E-ISSN:2456-3110

Review Article

Auto-Immune Disease

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

Role of Ayurvedic Medicinal Plants in Auto-immune disorders and their management

Rawat N.1*, Sharma S.2
DOI: http://dx.doi.org/10.21760/jaims.8.3.20

1* Nivedita Rawat, Post Graduate Scholar, Department of Dravyaguna, Pt. Khushilal Sharma Government (Auto.) Ayurvedic College and Institute, Bhopal, Madhya Pradesh.

2 Sharddha Sharma, Assistant Professor, Department of Kayachikitsa, Pt. Khushilal Sharma Government (Auto.) Ayurvedic College and Institute, Bhopal, Madhya Pradesh.

Auto-immune disease is an abnormal condition in which immune system start producing auto-antibodies against constituents of its own tissues. Under normal circumstances immune system will not destroy self-antigens, but in Auto-immune disease breakdown of mechanisms responsible for self-tolerance and induction of an immune response against component of the self-body tissues. Activation of self- reactive clones of T or B lymphocytes generating humoral or cell mediated response against self-antigen. Worldwide up to 700 million peoples are estimate to be suffering from auto-immune disease. According to Ayurveda cause of auto-immune disease is due to mechanism of aberrant ‘Agni’ and ‘Ama’ production may occur at macro and micro level. That Ama is full of antigen or the molecules which are mimicking the shape and structure of our healthy tissues. Those molecules are intermediary harmful metabolites which are attacked by our immune system to neutralize. That’s how the autoimmune diseases are start. Also, in auto-immune disease different Dhatvagnis are involved and Dhatus and related Shrotas suffer, resulting Dhatukshay, Ojakshay occurs and further multiple Koshtang and there Avayav affected. Ayurvedic principles are specific and provide numerous medicinal plants which have immuno-modulator properties, like Ashwagandha, Amalaki, Guduchi, Pippali, Punarnava, Yashtimadhu, Vidang etc. the present paper deals with various researches done on Ayurvedic medicinal plants in management of Auto immune disease. Detailed description of all these drugs on Auto-immune disease will be mentioned in full paper.

Keywords: Auto-Immune Disease, Ama, Immune-Modulator, Ojakshaya

Corresponding Author How to Cite this Article To Browse
Nivedita Rawat, Post Graduate Scholar, Department of Dravyaguna, Pt. Khushilal Sharma Government (Auto.) Ayurvedic College and Institute, Bhopal, Madhya Pradesh, .
Email: 		Nivedita Rawat, Sharddha Sharma, Role of Ayurvedic Medicinal Plants in Auto-immune disorders and their management. J Ayu Int Med Sci. 2023;8(3):108-115.
Available From
https://jaims.in/jaims/article/view/2343

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-30 2023-02-01 2023-02-08 2023-02-15 2023-02-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2023by Nivedita Rawat, Sharddha Sharmaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

The immune system usually guards against bacteria and viruses. When it senses the foreign invaders, the immune system sends out fighter cells to attack them. Usually, the immune system know the difference between foreign cells and own cells. In an Autoimmune disorder, the immune system mistakes to recognized, part of your body, like your joints or skin or tissues, as foreign. It releases protein called auto-antibodies that attack healthy cells and further caused variety of diseases. The disease and progression vary from person to person.

Ayurveda based on a holistic view. Ayurvedic principles are specific and yet broad enough to facilitate application to and analysis of even the new and emerging disease and syndrome. According to Ayurveda cause of auto-immune disease is due to mechanism of aberrant ‘Agni’ which produced Ama and weak Ojas. Also, in auto-immune disease different Dhatvagnis are involved. Ayurvedic principles are specific and it treats the root cause of disease rather than the symptoms of autoimmune disease. Ayurveda focuses on restoring, balancing and strengthening the immune system, threw work on Agni and Ojas. The modulation of immune system response by using Ayurvedic herbal medications as a possible therapeutic measure has now become a subject of scientific investigation. It provides numerous medicinal plants which have immuno-modulator properties, like Ashwagandha, Amalaki, Guduchi, Pippali, Punarnava, Yashtimadhu, Vidang etc. The present paper deals with various researches done on Ayurvedic medicinal plants in management of Auto immune disease.

Auto-immune disease: Autoimmune disease is a condition which is triggered by the immune system initiating an attack on self-molecules due to the deterioration of immunologic tolerance to auto-reactive immune cells.[1] The initiation of attacks against the body’s self-molecules in autoimmune diseases, in most cases is unknown, but a number of studies suggest that they are strongly associated with factors such as genetics, infections and/or environment. Autoimmunity is characterized by the reaction of cells (auto reactive T-lymphocytes) or products (autoantibodies) of the immune system against the organism’s own antigens (auto antigen). It may be part of the physiological immune response (natural autoimmunity) or pathologically induced, which may eventually lead to development of clinical abnormalities (autoimmune disease).[2]

ADs may be either organ-specific (e.g., thyroid, β-cells of the pancreas), where unique tissue-specific antigens are targeted, or may be more systemic, in which multiple tissues are affected, and a variety of apparently ubiquitously expressed auto antigens are targeted.[3]

Common type of Auto-immune disease are - Type 1 diabetes, Rheumatoid arthritis, Pernicious anemia, Celiac sprue disease, Vitiligo, Scleroderma, Psoriasis, Inflammatory bowel disease, Addison’s disease, Hashimoto’s disease and many more.

Factor affecting Auto-immune disease

The exact cause of autoimmune disorders are unknown, but some factors may trigger changes that confuse the immune system. Genetic predisposition, environmental factors (including infections) and gut dysbiosis play major role in the development of autoimmune disorder.

For example, one of the most common genetic associations with autoimmune disorder is the protein tyrosine phosphatase gene PTPN22 expressed in lymphocytes. It has been found in patients with many autoimmune disorder, Including Type-1 Diabetes mellitus, Rheumatoid arthritis (RA), Systemic lupus erythematosus (SLE), and autoimmune thyroiditis.[4]

Also, there are a host of environmental factors that trigger autoimmune disorder including Chemical toxicants, heavy metals, viruses, bacteria, emotional stress and drugs etc. For example, Smocking is a known risk for RA. Cigarette smoking may induce citrullination of proteins in pulmonary alveolar cells, which are highly specific for RA as are the HLA associations that are related to the development of these auto-antibodies.[5]

Also, it is clear that the gut micro biota has a profound and long term effect starting at birth on the host immune system. It is also evident that it plays a significant role in auto immune disease both inside and outside the gut.

Autoimmune diseases in Ayurveda

According to Ayurveda

समदोषः समाग्निश्च समधातु मलः क्रियाः।

प्रसन्न आत्मेद्रिय मनः स्वस्थ्यइतिअभिधीयते॥

(सु.सुत्र.15)


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The person who is in a state of equilibrium of body’s; Doshas (humors), Agni (digestive fire), Dhatus (tissues), Malah Kriya (Physiological functions of excretions etc.) and whose Aatma (soul), Indriya (senses) and Manah (mind) is happy all are considered as healthy person. Impaired Doshas, Agni, Dhatu and Malah Kriya caused diseases.

According to Ayurveda, Autoimmune disorder caused by impaired Agni which may produce endotoxins called ‘Ama’’. That Ama full of antigen or the molecules which are mimicking the shape and structure of our healthy tissues. Those metabolites they are attack by our immune system to neutralize and same in other tissues. That’s how the autoimmune disease start.

Also, in Autoimmune disease different Dhatwagnis are involved and Dhatus or related Shrotas may suffer. When Agni turns against normal Dhatus, destruction of Dhatus and their Avayav takes place, because in normal health there is a coordinated hormonal control over Agni. This controll is maintained by Doshas-Dhatus-Malas and Ojas. In autoimmune disease this control is lost at different domains.

In auto immune disorder the Doshas we can see how individuals with a Pitta predominant constitution would be prone to Autoimmune disorders. But Pitta doesn’t act alone. When Vata Doshas increases in the presence of high Pitta, it’s like wind blowing on a fire. The inflammation spreads throughout the body. Eventually the Agni deposit in a weak spot and the disease progresses at that site.

In initial stage due to constant unhealthy life style and Virudh Aahar accumulation of Mala [Mala Sanchay] and impaired Jatharagni begins formation of Ama in the body. In secondary stage due to Pitta dominancy over activity of Agni Bhav takes place resulting destruction of Dhatu function, Dhatukshaya and Ojakshaya occurs. In this stage inflammation take place. In advance stage of Autoimmune disease Vata Prakopa will lead to further pathologies in different Shrotas. Agni will go beyond its controlled. Samagni become Tikshagni and it is responsible for excessive Dhatupaka and multiple Koshtangs under going to be Paka as well as Koshtanga related organs.


Management of autoimmune disease in Ayurveda

Modulation of immune response by using Ayurvedic herbal medications as a possible therapeutic measure and it is being really practiced by the Ayurvedic practitioners for centuries. Enhancement of immune responsiveness of an organism against a pathogen by non-specifically activating the immune system using immuno-modulatory agents of plant origin is concept behind treating Autoimmune disorders in Ayurveda.[6]

Herbs, which affect the immune system in specific or non-specific mode, can be categorized under immuno herbs that are covered under the broad umbrella of Rasyana in Ayurveda.[7]

Here we have described the potential role of the Ayurvedic medicinal plants against Autoimmune disorders as immuno-modulators. As discussed below, several medicinal plants exhibit not only immunomodulatory activity but also a wide range of antioxidant, antiasthmatic, antiarrhythmic, anti-inflammatory, hepatoprotective, hypocholesterolemic, antifungal, cardiotonic, diuretic, and other medicinal activities.

1. Abutilon indicum (Malvaceae): Stimulates immune system, affects humoral immunity as shown by its effect in the indirect hemagglutination test, serum immunoglobulin levels. Also affects cell-mediated immunity, showing significant increase in neutrophil adhesion and carbon clearance.[8]

2. Adhatoda vasica Nees (Acanthanceae): The alcoholic extract of vasica is reported to reduce the count of neutrophils, thus diminishing the phagocytosis activity. The extract was found responsible to decrease in delayed-type hypersensitivity reactions and inhibitory effect on T lymphocytes and also reported to possess human immunodeficiency virus (HIV) protease inhibitory activity.[9]

3. Acacia catechu (Leguminosae): Aqueous extract affects humoral immunity as shown by its effect in the indirect hemagglutination test, serum immunoglobulin levels and mice lethality test. It also has effect on the cell-mediated immunity, showing significant increase in the neutrophil adhesion, carbon clearance and a reduction in cyclophosphamide induced neutropenia.[10]



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4. Achillea millefolium Koch (Compositae)
Extract exhibits significant stimulatory effect on both humoral and cellular immune functions in mice. Aqueous extract of plant shows significant increase in the delayed type of hypersensitivity response at a dose of 100 mg/kg. In the hemagglutination test, plant extract shows stimulatory effect in all doses.[11]

5. Actinidia macrosperma (Actinidiaceae)
Acts as immunomodulator by lymphocyte proliferation stimulation and by activating NK cells.[12]

6. Allium hirtifolium (Alliaceae)
Hydro alcoholic extract Increase in footpad thickness due to immunomodulatory Activity.[13]

7. Aloe veraex Linn. (Liliaceae)
Acemannan (primary polysaccharide from Aloe vera gel) incubated on special type of mouse macrophage cell line, RAW 264.7 for 24 h causes immunostimulation due to activation of Macrophages.[14],[15],[16]

8. Alternanthera tenella Colla (Amaranthaceae)
Immunostimulation through modulation of B-lymphocyte functions was achieved using aqueous extracts of A. tenella.[17]

9. Andrographis paniculata Nees (Acanthaceae)
Andrographolide acts as inhibitor of TNF-a and induces significant stimulation of both “antigen specific” and “antigen nonspecific” types of immune responses in mice, showing effectiveness against a variety of infectious and oncogenic (cancer causing) agents.[18]

10. Asparagus racemosus (Liliaceae)
The aqueous extract of A. racemosus showed significant increase of CD3(+) and CD4/CD8(+). This effect is proposing its effect on T cell activation. Higher antibody titres and delayed-type hypersensitivity (DTH) responses were also reported along with the effect on activated lymphocytes.[19]

11. Bauhinia variegata (Caesalpiniaceae)
Increase in macrophage stimulatory activity, neutrophil adhesion and hemagglutination antibody titer confirms its immunomodulatory potential.[20]

12. Boswellia spp. (Burseraceae)
Stimulatory effect on lymphocyte proliferation.[21]


13. Chlorophytum borivilianum (Liliaceae)
Observed an increase in DTH, % neutrophil adhesion and in vivo phagocytosis by carbon clearance method after treatment with extracts, proving its potential as an immunomodulator.[22]

14. Cissampelos pareira (Menispermiaceae)
Stimulates immune system, affects humoral immunity as shown by its effect in the indirect hemagglutination test, serum immunoglobulin levels. It also affects cell-mediated immunity.[23]

15. Citrus natsudaidai Hayata (Rutaceae)
Immunostimulatory effect on lymphocyte proliferation, induction of cytokine (TNF-α, INF-β).[24]

16. Cleome gynandra (Capperdiceae)
Stimulatory effect on both humoral immunity as well as cell-mediated immunity by stimulating phagocytosis, increases in DTH (delayed type hypersensitivity response).[25]

17. Cordia superba And C. rufescens A. DC. (Boraginaceae)
methanolic Extract showed a significant immunomodulation by stimulating the NO (nitric oxid), IFN-γ and lipopolysaccharide.[26]

18. Couroupita guianensis (Lecythidaceae) Naglingam
Extract showed immunostimulation in vitro and in vivo and increased phagocytic activity thus an increase in phagocytic index and in DTH.[27]

19. Curcuma longa (Haridra)
Curcumin, one of the main active principle of C. longa is reported to inhibit NF-κB activation post exposure of various inflammatory stimuli in 117 randomized control trials. There was a significant reduction in TNF-α, IL-6, TGF-β and MCP-1 following curcumin supplementation.[28]

20. Ganoderma lucidum (Fr.)P. Karst. (Polyporaceae)
Induction of cytokine (TNF-α, IFN-γ) by Ganoderma suggests its immunomodulatory potential.[29]

21. Glycyrrhiza glabra (Yastimadhu)
Glycyrrhizin, the main active constituent of the plant, is reported to interfere with immune responses by targeting dendritic cells. It also upregulate the expression of CD40, CD86 and MHC-ІІ maturation markers on dendritic cells as well as enhances the production of IL-12 by these cells. It also increases the IFN-γ and IL-10 and further


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reduces IL-4 production.[30] The root extract of G. glabra in association with zinc has also shown immunomodulatory activity.[31]

22. Gymnema sylvestreBr. (Asclepiadaceae)
Aqueous Extract showed significant immunomodulation at all concentrations in various in vitro models by exerting a stimulating effect on phagocytic activity, neutrophil locomotion and chemotaxis.[32]

23. Hibiscus rosa sinensis Linn. (Malvaceae)
Stimulatory effect on both humoral immunity as well as cell mediated immunity by stimulating phagocytosis, increases in DTH.[33]

24. Hyptis suaveolens (L.) Poit., (Lamaceae)
Potentially suppresses immune system affecting both humoral immunity and cell-mediated immunity as shown by its effect in indirect hemagglutination test.[34]

25. Lagenaria siceraria (Cucurbitaceae)
Ethanolic Extract showed immunostimulation in vitro and in vivo by increasing the DTH.[35]

26. Morus alba (Moraceae)
Methanolic Extract affects humoral immunity as shown in the indirect hemagglutination test, serum immunoglobulin levels and mice lethality test. It also affects cell-mediated immunity, showing significant increase in the neutrophil adhesion, carbon clearance and a reduction in cyclophosphamide induced neutropenia.[36]

27. Murraya koenigii (L) Spreng. (Rutaceae)
Methanolic Extract showed immunostimulation in vitro and in vivo. Significant increase in NO production by mouse peritoneal macrophages is detected in cultures. Supernatants indicated increase phagocytic activity of macrophages thus increase in phagocytic index by rapid removal of carbon particles from blood stream.[37]

28. Nyctanthes arbor-tristis (Oleaceae)
Potentially stimulates immune system and affects both humoral immunity as well as cell-mediated immunity as shown by its effect in the indirect hemagglutination test and serum immunoglobulin levels.[38]

29. Ocimum sanctum (Labiateae)
Aqueous/alcoholic Extract shows increased DTH to sheep red blood cells SRBCs. Alcoholic extract was more potent than aqueous

in producing delayed type hypersensitivity response. Both extracts have marginal stimulatory effect on humoral immunity.[39]

30. Phyllanthus emblica (Emblica officinalis) (Aamlaki)
P. emblica is reported to enhance NK cell activity and antibody-dependent cellular cytotoxicity in syngeneic BALB/c mice.[40] E. officinalis stimulates humoral and cell-mediated immunity along with macrophage phagocyte.[41]

31. Picrorhiza scrophulariiflora (Scrophulariaceae)
Strong inhibitory activity of P. scrophulariiflora towards the classical pathway of complement, chemiluminescence and T-cell proliferation assay was observed for the diethyl ether extract.[42]

32. Randia dumetorum (Rubiaceae)
Modulates immune system depending upon fractions and mechanism involved in stimulation and increase in DTH response.[43]

33. Stereospermum suaveolens (Patla)
The root extract is reported to increase the total leukocyte count and the population of monocyte and neutrophil in experimental studies. Immunostimulatory potential is reported via DTH response, phagocytic activity and intracellular killing potential of phagocytes.[44]

34. Terminalia arjuna (Combretaceae)
Plant showed immunomodulation by increasing the secondary immune response as evidenced by an increase in Anti- SRBC antibody titre (ASRBs) antibody titer but failed to modulate primary immune response.[45]

35. Terminalia chebula (Haritaki)
The aqueous extract of dried fruits of T. chebula was reported to increase humoral antibody titre and DTH in mice. Another study also reported enhanced expression of Th1 cytokine, INF-γ; decreased IL 4; increased percentage of CD4+ cells; lymphocyte proliferation; macrophage phagocyte response; and DTH response in mice.[46]

36. Tinospora cordifolia (Menispermiaceae)
Improves the phagocyte function without affecting cell-mediated and humoral immune systems and also causes inhibition of C3 canvertase of the classical complement pathway, hence acts as immunomodulator.[47] The aqueous extract of T. cordifolia is reported to influence the cytokine


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production, mitogenicity, stimulation and activation of immune effector cells. In vitro evidence also supports it by showing upregulating effect on the IL-6 cytokines facilitating the acute response to injuries, inflammation, activation of cytotoxic T cells and B cell diffraction.[48]

37. Withania somnifera (L.) Dunal (Ashwagandha)
The aqueous extract of roots of W. somnifera was reported to upregulate Th1-dominant polarization, thus supporting the humoral immunity and cell-mediated immune responses in BALB/c mice.[49] The methanolic extract of the roots enhances the level of IFN-γ, IL-2 and granulocyte macrophage colony-stimulating factor in mice.[50] Another study reports that the aqueous extract enhances nitric oxide synthetase activity of the macrophages, activates and mobilizes macrophages for rendering increased phagocytic activity and potentiates activity of lysosomal enzymes.[51]

Discussion

For Autoimmune disease one of the therapeutic strategies in Ayurvedic medicines is to enhance the body’s overall natural resistance to the disease causing agent rather than directly neutralizing the agent itself. In Ayurveda Toxin removal through Panchkarma, improving metabolic activities using herbal medicine like Neem, Guggulu, Vasa, Patolpatra etc., increasing Ojas production with the help of Guduchi, Amalaki, Yashtimadhu, Pippali etc. and immune system correction with the help of herbal medicine are helpful to treat the autoimmune disease. Ayurveda describe a number of drug as Rasayan and Ojovardhak which are claim to possess immunomodulory effect. Rasayana work at the level of Rasa, Agni and Srotas to achieved the immune enhancement. Also balanced lifestyle and diet prevent autoimmune diseases.

Conclusion

1. Smith, D.A., Germolec, D.R. 1000. Introduction to Immunology and Autoimmunity. Environmental Health Perspectives. 107(5): 661-665.

2. Kasper, Braunwaldsanci, longo, jamesons. Harrison`s principles of intemal medicine. 16th ed. McGraw 'ill Medical 2003;2:471- 477.

3. Von Mühlen CA, Tan EM.Autoantibodies in the diagnosis of systemic rheumatic diseases. Semin Arthritis Rheum,1995; 24: 323-358.

4. J.C.Barrett, D.G.Clayton, P.Concannon et.al.,”Genomewide association study and meta-analysis find that over 40 loci affect risk of type-1 diabetes.” Nature genetics, Vol.41, No.6,PP.703-707,2009.

5. L..Klareskog, P. Stolt, K. Lundberg et.al.,” A new model for an etiology of rheumatoid arthritis; smoking may trigger HLA-DR(Shared epitope) restricted immune reaction to auto-antigen modified by citrullination” Arthritis and Rheumatism, Vol.54,no.1,PP.38-46,2006.

6. Vd. Sandeep k. Patel and Vd. Sunil B.Patil, “A review article on autoimmune disorders and immunomodulation in Ayurveda with help of Rasayana as immunomodulator”, WJPLS, 2020,Vol.6,Pg-75-77.

7. Doshi GM, Une HD, Shanbhag PP.Rasayans and non- rasayans herbs: Future immunodrug – targets. Pharmacogn Rev. 2013;7:92-96. Doi: 10.4103/09737847.120506.[PMC free article] [Pub Med]

8. Dashputre NL, Naikwade NS. Immunomodulatory activity of Abutilon indicum Linn. on albino mice. IJPSR 2010;1(3):178-84.

9. Singh KP, Upadhyay B, Pra R, Kumar A (2010) Screening of Adhatoda vasica Nees as a putative HIV-protease inhibitor. J Phytol 2.

10. Syed I, Mohammed A. Immunomodulatory activity of Acacia catechu. Indian J Physicol Pharmacol 2009;53(1):25-33.

11. Sharififar F, Pournourmohammadi S, Arabnejad M, Rastegarianzadeh R, Ranjbaran O, Purhemmaty A. Immuno-modulatory activity of aqueous extract of Heracleum persi-cum Desf. in mice. IJPR 2009;8(4):287-92.

12. Lu Y, Fan J, Zhao Y, Chen S, Zheng X, Yin Y, Fu C. Immuno-modulatory activity of aqueous extract of Actinidia macro-sperma. Asia Pac J Clin Nutr 2007;16(1):261-5.

13. Jafarian A, Ghannadi A, Elyasi A. The effects of Allium hirtifolium Boiss. on cell-mediated immune response in mice.IJPR 2003;2:51-5.

14. Sikarwar Mukesh S, Patil MB, Shalini Sharma, Vishnu Bhat.Aloe vera: plant of immortality. IJPSR 2010;1:7-10.

15. Hamman JH. Composition and applications of Aloevera leaf gel. Molecules 2008;13:1599-616.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)113
Rawat N et al: Ayurvedic Medicinal Plants in Auto-immune disorders and management

16. Cooper JC, Turcasso N. Immunostimulatory effects of b-1,3 glucan and acemannan. JANA 1999;2:5-11.

17. Guerra RNM, Pereira HAW, Silveria LMS, Olea RSG. Evaluation of immunomodulatory and anti-inflammatory effects and phytochemical screening of Alternanthera tenella Colla(Amaranthaceae) aqueous extract. Braz J Med Biol Res 2003;36:1215-9.

18. Varma A, Padh H, Shrivastava N. Andrographolide: A new plant-derived antineoplastic entity on horizon. Evid Based Complement Alternat Med 2011;2011:815390.

19. Gautam M, Saha S, Bani S, Kaul A, Mishra S, Patil D, Satti NK, Suri KA, Gairola S, Suresh K, Jadhav S, Qazi GN, Patwardhan B. Immunomodulatory activity of Asparagus racemosus on systemic Th1/Th2 immunity: implications for immunoadjuvant potential. J.Ethnopharmacol. 2009;121:241–247. doi: 10.1016/j.jep.2008.10.028.

20. Ghaisas MM, Saikh SA, Deshpande AD. Evaluation of immuno-modulatory activity of ethanolic extract of stem bark of Bauhinia variegata Linn. IJGP 2009;3(1):70-4.

21. Mikhaeil BR, Maatooq G, Badria T, Farid AA, Mohamed MA. Chemistry and immunomodulatory activity of frankincense oil. J Chem Sci 2002;58:230-8.

22. Thakur M, Bhargava S, Dixit VK. Immunomodulatory activity of Chlorophytum borivilianum Sant. F. Evid Based Complement Alternat Med 2006;4(4):419-23

23. Bafna A, Mishra S. Antioxidant and immunomodulatory activity of the alkaloidal fraction of Cissampelos pareira Linn.O ̈PhG. 2009;78:21-31.

24. Tanaka T, Sugiura H, Inaba R, Nishikawa A, Murakami A, Koshimizu K, Ohigashi H. Immunomodulatory action of Citrus auraptene on macrophage functions and cytokine production of lumphocytes in female BALB/c mice. Carcinogenesis 1999;20(8):1471-6.

25. Gaur K, Kori ML, Nema RK. Comparative screening of immunomodulatory activity of hydro-alcoholic extract of Hibiscus 182 D. Kumar et al. rosa sinensis Linn. and ethanolic extract of Cleome gynandra Linn. GJP 2009;3(2):85-9.

26. Costa JFO, David JPL, David JM, Giulietti AM, Queiroz LP, Santos RR, Soares MBP. Immunomodulatory activity of extracts from Cordia superba Cham. and Cordia rufescens A. DC. (Boraginaceae), plant species native from Brazilian semi-arid. Rev Bras Farmaacogn 2008;18(1):11-5.

27. Pradhan D, Panda PK, Tripathy G. Evaluation of immuno-modulatory activity of methanolic extract of Couroupita guianensis Aubl flowers in rat. NPR 2009;8(1):37-42.

28. Panahi Y, Hosseini MS, Khalili N, Naimi E, Simental-Mendía LE, Majeed M, Sahebkar A. Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: a post-hoc analysis of a randomized controlled trial. Biomed Pharmacother. 2016;82:578–582.doi: 10.1016/j.biopha.2016.05.037

29. Habijanic J, Berovic M, Wraber B, Hodzar D, Boh B. Immunostimulatory effects of fungal polysaccharides from Ganoderma lucidum submerged biomass cultivation. Food Technol Biotechnol 2001;39(9):327-31.

30. Bordbar N, Karimi MH, Amirghofran Z. The effect of glycyrrhizin on maturation and T cell stimulating activity of dendritic cells. Cell Immunol. 2012;280:44–49. doi: 10.1016/j.cellimm.2012.11.013

31. Mitra Mazumder P, Pattnayak S, Parvani H, Sasmal D, Rathinavelusamy P. Evaluation of immunomodulatory activity of Glycyrhiza glabra L roots in combination with zing. Asian Pac J Trop Biomed. 2012;2:S15–S20. doi: 10.1016/S2221-1691(12)60122-1

32. Malik JK, Manvi FV, Nanjwade BK, Alagawadi KR, Sinsh S.”Immunomodulatory activity of Gymnema sylvestre R.Br.leaves on in vitro human neutrophils”.J Pharm Res 2009;2(8):1284-6.

33. Gaur K, Kori ML, Nema RK. Comparative screening of immunomodulatory activity of hydro-alcoholic extract of Hibiscus 182 D. Kumar et al. rosa sinensis Linn. and ethanolic extract of Cleome gynandra Linn. GJP 2009;3(2):85-9.

34. Jain V, Bhagwat D, Jat RC, Bhardwaj S. The immunomodulation potential of Hyptis suaveolens. IJPRD 2005;1(11):1-6.

35. Deshpande JR, Choudhary AA, Mirsha MR, Meghre VS, Wadokar SG, Dorle AK. Benefical effects


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)114
Rawat N et al: Ayurvedic Medicinal Plants in Auto-immune disorders and management

of Lagenaria siceraria Mol. Fruit epicarp in animal models. Indian J Exp Biol 2008;46:234-42.

36. Bharani SER, Asad M, Dhamanigi SS, Chandrakala GK. Immunomodulatory activity of methanolic extract of Morus alba linn. (mulberry) leaves. Pak J Pharm Sci 2010;23(1):63-8.

37. Shah SA, Wakade AS, Juvekr AR. Immunomodulatory activity methanolic extract of Murraya koenigii (L) Spreng. leaves. Indian J Exp Biol 2007;46:505-9.

38. Kannan M, AJA Ranjit Singh, Ajith Kumar TT, Jegatheswari P, Subburayalu S. Studies on immunobioactivities of Nyctanthes arbortristis (Oleaceae). Afr J Microbiol Res 2007;1(6):88-91.

39. Vaghasiya J, Datani M, Nandkumar K, Malaviya S, Jivani N. Comparative evaluation of alcoholic and aqueous extracts of Ocimum sanctum for immunomodulatory activity. Int J Pharm Biol Res 2010;1(1):25-9.

40. Suresh K, Vasudevan DM. Augmentation of murine natural killer cell and antibody dependent cellular cytotoxicity activities by Phyllanthus emblica, a new immunomodulator. J Ethnopharmacol. 1994;44:55–60. doi: 10.1016/0378-8741(94)90099-x.

41. Suja RS, Nair AMC, Sujith S, et al. Evaluation of immunomodulatory potential of Emblica officinalis fruit pulp extract in mice. Indian J Anim Res. 2009;43:103–106.

42. Smit HF. Picrorhiza scrophularii flora from traditional use to immunomodulatory activity [doctoral thesis]. Utrecht,Netherlands: University of Utrecht; 2000.

43. Satpute KL, Jadhav MM, Karodi RS, Katare YS, Patil MJ, Rukhsana Rub, Bafna AR. Immunomodulatory activity of fruits of Randia dumetorum Lamk. JPP 2009;1(3):36-40.

44. Maji AK, Samanta SK, Mahapatra S, Banerji P, Banerjee D. In-vivo immunomodulatory activity of standardized Stereospermum suaveolens (Roxb.) DC. root extract. Orient Pharm Exp Med. 2014;14:47–54. doi: 10.1007/s13596-013-0132-4.

45. Halder S, Bharal N, Mediratta PK, Kaur I, Sharma KK. Anti-inflammatory, Immunomodulatory and anti-nociceptic activity of Terminalia arjuna Roxb. Bark powder in mice and rats. Indian J Exp Biol 2009;47:577-83.

46. Rubab I, Ali S. Dried fruit extract of Terminalia chebula modulates the immune response in mice. Food Agric Immunol. 2016;27:1–22. doi: 10.1080/09540105.2015.1055554.

47. Sinha K, Mishra NP, Singh J, Kanjusa SPS.Tinospora cordifolia, a reservoir plant for therapeutic applications: A review. IJTK 2004;3(3):257-70.

48. Sharma U, Bala M, Kumar N, Singh B, Munshi RK, Bhalerao S. Immunomodulatory active compounds from Tinospora cordifolia. J Ethnopharmacol. 2012;141:918–926. doi: 10.1016/j.jep.2012.03.027.

49. Bani S, Gautam M, Sheikh FA, Khan B, Satti NK, Suri KA, Qazi GN, Patwardhan B. Selective Th1 up-regulating activity of Withania somnifera aqueous extract in an experimental system using flow cytometry. J Ethnopharmacol. 2006;107:107–115. doi: 10.1016/j.jep.2006.02.016.

50. Iuvone T, Esposito G, Capasso F, Izzo AA. Induction of nitric oxide synthase expression by Withania somnifera in macrophages. Life Sci. 2003;72:1617–1625. doi: 10.1016/s0024-3205(02)02472-4.

51. Rasool M, Varalakshmi P. Immunomodulatory role of Withania somnifera root powder on experimental induced inflammation: an in vivo and in vitro study. Vascul Pharmacol. 2006;44:406–410.doi: 10.1016/j.vph.2006.01.015.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)115