Scientific Basis for Ayurvedic Therapies -22

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

Constipation (Vibandha)

Shankar K. Mitra and Paramesh R. Rangesh

18.1 Introduction

Constipation is the infrequent and difficult passage of stools. The frequency of bowel

movements among healthy people varies greatly, ranging from three movements/day to

three times/week. As a rule, if more than 3 days pass without a bowel movement, the

intestinal contents may harden, and a person may have difficulty or even pain during

elimination. Sometimes stools may harden and be painful to pass even after shorter

intervals between bowel movements. Constipation is a common, often frustrating, and

difficult to manage problem in the elderly. Approximately 25% of all Americans over 65

years old experience constipation.

1

Ayurvedic therapies are very effective treatments for

constipation.

18.2 Ayurvedic Concept

Most people develop constipation after years of either an imbalanced lifestyle or diet. In

general, there are some contributing factors. The most common is the suppression of

natural urges resulting in the subsequent disappearance of the normal eliminative urges.

For example, first thing in the morning (typically at or before dawn) there should be a

natural urge to eliminate. We often find this natural urge inappropriate or inconvenient

at certain times and force ourselves to suppress it. This habitual suppression can lead to

a kind of psychosocial form of constipation whereby elimination may be regular but not

complete. If elimination does not naturally conform to the Ayurvedic definition of normal

(i.e., every morning), then the elimination cannot be complete and the colon is therefore

constipated.

Normal elimination for one person may not be normal for someone else. In general, one

is probably constipated if one passes hard stools fewer than three times/week.

2

In some

cases, the person may also have a bloated feeling or abdominal cramping or pain.

A few commonsense lifestyle changes, including getting more exercise, eating high-fiber

foods, and drinking plenty of fluids, especially water, can go a long way toward preventing

and alleviating many cases of constipation.

3

In Ayurveda, it is described that the normal stool has a definite consistency and hardness,

which is called well-formed stool. During digestion, food undergoes an acidic state in

which it is in semiliquid form in the small intestines. As it travels further in the large

intestine, this digested food (called

ahara rasa

) is absorbed and the waste is left in the large

intestine. The cecum, the first portion of this part of the gastrointestinal tract, has the

dominance of

vata

and

pitta

dosas

that helps in drying of waste and giving it a form. When

these

dosas

are in a pathological state, it results in excess drying of the fecal matter. This

stool becomes dry and hard and is expelled in small quantities with difficulty. In such

situations, if an individual holds the urge to defecate for various reasons, there will be a

possibility of collection of fecal matter that becomes very hard; this is a result of too much

absorption of water from the stool. In many diseases, constipation occurs as a symptom.

In order to avoid this, one has to drink large amounts of water.

18.3 Definition

In Ayurveda, constipation is called

vibandha

. The word

vibandha

is derived from “vi”

prefixed to “bandh,” meaning that which is especially bound (in the intestine) or

obstructed. Its synonyms are

purishasanga

,

purishanaha

(both meaning the accumulation of

feces),

vishtambha

(obstruction),

kricchravitka

,

alpavitka

(both meaning the passing of a small

quantity of stool), and

anaha

(bloated abdomen due to accumulation of stools). Constipation

is derived from Latin, “con” meaning together and “stipare,” meaning to cram or pack.

18.4 Clinical Description

The clinical feature of the disease, described in conventional medicine as having a bowel

movement not every day, does not necessarily mean one is constipated. A person is most

likely constipated if he or she experiences the following:

1. Passes a hard stool fewer than three times/week

2. Strains more than one of four times

3. Has abdominal bloating or discomfort

3

Ayurvedic literature describes the clinical features of the disease as the condition that

is manifested with the following signs and symptoms:

1. Pain in the abdomen (left hypochondriac, iliac, and umbilical regions)

2. Reduced bowel movement

3. Painful defecation

4. Dry stools

5. Indigestion

6. Headache

7. Churning pain in rectum

8. Pain in the sacral region

4

18.5 History and Epidemiology

This disease is referred to many times in

Caraka

Samhita

.

5

Constipation is the most common

gastrointestinal complaint in the U.S., resulting in about 2 million annual visits to the

doctor.

6

Most people treat themselves without seeking medical help, as is evident from

the $725 million Americans spend on laxatives each year.

7

18.6 Etiology

According to Ayurveda, constipation is mainly caused by aggravation of

vata

, though it

can sometimes be caused by aggravation of

pitta

and

kapha

dosas.

Constipation is generally

caused by wrong and untimely bowel habits, a controlled urge to defecate, improper

eating habits and untimely food intake, eating food that is difficult to digest and dominated

with astringent properties, and not eating enough vegetables or salads (dietary fiber).

Frequent fasting is also considered as a cause of constipation. It is also caused by not

sleeping well or sleeping very late at night, irritable colon, colitis, and negative emotions

like stress, grief, fear, worry, etc.

The following are some of the most common causes of constipation, according to conventional

medicine:

1. Improper diet — The most common cause of constipation may be a diet high in

animal fats and refined sugar but low in fiber found in vegetables, fruits, and

whole grains.

2. Not enough liquids — Liquids like water and juice add fluid to the colon and

bulk to stools, making bowel movements softer and easier to pass. People who

have problems with constipation should drink enough of these liquids every day,

about eight 8-oz glasses. Other liquids that contain caffeine (e.g., coffee and cola)

seem to have a dehydrating effect.

3. Lack of exercise — Lack of exercise can lead to constipation, although doctors do

not know precisely why. For example, constipation often occurs after an accident

or during an illness when one must take bed rest and cannot exercise.

4. Changes in life or routine — During pregnancy, women may be constipated

because of hormonal changes or because the heavy uterus compresses the intestine.

Aging may also affect bowel regularity, because a slower metabolism results

in less intestinal activity and muscle tone.

5. Ignoring the urge to have a bowel movement — People who ignore the urge to

have a bowel movement may eventually stop feeling the urge, which can lead to

constipation.

6. Laxative abuse — People who habitually take laxatives become dependent upon

them and may require increasing dosages until the intestine becomes insensitive

and fails to work properly.

7. Travel — People often experience constipation when traveling long distances,

which may relate to changes in lifestyle, schedule, diet, and drinking water.

8. Fissures and hemorrhoids — Painful conditions of the anus can produce a spasm

of the anal sphincter muscle, which can delay a bowel movement.

9. Specific diseases — Diseases that cause constipation include neurological disorders,

metabolic and endocrine disorders, and systemic conditions that affect organ

systems. These disorders can slow the movement of stool through the colon,

rectum, or anus.

10. Mechanical compression — Scarring, inflammation around diverticula, tumors,

and cancer can produce mechanical compression of the intestine and result in

constipation.

11. Irritable bowel syndrome (IBS) — Also known as spastic colon, IBS is one of the

most common causes of constipation. Some people develop spasms of the colon

that delay the speed with which the contents of the intestine move through the

digestive tract, leading to constipation.

12. Nerve damage — Injuries to the spinal cord and tumors pressing on the spinal

cord can produce constipation by affecting the nerves that lead to the intestine.

13. Medications — Many medications can cause constipation. These include pain

medications (especially narcotics), antacids containing aluminum, antispasmodic

drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants

for epilepsy, antiparkinsonism drugs, and antihypertensive calcium

channel blockers.

14. Problems with colon and rectum — The peristaltic activity of the intestine may

be ineffective and result in colonic inertia or outlet obstruction. Intestinal obstruction,

scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's

disease, or cancer can compress, squeeze, or narrow the intestine and

rectum and cause constipation.

18.7 Pathogenesis and Pathology

Normally muscle contractions propel the waste products of digestion through the intestines.

In the large intestine, reabsorption of up to 90% of the water and salt takes place

because they are essential for many of our body's functions. If too much water is absorbed

or if the waste moves too slowly, one may become constipated.

3

According to Ayurveda, the

apana vata

affected (due to various etiological factors) dries

up the stools, which obstructs the bowel movements and results in constipation. In short,

the pathology of the disease is described as a result of the obstruction or reduced motility

in the large intestine, the part of the excretory system, and due to the pathological changes

in

apana

vata

involving the fecal matter.

18.8 Clinical Features

The Ayurvedic literature describes two types of constipation:

1. Constipation due to

ama

(

amaja anaha

) — Constipation caused by

ama

presents

with the following symptoms: thirst, burning sensation in the head, pain in the

abdomen, and suppression of eructation and coryza.

2. Constipation due to feces (

purishaja anaha

) — In this type of constipation, retention

of feces and urine, acute abdominal pain, and fainting are seen. Vomiting of

undigested material and pedal edema may also occur in severe cases.

Current practitioners and information sources classify the types of constipation based

on

dosa

dominance in a constitution.

18.8.1

Vata

Constipation

In Ayurveda, excretory process is controlled by

vata

, the principle that governs all kinds

of movement in the body. The particular

subdosa

of

vata

involved in constipation is called

apana

vata

.

Apana

vata

controls the movements in the pelvis and elimination and reproduction.

Typically, when

apana

vata

gets out of balance, it will first cause dryness in the

colon where the stool can become hard and impacted.

18.8.2

Pitta

Constipation

The dominance of

pitta

, whose property is heat, causes this form of constipation. An

increased heat in the colon can also dry out the colon, aggravating

apana

vata

and leading

to constipation.

18.8.3

Kapha

Constipation

When there is excess

vata

or dryness in the colon, the body will defend itself by producing

more colonic mucus to combat dryness. When this happens in excess, the clogged colon

with mucus causes a

kapha

-based constipation. This imbalance combined with a mucusforming

diet will result in a condition that could become chronic.

8

18.9 Diagnosis

A diagnosis of constipation generally depends on the medical history and a physical

examination. The doctor will first want to make sure there is no blockage (intestinal

obstruction) in the small intestine or colon, an endocrine condition (e.g., hypothyroidism),

or an electrolyte disturbance (e.g., excessive calcium in the blood [hypercalcemia]). The

doctor may also check the medications in case they may be causing the constipation.

In some cases, the doctor may order a test for hidden (occult) blood in stools. Alternatively,

one may have a barium enema. A sigmoidoscopy may help detect problems in the

rectum and lower colon, in addition to routine blood, urine, and stool tests. One may also

perform a proctosigmoidoscopy. In many cases, the doctor will be able to see the rectum

and sigmoid colon more easily with this procedure than with a barium enema.

9

18.9.1 Medical History

The doctor may ask a patient to describe the constipation, including duration of symptoms,

frequency of bowel movements, consistency of stools, presence of blood in the stool, and

toilet habits (frequency and place of bowel movements). Recording eating habits, medication,

and level of physical activity or exercise under personal history also helps the

doctor determine the cause of constipation.

10

18.9.2 Physical Examination

A physical exam may include a digital rectal exam with a gloved, lubricated finger to

evaluate the tone of the anal sphincter and to detect tenderness, obstruction, or blood.

18.9.3 Clinical Course and Prognosis

Constipation associated with intense thirst and weakness with severe abdominal pain is

considered difficult to manage according to Ayurveda.

According to conventional medicine, medical intervention is necessary if one experiences

a recent, unexplained onset of constipation or change in bowel habits or any of the

following symptoms, which might indicate a more serious health condition:

1. Constipation that lasts longer than 7 days, despite changes in diet or exercise

2. Intense abdominal pain

3. Blood in the stool

Although constipation can be extremely bothersome, it usually is not serious. If it

persists, and especially if straining results, one may develop complications such as hemorrhoids

and cracks or tears in the anus called abrasions or fissures.

Very severe or chronic constipation can sometimes cause a fecal impaction, a mass of

hardened stool not eliminated by a normal bowel movement. An impaction can be very

dangerous, and one may need to have it manually removed by a nurse or doctor.

18.10 Therapy

Although treatment depends on the cause, severity, and duration, in most cases dietary

and lifestyle changes will help relieve symptoms and help prevent constipation. As in all

other gut problems, fasting is an important initial remedy. One should fast at least once

a month so that the gut is clean and digestion is complete. This facilitates smooth passage

of stools and a sense of complete evacuation. Along with oil, ghee (clarified butter), milk,

and some roughage (i.e., green leafy vegetables) should be included in the diet.

If the staple diet consists of bread, boiled vegetables, vegetable or animal protein, salad

or dry foodstuffs, the content of ghee in the diet should be increased. Paradoxical as this

may sound, ghee in measured quantities does not increase bad cholesterol.

11

Ayurveda

has instead attributed ghee to many useful effects, including the lubrication of blood

vessels, which delays aging. One should pursue the habit of drinking milk before sleeping

and add 1 tsp of ghee to it or use ghee with hot water; this is very beneficial in mild to

moderate constipation. Administering a laxative will lubricate the walls and help elimination

for the constipated patient and provides symptomatic relief at best. However, the

goal of the Ayurvedic approach is to understand why and how the constipation manifested

and to restore balance specifically while enlivening the body’s natural ability to sustain

normal elimination. With the proper diagnosis established, the treatment for constipation

is relatively simple. The general line of treatment would include the following:

1. Application of oil massage (

abhyanga

) and sauna (

svedana

)

2. Intake of medicated fats (

snehapana

), purgation (

virecana

), and an enema (

anuvasana

basti

) with honey, rock salt, and castor oil

3. Anal suppositories such as

phalavarti and snehavarti

18.10.1 Purgation Therapy

(

Virecana

)

Virecana

, or purgation, is administered for cleansing of

pitta

and stools in the intestine.

Virecana

cleanses the small intestine and colon. Many herbs and other ingredients are used

as laxatives or purgatives. These include senna, prunes, bran, flaxseed husk, psyllium

husk, cow's milk, salt, castor oil, raisins, and mango juice. When taking these herbs, it is

important to follow a restricted diet.

The dose and the selection of herbs also depend on the nature of one’s bowel, called

koshta

in Ayurveda. The literature describes three types of bowels: extremely harsh,

weak, and moderate. The extremely harsh bowel (

krura koshtha

) is controlled by more

vata

and

kapha

, and the person with this type fails to purge and needs drastic purgatives

in higher doses. The extremely weak bowel (

mrudu koshtha

) is controlled by

pitta

and

purges to the intake of milk and needs lower doses of purgatives. The moderate bowel

(

madhya koshtha

), which is under the influence of balanced

dosas

, requires moderate doses

of purgatives.

Among the Ayurvedic medicines available for treatment of constipation, the most common

one is triphala powder (compound powder of fruit rinds of Indian gooseberry

[

Emblica officinalis

], chebulic myrobalan [

Terminalia chebula], and Belliric myrobalan [Terminalia

bellirica]) to be taken with ghee. Otherwise, the mucosal lining becomes dry and

leads to further constipation, setting a vicious cycle into motion. In keeping with the

emphasis laid on individualization of treatment by Ayurveda, the doses of these medicines

vary in different individuals.

Some of the laxatives that can be effectively used in constipation are the following:

1. Bhagottara curna — The powders of the following ingredients are mixed in increasing

ratio: resin of asfetida (Ferula foetida), rhizome of sweet flag (Acorus calamus),

blacksalt, rhizome of dried ginger (Zingiber officinale), cumin seeds (Cuminum

cyminum), fruit rind of chebulic myrobalan, and root of inula (Inula racemosa). The

mixture is taken twice/day at the dose of 3 to 6 g.

2. An equal quantity of powders of rhizome of sweet flag, fruit rind of chebulic

myrobalan, root of leadwort (Plumbago zeylanica), salt of potassium and sodium

(yavakshara), long pepper (Piper longum) fruit, atis root (Aconitum heterophyllum),

and rhizome of costus (Saussurea lappa) is taken twice/day with warm water at a

dose of 3 to 6 g.

3. 5 g of fruit pulp of Indian laburnum (Cassia fistula) is taken with 50 ml of water

and 5 to 10 g of unrefined sugar once/day.

4. 5 g of fruit rind of small Chebulic myrobalan is to be taken with 0.5 g of salt at

bed time.

5. A powder of purified and fried resin of asafetida, garcinia fruit (Garcinia indica),

fruit of bishop’s weed (Ptychotis ajowan), rock salt, and seed of fennel (Foeniculum

vulgare) is taken in equal parts. A dose of 2 to 6 g of the powder can be taken with

5 ml of fresh lemon juice twice/day.

Commercially available Ayurvedic formulas commonly used to treat constipation are

listed in Table 18.1.

Local applications:

1. Poultice of asafetida is applied around the umbilicus.

2. Poultice prepared from equal parts of salt petre, fruit rind of Indian gooseberry,

ammonium chloride, and sesame seeds (Sesamum indicum) is applied around the

umbilicus.

18.10.2 Enema (Basti)

The medication rectally administered to control vata, which is mainly located in the colon,

is known as basti or medicated enema. In general, this treatment is used to flush out the

loosened dosas (including stools) through the intestinal tract. This therapy is administered

in chronic and extreme conditions of constipation. It is also administered to patients with

habitual constipation and weak patients who cannot be subjected to purgation. This

therapy is done under the supervision of a physician. There are over 100 specific enemas

listed in Ayurveda to treat constipation and for other panchakarma procedures.

An enema involves introducing medicinal substances, such as sesame oil, cow’s ghee,

and other herbal decoctions, in a liquid medium into the rectum. This treatment is especially

good for vata disorders and it alleviates constipation and abdominal distension.

The common type of enemas are the following:

1. Oil enema or anuvasana basti — 1/2 to 1 cup of warm sesame oil or castor oil (for

chronic constipation)

2. Decoction enema or asthapana basti (herbal enema) — 1/2 cup of gotukola (Centella

asiatica) decoction with 1/2 cup of warm sesame oil or honey mixed with sesame

oil and rock salt (for acute constipation)

3. Nutritional enema — 1 cup of warm milk, 1 cup of meat broth, or 1 cup of bone

marrow soup4 (for chronic constipation where general weakness is a problem)

TABLE 18.1

List of Ayurvedic Formulas Used for Constipation

Name of Formulation Activity Dose Adjuvant Ref.

Triphala Curna Laxative, digestive 2–6 g two times/

day

50 ml warm water and

ghee

5

Hingvadi Curna Carminative,

antiflatulent, laxative

1–2 g two times/

day before or with

meals

Warm water, buttermilk

and ghee

12

Yashtyadi Curna syn.

Madhukadi curna or

Svadishta virecana

Laxative 3–6 g at bedtime Warm water 13

Pancasakara curna Antiflatulent, laxative 3–6 g at bedtime Warm water 13

Trivritadi leha Laxative 6–12 g on an empty

stomach in the

morning

Warm water 5

Icchabhedi Rasa Drastic purgative,

contraindicated for

regular use in

constipation (for

virecana therapy

only)

120–240 mg on an

empty stomach

early morning

Cold water 12

Contraindications for the enema are people suffering from chronic indigestion, bleeding

from the rectum, cough, breathlessness, diarrhea, diabetes, and severe anemia; the elderly;

or children under 7 years old. People suffering from acute fever, diarrhea, cold, paralysis,

heart pain, or severe pain in the abdomen are not given decoction enemas.

18.10.3 Vata Constipation

Oleation (snehana) and purgation (virecana) is the general line of treatment for all vata,

pitta, and kapha constipations. A monthly oleation with ghee followed by castor oil purgation

provides eliminative support and cumulatively reinstates a more unctuous environment

in the colon. To ensure such an effect, moistening and vata-balancing herbs are

administered between oleations and purgations. This kind of therapy should not be

continued beyond 3 months, and the following procedure is helpful:

1. While eating light food for a week, one should start each day with progressively

increasing amounts of liquid ghee (2–4–6 tsp) taken orally. (Note: Avoid this procedure

if fat intolerant.)

2. On the eve of the 4th day, take a warm bath before retiring and drink 6 tsp of

castor oil as a purgative.

3. If there is any sign of weakness or fatigue, avoid the procedure above and simply

take 1/2 to 1 tsp of castor oil every night for 1 month. This should not produce a

purgative effect. If it does, take less castor oil, because a continuous laxative effect

can deplete body fluids and electrolytes.

For a proper diet, cold and dry foods should be avoided. Eat heavier warm foods with

an emphasis on oily foods such as nuts, oils, and cooked grains.

18.10.4 Pitta Constipation

Purgation therapy provides a cooling, moistening, and eliminative effect, making it the

treatment of choice for this type. Herb therapy includes the following:

1. Take 1 to 2 tsp of aloe gel (Aloe vera), three times/day.

2. Take 1 tsp of triphala with ghee to make a paste and take three times/day.

3. Take licorice (Glycyrrhiza glabra), F. vulgare, and coriander (Coriandrum sativum) tea

three times/day.

4. Take 1 tsp of psyllium husk mixed well with 8 oz of warm water for 5 min before

bedtime.

5. For severe cases, rhubarb root (Rheum emodi) and Indian senna (Cassia angustifolia)

leaf can be taken individually or together as needed.

For a proper diet, one should favor foods that are slightly oily and cooked and avoid

hot, spicy, and pungent foods.

18.10.5 Kapha Constipation

The aim of the treatment is to reduce kapha with dietary changes. Foods rich in hot and more

pungent spices, such as ginger and black pepper, are recommended. Mucus-producing

foods, including cheese, sugar, yogurt, bread, and pastries, should be especially avoided at

night. The following herbal remedies are useful:

1. 1 to 2 tsp of psyllium husk (Plantago ovata) taken with 8 oz of water three times/

day.

2. 8 to 10 glasses of warm honey water daily.

3. 1/2 to 1 tsp of triphala taken with honey three times/day.

4. Aloe, rhubarb, and Indian senna are bitter laxatives that will combat the intestinal

kapha and provide an eliminative effect.

Note: While treating for vata, pitta, or kapha constipation there should not be an excess

of bowel movements. If there is such an effect, reduce the dose of recommended

therapy. If there is no improvement in 2 weeks of treatment, the dosages should be

increased.8

18.10.6 General Dietary Recommendation

A diet with enough fiber (20 to 35 g/day) helps form soft, bulky stools. A doctor or dietitian

can help plan an appropriate diet. High-fiber foods include beans, whole grains, bran

cereals, fresh fruits, and vegetables such as asparagus, sprouts, cabbage, and carrots. For

people prone to constipation, limiting foods that have little or no fiber such as ice cream,

cheese, meat, pizza, and processed foods are also important.

18.10.7 General Lifestyle Changes

Other changes that can help treat and prevent constipation include drinking enough water

and other liquids (e.g., fruit and vegetable juices and clear soup), engaging in daily

exercise, walking a mile, and reserving enough time to have a bowel movement. In

addition, the urge to have a bowel movement should not be ignored. People who are

dependent on laxatives need to gradually stop using the medications with the help of a

physician.

18.10.8 Prevention of Constipation

It is well known that prevention is the best approach to constipation. Although there is

no way to ensure never experiencing constipation, the following guidelines should help.

It is important to eat a well-balanced diet that includes unprocessed bran, whole-wheat

grains, fresh fruits, and vegetables. Drink plenty of fluids, exercise regularly, have a regular

time for breakfast, lunch, dinner, and have undisturbed visits to the toilet. It is very

important not to ignore the urge to defecate and avoid a dependence on laxatives. Improve

the digestion with the use of light spices such as cumin seeds, coriander, turmeric powder,

fennel, and asafetida. Drinking a glass of warm milk at bedtime helps in evacuation the

next morning. Regulate your sleeping hours. Ayurveda advises the common saying, “early

to bed and early to rise.” In the morning after waking up, drink a glass or two of preferably

warm water and then wait a few minutes before going for evacuation. Massaging the

whole body with oil (abhayanga) once or twice a week and applying oil or ghee on the

naval area daily helps in preventing constipation.

18.11 Scientific Basis

A review of pharmacological studies on various Ayurvedic plants used in the therapies

of constipation are presented in this section.

18.11.1 Aloe vera (Aloe)

Barbaloin or aloin derived from the inner sheath cells of Aloe leaves is a laxative. In

vitro studies have revealed the inhibitory effect on sodium and potassium pump and

chloride channels at the colonic membrane.14 Aloe anthroquinones were reported to

enhance large-intestinal propulsion and water secretion in rats and mice.15,16 Randomized

controlled trials have documented its potency as a cathartic in chronically constipated

adults.17

18.11.2 Plantago ovata (Psyllium)

The ground seeds or husks of psyllium are used in dietary supplements for increased

fiber, cholesterol reduction, and laxative activity.18 In a randomized double-blind placebo

study,19 psyllium was found to be effective for stool frequency and consistency in patients

with chronic constipation. In an open study,20,21 conducted in patients having manifestations

of irritable bowel syndrome with constipation, psyllium showed good results.

18.11.3 Cassia senna (Senna)

Senna leaf contains 1.5 to 3% hydroxyanthracene glycosides, mainly sennosides A and B,

which are rheindianthrones, and smaller amounts of sennosides C and D, which are rheinaloe-

emodin-heterodianthrones. Modern human studies have investigated the use of

senna for the following:

1. Treating severe constipation22,23

2. Treating chronic constipation in long-stay elderly patients24

3. Managing morphine-induced constipation25

4. Improving colonoscopy preparation with lavage26

5. Managing constipation in the immediate postpartum period27

6. Managing postoperative constipation in anorectal surgery28

7. Treating disorders characterized by slow intestinal transit time or constipation29

8. Using as a laxative for terminal cancer patients treated with opiates30

18.11.4 Rheum officinale (Rhubarb)

The active chemical constituents of rhubarb are anthraquinone glycosides, aloe-emodin,

and physcion.31,32 Experimental studies33 have revealed that the laxative effect is due to

the inhibition of water and electrolyte reabsorption in the large colon and to a stimulant

effect on intestinal motility. Clinically, it is used to soften stool in anal fissures and

hemorrhoids and is used postoperatively for anorectal surgeries. It is also effective as

a cathartic and therefore used for colonoscopy preparations.34

18.11.5 Prunus persica (Almond)

The leaf decoction of almond is used traditionally as anthelmintic and laxative. An experimental

study35 has revealed that the aqueous extract of leaves exhibits cholinomimetic

activity, which may result in its laxative effect.

18.11.6 Terminalia chebula (Chebulic Myrobalan)

T. chebula is a commonly advocated agent in Ayurveda for improving gastrointestinal

motility. Charles Foster rats were administered T. chebula (100 mg/kg/day for 15 days

orally), metoclopramide, or atropine, which established prokinetic and antikinetic activities,

respectively. T. chebula was found to increase the percent of gastric emptying. The

enhancement of gastric emptying was comparable with that produced by metoclopramide.

This indicates that T. chebula can be a useful alternative to the prokinetic drugs available

today.36,37

18.11.7 Cassia fistula (Indian Laburnum)

The seeds and dried pulp in the pod of this fruit act as a purgative. The flowers soothe

the eyes and the pods suppress acidity, making it useful in treating constipation associated

with burning pain in the stomach (pitta type). The water extract is also used for treating

constipation in pregnant women, children, and elderly persons. The pulp, prepared from

its fruits, is a laxative used in the treatment of constipation.38

18.11.8 Mallotus philippinensis (Indian Kamala)

The kampillaka plant is excellent in treating constipation associated with worm infestation

as it first kills worms and then, due to its purging effect, gets rid of them. A powder made

of kampillaka is especially useful. Sometimes worm infestation causes itching of the skin.

At such times, taking kampillaka powder at night in the dose of only 500 mg to 1 g is

useful.39

18.11.9 Ricinus communis (Castor)

Castor seed oil is a harmless laxative in small doses. In large doses it is and can be safely

used throughout the year.40

Acknowledgments

The authors acknowledge the data input provided by M.V. Venkatranganna and S. Gopumadhavan,

Pre-Clinical Pharmacology Laboratory, R&D Center, The Himalaya Drug Company,

Makali, Bangalore, India.

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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)