Scientific Basis for Ayurvedic Therapies -25

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

Diarrhea (Atisara) and Dysentery (Pravahika)

Shankar K. Mitra and Paramesh R.

Rangesh

21.1 Diarrhea

21.1.1 Introduction

Diarrhea, a condition of loose, watery stools that occur more than three times in a day, is

a common problem that usually lasts a day or two and goes away on its own without any

special treatment. Prolonged diarrhea can be a sign of other problems. Diarrhea can cause

dehydration, which is particularly dangerous in children and the elderly, and it must be

treated promptly to avoid serious health problems. People of all ages can get diarrhea.

The average adult has a bout of diarrhea about four times a year.

Diarrhea is called

atisara

in Ayurveda. Frequent passing of watery stools is the cardinal

feature. According to Ayurveda, diarrhea results from the excess mass of stools and

endotoxins

(

ama

) in the gastrointestinal (GI) tract, and this excess is eliminated through

the nearest outlet (rectum) as diarrhea. Digestive and excretory systems, the two parts of

the GI tract called

mahasrotas

, influence each other. The common etiological factors in the

diseases of these systems are dyspepsia and endotoxin.

1

21.1.2 Definition

Atisara

in Sanskrit means frequent passing of excessively watery, unformed stool. Other

descriptions include watery stools, frequent bowel movements, and loose bowel movements.

21.1.3 Clinical Description

Clinical features of different types of diarrhea are listed in Table 21.1. The major clinical

features of diarrhea

are increased fluidity in stools, increased frequency of bowel movement,

and increased stool volume.

Although diarrhea is not considered a disease or disorder on its own in conventional

medicine, Ayurvedic literature records it as both a symptom and an independent disease.

The World Health Organization (WHO) defines diarrhea as the passage of loose or

watery stools, at least thrice in a 24-h period. However, it is the consistency of the stools

rather than the frequency that is most important. Frequent passing of formed stools is not

diarrhea.

2

21.1.4 History and Epidemiology

Diarrhea dates back to history of human life. According to Indian mythology, the disease

was said to exist in the first age (s

athya yuga

) and was observed to be the outcome of

abnormal food habits and emotional disturbance.

3

More than 1 billion people worldwide suffer one or more episodes of acute diarrhea

each year. Because of poor sanitation and more limited access to health care, acute infectious

diarrhea remains one of the most common causes of mortality in developing countries,

particularly among children younger than 3 years old. It accounts for 5 to 8 million

deaths every year.

On average, children in developing countries experience three episodes of diarrhea each

year. In 1993, an estimated 3.2 million children under 5 years old died from diarrheal

disorders. Eight of 10 of these deaths occur in the first 2 years of life. In many countries,

diarrheal disorders, including cholera, are also an important cause of morbidity among

older children and adults.

2

21.1.5 Etiology

According to Ayurveda, diarrhea is caused mainly by the consumption of excessive food

that is hard to digest (e.g., protein-rich and fatty foods). In addition, eating foods that are

too dry, too hot, or too cold; drinking contaminated water and alcoholic beverages; eating

TABLE 21.1

Clinical Features of Different Types of Diarrhea

Nature

Vata Pitta Kapha Tridosa

Emotional

Color of stool Bluish Yellow, reddish Whitish Fatty and meatsoup

like

Blood red

Nature of stool Frothy Watery, foul

smell

Mucus, foul

smell

Watery Watery, with or

without smell

Frequency Frequently

with sound

Not frequently Less, without

sound,

incompletely

Alternate Frequently

Quantity Less More Less Sometimes

more or less

More

Associated

symptoms

Pain in

abdomen

and pelvis

Fever, thirst,

sweating

Drowsy,

nausea,

horripulation

Combination Headache,

burning

sensation

Complication Rectum

prolapse

Inflammation

of rectum

Painful rectum Combination

of all

Rectum

prolapse

foods with contradictory properties (

viruddhasana

); eating frequently (

adhyasana

); eating

improperly cooked foods (

aparipakvasana

); and eating incompatible foods (

asathmya bhojana

) also result in diarrhea. Certain behaviors and lifestyles may also lead to diarrhea.

Examples include emotional stress, fear, or grief and controlling natural urges such as

urination and defecation (

vega dharana

). Disorders such as indigestion (

ajirna

), irritable

colon (

grahani

), hemorrhoids (

arshas

), helminthiasis (including microbial infection [

krimi

]

also result in diarrhea.

1

Conventional medicine indicates that diarrhea may be caused by an infection or an intestinal

disease. A few of the more common causes of diarrhea are bacterial or viral infections

from consuming contaminated food or water. The common bacteria known to cause diarrhea

are campylobacter, salmonella, shigella,

Escherichia coli,

and viral infections (e.g., rotavirus,

Norwalk virus, cytomegalovirus, herpes simplex virus, viral hepatitis, etc.). Certain food

intolerances such as lactose (sugar found in milk) and parasites that can enter the body

through food or water (e.g.,

Giardia lamblia, Entamoeba histolytica,

and

Cryptosporidium

) can

cause diarrhea

.

Reaction to medicines, such as antibiotics, blood pressure medications, and

antacids containing magnesium; intestinal diseases, such as inflammatory bowel disease

and celiac disease; functional bowel disorders, such as irritable bowel syndrome (IBS);

poststomach surgery; and gallbladder removal can result in diarrhea.

Certain people who travel to foreign countries are at risk for traveler’s diarrhea due to

consuming food or drinking water contaminated with bacteria, viruses, or parasites.

Traveler's diarrhea is a particular problem for people visiting developing countries.

2

Children

can have acute (short-term) or chronic (long-term) forms of diarrhea. Causes include

bacteria, viruses, parasites, medications, functional disorders, and food sensitivities. Infection

with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus

diarrhea usually resolves in 5 to 8 days.

21.1.6 Pathogenesis and Pathology

Ayurveda describes the pathogenesis of diarrhea as caused by various etiological factors

discussed above. The fluid content of the intestines increase, slowing down the activity

of digestive enzymes. This fluid that mixes with the stool in the intestine increases the

bulk and is propelled by the force of

vata

; as a result, the contents of the intestine are

thrown out in the form of diarrhea.

1

In conventional medicine, the pathology of this disease is due to infections, generally

short lived and self-limiting. Common forms of diarrhea are grouped under terms such

as gastroenteritis. These conditions may include vomiting and often appear in miniepidemics

in schools, neighborhoods, or families. Most cases of diarrhea will stop without

treatment in a few days.

Diarrhea broadly has infectious, drug-induced, food-related, postsurgical, inflammatory,

transit-related, and psychological causes. These causes produce diarrhea by four distinct

mechanisms: increased osmotic load, inflammation, fluid secretion, and decreased absorption

time.

21.1.7 Diagnosis

21.1.7.1 Prodromal Features of Diarrhea

According to Ayurveda, the clinical manifestation of diarrhea is preceded with the following

signs and symptoms: pricking pain in the epigastric, umbilical, anal, and general

abdominal regions; general body malaise; constipation and obstruction in flatus movement;

abdominal bloating; and indigestion.

4

21.1.7.2 Main Types of Diarrhea

There are broadly six types of diarrhea:

1. Diarrhea due to the imbalance of

vata

(

vata atisara

)

2. Diarrhea due to the imbalance of

pitta

(

pitta atisara

)

3. Diarrhea due to the imbalance of

kapha

(

kapha atisara

)

4. Diarrhea due to imbalance of

tridosa

(

sannipata atisara

)

5. Diarrhea due to emotional disturbances (

sokaja

including

bhayaja

)

6. Diarrhea due to the imbalance of and due to enterotoxin (

ama atisara

)

1

21.1.7.2.1 Enterotoxic Diarrhea (Ama Atisara)

To aid treatment, enterotoxic diarrhea is classified into two kinds: with enterotoxin (

sama

)

and without enterotoxin (

nirama

or

pakva

). The characteristic features of the stool with

enterotoxin are described as improperly digested stool with a distinct foul smell that is

slimy or incompacted and is associated with flatulence, abdominal pain, and salivation.

The nonenterotoxic diarrhea is devoid of the above features and it also sinks in water.

4

The diarrhea could be mild, moderate, or intense.

21.1.7.3 Other Types of Diarrhea

21.1.7.3.1 Hemorrhagic Diarrhea (Rakta Atisara)

Hemorrhagic diarrhea is an exacerbated variant or latter stage of

pitta

-

atisara

. If a patient

is suffering from

pittaja

diarrhea, then ventures into excessive use of spicy foods, salt, or

alcohol may result in hemorrhagic diarrhea, which is characterized by the passage of blood

along with the stools.

1

21.1.7.3.2 Infective Diarrhea (Jvara Atisara)

Etiology of infective diarrhea is the result of etiological factors of fever and diarrhea, with

the symptoms of diarrhea associated with fever.

1

21.1.7.3.3 Clincial Types of Diarrhea

In conventional medicine, four clinical types of diarrhea are recognized:

1

.

Acute bloody diarrhea (also known as dysentery) — The main dangers are intestinal

damage, sepsis, and malnutrition. Other complications, including dehydration,

may also occur.

2. Acute watery diarrhea (including cholera) — This type of diarrhea lasts several

hours or days. The main danger is dehydration, and weight loss also occurs if

feeding is not continued.

3. Persistent diarrhea — This type of diarrhea lasts 14 days or longer. The main danger

is malnutrition and serious nonintestinal infection. Dehydration may also occur.

Table 21.1 shows the details of their presenting features.

4. Diarrhea

with severe malnutrition (marasmus or

kwashiorkor

) — The main dangers

of this type of diarrhea are severe systemic infection, dehydration, heart failure,

and vitamin and mineral deficiency.

The management of each type of diarrhea should prevent or treat the main cause that

each one presents.

2

Diagnostic tests to find the cause of diarrhea include the following:

1. Medical history and physical examination

2. Stool culture to determine the bacterial infection

3. Blood tests

4. Fasting tests

5. Sigmoidoscopy

6. Colonoscopy (similar to sigmoidoscopy, but the doctor looks at the entire colon)

21.1.8 Clinical Course and Prognosis

According to Ayurveda, diarrhea is difficult to cure if the stool is purple (ripe jamun fruit)

or liver brown; amount of stool elimination is small; the consistency resembles dehydrated

butter (

ghee

), oil, fat, or meat soup; embedded with shiny particles; and has a very fishy

odor. Patients with severe thirst, generalized burning sensation, unconsciousness, dyspnea,

relaxed rectal sphincters, rectal prolapse, loss of strength, muscular wasting, loss of

blood, and severe arthritic pain along with diarrhea will be very difficult to cure.

The diarrhea due to the involvement of all three

dosas

and emotional types are also

difficult to treat successfully.

4

Diarrhea can be either acute or chronic. The acute form, which lasts less than 3 weeks,

is usually related to a bacterial, viral, or parasitic infection. Chronic diarrhea lasts more

than 3 weeks and is usually related to functional disorders like IBS or diseases like celiac

disease or inflammatory bowel disease.

21.1.8.1 Complications

Common complications of diarrhea are pain in the abdomen, dysentery, tymphanitis, rectal

prolapse, anuria, edema, severe infection, and loss of consciousness.

1

According to conventional medicine, fluid loss with consequent dehydration, electrolyte

loss (Na, K, Mg, Cl), and even vascular collapse may occur. Patients who are very young,

old, or debilitated may collapse rapidly or have severe diarrhea (such as those with

cholera). HCO

3

loss may cause metabolic acidosis. Serum sodium concentrations vary

according to the composition of diarrheal losses relative to plasma. Hypokalemia may

occur in severe or chronic diarrhea or if the stools contain excess mucus. Hypomagnesemia

after prolonged diarrhea may cause tetany.

21.1.9 Therapy

The fundamental principle of treatment in diarrhea is to keep away from the causative

factors as previously described. Treatment has to be undertaken based on the nature of

the stool — with endotoxin (of recent origin) or without endotoxin (chronic).

21.1.9.1 Enterotoxic Diarrhea

In case of a mild degree of toxin, advice on diet and carminatives are used. While in moderate

degree, digestives are administered. In case of an intense degree, the patient is subjected to

detoxification (shodhana–virecana, basti), using herbs to eliminate toxins.2

The use of antimotility drugs is contraindicated in the beginning of enterotoxic diarrhea,

in order to prevent the enterotoxin from remaining in the gut. The reduction of

bowel movement results in convulsive disorders, abdominal distension, irritable colon,

hemorrhoids, anal fissures, edema, anemia, and splenomegaly. Antimotility drugs are

used in cases of infants, the elderly, dehydrated conditions, infective diarrhea, and excess

diarrhea.5

The diet should be restricted to light food like soup of mudga (green gram) with ginger

or cooked rice (100 to 250 g with 1 to 6 g of ghee). Depending upon the desire and taste,

using buttermilk, rice gruel, or rice corn soaked in water is advised. These will be more

nourishing and act as a digestive aid.

the herbs):

1. Chebulic myrobalan (Terminalia chebula) fruit powder at a dose of 1 to 3 g with

250 mg of long pepper (Piper longum) fruit powder are advised along with warm

water. Care should be taken, as large doses of this will result in more bowel

movements. This formula helps eliminate toxins.

2. A tea made of rhizomes of calamus (Acorus calamus), aconitum species, nutgrass

(Cyperus rotundus), aerial parts of fumaria (Fumaria officinalis), root of pavonia

(Pavonia odorata), and rhizome of ginger taken at a dose of 50 ml two to three

times/day is given to improve digestion.3

3. Powder of fried cumin (Cuminum cyminum), rhizome of nutgrass, long pepper, or

ginger at a dose of 5 g is mixed with 1 l of buttermilk and divided into four parts.

Each dose should be taken at 6-h intervals.

4. Ginger powder (1 to 3 g) taken with an equal quantity of sugar two times/day is

useful in relieving the symptoms of enterotoxin.

5. Powder of kurchi seed (Holarrhena antidysenterica), bark of cinnamomum (Cinnamomum

zeylanicum), root of vetiver (Vetivera zizanioides), seed of jambul (Syzygium

cumini), and fruit pulp of bael (Aegle marmelos) are mixed in equal

quantities. A dose of 3 to 6 g of this mixture is taken with buttermilk three

times/day.

6. Equal quantities of the powder of pop of old paddy (laja), fruit of coriander

(Coriandrum sativum), and resin of silk cotton tree (Bombax ceiba) are mixed with

double-quantity fennel seeds (Foeniculum vulgare). A dose of 3 to 6 g of this mixture

is taken with warm water two times/day.

7. Powder of nutmeg (Myristica fragrans), cumin seeds, and fruit pulp of bael are

mixed in equal quantity and triturated with lime water to make pills each weighing

800 mg. One pill is taken in the morning with rice water in the case of pitta

diarrhea and with 25 to 75 ml camphor water for kapha diarrhea.6

The following herbal mixtures are recommended (see Section 21.1.10 for the names of

© 2004 by CRC Press LLC

378 Scientific Basis for Ayurvedic Therapies

A few compound formulations used in the treatment of enterotoxic diarrhea are given

below:

21.1.9.2 Nonenterotoxic Diarrhea

This condition is treated with carminatives and antimotility herbs. The following herbal

mixtures are recommended:

1. A dose of 3 to 6 g of a mixture of equal quantity of powders of the bark of kurchi

and rhizome of aconitum species is taken three to four times/day with honey.5

2. A dose of 3 to 6 g of powder of fruit pulp of bael mixed with 100 to 250 ml

buttermilk is taken three to four times/day.

3. A dose of 3 to 6 g of powder of bark or seeds of kurchi is taken with 100 to 250

ml buttermilk three to four times/day.

4. A decoction of equal parts of fruit pulp of bael, rhizomes of pavonia and aconite

species, rhizomes of nutgrass, and sida root (Sida cordifolia) and bark of kurchi is

taken at the dose of 14 to 28 ml three times/day.7

21.1.9.3 Vata Diarrhea

Vata diarrhea is treated with herbs that improves digestion, followed by antidiarrheal

herbal formulas. A decoction of rhizomes of calamus, aconitum, and nutgrass, and seed

of kurchi is given.9

21.1.9.4 Pitta Diarrhea

Pitta diarrhea is treated with a light diet, carminatives, fluids, and mineral supplements

such as rice gruels and fruit juice. If this fails, resort to palliatives and antimotility agents

and medicated enema. A mixture of equal quantity of powders of dry extract of berberis

(Berberis aristata), rhizome of aconite, bark of kurchi, flowers of woodfordia (Woodfordia

fruitcosa), and ginger is given at a dose of 3 to 6 g with rice water two to three times/day.

For a medicated decoction enema (asthapana basti), the paste of the fennel seeds (Foeniculum

vulgare), roots of asperagus (Asparagus racemosus), cow’s milk, roots of licorice (Glycyrrhiza

glabra), sesame oil, cow’s ghee, and fruit pulp of bael are used.3 This herbal

Name of Formulation Activity Dose Adjuvant Ref.

Gangadhara curna Digestive, appetizer,

antidiarrheal

1–3 g three

times/day

Jaggery, buttermilk

and honey

7

Jatiphaladi curna Carminative,

antidiarrheal

1–2 g three

times/day

Honey, buttermilk

and water

7

Lai curna Antiflatulent,

antidiarrheal

1–3 g three

times/day

Buttermilk 5

Jatiphaladi vati Antimotility,

antispasmodic

60–120 mg three

times/day

Buttermilk and water 8

Karpura vati Antimotility,

antispasmodic

120–240 mg two

times/day

Honey 8

Kutajarishta8 Digestive,

antidysenteric

15–30 ml two

times/day

Equal quantity of water 8

combination helps to decrease the motility of intestine. The diet includes goat milk and

meat soup with rice.9

21.1.9.5 Kapha Diarrhea

Kapha diarrhea is treated best with fasting and by improving digestion because it occurs

due to excessive eating. A decoction of chaba (Piper chaba), aconite, nutgrass, bael, ginger,

kurchi seed and bark, and chebulic myrobalan in equal quantities are given at a dose of

15 to 30 ml.9

A few compound formulations used in the treatment of vata and kapha diarrheas are

given here:

21.1.9.6 Hemorrhagic Diarrhea

The bleeding in hemorrhagic diarrhea has to be stopped immediately. Analgesics (vadanasthapana)

and styptics (rakthasthambhaka) as well as antidiarrheals have to be used. The

following herbal mixtures are recommended:

1. A dose of 3 to 6 g of the powder of asparagus (Asparagus racemosus) root mixed

with 120 ml of goat’s milk, three to four times/day, is taken while following a

strict rice-milk diet.3

2. A dose of 3 to 6 g of white sandalwood (Santalum album) powder is mixed with

an equal quantity of honey and 5 to 10 g of sugar. It is taken two or three times/

day along with rice water and relieves thirst, burning, and bleeding.

3. A dose of 5 to 10 g of cow’s milk butter mixed with honey and candy sugar in

equal quantities helps stop bleeding.9

4. A dose of 3 to 6 g of powder of the fruit pulp of bael is taken with an equal

quantity of jaggery.

5. A dose of 3 to 6 g of banyan shoot (Ficus bengalensis) paste is taken with 100 to

250 ml of rice water three times/day.

6. A dose of 28 ml of the fresh juice of the leaves of jambul, Indian gooseberry, and

mango in equal quantity is mixed with 14 g of honey and 100 ml of goat’s milk.

The solution is taken three times/day.

7. A dose of 2 to 6 g of red sandalwood (Pterocarpus santalinus) powder with 6 g of

sugar and 6 g of honey, followed by a potion of 100 to 250 ml of rice water, is

taken two times/day.5

Goat’s milk is given with honey and sugar as a drink and even as a rectal douche.3

Name Formulation Activity Dose Adjuvant Ref.

Kutajavaleha Antidiarrheal 5–10 g three times/day Water 10

Agasthisutaraja rasa Antidiarrheal 60–120 mg three times/day Cumin,

nutmeg,

powders

5

Kanakasundara rasa Antidiarrheal 60–120 mg three times/day Buttermilk 8

A few compound formulations used in the treatment of hemorrhagic diarrhea are given

below:

21.1.9.7 Emotional Diarrhea

Treatment in emotional diarrhea is similar to vata diarrhea. In addition, entertainment and

counseling is advised.

21.1.9.8 Infective Diarrhea

The line of treatment in this condition involves fasting or taking light and easily digestible

food and digestive agents along with antipyretic drugs. A dose of 15 to 30 ml of a decoction

of the equal parts of fruit pulp of bael, rhizomes of ginger and musk, fruit of coriander,

and roots of sida should be taken once daily early in the morning. A 15- to 30-ml dose of

the following decoction is given two times/day: equal quantities of aerial parts of velvet

leaf (Cissampelos pareira), andrographis, fumaria, rhizomes of nutgrass, ginger, seeds of

kurchi, and tinospora stem in water.7

The compound formulations used in the treatment of infective diarrhea are listedbelow:

21.1.9.9 Rectal Prolapse

If the anal region is inflamed, a sitz bath with cold extract of snakeguard leaves (Trichosanthes

dioica) and licorice is given. If it is associated with a burning sensation, goat’s milk

mixed with honey and sugar is douched or applied as a wash locally and is also taken

internally. A poultice of Woodfordia flower, Lodh bark (Symplocos racemosa), and blackgram

seeds helps reduce inflammation and bleeding and is applied on the end part. A

cotton swab soaked in a medicated ghee (shatadhoutha ghrita) is also applied or plugged

locally.9,12

The compound formulations for all types of diarrheas are listed as follows:

Name of Formulation Activity Dose Adjuvant Ref.

Dadimashtaka curna Antidysenteric 3–6 g three

times/day

Water 5

Dadimavaleha Antidysenteric 6–12 g three

times/day

Honey and

water

11

Ushirasava Hemostatic 15–30 ml two

times/day

Equal water 8

Bola parpati Hemostatic 120–240 mg

three times/

day

Sugar, honey,

buttermilk

5

Name of Formulation Activity Dose Adjuvant Ref.

Karpura rasa Digestive, antipyretic,

antidiarrheal

60–120 mg three

times/day

Water 8

Lakshminarayana rasa Antipyretic and

antidiarrheal

120–240 mg

three times/

day

Ginger juice and

honey

5

Mritasanjivini rasa Antidiarrheal 360 mg two

times/day

Honey 5

21.1.9.10 Lifestyle Changes

are all advised in treating diarrhea. Sleeping immediately after a meal also helps control

diarrhea and helps in recovery. As one improves, soft and bland foods, raw bananas,

guava fruit, plain rice, baked potatoes or dioscorea tubers, toast, crackers, cooked carrots,

and baked chicken without the skin or fat are recommended. For children, the bananas,

rice, apple sauce, and toast diet is recommened.14

that are greasy, high fiber, or very sweet are contraindicated. Negative emotions like fear,

grief, and anger, and suppression of the urges of defecation and urination should also be

avoided.

The treatment of any type of diarrhea is considered complete when urination and

passage of flatus without the appearance of stool, increased appetite, and a feeling of

lightness in the abdomen are observed.4

21.1.10 Scientific Basis

The inhibitory effect of ayurvedic plants on enteropathogenic bacterias is presented in

21.1.10.1 Holarrhena antidysenterica (Kurchi)

This herb has been indicated in many diseases apart from dysentery in all the forms

described in Ayurveda.15 The total alkaloids of the bark has shown antibacterial activity

on the intestinal bacteria, E. coli.16 Kurchamine, an alkaloidal fraction from the bark,

effectively reduced the intestinal amoebic infection in rats and hepatic amoebiasis in

hamsters. The activity was comparable with emetine hydrochloride.17 Clinical tests with

conessine from the bark on patients with intestinal and hepatic amebiasis have been given

results comparable with those obtained with emetine.18

21.1.10.2 Myristica fragrans (Nutmeg)

The seed or nutmeg of Myristica fragrans is considered a folk remedy for diarrhea. Experimental

studies with petroleum ether, chloroform, and ethanol extract showed a reduction

in fecal output, inhibition of castor oil-induced diarrhea, and enteropooling in rats. The

protective effect of nutmeg in castor oil-induced diarrhea indicates the action could be

due to the inhibition of prostaglandin biosynthesis.19

Name of Formulation Activity Dose Adjuvant Ref.

Rasa parpati Intestinal antiseptic 125 mg two

times/day

Honey 13

Panchamrita parpati Antidysenteric 125–250 mg two

times/day

Honey, curd, and

buttermilk

8

Svarna parpati Antidysenteric,

tonic

125 mg two

times/day

Honey 5

Vijaya parpati Antidysenteric,

tonic

125–375 mg two

times/day

Water and honey 8

Old rice, mung beans, asafetida, garlic, Indian gooseberry, a liquid diet, and raw bananas

Fatty foods (which are heavy for digestion); excess of meat; milk products; and foods

Table 21.2. Other studies on ayurvedic herbs are summarized below.

TABLE 21.2

Inhibitory Effect of Ayurvedic Plants on Enteropathogenic Bacterias

Name Part Solvent Aa Ba Ca Da

MICD/IC50 (mg or mg/ml,

or mg or mg/ml) Ref.

Ocimum basilicum Leaf Ethanol 6 6 6 NT S. typhi (>10 mg) 49

Psidium guajava Leaf Methanol 9 8 13 NT S. flexneri (>10 mg) 49

Punica granatum Fruit Methanol N/A N/A NT NT 12 mg/ml 50

Bergenia ciliata Rhizome Methanol 15 NT NT 12 1.0 mg 51

Caesalpinia bonducella Seeds Methanol 20 19 15 NT E. coli (10 mg/ml),

S. typhi (0.62 mg/ml),

S. flexneri (2.5 mg/ml)

52

Ficus racemosa Leaf Petroleum ether 19 NT NT NT 25 mg/ml 53

Capsicum annum Fruit Ethanol N/A NT NT NT 100 mg/ml 54

Holarrhena antidysenterica Stem bark Aqueous >25 >25 >20 >30 200 mg/ml 55

Murraya koenigii Leaf Chloroform 8 NT 10 NT 500 mg 56

Syzygium cumini Stem bark Ethanol N/A N/A NT NT 128 mg/ml 57

Astercantha longifolia Whole plant Chloroform 15 NT NT NT 100 mg/ml 58

Leptadenia arborca Whole plant Methanol 16 NT NT NT 100 mg/ml 58

Tephrosia purpurea Whole plant Methanol 17 NT NT NT 100 mg/ml 58

Withania somnifera Whole plant Methanol 15 NT NT NT 100 mg/ml 58

Evolvulus alsinoides Leaf Methanol 17 NT NT NT 100 mg/ml 59

Chloroform 17 NT NT NT 100 mg/ml 59

Abrus precatorius Stem Methanol 18 NT NT NT 100 mg/ml 59

Clitoria ternatea Whole plant Methanol 15 NT NT NT 100 mg/ml 59

Plumbago zeylanica Stem and leaf Methanol 19 NT NT NT 100 mg/ml 59

Calotropis procera Root Ethanol 15 NT NT NT 10 mg/ml 60

Trigonella foenum graecum Seeds Ethanol 20 NT NT NT 100 mg/ml 61

Allium sativum Cloves Water 12 18 30 32 30 mg 62

Cassia occidentalis Flower Ethanol 8 NT NT NT 10 mg 63

Callus Ethanol 8 NT NT NT 10 mg 63

Tachyspermum ammi Fruit Ethanol N/A NT NT NT 6.25 mg/ml 64

Hemidesmus indicus Root Ethanol N/A NT NT NT 25 mg/ml 64

Cassia fistula Seed Ethanol N/A NT NT NT 12.5 mg/ml 64

Terminalia bellerica Exocarp Ethanol N/A NT NT NT 12.5 mg/ml 64

Phylanthus emblica Fruit Ethanol N/A NT NT NT 12.5 mg/ml 64

Oxalis corniculata Leaf Ethanol N/A NT NT NT 12.5 mg/ml 64

Plumbago indica Leaf Ethanol N/A NT NT NT 12.5 mg/ml 64

Aegle marmelos Leaf Methanol 5 8 5 NT 50 mg/ml 65

Terminalia chebula Fruit Alcoholic >20 >20 NT NT 200 mg/ml 66

Emblica officinalis Fruit Alcoholic >20 >20 NT NT 200 mg/ml 66

aA = Escherichia coli; B = Salmonella typhi; C = Shigella flexneri; D = Vibrio cholerae.

Note: Values indicate bacterial inhibition zone (mm); MICD = minimal inhibitory concentration in disk.

21.1.10.3 Dioscorea oppositifolia (Chinese Wild Yam)

The tuber extract is known to have antidiarrheal activity in infantile diarrhea.20

21.1.10.4 Psidium guajava (Guava)

In fruits with therapeutic properties for antidiarrheal and laxative uses, the presence of

lectins may be the bioactive properties that interfere with bacterial adhesion, which are

thought to be competing for glycoside signal sites in the attachment. Guava has a galactose-

specific lectin that prevents adhesion of E. coli O157:H7 to red cells; this lectin is

mediated by galactose. Prevention could also be due to their capacity of agglutinating E.

coli by guava.21 The antidiarrheal properties of the water and methanolic extracts of Psidium

guajava leaves have been demonstrated with anteriority; their spasmolytic effect was

attributed to quercetin, a flavonoid contained in this plant.22 The spasmolytic effects of

Psidium guajava leaf methanol, hexane, and water extracts were demonstrated in the guinea

pig isolated ileum-perfused model suggesting the existence of two different types of active

components.23

21.1.10.5 Musa paradisica (Banana)

Banana flakes can be used as a safe, cost-effective treatment for diarrhea in critically ill

tube-fed patients. Banana flakes can be given concurrently with a workup for Clostridium

difficile colitis, expediting the treatment of diarrhea.24

21.1.10.6 Nelumbo nucifera (Sacred Lotus)

Extract of Nelumbo nucifera rhizome reduced not only the frequency of defecation, wetness

of fecal dropping and prostaglandin-2 (PGE2)-induced enteropooling, but also significantly

reduced the propulsive movements of charcoal meal significantly in experimental rats. 25,26

21.1.10.7 Ficus bengalensis (Banyan Tree) and Syzygium cumini (Jamun)

Ethanol extracts of Ficus bengalensis Linn. (hanging roots) and Syzygium cumini Linn. (bark)

showed significant inhibitory activity against castor oil-induced diarrhea and PGE2-

induced enteropooling in rats. These extracts also showed a significant reduction in GI

motility in charcoal meal tests in rats. The results obtained establish the efficacy of all

these plant materials as antidiarrheal agents.27

21.1.10.8 Acorus calamus (Sweet Flag) and Aegle marmelos (Bael)

A study was conducted on the effect of aqueous and methanolic plant extracts of Acorus

calamus rhizome, Pongamia glabra leaves, Aegle marmelos unripe fruit, and Strychnos nuxvomica

root bark for their antidiarrheal potential against castor oil-induced diarrhea in

mice. Results showed that methanolic extracts were more effective than were aqueous

plant extracts. The methanolic extracts significantly reduced induction time of diarrhea

and total weight of the feces. The result establishes the efficacy of these plant extracts as

antidiarrheal agents.28

21.1.10.9 Clerodendrum phlomidis (Clerodendrum)

The methanolic extract from the leaves of Clerodendrum phlomidis Linn. (Agnimantha)

(MECP) was examined for its antidiarrheal potential against several experimental models

of diarrhea in Wistar albino rats. MECP showed significant inhibitory activity against

castor oil-induced diarrhea and PGE2-induced enteropooling in rats. The extract also

showed a significant reduction in GI motility in charcoal meal test in rats. The results

obtained establish the efficacy and substantiated the folklore claim as an antidiarrheal

agent.29

21.1.10.10 Piper nigrum (Black Pepper)

Antidiarrheal activity of piperine (Piper nigrum) against castor oil, magnesium sulphate,

and arachidonic acid was studied in mice. It significantly inhibited diarrhea produced by

these cathartics at an oral dose of 8 and 32 mg/kg. Inhibition of castor oil-induced

enteropooling by piperine suggests its inhibitory effect on prostaglandins.30

21.1.10.11 Berberis aristata (Indian Barberry)

Berberine was effective in reducing water and electrolyte secretions induced by E. coli

heat-stable enterotoxin. These findings indicate that berberine may be an effective antidiarrheal

agent in E. coli heat-stable enterotoxin-mediated secretory diarrhea. The results

also provided a basis for the frequent empirical use of berberine alkaloid and berberinecontaining

plants in gastroenteritis and infectious diarrhea in Asian and other countries.31

21.1.10.12 Punica granatum (Pomegranate)

Experimental studies32 on methanolic extract of Punica granatum fruit rind have reported

antidiarrheal and antibacterial activity against Staphylococcus aureus, E. coli, Kleibsella pneumoniae,

Proteus vulgaris, and Salmonella typhi.

21.1.10.13 Tinospora cordifolia (Tinospora gulancha)

Tinospora cordifolia was reported to be active against Entamoeba histolytica.33

21.1.10.14 Clinical Trials

21.1.10.14.1 Diarex

Diarex is a polyherbal formulation containing Holarrhena antidysenterica, Tinospora cordifolia,

Aegle marmelos, Punica granatum, and Cyperus rotundus as its constituents. Holarrhena

antidysenterica is reported to be more effective in treating amoebic dysentery.34 Aegle marmelos

is reported to be a very effective remedy in controlling acute diarrhea.35 A combination

of Aegle marmelos, Punica granatum, and Tinospora cordifolia along with other herbs is known

to have potential antispasmodic activity.36 Clinical trials of diarex have showed to be

effective in acute chronic and infectious diarrhea.37

21.1.10.14.2 Calotropis procera (Indian Madder)

A pilot study was conducted on the effect of the root bark of Calatropis procera (arka) in

73 patients of diarrhea. The powder was administered at 250 mg three times/day with

buttermilk for 7 days. The consistency of the stools was achieved on the first day of the

treatment. There were 49 patients (67.1%) who had complete relief and 18 patients (24.7%)

who had marked relief.38

21.1.10.14.3 Compound herbal powder (Solanum torvum, Murraya koenigii, Mangifera indica,

Carum roxburghianum, Emblica officinalis, Punica granatum, and Trigonella foenum-

graecum)

An open clinical trial39 examined the role of a compound herbal powder (consisting of

Solanum torvum, Murraya koenigii, Mangifera indica, Carum roxburghianum, Emblica officinalis,

Punica granatum, and Trigonella foenum-graecum) in the management of nonspecific diarrhea

in 25 subjects. Results showed marked relief in loose stools (76%), tenasmus (85%), acid

belching (69.5%), borborygmus (66.6%), and bloating of abdomen (62.5%). During the

study no adverse reactions were noted.

21.1.10.14.4 Valeriana officinalis (Valerian)

In a clinical observation and experimental study,40 Valeriana officinalis was found to be an

effective medicine in controlling infantile rota viral diarrhea.

21.1.10.14.5 Green bananas

In a double-blind trial,41 green bananas and pectin were shown to be useful in the dietary

management of persistent diarrhea in hospitalized patients. The plantain flour-based solution

proved effective for the treatment of dehydration due to acute diarrheal diseases and

should be considered as an alternative when standard WHO oral rehydration solution

(WHO-ORS) is not available.42

21.1.10.14.6 Soy fiber

A randomized, blind clinical trial43 was conducted on soy fiber and rice-based oral rehydration

solutions. Results showed that these solutions reduced the duration of watery

stools during acute diarrhea caused by bacterial and viral pathogens.

21.2 Dysentery

21.2.1 Introduction

Dysentery is a term used for diarrhea when there is evidence that organisms have invaded

the intestinal wall and caused pus, mucus, and blood to appear in the stool. There is often

fever and abdominal cramps as well. Although the term dysentery conjures up more

emotion, there is no clear-cut line between diarrhea and dysentery, and treatments are

often the same.

In its classic form, dysentery leads to symptoms of cramping abdominal pain, diarrhea,

and blood and mucus in the feces. Initially, the diarrhea may be copious but soon becomes

frequent and of small volume; the patient often complains of painful defecation. It is

sometimes accompanied by other symptoms such as vomiting and fever. The shigella

infection (Sd1) rarely involves other parts of the body. However, more severe forms of

infection can occur, particularly in travellers abroad. In these cases, the patient may become

very ill and dehydrated, and in the absence of medical treatment, dysentery can be fatal.44

Some authors of Ayurvedic literature consider this disease as an advanced stage of kapha

diarrhea as well as enterotoxic diarrhea.3 Others consider it an individual disease.4

21.2.2 Definition

In Ayurvedic medicine pravahika is the term used to indicate dysentery, which means

moving with force. It is synonymous with visramsa, antargranthi, annagranthi, niscaraka, or

nissaraka. Dysentery is an acute disease in which the stools and mucus secretion causes a

delay in evacuation due to kapha and vata dosas resulting in straining down the stools.1

The word dysentery is derived from the Greek dusenteria, meaning bad intestine.

21.2.3 Clinical Description

Passage of stool with mucus and tenesmus and a feeling of incomplete evacuation characterize

the disease.1 Dysentery is a disease in which the patient passes a small quantity

of mucoid, slimy, or bloodstained stool with considerable tenesmus, gripping abdominal

pain, and burning sensation.14 More or less fever, loss of appetite, sleeplessness, and

restlessness at night also are noticed. Sometimes the abdomen is distended.

Severe symptoms include having a high fever, being very thirsty and having a red

tongue; the abdomen may appear sunken in some cases, straining ceases, and the bowels

become relaxed and may prolapse. The passage of urine is infrequent and is accompanied

by a burning sensation. The pulse becomes slow, breathing becomes rapid, and generally,

the patient looks pale and emaciated. This condition should not be allowed to continue.1

21.2.4 History and Epidemiology

Man has known dysentery in its severe form since ancient times, but most cases acquired

in the developed world today are mild. The earliest literature in Ayurveda describes this

disease in the chapter on diarrhea, whereas the latest authors have recorded this disease

as an individual entity.

Shigella infection has caused epidemics of dysentery throughout the world. It caused a

4-year epidemic in Central America beginning in 1968 that resulted in more than 500,000

cases and at least 20,000 deaths.44

21.2.5 Etiology

Accoring to Ayurveda, the main causes for this disease are similar to diarrhea. These

causes especially include foods that are incompatible (Ahita), extremely spicy, and heavy

to digest (e.g., protein-rich foods). Drinking contaminated water is also another important

cause.1

In conventional medicine, bacterial or viral infection, infestation of protozoa or parasitic

worms, and chemical irritants are described as major causes of the disease. Some of these

causes include the following:

1. Inflammation of the rectum and large intestine

2. Eating insufficient foods

3. Having an improper diet

4. Drinking too much liquid with meals

6. Eating the wrong combinations of foods

7. Being in unhygienic surroundings

8. Eating fruits or vegetables that have started decomposing

9. Eating foods that have been in pantries that are not well ventilated

10. Eating improperly refrigerated, contaminated foods

Irritated bowels, habitual constipation, and taking certain types of medicine (e.g., laxatives)

may also be the cause.

21.2.6 Pathogenesis

This disease can occur in two stages. The primary stage is due to food and other factors,

whereas the secondary stage is due to kapha diarrhea.

21.2.6.1 Transmission

In conventional medicine, few studies have been done to determine how dysentery is

spread. The most likely modes of transmission are person-to-person contact and contaminated

water and food. Epidemics of Sd1 usually occur in impoverished areas. They affect

people of all ages, with the highest age-specific incidence occurring among adults and the

highest case-fatality rates occurring among children.44

21.2.7 Diagnosis

According to Ayurveda, dysentery is diagnosed into four types. These categories are based

on the nature of signs and symptoms and are diagnosed into the following four types:

1. Vata dysentery — Defecation with tenesmus and abdominal pain

2. Pitta dysentery — Defecation with a burning sensation

3. Kapha dysentery — Defecation with mucus

4. Rakta dysentery — Defecation with blood

The enterotoxic and nonenterotoxic stages of this disease are diagnosed based on the

tests described in diarrhea.1

The types of dysentery, such as amebic, bacillary, balantidial, malignant, and viral, are

determined based on microscopic examination of the stool.44

21.2.8 Clinical Course and Prognosis

Dysentery is a curable disease. If it is left untreated, it leads to irritable colon disease.1

21.2.9 Therapy

The treatment of dysentery is aimed at eliminating the offending and toxic matter from

the intestines, alleviating painful symptoms, stopping the virulence of the bacteria, and

promoting the healing of any ulcers in the intestine. Antimotility agents should not be

used in the early stages of dysentery because of the presence of enterotoxin. In such

conditions, mild laxatives are recommended. Using herbal formulas to improve digestion

and produce a carminative effect is preferred to achieve a long-lasting effect.

The bark of kurchi (Holaarhena antidysenterica) and the raw, tender fruit pulp of bael

(Aegle marmelos) are the most important herbal ingredients in dysentery. Bastard saffron

(Mesua ferrea) flower bud, lodh bark (Symplocos racemosa), and silk cotton-tree resin (Bombax

malabarica) are the styptic plants to be used. All prescriptions for diarrhea are also useful

for dysentery.12

Among specific herbal remedies, bael fruit is, perhaps, the most efficacious in the

treatment of dysentery of both the varieties. The pulp of this fruit is mixed with jaggery

and should be given three times/day. To deal with a chronic case of dysentery, unripe

bael fruit is roasted over a fire and the pulp is mixed with water. Large quantities of the

infusion are administered with jaggery. The pulp of the unripe fruit mixed with an equal

quantity of dried ginger can also be given with buttermilk.

The use of pomegranate rind is another effective remedy for dysentery. About 60 g of

the rind is boiled in 250 g of milk until half of the milk has evaporated. It is administered

to the patient in three equal doses at suitable intervals.45

21.2.9.1 Food and Lifestyle

Adequate bedrest; a light diet; the use of potassium broth, soybean milk, or oatmeal milk;

and drinking at least 1 pt/day of ginger or barley water are highly recommended. Chewing

the food thoroughly before swallowing is most important.

Fasting is the best corrective remedy for dysentery. The patient should fast as long as

acute symptoms are present. During the period of fasting, only fruit juice (orange) and

water should be taken. In the alternative, the patient should subsist on buttermilk until

the acute symptoms are over. Buttermilk combats offending bacteria and helps establish

helpful microorganisms in the intestines.

The following foods are useful for patients with dysentery:

1. Old rice

2. Gruel prepared from pop of paddy

3. Soup prepared from phaseolus bean or lentil

4. Milk and butter from a goat or cow

5. Fresh or dried ginger

6. Leaves of wood sorrel

7. Fruits of jamun (Eugenia jambulana), pomegranate, and bael (Aegle marmelos)

8. Flower and fruit of banana

In addition, dysentery patients should avoid the following:

1. Uncherished food (asatmya bjojana)

2. Spicy and sour food

3. Incompatible articles of food (viruddha ahara)

4. Food that is difficult to digest

5. Products of sugarcane, wheat, black phaseolus bean, barley, and leaves of a variety

of chenopodium

Excessive water intake and bathing, staying awake late in the night, and irregular hours

of sleep should also be avoided.7

Compound formulations used in the treatment of dysentery are listed below:

21.2.10 Scientific Basis

21.2.10.1 Punica granatum (Pomegranate)

A decoction or tea infusion of Punica granatum peel was used in the in vitro experiments

against Vibrio cholerae. Results showed the best bactericidal effect, and it is suggested to

use them to stop cholera spreading.14

21.2.10.2 Berberis aristata (Indian Barberry)

Berberine, an alkaloid from the plant Berberis aristata, inhibited by approximately 70% of

the secretory responses of the heat-labile enterotoxins of V. cholerae and E. coli in the rabbitligated

intestinal loop model.

 

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)