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.
Liver biopsy was done in 4 cases before and after treatment. Sections showed picture icteric hepatitis which returned to normal at the end of treatment.
Besides weight gain, the B.S.P. results were also within normal limits at the end of therapy, except in one case where the B.S.P. value was 8% and the patient had the longest period of suffering. In this case hepatomegaly also persisted for a long time even after the disappearance of jaundice.
A summary of the observations has been made in Table IV stressing the main points of comparison of results, of treatment of viral hepatitis with ‘Liv.52’ alone, placebo and ‘Liv.52’ and steroid combined.
DISCUSSION
It will appear from the foregoing observations that response to drug therapy against placebo is encouraging in the treatment of viral hepatitis. The period of recovery is shorter in cases treated by either ‘Liv.52’ alone or ‘Liv.52’ and steroid combined (6 and 4 weeks respectively), whereas with a placebo it is much longer (9 weeks). Though the combined ‘Liv.52’ and steroid therapy was restricted to the severe and moderately severe types of cases, specially those showing features of pre-coma or coma, the total time taken for recovery was almost the same as in those treated with ‘Liv.52 alone.
Body weight is usually lost in this illness and an adult patient may lose about 10 lbs. (Sherlock, 1968). But cases treated with ‘Liv.52’ did not show gross loss in weight, on the other hand, body weight was constant or even increased in some cases as in those treated with ‘Liv.52’ combined with steroid. This is another advantage in treating cases of viral hepatitis with ‘Liv.52’ because the drug had been found to be a good anabolic agent (Damle and Deshpande, 1966; Kale et al., 1966; Kulkarni and Joglekar, 1970). Patients treated with placebo alone actually showed more loss in body weight.
Natural clinical cure is common in this disease and has, therefore, led to the general unwillingness of physicians to institute scientific methods for evaluating therapy in human subjects. Moreover, clinical cure is generally thought to be a guarantee of recovery from the disease without any trace of residual liver cell damage. This point, however, can only be verified clinically by estimation of B.S.P. values when jaundice and subjective symptoms have disappeared. This procedure has been recommended for proper evaluation of therapy in this disease by Chalmers (1962) and Sherlock (1968). By adopting their procedure we found that patients treated with ‘Liv.52’ alone or with ‘Liv.52’ combined with steroid showed normal B.S.P. values, that is, there was no residual liver cell damage at the end of therapy. This was not so in cases treated with placebo only, where abnormal B.S.P. excretion values were demonstrated. Thus the previous experimental and clinical observations on prevention of hepatic cell damage by ‘Liv.52’ have been confirmed in our study. This beneficial effect is also proved histologically in the present study. Though liver biopsy was not done in all cases, histological evidence of acute hepatic cell necrosis when detected at the beginning of therapy was followed by restoration of normal hepatic structure at the end.
On the other hand, in cases treated only with placebo, the histological picture of acute icteric hepatitis with areas of hepatic cell necrosis at the beginning, have ended in portal scarring and fibroblastic proliferation with early formation of septae and mild degree of liver cell damage, suggesting thereby a phase of chronic hepatitis. These findings are correlated to B.S.P. studies. The phase of chronic hepatitis might lead to a chronic vague illness and ultimately develop into a full-fledged picture of hepatic cirrhosis.
The role of steroid is controversial, even in recent years, in the management of viral hepatitis and is mostly reserved for severely ill patients. Its anti-inflammatory, anabolic and other properties possibly contribute to the therapeutic success. ‘Liv.52’ when combined with steroid has shown the best results in our series. The duration of illness was shortest and there was no evidence of residual cell damage, as judged from B.S.P. values at the end of therapy and hepatic histology also returned to normal. It is probable that the anabolic effect of ‘Liv.52’ and its role in prevention of hepatic cells damage might have acted synergistically with the effects of steroid to produce continued good results as shown in our study. As such, ‘Liv.52’ may be given in combination with steroids in severe cases of viral hepatitis. In mild and moderately severe cases ‘Liv.52’ alone may help the patients to have a rapid and uneventful recovery. Our observations confirm those of Arora (1969) who has studied 676 cases of viral hepatitis recently and has arrived at a similar conclusion.
SUMMARY
A study of the effects of treatment of infectious hepatitis with an indigenous drug ‘Liv.52’ has been done and clinical recovery was finally assessed by B.S.P. excretion tests and in some cases by liver biopsy at the end of therapy in a group of cases. The therapeutic results have been compared with those of a placebo and a combination of the drug with steroid.
Use of the drug in mild and moderately severe cases of infective hepatitis is recommended in order to prevent prolonged course of illness and residual liver cell damage.
ACKNOWLEDGEMENTS
We are thankful to Swami Gahanandaji, Secretary, Ramakrishna Mission Seva Pratishthan, for his permission to utilise hospital materials and records for this study.
The work was supported by a generous grant given by The Himalaya Drug Co., Bombay, who also supplied us with B.S.P. dyes, ‘Liv.52’ tablets and placebos necessary for the study.
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Refference: http://www.himalayahealthcare.com/pdf_files/liv203.pdf