Background: Liver diseases and chronic inflammatory disorders represent a profound global health challenge, significantly contributing to morbidity and mortality. In resource-limited settings such as Yemen, this burden is compounded by high rates of viral hepatitis, metabolic liver disorders, and inadequate access to modern synthetic therapies. Objective: To systematically review the epidemiology of hepatic and inflammatory disorders in Yemen and provide a comprehensive ethnobotanical and pharmacological rationale for a polyherbal intervention combining Acalypha fruticosa and Tribulus terrestris. Methods: A detailed review of the literature was conducted, mapping the phytochemistry, traditional uses, and molecular mechanisms of both plants to identify synergistic hepatoprotective and anti-inflammatory properties. Discussion: The integration of multiple herbs addresses the multifactorial nature of liver injury. Acalypha fruticosa offers robust anti-inflammatory action by activating PPAR-α and PPAR-γ receptors via its cyanogenic glycoside, Acalyphin. Concurrently, Tribulus terrestris protects hepatocytes from oxidative stress and downregulates the NF-κB pathway via steroidal saponins and Tribulusamides. The amphiphilic nature of Tribulus saponins theoretically enhances the bioavailability of antioxidant flavonoids from Acalypha. Conclusion: A dual-herb approach combining A. fruticosa and T. terrestris presents a scientifically justified, multi-target strategy for managing hepatic inflammation. This synergism offers a sustainable, cost-effective, and safe alternative to single-target synthetic hepatoprotectives.
Amina El-Shaibany1,3*, Maged Alwan Noman2,3, Mahmoud Mahyoob Alburyhi2, Abdalwali Ahmed Saif2, Alaa Al-Deen Fahd Al-Khulaidi3, Majed Mohammed Al-Dhaiah3, Abdulghani Ayed Haimed3 and Abdul Majeed Dhaif Faris3 (Sat,) studied this question.