Jaundice is yellowish discolouration 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; 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 haemoglobin, 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 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 blood.
• (2) Due to functional disturbance of the liver that prevents removal, conversion and secretion of bilirubin. It is characteristic of hepatitis.
• (3) Due to blockage of the bile ducts causing 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 yellowish colouration 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 colour but the urine is yellow. In haemolytic jaundice, the patient suffers from anaemia and both the urine and stool are of orange colour. In jaundice caused by blockage of the bile ducts, bile does not enter the intestines so there is 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 claycoloured in obstructive jaundice because of the absence of bilirubin that normally gives stool its brown colour. 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 for jaundice. For example, excessive use of alcohol is suggestive of alcoholic liver disease, whereas use of hepatotoxic drugs suggests drug-toxicityinduced jaundice and sharing of syringes for injection of drugs points towards viral hepatitis. Attacks of abdominal pain in a patient with jaundice suggests blockage of the bile ducts usually by gallstones. Bulky and clay coloured 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 as 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 literature and commercially manufactured for jaundice and liver disorders essentially contain Katuka as one of the ingredients. Katuka and its formulations find mention 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.

English name	Picrorhiza, Hellebore
Latin name	Picrorhiza kurroa Royle ex Benth.
Family	Scrophulariaceae
Part used	Rhizome with roots

Main chemical constituents

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

Quality standards

Identity, purity and potency of Katuka rhizome for its oral use is estimated on the basis of the following physical constants.

Foreign matter	Not more than 2%
Total ash	Not more than 7%
Acid-insoluble ash	Not more than 1%
Alcohol-soluble extractive	Not less than 10%
Water-soluble extractive	Not less than 20%

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 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, anti-pyretic, immunomodulating, free-radical scavenging, anti-spasmodic and antiinflammatory properties. 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 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 the 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, anaemia, 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 pharmacopoeia 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.

Further reading

• (1) Antarkar DS et al. Double blind clinical trial of Arogyavardhini, an Ayurvedic drug in acute viral hepatitis. Indian J. Med. Res. 1980.
• (2) Chatterjee A, Pakrashi SC. The Treatise on Indian medicinal plants. Vol. 5. New Delhi: National Institute of Science Communication, Council of Scientific and Industrial Research, 1997.
• (3) Chunekar KC. Bhavaprakasha nighantu. Varanasi: Chaukhambha Bharati Academy, 1999.
• (4) Doreswamy R, Sharma D. Plant drugs for liver disorders management. Indian Drugs. 1995.
• (5) Warrier, PK et al Eds. Indian medicinal plants. Vol. 4. Madras: Orient Longman Ltd., 1997.
• (6) Khare CP. Indian medicinal plants. New Delhi: Springer (India) Private Limited, 2007.
• (7) Indian Council of Medical Research. Medicinal plants of India Vol. II. New Delhi: 1987.
• (8) Sharma PV. Dravyaguna vijnana. Varanasi: Chaukhambha Sanskrit Sansthana, 1981.
• (9) Sharma PV. Classical uses of medicinal plants. Varanasi: Chaukhabha Visvabharati. 1996.
• (10) Vaidya AB et al. Picrorhiza kurroa (Kutaki) royle ex benth as a hepatoprotective agent – experimental & clinical studies. J. Postgrad. Med. 1996.

Source: Traditional Herbal Remedies for Primary Health Care - WHO