Bulla Health Dictionary

Linn.

Family: Annonaceae.

Habitat: A native to South America and the West Indies; now cultivated throughout India.

English: Custard Apple, Sugar Apple, Sweet-sop.

Ayurvedic: Gandagaatra, Sitaa phala (also equated with Curcurbita maxima).

Unani: Sharifaa.

Siddha/Tamil: Sitaaphalam, Atta.

Action: Leaves—insecticide (seed powder, mixed with leaf juice is used for removing lice from scalp). Seeds—abortifacient. Root— purgative, used in blood dysentery.

Fruit—invigorating, sedative to heart, antibilious, antiemetic, expectorant. Dried, powdered unripe fruits—used for treating ulcers. Ripe fruit made into paste with betel leaves is applied to tumour to hasten suppuration. Leaves, bark, unripe fruit—strongly astringent; used for diarrhoea and dysentery.

A fraction of total alkaloid from roots exhibits antihypertensive, antispasmodic, antihistaminic and bron- chodilatory properties. Leaves contain a cardiotonic alkaloid, quinoline. Squamone and bullatacinone were selectively cytotoxic to human breast carcinoma.

In Cuban medicine, leaves are taken to reduce uric acid levels.... annona squamosa

An inhaled corticosteroid drug used in the treatment of bronchial asthma to prevent asthma attacks. It is administered using an inhaler. Side effects of budesonide, which include hoarseness, throat irritation and, rarely, fungal infections, can be reduced by rinsing the mouth after administration.

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Buerger’s disease A rare disorder, also called thromboangiitis obliterans, in which the arteries, nerves, and veins in the legs, and sometimes those in the arms, become severely inflamed. Blood supply to the toes and fingers becomes cut off, eventually causing gangrene. The disease is most common in men under the age of 45 who smoke heavily. bulimia An illness that is characterized by bouts of overeating usually followed by self-induced vomiting or excessive laxative use. Most sufferers are girls or women between the ages of 15 and 30. In some cases, the symptoms coexist with those of anorexia nervosa. Repeated vomiting can lead to dehydration and loss of potassium, causing weakness and cramps, and tooth damage due to the gastric acid in vomit. Treatment includes supervision and regulation of eating habits, and sometimes, antidepressant drugs and/or psychotherapy. bulk-forming agent A substance that makes stools less liquid by absorbing water: a type of antidiarrhoeal drug. bulla A large air- or fluid-filled bubble, usually in the lungs or skin. Lung bullae in young adults are usually congenital. In later life, lung bullae develop in patients with emphysema. Skin bullae are large, fluid-filled blisters with a variety of causes, including the bullous disease pemphigus.... budesonide

n. a group of conditions caused by fungi of the genus Aspergillus, usually Aspergillus fumigatus. These conditions nearly always arise in patients with pre-existing lung disease and fall into three categories. The allergic form most commonly affects asthmatic patients and may cause collapse of segments or lobes of a lung. The colonizing form leads to formation of a fungus ball (aspergilloma), usually within a pre-existing cavity in the lung (such as an emphysematous *bulla or a healed tuberculous cavity). Similar fungus balls may be found in other cavities, such as the eye or the sinuses around the nose. The third form of aspergillosis, in which the fungus spreads throughout the lungs and may even disseminate throughout the body, is rare but potentially fatal. It is usually associated with deficiency in the patient’s immunity.... aspergillosis

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

Terminalia spp.

Combretaceae

The genus Terminalia includes a large group of medicinally valuable trees. They belong to the family Combretaceae.

The most important medicinal species of the genus Terminalia are the following.

1) T. arjuna (Roxb.ex DC) Wight & Arn.

San: Arjunah, Kakubhah;

Hin: Arjun, Kahu, Kahua;

Mal: Marutu, Nirmarutu, Venmarutu, Attumarutu, Pulamatti;

Tam: Attumarutu, Nirmarutu, Vellaimarutu, Marutu;

Kan: Maddi.

It is a large evergreen tree commonly found in Madhya Pradesh, Bihar and Peninsular and India. It has buttressed trunk and spreading crown with drooping branches. Bark is smooth, grey outside and flesh coloured inside, flaking off in large flat pieces. Leaves are simple, sub-opposite, oblong or elliptic, coriaceous, crenulate, pale dull green above, pale brown beneath, often unequal sided, nerves 10-15 pairs and reticulate. Flowers are white, arranged in panicles of spikes with linear bracteoles. Fruits are ovoid or oblong with 5-7 short, hard angles or wings, the lines on the wings oblique and curving upward (Warrier et al 1996).

The bark is useful in fractures, ulcers, urethrorrhoea, leucorrhoea, diabetes, vitiated conditions of pitta, anaemia, cardiopathy, fatigue, asthma, bronchitis, tumours, internal and external haemorrhages, cirrhosis of the lever and hypertension. It is used in fractures and the powdered bark is taken with milk. The bark powder is diuretic and has a general tonic effect in cases of cirrhosis of liver. The bark has been considered by the ayurvedic physicians as well as by modern practitioners as a cardiac tonic. It is given as a decoction with milk (NRF, 1998). In Ayurveda, “Arjunaghrita” and “Arjunarishta” are two important cardiotonic preparations of this drug.

Fruits contain flavanones - arjunone and 5,7,2’, 4’ - tetramethoxy flavone and a chalcone - cerasidin. Other constituents are -sitosterol, friedelin, methyloleanolate, gallic acid, ellagic acid and arjunic acid. Bark gave a triterpene arjungenin, triterpene glucosides I, II and III. Stem bark gave flavones - baicalein and arjunolone characterised as 6,4’ - dihydraxy - 7-methoxy flavone. Stem bark yields oxalic acid and tannins besides complex glycosides (Bhatra et al, 1980). Bark is alexertic, styptic, antidysenteric, astringent, antiasthmatic, febrifuge, expectorant, cardiotonic aphrodisiac and diuretic. Fruit is deobstruent. Stem-bark is CVS and CNS active, diuretic and abortifacient. Aerial part is CNS depressant and semen coagulant.

2) T. alata Heyne ex Roth. Syn. T. tomentosa (Roxb. Ex. Dc.) W & A.

San: Dharaphala, Saradru, Sajada;

Hin. Ain;

Ben: Asan, Paishal;

Mal: Tehmbara;

Tam: Karramarda, Karu Murutha, Marudam, Pudavam.

This tree is distributed in Himalaya from Kangra eastwords to Goalpara in Assam and southwards throughout the Peninsular India, upto 1200 m. The bark of the tree is widely used in ulcers, fractures, bronchitis and diarrhoea. Hydrolysis of the gum gives oligosaccharides, disaccharides and monosaccharides. Leaves and fruits give -sitosterol. Bark is diuretic, antihaemorrhagic, styptic, cardiotonic and semen coagulant.

3) T. bellirica (Craertn.) Roxb.

San: Aksha, Anilaghanaka, Baheduka, Harya, Kalinda;

Hin: Bulla, Sagona;

Ben: Bahera, Baheri;

Tam: Akkam, Kalanduri, Tani;

Tel: Bhutavasamu Tadi, Tandra, Vibhutakamu.

Belliric Myrobalan is distributed throughout India, upto 900 m. Its bark is used in anaemia and leucoderma. The fruit is used in bronchitis, strangury, sore throat, diseases of eye, nose, heart and bladder, hoarseness and piles. It forms an important constituent of the ayurvedic drug ‘triphala’. Furits contain -sitosterol, gallic and ellagic acids, ethyl gallate, galloyl glucose, chebulagic acid and a cardiac glucoside bellaricanin. Alcoholic extract of the fruit possesses bile-stimulating activity. Alcoholic extract, 30 mg/kg does not affect blood pressure and respiration, but a higher dose of 60 mg/kg produces a fall in blood pressure. Furit has anticancerous and flower has spermicidal activity. Bark is mild diuretic. Fruit is astringent, antidropsical, antileprotic, antiinflammatory, antidiarrhoeal, antibilious, stomachic, antiasthmatic, tonic, anticephalgic, bechic, anthelmintic and attenuant. Kernel is narcotic. Semi -ripe fruit is purgative. Gum is demulcent (Husain et al, 1992)

4) T. bialata steud.

White Chugalam or silver grey wood is a common tree of Andaman Islands. Its bark is used as a cardiac stimulant.

5) T. Catappa Linn.

San: Grahadruma;

Hin: Badam;

Ben: Bangla Badam:

Tam: Natuvdom, Vadhamkottai;

Tel: Vedam, Voda Movettilla; Mar: Jangli Badama, Nat Badam.

Indian Almond or Tropical Almond is a popular tree cultivated throughout the warmer parts of India including Andaman Islands and other adjacent island. Oil from the kernel is a substitute for almond oil. The leaf is used in scabies and colic. Husk and endocarp contain tannins and pentosans. Oil from kernel contains oleic, linoleic, palmitic and stearic acids. Heart wood and stem bark contains -sitosterol and its palmitate. Heartwood in addition contains terminolic acid and triterpenic methyl esters. The aerial part of the plant is diuretic. The bark is astringent, mild diuretic, cardiotonic and antidysenteric. Leaf is sudorific, antirheumatic, antileprotic and anticephalalgic.

6) T. Coriacea (Roxb.) syn. T. tomentosa (Roxb. ex. DC.) W. & A. var. coriacea (Roxb.) C. B. Clarke

Tam: Anaimikkuvam, Sadagam;

Kan: Banapu;

Tel: Tani.

Leathery Murdah is a tree commonly used as a cardiac stimulant. It is widely distributed in the drier and warmer parts of Andhra Pradesh and Tamil Nadu upto 1350 m and in Central India. Its bark is mainly used as a cardiac stimulant and in atonic diarrhoea and callous ulcer. It is also CVS active.

7) T. myriocarpa Heurck. & Muell. Arg.

Ben: Panisaj; Ass: Hollock, Jhalna.

Hollock is a tree of the Himalayas widely distributed from Nepal to Arunachal Pradesh and in Assam at 1000 m. The bark is cardiac stimulant and mild diuretic. Bark give -sitosterol, fructose and 4,4’,5,5’,6,6’ - hexadydroxy diphenic acid dilactone. Bark also contains tannis - ellagic, gallic, chebulinic and chebulagic acids.

8) T. Pallida Brandis.

Tam: Vellai Kadukkay;

Tel: Tella Karaka, Velama Karka.

The plant is distributed throughout south India, upto 600m. Its bark is a mild diuretic.

9) T. Paniculata Roth.

Mal: Marutu, Pe Marutu, Ven Marutu;

Tam: Pei Kadukai, Ven Maruthu, Ilai Kadukkay, Marudu, Pullatti;

Tel: Nimiri, Pulamaddi, Putamanu, Pulanallamanu;

Kan: Maruva, Matti.

Flowering Murdah is a tree which is widely used in opium poisoning. It is distributed in the Western and Eastern Ghats, upto 1200m. The bark is used in parotitis and flowers in opium poisioning. Heart wood give 3, 3’-0-di-methylellagic acid and 3,4,3’0-trimethyl flavellagic acid, -sitosterol, an uncharacterized triterpene carboxylic acid; a glycoside -3,3’ di-0 - methyl ellagic acid - 4 - monoglucoside and 0 - penta methyl flavellogic acid. The stem bark is anticancerous, diuretic, cardiotonic CVS active and shows antagonism of amphetamine hyperactivity. Flower is anticholerin (Husain et al, 1992)

10) Terminalia chebula Retz. Syn. Myrobalanus chebula (Retz.) Gaertner

Eng: Chebulic myrobalan;

San,

Ben: Haritaki;

Hindi:Harara, Harir,

Har; Mal:Kadukka; Ass:Hilikha; Kan:Alale;

Mar:Habra,

Hirada;

Ori:Harida;

Guj: Hirdo;

Pun:Helela;

Tam:Amagola;

Tel: Karaka

Chebulic myrobalan is a medium deciduous tree, the fruit of which is a common constituent of “Triphala” capable of imparting youthful vitality and receptivity of mind and sense. It is a major constituent in the ayurvedic preparations like Abhayarishta, Abhaya modak, Haritaki khand, Triphaladi churnam and Agastya rasayanam. In allopathy it is used in astringent ointments. In unani system, it is used as a blood purifier. The pulp of the fruit is given in piles, chronic diarrhoea, dysentery, costiveness, flatulence, asthma, urinary disorders, vomiting, hiccup, intestinal worms, ascites and enlarged spleen and liver. Powder of the fruit is used in chronic ulcers and wounds, carious teeth and bleeding ulceration of the gums. The bark is a good cardiac tonic. The fruit is valuable for its tannins and dyes. The wood is used for building purposes, agricultural implements, plywood and match box industries. It is also grown as a shade tree.

The plant is found throughout India chiefly in deciduous forests, on dry slopes upto 900m especially in Bengal, Tamil Nadu, West coast and Western Ghats. The plant is also reported in Sri Lanka, Nepal and Burma.

Terminalia chebula Retz. syn. Myrobalanus chebula (Retz.) Gaertner comes under family Combretaceae. It is a medium sized deciduous tree with a cylindrical bole, rounded crown, spreading branches with dark brown bark and brownish gray heartwood. Leaves are simple, alternate or subopposite, ovate or elliptic ovate with short petioles bearing 2 glands below the blades. Flowers pale yellow or white in 4-10cm long axillary spikes. Calyx tube hairy pale yellow and 5 lobed; no petals. Stamens consist of 10 filaments subulate, anthers small; ovary inferior, 1-celled with 2-3 pendulous ovule. Fruit is a drupe, ovoid glossy, glabrous, faintly angled and yellow to orange brown in colour. Seeds are hard and pale yellow.

Kernel oil of Chebulic myrobalan contains 6 fatty acids viz. Palmitic, stearic, oleic, linoleic, arachidic and behenic acid. The fruits contain chebulinic acid, tannic acid, gallic acid, chebulin and tannin. Leaves contain terpenes and saponins and -sitosterol is present in the bark (Beri, 1970; Khalique and Nizamuddin, 1972; Miglani and Chawla, 1974). Fruits are astringent, purgative, tonic, carminative, alternative and antispasmodic. Flowers and fruits are antiviral and hypoglycaemic. Wood is oxytocic and hypothermic (Husain et al, 1992).

Agrotechnology: Terminalia species are, in general, subtropical trees. Young plants prefer shade while the matured plants tolerate light frost and drought. It grows well in hilly areas. This is propagated by seeds. Natural multiplication happens rarely due to the poor seeds germination. Seeds soaked in water for 48 hours before sowing in seedbeds which should be covered with straw after sowing. It is watered immediately. Usually it takes 3-5 months to germinate. It can be transferred to polybags at two-leaf stage. One-year-old seedlings are ready for transplanting. For transplanting, pits are made of 50cm cube at a spacing of 4m. Organic manure, added regularly, promotes growth. Irrigation is required during first year. Weeds should be removed regularly. This plant grows slowly. It fruits within 6-7 years. This is continued for many years. It is coppiced well. Fruits are collected immediately after falling down or covered with soil to protect it from pests. Fruits dried well in sun and used or stored. The hard seed coat is removed before sowing.... terminalia