7 lecture Seven.pdf

# Herbal treatments for diarrhea This section outlines herbal medicinal approaches to treating diarrhea, focusing on rehydration strategies and the use of tannin-containing remedies [2](#page=2). ### 1.1 Rehydration therapy in diarrhea The primary approach to managing diarrhea using herbal medicine is oral rehydration therapy (ORT) [2](#page=2). #### 1.1.1 Sugar-salt solutions ORT typically involves sugar-salt solutions, frequently enhanced with the addition of starch [2](#page=2). #### 1.1.2 Starch as a rehydration agent Starch-based substances, including rice, potato, wheat, and maize, are utilized either as suspensions or in the form of starch-based foods like gruels for rehydration purposes [2](#page=2). > **Tip:** The use of starch in rehydration is not merely for energy provision but also plays a crucial role in the absorption of sodium and water. ##### 1.1.2.1 Mechanism of starch in rehydration The polysaccharides present in starch undergo hydrolysis within the gastrointestinal tract (GIT), yielding sugars that are subsequently absorbed. This process leverages the co-transport mechanism of sugar and sodium ions (Na+) from the GIT lumen into the intestinal cells and mucosa. Consequently, starch suspensions actively shift the balance of Na+ towards the mucosal side, thereby enhancing water absorption and supplying the body with energy [2](#page=2). ### 1.2 Tannin-containing drugs for diarrhea Following rehydration therapies, tannin-containing drugs represent the second line of treatment for diarrhea [2](#page=2). #### 1.2.1 Properties of tannins Tannins are characterized as astringent, polymeric polyphenols that are widely distributed in various plant-derived drugs [2](#page=2). #### 1.2.2 Key herbs containing tannins Prominent herbs utilized for their tannin content include Black catechu, Acacia catechu, and Oak bark. Even common beverages like tea and coffee also contain tannins [2](#page=2). #### 1.2.3 Safety and contraindications of tannins While generally considered safe, caution is advised when administering tannin-containing herbs concurrently with other medications. Tannins exhibit incompatibility with alkalis and alkaloids, forming complexes with proteins and amino acids [2](#page=2). > **Tip:** Be mindful of potential drug interactions when using tannin-rich herbs, particularly if the patient is on other medications or supplements. --- # Herbal treatments for constipation This section summarizes various plant-derived laxatives used for constipation, categorized into bulk-forming, stimulant, and osmotic types. ### 2.1 Bulk-forming laxatives These are agents with a high fiber content, often rich in polysaccharides, that swell in the gastrointestinal (GI) tract. They are typically undigested and pass through the GI tract unchanged, providing nutrients for colonic bacteria and influencing gut flora composition and food metabolism, which can lead to increased gas. Bulking agents contain a large amount of fibers, while swelling agents are primarily plant material, often seeds, rich in mucilage. The swelling index serves as a marker for the quality of bulk-forming laxatives, indicating the polysaccharide content. Preparations of these laxatives must always be taken with ample water. Conversely, they can be used to treat diarrhea if taken with very little fluid, allowing them to absorb fluid from the lumen and increase stool consistency [3](#page=3). #### 2.1.1 Linseed (Flaxseed) * **Constituents:** Mucilages (3-10%) with high swelling capacity, cyanogenic glycosides (0.05-0.1%), fatty oil (30-45% primarily linolenic, linoleic, and oleic acids), proteins (20-27%), lignans, and phenylpropane derivatives [3](#page=3). * **Pharmacological Effects:** The laxative effect is attributed to bulk material and mucins. Animal experiments have shown a reduction in liver cholesterol levels due to unsaturated fatty acids and a blood sugar-lowering effect. The antitumor effect is linked to lignans, which possess antimycotic, antioxidative, and anti-estrogenic properties. A potential toxic principle involves cyanogenic glycosides, which can yield HCN, but no signs of poisoning have been observed in humans with high single doses or chronic intake [4](#page=4). * **Indications & Usage:** Approved for constipation and inflammation of the skin [4](#page=4). * **Contraindications:** Ileus, esophageal stricture, and acute inflammatory illnesses of the intestine, esophagus, and stomach entrance [4](#page=4). * **Precautions & Adverse Reactions:** No health hazards or side effects are known with proper therapeutic dosages. Excessive use with insufficient fluid intake can lead to ileus. Cyanogenic glycosides do not pose a danger at therapeutic dosages as they are only partially broken down, and increased cyanide ion or thiocyanic acid levels in blood have not been demonstrated. For inflammatory bowel conditions, pre-swollen flaxseed is recommended [4](#page=4) [5](#page=5). * **Drug Interactions:** Absorption of other simultaneously taken drugs may be delayed [5](#page=5). * **Food Interactions:** Absorption of flaxseed oil is facilitated when taken with food [5](#page=5). #### 2.1.2 Ispagula, Psyllium, Wheat bran * **Constituents:** Mucilages (10-12% in the seed coat, mainly arabinoxylans), iridoids (e.g., aucubin), pyridine alkaloids, proteic substances, and fatty oil [5](#page=5). * **Pharmacological Effects:** The mucins exert a laxative and antidiarrheal effect by regulating intestinal peristalsis through swelling [5](#page=5). * **Indications & Usage:** Approved for constipation and diarrhea [5](#page=5). * **Contraindications:** Pathologic GI tract constriction, inflammatory GI tract illnesses, impending or present ileus, and severely variable diabetes mellitus [6](#page=6). * **Precautions & Adverse Reactions:** No health hazards or side effects are known with proper therapeutic dosages. Allergic reactions (rhinitis, conjunctivitis, asthma, urticaria) can occur in isolated cases. Incorrect administration with insufficient fluid can lead to esophageal or intestinal obstruction, especially in the elderly [6](#page=6). * **Drug Interactions:** Absorption of other simultaneously taken drugs could be delayed [6](#page=6). ### 2.2 Stimulant laxatives These are typically anthraquinone-containing drugs, often found as glycosides in plants. They are metabolized to anthrone types in the colon and caecum by natural GI flora. Anthranoid drugs act directly on the intestinal mucosa, increasing colonic peristalsis, reducing transit time, and consequently decreasing water reabsorption from the colon. Monomeric aglycones like emodin and aloe emodin have demonstrated genotoxic and mutagenic effects in bacterial and mammalian cell lines. Long-term use may cause blackening of the colon due to metabolite incorporation and is associated with an increased risk of colon carcinoma. They are contraindicated in pregnancy as they can affect the uterus and increase abortion risk [6](#page=6) [7](#page=7). #### 2.2.1 Examples of Stimulant Laxatives * **Senna leaves and fruits** [Cassia acutifolia & Cassia angustifolia [7](#page=7). * **Cascara bark** [Rhamnus purshiana and **Frangula bark** [Rhamnus frangula: These barks contain cascarosides and glucofrangulin, respectively. Fresh bark contains emetic and colicky anthrone and dianthrone glycosides and requires storage for one year for oxidation to less toxic anthraquinones [7](#page=7). * **Castor Oil:** Contains glycerides that yield irritant ricinoleic acid upon hydrolysis [7](#page=7). #### 2.2.2 Senna * **Constituents:** Anthracene derivatives (2.5-3.5%) including sennosides A, A1, B, C, and D; and naphthacene derivatives such as 6-hydroxymusizin glucoside [7](#page=7). * **Pharmacological Effects:** Senna is an anthranoid stimulant laxative. Its laxative effect is mediated by sennosides and their active metabolite, rhein anthrone, in the colon. It inhibits water and electrolyte absorption from the large intestine, increasing intestinal content volume and pressure, which stimulates colon motility. It also stimulates active chloride secretion, increasing water and electrolyte content, a process dependent on calcium. The secretion is mediated by stimulation of endogenous prostaglandin E2 [7](#page=7) [8](#page=8). * **Indications & Usage:** Used for constipation and bowel evacuation before diagnostic GI and colorectal tests [8](#page=8). * **Tip:** Stimulating laxatives should not be used for more than 1 to 2 weeks without medical advice [8](#page=8). * **Contraindications:** Intestinal obstruction, acute inflammatory intestinal diseases, or appendicitis [8](#page=8). * **Precautions & Adverse Reactions:** * **General:** Spasmodic GI complaints can occur due to the purgative effect or overdosage. Prolonged use may rarely lead to cardiac arrhythmias, nephropathies, edema, and accelerated bone deterioration. Senna abuse can cause tetany, aspartyl glucosamine excretion, and hypogammaglobulinemia [8](#page=8). * **Electrolyte Abnormalities:** Long-term use causes electrolyte loss, particularly potassium ions. Hypokalemia can result in hyperaldosteronism, albuminuria, hematuria, inhibition of intestinal motility, and muscle weakness [8](#page=8). * **Drug Potentiation:** Hypokalemia can potentiate cardioactive glycosides and antiarrhythmics [8](#page=8). * **Finger Clubbing:** Observed with senna abuse and is reversible upon discontinuation [9](#page=9). * **Cathartic Colon:** Anatomic alteration of the colon (loss of haustral folds) seen with chronic use (more than three times weekly for 1 year or longer), suggesting neuronal injury or damage to the colonic longitudinal musculature [9](#page=9). * **Carcinogenesis:** Carcinogenic activity in the colon following long-term administration of anthracene drugs is not fully clarified [9](#page=9). * **Melanosis Coli:** Prolonged use may lead to melanosis coli, where melanic substance precursors are derived from anthranoid laxatives [9](#page=9). * **Occupational Sensitization:** IgE-mediated allergy, asthma, and rhino conjunctivitis have been reported after occupational exposure [9](#page=9). * **Tissue Damage:** Chronic high-dose treatment can reduce vasoactive intestinal polypeptide and somatostatin levels in the colon, potentially indicating damage to enteric nervous tissue [9](#page=9). * **Drug Interactions:** * **Digitalis Glycosides:** Potassium loss from prolonged use or abuse can potentiate digitalis toxicity [9](#page=9). * **Antiarrhythmics:** Potassium loss may potentiate arrhythmias when given with antiarrhythmics [9](#page=9). * **Estrogen:** Serum estrogen levels may decrease due to increased intestinal transit affecting absorption [9](#page=9). * **Indomethacin (NSAIDs):** Can cause dose-dependent inhibition of net fluid transport by inhibiting prostaglandin E2, reducing senna's therapeutic effect [10](#page=10). * **Nifedipine (calcium channel blocker):** Rhein anthrone's therapeutic effects involve calcium channels, which can be blocked by nifedipine but not verapamil [10](#page=10). * **Pregnancy:** Should not be used during pregnancy or nursing [10](#page=10). * **Pediatric Use:** Not for children under 2 years; children aged 2-12 should follow dosage recommendations [10](#page=10). * **Elderly:** Elderly patients should start with half the normal dose [10](#page=10). * **Preparation:** Infusion: steep 0.5-2 gm of comminuted drug in hot (not boiling) water for 10 minutes, then strain; or steep in cold water for 10-12 hours, then strain. The cold-water method may result in a solution with less resin, reducing abdominal pain. Onset of action is 10-12 hours later [10](#page=10). ### 2.3 Osmotic laxatives Lactulose and lactose are dimeric sugars derived from milk, useful for treating long-term constipation. Lactose is split into glucose and galactose in the GI tract. Galactose is poorly absorbed and metabolized by colonic bacteria into acids (e.g., lactic, acetic acid) which have an osmotic effect. This also leads to increased bacterial multiplication in the colon, resulting in softer, increased fecal volume and subsequent increased GI peristalsis [10](#page=10). --- # Main gastrointestinal disorders treated by herbal medicine This section outlines common gastrointestinal disorders that are addressed using herbal medicinal treatments, detailing the primary approaches and mechanisms of action for each condition [2](#page=2). ### 3.1 Diarrhea Diarrhea is a prevalent gastrointestinal disorder for which herbal medicine offers distinct treatment lines [2](#page=2). #### 3.1.1 First-line treatment for diarrhea The initial approach to managing diarrhea involves oral rehydration therapy (ORT), often incorporating starch-based solutions or foods [2](#page=2). * **Starch as a therapeutic agent:** Materials such as rice, potato, wheat, and maize are utilized in suspension or as starch-based foods like gruels [2](#page=2). * **Mechanism of starch in rehydration:** The polysaccharides present in starch are hydrolyzed within the gastrointestinal tract (GIT), yielding sugars that are subsequently absorbed. This process is crucial because the absorption of sugars and sodium ions ($Na^+$) from the GIT lumen into the cells and mucosa occurs via co-transport. Consequently, starch suspensions actively shift the balance of $Na^+$ towards the mucosal side, thereby enhancing water absorption and supplying the body with energy [2](#page=2). #### 3.1.2 Second-line treatment for diarrhea Following the initial rehydration phase, tannin-containing herbal drugs are employed as a second-line treatment [2](#page=2). * **Characteristics of tannins:** Tannins are described as astringent, polymeric polyphenols that are widely distributed in medicinal plants [2](#page=2). * **Key herbs containing tannins:** Prominent herbs used for their tannin content include black catechu, *Acacia catechu*, and oak bark. Even common beverages like tea and coffee also contain tannins [2](#page=2). * **Safety and contraindications:** While generally considered safe, caution is advised when administering tannin-rich herbs concurrently with other medications. This is because tannins are incompatible with alkalis and alkaloids, and they can form complexes with proteins and amino acids, potentially affecting the absorption or efficacy of other drugs [2](#page=2). > **Tip:** When using tannin-containing herbs, be mindful of potential interactions with other medications due to their protein-binding and alkaloid-precipitating properties [2](#page=2). --- ## Common mistakes to avoid - Review all topics thoroughly before exams - Pay attention to formulas and key definitions - Practice with examples provided in each section - Don't memorize without understanding the underlying concepts

| Term | Definition | |------|------------| | Phytotherapy | The medicinal use of plants or plant-derived substances to treat or prevent disease and promote well-being. | | Gastrointestinal Tract (GIT) | The series of organs responsible for digesting food and absorbing nutrients, extending from the mouth to the anus. | | Oral Rehydration Therapy (ORT) | A treatment for dehydration, especially that due to diarrhea, which involves drinking a solution of sugar and salt in water. | | Polysaccharides | Complex carbohydrates composed of many monosaccharide units linked together, such as starch and cellulose, often found in plants. | | Tannins | Astringent, polymeric polyphenolic compounds found in plants that can bind to proteins and other organic compounds, often used for their medicinal properties. | | Laxative | A substance that aids in the defecation of stools, used to treat constipation. | | Bulk-forming Laxative | A type of laxative that absorbs water in the intestine to form a gel-like mass, which softens and increases stool bulk, stimulating bowel movements. | | Fiber | Indigestible plant material that aids digestion by adding bulk to stool and promoting bowel regularity. | | Mucilage | A gummy substance produced by plants, which swells in water and can be used for its soothing and bulking properties in laxatives. | | Swelling Index | A measure indicating the amount of polysaccharides present in a plant material, used to assess the quality of bulk-forming laxatives. | | Cyanogenic Glycosides | Plant compounds that can release hydrogen cyanide (HCN) upon hydrolysis, potentially causing toxicity if ingested in sufficient quantities. | | Lignans | A class of polyphenolic compounds found in plants, known for their antioxidant, antimycotic, and anti-estrogenic properties. | | Ileus | A painful condition characterized by the blockage or paralysis of the intestines, preventing normal passage of intestinal contents. | | Stimulant Laxatives | Laxatives that work by directly stimulating the intestinal lining, increasing peristalsis and promoting bowel movements. | | Anthraquinones | A group of compounds found in plants, often used as stimulant laxatives, which act on the colonic mucosa to increase motility. | | Sennosides | Glycosides of anthraquinones found in Senna, acting as potent stimulant laxatives by increasing water and electrolyte secretion in the colon. | | Cathartic Colon | An anatomical alteration of the colon resulting from chronic use of stimulant laxatives, characterized by loss of haustral folds and potential neuronal damage. | | Melanosis Coli | A benign pigmentation of the colonic mucosa, appearing dark brown or black, often associated with prolonged use of anthranoid laxatives. | | Osmotic Laxative | A laxative that works by drawing water into the intestines from surrounding tissues, softening stool and promoting defecation. | | Lactulose | A synthetic sugar used as an osmotic laxative that is not absorbed in the small intestine and is fermented by colonic bacteria, drawing water into the colon. |