Medicinal plants having antidiarrheal activity.
Diarrhea is a common gastrointestinal problem characterized by loose watery stool and mild to severe dehydration. Annually, about 1.7–5 billion new cases of diarrhea were reported. In developing countries, it is more common, where young kids have diarrhea approximately three times/year. In 2013, 1.26 million deaths occurred due to diarrhea, whereas in 1990, the figure was slightly higher (2.58 million). In 2012, diarrhea was the second most common reason of death (11%, n = 0.76 million) in children less than 5 years. Although various synthetic drugs are being prescribed as standard therapy for diarrhea, they have side effects. It is possible to prescribe the herbal medicine for diarrhea, which is safe and effective. In this study, medicinal plants discussed are proven to be scientifically active in diarrheal diseases. This study reviews about current medicinal plants used in the treatment of diarrhea. The use of medicinal plants for diarrhea results in improvement of the symptom. Moreover, studies on large scale are needed to characterize the beneficial role of medicinal plants in the treatment of diarrhea.
- infectious disease
- medicinal plants
- literature review
Diarrhea increased the frequency of bowel movements. Diarrhea is a clinical syndrome of diverse etiology associated with loose or watery stools often with vomiting and fever. Various bacteria, viruses, and parasites cause diarrhea. The most common causes of acute diarrhea are infectious agents . In the Western world, normal fecal weight is less than 200 grams/day with firm to hard consistency of the stools. In India, greater dietary fiber content of the diet increases the fecal mass and its water content. Therefore, it is better to define diarrhea as the condition in which fecal mass and water content are greater than usual. Diarrhea is of two types. One type is called infectious and other is called noninfectious. Bacterium, virus, and parasites cause infectious diseases. Diarrhea affects all age groups but it is most commonly seen in children. Transmission of infection mostly occurs through the fecal-oral pathway. Microscopy and stool cultures are diagnostic investigation for diarrhea. Diarrhea is prevented by precaution such as handwashing. Acute diarrhea may also be caused by drugs or toxins. Infectious agents are also responsible for chronic diarrhea. Foods additives, medications, irritable bowel syndrome, malabsorption, and inflammatory bowel diseases are other causes of diarrhea. Diarrhea occurs due to various drugs. Digoxin is usually prescribed for treatment of heart disorders; sometimes diarrhea is seen in the patients taking digoxin. Antibiotics are prescribed for treatment of various ailments including diarrhea, but sometimes it has been observed that diarrhea occurs in the patient taking antibiotics. Diverticulitis is another cause of diarrhea. Infarction of bowel is also responsible for diarrhea .
|Poaceae||Leaves and stems||Antidiarrheal, anti-inflammatory, chemopreventive|||
|Apocynaceae||Roots, bark, and leaves||Antidiarrheal|||
|Fabaceae||Root, leaves||Antidiarrheal, antidepressant, hypolipidemic|||
|Nymphaeaceae||Roots, flowers||Antidiarrheal, anxiolytic, anticancer|||
|Rubiaceae||Roots, leaves||Antidiarrheal, anti-inflammatory|||
|Anacardiaceae||Seed||Antidiarrheal, immunomodulant, hypoglycemic|||
|Caesalpiniaceae||Leaves||Antidiarrheal, Anti-inflammatory, antipyretic, analgesic|||
1.1 Types of diarrhea
1.1.1 Acute diarrhea
Acute diarrhea remains less than 2 weeks. Protozoa, bacteria, virus, food intolerance, and emotional stress cause acute diarrhea .
1.1.2 Chronic diarrhea
Chronic diarrhea remains more than 4 weeks.
22.214.171.124 Types of acute diarrhea
126.96.36.199.1 Inflammatory diarrhea
The large intestine is involved in inflammatory diarrhea by invasive parasites or bacteria. Signs and symptoms include fecal urgency, tenesmus, abdominal cramps, fever, small-volume stools, and bloody stool .
188.8.131.52.2 Noninflammatory diarrhea
The small intestine is involved in noninflammatory diarrhea. In this type, toxins or viruses affect the small intestine that interferes with water and salt balance. Signs and symptoms include cramps, vomiting, nausea, and large-volume watery diarrhea .
1.2 Causes of diarrhea
Causes of diarrhea can be divided into two categories: environmental factors and causative agents.
1.2.1 Environmental factors
Diarrhea is common in bottle-fed children than in breast-fed children. Unhygienic preparations of milk feed, the use of unhygienic bottles, and their contamination by flies and insects may lead to infection of milk, which is an excellent media for the growth and multiplication of organism. On the contrary, breast milk is clean, and it inhibits the growth of organism due to the presence of lactoferrin, lysozymes, leucocytes, macrophages, lactobacillus, and antibodies in it. Infected water and food are also responsible for frequent diarrhea in older children and adults.
1.2.2 Causative agents
Acute diarrhea may be secretory or invasive. Secretory types of diarrhea are caused by bacteria
Cholera is a severe acute gastrointestinal infection cause by
It consists of two subunits A and B. Subunit B binds to a glycolipid in microvillus membrane. Subunit A enters into cell and inactivates 60S ribosomal subunit. Protein synthesis is stopped and sloughing off of dead cells occurs, and as a result bloody diarrhea occurs .
This virus causes typical clinical symptoms of diarrhea preceded or followed by vomiting and fever. It is responsible for 50% diarrheal cases, in children between 6 months and 2 years of age. In developing countries,
This genus consists of 200 serotypes, which cause diarrhea both in man and animals.
It is a spore-bearing bacillus. It causes primarily abdominal cramps and watery diarrhea. Organisms are transmitted through food. In cooked stored food, vegetative cells are destroyed by heat, but spores germinate into vegetative cells on cooling or storing the food .
They contain enterotoxins, which are responsible for vomiting and diarrhea. It is a common inhabitant of the human nose, throat, feces, and skin. Foodstuffs like meat and potato stuffs are favorable media for its growth. Enterotoxin being heat stable is not destroyed on heating .
It contaminates soil-grown food and milk. It causes diarrhea and abdominal cramps. It may stimulate staphylococcal food poisoning characterized by nausea and vomiting. Its spores survive at high temperature and boiling and multiply rapidly on cooling and storage.
It invades the large intestine and causes dysentery. Trophozoites containing RBC in stool or cysts are diagnostic. Trophozoites are not infectious but cysts are infectious. Encystment does not occur outside the body. It is passed through uncooked food, water, and from person to person. Cysts of
It causes watery diarrhea, loose and foul-smelling stools. Abdominal cramps, anorexia, and distension of abdomen are common. Cysts of
1.3 Levels of dehydration in children with acute diarrhea
Sign and symptom of hydration include skin pinch (immediate), drinking (normal), eyes (not sunken), and alertness (normal) .
1.3.2 Mild dehydration
Signs and symptoms of mild dehydration include restlessness or irritability, slow skin pinch, drinking eagerly, and sunken eyes .
1.3.3 Severe dehydration
Severe dehydration includes very slow skin pinch, drinking poorly or not at all, sunken eyes, and abnormally sleepy or lethargic .
Etiology of diarrhea includes entero-adhesive
1.3.5 Host factors
Host factors include malnutrition , lactose intolerance, and repeated bouts of diarrhea.
1.3.6 Investigation of diarrhea
Investigation of stool includes stool analysis, stool culture in bloody diarrhea, serum electrolytes, serum urea and creatinine, and sigmoidoscopy if ulcerative colitis is suspected .
1.3.7 Principle of treatment
Immune-enhancing drugs should be prescribed to enhance immunity. Diaphoretic drugs are given to control fever. Antimicrobial drugs are prescribed to treat bacterial diarrhea. Anti-inflammatory drugs are given in case of cytotoxins. Gastrointestinal antiseptic herbs can be prescribed. Antiprotozoal herbs are given in case of protozoal infection .
Soups are advised to patients with diarrhea. Patients are encouraged to take fruit drinks. Caffeine, alcohol, milk products, fats, and high-fiber diets are avoided to rest bowel. Fluids are given at the rate of 5–200 mg/kg/d depending on the hydration state. Intravenous fluids are preferred in patients with severe diarrhea. Normal saline or Ringer’s lactate is given to restore water and electrolytes .
1.3.9 Oral rehydration therapy
Oral rehydration is given to check or prevent fluid and electrolyte losses and disturbances in all cases of diarrhea of all etiologies. It replaces all fluid and electrolytes in continuing diarrhea. Glucose will provide energy to the body. Glucose by coupling mechanism facilitates absorption of sodium and water. In rural areas where glucose is not available, sucrose of ordinary cane sugar may be used in place of glucose though it is no better than glucose. Sodium and water given orally are poorly absorbed in the small intestine in the absence of glucose. Any safe water can be used for oral rehydration fluid. In case of doubtful hygienic water, it should be boiled and cooled before mixing ingredients in it. In rural areas, the shallow well water are always infected water; therefore boiled and cool water sufficiently treated with bleaching powder should be used. Adequate replacement of potassium loss is particularly important in malnourished children. Sodium bicarbonate rapidly corrects acidosis. Sodium bicarbonate is absorbed during diarrhea. Mild transient alkalosis is of little importance. Its absence from oral rehydration solution shall not lead to bicarbonate bound sodium absorption. This will not only delay the correction of acidosis, but in its absence, acidosis may also become irreversible in many cases.
1.4 Antidiarrheal agents
1.4.1 Anti-motility drugs
Antimuscarinics such as atropine, mepenzolate, propantheline, and dicyclomine are effective in diarrhea. Loperamide is prescribed in diarrhea. Loperamide reduces the intestinal motility. Loperamide only reduces the symptoms of diarrhea. Therefore, cause of diarrhea should be sought .
1.4.2 Antibiotic therapy
This is a somatostatin analogue, which inhibits secretion of local hormones of gastrointestinal tract like gastrin, motilin, VIP, glucagon, and serotonin. Octreotides are prescribed in diarrhea caused by carcinoid tumor, VIPoma, vagotomy, dumping syndrome, short bowel syndrome, and AIDs. Adverse effects include nausea and GIT upsets. Prolonged therapy may cause effects of excessive somatostatin like cholelithiasis .
It is available in tablets containing diphenoxylate and atropine. Atropine is added to discourage the addiction liability with diphenoxylate. This combination of diphenoxylate with atropine is known as co-phenotrope .
Kaolin, pectin, chalk, ispaghula, methylcellulose, and sterculia can be used in the treatment of diarrhea, but their effect is weak. Ispaghula, methylcellulose, and sterculia are used in cases of diverticular disease, ileostomy, and colostomy .
1.5 Medicinal plants with antidiarrheal and related beneficial properties
It belongs to family Lecythidaceae. Leaves and stem are used treat diarrhea. Chemical constituents contain flavonoids, tannins, saponins, and triterpenoids. It is used in bronchitis, cancer, wounds, dysentery, jaundice, diarrhea, boil, ulcer, filaria, swelling, fever, ear pain, skin diseases, stomach diseases, smallpox, body pain, rheumatic pain, eye complaints, asthma, and dental disorders. It is anthelmintic, demulcent, tonic, anticancer, antipyretic, antidiarrheal, antioxidant, antileishmanial, hepatoprotective, and analgesic . The methanol extract of this plant was used for study. Mice were selected for study. Castor oil-induced diarrhea was prevented by the use of
It belongs to family Berberidaceae. Roots, fruits, leaves, and stem are used to treat diarrhea. Chemical constituents contain palmitine, berberine, iron, zinc, calcium, and vitamin C. It is used in gonorrhea, chronic diarrhea, piles, broken bones, wounds, acute conjunctivitis, jaundice, and diabetes . Pharmacological activities include antioxidant, antidiarrheal, and wound healer . Arshad et al. reported the ethnomedicinal use of this plant in diarrhea .
It belongs to family Lythraceae. Parts used are twig exudates, fruit, flowers, and stem. Chemical constituents contain copper, potassium, phosphorus, sulfur, carotene, vitamin c, fiber, pectin, pelletierine, isopelletierine, iron, calcium, magnesium, calcium, and carbohydrates. It is used in diabetes mellitus, cancer, and cardiovascular disorders. It is antiviral, antibacterial, antidiabetic, chemopreventive, antioxidant, and cardioprotective  reported the antidiarrheal activity of
It belongs to family Boraginaceae. Parts used are roots. Chemical constituents contain lanast-5-en-3β-D-glucopyranosyl-21 (24)-olide, stigmast-5-en-3β-ol-23-one, n-dotriacont-9-one-13-ene, n-pentacos-9-one, stigmast-5-en-3β-ol-21(24)-olide, n-nonacosanyl palmitate, n-tetradecanyl laurate, and n-decanyl laurate. It is used in dysentery, skin diseases, leprosy, and fever. It is diuretic, antimicrobial, and anti-inflammatory . Antidiarrheal activity of
It belongs to family Lamiaceae. Parts used are dried leaves and young twigs. It is used in diarrhea and dysentery. It is carminative, stimulant, antipyretic, antinociceptive, cytotoxic, insecticidal, calcium channel blocker, and antimicrobial .
It belongs to family Mimosaceae. Parts used are leaves and pods. It is used in diarrhea, dysentery, gonorrhea, diabetes mellitus, sore throat, and cancer . It is anti-plasmodial, chemopreventive, larvicidal, antidiarrheal, hypotensive, and immunomodulant . Antidiarrheal activity of
It belongs to family Apocynaceae. Parts used are barks. Chemical constituents contain porphyrin, alstonine, echitamine, picrinine, detamine, and strictamine. This plant has been used in diarrhea, dysentery, and hypertension . It is bronchodilator, antimalarial, spasmolytic, antidiarrheal, anticancer, and neuroleptic. Castor oil-induced diarrhea was prevented by the crude extract of
It belongs to family Capparaceae. Parts used are flowers and leaves. It is used in diarrhea, cardiovascular disorders, and pyrexia. It is antidiarrheal, antipyretic, antimicrobial, anti-ulcer, and immunostimulant . Methanolic extract of this plant was used for antidiarrheal activity. The activity of plant extract was investigated in castor-induced diarrhea. Mice were selected for study. There was significant reduction in diarrhea in mice. Three level doses (100, 150, and 200 mg/kg) of extract were used for activity. Extract prevented castor oil-induced diarrhea. This activity of plant was comparable to loperamide-treated animals. Intestinal transit was decreased up to 75.97%. This study indicated that plant is effective in diarrhea .
It belongs to family Amaranthaceae. Parts used are seeds. It is used in hypertension, inflammation, jaundice, ulcer, skin eruption, and diarrhea. It is antioxidant, antidiarrheal, immunomodulant, antimetastatic, antidiabetic, and wound healer . Alcoholic extract of plant was used for study. Different experimental models were used. Diarrhea was induced by castor oil and PGE (2). Loperamide at dose of 2 mg/kg and atropine at dose of 0.1 mg/kg were used as standard drugs. Two level doses (100 and 200 mg/kg) of extract were used for antidiarrheal activity. Antidiarrheal activity of extract was dose-dependent. This study indicated that plant has antidiarrheal activity .
It belongs to family Leguminosae. Parts used are leaves and roots. Chemical constituents contain fatty acids, iodine, oil, and carbohydrates. It is used in pruritis, worms, dysentery, cancer, and inflammation. It is antidiarrheal and antidiabetic. Akah et al. reported the antidiarrheal properties of
It belongs to family Moraceae. Parts used are leaves. Chemical constituents contain wax, tannin, caoutchouc acid, glucoside, beta-sitosterol, hispidin, bergapten, and psoralen latex. It is used in ulcer, psoriasis, anemia, piles, jaundice, hemorrhage, vitiligo, diarrhea, diabetes, epilepsy, and hepatitis. It is antidiuretic, antibacterial, anti-inflammatory, hypolipidemic, memory enhancer, hepatoprotective, and anticancer . Methanol extract of this plant was used for study. Diarrhea was induced by castor oil. Enteropooling was induced by PGE (2). This study was conducted in rats. Extract prevented diarrhea and enteropooling induced by castor oil and PGE (2). Charcoal meal test was also performed. Gastrointestinal motility was also reduced by the use of this extract. This study indicated that plant has antidiarrheal activity .
It belongs to family Combretaceae. Parts used are fruit. Chemical constituents contain tannins, beta-sitosterol, chebulagic acid, ethyl gallate, ellagic acid, and gallic acid. It is used in jaundice, tuberculosis, and inflammation. It is antidiarrheal, antioxidant, antispasmodic, hypoglycemic, and bronchodilator [50, 51]. Antidiarrheal activity of plant was investigated. The activity of this plant was also investigated against
This review has revealed that medicinal plants continue to play a vital role in the primary health care of the people. More than half of the people in the world use medicinal plants regularly to treat many ailments, including diarrhea. Hence, further work should be done on the characterization and pharmacological validation of the use of medicinal plants for the treatment of diarrhea. Medicinal plants have potential to treat diarrhea and are prescribed by Unani physician all over the world. Improving hygienic condition prevents diarrhea. Documentation of medicinal plants used to treat diarrhea will help the physician in their practice. There is only description of medicinal plants, but further study should be carried out to find the active constituents responsible for efficacy to treat diarrhea.
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