Punarnawaa (Boerhaavia diffusa)

Punarnawaa (Boerhaavia diffusa)


Introduction

Punarnawaa is a perennial, spreading weed found growing wildly in poor soil and is native to both India and Brazil. From Vedic period up to modern era, Punarnawaa is lauded for its medicinal values. 

Punarnawaa is a folk medicine and super-food as well. In West Bengal and Assam Punarnawaa leaves are eaten as a pot-herb (as a vegetable or as a flavoring agent) and are understood to prevent renal calculi. In other areas, the entire plant, including the root, is eaten in curries and soups, while the seeds and roots are used in cereals and pancakes. Country folks plant Punarnawaa in their gardens to repel poisonous snakes and scorpions. 

Traditional herbal healers apply Punarnawaa to the vagina and tie roots wrapped in red cord, around the woman’s waist to hasten delivery. They also apply Punarnawaa to the breast to treat breast abscess. They use Punarnawaa mixed in honey to treat conjunctivitis. [1]

Literally, Punarnawaa means the ‘Renewer’. (Punarnawaa= Punar+Nawaa; Punar means once again and nawaa means becoming new). Quite a name to live up to for folk observed that the dead, dry plant would spring again to new green life. On the philosophy of the “Doctrine of Signatures” or on the “Theory of Signatures”, the herbalists and Ayurvedic physicians took this to mean that the plant was rejuvenative, a fact now supported by a rigorous scientific research. They also believe that by daily or routine use of Punarnawaa, body rejuvenates and a fellow becomes ‘young’ again. 

[Note: The philosophy of the “Doctrine of Signatures”, dating from the time of Dioscurides and Galen, states that, herbs that resemble various parts of the body can be used to treat ailments of that part of the body. A theological justification offered by botanists like William Coles for this philosophy, was that God would have wanted to show men what plants would be useful for treating ailments of various parts of the body. “It was reasoned that the Almighty must have set his sign or signature upon the various means of curing disease which he provided.”] [2]

As this plant grows low and its numerous, long, slender, interlocking stems of the inflorescence resemble an immature spider or a spider’s web it is known as spiderling.   
                 

                            Spider                                   Spiderling


In 18th century a famous Dutch physician, Hermann Boerhaave described its medicinal uses. The genus of this plant, Boerhaavia is named after Hermann Boerhaave.
[3], [4], [5], [6]

Other Names

Botanical:    Boerhaavia diffusa
Sanskrit :    Kahtilla, Shophaghnee, Shothaghnee, Varshabhu
English:      Horse Purslene, Hog Weed  
Assamese :  Ranga Punarnabha
Bengali :     Rakta punarnava
Gujrati :     Dholisaturdi, Motosatodo
Hindi :       Gadapurna, Lalpunarnava
Kannada : Sanadika, Kommeberu, Komma
Kashmiri : Vanjula Punarnava
Malayalam : Chuvanna Tazhutawa
Marathi : Ghetuli, Vasuchimuli, Satodimula, Punarnava, Khaparkhuti
Oriya: Lalapuiruni, Nalipuruni
Punjabi : ltcit (Ial), Khattan
Tamil : Mukurattai (Shihappu)
Telugu : Atikamamidi, Erra galijeru [7]

Taxonomic classification

Kingdom:        Plantae
(unranked):     Angiosperms
(unranked):     Eudicots
(unranked):    Asterids, Core eudicots                              
Order:            Caryophyllales
Division:         Magnoliophyta
Class:             Magnoliopsida
Family:           Nyctaginaceae   [8]

Boerhaavia (Punarnawaa), is a genus of about 40 species of annual herbaceous plants in the four o’clock flower family, Nyctaginaceae. [9]

Geographical distribution

Punarnawaa is a trailing herb found from the warmer parts of India up to a height of 2000 meters in the Himalayan area. It is also found grown in the wastelands, ditches, marshy places and fields during and after the rainy season. It is found in many warm, tropical and subtropical countries such as Sri Lanka, Sudan, Africa, China and Australia. Punarnawaa is cultivated for medicinal purpose in West Bengal. [10], [11]

Plant Morphology
Macroscopic Characteristics



Plant: Punarnawaa is a trailing herb found throughout India. For medicinal purpose it is collected after rainy season. It is diffusedly branched with stout root stock and many long slender, prostrate or ascending branches.




Root- well developed, thick, deep penetrating, long, tortuous, cylindrical, tap root, 0.2 to 1.5 cm in diameter; yellowish brown to brown in color; surface mostly soft but rough due to minute, longitudinal striations; root scars, fracture, short; no distinct odor; taste slightly bitter.




Stem- greenish purple, stiff, slender, cylindrical, swollen at nodes, minutely pubescent, glabrous, prostrate or ascending, 4-10 cm long, divaricately branched; branches from common stalk.  



Leaves- opposite, in unequal pairs, larger ones 2.5-3.7 cm long and smaller ones1.2-1.8 cm long; oblong; apex slightly pointed or rounded; base rounded; upper surface green , lower surface white; margin undulate, dorsal side pinkish; thick in texture; petioles nearly as long as the blade, slender.




Flowers- very small, pink, sessile or having a small stalk; 10-25 cm, in small umbels, arranged on slender, long stalks, 4-10 corymb, axillary, in terminal panicles; bracteoles, small, acute, perianth tube constricted above the ovary, lower part greenish, ovoid, ribbed, upper part pink, funnel shaped, 3mm long, tube 5 lobed; stamen 2-3


                                

Fruit- one seeded nut, 6 mm long, rounded, broadly and bluntly 5 ribbed, viscidly glandular


Microscopic Characteristics

Root-  Transverse Section (TS) of mature root shows cork composed of thin-walled tangentially elongated cells with brown walls in outer few layers, cork cambium of 1-2 layers of thin walled cells; secondary cortex consists of consists of 2-3 layers of parenchymatous cells followed by cortex composed of 5-12 layers of thin-walled, oval to polygonal cells; several concentric bands of xylem tissue alternating with wide zone of parenchymatous tissue present below cortical regions; number of bands vary according to thickness of root and composed of vessels, tracheids and fibers; vessels mostly found in groups of 2-8 in radial rows, having simple pits and reticulate thickening; tracheids small, thick-walled with simple pits, fibers separate, elongated, thick-walled, spindle-shaped with pointed ends; phloem occurs as hemispherical or crescentic patches outside each group of xylem vessels and composed of sieve elements and parenchyma, broad zone of parenchymatous tissue, in between two successive rings of xylem elements composed of thin-walled more or less rectangular cells arranged in radial rows; central region of root occupied by primary vascular bundles, numerous raphides, of calcium oxalate, in single or in group present in cortical region and parenchymatous tissue in between xylem tissue; starch grains simple and compound having 2-4 components found in abundance in most of cells of cortex, xylem elements in parenchymatous tissue between xylem elements,  simple starch grains mostly rounded in shape, measuring 2.75-11 microns in diameter.   
Stem- Transverse Section (TS) of stem shows a single layer of epidermis consisting of cuboidal cells; uniseriate glandular trichome consisting of 9-12 stalked cells and ellipsoidal head, 150-220 micron long; cortex consists of 1-2 layers of parenchyma; endodermis indistinct; pericycle 1-2 layered, thick-walled, often containing scattered, isolated fibers; stele consisting of many small vascular bundles often joined together in a ring and many big vascular bundles scattered in ground tissue; intra fascicular cambium present.
Leaf- Transverse Section (TS) of leaf shows anomocytic stomata on both sides; a few short hairs on the surface, the epidermis and the hairs of the leaf are covered with a continuous layer of cuticle. The epidermis at the upper side generally consists of cuboidal and lower side of the tubular cells. The lamina is traversed by several veins, each surrounded by permanent bundle sheath. The palisade one layered; spongy parenchyma 2-4 layered with small air spaces; idioblasts containing raphides; occasionally clustered crystals of calcium oxalate and orange-red resinous matter present in mesophyll. [13], [14]

Parts Used

Whole herb, roots and seeds

Phytochemistry
 
Punarnawaa contains Punarnavine (Alkaloids), Beta-sitosterol (Phytosterol), Liriodendrin (Lignans), Punarnavoside (Rotenoids), Boerhavin (Xanthones),         Flavones, Steroids, Triterpenoids, Hypoxanthine, L-arabinofuranoside, Ursolic acid, Punarnavoside (Glycoside) an antifibrinolytic agent, Arachidic acid, Palmitic acid, Tetracosanoic acid, Hexacosonoic acid, Stearic acid, Ursolic acid, Hentriacontane, Beta-Ecdysone, Fifteen aminoacids including six essential amino acids, glycoproteins and large quantities of potassium nitrate.

The roots are rich in proteins and fats. They contain 14 amino acids including 7 essential ones. They are rich in alkaloids, rotenoids boeravinones A to F, dihydroisofurenoxanthin, punarnavoside an antifibrinolytic agent, lignans, liriodendrin and syringareseniol.

The seeds contain fatty acids and allantoin.
Phytochemical screening of the roots of Boerhaavia diffusa of different ages revealed that the maximum alkaloid count (2%) accumulated in the roots of 3 year old mature plant [15], [16]

Identity, Purity and Strength
(1)
Foreign matter: Not more than 2 percent
Total ash: Not more than 15 percent
Acid-insoluble ash: Not more than 6 percent
Alcohol-soluble extractive: Not less than 1 percent
Water-soluble extractive: Not less than 4 percent [17]

(2) Standardization values accepted by other researchers

Foreign matter: Not more than 2 percent
Total ash: Not more than 10 percent
Acid-insoluble ash: Not more than 3 percent
Heavy metals: 1.0 g complies with the limit test for heavy metals
Loss on drying: Not more than 10.0 percent
Microbial contamination: should comply with microbial contamination tests. [18]

(3) Standards accepted by I. P. in 2010

Foreign organic matter: Not more than 2.0 per cent.
Ethanol-soluble extractive: Not less than 0.5 per cent.
Water-soluble extractive: Not less than 9.0 per cent by method I.
Total Ash: Not more than 10.0 per cent.
Acid-insoluble ash: Not more than 3.0 per cent.
Heavy metals: 1.0 g complies with the limit test for heavy metals
Loss on drying: Not more than 10.0 per cent, determined on 5 g by drying in an oven at 105┬║.
Microbial contamination: Complies with the microbial contamination tests.
Assay-- Determine by liquid chromatography [19]

Cytological Identity

7 Chromosome counts in Boerhavia diffusa L. [20]

Genetic study

By using RAPD marker method genetic identity of Boerhaavia diffusa has been established accurately. [21]

Safety Tests
No safety data for each specific species of herb is available. Here are general guidelines: 

Heavy Metals:
Arsenic:         Not more than 5.0 mg/kg
Mercury:        Not more than 0.5mg/kg
Lead:              Not more than 10.0 mg/kg
Chromium:    Not more than 0.3 mg/kg

Microbial Limits:

Total bacterial count:                                  Not more than 105cfu/g
Total yeast and mould count:                     Not more than 104cfu/g
Bile tolerant gram negative bacteria:          Not more than 104cfu/g

Specific Pathogens:

Salmonella spp:                        Absent in 25 g
Escherichia coli:                     Absent in 1g   
Staphylococcus aureus:         Absent in 1g          
Pseudomonas aeruginosa:     Absent in 1g [22]



Properties and Pharmacology

Ayurvedic properties

Ganas (Classical Catagories)
        Charaka+ Ganas- Warga: Swedopaga (Adjunct to sweating)
        Sushruta+Ganas- Warga: Vidhaarigandhaadi gana and Shaaka warga
        Ashtaanga Sangraha+ Ganas-Warga: Shaaka warga

 

Energetics

 

Rasa (Taste): Madhura (sweet), Tikta (bitter), Kashaaya (astringent), Katu (Acrid, piquant)
Weerya/Virya (Energy State): Ushna (hot)
Wipaaka/ Vipak (End result, Post digestive effect): Madhura (sweet)
Prabhaava/ Prabhav (Special Effect, Prominent Effect):

Note: Here I wish to clarify the meaning of these technical words:
Virya (Weerya): Potency, power, vigor
Vipak (Wipaak): After digestion change of taste. The food we take is acted upon by jatharagni (digestive activity) and the taste of the food changes. The original rasa (taste) changes to vipak (new or same taste.)
Prabhav (Prabhaawa): Effect, prominent, peculiar or special action of an herb. Innate and specific property

Gunas (Qualities): Rooksha (dry)
Effects on Doshas: Waata, Pitta, Kapha
Actions on Dhaatus (Tissues): Rasa (Lymph), Rakta (blood), Maansa (Muscles), Meda (Adipose System), Majja (Bone marrow and nerves), Shukra (Semen or reproductive fluids)
Actions on Srotas (Systems): Rasawaha (Lymphatic system), Raktawaha (Hemopoetic system), Maansa (Muscles)

Auyrvedic Actions (Karma)

 

Anulomana: Prokinetic, Carminative
Shothahara: Anti-inflammatory, Relieves edema
Mootrala: Diuretic
Waatahara: Carminative, causes expulsion of gas
Shlemahara: Expectorant, causes expulsion of phlegm
Kaasaghna: Antitussive
Jwarahara: Antipyretic
Rasaayana: Rejuvenator, Adaptogen  [23], [24]

Important References from Ayurvedic Texts

Charak Samhitaa:

Swedopaga: Adjunct to sweat therapy (diaphoresis) 
Kaasaghna: Antitussive
Wayasthaapaak: Age-stabilizer, Anti-aging
Kushthaghna: Anti-leprotic  [25]

Sushruta Samhitaa:

Shothaghna: Anti-inflammatory, Relieves edema
Jwaraghna: Anti-pyretic
Ashtaanga Sangraha
Kaasaghna: Antitussive
Rasaayana: Adaptogen, Rejuvenator
Wayahsthaapak: Antiaging

Bhaawaprakaasha Nighantu
Kaphaghna: Allays expectoration
Shothaghna: Anti-inflammatory, Relieves edema

Shaarngadhara Samhita

Mootrala: Diuretic  [26]

Ayurvedic Actions

Deepana: Enkindling appetite, Appetizer               
Shothaghna: Anti-inflammatory, Relieves edema         
Kasahara: Antitussive       
Wayasthaapana: Age-stabilize, Promoter of youth and longevity
Rasayana: Rejuvenative, Adaptogen                     
Hridaya: Beneficial to the heart
Stambhana: Constipating, Styptic                 
Chakshushya: Beneficial to eyes                             
Arshaghna: Anti-hemorrhoidal            
Shoola- prashamana: Anti-colic
Mootrala: Diuretic                     
Ashmarighna: Anti-uro-lithiasis, stone breaker              
Mootrakricchaghna:  Relieves or alleviates dysuria [27], [28]

Modern View

 In Ayurveda Punarnawaa is commonly used for jaundice, liver diseases, diabetes, edema, oliguria, anemia, inflammatory edema, diseases of the eye. Enthralled by its medicinal uses described in Ayurveda, recently pharmacologists and clinicians investigated Punarnawaa for all these activities. Their studies validated the claims mentioned in Ayurvedic scriptures. They concluded that Punarnawaa does possess anti-inflammatory, immunomodulatory, anti-microbial, anti-viral, insecticidal, anti-stress, hepatoprotective, diuretic and anti-fertility activities. [29]

Recent pharmacological studies have demonstrated that Punarnawaa possesses anticonvulsant, anti-nociceptive, anti-inflammatory, antibacterial, anti-oxidant, immunomodulatory, anti-allergic, anthelmintic, febrifuge, hepatoprotective, anti-diabetic, diuretic, anti-urolithiatic, nephroprotective, anti-tumor and anti-metastatic activities. These activities are attributed to the chemical ingredients alkaloids (punarnavine), rotenoids (boeravinones A to J) and flavones. [30]

Punarnawaa is now officially included as diuretic in IP. Its diuretic action is attributed to the presence of xanthone, beta-ecdysone and flavonoid. Arabinofuranoside present in the herb was found to lower serum uric acid in experimental animals and also in humans.  

Clinical trials on patients suffering from nephritic syndrome revealed that Punarnawaa reduces urinary protein excretion and increases serum protein levels. This activity is attributed to the presence of rotenoids in the plant. [31]

Punarnavine (Alkaloids)
Molecular formula: C17H22N2O
Structural formula: 




Punarnavine is an alkaloid found in Boerhaavia diffusa. It exhibits anti-inflammatory, anti-oxidant, immunomodulatory, anti-angiogenic, (via down regulation of VEGF), anti-metastatic activities. It induces apoptosis in B16F-10 melanoma cells by inhibiting NF-kB signaling.

In experiments on cats, intravenous injection of punarnavine produced persistent rise of blood pressure and marked diuresis. In a clinical trial for treatment of nephrotic syndrome, the aqueous extract induced profuse diuresis, relieved edema, decreased albuminuria, raised serum protein level, normalized serum cholesterol level and caused an overall improvement in health.
According to some researchers the diuretic action of punarnavine/punarnavoside or entire plant of Punarnawaa is due to inhibition of kidney succinic dehydrogenase system. [32], [33]

Beta-sitosterol (Phytosterol)
Sitosterol
Molecular formula: C29H50O
Structural formula:



Beta-Sitosterol

Beta-Sitosterol is one of several phytosterols (plant-sterols) with chemical structure similar to that of cholesterol. Beta-Sitosterol is a white, waxy powder with a characteristic odor. It is hydrophobic and soluble in alcohols.  

Beta-Sitosterol is found in fruits, vegetables, nuts, and seeds. It is found in pumpkin seeds, cashew, rice bran, wheat germ, corn oil, soybeans and dandelion coffee.

It inhibits absorption of cholesterol from the intestine and reduces total cholesterol and LDL cholesterol. After absorption from the intestine it is incorporated in the cellular membrane.

One small study shows a positive effect on male hair loss in combination with Saw palmetto. In Europe Beta-Sitasterol is used in herbal therapy for benign prostatic hyperplasia (BPH). It is also used for boosting the immunity; prevent colonic cancer, gallstones, rheumatoid arthritis, tuberculosis, psoriasis, allergies, bronchial asthma, bronchitis, chronic fatigue syndrome and erectile dysfunction.

Beta-Sitosterol should be avoided during pregnancy and breast-feeding.

Beta-Sitosterol should be avoided by individuals with sitosterolemia, a rare inherited fat-storage disorder. This condition is correlated with increased risk of heart disease (even heart attacks) and worsening existing heart disease. 

Beta-Sitosterol is a precursor of anabolic steroid boldenone undecyclate that is used in veterinary medicine to induce growth in cattle but commonly abused anabolic steroid in sports. [34], [35]

A study conducted in the Department of Urology, Ruhr-University, Bochum, Germany showed significant improvement in symptoms of the patients of benign prostatic hyperplasia treated with Beta-Sitosterol [36]

Liriodendrin (Lignans)
Molecular formula: C34H46O18
Structural formula:




Liriodendrin is an antiarrhythmic lignin. [37]

Liriodendrin is anti-inflammatory and anti-nociceptive. In an experimental study liriodendrin caused a reduction in acute paw edema induced by carrageenan in rats.  [38]

Liriodendrin may be a potent suppressor of Calcium chloride-induced arrhythmias. The anti-arrhythmic effect of 5mg/kg of liriodendrin was found to be similar to that of 1.05mg/kg of verapamil [39] 

Liriodendrin is calcium channel blocker anti-hypertensive agent. [40] 

Punarnavoside (Rotenoids)

Molecular formula: C28H30O10
Structural formula:



Punarnavoside is a phenolic glycoside. [41]

Rotenoids are anti-inflammatory agents. They have anti-oxidant and genoprotective and anti-cancer activity. It is an anti-fibrinolytic agent [42], [43] 
 Punarnavoside is a phenolic glycoside. [41]

Rotenoids are anti-inflammatory agents. They have anti-oxidant and genoprotective and anti-cancer activity. It is an anti-fibrinolytic agent [42], [43]


Boeravinone (Xanthones)

Molecular formula: C17H12O6
Structural formula:



Boeravinone shows anti-inflammatory, anti-oxidant, genoprotective and anti-cancer activity. [45] 

Hypoxanthine

Molecular formula: C5H4N4O
Structural formula:



Hypoxanthine is a naturally occurring purine derivative. It is occasionally found as a constituent of nucleic acids. [46]

Hypoxanthine is calcium channel blocker anti-hypertensive agent. [47]

L-arabinofuranoside

Molecular formula: C11H13NO7
Structural formula:




It has weak anti-malarial activity [49] 

Ursolic acid

Molecular formula: C30H48O3
Structural formula:







Ursolic acid is a pentacyclic triterpene acid. It occurs in apples, basil, thyme, peppermint and cranberries. Apple peels contain large quantities of ursolic acid. 

By inhibiting the STAT3 activation pathway ursolic acid inhibits various cancer cell types, one of which includes human fibrosarcoma. It may also induce apoptosis in certain cancer cells. It is used in cosmetics. It has potential use as cardioprotective compound. [50]

Ursolic acid stimulates muscle growth and increases skeletal muscle mass. It increases brown fat, increases energy expenditure leading to reduce obesity. It is improve glucose tolerance and decreases hepatic steatosis. Ursolic acid is therefore used to treat obesity, glucose intolerance and fatty liver disease. [51]

Beta-Ecdysone
Molecular formula:  C27H44O6                        
Structural formula:




Beta-ecdysones are steroidal prohormones. Ecdysteroids appear in many plants. They offer protection to plants against herbivorous insects. They have been reputed to have medicinal value and are part of herbal adaptogenic remedies, yet an ecdysteroid precursor in plants has been shown to have cytotoxic properties.  [52]

In animals ecdysones control molting (moulting aka sloughing = shedding feathers, hair, skin, exoskeleton). In higher animals they are known as inducers for gene-switch systems. In mammals and humans they have actions like estrogens without untoward effects of estrogens. [53]

Some testimonials from modern research

Anti-Inflammatory Activity

In one study Punarnawaasawa, a fermented decoction of Punarnawa (Boerhaavia diffusa) significantly inhibited carrageenan-induced rat paw edema, cotton pellet-induced granuloma, formalin-induced paw licking and yeast-induced hyperpyrexia. Punarnawaasawaa also healed pyloric ulcers in rats. [54]

Anti-oxidant activity

Chloroform, ethanol and water extracts of dried roots of Punarnawaa were screened to evaluate the anti-oxidant activity of the herb. Among these three extracts, ethanol extract showed the best anti-oxidant activity than the other two.

This study validates that Punarnawaasawa containing self- generated alcohol is the best preparation for medicinal use. [55]


Immunomodulatory activity

Punarnavine is an alkaloid present in Punarnawaa. The effect of Punarnavine on the immune system was studied by some researchers using Balb/c mice. Intraperitoneal administration of Punarnavine (40 mg/kg body weight) increased WBC count, bone marrow cellularity number of alpha-esterase positive cells. Administration of Punarnavine along with sheep RBCs produced an enhancement in circulating antibody titer and the number of plaque forming cells in the spleen. Punarnavine also showed enhanced proliferation of spleenocytes, thymocytes and bone marrow cells both in the presence and absence of specific mitogens in vitro and in vivo. Administration of Punarnavine significantly reduced the LPS (Lipopolysaccharide) induced elevated levels of proinflammatory cytokines such as TNF-alpha, IL-1beta and IL-6 in mice. These results indicate the immunomodulatory activity of Punarnavine. [56]

Punarnavine was studied for its effect on cellular and humoral functions in mice. Oral administration of the alkaloid (25-100 mg/kg body weight) significantly inhibited sheep RBC-induced delayed hypersensitive reactions in mice. The inhibition was observed only during post-immunization drug treatment, while no effect during pre-immunization drug treatment was observed. A significant dose-related increase in antibody titer was observed during pre- and post-immunization treatment. Punarnavine failed to show any blastogenic responsiveness of murine splenocytes to Concanvalin A (Con A) and Lipopolysachharide (LPS). Similarly, Punarnavine did not display any mitogenic activity. [57]

Antimicrobial Activity

The ethanolic extract of the whole plant of Boerhaavia diffusa (Punarnawaa) shows significant antimicrobial activity against Staphylococcus aureus strains, Bacillus subtilis UC564, Salmonella typhi DI and Escherichia coli. Needless to say, that the activity was dose dependant. [58]

Antiviral Activity

Recently Punarnawaa was found to be a potent antiviral agent. It showed antiviral activity against many viruses. The antiviral agent isolated was a glycoprotein with molecular weight of 16-20 kDa. (Awasthi and Verma, 2006) [59]


The antiviral action glycoprotein is said to be mediated via RNA of viruses. We did not find any reference or research paper stating clearly that Punarnawaa has anti-hepatitis virus (virus A to E) activity. Punarnawaa is used in polyherbal Ayurvedic formulations for the treatment of jaundice (viral hepatitis) because of its hepatoprotective activity and the synergism with other herbs having antiviral activity. (For details read below: Hepatoprotective Acivity)   

Hepatoprotective Activity

Punarnawaa roots normalize the elevated levels of SGOT, SGPT, serum acid phosphatase and serum alphafetoprotein. The experimental work done by researchers validates the use of Punarnawaa roots in hepatic ailments by several tribes in India. The alcoholic extract of whole plant produced increase in bile flow in rats. This shows Punarnawaa has choleretic activity.

Punarnawaa reduces elevated levels of cholesterol and triglycerides and reduces or prevents the accumulation of fat in the liver. [60]


Mechanism of Hepatoprotection:

Does Punarnawaa regenerate hepatocytes? May be may be not! If administered internally as medicine, does it repair hepatocyte damage? It certainly does! If administered internally as adaptogen (Known as Rasaayana in Ayurveda); does it arrest further liver damage? It certainly does!!  

By virtue of its anti-inflammatory, anti-oxidative, anti-microbial, anti-viral, immunomodulatory, laxative, choleretic, detoxificating and diuretic activities Punarnawaa acts as a hepatoprotective agent. I would say Punarnawaa is a hepatoprotective agent par excellence! [61]

Culinary uses

Used as vegetable in some states in India.

Medicinal Actions and Uses

Traditional Uses

In India, Nepal, Sri Lanka and Tibet Punarnawaa is used for gastritis, amlapitta (hyperacidity), intestinal colic, diarrhea, jaundice, liver-gallbladder disorders, fatigue, anemia, muscular pain, urinary disorders, ophthalmic problems, blindness, menstrual disorders, increasing virility and treatment of edema. People in tribal area use it to hasten child birth. [62]

Usages in Ayurveda

In Ayurveda it is used as stomachic in dyspepsia, to treat intestinal colic, jaundice and anemia. As diuretic it is used to treat ascites, dropsy (CCF); to treat enlargement of the spleen. It is used for obesity and alopecia [63]

Usages in Modern Medicine

It should be considered for the treatment of viral hepatitis, non alcoholic fatty liver disease, in precirrhotic stage of liver disease and as diuretic in portal hypertension to treat ascites.     

Toxicity, Contraindications

Punarnawaa in moderate doses is laxative but in large doses can be a drastic purgative; hence should be used with caution in children and must not be used during pregnancy and lactation. [64]

Preparations and dosages

Punarnawaadi Kwaath: (Punarnawaashtak)

A dose of 30ml of decoction is prepared from 1.56 gm each of Punarnawaa (Boerhaavia diffusa), Bakan ninb (Melia azadirachta), Kutakee (Picrorrhiza kurroa), Guduchee (Tinospora cordifolia), Hareetakee (Terminalia chebula), Daaru haridraa (Berberis aristata), Patola (Trichosanthes dioica), Aardraka or Shunthee (Zingiber officinalis/ Zingiber officinale). 

Dose: 20 to 30 ml
Punarnawaasawa:
Dose: 20 t0 30 ml
Punarnawaadi Choorna:
Root powder
Punarnawaadi Mandoor:
For anemia
Punarnawaa Guggula:
Punarnawaambu:
Sukumaar ghrita:
Shothaghna Lepa:   [65], [66]




References

Debit Bhowmik et al, Traditional Indian Herbs Punarnava and its Medicinal Importance, Journal of Pharmacognosy and Phytochemistry; Vol. No. 1, 2012;
www.phytojournal.com 



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