Traditional Kerala Ayurvedic Formulations as a Guideline for the Management of Inflammatory Bowel Disease (IBD) – A Review
DOI:
https://doi.org/10.18311/jnr/2023/31395Keywords:
Chikitsamanjari, Inflammatory Bowel Disease (IBD), Jataravrana, Kerala Ayurveda LiteratureAbstract
Inflammatory Bowel Disease (IBD) refers to conditions characterized by the presence of idiopathic intestinal inflammation. The main challenge in the management of IBD is the adverse effects associated with the currently available drugs. Also, not all patients respond completely to the conventional treatments of IBD and its efficacy wanes over time. Thus, the use of complementary and alternative medicine is increasing, as a safer alternative. Certain traditional Ayurveda literature of Kerala describe a condition termed ‘jatara vrana’ (ulcer of the gastrointestinal tract), which, along with its associated clinical features, resembles IBD. Due to the similarity in pathology and presenting features, the line of treatment adopted in the management of jatara vrana may be extended to that of IBD. A close observation of the formulations described in the management of jataravrana described in Chikitsamanjari (a regional Ayurvedic literature of Kerala) reveals that in each formulation individual drugs with varying mechanisms of action, including anti-ulcerative (vranaropana), anti-diarrheal (atisaraghna), anti-inflammatory (sophahara), anti-pyretic (jwarahara) or analgesic (vedanahara) activities, have been logically selected and combined. The active components of some of these drugs have been proven to have various effects in IBD pathology. Though these treatment principles have been used traditionally and Ayurvedic management is promising in many experimental models, it is essential to supplement it with well-designed clinical trials to define the exact role of each of these formulations in the prevention or management of IBD.
Downloads
Metrics
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 K. K. Bindu, B. Gopika Menon (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Accepted 2023-04-21
Published 2023-06-13
References
Williams NS, O’Connell PR, McCaskie A, Editors. Bailey and Love’s short practice of surgery. Florida: CRC press. 2018; 1266.
Kedia S, Ahuja V. Epidemiology of inflammatory bowel disease in India: the great shift east. Inflamm Intest Dis. 2017; 2(2):102-15. https://doi.org/10.1159/000465522 DOI: https://doi.org/10.1159/000465522
Jain M, Venkataraman J. Inflammatory bowel disease: An Indian perspective. Indian J Med Res. 2021; 153(4):421-30. https://doi.org/10.4103/ijmr.IJMR_936_18 DOI: https://doi.org/10.4103/ijmr.IJMR_936_18
Ralston SH, Penman ID, Strachan MW, Hobson R, Editors. Davidson’s Principles and Practice of Medicine E-Book. Edinburgh: Elsevier Health Sciences. 2018; 816.
Matsuoka K, Kobayashi T, Ueno F, Matsui T, Hirai F, Inoue N, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol. 2018; 53(3):305-53. https://doi.org/10.1007/s00535-018-1439-1 DOI: https://doi.org/10.1007/s00535-018-1439-1
Catanzaro D, Rancan S, Orso G, Dall’Acqua S, Brun P, Giron MC, et al. Boswellia serrata preserves intestinal epithelial barrier from oxidative and inflammatory damage. PLoS One. 2015; 10(5). https://doi.org/10.1371/journal.pone.0125375 DOI: https://doi.org/10.1371/journal.pone.0125375
Yeshi K, Ruscher R, Hunter L, Daly NL, Loukas A, Wangchuk P. Revisiting inflammatory bowel disease: Pathology, treatments, challenges and emerging therapeutics including drug leads from natural products. J Clin Med. 2020; 9(5):1273. https://doi.org/10.3390/jcm9051273 DOI: https://doi.org/10.3390/jcm9051273
Ben-Horin S, Mao R, Chen M. Optimizing biologic treatment in IBD: Objective measures, but when, how and how often? BMC Gastroenterol. 2015; 15:178. https://doi.org/10.1186/s12876-015-0408-x DOI: https://doi.org/10.1186/s12876-015-0408-x
Coelho MR, Romi MD, Ferreira DM, Zaltman C, Soares-Mota M. The use of curcumin as a complementary therapy in ulcerative colitis: A systematic review of randomized controlled clinical trials. Nutrients. 2020; 12(8):2296. https://doi.org/10.3390/nu12082296
Triantafyllidi A, Xanthos T, Papalois A, Triantafillidis JK. Herbal and plant therapy in patients with inflammatory bowel disease. Ann Gastroenterol. 2015; 28(2):210-220. PMID: 25830661. PMCID: PMC4367210.
Aggarwal B, Prasad S, Reuter S, Kannappan R, Yadav V, Park B, et al. Identification of novel anti-inflammatory agents from Ayurvedic medicine for prevention of chronic diseases: “reverse pharmacology” and “bedside to bench” approach. Curr Drug Targets. 2011; 12(11):1595-653. https://doi.org/10.2174/138945011798109464 DOI: https://doi.org/10.2174/138945011798109464
Khanal H, Krishniya K, Joshi RK. Ayurvedic perspective of Ulcerative colitis and its management. World J Pharm Res. 2020; 9(9):461-78. https://doi.org/10.20959/wjpr20209-18383
Pooja BA, Bhatted S. Ayurvedic management of Pravahika- A case report. Ayu. 2015; 36(4):410-12. https://doi.org/10.4103/0974-8520.190701 DOI: https://doi.org/10.4103/0974-8520.190701
Patange GP, Giri SR, Kharat JS. Crohn’s disease: A review based on Ayurveda and Modern perspective. World J Pharm Res. 2019; 8(10):1638-45. https://doi.org/10.20959/wjpr201910-15616
Gopalapillai KG (editor). Chikitsamanjari. Part I (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 1/197-8.
Gopalapillai KG (editor). Chikitsamanjari. Part II (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 51/30-6.
Sreeman Namboodiri D (editor). Yogamrutham (Malayalam). Alappuzha: Vidyarambham Publishers. 2014; 1/79-80.
Ramavarier Kaikulangara. Arogyakalpadrumam (Malayalam). Thrissur: Sahithi Books. 2011; 19/19-20.
Wenzl HH. Diarrhoea in chronic inflammatory bowel diseases. Gastroenterology Clin North Am. 2012; 41(3):651-75. https://doi.org/10.1016/j.gtc.2012.06.006 DOI: https://doi.org/10.1016/j.gtc.2012.06.006
Anbazhagan AN, Priyamvada S, Alrefai WA, Dudeja PK. Pathophysiology of IBD associated diarrhoea. Tissue barriers. 2018; 6(2):e1463897. https://doi.org/10.1080/21688370.2018.1463897 DOI: https://doi.org/10.1080/21688370.2018.1463897
Ralston SH, Penman ID, Strachan MW, Hobson R, Editors. Davidson’s Principles and Practice of Medicine E-Book. Elsevier Health Sciences. 2018; 817.
Szigethy E. Pain management in patients with inflammatory bowel disease. Gastroenterol Hepatol (NY). 2018; 14(1):53-6. PMID: 29491764.
Ribaldone DG, Brigo S, Mangia M, Saracco GM, Astegiano M, Pellicano R. Oral manifestations of inflammatory bowel disease and the role of non-invasive surrogate markers of disease activity. Medicines (Basel). 2020; 7(6):33. https://doi.org/10.3390/medicines7060033 DOI: https://doi.org/10.3390/medicines7060033
Elahi M, Telkabadi M, Samadi V, Vakili H. Association of oral manifestations with ulcerative colitis. Gastroenterol Hepatol Bed Bench. 2012; 5(3):155-60. PMID: 24834217.
Chad T, Brown J. Chronic cough in a patient with stable ulcerative colitis: a rare but important extraintestinal manifestation of inflammatory bowel disease. BMJ Case Rep. 2019; 12(1):bcr-2018-227066. https://doi.org/10.1136/bcr-2018-227066 DOI: https://doi.org/10.1136/bcr-2018-227066
Gordon M, Sinopoulou V, Iheozor-Ejiofor Z, Iqbal T, Allen P, Hoque S, et al. Interventions for treating iron deficiency anaemia in inflammatory bowel disease. Cochrane Database of Syst Rev. 2021; 1(1):CD013529. https://doi.org/10.1002/14651858.CD013529 DOI: https://doi.org/10.1002/14651858.CD013529.pub2
Gopalapillai KG (editor). Chikitsamanjari. Part I (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 1/200.
Bindu KK, Joshi Mrudula Vinayak. Critical study on Chikitsamanjari with special reference to regional contribution to the therapeutic tradition of Ayurveda. Pune: Tilak Maharashtra Vidyapeeth. 2019. http://hdl.handle.net/10603/312377
Pallie MS, Perera PK, Kumarasinghe N, Arawwawala M, Goonasekara CL. Ethnopharmacological use and biological activities of Tragia involucrata L. Evidence-Based Complementary and Alternat Med. 2020; 8848676. https://doi.org/10.1155/2020/8848676 DOI: https://doi.org/10.1155/2020/8848676
Gobalakrishnan R, Kulandaivelu M, Bhuvaneswari R, Kandavel D, Kannan L. Screening of wild plant species for antibacterial activity and phytochemical analysis of Tragia involucrata L. J Pharm Anal. 2013; 3(6):460-5. https://doi.org/10.1016/j.jpha.2013.07.001 DOI: https://doi.org/10.1016/j.jpha.2013.07.001
Velu V, Banerjee S, Radhakrishnan V, Gupta G, Chellappan DK, Fuloria NK, et al. Identification of Phytoconstituents of Tragia Involucrata leaf Extracts and Evaluate their Correlation with Anti-inflammatory and Antioxidant Properties. Antiinflamm Antiallergy Agents Med Chem. 2021; 20(3):308-15. https://doi.org/10.2174/1871523020666210126144506 DOI: https://doi.org/10.2174/1871523020666210126144506
Islam MS, Sana S, Haque ME, Rahman SMM, Samad A, Al Noman A, et al. Methanol, ethyl acetate and n-hexane extracts of Tragia involucrata L. leaves exhibit anxiolytic, sedative and analgesic activity in Swiss albino mice. Heliyon. 2021; 7(1):e05814. https://doi.org/10.1016/j.heliyon.2020.e05814 DOI: https://doi.org/10.1016/j.heliyon.2020.e05814
Dhara AK, Pal S, Nag Chaudhuri AK. Psychopharmacological studies on Tragia involucrata root extract. Phytother Res. 2002; 16(4):326-30. https://doi.org/10.1002/ptr.891 DOI: https://doi.org/10.1002/ptr.891
Sarkar PK, Mukhopadhyay CD. Mechanistic insights from the review and evaluation of ayurvedic herbal medicines for the prevention and management of COVID-19 patients. J Herb Med. 2022; 32:100554. https://doi.org/10.1016/j.hermed.2022.100554 DOI: https://doi.org/10.1016/j.hermed.2022.100554
Liu S, Li Q, Liu F, Cao H, Liu J, Shan J, et al. Uncovering the mechanism of curcuma in the treatment of Ulcerative colitis based on network pharmacology, molecular docking technology, and experiment verification. Evid Based Complement Alternat Med. 2021; 6629761. https://doi.org/10.1155/2021/6629761 DOI: https://doi.org/10.1155/2021/6629761
Chandan S, Mohan BP, Chandan OC, Ahmad R, Challa A, Tummala H, et al. Curcumin use in ulcerative colitis: Is it ready for prime time? A systematic review and meta-analysis of clinical trials. Ann Gastroenterol. 2020; 33(1):53-58. https://doi.org/10.20524/aog.2019.0439 DOI: https://doi.org/10.20524/aog.2019.0439
Karthikeyan A, Young KN, Moniruzzaman M, Beyene AM, Do K, Kalaiselvi S, et al. Curcumin and its modified formulations on Inflammatory Bowel Disease (IBD): The story so far and future out-look. Pharmaceutics. 2021; 13(4):484. https://doi.org/10.3390/pharmaceutics13040484 DOI: https://doi.org/10.3390/pharmaceutics13040484
Coelho MR, Romi MD, Ferreira DMTP, Zaltman C, Soares-Mota M. The use of curcumin as a complementary therapy in Ulcerative colitis: A systematic review of randomized controlled clinical trials. Nutrients. 2020; 12(8):2296. https://doi.org/10.3390/nu12082296 DOI: https://doi.org/10.3390/nu12082296
Basu S, Hazra B. Evaluation of nitric oxide scavenging activity, in vitro and ex vivo, of selected medicinal plants traditionally used in inflammatory diseases. Phytother Res. 2006; 20(10):896-900. https://doi.org/10.1002/ptr.1971 DOI: https://doi.org/10.1002/ptr.1971
Gopalapillai KG (editor). Chikitsamanjari. Part I (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 1/201.
Umamaheswari M, Asokkumar K, Rathidevi R, Sivashanmugam AT, Subhadradevi V, Ravi TK. Antiulcer and in vitro antioxidant activities of Jasminum grandiflorum L. J Ethnopharmacol. 2007; 110(3):464-70. https://doi.org/10.1016/j.jep.2006.10.017 DOI: https://doi.org/10.1016/j.jep.2006.10.017
El-Shiekh RA, Hussein D, Atta AH, Mounier SM, Mousa Shiekh MR, Abdel-Sattar E. Anti-inflammatory activity of Jasminum grandiflorum L. subsp. floribundum (Oleaceae) in inflammatory bowel disease and arthritis models. Biomed Pharmacother. 2021; 140:111770. https://doi.org/10.1016/j.biopha.2021.111770 DOI: https://doi.org/10.1016/j.biopha.2021.111770
Mortazavi H, Mashhadiabbas F, Mortazavi SAR, Rezaeifar K, Farhangi M. Formulation of a Jasmine Grandiflorum containing mucoadhesive and evaluation of its healing effect on oral biopsy ulcers. Clin Oral Investig. 2020; 24(4):1591-7. https://doi.org/10.1007/s00784-019-03171-w DOI: https://doi.org/10.1007/s00784-019-03171-w
Wangensteen H, Klarpås L, Alamgir M, Samuelsen AB, Malterud KE. Can scientific evidence support using Bangladeshi traditional medicinal plants in the treatment of diarrhoea? A review on seven plants. Nutrients. 2013; 5(5):1757-800. https://doi.org/10.3390/nu5051757 DOI: https://doi.org/10.3390/nu5051757
Maniyar Y, Bhixavatimath P, Agashikar NV. Antidiarrhoeal activity of flowers of Ixora Coccinea Linn. in rats. Journal of Ayurveda and Integrative Medicine. 2010; 1(4):287-91. https://doi.org/10.4103/0975-9476.74422 DOI: https://doi.org/10.4103/0975-9476.74422
Adnan MS, Al-Amin MM, Uddin MM, Shohel M, Bhattacharjee R, Hannan JM, et al. Analgesic, anti-inflammatory and antipyretic effects of Ixora coccinea. J Basic Clin Physiol and Pharmacol. 2014; 25(4):423-8. https://doi.org/10.1515/jbcpp-2013-0125 DOI: https://doi.org/10.1515/jbcpp-2013-0125
Mukherjee S, Koley H, Barman S, Mitra S, Datta S, Ghosh S, et al. Oxalis corniculata (Oxalidaceae) leaf extract exerts in vitro antimicrobial and in vivo anticolonizing activities against Shigella dysenteriae 1 (NT4907) and Shigella flexneri 2a (2457T) in induced diarrhoea in suckling mice. J Med Food. 2013; 16(9):801-9. https://doi.org/10.1089/jmf.2012.2710 DOI: https://doi.org/10.1089/jmf.2012.2710
Kumar A, Agarwal K, Maurya AK, Shanker K, Bushra U, Tandon S, et al. Pharmacological and phytochemical evaluation of Ocimum sanctum root extracts for its anti-inflammatory, analgesic and antipyretic activities. Pharmacogn Mag. 2015; 11(1):S217-24. https://doi.org/10.4103/0973-1296.157743 DOI: https://doi.org/10.4103/0973-1296.157743
Kamyab AA, Eshraghian A. Anti-Inflammatory, gastrointestinal and hepatoprotective effects of Ocimum sanctum Linn: an ancient remedy with new application. Inflamm Allergy Drug Targets. 2013; 12(6):378-84. https://doi.org/10.2174/187152811266131125110017 DOI: https://doi.org/10.2174/1871528112666131125110017
Lee J, Choi HS, Lee J, Park J, Kim SB, Shin MS, et al. Preparation of herbal formulation for inflammatory bowel disease based on In Vitro screening and In Vivo evaluation in a mouse model of experimental colitis. Molecules. 2019; 24(3):464. https://doi.org/10.3390/molecules24030464 DOI: https://doi.org/10.3390/molecules24030464
Lal UR, Singh IP. Review and implications of traditional indian medicine for inflammatory bowel disease. Translational Studies on Inflammation. 2019. https://doi.org/10.5772/intechopen.89465 DOI: https://doi.org/10.5772/intechopen.89465
Gopalapillai KG (editor). Chikitsamanjari. Part I (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 1/202.
Sahoo HB, Sahoo SK, Sarangi SP, Sagar R, Kori ML. Anti-diarrhoeal investigation from aqueous extract of Cuminum cyminum Linn. Seed in Albino rats. Pharmacognosy Res. 2014; 6(3):204-9. https://doi.org/10.4103/0974-8490.132596 DOI: https://doi.org/10.4103/0974-8490.132596
Deshmukh CD, Veeresh B, Pawar AT. Protective effect of Emblica officinalis fruit extract on acetic acid induced colitis in rats. J Herb Med Toxicol. 2010; 4(2). https://doi.org/10.3923/rjmp.2010.141.148 DOI: https://doi.org/10.3923/rjmp.2010.141.148
Kostoff RN, Briggs MB, Shores DR. Treatment repurposing for inflammatory bowel disease using literature-related discovery and innovation. World J Gastroenterol. 2020; 26(33):4889-4899. https://doi.org/10.3748/wjg.v26.i33.4889 DOI: https://doi.org/10.3748/wjg.v26.i33.4889
Gopalapillai KG (editor). Chikitsamanjari. Part II (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 51/30.
Seo JY, Lee C, Hwang SW, Chun J, Im JP, Kim JS. Nimbolide inhibits nuclear factor-КB pathway in intestinal epithelial cells and macrophages and alleviates experimental colitis in mice. Phytother Res. 2016; 30(10):1605-14. https://doi.org/10.1002/ptr.5657 DOI: https://doi.org/10.1002/ptr.5657
Gopalapillai KG (editor). Chikitsamanjari. Part II (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 51/31-2.
Li H, Chen X, Liu J, Chen M, Huang M, Huang G, et al. Ethanol extract of Centella asiatica alleviated dextran sulfate sodium-induced colitis: Restoration on mucosa barrier and gut microbiota homeostasis. J Ethnopharmacol. 2021; 267:113445. https://doi.org/10.1016/j.jep.2020.113445 DOI: https://doi.org/10.1016/j.jep.2020.113445
Yun X, Fang Y, Lv C, Qiao S, Tao Y, Dai Y, et al. Inhibition of the activation of γδT17 cells through PPARγ-PTEN/Akt/GSK3β/NFAT pathway contributes to the anti-colitis effect of madecassic acid. Cell Death Dis. 2020; 11(9):752. https://doi.org/10.1038/s41419-020-02969-x DOI: https://doi.org/10.1038/s41419-020-02969-x
Gopalapillai KG (editor). Chikitsamanjari. Part II (Malayalam). Trivandrum: Sree Chitra Ayurveda Series. 1934; 51/34.
Zulaikhah ST. Health benefits of tender coconut water (TCW). Int J Pharm Sci Res. 2019; 10(2):474-80.
Fu L, Pei D, Yu M, Shang H, Si JG, Zhang HW, et al. New phenolic acids from the whole herb of Elephantopus scaber Linn. and their anti-inflammatory activity. Nat Prod Res. 2021; 35(21):3667-74. https://doi.org/10.1080/14786419.2020.1723086 DOI: https://doi.org/10.1080/14786419.2020.1723086
Hiradeve SM, Rangari VD. A review on pharmacology and toxicology of Elephantopus scaber Linn. Nat Prod Res. 2014; 28(11):819-30. https://doi.org/10.1080/14786419.2014.883394 DOI: https://doi.org/10.1080/14786419.2014.883394
Gopalapillai KG (editor). Chikitsamanjari. Part II (Malayalam). Trivandrum: Sree Chitra Ayurveda Series; 1934; 51/35.
Yang Y, Wang S, Bao YR, Li TJ, Yang GL, Chang X, et al. Anti-ulcer effect and potential mechanism of licoflavone by regulating inflammation mediators and amino acid metabolism. J Ethnopharmacol. 2017; 199:175-182. https://doi.org/10.1016/j.jep.2017.01.053 DOI: https://doi.org/10.1016/j.jep.2017.01.053
Murugan SK, Bethapudi B, Raghunandhakumar S, Purusothaman D, Nithyanantham M, Mundkinajeddu D, et al. A flavonoid rich standardized extract of Glycyrrhiza glabra protects intestinal epithelial barrier function and regulates the tight-junction proteins expression. BMC Complement Med Ther. 2022; 22(1):38. https://doi.org/10.1186/s12906-021-03500-1 DOI: https://doi.org/10.1186/s12906-021-03500-1
Padumadasa C, Dharmadana D, Abeysekera A, et al. In vitro antioxidant, anti-inflammatory and anticancer activities of ethyl acetate soluble proanthocyanidins of the inflorescence of Cocos nucifera L. BMC Complement Altern Med. 2016; 16:345. https://doi.org/10.1186/s12906-016-1335-2 DOI: https://doi.org/10.1186/s12906-016-1335-2
Chithra MA, Ijinu TP, Kharkwal H, et al. Phenolic rich Cocos nucifera inflorescence extract ameliorates inflammatory responses in LPS-stimulated RAW264.7 macrophages and toxin-induced murine models. Inflammopharmacol. 2020; 28:1073-89. https://doi.org/10.1007/s10787-019-00620-6 DOI: https://doi.org/10.1007/s10787-019-00620-6
Gopalapillai KG (editor). Chikitsamanjari. Part II (Malayalam). Trivandrum: Sree Chitra Ayurveda Series.1934; 5/36.
Bhattacharya S, Banerjee D, Bauri AK, Chattopadhyay S, Bandyopadhyay SK. Healing property of the Piper betel phenol, allylpyrocatechol against indomethacin-induced stomach ulceration and mechanism of action. World J Gastroenterol. 2007; 13(27):3705-13. https://doi.org/10.3748/wjg.v13.i27.3705 DOI: https://doi.org/10.3748/wjg.v13.i27.3705
Nayaka NMDMW, Sasadara MMV, Sanjaya DA, Yuda PESK, Dewi NLKAA, Cahyaningsih E, et al. Piper betle (L): Recent review of antibacterial and antifungal properties, safety profiles, and commercial applications. Molecules. 2021; 26(8):2321. https://doi.org/10.3390/molecules26082321 DOI: https://doi.org/10.3390/molecules26082321
Fazal F, Mane PP, Rai MP, Thilakchand KR, Bhat HP, Kamble PS, et al. The phytochemistry, traditional uses and pharmacology of Piper Betel. linn (Betel Leaf): A pan-asiatic medicinal plant. Chin J Integr Med. 2014. https://doi.org/10.1007/s11655-013-1334-1 DOI: https://doi.org/10.1007/s11655-013-1334-1
Shine VJ, Latha PG, Shyamal S, Suja SR, Anuja GI, Sini S, et al. Gastric antisecretory and antiulcer activities of Cyclea peltata (Lam.) Hook. f. and Thoms. in rats. J Ethnopharmacol. 2009; 125(2):350-5. https://doi.org/10.1016/j.jep.2009.04.039 DOI: https://doi.org/10.1016/j.jep.2009.04.039
Singh SG, Nishteswar K, Patel BR, Nariya M. Comparative antipyretic and analgesic activities of Cissampelos pareira Linn. and Cyclea peltata (Lam.) Hook. F. and Thomas. Ayu. 2016; 37(1):62-6. https://doi.org/10.4103/ayu.AYU_208_14 DOI: https://doi.org/10.4103/ayu.AYU_208_14
Shine VJ, Anuja GI, Suja SR, Raj G, Latha PG. Bioassay guided fractionation of Cyclea peltata using in vitro RAW 264.7 cell culture, antioxidant assays and isolation of bioactive compound tetrandrine. J Ayurveda Integr Med. 2020; 11(3):281-6. https://doi.org/10.1016/j.jaim.2018.05.009 DOI: https://doi.org/10.1016/j.jaim.2018.05.009
Ibrahim B, Sowemimo A, van Rooyen A, Van de Venter M. Antiinflammatory, analgesic and anti-oxidant activities of Cyathula prostrata (Linn.) Blume (Amaranthaceae). J Ethnopharmacol. 2012; 141(1):282-9. https://doi.org/10.1016/j.jep.2012.02.032 DOI: https://doi.org/10.1016/j.jep.2012.02.032
Labanski A, Langhorst J, Engler H, Elsenbruch S. Stress and the brain-gut axis in functional and chronic-inflammatory gastrointestinal diseases: A transdisciplinary challenge. Psychoneuroendocrinology. 2020; 111:104501. https://doi.org/10.1016/j.psyneuen.2019.104501 DOI: https://doi.org/10.1016/j.psyneuen.2019.104501
Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress triggers flare of inflammatory bowel disease in children and adults. Front Pediatr. 2019; 7:432. https://doi.org/10.3389/fped.2019.00432 DOI: https://doi.org/10.3389/fped.2019.00432
Feagan BG, Lémann M, Befrits R, Connell W, D’Haens G, Ghosh S, et al. Recommendations for the treatment of Crohn’s disease with tumor necrosis factor antagonists: An expert consensus report. Inflamm Bowel Dis. 2012; 18(1):152-60. https://doi.org/10.1002/ibd.21870 DOI: https://doi.org/10.1002/ibd.21870
Payyappallimana U, Venkatasubramanian P. Exploring ayurvedic knowledge on food and health for providing innovative solutions to contemporary healthcare. Front Public Health. 2016; 4:57. https://doi.org/10.3389/fpubh.2016.00057 DOI: https://doi.org/10.3389/fpubh.2016.00057