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316 Seyedeh Mahnaz Karimi
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and finally wound healing drugs are used.
Some cleansing and emollient herbal medicines are juice of jujube (Ziziphus jujuba),
violet, poppy, root of dog rose, flower of
mallow, seeds of sebesten (Cordia myxa),
chicory (Cichorium intybus), quince (Cydonia
oblonga), and traganth gum. Some multiherbal drying medicines are “caraway maʿ-
jun” (maʿjun is an oral, semisolid traditional
medicine consisting of several herbs with
honey), athānasyā maʿjun, lozenge of linseed, mitrādāte maʿjun, and Armenian bole
poultice. If the lung ulcer is old, tar with
honey is recommended for a small spoon
only once. For treatment of fever, sugar
syrup including fennel seeds, licorice root
paste, and maidenhair fern extract is very
effective. Avicenna has considered the incense (administered by funnel) of natural
compounds such as pepper, sweet olive
leaves, birthwort (Aristolochia spp.), caper
root bark, and poplar bark to clean and dry
lung ulcers. It is stated in Canon that consuming a herbal mixture made from rose
petals and sugar (which is mentioned in
Traditional Persian Medicine (TPM) books)
every day for a year is very effective for
treating TB.
For people with TB, consumption of certain foods – such as poultry meat (Francoli-
nus spp.), barley juice, wheat bread, rice
soup, pumpkin, raisins, crabs, vegetables,
lentils, cucumber, casaba melon, cabbage,
and asparagus – as well as beverages such as
sweet white wine, oxymel, or a drink con
taining sorrel is recommended. These patients should not be angry and should rest.
Drinking buttermilk is highly recommended
in patients with TB in accordance with the
principles. The lactating animal should eat
plants that are effective in healing lung ulcers like knotgrass.
Myrtle seed, violet seed, bamboo cane,
traganth, burnt crabs, hemp, gum arabic, lily
juice with purslane juice, and cucumber juice
are useful for bloody cough. Rubbing carved
red or white sandalwood in rose water with a
little clay topically on the right side of the
chest is useful for the treatment of uvulitis
(Ibn Sinā, 2015a).
Brief Review on the Most Common
Types of Tuberculosis and Their
Treatments in Modern Medicine
Tuberculosis
TB is caused by M. tuberculosis, which is a
nonmotile, aerobic, rod-shaped bacterium
and is transmitted through droplet infection
(Suárez etal., 2019). After inhalation, the
bacterium grows intercellularly and extracellularly in the well-ventilated lung, especially in the alveolar macrophages. Intracellular bacteria also survive the body’s defense
mechanism and form the tuberculous granulomas (Stewart et al., 2003). Most patients
develop a latent tuberculosis infection (LTBI)
without any clinical symptoms (WHO, 2018).
The risk of reactivation of the TB infection is
higher in the first 2 years after the initial infection and in children and those with untreated HIV infection (WHO, 2018). Also,
the risk of TB reactivation increases in conditions of immunosuppression such as diabetes mellitus and terminal kidney failure
(Suárez etal., 2019).
Latent tuberculosis infection
LTBI is an infection with a vital nonreplicating TB pathogen. The results of immunologic
tests (interferon-γ release assays) are positive
but signs cannot be detected on the radiograph. These people have no clinical symptoms and they are not contagious, but their
infections can become active by weakening
the cellular immunity (Suárez etal., 2019).
Forms of disease
Pulmonary tuberculosis
In 2017, almost three-quarters of TB cases
registered in Germany affected the lungs
(Brodhun et al., 2019). These people had
shown symptoms such as fever, night sweats,
fatigue, violent cough, and hemoptysis. In
Tuberculosis Management 317
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people without immunodeficiency, pulmonary TB progresses slowly, but in children and
people with immunodeficiency, it progresses
much faster (Suárez etal., 2019).
Extrapulmonary tuberculosis
Prevalence of extrapulmonary TB is very
low; however, reports from some regions
have shown that it is increasing. It is more
common in children and immunocompromised individuals and its symptoms vary depending on the individual organ involved
(Oliveira et al., 2007). In 2017, half of extrapulmonary TB cases registered in Germany involved lymph node TB (Brodhun
etal., 2019). Disseminated TB is an infection
in which mycobacteria have spread from the
lungs to two or more organ systems; it was
previously seen only in children or persons
with immune suppression, but has now also
been identified in people without defective
immune systems (Suárez etal., 2019).
Treatment
The World Health Organization (WHO) has developed a new strategy to control TB called
DOTS (Directly Observed Treatment, Shortcourse). Treating TB generally requires taking
several antibiotics for a long time (Bansal etal.,
2018). The aim of TB treatment is to cure the
disease and reduce its transmission. Anti-TB
drug regimens are usually successful with efficacy of up to 95%, but this percentage varies
with location. The DOTS strategy has five
elements: political commitment and financial
support to control TB; identifying patients;
providing an effective and standard medication
regimen; ensuring regular supply of medicine;
and reporting of the results. The importance of
using this strategy is greater in children, the
elderly, and homeless persons, and for people
with drug-resistant TB (Rabahi etal., 2017).
Standard treatment
Conservative treatment for pulmonary TB
includes 2 months of quadruple therapy with
INH, RMP, pyrazinamide (PZA), and ethambutol (EMB), followed directly by a further
4 months of dual administration of RMP and
INH (Bass etal., 1994; Suárez etal., 2019).
In extrapulmonary forms, depending
on the organ involved, higher dosage and
longer treatment are needed, such as TB of
the central nervous system, which requires
12 months of treatment (Suárez et al., 2019).
Resistance to standard drugs and
preventive treatment
In some patients, resistance to one of the
abovementioned TB drugs (INH, EMB, RMP,
PZA, streptomycin) may occur. Multiple resistance occurs when resistance to more
than one drug (including RMP or INH) is observed. This requires prolonged treatment
in specialized centers where the use of
fluoroquinolone is replaced accordingly
(Suárez etal., 2019).
Preventive treatment means treating
the bacteria at rest. It is important for
people with HIV or those taking immunosuppressive drugs to reduce the risk of bacterial activation (Suárez etal., 2019).
Adverse effects
Side effects of applied TB drugs include skin
complications such as flushing and itching
(mostly with RMP and INH), gastrointestinal complications such as nausea and
vomiting, visual side effects (with EMB and
streptomycin), hepatotoxicity, arthralgia,
and neuropathy such as tingling. Side effects
are often mild, such as gastrointestinal side
effects or exanthema, which are treated
symptomatically, but sometimes these complications are severe (4 to 9% of patients). In
severe hepatotoxicity, temporary discontinuation of treatment is required. Ophthalmologic examination at 4-week intervals is
recommended for the detection of visual
neuroma (less than 1% of patients with
EMB). Neurologic complications such as
peripheral neuropathy and psychosis are
rare (less than 1%) (Gülbay et al., 2006).
318 Seyedeh Mahnaz Karimi
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However, in high-risk individuals, such as in
pregnancy, pyridoxine with INH is recommended for prevention (WHO, 2016). PZA
can increase serum uric acid; therefore, dose
adjustment is required for EMB and PZA in
renal failure (Suárez etal., 2019).
Scientific Evaluation of Medicinal
Plants Mentioned for the
Management of Tuberculosis
in Canon of Medicine
The medicinal herbs mentioned for the
management of TB in Avicenna’s Canon and
some scientific evidences substantiating
their efficacy are described individually in
this section. All the collected results are
shown in Tables 9.1, 9.2, 9.3, and 9.4.
Aristolochia species
Aristolochia (birthwort) is a genus with more
than 500 species belonging to the Aris-
tolochiaceae family. Aristolochia spp. are
subshrubs or shrubs and are widely distributed in tropical, subtropical, and temperate
regions of the world. Their secondary metabolites are aristolochic acids and esters,
aristolactams, aporphines, flavonoids, lignans, protoberberines, isoquinolines, benzylisoquinolines, amides, biphenyl ethers,
coumarins, tetralones, terpenoids, benzenoids, and steroids (Kuo etal., 2012). Aristolochic acids are the main compounds in
most Aristolochia spp., which have nephrotoxicity and genotoxicity (Bartha et al.,
2019). The roots of Aristolochia spp. were
used in traditional medicine. Avicenna has
considered the incense of roots of caper,
poplar, and Aristolochia to be effective in
treating TB (Ibn Sinā, 2015a).
Several studies have shown that the extracts of Aristolochia brevipes Benth., Aris-
tolochia cymbifera Mart., Aristolochia indica
L., Aristolochia mollissima Hance, and Aris-
tolochia taliscana Hook. & Arn. have significant antimicrobial properties (Kuo e tal ., 2012).
Isolated licarin (5 mg/kg) from A. taliscana
root was evaluated for 30 and 60 days in
mice infected with drug-sensitive or MDR
strains and showed a significant decrease in
pulmonary bacillary burdens and no abnormalities in main organs. The study proved
the antitubercular and anti-inflammatory
properties of licarin in an animal model
(León-Díaz etal., 2013). Navarro-García and
co-workers showed that the dichloromethane extract obtained from the rhizomes of
A. brevipes has strong in vitro antimycobacte-
rial activity against M. tuberculosis H37Rv
and aristolactam I was identified as the most
active compound against all mycobacterial
strains. In traditional medicine, A. brevipes
was used for diarrhea, arthritis, cleansing
wounds, and bloody cough (Navarro-García
etal., 2011). Isolated eupomatenoid-1 from
Aristolochia elegans Mast. rhizomes has anti-
mycobacterial activity against M. tuberculosis H37Rv (Jiménez-Arellanes etal., 2012).
Another study showed that the substances
cubebin and fargesin isolated from A. elegans
rhizome have antimycobacterial activity
against M. tuberculosis H37Rv, four monore-
sistant variants, and two MDR M. tubercu-
losis clinical isolates (Oliveira etal., 2007).
A. elegans Mast. (guaco) is known for its
expectorant, antitussive, antiasthmatic,
analgesic, antihistamine, and detoxicant
effects (Shi etal., 2004). As a result, due to
their antimicrobial, antitussive, and antiinflammatory activity, Aristolochia spp. are
considered in the treatment of TB, but the
effects of nephrotoxicity should be further
investigated.
Capparis spinosa L.
Capparis spinosa L. (caper), belonging to the
family Capparaceae, is a perennial shrub
that grows mainly in warm climates and
grows sparingly in most parts of the Middle
East as a wild plant (Ehsanifar etal., 2017;
Annaz et al., 2022). Roots and flower contain pectin, saponin, aresin material,
aminoglycosides, and kaparyroutin. It has
been found that the main chemical active
No. Scientific name Synonym Arabic name Common English name Family
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1 Acacia senegal (L.) Britton
Basion ym: Mimosa senegal L.
2 Asparagus officinalis L. Asparagopsis adscendens Roxb.
3 Adiantum capillus-veneris L. Adiantum africanum R. Br.
4 Aristolochia clematitis L. Aristolochia infesta Salisb.
5 Astragalus gummifer Labill. – Kathyr a’ Traganth, gum dragon Fabaceae (Leguminosae)
6 Capparis spinosa L. – Kabar Caper, caperberry Capparaceae
7 Carum carvi L. Bunium carvkammun L.
8 Cichorium intybus L. – Hendeba’ Chicory Asteraceae (Compositae)
9 Cinnamomum camphora L. Camphora camphora L. Kafur Camphor laurel Lauraceae
10 Commiphora mukul (Hook. ex
Stocks) Engl.
Basion ym: Balsamodendrum
mukul Hook. ex Stocks
11 Cordia myxa L. – Sebestan Assyrian plum, lasura, laveda Boraginaceae
12 Cuscuta epithymum (L.) L.
Basion ym: Cuscuta eur opaea
var. epithymum L.
13 Cydonia oblonga Mill. Cydonia communis Loisel.
14 Drimia maritima (L.) Stearn
Basion ym: Scilla maritima L.
15 Foeniculum vulgare Mill. Anethum dulce DC.
Acacia cufodontii Chiov.
Acacia seneg al (L.) Willd.
Asparagus satawur
Protasparagus adscendens Roxb.
Adiantum capillus Sw.
Aristolochia tenuis Houtt.
Carum aromaticum Salisb.
Balsamea mukul Baill. Moql Indian bdellium tree, guggul,
– Aftimun Clover dodder Convolvulaceae
Cydonia cydonia (L.) Pers.
Charybdis maritima (L.) Speta
Urginea maritima (L.) Baker
Anethum foeniculum L.
Foeniculum azoricum Mill.
Samgh Gum arabic, gum acacia, Fabaceae (Leguminosae)
Haliun Asparagus Asparagaceae
Barshiavoshan Venus’s hair, maidenhair fern Pteridaceae
Zarawand Birthwort Aristolochiaceae
Kammun Caraway Apiaceae
mukul
Safarjal Quince Rosaceae
Ashqeil, ʿonsol Squill Asparagaceae
Razianj Fennel Apiaceae
Burseraceae
Tuberculosis Management 319
Continued
No. Scientific name Synonym Arabic name Common English name Family
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16 Glycyrrhiza glabra L. Glycyrrhiza glabra subsp .
glandulifera (Waldst. & Kit.)
Ponert
Glycyrrhiza glabra var. laxifoliolat a
X.Y. Li
17 Linum usitatissimum L. – Katan Linseed, flaxseed Linaceae
18 Malva sylvestris L. – Khobbazi Cheeses, high mallow, tall
19 Myrtus communis L. – As Myrtle Myrtaceae
20 Papaver somniferum L. – Khashkhah Opium poppy Papaveraceae
21 Populus alba L. – H awr abyad Silver-leaf poplar, white-leaf
21 Portulaca oleracea L. – Baqlah hamqa’ Duck-weed, little hogweed,
20 Santalum album L. Sirium myrtifolium L. Sandal Sandalwood Santalaceae
22 B ambusa bambos (L.) Voss
Basion ym: Arundo bambos L.
Rosa actinodroma
Rosa adenocalyx
24 Rosa × damascena Herrm. – Wardat al-hamra’ Damask rose, Persian rose Rosaceae
25 Rumex acetosella L. Acetosa acetosella (L.) Mill. H ommad Red sorrel, sheep’s sorrel Polygonaceae
26 Vicia er vilia (L.) Willd.
Basion ym: Ervum ervilia L.
27 Viola odorata L. – Banafsaj Sweet violet Violaceae
28 Ziziphus jujuba Mill. – Oʿnnab Jujube Rhamnaceae
Ervilia sativa
Lens pygmaea Grossh.
– T abashir Indian thorny bamboo Poaceae
Sus Licorice, liquorice Fabaceae (Leguminosae)
Malvaceae
mallow
Salicaceae
poplar
Portulacaceae
purslane
Kersannah Bitter vetch, ervil Fabaceae (Leguminosae)
320 Seyedeh Mahnaz Karimi
Plant Part/extract Active constituent Method Animal Effect Reference
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Aristolochia
taliscana
Carum carvi Fruits/butanol
Cichorium intybus R
Cuminum cyminum,
Carum carvi
Glycyrrhiza glabra Root/LDPI
Roots/hexane
extract
extract
oots/aqueous
extract
Roots/aqueous
extract
Fruits/aqueous
extract
containing
licorice extract
Licarin Inducing disease with
Mycobacterium
tuberculosis H37Rv or
MDR, treating with licarin
(5 mg/kg); post
treatment, determining
lung bacilli loads and
pneumonia percentage
Triflorin (kaempferol-3-β-
D-galactoside)
Inulin INH-induced hepatotoxicity
Inulin PZA-induced hepatotoxicity
3,5-Dihydroxyflavone-7-O-
β-D-galacturonide-4-Oβ-D-glucopyranosid
(cumin)
Glabridin Film hydration technique
Determining bioavailability
indices of the anti-TB
drugs RMP, PZA,
and INH
in adult male mice
in male mice
Determining plasma levels
and bioavailability of RIF,
INH, and PZA
and freeze-dried
BALB/c mouse Antitubercular effect against
both mycobacterial
strains, no major signs of
damage in subacute
toxicity
at
Wistar r
BALB/c albino
mouse
BALB/c albino
mouse
Wistar new line
rat
Mouse Antitubercular activity Viswanathan
Herbal bioenhancer of the
anti-TB drugs
Hepatoprotective Ali etal. (2016)
Hepatoprotective Munir etal.
Bioenhancer of the anti-TB
drugs
León-Díaz etal.
(2013)
Sachin etal.
(2009)
(2019)
Bhusari (2010)
etal. (2019)
Tuberculosis Management 321
Tab le 9.3. Recent in vitro studies on medicinal plants for treatment of TB mentioned in Avicenna’s Canon of Medicine.
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Plant Part/extract Active constituent Assay Effect Reference
Aristolochia
brevipes
Aristolochia
elegans
Aristolochia
Cham.
Aristolochia
triangularis
Capparis spinosa Fruits/methanol extract – MIC of bacterial growth by
Glycyrrhiza
glabra
Populus alba L. Leaves/aqueous and
Myrtus communis Leaf extract Limonene, 1,8-cineole,
Rosa ×
damascena
Rhizome/
dichloromethane
extract
Rhizomes/hexane extract Fargesin, cubebin
Leaf, root and stem/
aqueous and
hydroalcoholic extracts
Rhizome and stem/
methanol extract
Root/LDPI containing
licorice extract (LE)
Root/ethanolic extract
Rhizome Isoliquiritigenin and
ethanol extract
Flowers Citronellol, nerol Hydrodistillation and solvent
Aristolactam I Antimycobacterial activity
by fluorometric
microplate Alamar Blue
assay, column
chromatography, NMR
1
H-NMR, microplate Alamar
Blue assay
Nerolidol Time-to-kill assay Antimycobacterial activity Oliveira etal. (2007)
Nerolidol Microplate Alamar Blue
assay
the proportional method
Glabridin Film hydration technique
and freeze-drying
Glabridin TLC, NMR, MIC by the
twofold serial dilution
technique, standard
REMA
Molecular docking and in
liquiritigenin, analog
Flavonoids, polyphenols Disk method, TLC Antimycobacterial effect
and α-pinene
silico ADME studies
Proportional method Antimicrobial activity Zanetti etal. (2010)
extraction
Antimycobacterial activity
against resistant
Mycobacterium
tuberculosis (MDR-TB)
Antimycobacterial activity Jiménez-Arellanes
Antimycobacterial activity Pereira etal. (2018)
Antimycobacterial activity Ehsanifar etal.
Antitubercular activity Viswanathan etal.
Antimicrobial activity against
both Gram-positive and
Gram-negative bacteria,
antitubercular activity
Anti-tuberculosis activity Gaur etal. (2015)
against three mycobacter ia:
Mycobacterium smegmatis,
Mycobacterium aurum, and
Mycobacterium bovis
M. bovis inactivation Fatemeh etal.
Navarro-García etal.
(2011)
etal. (2012)
(2017)
(2019)
Gupta etal. (2008)
Haouat etal. (2013)
(2015)
322 Seyedeh Mahnaz Karimi
Santalum album Endophytic fungus Asperterpenoid A Single-crystal XRD using Cu
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Kα radiation, antimicrobial
activity by conventional
broth dilution assay
Sandalwood essential oil Sesquiterpene alcohols
α-santalol, β-santalol,
epi-β-santalol, and
trans-α-bergamotol
with α- and β-santalol
Viola odorata Flower Salicin and phenyl
alanine ethyl ester
ADME, absorption, distribution, metabolism, excretion; HPLC, high-performance liquid chromatography; LCMS, liquid chromatography–mass spectrometry; MDR-TB, multidrug-resistant
TB; mPTPB, M. tuberculosis protein tyrosine phosphatase B; MtSK, M. tuberculosis shikimate kinase; NMR, nuclear magnetic resonance spectroscopy; REMA, resazurin microtitre
plate assay; TLC, thin layer chromatography; XRD, X-ray diffraction.
LCMS, colorimetric
microdilution broth assay
Preparative HPLC, LCMS,
determining MIC
Anti-inflammatory activity,
potent inhibitory activity
against mPTPB
Antituberculosis activity, MtSK
inhibition
Antimicrobial activity against
M. tuberculosis H37Rv
Yan etal. (2018)
Rants’o etal. (2017)
Hassan and Naeem
(2014)
Tuberculosis Management 323
Table 9.4. Clinical studies on medicinal plants for treatment of TB mentioned in Avicenna’s Canon of Medicine.
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Plant Treatment group Control group Study design No. of patients
Carum carvi A single FDC
containing RMP (450
mg), INH (300 mg),
and PZA (1000 mg),
plus capsule of C.
– Prospective,
two-period,
open-label,
crossover
experiment
20 10 days ↑ Plasma levels, C
carvi extract (100 mg)
Glycyrrhiza
glabra
Capsule (450 mg) of
Rasayana daily along
with the standard
regimen of
pulmonary TB
Standard regimen of
pulmonary TB, which
includes INH (600 mg)
RMP (450 mg), PZA (150
mg), and EMB (1200 mg),
Single-blind
controlled study
133 60 days ↓ Cough, fever,
3 times weekly on
alternate days
Licorice, nettle, tansy,
mint
Essentiale, legilon, Liv-52,
hemodez
Single-blind
controlled study
112 ↓ Occurrence of HTR Galitskií etal.
Treatment
duration Result Reference
,
Choudhary
and AUC of RMP,
max
etal.
(2014)
INH, and PZA
Vyas etal.
dyspnea, and
(2012)
hemopty sis; ↑ body
weight
(1997)
324 Seyedeh Mahnaz Karimi
AUC, area under the plasma drug concentration versus time curve; C
, maximum serum concentration.
max
Tuberculosis Management 325
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compounds are flavonoids (Heidari et al.,
2003). In TPM, different parts of the plant
like fruits, roots, bark, leaves, buds, and
stems were used. Therapeutic effects of caper
in traditional medicine include especially improving liver function, anti-flatulence, prevention of atherosclerosis, and improving
anemia, gout and arthritis (Rhizopoulou
etal., 2006). It has been shown that C. spinosa
fruits possess considerable antimycobacterial properties in the laboratory (Ehsanifar
etal., 2017).
Carum carvi L.
Caraway (Carum carvi L.) belongs to the fam-
ily Apiaceae. This species is cultivated all
over the world and widely used in food products (Rasooli and Allameh, 2016). Caraway
has many uses in traditional medicine such
as for gastrointestinal problems (cramps,
nervous cardiac-gastric complaints, flatulence, irritable intestinal, indigestion, low
appetite, infant colic) and for improving lactation. It is a tranquilizer, diuretic, emenagogue, aphrodisiac, and astringent (Al-Snafi,
2015; Rasooli and Allameh, 2016). In caraway essential oil, more than 30 compounds
have been identified of which carvone and
limonene represent the main substances
(Wichtmann and Stahl-Biskup, 1987; Edláková etal., 2003). The essential oil obtained
from caraway fruits showed promising inhibitory activity against M. tuberculosis, nine
other pathogenic bacteria, and six phytopathogenic fungi (Sadowska and Obidoska,
1998). Another study showed that caraway
active principles act as a bioenhancer and
are able to modify the kinetics of drugs used
in TB treatment. After administration of
caraway extracts in fixed dose combination
(FDC) to 20 healthy human volunteers, increased plasma levels of RMP, INH, and PZA
were observed (Choudhary etal., 2014). Due
to caraway’s pharmacologic properties such
as antimicrobial, antioxidant, analgesic,
bronchial relaxant effects, and enhancement of TB drug kinetics, it can be considered a useful phytopharmaceutical drug
in the treatment of TB (Al-Snafi, 2015).
Cichorium intybus L.
Chicory (Cichorium intybus L.), a Mediterra-
nean erect perennial plant, belongs to the family Asteraceae. Previous studies showed that
application of chicory root extracts provides
liver protective, immunomodulatory, antiglycemic, anti-inflammatory, lipid-lowering, neuroprotective, and gastrointestinal tract protective effects (Munir etal., 2019). Previous
studies were published proving that the extract
of C. intybus roots has significant hepatoprotective activity in high doses (Ali etal., 2016;
Munir etal., 2019).
Glycyrrhiza glabra L.
Licorice (Glycyrrhiza glabra L.) is a traditional
medicinal plant, the root of which is very sweet,
moist, and soothing and contains flavonoids
and triterpenoids (Lee et al., 2009). Some
bioactive compounds identified in licorice root
are glabridin and liquiritin (a glycosidic form of
liquiritigenin) (Lee et al., 2009; Sharma et al.,
2016; Roque et al., 2018). Previous studies
have shown that these compounds possess
anti-inflammatory, antiulcer, antimicrobial,
and antifungal activities (Roque etal., 2018).
In Avicenna’s Canon the decoction or extract of roots was considered useful for TB
treatment. Avicenna has suggested to use fennel fruits, licorice root paste, and maidenhair
fern extract for treatment of TB fever (Ibn
Sinā, 2015a). It was shown that glabridin is an
active compound against M. tuberculosis
H37Ra and H37Rv strains at 29.16 μg/ml concentration (Gupta etal., 2008). In vivo evaluation of a liposomal dry powder for inhalation
(LDPI) containing licorice extract showed a
significant reduction in bacterial counts in the
lungs and spleen of TB-infected mice (Viswanathan etal., 2019). Administration of a herbal
medicine containing several herbs including
licorice, called Rasayana, along with anti-Koch’s treatment (AKT) showed that, due
to its antioxidative, immunoprotective, and
free radical scavenging properties, Rasayana
therapy was able to significantly decrease TB
complications like cough, fever, dyspnea, and
hemoptysis (Vyas etal., 2012).
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