/M/H	14	O.P.D.	“	0.8%	Gained by 3 kgs	“	Good
6.	N.R. 18/M/H	6	O.P.D.	“	0.4%	Loss by 2 kgs	“	Good
7.	B.R. 18/M/H	6	O.P.D.	“	3.8%	Constant	“	Good
8.	T.S. 12/M/H	11	Hosp. & O.P.D.	“	—	Loss by 3 kgs	“	Good
9.	R.B. 18/F/H	5	Hosp. & O.P.D.	“	1%	Loss by 1 kg.	“	Good
10.	L.P.B. 32/M/H	6	O.P.D.	“	1.6%	Loss by 5 kgs	“	Good
11.	P.S. 25/M/H	6	O.P.D.	“	2.4%	Loss by 3 kgs	“	Good
12.	K.C.M. 30/M/H	6	O.P.D.	“	2.6%	Gained by 2 kgs	“	Good
13.	D.C.	8	Hosp. & O.P.D.	“	0.4%	Loss by 4 kgs.	Done I–Picture of icteric hepatitis II–Areas of focal necrosis persisting, otherwise normal

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