Use of Guduchi (Tinospora Cordifolia): Infodemic wave during COVID-19.
Ayurveda is recognized across the globe as herbal medicine since it is primarily based on the use of medications in the form of herbal preparations. Many herbal medications have been used to reduce symptoms and improve health and immunity during the COVID- 19 pandemic. Guduchi (Tinospora Cordifolia), commonly known as Giloy, is one of the most abundantly used key factors for immunomodulators. Giloy has long been claimed as a source of several therapeutic advantages, with Ayurvedic practitioners waxing philosophies about its potential anti-inflammatory, anti-fever, and anti-cancer properties. A web-based survey study collecting primary data related to medicinal plants used during COVID -19 suggests Tinospora cordifolia as a commonly used herbal plant in Nepal. 1 It is listed by the Ministry of Health & Population of Nepal, Department of Ayurveda & Alternative Medicine, Teku, Kathmandu, as an alternative medicine to boost the immunity power of people.2 Moreover, National Clinical Management Protocol based on Ayurveda and Yoga for management of Covid-19 with the research expert indexed Guduchi as one of the potent drugs among four drugs recommended for use during COVID-19 in India.3
Fact-checking server recorded the results of research that show the use of the Tinospora cordifolia leading to liver damage in India. It became a source of contention between a group of Mumbai-based physicians and Ayush Ministry over a study that attempted to connect it to liver damage. The result was published in the peer-reviewed Journal by the doctors affiliated with a reputed Hospital in Navi Mumbai.4 The article featured six individuals who had suffered substantial liver damage and were discovered to have taken Tinospora cordifolia (TC) in the preceding days based on the observational study during September 2020 to December 2020 and followed up until March 2021. The study includes participants with acute hepatitis and recent exposure to ingestion/consumption of a distinctive formulation containing Giloy. Reporting of six patients (4 women, 2 men) with a median (IQR) age of 55 years (45-56) shows a history of Tinospora cordifolia intake reporting signs of acute hepatitis. The intake lasted 90 days on average (21–210). The biopsy results revealed liver damage, which was related to the intake of plant Tinospora cordifolia during COVID-19.
Following the study's release and media spread, the Ministry of Ayush, Government of India debunk the statement, publishing a statement that questioned the findings, considering the misinformation and questions to the facts of study about the “lacking analytical parameters of the composition of herb, bias observational study and provides remarks of misleading and devastating to India's traditional medicine system. The statement raised by the AYUSH system was acknowledged by the authors as limitations of the study stating that they haven’t gone deep into “analyzing the contents of the plant parts which the patients had ingested" before admission. 5
Controversial news widely spread in Nepal regarding the irrational use of the TC during COVID-19 which escalated when Barshaman Pun, political leader of Nepal suffered the complication of liver disease. Barshaman Pun suffered from hereditary hyperbilirubinemia.6 The information was released at a press meet after the management of the disease from Thailand. This short note produced massive controversy on the use of TC among medical fraternities. Ayurveda officials made statements concerning the irrational use, intake without species identification, non-standardized product, and dependence of use without the guidance of the registered Ayurvedic Practitioners of Nepal. Fact-checking states, Pun is not sure of the quality of the herb intake. Nepalese officials seek fact-checking information from the official documents released by the Ministry of Social Development, Lumbini Province: “Ayurveda Drug Manual for health care workers in response to COVID-19”,7 Department of Ayurveda,2 and Alternative Medicine, Government of Nepal and debunking information from Ayush Ministry of India. During COVID-19, most of the Nepalese consumed locally available Guduchi, the form of decoction prepared by applying simple local technique. Patients suffering from co-morbidity like Diabetes, Hypertension consumed the decoction for several months during the COVID-19 Pandemic.
Botanical identity of the drug is crucial as the variety of Guduchi used for medicinal purposes is Tinospora Cordifolia only and not much with the varieties like Tinospora sinensis or Tinospora crispa. There is a documented record of the use of herbal medicines containing Tinospora crispa inducing toxic hepatitis.8 It was also suggested that to strengthen their case, the writers would have sought the advice of a botanist or an Ayurvedic specialist. It was also unclear whether the authors have taken into account the past and present medications of the patients as four among the patients were associated with autoimmune disorders. Overall, the study has insufficient information, which is deceptive and defamatory to Ayurvedic ideas and practices. A topic of debate raised in this situation stating that the so-called benefits of Giloy are not supported by solid evidence-based medical research.
TC is a medicinal plant that has long been utilized in folk and Ayurvedic medicine. Phytochemical analytical studies have explored chemicals such as alkaloids, diterpenoid lactones, glycosides, steroids, sesquiterpenoids, and phenolics. These chemicals have anti-diabetic,9,10 antipyretic,11 anti-inflammatory,12 antioxidant,13 hepatoprotective,14 and immunomodulatory effects.15 Recorded safety studies of TC also have highlighted No acute toxicity in oral administration of the aqueous extract of Tinospora cordifolia at a dose of 150 mg/kg body weight.16 Ethnobotany, taxonomical, phytochemistry, and pharmacology is highlighted in different scientific studies.17
Scientific evidence relevant data and its therapeutic applications substantiates that Giloy has a diverse activity and it is safe to use. Giloy is one of the major ingredients of Ayurvedic medications. TC is indexed in the “The International Pharmacopoeia - WHO'' and “Ayurvedic Pharmacopoeia of India ''.18,19 There have been no adverse events reported in any clinical practice or clinical trial by pharmacovigilance. These are major facts for “Guduchi as a medicinal valued herb”. Giloy is considered a natural immunity booster, its use appears to have surged in its use during the pandemic's wave as complementary medicine. The clinical outcomes of the interventions and the studies were recorded in a repository like Ayush Clinical Case Repository (ACCR) portal.3 Numerous clinical trials on the formulations containing Guduchi were recorded in the Clinical registries. There is a need for creating evidence to analyze the outcomes of those recorded studies. Government agencies have to check out and debunk the misinformation of the infodemics, which is a challenging issue during COVID-19. A careful analysis is required before making the claims, and scientific data-supported analysis is needed in presenting the remarks on herbal medicines. It is the responsibility of the Ayurveda and Alternative medical community to substantiate the use of Giloy, which has long been utilized.
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