Herbal Alternatives to Mesalamine for Ulcerative Colitis Treatment

Abstract

Ulcerative colitis is a chronic relapsing inflammatory bowel disease which causes ulcers and inflammations in the intestines, this disease affects mostly the innermost lining of the large intestine particularly part of colon and rectum, but can affect the whole length of colon. The usual onset of Ulcerative colitis is chronic rather than sudden. This inflammatory bowel disease can make the person very much feeble and debilitating and can lead to life-threatening complications in some cases. It is a disease of unknown etiology, the possible causes includes immune system malfunctions and genetic inheritance.

The clinical manifestations of the disease vary according to the severity of inflammation and the site of the disease. Few commonly occurring features of ulcerative colitis include the diarrhea, usually with bleeding and mucous, abdominal cramping, pain in the rectum, bleeding from rectum, blood with stool, urgency to defecate but there is inability to defecate despite this urgency, weight loss, chronic fatigue, fever, there is developmental disorders in the children with ulcerative colitis, irritability, and mental stress.

Modern Allopathic treatment for ulcerative colitis is focused on symptomatic relief, use of anti-inflammatory medications, corticosteroids, and then use of immunosuppressant medications. Atlast they are left with the surgical removal of the affected part of the colon. Mesalamine, commonly sold under the brand name of Mesacol, is the choice of drug used by Allopathic medicine for the remission of active Ulcerative colitis.

Mesalamine belongs to the class of 5-Aminosalicylic acid derivative drugs. This class of drugs has anti-inflammatory properties that is helpful in checking the bleeding and mucus associated with mild to moderate ulcerative colitis.

Mesacol is available in following formulations/dosage

1. Mesacol 400 mg
2. Mesacol 800 mg
3. Mesacol 1.2 grams
4. Mesacol enema 4 g/60 ml.

After realising that Mesalamine (5-Aminosalicylic acid) is active moiety in Ulcerative colitis, but is not that much effective orally as most of this medicine is absorbed in the small intestine and unable to reach the large intestine (colon- the most affected part by UC). So the tablet with an acrylic polymer coating which is pH sensitive has been formulated for a delayed release of this medication.

A dose of 2.4 gram has been found to improve the symptoms of about 50% of cases in mild to moderate cases of Ulcerative colitis. The other route of administration of this drug is by a retention enema.

But this drug has multiple adverse effects on the body. Out of those side effects the mild ones include abdominal pain, diarrhea, nausea, headache etc. Whereas the severe side effects include fever, hypersensitivity reactions, rashes, itching and leukopenia. Use of this drug for a longer duration, has shown its nephrotoxic potential. Mesalazine is known to have drug interaction with glucocorticoids and enhancing their gastric toxicity and its interaction with sulfonylureas can increase its hypoglycemic action. The other possible intractable medicines include furosemide, methotrexate, coumarins, rifampicin, and spironolactone etc.

Moreover, the physician mostly advised the patients that they had to live on the medicine for lifelong. And when there is resistance to the lower dosage of the medicine on long term use they just shift to the higher dosage which will simultaneously increase the risk of adverse effects as well.

According to Ayurveda

Ayurveda, being the oldest Science of Medicine is treating the various acute and chronic ailments since ages, has the two perfect formulations as the best alternative of Mesalamine, and these formulations are Kutaj Ghan Vati and Vatsakadi Churna. These two classical formulations are proven to have better results than the mesalamine, in a much effective way and that too with relatively lesser side effects.

Let’s discuss about these two formulations in detail

1. Kutaj Ghan Vati
2. Vatsakadi Churna

1. Kutaj Ghan Vati

This tablet formulation is made with the standardised extract of Kutaj (Holarrhena antidysenterica). Kutaj is the herb used for the management of vitiated kapha and pitta dosha. It is the perfect herb used for treating the Atisaar (diarrhea), Grahani dosha (Irritable Bowel Syndrome), Kahstaj grehni (Ulcerative colitis) etc. diseases since ages. The bark is the therapeutically used part of the plant used for its astringent action, anthelmintic and amoebicidal activity which makes it a significant herb for treating various dysentery and gastric disorders.

Chemical composition of the bark of Holarrhena antidysenterica contains free alkaloids such as conimine and conessine, alkaloids such as conessidine, holarrhenine, holarrhetine and holafrine.

Acharya Charaka had mentioned this herb in the four groups of ten best herbs indicated in particular disease i.e.

1. Arshogana– it has been indicated for the treatment of piles.
2. Kandu Ghana– for relieving the itching.
3. Stanya Shodhana– used for detoxifying the breast milk.
4. Asthapanopaga– used for catalysing the therapeutic enema.

Ayurvedic properties of the Kutaj that makes it perfect for the alternative of the drug Mesalmine include

Ayurvedic properties of Bilva

1. Ras (taste) – Tikta, kashay.

This means that the taste of this herb is bitter and astringent which helps in the stoppage of the bleeding in the stools.

2. Guna- Laghu, Rooksha

Kutaj is lite and dry in nature which is helpful in balancing the mucous condition associated with the ulcerative colitis.

Virya- Sheet

The cool potency of this herb also adds up to the blood stopping ability of the herb.

3. Vipaka- katu

• The pungent metabolic property (after digestion), adds on to its anti-inflammatory actions.
• In a nutshell, this herb can manage the pitta and kapha dosha.

Kutaj is beneficial in arsh (piles), atisaar (diarrhea), pitta astra (pitta & bleeding related disorders), kapha (mucous), ama (endotoxins) and kustha (skin disorders). It is also having antipyretic effects.

2. Vatsakadi Churna

Vatsakadi churna is another classical formulation with Vatsak (Holarrhena antidysenterica) & Bilva (Aegle marmelos). Bilva is beneficial in relieving digestive disorders, regulating blood sugar levels and in elimination of excess heat from the body. In combination with Kutaj, bilva is very much effective in treating the mucous related condition of the patients of ulcerative colitis and Irritable bowel syndrome and relieves the chronic diarrhea.

Ayurvedic properties of Bilva

• Ras (taste) – Tikta (Bitter), kshaya (Astringent)
• Guna (properties) – Laghu (light), Ruksha (dry)
• Virya (potency) – Ushna (hot)
• Vipaka (post digestion effect) – katu (Pungent)
•  Karma (uses) – Piles, Dysentery, Mucus

Conclusion

In nutshell, the combination of these two medicinal formulations is used to treat the various inflammatory bowel diseases since ages. These both when used together have a synergistic role in reducing inflammation of the large intestines and reducing the flow of blood and mucus in the stool. On long term use, this medicine helps in healing up the damaged or inner lining of the colon or rectum, in a much more effective way than Mesalamine. Moreover, both Vatsakadi churna and kutaj ghan vati are herbal based medicines and thus are safer to use even for the long term.