Panchakarma is a basic form of therapy that includes five treatments, such as vomiting, enemas, and bleeding, the three primary forces of the body in Ayurveda that detoxify the body and balance the doshas (Jhunjhunwala et., al 2021). In Panchakarma, after the initial lubricating, excess waste is purified. Panchakarma therapy is unique in that it incorporates methods for preventing, treating, and promoting various diseases. This section will review pharmacokinetics, distribution, metabolism, absorption, precautions, contraindications, side effects, drug interactions, FDA approval status, and future outlook on three herbs used in Panchakarma: Triphala (Emblica officinalis, Terminalia bellirica, Terminalia chebula), Guduchi (Tinospora cordi) and Neem (Azadirachta indica).
Triphala
Pharmacodynamics
Triphala is a polyherbal medicine made from the dried fruits of three plant species: Emblica officinalis,Terminalia bellerica, and Terminalia chebula, all of which are native to the Indian subcontinent (Peterson et., al 2017). The name “Triphala” from the Sanskrit word “Tri.” ” That is three, “fruits” and nuts. In Ayurvedic medicine, they are classified as tridoshi compounds that enhance longevity and youthfulness in individuals of different constitutions and ages (Peterson et., al 2017). Ayurvedic classifications that date back to the classical era include shukrala, digestive, carminative, expectorant, antispasmodic, bronchodilator, bowel tonic at low dosages, mild laxative at regular amounts, and purgative at large doses.
Pharmacokinetics
Polyphenols are mostly broken down and absorbed in the mouth, with a small amount of processing and absorption happening in the stomach (Wang et al., 2023). Meanwhile, many polyphenols are broken down in the intestines through deglycosylation, methylation, and glucuronidation, which removes sugars and forms other chemicals. Triphala contains reasonably well-assimilated polyphenols, such as chebulagic acid, corilagin, and chebulinic acid monomers. In contrast, gallic acid and ellagic acid are compared and shown to have poor absorption, low bioavailability, and easy saturation. According to Lu et al. (2019), there is proof that tissues with high blood counts, such as the heart, liver, spleen, and lung, contain chebulinic and chebulagic acids. Moreover, gallic acid is significantly absorbed by the gastrointestinal system and is mainly distributed in the kidneys, with other organs following.
Precautions and Contradictions
Triphala use is contradicted in cases of persistent diarrhea (Peterson et., al 2017). Before using triphala ghrita, those taking medicine for hypertension should speak with their doctor.
Adverse Effects
Wang et.., al (2023) note thatTriphala can be a valuable remedy for constipation, but excessive doses can cause stomach cramps, gastritis, and diarrhea.
Drug Interactions
According to Peterson et., al (2017), triphala may interact with certain drugs, such as those processed by the cytochrome P450 system, anticoagulants, and antidiabetic drugs. By suppressing digestive enzymes and perhaps decreasing glycolytic enzymes, Triphala may operate similarly to pharmaceutical medications for diabetes in lowering blood glucose levels and preventing the absorption of glucose.
FDA Approval and Future Considerations
According to ClinicalTrials.gov. (2021), The FDA has not explicitly approved Triphala as a medicinal medication. Its constituent parts, though, might be accepted as safe for ingestion in dietary supplements. Triphala is still being studied for its therapeutic potential, especially for diseases associated with inflammation and metabolism. More government funding and support is needed to continue research to establish the therapeutic value of these plant-based therapies in human clinical trials and to understand the critical biological mechanisms
References
ClinicalTrials.gov. (2021). Effects of Triphala and VSL#3 Probiotic Supplementation on Stool Microbiome Profiles and Inflammation (TRIPH2017). Retrieved from https://classic.clinicaltrials.gov/ct2/home
Jhunjhunwala, A., Tiwari, R. C., Dikshit, M., & Sharma, V. B. (2021). Role of Panchakarma in Visha Chiktisa. Journal of Ayurveda and Integrated Medical Sciences, 6(4), 154–158.
Peterson, C. T., Denniston, K., & Chopra, D. (2017). Therapeutic Uses of Triphala in Ayurvedic Medicine. Journal of alternative and complementary medicine (New York, N.Y.), 23(8), 607–614. https://doi.org/10.1089/acm.2017.0083
Wang, W., Ige, O., Ding, Y., He, M., Long, P., Wang, S., Zhang, Y., & Wen, X. (2023). Insights into the potential benefits of Triphala polyphenols toward the promotion of resilience against stress-induced depression and cognitive impairment. Current Research in Food Science, p. 6, 100527. https://doi.org/10.1016/j.crfs.2023.100527
Guduchi (Tinospora cordifolia)
Pharmacodynamics
Cordifolia, commonly known as Guduchi, is a large, slender, perennial, deciduous, climbing tree with smooth and succulent stems spread throughout India and is a common herb used in Ayurvedic medicine (Valte & Attarde, 2022). This plant contains various compounds such as alkaloids, diterpenoid lactones, glycosides, steroids, sesquiterpenoids, phenolics, aliphatic compounds, and polysaccharides. Anti-inflammatory, anti-stress, anti-malaria, liver-protective, Immune-modulatory, and so on, as well as potential drugs, have discovered various anti-tumor agents. According to Nnamani et., al (2023), Guduchi also improves memory and acts as an immune booster.
The stem extract of tinospora cordifolia appears to inhibit α-glucoside which may be related to the saponarin (apigenin-6-C-glucosyl-7-O-glucoside) content, which appears to be a mixed competitive inhibitor of intestinal maltase and sucrase albeit weaker than that of galactinol and sotalol from Salacia reticulate (Venkatesh & Huded, 2022). There are likely other bioactives, as saponarin is highly present in the leaves. At the same time, the water extract of the stem is still effective, possibly due to the protoberberine alkaloids jatrorrhizine, palmatine, and magnoflorine (Nnamani et al., 2023). High levels of the stem extract, as well as isolated saponarin, appear to potently inhibit sugar enzymes in the enzyme, with robust efficacy against maltase (high levels causing near complete inhibition)
Pharmacokinetics
Oral intake of guduchi results in gastrointestinal tract absorption (Nnamani et., al 2023). Following absorption, the body’s active ingredients are transported throughout the bloodstream and biotransformed in the liver.
Drug Interactions
Medications for diabetes (antidiabetic drugs) interact with Gaduchi. Tinospora cordifolia might lower blood sugar levels through the removal of the inhibitory effect of serotonin on insulin release (Nnamani et. al 2023), therefore taking Tinospora cordifolia along with diabetes medications might cause blood sugar to drop too low.
Adverse Effects
Nnamani et., al (2023) denote that Tinospora cordifolia has recently been shown to cause acute hepatitis.
Precautions and Contradictions
According to Venkatesh & Huded (2022), Guduchi may make the immune system more active if one has autoimmune diseases, including multiple sclerosis (MS), rheumatoid arthritis (RA), lupus (systemic lupus erythematosus, SLE), or other conditions. This might exacerbate autoimmune disease symptoms.
FDA Approval and Future Considerations
Despite its historical use, Guduchi lacks FDA approval as a therapeutic agent and presents legal challenges for herbal medicine. Ongoing research efforts aim to identify the therapeutic mechanism of guduchi and determine its clinical efficacy in various disease states.
References
Nnamani, I., Tolu-Akinnawo, O., Dufera, R. R., Akintunde, A., & Maliakkal, B. (2023). Tinospora cordifolia (Guduchi/Giloy)-Induced Liver Injury: A Case Review. Cureus, 15(5), e39793. https://doi.org/10.7759/cureus.3979
Valte, V. S., & Attarde, L. D. (2022). A brief review of Guduchi (Tinospora cordifolia). International Journal of Pharmaceutical Sciences and Research, 13(5), 1818-1832.
Venkatesh, H., & Huded, S. (2022). Assessment of bioavailability of Guduchi (Tinospora cordifolia) Kashaya in healthy volunteers. Journal of Pharmacognosy and Phytochemistry, 11(5), 124-127.
Neem (Azadirachta indica)
Pharmacodynamics
Neem (Azadirachta indica) is a member of the Meliaceae family; its many antioxidants are believed to participate in its health-promoting properties (Seriana et al., 2021). It has been widely used in Chinese, Ayurvedic, and Unani medicine to prevent many diseases and treat them worldwide, especially in the Indian subcontinent. The therapeutic benefits of neem leaves have been documented.
According to Batra (2022), neem leaves and its components have a variety of beneficial properties, such as anti-immune, anti-inflammatory, anti-hyperglycemic, anti-inflammatory, anti-inflammatory properties anti-malarial, anti-fungal, anti-bacterial, anti-bacterial, anti-bacterial and anti-mutagenic Neem leaf extracts have various biological and medicinal applications such as fever damage, analgesia, hepatotoxic, spermicidal, Anti-implant, anti-hyperglycemic, anti-ulcer, anti-fungal, anti-bacterial, anti-inflammatory, immunomodulatory, anti -mutagenic, anti-cancer, anti-malarial, anti-bacterial, anti-viral, anti-inflammatory against birth, and contraception (Ahmad et., al 2019). Neem paste can treat many ailments, such as boils, ulcers, burns, and wounds.
Pharmacokinetics
Neem is administered orally, absorbed into the stomach, and distributed throughout the body via blood circulation (Ahmad et al., 2019). Neem oil that has been cleaned up and does not contain azadirachtin comprises fatty acids and glycerides. These chemicals are often found in food. They are broken down, used for energy, and built into cells as soon as they enter the body.
Drug interactions
Antidiabetes medications interact with neem. Neem may reduce blood glucose levels. Combining neem with diabetes drugs can lead to hypoglycemia.
Precautions and Contradictions
Neem leaf juice is not recommended for those who take acetaminophen regularly. In lab trials, rats who received acetaminophen and neem leaf extract regularly developed liver damage (Batra, 2022). Pregnant and nursing mothers, however, should take precautions; neem oil and neem bark have the potential to induce a miscarriage.
Adverse Effects
Reported adverse effects to Neem intake at different doses include vomiting, hypoglycemia, moderate transitory eosinophilia, encephalopathy, ventricular fibrillation, and cardiac arrest (Seriana, et., al 2021). The severe side effects include vomiting, diarrhea, sleepiness, blood disorders, seizures, loss of consciousness, coma, brain disorders, and death. According to Batra (2022), pregnant and nursing mothers, however, should take precautions; neem oil and neem bark have the potential to induce a miscarriage.
FDA Approval and Future Considerations
The FDA has not evaluated neem for safety or effectiveness and does not adhere to most prescription medications’ quality and safety requirements. Ahmad et al. (2019) recommend further research on its biological components to enhance its commercial and medicinal applications.
References
Ahmad, S., Maqbool, A., Srivastava, A., & Gogol, S. (2019). Biological detail and therapeutic effect of Azadirachta indica (neem tree) products review. Evidence Based Med. Healthcare, 6(22), 1607-1612.
Batra, N., Kumar, V. E., Nambiar, R., De Souza, C., Yuen, A., Le, U., Verma, R., Ghosh, P. M., & Vinall, R. L. (2022). Exploring the therapeutic potential of Neem (Azadirachta indica) for prostate cancer: A literature review. Annals of Translational Medicine, 10(13). https://atm.amegroups.org/article/view/97030
Seriana, I., Akmal, M., Darusman, D., Wahyuni, S., Khairan, K., & Sugito, S. (2021). Neem Leaf (Azadirachta et al.) Ethanolic Extract on Rats’ Liver and Kidney Function. TheScientificWorldJournal, 2021, 7970424. https://doi.org/10.1155/2021/7970424
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