Emaciation Health Dictionary

Linn.

Family: Euphorbiaceae.

Habitat: Occurs throughout the plains of India, ascending the hills in Orissa up to 210 m.

English: Indian Acalypha.

Ayurvedic: Kuppi, Muktavarchaa, Haritamanjari

Siddha/Tamil: Kuppaimeni.

Folk: Khokli, Kuppi, Aamaabhaaji.

Action: Antibacterial (leaf used in scabies). Plant—emetic, expectorant (used in bronchitis, asthma, pneumonia). Tincture of fresh plant is used in homoeopathy for incipient phthisis with bloody expectorations, emaciation and arterial haemorrhage.

The plant contains kaempferol; leaves and twigs contain acalyphamide and other amides, quinone, sterols, cyanogenic glycoside.

The herb causes intestinal irritation.... acalypha indica

Burm.

Synonym: A. philippense Linn.

Family: Adiantaceae.

Habitat: Throughout the greater part of India, up to an altitude of 1,200 m.

English: Walking Maidenhair Fern. Black Maidenhair (A. venustum G. Don is also known as Hansaraaja.)

Ayurvedic: Hansapadi, Hansapaadi, Raktapaadi, Kitamaataa, Tri- paadikaa, Hansaraaja; a substitute for Taamrachuda-paadikaa.

Siddha/Tamil: Seruppadai.

Folk: Raajhans, Mubaaraka.

Action: Febrifugal, antidysenteric, soothing agent in erysipelas. The rhizome is also prescribed for strangury, atrophy, emaciation or cachexy, muscular pain; emetic in large doses.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the dried whole plant in psychosis-related fear. (It is one of the ingredients of the classical drug Maanasamitra Vataka, prescribed for mental disorders.)

The chemical constituents are chlorophyll-degradation products and higher carotenoids.

Dosage: Whole plant-1-3 g (API Vol. III.)... adiantum lunulatum

(Linn.) Kuntze.

Synonym: Clerodendron siphonan- thus (R. Br.) C. B. Clarke.

Family: Verbenaceae.

Habitat: Cultivated as an ornamental throughout India, especially in South and Eastern India.

English: Turk's Turban, Tube- Flower.

Ayurvedic: Vaamana-haati (a substitute for Bhaarangi).

Siddha/Tamil: Kavalai, Narivalai.

Action: Root—used for asthma, cough, scrofulous affections. Leaf— vermifuge. Resin—antirheumatic. The plant is also used in fever, atrophy, emaciation of cachexia and consumption.

The leaves contain flavonoids—scu- tellarein (0.5%), hispidulin (0.1%) and their 7-O-glucuronides; also sterols. Flowers contain beta-sitosterol and tri- terpenoids. The bark yields hexitol and sorbitol.

The flavone, pectolinarin and a di- terpene, oncinotine, exhibit antifee- dant activity.... clerodendrum indicum

Coca leaves are obtained from two South American plants, Erythroxylum coca and Erythroxylum truxillense, and contain an alkaloid, cocaine. Cocaine has marked effects as a stimulant, and, locally applied, as an anaesthetic by paralysing nerves of sensation. The dried leaves have been used from time immemorial by the South American Indians, who chew them mixed with a little lime. Their e?ect is to dull the mucous surfaces of mouth and stomach, with which the saliva, produced by chewing them, comes into contact – thus blunting, for long periods, all feeling of hunger. The cocaine, being absorbed, stimulates the central nervous system so that all sense of fatigue and breathlessness vanishes for a time. It was by the use of coca that the Indian post-runners of South America were able to achieve their extraordinary feats of endurance. The continued use of the drug, however, results in emaciation, loss of memory, sleeplessness and general breakdown. DEPENDENCE on cocaine or a derivative, ‘crack’, is now a serious social problem in many countries.

Uses Before the serious effects that result from its habitual use were realised, the drug was sometimes used by hunters, travellers and others to relieve exhaustion and breathlessness in climbing mountains and to dull hunger. Derivatives of cocaine are used as locally applied analgesics via sprays or injections in dentistry and for procedures in the ear, nose and throat. Because of its serious side-effects and the risk of addiction, cocaine is a strictly controlled Class A drug which can be prescribed only by a medical practitioner with a Home O?ce licence to do so.... cocaine

D. Don.

Family: Liliaceae.

Habitat: Uttaranchal, Himachal Pradesh.

Ayurvedic: Kaakoli, Madhuraa, Kshira, Vayhasthaa, Karnikaa, Vaayasoli.

Action: Tuberous root—used as a tonic in emaciation and as a source of energy, after dry roasting.

Dosage: Tuberous root—3-6 g. (API, Vol. III.)... lilium polyphyllum

A disease of rodents such as rabbits and rats, caused by the bacillus, Francisella tularense, and spread either by ?ies or by direct inoculation – for example, into the hands of a person engaged in skinning rabbits. In humans the disease takes the form of a slow fever lasting several weeks, with much malaise and depression, followed by considerable emaciation. It was ?rst described in the district of Tulare in California, and is found widely spread in North America and in Europe, but not in Great Britain. STREPTOMYCIN, the TETRACYCLINES and CHLORAMPHENICOL o?er e?ective treatment.... tularaemia

Bacopa monnieri

Scrophulariaceae

San: Brahmi, Sarasvati;

Hin: Barami, Jalnim;

Ben: Boihim-sak;

Mal: Brahmi , Nirbrahmi;

Tam: Nirpirami, Piramiyapundu; Kan, Mar: Nirbrahmi

Importance: Brahmi or Thyme leaved gratiola is an important drug in Ayurveda for the improvement of intelligence and memory and revitalisation of sense organs. It clears voice and improves digestion. It is suggested against dermatosis, anaemia, diabetes, cough, dropsy, fever, arthritis, anorexia, dyspepsia, emaciation, and insanity. It dispels poisonous affections, splenic disorders and impurity of blood. It is useful in vitiated conditions of kapha and vata, biliousness, neuralgia, ascites, flatulence, leprosy, leucoderma, syphilis, sterility and general debility. The whole plant is used in a variety of preparations like Brahmighrtam, Sarasvataristam., Brahmitailam, Misrakasneham, etc. In unani Majun Brahmi is considered as a brain tonic.

Distribution: The plant grows wild on damp places and marshy lands in the major part of the plains of India, Pakistan, Afghanistan, Nepal, Sri Lanka and other tropical countries.

Botany: Bacopa monnieri (Linn.) Pennell. syn. Monniera cuneifolia Michx., Herpestis monniera (Linn.) H.B. & K. belongs to the family Scrophulariaceae. It is a prostrate, juicy, succulent, glabrous annual herb rooting at the nodes with numerous ascending branches. Leaves are simple, opposite, decussate, sessile, obovate-oblong or spatulate, entire, fleshy, obscurely veined and punctate. Flowers are pale blue or whitish, axillary, solitary, arranged on long slender pedicels. Fruits are ovoid, acute, 2-celled, 2-valved capsules and tipped with style base. Seeds are minute and numerous (Warrier et al, 1993).

Agrotechnology: The plant grows throughout the warm humid tropics upto 1200m elevation. Brahmi gets established well in water logged fields. The plant is propagated vegetatively by stem cuttings. Land is prepared by ploughing 2 or 3 times. Two to three tonnes/ha of cowdung or compost is applied and the field is again ploughed and levelled. Stem cuttings, 10cm long are spread at a spacing of 20cm. Waterlogging to height of 30cm is always required. Rooting may start within 15-20 days. It will spread over the field within 6 months. Regular application of organic manure will take care of the manurial requirement. Weeding once in a month is required. Care should be taken to maintain water level at a height of 30cm during the growth period. No serious pests or diseases are noted in this crop. Harvesting commences from sixth months onwards. Brahmi leaves can be collected once a month. After 3 years, the whole crop is harvested and removed. Fresh cultivation can be carried out in the same field.

Properties and activity: Earlier workers have reported the isolation of the alkaloids brahmine and hespestine and a mixture of 3 alkaloids from the leaves. Mannitol and saponins were reported later. Subsequent work described isolation of some C27, C29, and C31 hydrocarbons and betulic acid from this plant material. A systematic examination has resulted in the isolation and identification of two saponins designated as bacosides A and B. Bacoside A has chemical structure represented as 3-(-L-arabinopyranosyl)-O- - D-glucopyranoside-10, 20-dihydroxy-16-ketodammar-24-ene. The mixture of bacosides A and B on hydrolysis give four sapogenins, glucose and arabinose. The constitution of bacogenin A, has been established as 3 -30-dihydroxy-20(5)-25-epoxy-22-methyl-24-nor-dammar-22-en-16-one. Bacogenin A2 has been shown to be an isomer of bacogenin A, differing in configuration at C-20. Bacogenin A4 has been identified as ebelin lactone.

The plant is reported to have shown barbiturate hypnosis potentiation effect. The plant is anticancerous and improves learning ability. It is used as a tranquilliser. The plant is astringent, bitter, sweet, cooling, laxative, intellect promoting, anodyne, carminative, digestive, antiinflammatory, anticonvulsant, depurative, cardiotonic, bronchodialator, diuretic, emmenagogue, sudorfic, febrifuge and tonic (Basu et al, 1947; Rastogi et al 1960).... brahmi

Linn. Family: Umbelliferae; Apiaceae.

Habitat: Native to Europe. English: Wild Parsnip. Unani: Shaqaaq-ul-Misri.

Action: Root—galactagogue, aphrodisiac, spermatogenetic. An important ingredient of Unani compounds for oligospermia, low sexual drive and debility. Shaqaaq-ul-Misri has also been equated with Trachydium lehmanni Benth. In Kashmir, Eryngium caeru- leum Bieb (Umbelliferae) and in Chak- rata, Polygonatum verticillatum All. (Liliaceae) are known as shaqaaqul (also Dudhaali). Polygonatum verticillatum rhizomes are used in Tibetan medicine for emaciation and senility. The dried rhizomes contain diosgenin.... pastinaca secacul

A severe form of protein and calorie malnutrition that usually occurs in famine or semi-starvation conditions. Marasmus is common in young children in developing countries. The disorder causes stunted growth, emaciation, and loose folds of skin on the limbs and buttocks due to loss of muscle and fat. Other signs include sparse, brittle hair; diarrhoea; and dehydration.

Treatment includes keeping the child warm and giving a high-energy, proteinrich diet. Persistent marasmus can cause mental handicap and impaired growth. (See also kwashiorkor.)... marasmus

n. a nutritional disorder due to deficiency of *vitamin B1 (thiamine). It is widespread in rice-eating communities in which the diet is based on polished rice, from which the seed coat (which is rich in thiamine) has been removed. Beriberi takes two forms: wet beriberi, in which there is an accumulation of tissue fluid (*oedema), and dry beriberi, in which there is extreme emaciation. There is nervous degeneration in both forms of the disease and death from heart failure is often the outcome.... beriberi

n. a condition caused by the presence of the fluke Clonorchis sinensis in the bile ducts. The infection, common in the Far East, is acquired through eating undercooked, salted, or pickled freshwater fish harbouring the larval stage of the parasite. Symptoms include fever, abdominal pain, diarrhoea, liver enlargement, loss of appetite, emaciation and – in advanced cases – cirrhosis and jaundice. Treatment is unsatisfactory although *praziquantel has proved beneficial in some cases.... clonorchiasis

Murraya Koenigii

Rutaceae

San: Kalasakh, Kaidaryah

Hin: Mithinim, Katnim

Ben: Barsunga

Mal: Kariveppu, Karuveppu

Tam: Kariveppilai, Karuveppu

Kan: Kari Baeva

Tel: Karivepaku

Ass: Narasingha, Bishahari

Importance: Curry leaf, a plant of homestead gardens has gained importance as a commercial crop and is cultivated for its culinary and medicinal value. The plant is highly esteemed for its leaves which promote appetite and digestion and destroy pathogenic organisms. It is reported to be useful in emaciation, skin diseases, hemopathy, worm troubles, neurosis and poisons. They are useful in vitiated conditions of kapha and pitta, hyperdipna, colic, flatulence, diarrhoea, dysentery, vomiting, inflammations and foul ulcers. “Kaidaryah” drug is prepared using this plant which improves voice, stimulates digestion and destroys concocted poisons in the system. The important preparations using the drug are Kalasadi kasayam, Pamantaka tailam, Jatyadi tailam, Jatyadi ghrtam, etc (Sivarajan et al,1994).

Distribution: Curry leaf is seen in the foot of the Himalaya and Bashahi eastwards to Sikkim and Peninsular India, upto 1700m. It is also found in Sri Lanka, Burma, Indo-China, South China and Hainan. Commercial cultivation in India is limited to Tamil Nadu and Karnataka states.

Botany: The genus Murraya of the family Rutaceae includes the following species:

M. Koenigii (Linn.) Spreng. syn. Bergera koenigii Linn.

M. Exotica Linn. syn. M. paniculata (Linn.) Jack.

Murraya koenigii is a small aromatic tree with dark grey bark and closely crowded spreading dark green foliage. Leaves are imparipinnate and alternate. Leaflets are alternate, obliquely ovate or somewhat rhomboid, gland dotted and strongly aromatic. Flowers are white, arranged in much branched terminal corymbose cymes and fragrant. Fruits are subglobose or ellipsoid berries, purplish black when ripe and 2-seeded (Warrier et al, 1995).

Agrotechnology: Curry leaf tree does not choose a specific climate and can come up even in dry climate too. In places where minimum temperature goes below 13 C, the growth of the shoot will be slightly affected. It comes up well in light textured red soils. DWD-1 and DWD-2 are two improved varieties released from UAS, Dharwad. Curry leaf is propagated by seed. Main field is to be ploughed repeatedly. A spacing of 90-120cm is followed on either side. Pits of size 30cm3 are dug out one month before planting and filled with top soil mixed with well decomposed FYM at the time of planting. Healthy seedlings are planted in the centre of the pits. Then long furrows are formed connecting all the pits to facilitate easy irrigation. The seedlings are irrigated once in 5-7 days upto 3 years and once in 15 days afterwards. The field should be kept free from weeds. Plants may be trained and pruned to maintain a bush of 1m in height. For better growth and yield, each plant is fertilised with 20kg of FYM besides 150:25:50g of N, P2O5, K2O/ year. Attack of aphids in the vegetative stage can be controlled by spraying of dimethoate at 2ml/l of water. Leaves from such sprayed plants should be harvested only after 10 days. Spraying carbendazim at 1g/l can take care of leaf spot diseases. The crop comes to first harvest at the end of first year. The yield of leaves account to 400kg/ha at the end of first year, 2000 to 2200kg/ha in the second and third year harvested at an interval of four months and 2500kg/ha in the fourth year harvested at three months interval. From fifth year onwards it is harvested at 2.5-3 months interval giving an yield of 3500-5000kg/ha (Kumar et al, 1997).

Properties and activity: All parts of the plant, especially the leaves are rich in carbazole alkaloids. These include members with (i) C13 - skeleton -murrayanin, mukoeic acid, mukonine and mukonidine; (ii) C18 - skeleton including gerinimbine, koenimbine, murrayacine, koenigine and koenigicine (koenidine); and (iii) C23- skeleton containing mahanimbine, mahanimbicine, iso- mahanimbicine, mahanine, mahanimbinine, murrayayazoline, murrayazolinine, murrayazolidine, cyclomahanimbine and bicyclomahanimbicine. Other carbazole bases include mukoline, mukolidine (C13 group, from roots), mukonicine (C18 from leaves), the biogenetically significant mukonal (C13, stem-bark), mahanimboline (C23, root-bark), iso- murrayazoline (C23, stem-bark). The leaves gave a coumarin glucoside, scopolin also. Essential oil from leaves contained -caryophylline, -gurjunene, -elemene, - phellandrene, -thujene as major constituents.

The roots, bark and leaves are bitter, acrid, astringent, cooling, aromatic, demulcent, depurative, anthelmintic, febrifuge, stomachic, appetising, carminative, antiinflammatory and antiseptic. Aerial part is spasmolytic and antiprotozoal. Root is antiprotozoal, CVS active and has effect on nictitating membrane. Leaf is hypoglycaemic (Hussain et al,1992).... curry leaf

The LIVER may be extensively diseased without any obviously serious symptoms, unless the circulation through it is impeded, the out?ow of BILE checked, or neighbouring organs implicated. JAUNDICE is a symptom of several liver disorders, and is discussed under its separate heading. ASCITES, which may be caused by interference with the circulation through the portal vein of the liver, as well as by other reasons, is also considered separately. The presence of gallstones is a complication of some diseases connected with the liver, and is treated under GALLBLADDER, DISEASES OF. For hydatid cyst of the liver, see TAENIASIS. Liver diseases in a tropical environment are dealt with later in this section.

In?ammation of the liver, or HEPATITIS, may occur as part of a generalised infection or may be a localised condition. Infectious hepatitis, which is the result of infection with a virus, is one of the most common forms. Many di?erent viruses can cause hepatitis, including that responsible for glandular fever (see MONONUCLEOSIS). Certain spirochaetes may also be the cause, particularly that responsible for LEPTOSPIROSIS, as can many drugs. Hepatitis may also occur if there is obstruction of the BILE DUCT, as by a gall-stone.

Cirrhosis of the liver A disorder caused by chronic damage to liver cells. The liver develops areas of ?brosis or scarring; in response, the remaining normal liver cells increase and form regeneration nodules. Those islands of normality, however, suffer from inadequate blood supply, thus adversely affecting liver function. Alcohol is the most common cause of cirrhosis in the United Kingdom and the USA, and the incidence of the disorder among women in the UK has recently risen sharply as a consequence of greater consumption of alcohol by young women in the latter decades of the 20th century. In Africa and many parts of Asia, infection with hepatitis B virus is a common cause. Certain drugs – for example, PARACETAMOL – may damage the liver if taken in excess. Unusual causes of cirrhosis include defects of the bile ducts, HAEMOCHROMATOSIS (raised iron absorption from the gut), CYSTIC FIBROSIS, cardiac cirrhosis (the result of heart failure causing circulatory congestion in the liver), and WILSON’S DISEASE (raised copper absorption).

Symptoms Some people with cirrhosis have no signs or symptoms and the disease may be diagnosed at a routine medical examination. Others may develop jaundice, OEDEMA (including ascites – ?uid in the abdomen), fever, confusion, HAEMATEMESIS (vomiting blood), loss of appetite and lethargy. On examination, cirrhotic patients often have an enlarged liver and/ or SPLEEN, and HYPERTENSION. Liver function tests, cholangiography (X-ray examination of the bile ducts) and biopsy of liver tissue will help to reach a diagnosis.

Treatment Nothing can be done to repair a cirrhosed organ, but the cause, if known, must be removed and further advance of the process thus prevented. In the case of the liver, a high-protein, high-carbohydrate, low-fat diet is given, supplemented by liver extract and vitamins B and K. The consumption of alcohol should be banned. In patients with liver failure and a poor prognosis, liver TRANSPLANTATION is worthwhile but only after careful consideration.

Abscess of the liver When an ABSCESS develops in the liver, it is usually a result of amoebic DYSENTERY, appearing sometimes late in the disease – even after the diarrhoea is cured (see below). It may also follow upon in?ammation of the liver due to other causes. In the case of an amoebic abscess, treatment consists of oral metronidazole.

Acute hepatic necrosis is a destructive and often fatal disease of the liver which is very rare. It may be due to chemical poisons, such as carbontetrachloride, chloroform, phosphorus and industrial solvents derived from benzene. It may also be the cause of death in cases of poisoning with fungi. Very occasionally, it may be a complication of acute infectious hepatitis.

Cancer of the liver is not uncommon, although it is rare for the disease to begin in the liver – the involvement of this organ being usually secondary to disease situated somewhere in the stomach or bowels. Cancer originating in the liver is more common in Asia and Africa. It usually arises in a ?brotic (or cirrhotic) liver and in carriers of the hepatitis B virus. There is great emaciation, which increases as the disease progresses. The liver is much enlarged, and its margin and surface are rough, being studded with hard cancer masses of varying size, which can often be felt through the abdominal wall. Pain may be present. Jaundice and oedema often appear.... liver, diseases of

All.

Family: Liliaceae.

Habitat: Temperate Himalayas and Manipur.

Ayurvedic: Medaa. (Substitute: Asparagus racemosus.)

Unani: Shaqaaqul. (Substitute: Pastinaca secacul.)

Folk: Mithaa-dudhiaa.

Action: Used in Tibetan medicine for treating emaciation, senility, pulmonary affections. The rhizomes is valued as salep.

The dried rhizomes contain 6.2-9% diosgenin.

The lactins of the rootstock did not contain carbohydrates; the amino acid revealed presence of 28% aspartic acid and asparagine.

The plant exhibits diuretic properties. It gave a digitalis glucoside and is considered poisonous by the hill people in the Himalayas.... polygonatum verticillatum

There are two major forms of the disease: Trypanosoma brucei gambiense is con?ned to west and central Africa, and T.b. rhodesiense to central, east, and south-east Africa. The infection is caused by the bite of tsetse ?y (Glossina spp.). Clinically, a trypanosomal CHANCRE may develop at the site of the tsetse-?y bite. After introduction into the bloodstream, the parasite develops in blood and lymphatic glands. After the blood stage, it enters the central nervous system, causing characteristic neurological sequelae (see below). Infection may be followed by a generalised macular papular reaction. In

T.b. gambiense infection, enlarged glands in the neck (Winterbottom’s sign) may be striking. Onset of disease is accompanied by fever, progressive ANAEMIA, and enlarged glands; these signs and symptoms are followed by increasing lethargy, slowing of mentality, and physical weakness, and give way to headache and an increasing tendency to sleep. These symptoms are caused by proliferation of parasites in the patient’s cerebral blood vessels; this is accompanied by in?ammatory changes and disorganisation of nervous tissue. Patients become emaciated and develop bed sores. Death ?nally takes place either as a result of gross emaciation or of an intercurrent infection.

Diagnosis is by detection of trypanosomes in a blood specimen or, alternatively, a sample of cerebrospinal ?uid. Serological tests are of great value in diagnosis.

Treatment is with suramine or pentamidine; when cerebral involvement has ensued, melarsoprol – which penetrates the blood-brain barrier – is of value. In T.b. gambiense infection, e?ornithine has recently given encouraging results; however, this form of CHEMOTHERAPY is not e?ective in a T.b. rhodesiense infection. From the point of view of prevention, control of the tsetse-?y population is crucial; even so, only a very small percentage of these vectors is infected with Trypanosoma spp.... sleeping sickness

(Roxb.) W. & A.

Family: Combretaceae.

Habitat: Throughout the greater part of India, also grown as an avenue tree.

English: Arjun Terminalia.

Ayurvedic: Arjuna, Dhananjaya, Kaakubha, Kakubha, Aartagala, Indravriksha, Paartha, Virataru, Viravriksha.

Unani: Arjun

Siddha: Marudam.

Action: Bark—used as a cardiopro- tective and cardiotonic in angina and poor coronary circulation; as a diuretic in cirrhosis of liver and for symptomatic relief in hypertension; externally in skin diseases, herpes and leukoderma. Powdered bark is prescribed with milk in fractures and contusions with excessive ec- chymosis, also in urinary discharges and strangury. Fruit—deobstruent.

The Ayurvedic Pharmacopoeia ofIn- dia recommends the powder of the stembark in emaciation, chest diseases, cardiac disorders, lipid imbalances and polyuria.

The bark extract contains acids (ar- junolic acid, terminic acid), glyco- sides (arjunetin, arjunosides I-IV), and strong antioxidants—flavones, tannins, oligomeric proanthocyani- dins.

The bark extract (500 mg every 8 h) given to (58 male) patients with stable angina with provocable ischemia on treadmill exercise, led to improvement in clinical and treadmill exercise parameters as compared to placebo therapy.

These benefits were similar to those observed with isosorbide mononitrate (40 mg/day). (Indian Heart J. 2002, 54(4), 441.)

Arjunolic acid exhibited significant cardiac protection in isoproterenol- induced myocardial necrosis in rats.

T (Mol Cell Biochem, 2001, 224 (1-2), 135-42.) A study demonstrated that the alcoholic extract of Terminalia arjuna bark augmented endogenous antioxi- dant compounds of the rat heart and prevented from isoproterenol-induced myocardial ischemic reperfusion injury. (Life Sci. 2003, 73 (21), 27272739.) Cardiac lipid peroxidation in male Wistar rats was reduced by 38.8% ± 2.6% at a dose of 90 mg/kg, in a study based on aqueous freeze-dried extract ofthebark. (PhytotherRes. 2001,15(6), 510-23.)

Oral administration of bark powder (400 mg/kg body weight) for 10 days produced significant increase in circulating histamine, a little increase in 5-HT, catecholamines and HDL cholesterol, and decrease in total lipid, triglycerides and total cholesterol in normal rats.

Casuarinin, a hydrolyzable tannin, isolated from the bark, exhibited antiherpes virus activity by inhibiting viral attachment and penetration. 50% ethanolic extract of the bark exhibited significant increase in the tensile of the incision wounds.

Dosage: Stembark—3-6 g powder. (API, Vol. II.)... terminalia arjuna

Strychnos nux-vomica

Loganiaceae

San: Karaskara;

Hin: Kajra, Kuchila;

Mal: Kanjiram; ;

Tam: Itti, Kagodi, Kanjirai Mar:Jharkhatchura;

Kan: Hemmushti, Ittangi;

Tel: Mushti, Mushidi; Ori: Kora, Kachila

Importance: It is a large deciduous tree, with simple leaves and white fragrant flowers.

Strychnos is highly toxic to man and animals producing stiffness of muscles and convulsions, ultimately leading to death. However, in small doses it can also serve as efficacious cure forms of paralysis and other nervous disorders. The seeds are used as a remedy in intermittent fever, dyspepsia, chronic dysentery, paralytic and neuralgic affections, worms, epilepsy, chronic rheumatism, insomnia and colic. It is also useful in impotence, neuralgia of face, heart disease, spermatorrhoea, skin diseases, toxins, wounds, emaciation, cough and cholera. Leaves are applied as poultice in the treatment of chronic wounds and ulcers and the leaf decoction is useful in paralytic complaints. Root and root bark used in fever and dysentery (Nadkarni, 1982; Kurup et al, 1979).

Distribution: The plant is distributed throughout India in deciduous forests up to 1200m. It is also found in Sri Lanka, Siam, Indochina and Malaysia.

Botany: Strychnos nux-vomica Linn. is a large tree belonging to the family Loganiaceae. Leaves are simple, opposite, orbicular to ovate, 6-11.5x6-9.5cm, coriaceous, glabrous, 5 nerved, apex obtuse, acute or apiculate, transverse nerves irregular and inconspicuous. Inflorescence is many flowered terminal cymes, 2.5-5cm across. Bracts (5mm) and bracteoles (1.5mm) small. Flowers are white or greenish white and fragrant. Calyx 5 lobed, pubescent and small (2mm). Corolla salver shaped, tube cylindrical slightly hairy near the base within and greenish white, tube much elongate than the lobes. Tube 7mm and lobes 2.5mm long. Lobes 5 and valvate. Stamens 5, filaments short, 0.1mm long. Anthers 1.5mm subexerted, linear oblong. Ovary 1.5 mm, pubescent, 2 celled, ovules one to many. Style 9mm, stigma capitate. Fruit is a berry, 5-6cm diameter, globose, indehiscent, thick shelled, orange red when ripe with fleshy pulp enclosing the seeds. Seeds 1-many, discoid, compressed, coin like, concave on one side and convex on the other, covered with fine grey silky hairs.

The leaf fall is during December (do not shed all the leaves at a time) and new foliage appears in February. Flowering is during March - April and fruiting during May - December. Fruits take about 8-9 months to mature.

Properties and activity: Strychnine and brucine are the most important and toxic alkaloids present in the plant. They occur not only in the seeds but also in roots, wood, bark, fruit pulp and hard fruit shells. The minor alkaloids present in the plant are vomicine, -colubrine, -colubrine, pseudostrychnine and N-methyl-sec-pseudobrucine (novacine). Loganin a glycoside is also present (Warnat, 1932; Martin et al, 1953; Guggisberg et al, 1966; Bisset and Chaudhary, 1974). Chatterji and Basa (1967) reported vomicine as the major constituent alkaloid along with unidentified alkaloid in leaves and identified another alkaloid kajine (N-methyl pseudostrychnine) from the leaves of very young plants.

Root bark of S. nux-vomica yeilded 4-hydroxy-3-methoxy strychnine, 4 hydroxy strychine, nor-macusine, a new alkaloid 12 , 13 dihydro-12 -hydroxy isostrychnine named protostrychnine (Baser et al, 1979) methoxy strychnine, and mavacurine (Guggisberg et al, 1966). Leaves and root bark also yeilded 11 new alkaloids. 10-hydroxy strychnine, 3-12-dihydroxystrychnine, 12-hydroxy–11- methoxy strychnine, 3-12-dihydroxy- 11-methoxy strychnine,12-hydroxy strychnine-N- oxide 12-hydroxy-11-methoxy strychnine- N-oxide-19,20–dihydro isostrychnine, 16 , 17 dihydro-17 -hydroxy isostrychnine, O- methyl-macusine B, 16-epi-o-methyl–macusine B and normelinone B (Baser and Bisset, 1982).

De and Datta (1988) isolated 5 tertiary indole alkaloids viz. strychnine, brucine, vomicine, icajine and novacine from S.nux-vomica flowers. Bisset et al (1989) isolated and identified two phenolic glycosides salidroside and cuchiloside – a compound consisting of salidroside and an attached xylose unit, from the fruit of S.nux-vomica.

Rodriguez et al (1979) isolated an indole alkaloid from the seeds of S. nux- vomica and identified as a 3-methoxy icajine. A new alkaloid 15-hydroxy strychnine has been isolated from the seeds and the structure of the alkaloid established by spectroscopic data (Galeffi et al, 1979). Cai et al (1990a) isolated 4 new alkaloids isobrucine, isobrucine N-oxide, isostrychnine N-oxide and 2 hydroxy–3-methoxy strychnine from the heat treated seeds of S. nuxvomica and the structure of the alkaloids were determined by 13 CNMR (Cai et al, 1994). Cai et al (1990 b) studied the changes in the alkaloid composition of the seeds during drug processing. Saily et al (1994) determined the mineral elements in Strychnos nux-vomica. Corsaro et al (1995) reported polysaccharides from the seeds of Strychnos species.

Seeger and Neumann (1986) reviewed the physico-chemical characteristics, occurrence, identification, utilisation, poisoning, toxicity, kinetics, differential diagnosis and therapeutic uses of strychnine and brucine. Aspergillus niger, A. flavus and Pencillium citrinum showed regular association with Strychnos seeds and effectively deteriorated the alkaloid content of the seeds (Dutta, 1988; Dutta and Roy, 1992). Nicholson (1993) described the history, structure and synthesis of strychnine which occur in the seeds of S. nux-vomica. Rawal and Michoud (1991) developed a general solution for the synthesis of 2- azabicyclo (3.3.1) nonane substructure of Strychnos alkaloids.

Villar et al (1984) and Hayakawa et al (1984) developed HPLC method for the analysis of strychnine and brucine. Graf and Wittliner (1985), Kostennikova (1986) and Gaitonde and Joshi (1986) suggested different methods for the assay of strychnine and brucine. Biala et al, (1996) developed new method for the assay of alkaloids in S. nux- vomica.

The seeds are bitter, acrid, alexeteric, aphrodisiac, appetiser, antiperiodic, anthelmintic, digestive, febrifuge, emmenagogue, purgative, spinal, respiratory and cardiac stimulant and stomachic. The bark is bitter, and tonic and febrifuge (Nadkarni, 1954; Kurup et al, 1979; Warrier et al, 1996).

The quarternery alkaloid from the root bark of the Sri Lankan plant exhibited muscle-relaxant activity (Baser and Bisset, 1982). Antimicrobial activity of indole alkaloid isolated from the Strychnos nux-vomica was studied by Verpoorte et al, 1983. Shukla et al (1985) evaluated the efficacy of Rasnadigugglu compound consisting of S. nux-vomica, on rheumatoid arthritis and found to be effective in reducing inflammatory oedoma and rheumatoid arthritis. It also exhibited analgesic activity. A compound Unani formulation containing S. nux-vomica significantly attenuated withdrawal intensity in morphine dependent rats (Zatar et al, 1991). Shahana et al (1994) studied the effect of Unani drug combination (UDC) having Strychnos nux-vomica on the abstinence syndrome in moderately and severely morphine dependent rats. The UDC strikingly suppressed the abstinence syndrome was seen to possess central depressant and analgesic action.

Melone et al (1992) reported brucine-lethality in mice. Panda and Panda (1993) and Satyanarayanan et al (1994) reported antigastric ulcer activity of nux vomica in Shay rats. Banerjee and Pal (1994) reported the medicinal plants used by the tribals of plain land in India for hair and scalp preparation and S. nux-vomica being used to cure alopecia (baldness) by the tribals. Tripathi and Chaurasia (1996) studied the effect of S. nux-vomica alcohol extract on lipid peroxidation in rat liver.... strychnine tree

Chronic in?ammation of the lining of the COLON and RECTUM. The disease affects around 50 people per 100,000; it is predominantly a disease of young and middle-aged adults.

Symptoms The onset may be sudden or insidious. In the acute form there is severe diarrhoea and the patient may pass up to 20 stools a day. The stools, which may be small in quantity, are ?uid and contain blood, pus and mucus. There is always fever, which runs an irregular course. In other cases the patient ?rst notices some irregularity of the movement of the bowels, with the passage of blood. This becomes gradually more marked. There may be pain but usually a varying amount of abdominal discomfort. The constant diarrhoea leads to emaciation, weakness and ANAEMIA. As a rule the acute phase passes into a chronic stage. The chronic form is liable to run a prolonged course, and most patients suffer relapses for many years. SIGMOIDOSCOPY, BIOPSY and abdominal X-RAYS are essential diagnostic procedures.

Treatment Many patients may be undernourished and need expert dietary assessment and appropriate calorie, protein, vitamin and mineral supplements. This is particularly important in children with the disorder. While speci?c nutritional treatment can initiate improvement in CROHN’S DISEASE, this is not the case with ulcerative colitis. CORTICOSTEROIDS, given by mouth or ENEMA, help to control the diarrhoea. Intravenous nutrition may be required. The anaemia is treated with iron supplements, and with blood infusions if necessary. Blood cultures should be taken, repeatedly if the fever persists. If SEPTICAEMIA is suspected, broad-spectrum antibiotics should be given. Surgery to remove part of the affected colon may be necessary and an ILEOSTOMY is sometimes required. After recovery, the patient should remain on a low-residue diet, with regular follow-up by the physician, Mesalazine and SULFASALAZINE are helpful in the prevention of recurrences.

Patients and their relatives can obtain help and advice from the National Association for Colitis and Crohn’s Disease.... ulcerative colitis

 Sugar diabetes. Chronic disorder of fat, protein and carbohydrate metabolism. A decrease of insulin by the pancreas gives rise to high level blood sugar (glucose) which is eliminated in the urine by the kidneys. With low insulin production the body cannot convert food into energy. In Britain over 30,000 new cases are diagnosed each year. One in five people go blind because of diabetes. The genetic factor is important; it may run in families due to defect in the immune system. Women who have German measles during the first three months of pregnancy can have a child who develops diabetes during adolescence.

Etiology. The more severe form, in younger patients, needs insulin treatment, without which ketosis and diabetic coma are possible. The milder form in older patients can be managed with diet and hypoglycaemic agents. Now considered due to auto-immune attack on Islet of Langerhams cells in pancreas which secrete insulin. “The Pill” often raises blood sugar. Lack of trace minerals (chromium and zinc). Zinc is a component of insulin and Chromium produces enzymes to stimulate metabolism of sugars. Diabetes can cause heart attack, stroke, hardening of arteries, blindness. It is the leading cause of kidney failure and gangrene.

Symptoms. Great thirst. Urine of high specific gravity. Weakness, emaciation, skin ulcers, loss of tactile sensation in the fingertips (Vitamin B6). In men there may be inflammation of the glans penis and in women, itching of the vulvae. Boils are common. In spite of large appetite there may by severe weight loss. Magnesium deficiency.

Diabetics are subject to glaucoma and detachment of the retina. There is a high incidence of cataract of the eye. While surgery may be necessary, effective supportive herbal treatment can do much. Regular visits to the Hospital Specialist help detect in time future eye, kidney and circulation damage.

High fibre, low fat, high carbohydrate. To help control blood sugar a diabetic must avoid sweets.

Exercise lowers blood sugar.

Agents used with some success: Alfalfa, Damiana leaves, Fenugreek seeds, Aloe Vera juice, Dandelion, Fringe Tree, Guar gum, Garlic (anti-diabetic action shown by Dr Madaus, West Germany, 1967), Bilberry berries, Goat’s Rue (dried aerial parts reduce blood sugar BHP (1983), Olive leaves, onions, Nettles, Pipsissewa, White Horehound, Sweet Sumach, Jambul seeds rapidly reduce sugar in the urine. Karela. Gurmar, (Gymnema sylvestre) leaves are chewed in India to reduce sugar in the urine (mild cases). Balsam pear. Bitter melon (Momordica charastia).

Hypoglycaemic herbs can be effective where the pancreas still functions. Type 1 diabetes, suffered by children whose insulin-producing cells have been destroyed and who produce no insulin at all will always require administered insulin. Maturity-onset diabetes (Type 11) occurs in middle life, insulin- production being insufficient. This form is usually associated with obesity for which herbs are helpful.

Diabetics are specially prone to infections; a course of Echinacea at the onset of winter is beneficial. Coronary artery disease is common in diabetics (especially women) who may develop atherosclerosis at an early age. High blood pressure places undue strain upon kidneys which may excrete too much protein (Yarrow, Lime flowers, Hawthorn). Lack of sensation in the feet exposes the subject to unconscious bruising and injury from which septic ulceration may arise (Chamomile foot baths).

Alternatives. Liver herbs work positively on the pancreas. Diabetic cases should receive treatment for the liver also, Dandelion and Fringe Tree being a reliable combination. Dr John Fearn, California (Ellingwood) used Fringe Tree for all his cases of sugar in the urine: 10 drops, Liquid Extract, 4-5 times daily.

Tea. Equal parts: Peppermint leaves, Dandelion leaves, Goat’s Rue leaves. 1-2 teaspoons to each cup boiling water infuse 5-15 minutes. Cup 2-3 times daily.

Teas from any one of the following: Bilberry berries or leaves, Nettles, White Horehound, Alfalfa, Olive leaves.

Decoction. Fenugreek seeds. 2 teaspoons to each large cup water simmered gently 5 minutes. One cup daily, consuming the seeds.

Powders. Equal parts: Sweet Sumach, Jambul seeds, Dandelion. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Jambul, Fringe Tree, Goat’s Rue. Dose: 1 teaspoon thrice daily and at bedtime.

Tablets. Dr Alfred Vogel: tablet containing: Bilberry, Kidney Bean, Tormentil, English Walnut leaves, Alfalfa leaves, Cuckoo flowers.

Karela (Momordica Charantia) Hypoglycaemic action gave good results in clinical trials. Daily dose: 50/60ml fresh juice.

Evening Primrose. See entry.

Guar Gum. 5g unit dose sachets (Guarina) containing dispersible granules. This gum has shown beneficial effects for insulin-dependants.

Hypoglycaemics (second degree). Allspice, Bugleweed, Burdock, Ginseng, Lily of the Valley, Wormwood, Nettles.

Diabetic gangrene. Tinctures: equal parts, Echinacea, Thuja. Internally and externally. Internal dose: 30- 60 drops.

Diabetic neuralgia. Cayenne pepper (Capsicum). Frequently successful.

American traditional. It is claimed that 500mg Bayleaf, Cinnamon, Cloves and Turmeric halve the need for insulin in diabetics.

Diet. Dietary treatment has changed over the past few years. Patients are now advised by the British Diabetic Association to eat food rich in complex carbohydrates (starches) and high in fibre as in wholemeal bread, oats and wholegrain breakfast cereals, wholewheat pasta, brown rice, beans and lentils, vegetables and fruit. Fat intake should be carefully watched (lean meat); skimmed milk, polyunsaturated or low-fat cheeses and salad dressings. Certain foods are known to encourage the pancreas to produce more insulin: banana, barley, cabbage, lettuce, oats, olive, papaya, turnip, sweet potato.

Coffee intake should be limited to prevent hypoglycaemic symptoms.

Barley. A study has shown that the use of barley flour as a substitute for wheat in bread helps to control diabetes, in Iraq. (Naismith D, et al, ‘Therapeutic Value of Barley in Management of Diabetes’: Annals Nutr Metab, 35, 61-64 1991)

Supplementation. Vitamins A, B-complex, C, D, E, F. Vitamin B6. Brewer’s yeast. Minerals: Chromium 50mcg; Manganese 15mg; Magnesium 300mg; Zinc 25mg; to normalise glucose metabolism.

Note: Over 400 traditional plant medicines have been documented for diabetes, but few have been evaluated for efficacy. In the undeveloped countries they are chiefly used for non-insulin dependent diabetes. (Diabetes Care, 1989, Sept 12, p553)

Insulin dependents. Whether adults or children, insulin dependents should under no circumstances discontinue insulin injections.

Treatment by or in liaison with general medical practitioner.

Information. British Diabetic Association, 10 Queen Anne Street, London W1M 0BD, UK. Send SAE. ... diabetes, mellitus