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Katuka Powder for Jaundice

          Jaundice is a yellowish discoloration of the sclera (white part of the eyes) and skin caused by high levels of bilirubin in the blood. It is a major symptom and sign of serious disease of many organ systems; the most important among them being the liver. Jaundice is often associated with yellow urination which reflects excessive excretion of bilirubin in the urine as well. There is a direct correlation between the blood levels of bilirubin and the extent of tissue discoloration.

          Jaundice reflects a deranged state of bilirubin metabolism. Bilirubin is a waste product produced in the body from the globin part of hemoglobin, which is released from the destruction of old red blood cells and remains in the blood after iron is removed. It is the liver that is responsible to remove bilirubin from the blood by conjugating it and then secreting bilirubin-containing bile into the intestine via bile ducts. Jaundice may result from the following three main conditions:

1. Due to over-production of bilirubin exceeding the capacity of the liver to remove it from the blood. This kind of jaundice is found in the excessive breakdown of red blood cells due to their defective formation, or due to the effect of toxins or certain drugs when a large amount of bilirubin is released into the blood.
2. Due to functional disturbance of the liver that prevents removal, conversion, and secretion of bilirubin. It is characteristic of hepatitis.
3. Blockage of the bile ducts causes reduced flow of bile and bilirubin from the liver into the intestines. It is seen in conditions in which bile ducts get obstructed due to gall stones, cancer, or inflammation.

Symptoms:

          If the jaundice is due to liver disease – hepatitis, the patient apart from the yellowish coloration of eyes and skin may have symptoms like loss of appetite, mild fever, fatigue, weakness, and exhaustion. The liver may be slightly enlarged and tender. The stool may be light in color but the urine is yellow. In hemolytic jaundice, the patient suffers from anemia and both the urine and stool are of orange color. In jaundice caused by blockage of the bile ducts, bile does not enter the intestines so there is an impairment of fat digestion and absorption of fat-soluble vitamins. This condition leads to fatty stools and deficiency symptoms of fat-soluble vitamins. The stool is clay-colored in obstructive jaundice because of the absence of bilirubin that normally gives stool its brown color. A troublesome symptom found in patients with this type of jaundice is itching, which may be as severe as to cause scratching and disturbed sleep.

          The patient’s history can suggest the possible cause of jaundice. For example, excessive use of alcohol is suggestive of alcoholic liver disease, whereas the use of hepatotoxic drugs suggests drug-toxicity-induced jaundice, and sharing of syringes for injection of drugs points towards viral hepatitis. Attacks of abdominal pain in a patient with jaundice suggest blockage of the bile ducts usually by gallstones. Bulky and clay-colored stools and dark urine suggests obstruction in the passage of bile.

          Judicious use of Katuka powder along with necessary dietary precautions can successfully treat uncomplicated jaundice.

Katuka (Picrorhiza kurroa Royle ex Benth.):

          Katuka is a perennial hairy herb grown in alpine regions with temperate climatic conditions. The medicinal plant in Indian medicine is named Katuka or Katuki owing to its immense bitter taste. The rhizome of the plant is a bitter tonic used for the treatment of febrile and liver disorders. Uses of Katuka are documented in the ancient classical texts – Charaka Samhita and Sushruta Samhita. Most of the Ayurvedic remedies described in the literature and commercially manufactured for jaundice and liver disorders essentially contain Katuka as one of the ingredients. Katuka and its formulations find mentioned in the Ayurvedic Pharmacopoeia and the Ayurvedic Formulary of India. Apart from highly preferred use of Katuka in the treatment of jaundice and related diseases by Indian practitioners, scientific studies have established that it has an anti-inflammatory property, provides liver protection, and improves bilirubin excretion.

Composition: Katuka powder is made from dried rhizomes and roots of the plant for oral use.

Main Chemical Constituents3: Glucosides: picrorhizin and kutkins (mixture of kutkoside and picroside).

Quality Standards4: The identity, purity, and potency of Katuka rhizome for its oral use is estimated on the basis of the following physical constants.

Method of Preparation:

1. Take 50 grams of dried rhizomes of Katuka. Dry them further to remove moisture for easy powdering. Rhizomes should not have been harvested more than one year ago.
2. Grind rhizomes in a grinder or pulverizer till the fine powder is obtained.
3. Filter the powder through mesh size 85 to remove coarse fibers and other particles.
4. Keep the powder in a dry and air-tight plastic or glass container and consume it before the next rainy season.

Dosage Form: Dusty grey fine powder.

Therapeutic properties:

          Katuka is a bitter tonic with cooling, laxative, carminative, digestive, stomachic, cholagogue, hepato-protective, anti-viral, antipyretic, immunomodulating, free-radical scavenging, anti-spasmodic and anti-inflammatory properties5. In large doses, it acts like a purgative.

Dose and Mode of Administration:

          The dose of Katuka powder for adults is one to three grams and for children, 500 mg to 1 gram, to be taken twice daily with water, preferably after meals. Consuming the medicine on an empty stomach should be avoided as it may cause nausea and vomiting due to its highly bitter taste.

Indications and Uses:

          Katuka is useful in jaundice, liver and spleen dysfunctions, decreased appetite, flatulence, constipation and piles. It is also used in intermittent febrile conditions and skin diseases.

Precautions and Safety Aspects:

1. No side or toxic effects are reported in the literature with the recommended dose of Katuka. Clinical studies have shown no adverse effects in patients treated with Katuka alone and with formulations containing Katuka.
2. Katuka being a purgative, large doses should be used carefully in patients with loose motions and in pregnant women. The dose should be reduced; if stools are watery and associated with abdominal pain.
3. Bitter taste of the medicine may induce nausea and vomiting in sensitive individuals. This tendency can be masked by consuming medicine mixed with honey or sweet syrup.
4. Medication with Katuka should be stopped if the intensity of jaundice does not decrease within three to five days and the symptoms get aggravated. Chronic and severely jaundiced patients should consume Katuka under medical supervision.
5. Jaundice with complications such as body itching, bleeding, anemia, edema, loss of weight, etc. should be properly investigated and treated under medical supervision.
6. Hot, spicy, pungent, sour, fatty, and heavy foods should be avoided. It is advisable to take a soft, semi-solid or liquid diet during and after medication till normal digestive power is restored and the blood bilirubin level becomes normal.

References:

1. India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopeia of India. Part I, Vol. II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 1999. p. 85-87.
2. India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2003. p. 258.
3. Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 7. New Delhi: Central Council for Research in Ayurveda & Siddha, 2005. p. 181-182.
4. India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 1999. p. 86.
5. Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 7. New Delhi: India Central Council for Research in Ayurveda & Siddha, 2005. p. 180, 182.