Efficacy of Sharapunkhadi powder (a polyherbal formulation) in the management of nonalcoholic fatty liver disease

Introduction

Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of chronic liver disorders characterized by excessive hepatic lipid accumulation (steatosis) in the absence of significant alcohol intake. It may present with or without associated hepatic inflammation and fibrosis, and is strongly linked to metabolic dysfunction.

NAFLD is currently the most common chronic liver disease worldwide, affecting approximately 20%–30% of the general population.¹ It is projected to become the leading cause of liver-related morbidity, liver failure, and liver transplantation within the next decade. Increasing evidence supports NAFLD as the hepatic manifestation of systemic metabolic dysregulation, closely associated with insulin resistance, obesity, dyslipidemia, and cardiovascular disease.

Systemic burden and clinical significance of NAFLD

The clinical impact of NAFLD extends beyond hepatic pathology. Although disease progression may lead to cirrhosis and hepatocellular carcinoma, the majority of mortality in NAFLD patients is attributed to cardiovascular complications.

Emerging evidence indicates that NAFLD is independently associated with an increased risk of cardiovascular disease and chronic kidney disease, even after adjusting for conventional cardio-renal risk factors. This highlights its role as a multisystem metabolic disorder rather than an isolated hepatic condition.

Pathophysiological complexity and therapeutic challenges

The development and progression of NAFLD are multifactorial, involving visceral adiposity, insulin resistance, dyslipidemia, hyperglycemia, and oxidative stress. This complex pathogenesis makes therapeutic intervention challenging.

A key clinical objective is to prevent progression from simple steatosis to steatohepatitis, fibrosis, and ultimately end-stage liver disease. Importantly, NAFLD is potentially reversible in early stages, emphasizing the need for timely intervention.

Current therapeutic limitations and need for novel strategies

Currently available pharmacological therapies for NAFLD remain limited in efficacy. Most interventions primarily target individual components such as lipid accumulation or inflammation, rather than the multifactorial nature of the disease.

There is a growing need for multi-targeted therapeutic strategies that can simultaneously address metabolic dysfunction, hepatic injury, inflammation, and oxidative stress. This has prompted increased interest in natural products and plant-derived compounds with hepatoprotective and antihyperlipidemic properties.

Role of lifestyle modification in management

Dietary excess—particularly high-fat, high-calorie intake with low consumption of fiber-rich foods, fruits, vegetables, and omega fatty acids—is a major etiological factor in NAFLD development.

First-line management includes lifestyle interventions such as caloric restriction, increased physical activity, and weight reduction. However, long-term adherence is often poor, and complete disease remission may not be achieved in all patients, necessitating adjunct pharmacological therapy.

Rationale for herbal and polyherbal interventions

Given the limitations of conventional therapy, increasing attention has been directed toward herbal medicines and natural products with multi-target biological activity. These agents offer potential benefits in modulating lipid metabolism, improving insulin sensitivity, and reducing oxidative stress.

Accordingly, experimental and clinical research focusing on hepatoprotective and antihyperlipidemic herbal formulations is gaining importance as a complementary approach in NAFLD management.

Polyherbal formulation approach: Sharapunkhadi powder

In this context, Sharapunkhadi powder has been formulated as a polyherbal preparation² containing equal proportions of:

This formulation is designed to provide synergistic hepatoprotective, antioxidant, and metabolic regulatory effects, targeting multiple pathways involved in NAFLD pathogenesis.

Mechanistic basis of action

Digestive and metabolic correction:

Deepana and Pachana properties enhance enzymatic digestion and prevent accumulation of metabolic toxins (Ama), thereby restoring normal Dhatu formation. This leads to improvement in Agnivaishamya and related gastrointestinal symptoms such as nausea, vomiting, and dyspepsia.

Meda reduction and lipid metabolism:

Tikta Rasa and Ruksha Guna facilitate Lekhana (lipid scraping action), promoting reduction of hepatic fat accumulation. Katuki and Bhoomiamalaki aid in channel clearance and lipid mobilization, improving symptoms such as bloating, constipation, and abdominal discomfort.

Hepatobiliary stimulation:

Picrorhiza kurroa exhibits Yakrituttejaka (hepatic stimulation) and Pittavirechaka (bile secretion enhancement) properties, promoting lipid excretion via bile and reducing hepatic triglyceride accumulation.

Bioactive phytoconstituents and pharmacological basis

Tephrosia purpurea:

Rich in flavonoids and polyphenols, it exhibits antioxidant, anti-inflammatory, and hepatoprotective effects by reducing oxidative stress, stabilizing hepatocyte membranes, and lowering serum liver enzyme levels.

Phyllanthus niruri:

Hepatoprotective activity is attributed to lignans such as phyllanthin and hypophyllanthin, along with anti-inflammatory lignanoid fractions including nirtetralin and niranthin.

Picrorhiza kurroa:

Hepatoprotective effects are mediated by iridoid glycosides such as picroside I, picroside II, and kutkoside, which enhance antioxidant enzyme activity, reduce oxidative injury, and exhibit anti-inflammatory and immunomodulatory properties.

Evidence from experimental and clinical studies

Preclinical studies demonstrate that Picrorhiza kurroa significantly reduces hepatic lipid content and improves biochemical markers in NAFLD models. Similarly, extracts of Phyllanthus niruri and Tephrosia purpurea show marked hepatoprotective effects in toxin-induced liver injury models through antioxidant and free radical scavenging mechanisms.

Comparative therapeutic outcomes

Lifestyle modification alone showed improvement in early disease markers; however, the combination of Sharapunkhadi powder with lifestyle intervention demonstrated superior efficacy in reducing fatty liver grade and improving clinical symptoms, including gastrointestinal and metabolic complaints.

Conclusion

NAFLD can be conceptually correlated with Agnivikriti and Medoroga under the framework of Santarpanajanya Vyadhi. While lifestyle modification remains fundamental, Sharapunkhadi powder, due to its multi-target hepatoprotective, antioxidant, and lipid-lowering properties, provides enhanced therapeutic benefit.

Thus, Sharapunkhadi formulation may serve as a promising and safe polyherbal intervention for the management of NAFLD, particularly in early stages (Grade I–II), especially when combined with structured lifestyle modification.³

References:

1. Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ. 2014;349:g4596. Published 2014 Jul 29. doi:10.1136/bmj.g4596. https://pmc.ncbi.nlm.nih.gov/articles/PMC4168663/
2. Shankar P, Vijay B, Bhargavi, et al. A Case Report on Management of Liver Cirrhosis Using Ayurveda and Integrative Approach of Treatment. Case Reports Hepatol. 2024;2024:1176751. Published 2024 Nov 27. doi:10.1155/crhe/1176751. https://pmc.ncbi.nlm.nih.gov/articles/PMC11617052/
3. Remya E, Goyal M, Varsakiya J. Efficacy of Sharapunkhadi powder (a polyherbal formulation) and lifestyle modification in the management of nonalcoholic fatty liver disease-A randomized placebo-controlled clinical trial. Ayu. 2020;41(2):98-106. doi:10.4103/ayu.AYU_281_19. https://pmc.ncbi.nlm.nih.gov/articles/PMC8614208/