Picrorhiza kurroa Royle ex Benth (Family: Scrophulariaceae)
Sanskrit: Katuka, Katurohini Tamil: Katukarogini Hindi: Kutki
Picrorhiza kurroa is best known for its hepatoprotective action (see Chapter 4) because of the extensive scientific work carried out on this aspect, especially on the activity of picroliv, an iridoid glyco-side mixture isolated from Picrorhiza kurroa. However, in traditional medicine, it is known as a bitter tonic and laxative in small doses, al-though acting as a cathartic in larger doses.1
Kutkin, the iridoid glycoside mixture obtained by alcoholic extrac-tion of P. kurroa rhizomes, and its two constituent organic acids, cinnamic acid and vanillic acid showed significant choleretic and lax-ative effects in dogs2and rats.3Extraction with ethanol leads to en-richment of the laxative effect. The order of activity is picroside I (3.55), kutkoside, kutkin (3), defatted alcoholic extract (2.79), and alcoholic extract (2.31) when compared to crude drug powder.2
One gram of the rhizome powder caused moderate cathartic effect, with a single motion 10 hours after intake. With higher doses of 6 g, drastic purgation was seen.2The powder was better than decoction and cold infusion, probably because of the insolubility of the active constituents in water.
In a comparative study, it was found that kutlki was weight/weight 1.5 times more potent than senna and 7.26 times more potent than castor oil.2The safety and tolerability of kutlki is covered in Chapter 4
“Hepatoprotective agents.”
NOTES
1. Nadkarni AK. Dr. KM Nadkarni’s Indian materia medica (vol. 1, pp. 953-956).
Bombay: Popular Prakashan, 1976.
2. Chaturvedi GN, Gupta JP, Tiwari SK, Rai NP, Mishra A, Kumar S, Singh KP.
Research progress in Ayurvedic gastroenterology. J Res Edu Indian Med 1(4):7-15 (1982) and references cited therein.
3. Das PK, Tripathi RM, Agarwal VK, Sanyal AK. Pharmacology of kutkin and its two organic acid constituents—Cinnamic acid and vanillic acid. Indian J Exp Biol 14:456-458 (1976).
DIARRHEA
Diarrhea is very common in India, especially the ones due to bac-terial and protozoal infections. Thus infections like amoebiasis and giardiasis caused by protozoa and bacterial infections caused by Escherichia coli and Vibrio cholerae are common. It is also a major cause of morbidity and mortality and a large number of plants have been used in Ayurveda for control of diarrhea and dysentery.
Aegle marmelos Correa (Family: Rutaceae)
Sanskrit: Bilva Tamil: Vilvam
Hindi: Bel English: Stone Apple, Bengal
Quince, Bael
Aegle marmelos is a medium-sized tree and all parts including root, bark, leaves, fruits, and root bark are used as medicine. However, it is the fruit that is most commonly used. The ripe fruit is considered an excel-lent laxative, whereas the unripe or half-ripe fruit is used for the treat-ment of chronic diarrhea and dysentery. In India, Aegle marmelos was so commonly used by Western doctors during the British rule that it found its way into the British pharmacopoeia. It is official in the Indian Herbal Pharmacopoeia, 2002, as an antidiarrheal agent.1
The fruit contains large quantities of pectin, apart from alkaloids, sterols, and coumarins that have also been isolated. The methanolic2 (3-15 mg·animal⫺1) and 50 percent ethanolic3extract (100-200 mg·kg⫺1) of the unripe fruit has been found to exhibit an antidiarrheal effect in small animals.
A few clinical studies have been reported with preparations of un-ripe fruit. The syrup made from the fruits (Sharbat-e-Bael), a Unani preparation, which also uses the fruits, was studied at a dose level of
25 ml thrice a day for seven days in a number of cases of acute diar-rhea and dysentery.4
In an open trial, 5 g of unripe fruit powder was given thrice daily to 25 patients of chronic dysentery for 21 days. Fifty-two percent of the patients were completely cured, 44 percent showed improvement, and 4 percent remained unaffected.5
In a study, the effect of unripe fruit on intestinal parasites was tried out clinically and it was concluded that the drug was effective against Giardia, Entamoeba histolytica, and Ascaris lumbricoides.6Twelve grams of the unripe fruit pulp was given in cases of intestinal amoebiasis in three divided doses for 15 days with the response being
“excellent” in 81 percent of the cases.7In a randomized double-blind comparative trial to test the efficacy of dried unripe fruit powder in cases of shigellosis (dysentery caused by Shigella) it was not found useful, since it did not cause clinical improvement or bacteriological cure as compared to ampicillin.8
In another randomized double-blind clinical trial for 6 weeks with 169 patients with irritable bowel syndrome (IBS), a combination of Aegle marmelos and Bacopa monnieri was evaluated against standard therapy (clidinium bromide, chlordiazepoxide, and isaphagulla) and pla-cebo. The Ayurvedic combination that was tried out in 57 patients was effective in 64.9 percent, whereas the standard therapy in 60 patients was effective in 78.3 percent. There was a 32.7 percent improvement in the placebo group of 52 patients. The Ayurvedic combination was more useful in diarrhea, whereas the standard therapy was useful in the painful form of IBS. However, follow-up for 6 months showed similar rates of relapse for both treatment forms as compared to placebo.9
The fruit of Aegle marmelos is edible and widely consumed as fruit, despite the hard outer shell of some varieties, or as a fruit drink made with pulp and sugar syrup for its useful action on the stomach,10 especially in Bengal.
Cyperus rotundus Linn. (Family: Cyperaceae)
Sanskrit: Musta Tamil: Korai
Hindi: Koreti-jar English: Nut Grass
Cyperus rotundus is a common weed with aromatic tubers found growing throughout India. The root tuber is commonly used for diarrhea, dysentery, dyspepsia, indigestion, and piles.11 The tubers contain 0.5-0.9 percent of an essential oil containing sesquiterpenes,
-sitosterol, and a flavonol glycoside.12 The acetone and alcoholic extracts have shown broad spectrum antibacterial activity.13
Twenty patients with chronic diarrhea of more than 3 weeks dura-tion, or those in which there was early recurrence after an acute at-tack, were given 2 g of fine powder of Cyperus rotundus root tuber thrice daily along with 50 ml decoction made from 50 g tuber powder given daily for 15 days. The frequency of defecation was controlled by the fifth day of treatment. In addition it helped decrease fat malabsorption and improved lactose intolerance. Forty percent of patients were considered cured, whereas there was improvement in 30 percent.14 Further work is required to confirm and expand the scope of use.
Cyperus rotundus is generally considered safe and often used to treat stomach complaints in children. In commonly used doses of 1-3 g twice daily no adverse reactions have been reported.15
Holarrhena antidysentrica (Linn.) Wall. (Family:
Apocyanaceae)
Latin:Holarrhena pubescens (Buch.-Ham.) Wallich ex Don
Sanskrit: Kutaja Tamil: Veppalai
English: Conessi, Kurchee Hindi: Kurchi
Holarrhena antidysentrica is a small tree found growing through-out India up to 1,200 m elevation. The stem bark is best known as a single drug for the treatment of diarrhea and dysentery, although other parts like the seeds and leaves are also used medicinally. The bark contains up to 4 percent alkaloids, of which conessine has been shown to exhibit potent amoebicidal activity. Other constituents in-clude gum, resin, and triterpenes like lupeol and-sitosterol.16
Early pharmacological work on the antiamoebic activity of kutaja bark has been summarized.17Kutaja decoction has also been studied in vitro for its activity against diarrhea producing strains of Esche-richia coli and found to be effective.18
In an open trial, 40 patients of amoebiasis and/or giardiasis were treated with 4 g of kutaja bark powder in three divided daily doses for 15 days. Cysts were cleared in 70 percent of patients with intestinal amoebiasis (15), whereas all patients showed good clinical improve-ment. A few patients complained of burning sensation in the abdo-men, feet, and head, which was reversible on stopping the drug.19
Holarrhena antidysentrica is generally considered safe in doses of 2-4 g twice a day.20However, in the clinical trial on amoebiasis, side effects were burning in the abdomen, feet, and head, which subsided on stopping the drug.19In a study to assess side effects in 11 patients, the drug produced subjective symptoms and lowering of blood pres-sure in three patients.21 However, alcoholic extract of Holarrhena antidysentrica showed no cellular toxicity when tested against fresh sheep erythrocytes.22
In a country like India, where amoebiasis and diarrhea are wide-spread, kutaja bark powder or in the form of the preparation known as kutajarista, which is well tolerated, in which the drug is extracted by self-generated alcohol, deserves to be further studied.
Terminalia belerica Roxb. (Family: Combretaceae)
Sanskrit: Bibhitaka Tamil: Tanri
Hindi: Bahera English: Belleric Myrobalan
Terminalia belerica is a large deciduous tree found growing in forests throughout India. The fruit rind is extensively used in Ayurveda. It is a constituent of the three-fruit combination known as triphala that is very commonly used as a laxative and bowel tonic and, depending upon the dosage, also finds application in control of diarrhea.
Bahera is listed in the Indian Herbal Pharmacopoeia, 2002, as expectorant, hypolipidemic, and laxative. Depending upon the dose
administered it also finds use in control of diarrhea. It is a rich source (~17 percent) of phenolic acids and tannins from which gallic acid, ellagic acid, ethyl gallate, galloyl glucose, and chebulagic acid have been isolated.23
In vitro, the alcoholic extract of the fruit also has shown amoebicidal and bactericidal activity against a wide range of bacteria and is considered promising in various forms of dysentery.24This ex-tract was found to be better than chloramphenicol.
As a follow-up to the promising in vitro results, the drug was evalu-ated clinically and 25 patients were included in an exploratory study, which took place in five different clinics. Patients were given either 1-2 tablets containing 150 mg per tablet of methanolic extract of Terminalia belerica fruit pericarp or placebo thrice a day for 14 days. Doctors were allowed to stop treatment depending upon response and to vary the dose from 1 tablet thrice a day to 2 tablets thrice a day depending upon sever-ity. There were 12 patients on drug and 10 on placebo. All patients on drug responded to therapy and required 12 tablets for recovery. No side effects were observed. Patients on the drug who were found positive for cysts and bacteria became negative, whereas those patients on placebo continued to be positive even after the seventh day.25Considering the re-sults of this trial it needs to be extended to larger number of patients, es-pecially since Terminalia belerica is such a common drug, which would prove useful if the results can be confirmed.
Terminalia belerica is generally regarded as safe in the recom-mended dosages of 0.75-1.5 gram of the fruit powder taken twice a day.26 Alcoholic extract of Terminalia belerica showed no cellular toxicity when tested against fresh sheep erythrocytes.22
NOTES
1. Indian herbal pharmacopoeia (rev. new edn., pp. 40-48). Mumbai: Indian Drug Manufacturers’ Association, 2002.
2. Shoba FG, Thomas M. Study of antidiarrhoeal activity of four medicinal plants in castor oil induced diarrhoea. J Ethnopharmacol 76:73-76 (2001).
3. Rao CVA, Aziz I, Rawat AKS, Mehrotra S, Pushpangadan P. Antiulcer and antidiarrhoeal activity of Aegle marmelos Correa. Herb: The Natural Alternative (Abstract no. D-09). Gandhinagar, Gujarat: National Convention on Current Trends in Herbal Drugs. Ann Conf Indian Soc of Pharmacognosy, January 17-18, 2003.
4. Beg MZ, Khan NH. Effect of Aegle marmelos Corr. Syrup (Sharbat-e-Bael) in acute diarrhoea and dysentery cases (Abstract no. 23). Beenapara: Proc First Sem on Ilmul Advia, April 23-25, 1993.
5. Singh AK, Kumar A, Sharma KK. Shriphal powder: Antidysentric action.
Sachitra Ayurved 46:574-576 (1993).
6. Trivedi VP, Nesamany S, Sharma VK. A clinical study of effects of bilwa majja churna on intestinal parasites (Udar Krimi). J Res Indian Med Yoga Homeo-path 13 (2):28-35 (1978).
7. Chaturvedi GN, Gupta JP, Tiwari SK, Rai NP, Mishra A, Kumar S, Singh KP.
Research progress in Ayurvedic gastroenterology. J Res Edu Ind Med 1(4):7-15 (1982).
8. Haider R, Khan AK, Aziz KM, Chowdhury A, Kabir I. Evaluation of indige-nous plants in the treatment of acute shigellosis. Trop Geogr Med 43:266-270 (1991).
9. Yadav AK, Jain AK, Tripathi SN, Gupta JP. Irritable bowel syndrome: Thera-peutic evaluation of indigenous drugs. Indian J Med Res 90:496-503 (1989).
10. Nadkarni AK. Dr. KM Nadkarni’s Indian materia medica (vol. 1, pp. 45-49).
Bombay: Popular Prakashan, 1976.
11. Moos SN. Single drug remedies (pp. 55-56). Kottayam, India: Vaidyasarathy Press (P) Ltd, 1976.
12. The wealth of India, raw materials (first suppl. series, vol. 2, pp. 333-334).
New Delhi: National Institute of Science Communication, CSIR, 2001.
13. Puratchikody A, Jaswanth A, Nagalakshmi A, Anagumeenal PK, Ruckmani K.
Antibacterial activity of Cyperus rotundus. Indian J Pharm Sci 63:326-327 (2001).
14. Chaturvedi GN, Gupta JP, Tiwari SK, Rai NP, Mishra A, Kumar S, Singh KP.
Research progress in Ayurvedic gastroenterology. J Res Edu Ind Med 1(4):7-15 (1982).
15. Selected medicinal plants of India. A monograph on identity, safety and clini-cal usage (pp. 128-130). Bombay: Chemexcil. Basic Chemiclini-cals, Pharmaceuticlini-cals and Cosmetics Export Promotion Council of India, 1992.
16. Chaturvedi GN, Singh KP, Gupta JP. Phytochemistry and pharmacology of Holarrhena antidysentrica Wall (kutaja). Nagarjun 24(4):77-84 (1980).
17. Satyavati GV, Gupta AK, Tandon N. Medicinal plants of India (vol. 2, pp. 41-48).
New Delhi: Indian Council of Medical Research, 1987.
18. Daswani PG, Birdi TJ, Antarkar DS, Antia ANH. Investigation of the antidiarrhoeal activity of Holarrhena antidysentrica. Indian J Pharm Sci 64(2):164-167 (2002).
19. Singh KP. Clinical studies on amoebiasis and giardiasis evaluating the effi-cacy of kutaja (Holarrhena antidysentrica) in Entamoeba histolytica cyst passers.
Ancient Sci Life V:228-231 (1986).
20. Selected medicinal plants of India. A monograph on identity, safety and clini-cal usage (pp. 182-184). Bombay: Chemexcil. Basic Chemiclini-cals, Pharmaceuticlini-cals and Cosmetics Export Promotion Council of India, 1992.
21. Chaturvedi GN, Singh KP. Side effects of a traditional indigenous drug—
Kutaja (Holarrhena antidysentrica) (letters to the editor). Indian J Physiol Phar-macol 27:255-256 (1983).
22. Ahmad I, Mehmood Z, Mohammad F. Screening of some Indian medicinal plants for their antimicrobial properties. J Ethnopharmacol 62:183-193 (1998).
23. Indian herbal pharmacopoeia (rev. new edn., pp. 429-438). Mumbai: Indian Drug Manufacturers’ Association, 2002.
24. Bhutani KK, Kumar V, Kaur R, Sarin AN. Potential antidysentric candidates from Indian plants: A selective screening approach. Indian Drugs 24:508-513 (1987).
25. Patwardhan B, Bhutani KK, Patki PS, Dange SV, Gore DV, Borole DI, Shirolkar RB, Paranjpe PV. Clinical evaluation of Terminalia belerica in diarrhoea.
Ancient Sci Life X(2):94-97 (1990).
26. Selected medicinal plants of India. A monograph on identity, safety and clini-cal usage (pp. 312-314). Bombay: Chemexcil. Basic Chemiclini-cals, Pharmaceuticlini-cals and Cosmetics Export Promotion Council of India, 1992.