Evaluation of Siddha Compound Formulation Mahathoothulai chooranam in Combating Respiratory Illness: A Narrative Review

R Meena¹*, G Kiruthiga², P Prakash³

¹Central Council for Research in Siddha, Chennai - 600106, India.

²Central Council for Research in Siddha, Chennai - 600106, India.

³Sathyabama Institute of Science and Technology, Department of Biotechnology, Chennai - 600119, India.

*Corresponding Author E-mail: meenaprakashphd@gmail.com

ABSTRACT:

Siddha medicine is an ancient Indian medical system originated in South India. The holistic approach of the Siddha system finds cure for many ailments and also guides to a perfect living right from conception to death. The ‘S’ in the acronym AYUSH represents Siddha. The Siddha multiherbal formulation Mahathuthulathi chooranam, found in the classical text book Koshayi Anuboga Vaithiya Bramma Ragasiyam - part 2, is indicated for Aiyam (Phlegm) predominant diseases. The review seeks to establish the documented literature on the therapeutic efficacy of the Mahathuthulai chooranam in respiratory illness through a critical review. It was carried out by searching Siddha classic texts from the library of Siddha Central Research Institute, electronic search engines, databases such as Google scholar, Pub Med Central, NLM, Mendeley, Embase, Science Direct etc. The results of the review suggest that the drug can be a part of the comprehensive treatment of adverse respiratory illnesses in addition to prevention of complications in vulnerable risk patients. The drug is substantiated to be a safe and efficacious drug in treating acute respiratory illnesses through supporting evidences. A robust clinical trial is essential to evaluate the clinical outcomes to prove the drug’s efficiency.

KEYWORDS: Siddha, Mahathuthulathi chooranam, respiratory illnesses, polyherbal formulation.

1. INTRODUCTION:

Siddha Medicine, one of the ancient Indian AYUSH systems in practice since many centuries, was founded and developed by Siddhars adopting an inclusive approach. In Siddha system, diseases are classified into 4448 types by means of their fundamental vital humours, Vali/Vatham (Wind), Azhal/Pitham (Bile), Aiyam/Kabam (Phlegm) which forms the basis of all physiological functions in the body and any derangement of these cause diseases.¹.

The polyherbal formulation Mahathoothulai chooranam chosen from the Siddha classical text Koshayi anuboga vaithiya Bramma ragasiyam part 2 is indicated for all types of Kabham related diseases².

The medicine is an internal drug in Chooranam dosage form.

The prime objective of this review is to establish evidence for the therapeutic efficacy of the Mahathuthulai chooranam for management and prevention of respiratory illness as an anti-kaba drug.

2. Materials and Methods:

Fundamental classical information and scientific evidence on Pharmacological activities of Mahathuthulai chooranam were systematically reviewed by searching relevant articles from scientific databases, including Google scholar, Pub Med Central, NLM, Embase, Science Direct, AYUSH Research portal, Science Direct, Springer and others. Information from Siddha Classical books on herbal medicines were retrieved from the library of Siddha Central Research Institute, Chennai.

3. Fundamental of Aiyam/Kabam In Siddha:

The vital humour, Aiyam/Kabam (Phlegm) formed by principle of earth and water, is the “lubricatory factor” essential for nutritive function, immune modulation, hydration, structure – flexibility and digestion³. It is characterised by heaviness, lubricative, wet and cold.

4. Siddha Aspects of Treating Aiyam/ Kabam:

As Kabam is easily aggravated by heavy, pungent and

oily substances, a Kaba pacifying treatment regimen must include light, dry and warm ingredients. The pungency of the drug ingredients Will improve the phlegm drainage while the acrid, bitter tasting herbs will counteract the ill effects of the Kabam with its hot potency. In Siddha, the bitter taste has natural affinity to act on lungs (as the elemental composition of both comprises of air and space)^5,6.

5. Preparation of The Drug, Mahathoothulai Chooranam:

Mahathoothulai chooranam is a compound formulation chosen from the Siddha classical text Koshayi Anuboga Vaithya Brahma ragasiyam Part 2². It consists of 6 herbal ingredients and one animal product. The drug acts based on the synergistic principles of the individual drug ingredients⁷.

6. Standard Procedure of Preparation:

The fruit of S. trilobatum. L., Sphaeranthus amaranthoides Burm. f., Solanum xanthocarpum Schrad. & H. Wendl. and cow Bezoar are dried and powdered. Abies Webbiana Lindl., Alpinia officinarum Hance, Piper nigrum L. are shallow fried, powdered and mixed together. The dose is 2 grams and the adjuvant to be used is ghee or sugar. The drug is indicated for advanced Kaba (phlegmatic) diseases.^3,6.

7. Results - Evaluation of The Drug:

7.1 Phyto chemical screening of the Individual drugs:

The individual ingredients show the presence of tannins, tannic acids, alkaloids, steroids, flavonoids, proteins, amino acids, phenols and glycosides as secondary metabolites along with phenols, flavonoids and alkaloids. In addition, Starch, reducing sugar and saponins were also found.

7.2 Pharmacological actions of the individual drugs:

The individual drugs show pharmacological actions ranging from anti-inflammatory activity, bronchodilator activity, anti- asthmatic, anti-allergic activity, anti-nociceptive, anti-oxidant activities. The pharmacological actions with reference to pulmonary involvement in animal models are presented in Table 3.

Table 1. Herbal Composition Of Mahathuthulai Chooranam: ²

Ingredient	Botanical/Scientific name	Part Used	Quantity for ½ Kg drug
Thoothulai pazham	Solanum trilobatum.L.	Fruit	175 grams
Sivakaranthai pazham	Sphaeranthus amaranthoides. Burm.f.	Fruit	175 grams
Kandankathiri pazham	Solanum xanthocarpum Schrad. and H. Wendl.	Fruit	175 grams
Korosanai	Bezoar of Bos Taurus	Ox gall	4.2 gram
Thaalisapathiri	Abies Webbiana Lindl.	Leaves	105 grams
Sitrarathai	Alpinia Officinarum Hance	Root	35 grams
Milagu	Piper nigrum L.	Fruit	35 rams

Table 2: Presence Of Phytochemical Components In Individual Drug Ingredients:

Botanical name	Nature of the extract	Compounds
Botanical name	Nature of the extract	Steroid	Alkaloids	Phenolics	Flavonoids	Saponins	Tannins	Amino acids	Glycosides	Terpenoids
Sphaeranthus amaranthoides Burm.f ^8, . ⁹	Phenolic extract	+	+	+	+	+	+	+	-	-
Solanum trilobatum.L. ¹⁰	Aqueous extract leaves	-	+	+	+	-	+	+	+	+
Solanum xanthocarpum Schrad. & H. Wendl. ^11,12	Fruits ethanolic extract	+	+	+	_	+	+	+	+
Abbies webbiana Lindl ¹³	Leaf Methanol extract	+	+	+	+	+	+	_	+	+
Alpinia officiarum Hance¹⁴	Leaf hydro alcoholic extract	+	+	_	+	+	+	+	-	+
Piper nigrum L. ¹⁵	Fruit extract	-	+	+	_	-	+	+	-	+

Table 3: Pharmacological Activities of The Individual Ingredients:

Name of the plant	Experimental model	Active constituent and Potential activities	Mechanism of Action of active ingredients
Whole plant of Sphaeranthus amaranthoides Burm.f.	Carrageenan-induced paw edema model in rats – acute inflammation	Anti-inflammatory activity	The dose 1000 mg/kg of SLP produced a significant inhibition of carrageenan induced paw edema at +2h. Therefore, it can be inferred that the inhibitory effect of leaf powder of Sphaeranthus amaranthoides Burm.f. on carrageenan induced inflammation could be due to inhibition of the enzyme cyclooxygenase and subsequent inhibition of prostaglandin synthesis ¹⁷.
Flowers of Solanum trilobatum.L.	Open trial involving human subjects with mild to moderate asthma	Significant broncho dilator as evident in small airway obstructive disease.	Broncho dilator effect; reduction in the bronchial mucosal edema, and/or reduction in secretions within the airway lumen. Improvement in the actual value of FVC, FEV1, PEFR, FEF25-75% and subjective relief from asthmatic symptoms an hour after administration of S.trilobatum L./ S.xanthocarpum Schrad. & H. Wendl.¹⁸.
Flowers of Solanum xanthocarpum Schrad. & H. Wendl.	Isolated Goat tracheal chain, In vivo- Milk induced Eosinophilia, Mast cell degranulation, Capillary permeability	Solasodine . Anti-asthmatic and anti-allergic	Relaxed the histamine pre-treated contraction of the Isolated Goat tracheal chain, reduced milk induced eosinophilia (100m/kg,.i.p.), mast cells protected at a dose of 100 mg/kg,i.p., decreased capillary permeability by 62% in mice evident in optical density of eye^[19].
Leaves of Abies Webbiana Lindl.	Synergistic study with Sedatives (sleeping time); Carrageenan-induced rat paw edema	Taxol Anti-nociceptive and anti-inflammatory	Methanol extracts of the plant administered prior to the administration of standard sedatives; significant synergistic hypnotic actions were observed. Significant anti-inflammatory activity comparable to that of Standard diclofenac sodium due to histamine, kinin and prostaglandin inhibitory activity²⁰.
Dried rhizomes of Alpinia officiarum Hance.	Carrageenan-induced rat paw edema; DPPH radical scavenging activity	Anti-inflammatory. Antioxidant activity	The extract showed inhibition of right-hand paw edema on carrageenan-induced inflammation in rats and promising free radical scavenging effect of DPPH in a concentration-dependent manner up to a concentration of 100 μg/ml. the strong anti-inflammatory activity is linked with inhibition of ROS the production of which can damage cells, tissues, activating oxidative stress and triggering inflammation²¹.
Fruit of Piper nigrum L.	In vitro studies using proinflammatory transcription factor NF-kappaB, COX-1 and -2 enzymes, human tumor cell proliferation and lipid peroxidation (LPO).	Piperine anti-inflammatory, antioxidant and anticancer activities.	Piperine inhibits TNF-alpha induced adhesion of neutrophils to endothelial monolayer through suppression of NF-κB and IκB kinase activation. The extracts of black pepper at 200 microg/mL and its compounds at 25 microg/mL inhibited LPO by 45-85%, COX enzymes by 31-80% and cancer cells proliferation by 3.5-86.8%²².

SLP : Sphaeranthus amaranthoides Burm.f. leaf powder; FVC- Forced Vital capacity ; FEV1 Forced Expiratory Volume in 1 second; FEF25-75% - mean forced expiratory flow between the 25% and 75% of the FVC, DPPH - 2,2-diphenylpicrylhydrazyl, ROS- Reactive Oxygen species, TNF-alpha – Tumor Necrosis factor alpha; NF-κB - nuclear factor kappa-light-chain-enhancer of activated B cells, LPO – Lipo polysaccharides; COX - Cyclooxygenase.

8. Discussion:

The individual ingredients of the drug, ‘Mahathuthuvalai chooranam’ are part of the Siddha therapeutics employed in treating various acute and chronic respiratory infections. They are further part of the cuisine in Southern India. The synergism between ingredient herbs of same action potentiates the drug viz a viz the bitter and acrid tastes with hot potency in the post digestive transformation (Pirivu), an important aspect in Siddha Management. The toxicity profile of the individual ingredient drugs ensures safety for clinical usage.

The individual drugs screened for secondary metabolites showed significant presence of pharmacologically active phytoconstituents effective in attenuation as well as prevention of acute lung injury in various experimental animal models, including neutrophil recruitment to the lung, the production of pro-inflammatory cytokines and chemokines, oedema, and vascular permeability²³.

The pharmacological activities of the drug ranging from anti-inflammatory to anti-cancerous effect is mainly due to the presence of Secondary metabolites. Solanum trilobatum. L showed significant broncho dilator activity, along with antioxidant and anti-inflammatory activity. Abbies webbiana. Lindl. showed significant anti-nociceptive and anti-inflammatory activity. Sphaeranthus amaranthoides Burm.f., Solanum trilobatum. L, Solanum xanthocarpum Schrad. & H. Wendl , Abbies webbiana Lindl., Alpinia officinarum Hance, Piper nigrum.L. showed significant anti-microbial activity against respiratory pathogens. Gorosanai (Cow’s bezoar) shows predominant expectorant, anti-tussive effects and anti-asthmatic activity alongside attenuation of the acute lung injury. Piperine in addition provides enhanced bioavailability. Although many reports have evaluated the effects of these compounds in experimental models, studies evaluating clinical trials are scarce in the literature.

‘Pulmonary inflammation’ being the hallmark of many respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and acute respiratory syndrome distress (ARDS) and majority of these diseases are treated with anti-inflammatory therapy in order to prevent or to reduce the pulmonary inflammation¹⁶

The herbal ingredients of Mahathoothulai chooranam did not show signs of toxicity at the said level of LD 50 substantiating the safety of the drug^24,25,26. So, throughout the review of literature of the ingredients, Mahathuthulai chooranam has proved to be a safe and efficacious Siddha drug against respiratory illnesses. This has to be further studied through assessment of drug for Microbial assay, in resolving acute phase infections and improvement of respiratory functions (FVC, FEV1, PEFR and FEF 25–75%) in affected patients.

9. Conclusion:

Analysis of Siddha drug Mahathuthulai chooranam, clearly unveils its ingredients’ pharmacological efficacies and therapeutic usage in respiratory illnesses with marked inflammation. Its anti-oxidant capacity helps in role reversal of the injuries caused by peroxidase systems and various pro inflammatory cells. It is hence put to consideration that the Siddha drug Mahathuthulai chooranam has be subjected to further research in treating acute respiratory illnesses in view of the efficacy and safety profile.

10. CONFLICT OF INTEREST:

We declare that authors have no conflict of interest.

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Received on 28.12.2020 Modified on 12.02.2022

Research J. Pharm. and Tech 2023; 16(4):2057-2060.

DOI: 10.52711/0974-360X.2023.00338