See urination, excessive.
Habitat: Throughout the hotter parts of India. Found as a weed in the sub-Himalayan tract and other hills up to 1,200 m.
English: Country Mallow, Flowering Maples, Chinese Bell-flowers.Ayurvedic: Atibalaa, Kankatikaa, Rishyaproktaa.Unani: Kanghi, Musht-ul-Ghaul, Darkht-e-Shaan.Siddha/Tamil: Thutthi.Folk: Kanghi, Kakahi, Kakahiyaa.Action: Dried, whole plant— febrifuge, anthelmintic, demulcent, diuretic, anti-inflammatory (in urinary and uterine discharges, piles, lumbago). Juice of the plant— emollient. Seeds—demulcent (used in cough, chronic cystitis), laxative. Leaves—cooked and eaten for bleeding piles. Flowers— antibacterial, anti-inflammatory. Bark—astringent, diuretic. Root— nervine tonic, given in paralysis; also prescribed in strangury.
Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the root in gout, polyuria and haemorrhagic diseases.The plant contains mucilage, tannins, asparagines, gallic acid and ses- quiterpenes. Presence of alkaloids, leucoanthocyanins, flavonoids, sterols, triterpenoids, saponins and cardiac glycosides is also reported.Asparagine is diuretic. Gallic acid is analgesic. Mucilages act by reflex, loosen cough as well as bronchial tension. Essential oil—antibacterial, antifungal.The drug exhibits immunological activity. It augments antibody in animals. EtOH (50%) extract of A. indicum ssp. guineense Borssum, synonym A. asiaticum (Linn.) Sweet, exhibits anticancer activity.Related sp. include: Abutilon avicen- nae Gaertn., synonym A. theophrastiiMedic.; A. fruticosum Guill. et al.; A. hirtum (Lam.) Sweet, synonym A. graveolens Wt. and Arn.; A. muticum Sweet, synonym A. glaucum Sweet; and A. polyandrum Wight and Arn., synonym A. persicum (Burm. f.) Merrill (known as Naani-khapaat, Jhinaki- khapaat, Kanghi, Makhamali-khapaat and Khaajavani-khapaat, respectively, in folk medicine).Dosage: Root—3-6 g powder. (API Vol I.)... abutilon indicumHabitat: Temperate Himalaya from Kashmir to Bhutan, between altitudes of 900 and 3,000 m.
Ayurvedic: Paashaanabheda, Ashmaribhedikaa, Ashmaribhit, Ashmghna, Shilaabhit, Shilaabheda. (These synonyms are also equated with Aerva lanata Juss.)Siddha/Tamil: Padanbethi.Action: Leaf and root—antiscorbutic, astringent, spasmolytic, antidiarrhoeal. Used in dysuria, spleen enlargement, pulmonary affections as a cough remedy, menorrhagia, urinary tract infections. Alcoholic extract of roots— antilithic. Acetone extract of root- bark—cardiotoxic, CNS depressant and anti-inflammatory; in mild doses diuretic but antidiuretic in higher doses. Anti-inflammatory activity decreases with increasing dosage.
Due to its depressant action on the central nervous system, the drug is used against vertigo, dizziness and headache in moderate or low dosage.Key application: In lithiasis, dysuria, polyuria. (The Ayurvedic Pharmacopoeia of India; Indian Herbal Pharmacopoeia.)The rhizome contains an active principle bergenin (0.6%), gallic acid, glucose (5.6%), tannins (14.2-016.3%), mucilage and wax; a C-glycoside and beta-sitosterol.Bergenin prevented stress-induced erosions in rats and lowered gastric outputs.(Paashaanabheda indicates that the plant grows between rocks appearing to break them; it does not necessarily mean that it possesses lithotriptic property.)Dosage: Rhizome—20-30 g for decoction. (API Vol. I)... bergenia ligulataThe start of ‘dehydration’ is signalled by a person becoming thirsty. In normal circumstances, the drinking of water will relieve thirst and serious dehydration does not develop. In a temperate climate an adult will lose 1.5 litres or more a day from sweating, urine excretion and loss of ?uid through the lungs. In a hot climate the loss is much higher – up to 10 litres if a person is doing hard physical work. Even in a temperate climate, severe dehydration will occur if a person does not drink for two or three days. Large losses of ?uid occur with certain illnesses – for example, profuse diarrhoea; POLYURIA in diabetes or kidney failure (see KIDNEYS, DISEASES OF); and serious blood loss from, say, injury or a badly bleeding ULCER in the gastrointestinal tract. Severe thirst, dry lips and tongue, TACHYCARDIA, fast breathing, lightheadedness and confusion are indicative of serious dehydration; the individual can lapse into COMA and eventually die if untreated. Dehydration also results in a reduction in output of urine, which becomes dark and concentrated.
Prevention is important, especially in hot climates, where it is essential to drink water even if one is not thirsty. Replacement of salts is also vital, and a diet containing half a teaspoon of table salt to every litre of water drunk is advisable. If someone, particularly a child, suffers from persistent vomiting and diarrhoea, rehydration therapy is required and a salt-andglucose rehydration mixture (obtainable from pharmacists) should be taken. For those with severe dehydration, oral ?uids will be insu?cient and the affected person needs intravenous ?uids and, sometimes, admission to hospital, where ?uid intake and output can be monitored and rehydration measures safely controlled.... dehydration
Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.
Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.
Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.
A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.
Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production
– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).
Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.
Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.
Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.
Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).
Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;
(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.
Complications The risks of complications increase with duration of disease.
Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.
Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.
Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.
Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).
Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.
Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.
Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.
Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.
Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;
(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.
Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.
Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.
However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.
Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.
Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.
Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.
A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.
Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus
K
Diagram of glomerulus (Malpighian corpuscle).
Fortunately the body has two kidneys and, as most people can survive on one, there is a good ‘functional reserve’ of kidney tissue.
Symptoms Many patients with kidney disorders do not have any symptoms, even when the condition is quite advanced. However,
others experience loin pain associated with obstruction (renal colic) or due to infection; fevers; swelling (oedema), usually of the legs but occasionally including the face and arms; blood in the urine (haematuria); and excess quantities of urine (polyuria), including at night (nocturia), due to failure of normal mechanisms in the kidney for concentrating urine. Patients with chronic renal failure often have very di?use symptoms including nausea and vomiting, tiredness due to ANAEMIA, shortness of breath, skin irritation, pins and needles (paraesthesia) due to damage of the peripheral nerves (peripheral neuropathy), and eventually (rarely seen nowadays) clouding of consciousness and death.
Signs of kidney disease include loin tenderness, enlarged kidneys, signs of ?uid retention, high blood pressure and, in patients with end-stage renal failure, pallor, pigmentation and a variety of neurological signs including absent re?exes, reduced sensation, and a coarse ?apping tremor (asterixis) due to severe disturbance of the body’s normal metabolism.
Renal failure Serious kidney disease may lead to impairment or failure of the kidney’s ability to ?lter waste products from the blood and excrete them in the urine – a process that controls the body’s water and salt balance and helps to maintain a stable blood pressure. Failure of this process causes URAEMIA – an increase in urea and other metabolic waste products – as well as other metabolic upsets in the blood and tissues, all of which produce varying symptoms. Failure can be sudden or develop more slowly (chronic). In the former, function usually returns to normal once the underlying cause has been treated. Chronic failure, however, usually irreparably reduces or stops normal function.
Acute failure commonly results from physiological shock following a bad injury or major illness. Serious bleeding or burns can reduce blood volume and pressure to the point where blood-supply to the kidney is greatly reduced. Acute myocardial infarction (see HEART, DISEASES OF) or pancreatitis (see PANCREAS, DISORDERS OF) may produce a similar result. A mismatched blood transfusion can produce acute failure. Obstruction to the urine-?ow by a stone (calculus) in the urinary tract, a bladder tumour or an enlarged prostate can also cause acute renal failure, as can glomerulonephritis (see below) and the haemolytic-uraemia syndrome.
HYPERTENSION, DIABETES MELLITUS, polycystic kidney disease (see below) or AMYLOIDOSIS are among conditions that cause chronic renal failure. Others include stone, tumour, prostatic enlargement and overuse of analgesic drugs. Chronic failure may eventually lead to end-stage renal failure, a life-threatening situation that will need DIALYSIS or a renal transplant (see TRANSPLANTATION).
Familial renal disorders include autosomal dominant inherited polycystic kidney disease and sex-linked familial nephropathy. Polycystic kidney disease is an important cause of renal failure in the UK. Patients, usually aged 30–50, present with HAEMATURIA, loin or abdominal discomfort or, rarely, urinary-tract infection, hypertension and enlarged kidneys. Diagnosis is based on ultrasound examination of the abdomen. Complications include renal failure, hepatic cysts and, rarely, SUBARACHNOID HAEMORRHAGE. No speci?c treatment is available. Familial nephropathy occurs more often in boys than in girls and commonly presents as Alport’s syndrome (familial nephritis with nerve DEAFNESS) with PROTEINURIA, haematuria, progressing to renal failure and deafness. The cause of the disease lies in an absence of a speci?c ANTIGEN in a part of the glomerulus. The treatment is conservative, with most patients eventually requiring dialysis or transplantation.
Acute glomerulonephritis is an immune-complex disorder due to entrapment within glomerular capillaries of ANTIGEN (usually derived from B haemolytic streptococci – see STREPTOCOCCUS) antibody complexes initiating an acute in?ammatory response (see IMMUNITY). The disease affects children and young adults, and classically presents with a sore throat followed two weeks later by a fall in urine output (oliguria), haematuria, hypertension and mildly abnormal renal function. The disease is self-limiting with 90 per cent of patients spontaneously recovering. Treatment consists of control of blood pressure, reduced ?uid and salt intake, and occasional DIURETICS and ANTIBIOTICS.
Chronic glomerulonephritis is also due to immunological renal problems and is also classi?ed by taking a renal biopsy. It may be subdivided into various histological varieties as determined by renal biospy. Proteinuria of various degrees is present in all these conditions but the clinical presentations vary, as do their treatments. Some resolve spontaneously; others are treated with steroids or even the cytotoxic drug CYCLOPHOSPHAMIDE or the immunosuppressant cyclosporin. Prognoses are generally satisfactory but some patients may require renal dialysis or kidney transplantation – an operation with a good success rate.
Hydronephrosis A chronic disease in which the kidney becomes greatly distended with ?uid. It is caused by obstruction to the ?ow of urine at the pelvi-ureteric junction (see KIDNEYS – Structure). If the ureter is obstructed, the ureter proximal to the obstruction will dilate and pressure will be transmitted back to the kidney to cause hydronephrosis. Obstruction may occur at the bladder neck or in the urethra itself. Enlargement of the prostate is a common cause of bladder-neck obstruction; this would give rise to hypertrophy of the bladder muscle and both dilatation of the ureter and hydronephrosis. If the obstruction is not relieved, progressive destruction of renal tissue will occur. As a result of the stagnation of the urine, infection is probable and CYSTITIS and PYELONEPHRITIS may occur.
Impaired blood supply may be the outcome of diabetes mellitus and physiological shock, which lowers the blood pressure, also affecting the blood supply. The result can be acute tubular necrosis. POLYARTERITIS NODOSA and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) may damage the large blood vessels in the kidney. Treatment is of the underlying condition.
Infection of the kidney is called pyelonephritis, a key predisposing factor being obstruction of urine ?ow through the urinary tract. This causes stagnation and provides a fertile ground for bacterial growth. Acute pyelonephritis is more common in women, especially during pregnancy when bladder infection (CYSTITIS) spreads up the ureters to the kidney. Symptoms are fever, malaise and backache. Antibiotics and high ?uid intake are the most e?ective treatment. Chronic pyelonephritis may start in childhood as a result of congenital deformities that permit urine to ?ow up from the bladder to the kidney (re?ux). Persistent re?ux leads to recurrent infections causing permanent damage to the kidney. Specialist investigations are usually required as possible complications include hypertension and kidney failure.
Tumours of the kidney are fortunately rare. Non-malignant ones commonly do not cause symptoms, and even malignant tumours (renal cell carcinoma) may be asymptomatic for many years. As soon as symptoms appear – haematuria, back pain, nausea, malaise, sometimes secondary growths in the lungs, bones or liver, and weight loss – urgent treatment including surgery, radiotherapy and chemotherapy is necessary. This cancer occurs mostly in adults over 40 and has a hereditary element. The prognosis is not good unless diagnosed early. In young children a rare cancer called nephroblastoma (Wilm’s tumour) can occur; treatment is with surgery, radiotherapy and chemotherapy. It may grow to a substantial size before being diagnosed.
Cystinuria is an inherited metabolic defect in the renal tubular reabsorption of cystine, ornithine, lysine and arginine. Cystine precipitates in an alkaline urine to form cystine stones. Triple phosphate stones are associated with infection and may develop into a very large branching calculi (staghorn calculi). Stones present as renal or ureteric pain, or as an infection. Treatment has undergone considerable change with the introduction of MINIMALLY INVASIVE SURGERY (MIS) and the destruction of stone by sound waves (LITHOTRIPSY).... kidneys, diseases of
Habitat: Grown as a field and boundary fence and as curious on rockeries in gardens.
English: Holy Milk Hedge, Dog's Tongue.Ayurvedic: Snuhi, Samant-dugdhaa, Sehunda, Singhtunda, Snuk, Gudaa, Sudhaa, Vajra, Vajjri, Vajjradram, Thuuhar.Siddha/Tamil: Ielaikkali, Perumbu- kalli.Action: Latex—purgative, diuretic, antiasthmatic, expectorant, rube- facient. Used in ascites, polyuria, anasarca, chlorosis, tympanitis; externally on warts, cutaneous eruptions, scabies, unhealthy ulcers.
A succus compounded of equal parts of the juice and simple syrup is said to be used for giving relief in asthma.The triterpenoids, euphol, 24-meth- ylenecycloartenol, euphorbol hexa- cosonate, glut-5 (10)-en-1-one, glut-5- en-3 beta-yet-acetate, taraxerol, friede- lan-3 alpha-ol and -3 beta-ol have been reported from the plant.... euphorbia neriifoliaHabitat: Northwestern India, Gujarat, Rajasthan and South India.
Ayurvedic: Nirvishaa (var.) Mustaka (var.), Apivisha.Folk: Mustu (Maharashtra).Action: Root—febrifuge and antidermatosis. Also used for diabetes.
Kyllinga monocephala Rottb., synonym Cyperus kyllinga Endl., common throughout India, is also known as Nirvishaa, Nirbishi and Mustaa (var.). The root is used as diuretic (in polyuria), demulcent, refrigerant and antipyretic. It is prescribed for fistula, pustules, tumours, measles, diarrhoea and other intestinal affections.Traces of hydrocyanic acid are reported to be present in the root, stems and nutlets.... kyllinga tricepsHabitat: Himalayas from Kumaon to Assam, up to 1,500 m, Madhya Pradesh, Bihar, Deccan Peninsula.
English: White Turpeth.Ayurvedic: Muurvaa, Atirasaa, Madhurasaa, Gokarni, Morataa, Madhulikaa, Suvaa, Devi, Tejani, Tiktavalli.Siddha/Tamil: Perunkurinjan.Folk: Maruaa-bel.Action: Root—purgative, antispas- modic, mild CNS depressant; used in colic.
Ayurvedic Pharmacopoeia of India recommends the bark in lipid disorders, also in polyuria and haemorrha- gic diseases.Roots and seeds are rich in pregnane glycosides of 2-deoxysugars, which on hydrolysis gave genins and sugars. Stem yielded tenacissosides A to E. In folk medicine, the root is known as White Turpeth (Safed Nishoth). Op- erculina turpethum (Linn.) Silva Manso synonym Ipomoea turpethum R. Br. is the source of Turpeth (Nishoth) in Indian medicine.Dosage: Root—2-6 g powder, 1020 g for decoction. (API, Vol.II.)... marsdenia tenacissimaHabitat: Assam, Madhya Pradesh, Bihar, Gujarat, Andhra Pradesh, Karnataka, Jalgaon district (Maharashtra), West Bengal, Tamil Nadu and Kerala.
English: Banana, Plantain.Ayurvedic: Kadali, Rambhaa, Sakrtphala, Vaaranaa, Mochaa, Ambusaara, Anshumatiphal.Unani: Kelaa, Mouz.Siddha/Tamil: Vaazhai.Action: Fruit—mild laxative, combats diarrhoea and dysentery, promotes healing of intestinal lesions in ulcerative colitis. Unripe fruit considered useful in diabetes. Fruit powder—used as a food supplement in sprue and other intestinal disorders. Root— anthelmintic.
The Ayurvedic Pharmacopoeia ofIn- dia recommends the fresh rhizome in dysuria, polyuria (in females) and menstrual disorders; the flower in asthma, bleeding disorders, vaginal discharges and leucorrhoea.The pulp of ripe fruit (50 g/rat per day) given daily with standard food pellets prevented increase in blood pressure in deoxycorticosterone-in- duced hypertension in rats. This was found partially related to increased serotonin levels triggered by the high carbohydrate and tryptophan content of the fruit.Dietary fibre prepared from unripe banana exerted an antiatherogenic effect, keeping the levels of cholesterol in serum and aorta low, as also the level of LDL cholesterol in rats fed on cholesterol diet.An anti-ulcerogenic acylsterylgly- coside, sitoindoside IV, has been isolated from unripe banana.A pectin containing hexoses (32.4%) and uronic acid (52.5%) has been isolated from the pith of the stem. The pectin was found to exhibit significant hypolipidaemic and hypoglycaemic activity in rats.The flower extract exhibited hypo- glycaemic activity in rabbits.The pseudostem is reported to possess lithotriptic and antilithic properties. The extract reduced the precursor of oxalate formation, the liver glycolic acid content in hyperoxaluric rats.The benzene extract of the root exhibited significant antibacterial and an- tifungal activity.Dosage: Dried flower—10-20 g. (API, Vol. IV.)... musa paradisiacaHabitat: Native to tropical America; grown in Tamil Nadu.
English: Ceylon Spinach, Surinam Purslane, Flame Flower, Sweet Heart, Water Leaf, Ceylon Spinach.Folk: Pasali, Cylon-keerai (Tamil Nadu)Action: Leaves—used in polyuria. Diabetics and invalids use the leaves as a substitute for Amaranthus gangeticus Linn.... talinum triangulare
Habitat: Subtropical Himalayas from the Ravi eastwards at 9002,100 m.
English: Box Myrtle.Ayurvedic: Katphala, Kushb- hikaa, Shriparnikaa, Mahaavalkal, Bhadraa, Bhadravati.Unani: Kaayaphal.Siddha/Tamil: Marudam.Action: Bark—carminative, antiseptic. Used in fever, cough and asthma; also as a snuff in catarrh with headache. Fruit wax— used externally for ulcers. Fruit— pectoral, sedative.
The Ayurvedic Pharmacopoeia ofIn- dia recommends the stem bark and fruit in anaemia and polyuria.The stembarkgave myricanol, a pro- anthocyanidin. The root bark yielded beta-sitosterol, taraxerol and myricadi- ol. The stem bark exhibited analgesic, spasmolytic, hypotensive and antiar- rhythmic activity.Dosage: Fruit—3-5 g, stem bark— 3-5 g. (API, Vol. III.)... myrica nagiThe preferred route for the infusion of hyperosmolar solutions is via a central venous catheter (see CATHETERS). If parenteral nutrition is required for more than two weeks, it is advisable to use a long-term type of catheter such as the Broviac, Hickman or extra-corporeal type, which is made of silastic material and is inserted via a long subcutaneous tunnel; this not only helps to ?x the catheter but also minimises the risk of ascending infection.
Dextrose is considered the best source of carbohydrate and may be used as a 20 per cent or 50 per cent solution. AMINO ACIDS should be in the laevo form and should contain the correct proportion of essential (indispensable) and non-essential amino acids. Preparations are available with or without electrolytes and with or without fat emulsions.
The main hazards of intravenous feeding are blood-borne infections made possible by continued direct access to the circulation, and biochemical abnormalities related to the composition of the solutions infused. The continuous use of hypertonic solutions of glucose can cause HYPERGLYCAEMIA and glycosuria and the resultant POLYURIA may lead to dehydration. Treatment with INSULIN is needed when hyper-osmolality occurs, and in addition the water and sodium de?cits will require to be corrected.... parenteral nutrition
Habitat: Throughout India in shallow, freshwater lakes, ponds, ditches.
Ayurvedic: Aakhukarni (Kerala). (Suggested by Rashtriya Ayurveda Vidyapeeth.)Action: Root—digestive, diuretic, febrifuge, anthelmintic. Used for epistasis, fever and colic. Also for dysuria, polyuria and skin diseases.
In Kerala, Merremia emarginata (Convolvulaceae) or Hemionitis arifo- lia (Cheilanthaceae) are used as Aakhu- karni.Salvinia is an aquatic fern, rich in protein, minerals, chlorophyll and carotenoids. Its extract exhibited strong antifungal activity against Fusa- rium nivale.... salvinia cucullataHabitat: Throughout India in moist places.
English: Country Mallow.Ayurvedic: Balaa (yellow-flowered var.), Sumanganaa, Khara- yashtikaa, Balini, Bhadrabalaa, Bhadraudani, Vaatyaalikaa.Unani: Bariyaara, Khirhati, Khireti, Kunayi.Siddha/Tamil: Nilatutti.Action: Juice of the plant— invigorating, spermatopoietic, used in spermatorrhoea. Seeds— nervine tonic. Root—(official part in Indian medicine) used for the treatment of rheumatism; neurological disorders (hemiplegia, facial paralysis, sciatica); polyuria, dysuria, cystitis, strangury and hematuria; leucorrhoea and other uterine disorders; fevers and general debility. Leaves—demulcent, febrifuge; used in dysentery.
Ephedrine and si-ephedrine are the major alkaloids in the aerial parts. The total alkaloid content is reported to be 0.085%, the seeds contain the maximum amount. In addition to alkaloids, the seeds contain a fatty oil (3.23%), steroids, phytosterols, resin, resin acids, mucin and potassium nitrate.The root contains alkaloids—ephed- rine, si-ephedrine, beta-phenethyl- amine, carboxylated tryptamines and hypaphorine, quinazoline alkaloids— vasicinone, vasicine and vasicinol. Choline and betaine have also been isolated.A sitoindoside, isolated from the plant, has been reported to exhibit adaptogenic and immunostimulatory activities. Alcoholic extract of the plant possesses antibacterial and antipyretic propeptide. Ethanolic extract of the plant depresses blood pressure in cats and dogs.... sida cordifoliaCauses include psychiatric problems, which may cause a person to drink compulsively; diabetes mellitus; disorders of the kidney known as salt-losing states; and central diabetes insipidus. Any person who passes large quantities of urine should consult a doctor.... urination, excessive
Habitat: Forests of West Bengal, Central and South India, up to 1,200 m.
English: Clearing Nut tree.Ayurvedic: Kataka, Katakaphala, Payah-prasaadi, Chakshushya, Nirmali.Unani: Nirmali.Siddha/Tamil: Thettran, Thetrankot- tai.Action: Seed—antidiabetic, antidysenteric, emetic.
Mannogalactan from seeds reduces cholesterol and triglycerides (one-tenth and one-fifth when compared to clofi- brate). Seeds are also applied to abscesses, and venereal sores (internally in gonorrhoea). Fruits—antidiabet- ic; antidysenteric, expectorant. (Pulp is used as a substitute for ipecacuanha.)The Ayurvedic Pharmacopoeia ofIn- dia recommends the seed in dysuria, polyuria, urolithiasis, also in epilepsy.The seeds, leaves and trunk bark gave diabolin (major alkaloid) and acetyldiabolin. Seeds also gavebrucine, strychnine, novacine, icajine, oleanolic acid and its glycoside. Leaves and bark gave isomotiol, stigmasterol, campes- terol and sitosterol. Diabolin exhibits hypotensive activity.A decoction of seeds is given to treat stammering.The seeds resemble those of Nux- vomica but are non-poisonous. The ripe seeds are used for clearing muddy water.Dosage: Seed—3-6 g. (API, Vol. IV.)... strychnos potatorumHabitat: Cultivated throughout India up to 1,800 m.
English: Java Plum, Jambolan, Black Plum.Ayurvedic: Jambu, Mahaaphalaa, Phalendraa, Surabhipatra. (Fruit— black.)Unani: JaamunSiddha/Tamil: Naaval.Action: Fruit—stomachic, carminative, diuretic. Bark and seed— antidiarrhoeal. Seed—hypo- glycaemic. Leaf—antibacterial, antidysenteric.
Key application: Bark—in nonspecific acute diarrhoea and in topical therapy for mild inflammation of the oral-pharyngeal mucosa; externally in mild, superficial inflammation of the skin. (German Commission E.) The seed has been included among unapproved herbs by German Commission E, as the blood sugar-lowering effect could not be established by several researchers. Claimed applications mentioned in German Commission E monograph: in diabetes, also in combination preparations for atonic and spastic constipation, diseases of the pancreas, gastric and pancreatic complaints.The Ayurvedic Pharmacopoeia of India recommends the bark in acute diarrhoea and haemorrhagic diseases; the seed in hyperglycaemia and polyuria.The aqueous alcoholic extract of the bark contains bergenin, gallic acid and ethyl gallate.The fruit contains anthocyanins and yielded citric, malic and gallic acids. Gallic acid and tannins account for as- tringency of the fruit. Malic acid is the major acid (0.59%) of the weight of fruit; a small quantity of oxalic acid is reported to be present. Glucose and fructose are principal sugars in the ripe fruit; surcose was not detected.The seeds contain tannin (about 19%), ellagic acid, gallic acid (1-2%), beta-sitosterol, 0.05% essential oil; myricyl alcohol is present in the un- saponifiable matter.The stem bark yielded friedelan-3- alpha-ol, kaempferol, quercetin, beta- sitosterol and its glycoside, kaempferol- 3-O-glucoside, gallic acid, friedelin and betulinic acid. It contained eugenin and epi-friedelanol. 10-12% tannins were reported.The leaves contain aliphatic alcohols, sitosterols, betulinic acid and crategolic (maslinic) acid.The flowers contain triterpenic acids—oleanolic acid and crategolic acid. The oleanolic acid is a strong protector against adriamycin-induced lipid peroxidation in liver and heart microsomes.Phenols, including methylxantho- xylin and 2, 6-dihydroxy-4-methoxy- acetophene have been isolated from the plant (also from the seed).Seeds in a dose of 10 mg/kg p.o. on normal and alloxanized rabbits exhibited hypoglycaemic activity up to 23 and 20% respectively. The chloroform fraction of seed extract exhibited potent anti-inflammatory action against both exudative and prolifer- ative and chronic phases of inflammation, besides exhibiting significant anti-arthritic, antipyretic and analgesic activities. Water extract exhibited antibacterial property against S. boydi and S. dysentrae in cases of dysentery and diarrhoea.The bark extract is reported to have an effect on glycogenolysis and glyco- gen storage in animals.Dosage: Stem bark—10-20 g for decoction; dried seed—3-6 g powder. (API, Vol. II.)... syzygium cuminiiHabitat: 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: ArjunSiddha: 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 arjunaHabitat: Abundant in Northern India. Also occurs in the forests of Assam, West Bengal, Bihar, Assam, especially in Konkan.
English: Chebulic Myrobalan, Black Myrobalan.Ayurvedic: Haritaki, Kaayasthaa, Pathyaa, Shreyasi, Shivaa. (Jivanti, Puutanaa, Vijayaa, Abhayaa, Rohini, Chetaki, Amritaa—according to some scholars, these represent seven varieties of Haritaki; now used as synonyms.)Unani: Harad, Halelaa siyaah, Halelaa zard, Halelaa Kaabuli (varieties).Siddha/Tamil: Kadukkai.Action: Gentle purgative, astringent (unripe fruits are more purgative, ripe ones are more astringent; sennoside A and anthraquinone glycoside is laxative, tannins are astringent), stomachic, antibilious, alterative. Used in prescriptions for treating flatulence, constipation, diarrhoea, dysentery, cyst, digestive disorders, vomiting, enlarged liver and spleen, cough and bronchial asthma, and for metabolic harmony. Bark—diuretic.
The Ayurvedic Pharmacopoeia of India, along with other therapeutic applications, indicated the use of powder of mature fruits in intermittent fevers, chronic fevers, anaemia and polyuria.The fruits of T. chebula are used in combination with Emblica officinalis and T. bellirica (under the name Triphalaa) in the treatment of liver and kidney dysfunctions. The main purgative ingredient of Triphalaa is T. chebula (the purgative principle is in the pericarp of the fruit).Shikimic, gallic, triacontanoic and palmitic acids, beta-sitosterol, daucos- terol, triethyl ester of chebulic acid and ethyl ester of gallic acid; a new ellag- itannin, terchebulin, along with puni- calagin and teaflavin A have been isolated from the fruits. A new triterpene, chebupentol, and arjungenin, termi- noic acid and arjunolic acid were also isolated from the fruit.Antioxidant constituents of the plant, phloroglucinol and pyrogallol have been isolated along with ferulic, vanillic, p-coumaric and caffeic acids. Ether extract showed higher antioxidant activity than BHA and BHT, Acid esters present in phenolic fraction of extract, were found most effective.Dosage: Pericarp of mature fruit— 3-6 g powder. (API, Vol. I.)... terminalia chebulaHabitat: Tropical India and the Andamans.
Ayurvedic: Guduuchi, Gudu- uchikaa, Guluuchi, Amrita, Am- ritaa, Amritalataa, Amritavalli, Chinnaruuhaa, Chinnodbhavaa, Madhuparni, Vatsaadani, Tantrikaa, Kundalini. Guduuchi sattva (starch).Unani: Gilo, Gulanchaa. Sat-e-Gilo (starch).Siddha: Seenil, Amrida-valli.Folk: Giloya.Action: Herb—antipyretic, an- tiperiodic, anti-inflammatory, antirheumatic, spasmolytic, hypo- glycaemic, hepatoprotective. Water extract increases urine output. Stem juice—prescribed in high fever; decoction in rheumatic and bilious fevers. Aqueous extract of the plant—fabrifuge. Starch—antacid, antidiarrhoeal and antidysenteric.
The Ayurvedic Pharmacopoeia of India, along with other therapeutic applications, recommends the dried stems in jaundice, anaemia, polyuria and skin diseases.The stem contains alkaloidal constituents, including berberine; bitter principles, including columbin, chas- manthin, palmarin and tinosporon, tinosporic acid and tinosporol.The drug is reported to possess one- fifth of the analgesic effect of sodium salicylate. Its aqueous extract has a high phagocytic index.Alcoholic extract of the stem shows activity against E. coli. Active principles were found to inhibit in vitro the growth of Mycobacterium tuberculosis.Oral administration of alcoholic extract of the root resulted in a significant reduction in blood and urine glucose and in lipids in serum and tissues of alloxan diabetic rats. (Phytother Res. 2003 17 (4), 410-3.)A significant reduction in levels of SGOT, SGPT, ALP and bilirubin were observed following T. cordifolia treatment during CCl4 intoxication in mature rats. (J. Toxicol Sci. 2002, 27 (3), 139-46.) The plant extract showed in vitro inactivating activity in Hepatitis- B surface antigen. (Indian Drugs, 1993, 30, 549.)A new hypoglycaemic agent was isolated from the plant; it was found to be 1,2-substituted pyrrolidine.The starch from roots and stem, used in chronic diarrhoea and dysentery, contains a polysaccharide having 1-4 glucan with occasional branching points.Dosage: Stem—3-6 g powder; 2030 g for decoction. (API, Vol. I.)... tinospora cordifoliaHabitat: Throughout India.
English: Water Chestnut.Ayurvedic: Shrngaataka, Shrngaata, Shrngamuula, Trikota, Jalapha- la, Trikonaphala, Paaniyaphala, Jalkanda, Trikona, Trika.Unani: Singhaaraa.Siddha: SingaraAction: The Ayurvedic Pharmacopoeia of India recommends the use of dried kernels in bleeding disorders, threatened abortion, dysuria, polyuria and oedema.
Flour of dried kernels is used in preparations for breaking fast in India. The flour is rich in proteins and minerals. The flour, prepared from dried kernels, ofred and white varieties contain: phosphorus 45, 48; sulphur 122.81, 130.16; calcium 60, 20; magnesium 200, 160; sodium 100, 80; and potassium 1800, 1760 mg/100 g; iron 145.16, 129.02 and manganese 18.93, 11.36 ppm, respectively. The starch, isolated from flour, consists of 15% amylose and 85% amylopectin.Dosage: Dried seed—5-10 g powder. (API, Vol. IV.)... trapa bispinosa
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