Traditional Herbal Remedies for Primary Health Care PDF

Herbal medicines constitute the main component of traditional medicine, which have been used since thousands of years. They have made significant contribution to human health through their health promotive, curative and rehabilitative properties and in the prevention of illnesses. Indeed, many herba...

Herbal medicines constitute the main component of traditional medicine, which have been used since thousands of years. They have made significant contribution to human health through their health promotive, curative and rehabilitative properties and in the prevention of illnesses. Indeed, many herbal remedies used traditionally have become modern medicines through drug development. Digoxin, morphine, colchicine, and artemisinin are some notable examples. Long tradition of use of many herbal remedies and experiences passed on from generation to generation has brought about reliance by the people on herbal remedies. At present, the use of medicinal plants for health benefits is increasing worldwide. Traditional Herbal Remedies for Primary Health Care This publication contains 28 monographs on common ailments which can be readily treated with simple herbal remedies. They can be prepared easily and used within the ambit of primary health care. Each monograph Traditional Herbal Remedies provides description of the ailment, the form of traditional preparation, its composition, English name, Latin name and family of the plant, plant part for Primary Health Care used, main chemical constituents, quality standards, method of preparation, dosage form, therapeutic properties, indications and uses, dose and mode of administration, precautions and safety aspects, and important references. It is an attempt to promote the rational, safe and appropriate use of herbal medicines and mainstreaming of traditionally used herbal remedies. This manual can be used by health planners, policy makers, national and district health authorities and others involved in the health sector development and reform. It is also an attempt to increase availability and accessibility to cost-effective treatment of commonly encountered health problems with herbal remedies. It will be useful for education and training of community health workers as well. These efforts would eventually promote 'health for all' in the context of primary health care. ISBN 978 92 9022 382 5 World Health House Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110002, India Website: www.searo.who.int 9 789290 223825 Captions for photographs in the front cover: Upper row, Left to Right: Pods of Elettaria cardamomum Linn. and Holarrhena antidysenterica Roxb. ex Flem. Lower row, Left to Right: Fruits of Phyllanthus emblica Linn. and Terminalia chebula Retz. Traditional Herbal Remedies for Primary Health Care WHO Library Cataloguing-in-Publication data World Health Organization, Regional Office for South-East Asia. Traditional Herbal Remedies for Primary Health Care. 1. Medicine, Herbal. 2. Medicine, Traditional. 3. Complementary Therapies. 4. Plants, Medicinal. 5. Primary Health Care. ISBN 978-92-9022-382-5 (NLM classification: WB 925) © World Health Organization 2010 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from Publishing and Sales, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication does not necessarily represent the decisions or policies of the World Health Organization. Printed in India  iii Contents Acknowledgements.................................................................. v Glossary................................................................................ vii Foreword.............................................................................. viii 1. Acidity and gastritis Amalaki powder................................ 1 2. Common cold Trikatu powder................................. 7 3. Conjunctivitis Daruharidra decoction.......................13 4. Constipation Haritaki powder...............................17 5. Cough Pippali powder.................................23 6. Diarrhoea Kutaja powder.................................31 7. Earache Lashuna oil......................................37 8. Eczema Shirisha powder...............................43 9. Eye discharge Triphala decoction............................49 10. Fever Kiratatikta powder............................55 11. Fungal dermatosis Karanja powder...............................61 12. Headache Pippalimoola powder.........................67 13. Indigestion Chaturbhadra decoction....................71 14. Jaundice Katuka powder.................................79 Traditional Herbal Remedies for Primary Health Care iv 15. Joint Pain Ajamoda powder..............................85 16. Leucorrhoea Lodhra powder.................................91 17. Lice Infestation Dhattura paste.................................97 18. Malaise Ashvagandha powder......................105 19. Painful menstruation Shatpushpa powder........................111 20. Parasitic infestation Palasha powder..............................117 21. Piles (haemorrhoids) Surana powder..............................125 22. Scabies Gandhaka ointment........................129 23. Sexual dysfunction Kapikacchu powder.........................135 24. Sprain Haridra powder and paste...............141 25. Toothache Lavanga oil....................................147 26. Urinary disorder Gokshura powder...........................151 27. Vomiting Ela powder....................................157 28. Wound Haridra powder..............................163  v Acknowledgements The World Health Organization gratefully acknowledges the active participation and technical contributions of various collaborators in the preparation of this publication. These include: Editors: Dr D.C. Katoch, National Consultant (Traditional Medicine & Homeopathy), WHO Country Office for India and Dr K. Shein, Traditional Medicine Programme, WHO Regional Office for South-East Asia, New Delhi. Project Operational Officers: Prof. M.S. Baghel and Dr A. B. Thakar, Institute of Postgraduate Teaching & Research in Ayurveda (IPGTRA), Jamnagar (Gujarat). Experts for Technical Review and Finalization of Monographs: Prof. Gurdip Singh, Hassan (Karnataka); Prof. E. Surendran, Kottakal (Kerala); Prof. R.R. Dwivedi, Jamnagar (Gujarat); Prof H.M. Chandola, Jamnagar (Gujarat); Prof. B.L. Mehra, Paprola (Himachal Pradesh); Dr A. B. Thakar, Jamnagar (Gujarat); Dr (Mrs.) Surinder Katoch, New Delhi; Dr Shilpa Donga, Jamnagar (Gujarat); Dr Mandeep Kaur, Jamnagar (Gujarat); Dr P.K. Debnath, Kolkata (West Bengal); Dr A.B. Dey, New Delhi; Dr K. Shein (Traditional Medicine Programme, WHO Regional Office for South-East Asia, New Delhi; and Dr D. C. Katoch, WHO Country Office for India, New Delhi. Contributors for Monographs Development: Dr D.C. Katoch, WHO Country Office for India, New Delhi and Dr A. B. Thakar, Prof. K.S. Dhiman, Dr R. Manjusha, Dr R.N. Acharya, Dr S.K. Gupta, Dr H.A. Vyas, Dr B.R. Patel, Dr Shilpa Donga, Dr D.B. Vaghela, Dr Galib, Dr Darshana Pandya, Dr V.K. Kori, Dr T.S. Doodhamal, Dr Mandeep Kaur and Dr Rajgopal Bhatt from IPGTRA, Jamnagar. Traditional Herbal Remedies for Primary Health Care vi For Photographs: Institute of Postgraduate Teaching & Research in Ayurveda, Jamnagar; National Medicinal Plants Board, New Delhi; State Medicinal Plants Garden (State Medicinal Plants Board), Nadia (West Bengal); Ramakrishna Mission Herbal Garden Unit, Kolkata; Foundation for Revitalization of Local Health Traditions, Bangalore; Dr Sanjeev Lale, Indore; Dr T.K. Biswas, Kolkata; Dr A.K. Mitra, Kolkata; Dr P.K. Debnath, Kolkata; Mr B. Pramanik; Kolkata; Dr P.M. Varrier, Kottakal; Dr Y.K. Sharma, Paprola; Dr G.V.R. Joseph, New Delhi; and Dr A. Saraswathy, Chennai. Facilitation and guidance: Mr Sunil Nandraj, National Professional Officer (Health Systems Development), WHO Country Office for India, New Delhi. The WHO Regional Office for South-East Asia is also grateful to all other contributors in the preparation and publication of these monographs.  vii Glossary Churna Fine powder of the medicine. Ghrita Ghrita or Ghee is obtained by heating butter at high temperature and it is almost anhydrous milk fat. Kvatha Kvatha is a liquid prepared by boiling a herbal drug in water till one fourth of water remains and filtered. Lepa Local application of paste of the medicine. Malahara Semisolid preparation containing a medicine for external application. Taila Oil extracted from seeds of the plants. Traditional Herbal Remedies for Primary Health Care viii Foreword Traditional systems of medicines, including herbal medicines, have been used for many centuries for health care by people in countries of the South-East Asia Region as well as in other parts of the world. Traditional medicine continues to be a valuable source of remedies that have been used by millions of people around the world to secure their health. It has been developed from empirical experiences and from observations made by people who use them. It embodies age-old wisdom and knowledge accrued over thousands of years, and forms an integral part of the social and cultural heritage of peoples and countries. The system has been inherited and handed down from one generation to the next by custom and tradition. Since the concept of “Health for All” through primary health care (PHC) was launched at the International Conference on Primary Health Care at Alma-Ata in 1978, there has been a global movement to realize universal health-care coverage. However, in spite of advances made in the health sector, equitable health care coverage; availability, accessibility and affordability to conventional health care and services are quite often beyond the reach of people who are indigent, marginalized and underserved. Moreover, the present upsurge in the use of traditional medicines or complementary and alternative medicine – generated after the Alma-Ata International Conference – has become a global phenomenon. This development portends well for a more comprehensive health care delivery and health sector reform in facing new challenges in PHC due to demographic, economic, environmental, and social changes that have a negative impact on health development.  ix The revitalization of primary health care in 2008 was yet another clarion call for governments, all health and development workers and the world community to protect and promote the health of all people. In these efforts, the rich resources of traditional and herbal remedies are available and accessible to all who choose to use them – by tradition or cultural acceptance in the far and remote corners of countries or by choice of those in the affluent urban communities where there is a desire to return to nature and to use natural remedies in taking care of their own health. The global health scenario is facing new challenges due to global warming and economic down-turn that are now threatening health development. It is therefore crucial that all systems of medicine – whether conventional or traditional – in so far as they are beneficial and not deleterious to the health and well-being of the people must play their respective roles in promoting health, in preventing disease, in curing the sick, and in rehabilitating the infirm. It is through these concerted efforts that tangible gains can be achieved. It is envisaged that this publication will be instrumental in revitalizing primary health care in empowering community participation in self-care, in promoting the application of appropriate technology that is socially and culturally acceptable to the people, in making the health system more people-centered, and in improving equitable access to national health systems. Dr Samlee Pliangbangchang Regional Director Traditional Herbal Remedies for Primary Health Care  1 1 Amalaki powder for acidity and gastritis Heartburn is due to excessive secretion of gastric acid or its reflux to the food pipe along with delayed gastric emptying and fermentation of food. Gastric acidity and inflammation of the stomach is called gastritis, which produces a common symptom of burning sensation in the middle part of the upper half of the abdomen, while acid reflux causes throat and heartburn and delayed gastric emptying with fermentation leads to gaseous distension of abdomen and belching. These abnormalities lead to symptoms like nausea, loss of appetite, indigestion and mild to moderate upper abdominal pain and distress. Frequent dietary irregularities and ingestion of irritant materials like too spicy and sour foods, alcohol and analgesic drugs like aspirin are the common causes of acidity and gastritis. Mental stress significantly aggravates the symptoms of acidity and gastritis. Ayurveda designates the symptom complex of acid peptic disease as Amlapitta attributed to the impairment of digestive juices and protective lining of stomach. Improperly treated acidity may lead to peptic ulcer due to damage in the mucosal lining of the stomach and duodenum. Judicious use of Amalaki powder is effective in successful management of acidity and gastritis with certain do’s and dont’s described in the Ayurvedic texts: (1) It is advisable not to overeat and have long gaps between meals. Small frequent meals of soft and easily digestible food items should be taken. (2) Consumption of raw and leafy vegetables, fried, spicy, sour, salty, heavy and improperly cooked food, sheep’s milk, alcohol, curd, sesame seeds should be avoided. Traditional Herbal Remedies for Primary Health Care 2 (3) Use of vegetables with bitter taste such as bitter gourd, banana flowers, and pumpkin, pomegranate, honey, boiled and cooled water and food grains like wheat, rice and barley is beneficial in patients with acidity and gastritis. (4) Suppression of natural urges, particularly of vomiting and passing stools should be avoided. Amalaki (Phyllanthus emblica Linn.) The formulation is made from the dried mature fruits of Amalaki, which is a small or medium-sized tree found abundantly in mixed deciduous forests and cultivated in gardens and home yards. Ripe fruits are collected in late winter or early summer and are dried in shade. Dried fruits are then separated from the seeds and are kept in airtight plastic bags or boxes under dry storage conditions. Extensive uses of Amalaki as medicine and tonic are described in Indian Medicine and the medicinal plant is included in the Ayurvedic Pharamacopoeia of India1. Composition: The formulation is a fine powder made of single herbal ingredient Amalaki. English name Indian gooseberry Latin name Phyllanthus emblica (Linn.) Family Phyllanthaceae Plant part used Fruit A leafy branch of Amalaki with fruits. Dried fruits of Amalaki. Main chemical constituents2: Vitamin C, minerals and amino- acids.  3 Quality standards3 Purity and strength of dried mature fruits of Amalaki is determined on the basis of: Foreign matter Not more than 3% Total ash Not more than 7% Acid insoluble ash Not more than 2% Acid-soluble extractive Not less than 40% Water-soluble extractive Not less than 50% Method of preparation (1) Seedless dried fruits of Amalaki are cleaned and ground into fine powder using a grinder or pulverizer. (2) Powder is sieved through mesh 80 to remove coarse particles and fibers. (3) The powder should be kept in a dry airtight container to prevent exposure to moisture. (4) Potency of the properly preserved dried fruits lasts for one year. Dosage form: Fine, sour-tasting grayish to blackish powder. Therapeutic properties4: Antacid, anti-ulcer, anti-emetic, anti- inflammatory, antioxidant, immunomodulator, rejuvenator and a rich source of vitamin C. Dose and mode of administration In adults, the dose of Amalaki powder is 3 to 6 grams and in children 500 mg to 1 gram, twice a day, to be swallowed on an empty stomach or just before meals with water. Indications and uses (1) Hyperacidity, gastritis, anorexia, vomiting during pregnancy and anaemia associated with chronic acid peptic disease are the common indications for Amalaki powder. (2) Clinical trials have proven Amalaki to be effective in the management of acidic gastritis, non-ulcer dyspepsia and duodenal ulcer with significant prevention of recurrence of symptoms. (3) Amalaki powder can also be used as a natural supplement of vitamin C in nutritional deficiencies, pregnancy and chronic diseases. Traditional Herbal Remedies for Primary Health Care 4 Precautions and safety aspects (1) Amalaki powder is generally a safe medicine. No toxic or adverse effects are reported even with continuous use. Assay study for cellular toxicity of crude alcoholic extract of Amalaki has proved it safe. Safety of Emblica officinalis is attributed to its anti-mutagenic, anti-microbial, anti-inflammatory, anti- carcinogenic, anti-oxidant, anti-tumour and immuno-modulatory activities and numerous indications for its use in children and pregnant women. It is also safe to the baby if the nursing mother is taking this medication. (2) Individuals sensitive to sour taste should add sugar to the formulation or consume it in capsule form. Mixing it in warm water or with sugar or honey makes ingestion of Amalaki powder easy. (3) Amalaki has a cooling property and hence individuals intolerant to cold should consume it with ginger powder and warm water or honey. Even then if symptoms worsen, medication with Amalaki powder may be stopped. (4) It is advisable for patients of acidity and gastritis to avoid the intake of spicy, hard, heavy, dry and raw foods, particularly leafy vegetables and salad. Tendency of overeating and frequent munching and use of alcoholic beverages should be avoided. References (1) The Ayurvedic Pharmacopoeia of India. Ministry of Health & Family Welfare, Department of Indian Systems of Medicine & Homeopathy, New Delhi, India, Reprinted Edition, 2001 Part I, Vol. I, p. 5-6. (2) Sharma PC, Yelne MB & Dennis TJ. Database on Medicinal Plants Used in Ayurveda, Central Council for Research in Ayurveda & Siddha, New Delhi, 2001, Vol. 3, p. 14. (3) The Ayurvedic Pharmacopoeia of India. Ministry of Health & Family Welfare, Department of Indian Systems of Medicine & Homeopathy, New Delhi, India, Reprinted Edition, 2001, Part I, Vol. I, p. 5. (4) Sharma PC, Yelne MB & Dennis TJ. Database on Medicinal Plants Used in Ayurveda, Central Council for Research in Ayurveda & Siddha, New Delhi, 2001, Vol. 3, p. 12, 14. Further reading (1) Kirtikar KR & Basu BD. Indian Medicinal Plants, reprinted edition. L.M. Basu, Allahabad, India, Vol. III. 1988. (2) Kurup PNV, Ramdas VNK & Joshi P. Hand Book of Medicinal Plants (revised and enlarged). Central Council for Research in Ayurveda and Siddha, New Delhi. 1979.  5 (3) Mathew SM, Rao SB, Nair GRS. Anti-ulcer activity of Amla extract. Int. Seminar on Recent Trends in Pharm. Sci., Ootacamund, Abstr. No. A 7. 1995. (4) Parvathavarthini S et al. Anti-ulcer activity of Emblica officinalis (Indian gooseberry). Proc. Int. Cong. “Ayurveda 2000”, Chennai, Tamil Nadu, India, 28-30 Jan. 2000. (5) Rastogi RP & Mehrotra BN. Compendium of Indian Medicinal Plants, reprinted edition. Publications and Information Directorate, Council of Scientific and Industrial Research, New Delhi, Vol. 1, 2 & 3. 1993. (6) Sharma PV. Dravyaguna Vijnana. Chaukhambha Bharati Academy, Varanasi, Vol. II. 1981. (7) Sharma PV. Classical Uses of Medicinal Plants. Chaukhambha Visvabharati, Varanasi, India. 1996. (8) Shastri AD. Bhaishajyaratnavali. Chaukhambha Sanskrit Sansthana, Varanasi, India. 1981. (9) Varma MD et al. Amalaki rasayana in the treatment of chronic peptic ulcer. J. Res. Indian Med. Yoga & Homeop., Vol. 12(4). 1977. Traditional Herbal Remedies for Primary Health Care  7 2 Trikatu powder for common cold Common cold or coryza is a common respiratory problem caused by a variety of viral infections; commonest among them is the influenza virus and its variants. Individuals show considerable variation in susceptibility and environmental exposure is a contributory factor. The word “cold” is a catch-all term that describes symptoms such as sneezing, wet nose, running nose, scratchy throat, heaviness in head, body ache, headache, indigestion, nausea, stomach ache, vomiting, diarrhoea and fever. Frequent attacks of cold are a reflection of a temporary dip in immunity that is most often caused by insufficient rest; too many rich foods, stress and exposure to cold and dampness can also precipitate its occurrence. Frequent colds can make the individual vulnerable to secondary lower respiratory tract infections. Early and consistent attention, along with adequate time for convalescence, keeps all colds from becoming problematic. Trikatu is a simple herbal preparation with which common cold can be managed successfully taking prescribed precautions: (1) Patients suffering from common cold should prevent direct exposure to cold wind, intake of heavy meals, drinking of cold water, suppression of natural urges of stools, urine and flatus, sleeping on the floor and during daytime. (2) Light meals with spicy, sour and salty taste, curd, garlic, frequent drinking of warm water, fresh radish, brinjal (eggplant), and hot soup of green gram are helpful in common cold. (3) Covering head with cap or any warm cloth, steam bath, head massage, gargles with warm water and avoidance of anger facilitate recovery from the common cold. Traditional Herbal Remedies for Primary Health Care 8 Trikatu powder Trikatu powder is a simple formulation made by mixing fine powders of three commonly used herbal drugs in equal quantity namely dry ginger (Shunthi), black pepper (Maricha) and long pepper (Pippali). Trikatu, literally means ‘three pungents,’ because all the three ingredients are predominantly of pungent taste. All the three are spices used commonly in the kitchen and traded widely from India since ancient times. Composition Trikatu powder consists of fine powder of three pungent drugs viz. Shunthi, Maricha and Pippali in equal proportion. Shunthi is the dried rhizome of ginger. Maricha is the dried fruit of black pepper and Pippali is the dried fruit of long pepper. English Name Latin Name Family Part used Name Zingiber officinale Shunthi Dry ginger Zingiberaceae Rhizome Rose. Maricha Black pepper Piper nigrum Linn. Piperaceae Fruit Pippali Long pepper Piper longum Linn. Piperaceae Fruit Dried rhizomes of Dried fruits of Maricha. Dried fruits of Pippali. Shunthi. Main chemical constituents of Shunthi1: Essential oil, pungent constituents (gingerol and shogoal), resinous matter and starch. Main chemical constituents of Maricha2: Alkaloids (piperine, chavicine, piperidine and piplartine) and essential oil. Main chemical constituents of Pippali3: Essential oil and alkaloids (piperine, sesamin and piplartine).  9 Quality standards Alcohol/ Water Water ethanol Foreign Ingredients Total ash soluble soluble soluble matter ash extractive extractive Shunthi4 Not more Not more Not less than Not less Not more than 6% than 4.5% than than 2% 1.7% 10% Maricha5 Not more Not more - - Not more than 6% than 1% than 2% (acid soluble ash) Pippali6 Not more Not more Not less than Not less Not more than 5% than 6% 12% than 11% than 2% (acid soluble ash) Method of preparation (1) Take 50 grams of each of the three ingredients, dry them further to remove the moisture for easy powdering. (2) Take an equal quantity of each drug of Trikatu and mix well in a dry container. (3) Grind the mixture in a grinder or pulverizer till fine powder is obtained. (4) Sieve the powder through 85 size mesh to remove the coarse fibers and other particles if any. (5) Keep Trikatu powder in an air-tight dry container of glass or food grade plastic; store in a dry cool place away from direct sunlight. It is good to use the powder within one year. Dosage form: Blackish-brown fine powder. Therapeutic properties: Anti-inflammatory, analgesic, expectorant, digestive, carminative. Dose and mode of administration Adult dose of Trikatu is 2 grams given three times a day preferably with warm milk or water or honey. In children the dose may be reduced according to the age and can be given in a dose of 125 mg to 500 mg thrice a day. Another way is – add Trikatu powder to one cup of milk, boil it for a few minutes and take it warm. Traditional Herbal Remedies for Primary Health Care 10 Indications and uses Trikatu is used in combination with honey to alleviate diseases such as colds, rhinitis, cough, breathlessness, asthma, dyspepsia and obesity7. It also improves the digestive power. Precautions and safety aspects (1) No side effect or toxic effect of Trikatu has been mentioned in the classical literature. Clinical studies have also shown no adverse effects in patients treated with recommended dose of Trikatu powder alone as well as in combination with other herbal preparations. (2) Since Trikatu powder is hot in nature, large dose should be avoided as the patient may complain of burning sensation, burning micturition, etc. In such conditions, the use should be stopped immediately and the patient should be advised to take cooling agents and milk in plenty till the complaints subside completely. (3) Take simple diet with warm, light, soft and liquid foods. Avoid cold drinks, cold juices, ice cream, spicy, oily and too dry foodstuff. Stay in a warm and well ventilated room. (4) Warm saline gargles, steam inhalation and fomentation help in relieving cold symptoms. (5) Medication with Trikatu is not advisable for pregnant women. However, it is safe for the baby if a nursing mother is taking this medication. References (1) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 104. (2) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. III. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 117. (3) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3 New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 474. (4) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 103. (5) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. III. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 116.  11 (6) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. IV. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 91. (7) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. 2nd revised English edition. Part I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2003. p. 110. Further reading (1) Pandey GS, ed. Bhavamishra. Bhavaprakasha Nighantu. Varanasi: Chaukhambha Bharati Academy, 1999. (2) Dhanukar SA, Karandikar SM. Evaluation of anti-allergic activity of piper longum. Indian Drugs. 21(9) 1984. (3) Sarin YK. Illustrated manual of herbal drugs used in Ayurveda. New Delhi: Council of Scientific and Industrial Research & Indian Council of Medical Research, 1996. (4) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. (5) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda & Siddha, 2002. (6) National Institute of Science Communication. The useful plants of India. New Delhi: Council of Scientific and Industrial Research, 2000. Traditional Herbal Remedies for Primary Health Care  13 3 Daruharidra decoction for conjunctivitis Inflammation of conjunctiva causing redness of the eye is conjunctivitis. Conjunctiva is a thin, transparent mucous membrane covering the under surface of the eye lids and it extends from the eye lids to cover the anterior part of the eyeball up to the margin of the cornea. Common symptoms of conjunctivitis are redness, itching, stickiness, foreign body sensation, irritation, watering from the eyes and sometimes intolerance to light. Vision is generally normal but a slight blurring may occur if excess secretions form a film over the cornea. Conjunctivitis may begin in one eye but often spreads to involve both eyes. Conjunctivitis is most commonly due to viral and sometimes bacterial infections. But it can also result from allergic reactions or from chemical irritants, air pollution, smoke, shampoos, dirt, swimming pool chlorine or noxious fumes. Rarely, underlying chronic inflammatory conditions can also cause a persistent conjunctivitis. The infectious form of conjunctivitis is very common in children and is highly contagious. Traditionally, home remedies have been successfully used for soothing inflamed eyes with uncomplicated symptoms, minor infections, or allergies. Treatment consists primarily of cleansing the eyes and preventing the condition from spreading. Daruharidra decoction is a popular traditional formulation mentioned in Ayurvedic texts for the management of uncomplicated conjunctivitis. Daruharidra (Berberis aristata D.C.) Daruharidra (Indian berberry) is a shrub or small tree, distributed in the temperate and subtropical parts of Asia, Europe and America. Traditional Herbal Remedies for Primary Health Care 14 Daruharidra has been in use (as eye drops/ointment) for centuries for prophylactic as well as curative purposes in common eye ailments like conjunctivitis. It is an important ingredient of many traditionally used formulations meant for local ophthalmic use, commonly as decoction and solidified water extract called Rasanjana. These drug forms are used orally, locally as well as for topical ocular preparation. Antimicrobial activity of B. aristata is well demonstrated against a variety of bacteria, fungi, protozoas, helminths, chlamydia and viruses. The alkaloid berberine is known to possess anti-microbial properties against gram positive and gram negative bacteria. Composition The formulation consists of the decoction or solidified water extract of the stem or root of Daruharidra (Berberis aristata D.C.) termed as Rasanjana. English name Indian berberry Latin name Berberis aristata D.C. Family Berberidaceae Part used Stem and root. Flowering shoot of Daruharidra. Roots of Daruharidra. Main chemical constituents1 Alkaloids like berberine, berbamine, aromoline, karachine, palmitine, oxyacanthine and oxyberberine.  15 Quality standards2: Foreign matter Not more than 2% Total ash Not more than 14% Acid-insoluble ash Not more than 5% Alcohol-soluble extractive Not less than 6% Water-soluble extractive Not less than 8% Method of preparation (1) Soak overnight 5 grams of coarse powder of Daruharidra in 100 ml of water. (2) Boil the mixture till half of the water remains and filter it. (3) Use the filtrate at room temperature to irrigate the inflamed eye(s). Dosage form: Yellowish coloured liquid. Therapeutic properties3 Anti-inflammatory, antimicrobial, anti-diarrhoeal, anti-trachoma activity, and antipyretic. Indications and uses Conjunctivitis, trachoma and eye infection resulting from Chlamydia trachomatis, and chronic ophthalmic inflammation. Dose and mode of administration (1) Patient is made to lie down on the back with the neck slightly extended. Daruharidra is poured on the eye as thin stream with undine or with syringe without injection needle or canula. This procedure can be repeated twice or thrice in a day depending upon the severity of the symptoms. (2) Generally the eye should be kept closed but in case of eye discharge, pulling the lids apart and irrigating the eye may be required. (3) In cases where redness and burning sensation in the eye are prominent, irrigating fluid should be cold. When pain and discharge are prominent, then lukewarm decoction should be used. (4) Daruharidra decoction can also be applied in the form of eye drops in conjunctivitis. For this purpose keep 2 ml of the filtered decoction mixed with equal quantity of pure honey in an eye dropper vial and use this mixture within 12 hours by instilling 1 to 2 drops in each affected eye 4 to 6 times a day at regular intervals. Traditional Herbal Remedies for Primary Health Care 16 Precaution and safety aspects (1) Decoction and eye drops solution must be prepared fresh daily and kept in a sterile vessel. (2) Infection can be easily transmitted by touching or rubbing your eyes, make an effort to avoid it. (3) Protect the eyes from dirt, sunlight, other irritating substances and from repeated rubbing. (4) Avoid the use of cosmetics while suffering from conjunctivitis. (5) Remove contact lens, if it is worn. (6) For cleansing and soothing the eyes dip a clean cloth in warm water, wring it out and place it on the eye till it becomes cool. Then apply another cloth in the same way. (7) Avoid prolonged work under artificial light and excessive use of the eyes. (8) If eye symptoms aggravate or are not relieved within two-three days, seek doctor’s advice for necessary treatment. (9) Strictly avoid sharing clothes, handkerchiefs and towels and wash such items separately. (10) On coming in contact with a person suffering from conjunctivitis, wash your hands with soap and water properly. References (1) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 1. New Delhi: Central Council for Research in Ayurveda & Siddha, 2000. p. 121. (2) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 34. (3) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 1. New Delhi: Central Council for Research in Ayurveda & Siddha, 2000. p. 120-123. Further reading (1) The Wealth of India. Raw materials. New Delhi: Public Information Department, Council of Scientific & Industrial Research, 1988. (2) Chunekar KC. Bhavaprakasha Nighantu. Varanasi: Chaukhambha Bharati Academy, 1982. (3) Sabnis Mukund. Chemistry and pharmacology of Ayurvedic medicinal plants. Varanasi: Chaukhambha Surabharati Prakashana, 2006. (4) Singhal GD, Sharma KR. Ophthalmic and otorhinolaryngological considerations in ancient Indian surgery. Allahabad: Singhal Publications, 1976. (5) Acharya JT. ed. Sushruta samhita. Varanasi: Chaukhamba Orientalia, 1980.  17 4 Haritaki powder for constipation Constipation is a common problem which usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation. Other expressions of constipation include passage of unduly dry and hard faeces, sluggish action of bowel, etc. It is important to note that it is virtually impossible to define what constitutes a “normal bowel movement” in terms of frequency. Generally, frequency of bowel evacuation varies from person to person. As per a person’s tendency, lifestyle and dietary habit, frequency of defecation of 1-2 per day to thrice a week is considered as normal bowel habit for that individual, unless it creates any discomfort or disturbs his routine life. The volume of stool passed differs greatly in different races. Unsatisfactory bowel evacuation is the chief condition for diagnosis of constipation. Some other symptoms which accompany or result from constipation are indigestion, flatulence, abdominal pain or discomfort, headache and sleeplessness. The retention of hard faecal masses may give rise to spurious diarrhoea and in extreme situations can lead to intestinal obstruction especially in frail and bed-ridden older individuals. Various causative factors for constipation are given below. (1) Irritable bowel syndrome (2) Related to diet factors: Too bland food, e.g. with low fibre residue Too dry and astringent food Inadequate fluid intake (3) Intake of hard water (4) Metabolic disease like hypothyroidism Traditional Herbal Remedies for Primary Health Care 18 (5) Obstructive diseases of lower gastrointestinal tract (6) Drugs: opium, iron, blood pressure medicines (7) Irregular bowel habit (8) Sedentary lifestyle (9) Depressive disorders (10) Old age (11) Suppression of natural urge of defecation In Ayurveda, various laxative drugs are mentioned to treat such conditions. Out of these Haritaki powder is a simple herbal laxative which is frequently used for treating constipation following certain lifestyle changes. Some do’s and don’ts given in the Ayurvedic texts are helpful in preventing constipation: (1) Persons suffering from constipation should not ignore defecation urge nor should they strain for a long time to pass out stools. (2) Drinking of warm water and milk improves intestinal movements and is beneficial in relieving constipation. (3) Much deviation from the normal timing of meals and quantity of food should be avoided. It is beneficial to take soft, digestible and semi-solid food. (4) Heavy and untimely meals, eating food before the digestion of earlier food, and intake of dry, astringent and cold foods hamper intestinal movements adding to constipation. (5) Regular walking, physical activity and deep breathing and certain edibles like, ginger, lemon, resins, dates, figs and almond oil help in alleviating constipation. Haritaki (Terminalia chebula Retz.) Haritaki powder is a simple formulation made of its dried ripe fruits. The plant is also named as Pathya, owing to its beneficial effect for the channels (patha) of the body. It is not only used for constipation but for various gastrointestinal and systemic problems. Scientific studies have established2,7 its stomachic, laxative and anti-flatulence actions1. Judicious use of Haritaki with necessary dietary and lifestyle changes can treat constipation successfully as well as improve the physiological status of the gut.  19 Composition Haritaki powder is fine powder of dried ripe fruits of Terminalia chebula. English name Chebulic myrobalan, Ink nut Latin name Terminalia chebula Retz. Family Combretaceae Part used Dried fruits without seeds A fruit-bearing branch of Haritaki tree. Dried fruits of Haritaki. Main chemical constituents2 Anthraquinone, glycoside, chebulinic acid, chebulagic acid. Quality standards3 Identity, purity and potency of Haritaki fruits for its oral use is estimated on the basis of the following physical constants: Foreign matter Not more than 1% Total ash Not more than 5% Acid insoluble ash Not more than 5% Alcohol soluble extractive Not less than 40% Water soluble extractive Not less than 60% Method of preparation (1) Take dried fruits of Haritaki, remove their seeds and dry them further in the shade avoiding direct sunlight. Fruits should not have been harvested more than six months ago. (2) Make fine powder in a grinder or pulverizer. Traditional Herbal Remedies for Primary Health Care 20 (3) Sieve the powder through 85 size mesh to remove coarse fibers and other particles. (4) Keep the powder in a dry and air tight plastic or glass container and consume it within six months or before the next rainy season, whichever is earlier. Dosage form Brownish fine powder. Therapeutic Properties4 Haritaki has laxative, carminative, digestive, antispasmodic, anthelmintic, anti-microbial, anti-stress and endurance promoting properties. Dose and mode of administration To achieve laxative action of Haritaki, adult dose of powder is 3 to 6 grams and for children, the dose of Haritaki is 500 mg to 1 gram, to be taken with lukewarm water once a day on an empty stomach. It is preferably taken early in the morning or minimum three hours after dinner. Indication and uses Haritaki is useful in constipation, haemorrhoids, stomatitis, hyperacidity and associated gastrointestinal disorders. Precautions and safety aspects (1) No side or toxic effect of Haritaki is reported in classics with its recommended dose. Clinical studies have also shown no adverse effect in patients treated with Haritaki alone or with formulations. (2) It should not be prescribed to pregnant women. It is safe for the baby if the nursing mother is taking this medication. (3) The astringent and dry property of Haritaki may induce nausea in sensitive individuals. This may be masked by consuming it in tablet form or by preparing its decoction and adding jaggery to it. (4) Dose of Haritaki as a laxative varies from person to person according to their constitution, digestive power and bowel habit. Administration of Haritaki should be stopped if the desired effect is not achieved.  21 (5) Sudden altered bowel habit, alternate diarrhoea and constipation or persistence of the constipation in spite of proper administration of Haritaki, are the signs of some serious pathological conditions inside the gut. Therefore, the underlying cause must be properly investigated and treatment should be taken under medical supervision only. (6) Too dry a diet should be avoided and a diet with higher fibre content and liquids is advisable for the patient. Regular and proper lifestyle plays an important role in keeping the gut healthy. References (1) Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda and Siddha, 2005. p. 283. (2) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 47. (3) Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda and Siddha, 2005. p. 284. (4) Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi, Central Council for Research in Ayurveda and Siddha, 2005. p. 283-284. Further reading (1) Chatterjee A, Pakrashi SC. The treatise on Indian medicinal plants. Vol. 5. New Delhi: National Institute of Science Communication, Council of Scientific and Industrial Research, 1997. (2) Chunekar KC. Bhavaprakasha Nighantu. Varanasi: Chaukhambha Bharati Academy, 1999. (3) Sharma PV. Dravyaguna vijnana. Vol. II. Varanasi: Chaukhambha Sanskrit Sansthana, 1981. (4) Sharma PV. Classical uses of medicinal plants. Varanasi: Chaukhambha Visvabharati Academy, 1996. (5) Shastri AD. Bhaishajyaratnavali. Varanasi: Chaukhambha Sanskrit Santhana, 1981. (6) Council of Scientific and Industrial Research, National Institute of Science Communication and Information Resources. The useful plants of India. New Delhi: National Institute of Science Communication, 2000. Traditional Herbal Remedies for Primary Health Care  23 5 Pippali powder for cough Cough is a reflex phenomenon characterized by a sudden, violent expulsion of air from the mouth, with or without sputum, after deep inspiration and closure of the glottis. This is the most frequent respiratory symptom. Coughing is an important way to keep the throat and airways clear. However, involuntary excessive coughing means there is an underlying cause that compels the person to cough. The cough may be dry or productive. In dry cough there is only explosive sound with no or little material coming out from the airways. Whereas a productive cough is one that brings up phlegm or sputum, at times mixed with pus or blood or both. Cough can be either acute or chronic. Acute cough usually appears suddenly, goes away within 2-3 weeks and is often due to common cold, flu, or sinus infection. Chronic cough lasts longer than 2 to 3 weeks and is a symptom mostly of respiratory tract disease. Besides respiratory infections namely tuberculosis, other common causes of cough include chronic tobacco smoking, naso-bronchial allergy, bronchial asthma, chronic bronchitis with or without airway obstruction, lung abscess, bronchiectasis and bronchogenic tumours, reflux disease of gastrointestinal system, air pollution, heart failure, valvular heart disease and certain medicines used for the treatment of high blood pressure. The diagnosis of the cause of cough is essential before definitive therapy is initiated. Painful cough in association with fever indicates respiratory tract infection. Intermittent, ineffectual and exhausting cough occurs in chronic bronchitis and bronchial asthma and it is generally worst at night or on waking. Cough may be loose and readily productive of sputum in bronchiectasis and early stages of bronchial cancer. Sputum Traditional Herbal Remedies for Primary Health Care 24 production may be a relatively late development in lung tuberculosis. Loud and harsh cough without explosive character called stridor is found in whooping cough and in the presence of laryngeal or tracheal obstruction. Cough usually aggravates with change in temperature or weather. The explosive character of normal cough is lost in laryngeal paralysis. A short troublesome cough of old people due to chronic bronchitis recurs every winter and it is called winter cough. Cough due to smoking is usually dry and irritating. Clinical and radiological evaluation is usually diagnostic in a large majority of cases. While definitive therapy may wait diagnosis, symptomatic treatment usually provides relief. Ayurveda considers Kasa (cough) as a disease for which a specific line of treatment and various remedies are prescribed. Simple herbal remedies such as Pippali can successfully treat uncomplicated cough, if patients observe the prescribed precautions along with medication. These are: (1) Exposure to fumes and dust, sudden change of temperature in the surrounding, dry and spicy foods, chilled water and food, leafy vegetables and heavy meals should be avoided. (2) Soft, hot and easily digestible meals, edibles like honey, small cardamom, fresh ginger, radish, meat soup, goat milk and resins help to control cough. (3) It is advisable to resort to sleeping during the day and not to suppress urges of stools, urination and belching. Cough symptom can be controlled easily with frequent drinks of warm water, mental relaxation and with less talking. Pippali (Piper longum Linn.) Pippali powder is a single-ingredient herbal formulation made from the fruits of long pepper, an aromatic climber with perennial woody roots. The fruits are harvested around January while still green and unripe, as they are most pungent at this stage and of high medicinal value. Harvested fruits are dried in the sun till they turn grey or blackish. Use of Pippali as a multipurpose drug is first documented in Charaka Samhita, where it is listed among Rasayana (rejuvenative and immuno-enhancer) drugs and largely mentioned for the treatment of cough, respiratory distress, gastro-intestinal disorders, pulmonary tuberculosis etc. Besides codified knowledge about its uses, Pippali is largely used as a home remedy and in folk medicine. Long pepper  25 is a commonly used spice in India and other Asian countries and its medicinal usage is quite popular, particularly for the treatment of common ailments of childhood. Regarded as a drug of choice for cough of different origins, Pippali powder is widely used by Ayurvedic practitioners in India not only for symptomatic control but also for the treatment of root causes of cough affecting the naso-respiratory, digestive and blood systems. This popular plant medicine is even indicated for naso-respiratory allergy and tuberculosis of lungs and for immunodeficiency conditions. Pippali is described in the Ayurvedic Pharmacopoeia1 and in formulations in Ayurvedic Formulary of India2. Being simple, the formulation can be easily prepared at home for personal use. Scientific studies have proven its bio-availability enhancing, liver protective and immuno-stimulatory actions3. Composition Pippali powder is made from dried fruits of Piper longum. English name Long pepper Latin name Piper longum Linn. Family Piperaceae Part used Fruits A twig with unripe fruits of Pippali. Dried fruits of Pippali. Main chemical constituents4 Essential oil and alkaloids – piperine, sesamin and piplartine. Traditional Herbal Remedies for Primary Health Care 26 Quality standards1 As per the Ayurvedic Pharmacopoeia of India, quality standards determining the identity, purity and strength of long pepper fruits are based on the following aspects: Foreign matter Not more than 2% Total ash Not more than 7% Acid insoluble ash Not more than 0.5% Acid-soluble extractive Not less than 5% Water-soluble extractive Not less than 7% Pepper powder under the microscope shows deep, moss-green colour, fragments of parenchyma, oval or elongated stone cells, oil globules and starch grains. Method of preparation (1) Dried long pepper fruits are cleaned and powdered in a grinder or mortar. (2) Powder is sieved through mesh of 85 size and kept in an air- tight plastic or glass container. (3) Exposure to moisture should be avoided. It is advisable to prepare at least 50 grams of powder at a time. Dosage form Blackish green powder with aromatic odour and pungent taste. Therapeutic properties5 Pippali powder has anti-inflammatory, anti-phlegmatic, decongestant, anti-spasmodic, expectorant, anti-allergic, appetizer, anthelmintic, immunostimulatory and tonic properties. Dose and mode of administration The adult dose of the formulation is 1 gram to 3 grams and the children’s dose is 125 mg to 250 mg, two or three times a day, mixed with honey or warm water. Honey is the best vehicle for consuming Pippali powder. Jaggery or liquorice root powder may be used in place of honey, if the cough is dry, irritating and persistent. Warm water should be taken after consuming the medicine to facilitate its swallowing and fast absorption.  27 Indications and uses (1) Pippali powder is indicated for acute and chronic cough due to common cold, pharyngitis, laryngitis, bronchitis, naso-respiratory catarrh, respiratory allergy, asthma and smoking. (2) Non-specific cough is adequately manageable with Pippali Churna. (3) The formulation is also effective in controlling symptoms associated with cough-like sneezing, hiccough, nasal discharge, fever, poor appetite, indigestion, etc. Precautions and safety aspects (1) Pippali is regarded as safe in recommended doses. Ayurvedic literature does not specifically mention any toxicity or adverse effects from the use of Sitopaladi powder like formulations, which include Pippali. However, long-term use of Pippali alone is not recommended in Charaka Samhita. Scientific studies have shown 750-800 mg/kg dose as LD-50 value of piperine in mice. (2) Do not consume Pippali powder without mixing properly with honey or warm water. (3) Fried and spicy foods, chilled drinks, curd, yogurt, smoking and exposure to cold should be avoided while suffering with cough. Frequent sipping of warm water helps a lot to facilitate the effect of the medicine in controlling cough whether dry or productive. (4) Patients with cough lasting over 10-15 days should take proper medical advice for exact diagnosis of underlying cause and for needful treatment. (5) Patients with diabetes mellitus and obesity should use the formulation without honey or jaggery. Similarly, sugar and jaggery should not be taken with Pippali for long-term use in overweight and obese individuals suffering from chronic cough. (6) The formulation could alleviate cough resulting from lung tuberculosis and tumour or cancer of respiratory tract, but it is not the remedy for these underlying conditions. (7) If the sputum is mixed with blood or frank blood is coughed out, do not attempt to treat cough with Pippali powder. Traditional Herbal Remedies for Primary Health Care 28 (8) Stop medication with Pippali powder, if symptoms aggravate and dryness of mouth, excessive thirst and burning sensation in the body and urine appear. (9) Owing to the hot and lubricating nature of Pippali, its excessive and long-term use is contraindicated in Ayurvedic literature. Ignorance about this fact may lead to untoward symptoms. (10) Individuals with heat-dominating temperament and body constitution and menstruating and pregnant women should be careful in observing any unwanted effects while consuming Pippali powder. In case of adverse effects medical advice should be sought promptly. (11) Proper medical advice should be taken, if cough accompanies difficulty in breathing, swelling of face or feet, high grade fever, expectoration with foul-smelling yellowish-green phlegm, blood in sputum, difficulty in lying down, night sweating and unintentional weight loss. (12) Pippali powder has a potent antifertility activity; therefore, it must be used with caution in the first trimester of pregnancy. Women planning for pregnancy should avoid use of Pippali powder. However, the baby is not harmed if a lactating mother is taking this medication. References (1) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. IV. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2004 p. 91-92. (2) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2000. p. 49-56. (3) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, New Delhi, 2001. p. 475. (4) Sharma PC. Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 474. (5) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 473, 475.  29 Further reading (1) Annamalai AR, Manavalan R. Effects of trikatu and its individuals components and piperine on gastrointestinal tract, trikatu. Indian Drugs. 27, 1990. (2) Dhanukar SA & Karandikar SM. Evaluation of anti-allergic activity of piper longum. Indian Drugs. 1984; 21: 377-83. (3) Dhanukar SA, Karandikar SM, Desai M. Efficacy of piper longum in childhood asthma. Indian Drugs. 21, 1984. (4) Warrier PK et al. Eds. Indian medicinal plants. Vol. IV. Madras: Orient Longman Ltd., 1997. (5) Kirtikar KR & Basu BD. Indian medicinal plants. Vol. III. Allahabad: LM Basu, 1988. (6) Kurup PNV, Ramadas VNK, Joshi P. Handbook of medicinal plants. New Delhi: Central Council for Research in Ayurveda and Siddha, 1979. (7) Pharmacological investigations of certain medicinal plants and compound formulations used in Ayurveda and Siddha. New Delhi: Central Council for Research in Ayurveda and Siddha, 1996. (8) Sharma PV. Classical uses of medicinal plants. Varanasi: Chaukhambha Visvabharati, 1996. (9) Sharma PV. Dravyaguna vijnana. Vol. II. Varanasi: Chaukhambha Bharati Academy, 2001. Traditional Herbal Remedies for Primary Health Care  31 6 Kutaja powder for diarrhoea Diarrhoea is defined as the passage of abnormally liquid or unformed stools at an increased frequency, and denotes a change in the usual bowel movement. It is a symptom of various disease conditions of the gastrointestinal system and is often considered as a disease itself. Diarrhoea can be acute and chronic as per its causes. Acute diarrhoea lasts for hours or days and the number of bowel movements usually exceeds three per day. The causes of acute diarrhoea can be infectious or non-infectious. The usual clinical features of acute infective diarrhoea are frequent stools, sometimes with blood and mucous, pain during passing stools, abdominal pain, vomiting and fever. Severe diarrhoea leads to dehydration, which manifests itself as apprehension, cold clammy skin, rapid pulse, deep and rapid respiration, inelastic skin, sunken eyeballs, dry tongue, scanty urine and low blood pressure. Untreated acute diarrhoea can be fatal. The non-infectious category of diarrhoea can be caused by drugs such as antibiotics, certain antidepressants, antacids, bronchodilators, chemotherapeutic agents, laxatives, non-steroidal anti-inflammatory drugs, etc., and spurious diarrhoea, which follows chronic constipation especially in older people and in association with psychological stress. Chronic diarrhoea lasts for weeks or months and may be either persistent or recurrent. The aetiology of chronic diarrhoea is usually related to structural and functional disorders of the gastrointestinal tract. The clinical features of chronic diarrhoea are either persistent or recurrent with intervening periods of normalcy or constipation. Stool volume may be large or small and may be watery, loose, bulky or frothy. Diarrhoea may be accompanied by abdominal pain Traditional Herbal Remedies for Primary Health Care 32 or discomfort and abdominal distension. Systemic symptoms such as fever, anorexia, weight loss, generalized weakness and malaise may also be present. Untreated chronic diarrhoea can lead to mal- absorption syndrome and malnutrition. It is always important to understand the underlying cause of diarrhoea so that the right treatment can be planned. However, uncomplicated diarrhoea due to indigestion and infection can be managed with Ayurvedic formulation such as Kutaja powder along with necessary dietary precautions. Kutaja [Holarrhena antidysenterica (Roxb. ex Flem.) Wall.] Kutaja powder is a simple formulation prepared from the stem bark of Holarrhena antidysenterica (Roxb. ex Flem.) Wall., a small to medium-sized tree, found throughout India. The stem bark is collected from 8-12 years old trees during the middle of rainy season (July to September) and again at the end of winter by hewing and peeling and separating it from the attached wood. The stem bark is bitter in taste and used in Ayurveda for the treatment of gastrointestinal disorders, particularly diarrhoea and dysentery. Most of the Ayurvedic formulations described in literature and various commercially marketed formulations for diarrhoea essentially contain Kutaja as one of their ingredients. Kutaja is mentioned in the Indian Ayurvedic Pharmacopeias1 as well as Formulary2. Apart from the preferred use of Kutaja in the treatment of diarrhoea, scientific studies have established its anti-protozoal, anti-giardia and anti- amoebic properties.3 Composition Kutaja powder is prepared from the stem bark of Kutaja. English name Kurchi, Tellicherry bark Latin name Holarrhena antidysenterica Roxb. ex Flem. Wall. Family Apocynaceae Parts used Stem bark  33 Leafy shoots with flowers of Kutaja. Dried stem bark of Kutaja. Main chemical constituents4 Conessine, conessemine, kurchine, kurchicine, etc. Quality standards5 Identity, purity and potency of Kutaja Churna for its oral use are estimated on the basis of the following physical constants: Foreign matter Not more than 2% Total ash Not more than 7% Acid insoluble ash Not more than 1% Alcohol (60%) soluble Not less than 18% extractive Water soluble extractive Not less than 10% Method of preparation (1) Take 50 grams of dried stem bark of Kutaja and further dry it in the shade to remove moisture for easy powdering. (2) Grind stem bark in a grinder or pulverizer till fine powder is obtained. (3) Filter the powder through 85 mesh to remove coarse particles and fibers. (4) The shelf life of the powder is four months but it can retain its potency for at least six months, if kept in an air tight container and protected from direct sunlight and heat. Traditional Herbal Remedies for Primary Health Care 34 Dosage form Bitter brownish powder. Therapeutic properties6 The bark of Kutaja has anti-diarrhoeal, constipating, astringent, anti- dysenteric, anthelmintic, carminative and digestive properties. Dose and mode of administration The adult dose of Kutaja powder is 3-5 g and for children 500 mg to 1 g, twice or thrice daily with warm water, before meals. Indication and uses Kutaja bark is useful in various kinds of diarrhoea and dysentery. Precautions and safety aspects (1) No side effect or toxic effect of Kutaja powder has been mentioned in the classical Ayurvedic literature. Clinical studies have also shown no adverse effects in patients treated with Kutaja powder within the recommended dose alone as well as in combination with other home remedies. Kutaja may cause distension of the abdomen after using for a few days. (2) As prolonged use of Kutaja powder may produce constipation, hence as soon as the diarrhoea is checked the dose of Kutaja powder should be tapered off. (3) A study on the side effects of Holarrhena antidysenterica in patients has revealed that it can lead to subjective symptoms as well as hypertension7. Hence hypertensive patients should take Kutaja powder under medical supervision. (4) Prolonged use of Kutaja powder during pregnancy should be done under medical supervision. However, it is safe for the baby if a nursing mother is taking this medication. References (1) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I, Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2001. p. 78-79. (2) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part-II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2000. p. 66.  35 (3) Sharma PC, Yelne MB,& Dennis TJ. Data base on medicinal plants used in Ayurveda. Vol. II. New Delhi: Central Council for Research in Ayurveda & Siddha, 2002. p. 349. (4) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopeia of India. Part I, Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2001. p. 79. (5) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopeia of India. Part I, Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2001. p. 78. (6) Sharma PC, Yelne MB, Dennis TJ. Data base on medicinal plants used in Ayurveda. Vol. II. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 348. (7) Sharma PC, Yelne MB & Dennis TJ. Data base on medicinal plants used in Ayurveda. Vol. II. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 350. Further reading (1) Bhattacharjee SK. Handbook of medicinal plants. Jaipur: Pointer Publishers, 1998. (2) Chopra RN, Chopra IC, Varma BS. Supplement to glossary of Indian medicinal plants. New Delhi: Publications and Information Directorate, Council of Scientific and Industrial Research, 1992. (3) Chunekar KC. Bhavaprakasha nighantu. Varanasi: Chaukhambha Bharati Academy, 1982. (4) Dinesh Chandra, Dixit SK, Sen PC, Joshi D. An experimental study of Kutajarishta with special reference to amoebiasis. Ancient Sci. Life. 1988; 8(2). (5) Warrier PK et al. Eds. Indian medicinal plants. Vol. III. Madras: Orient Longman Ltd., 1966. (6) Janot MM, Cavier R. Anthelmintic properties of conessine hydrochloride. Ann. Pharm. Franc. 1949; 7: 549-552; Chem. Abstr., 44(5), 1950. Traditional Herbal Remedies for Primary Health Care  37 7 Lashuna oil for earache Pain in the ear is a very uncomfortable symptom, which may be due to the local causes in the ear or may relate to external causes. The earache may increase on lying down due to increased blood supply to the ear in recumbent position. The general causes of earache are as follows: (1) Exposure to extreme cold weather. (2) Exposure to pressure changes during diving or swimming and air travel. (3) Picking or probing the ear canal. (4) Improper instrumentation during the examination or treatment of ear. (5) Exposure to very high-pitched sounds. (6) Injury to the head especially the temporal bone. (7) Entry of water into auditory canal during bathing. (8) Local bacterial or fungal infection such as furuncles and otomycosis. (9) Impacted wax. (10) Referred pain due to carious tooth, impacted molar, ulcerative lesions in the oral cavity and tongue, osteoarthritis of temporo- mandibular joint, tonsillitis, etc. The earache can also be functional, which needs to be carefully observed. Management of earache requires proper evaluation and treatment before complications develop. Ayurveda prescribes instillation of medicated oil and juice of certain medicinal plants in Traditional Herbal Remedies for Primary Health Care 38 the affected ear. One of the simple formulations for earache used in traditional medicine is mustard oil prepared with garlic. Lashuna (Allium sativum Linn.) Lashuna oil comprises of cloves of garlic heated in mustard oil. Both Lashuna and mustard oil are commonly used drugs almost in every Indian kitchen and are well known for their medicinal properties in the traditional medicine of the Asian region. Lashuna comprises of bulbs of Allium sativum Linn., a perennial bulbous plant, cultivated as an important condiment crop in India. It is mainly used for facial paralysis, lock-jaw, flatulence, colic, arthralgia and dental caries. The oil of Lashuna is used for skin rashes and as an ear drop1. Sarshapa consists of dried seeds of Brassica campestris Linn., an erect, stout, simple or branched, glaucous, annual herb, 50 to 60 cm tall, commonly cultivated in Bengal, Bihar and Punjab, also found occasionally in wastelands and fields. The oil of Sarshapa is also used in the form of gargle and is also applied with rock salt for dental caries.2 In addition, it is also used for massage for increasing muscular strength and enhancing the colour and complexion of skin. Composition Lashuna oil comprises of Lashuna and mustard oil. English Name Latin Name Family Part Used Name Lashuna Garlic Allium sativum Liliaceae Bulb Linn. Sarshapa Mustard Brassica Brassicaceae Seed (Oil) compestris Linn. Cultivated plants of garlic. Garlic bulbs.  39 Main chemical constituents (1) Lashuna3: Volatile oil containing allyl disulphide, diallyl disulphide and also allin, allicin, mucilage and albumin. (2) Sarshapa oil2: Fixed oil and the glycerides of palmitic, stearic, oleic, linoleic, linolenic, eicosenoic, etc. Quality standards Identity, purity and potency of Lashuna and Sarshapa are estimated on the basis of the following physical constants. Acid Alcohol Water Volatile Foreign Total Ingredient insoluble soluble soluble oil/Fixed matter ash ash extractives extractives oil Lashuna3 Not more Not more Not more Not less _ Not less than 2% than 4% than 1% than 2.5% than 0.1% Sarshapa4 Not more Not more Not more Not less Not less Not less than 2% than 5% than 0.5% than 8% than 16% than 35% Preparation of mustard oil with garlic (1) Take about 20 ml (4 teaspoonsful) of mustard oil in a vessel and add 5-6 pieces of peeled and slightly crushed fresh garlic cloves. (2) Put the mixture on a slow fire for about 5 -10 minutes till garlic becomes brown and stop further heating. (3) Filter the mixture through cotton cloth to obtain clear oil and keep it in a clean glass bottle. Dosage form Lukewarm, pungent, yellowish-brown oil. Dose and mode of administration (1) Instill medicated oil in the affected ear drop by drop by tilting the head to opposite side and retain it for about 30 minutes by plugging the ear with cotton swab. (2) Repeat the process for other ear if affected. (3) Instillation of oil in the ears can be done twice daily for 2-3 days. Therapeutic properties Fresh garlic is anti-inflammatory, anti-fungal, anti-bacterial1, 5 anti- viral, and anthelmintic. Traditional Herbal Remedies for Primary Health Care 40 Indication and use Earache. Precaution and safety aspects (1) Local application of Lashuna oil is traditionally considered to be safe, but application on inflammatory lesions may produce burning sensation or slight irritation. (2) While using the oil, it should neither be too hot nor too cold. (3) The oil instillation should be avoided if there is ear discharge. (4) If there is no relief within three days, seek medical advice. References (1) Billore KV et al. Data base on medicinal plants used in Ayurveda. Vol. VI. New Delhi: Central Council for Research in Ayurveda & Siddha, 2004. p. 158. (2) Lavekar GS et al. Data base on medicinal plants used in Ayurveda. Vol. VIII. New Delhi: Central Council for Research in Ayurveda & Siddha, 2007. p. 313. (3) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. III. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 109. (4) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India, Part I, Vol. III. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 193. (5) Lavekar GS et al. Data base on medicinal plants used in Ayurveda. Vol. VIII. New Delhi: Central Council for Research in Ayurveda & Siddha, 2007. p. 314. Further reading (1) Ahsan M, Islam SN. Garlic: a broad spectrum antibacterial agent effective against common pathogenic bacteria. Fitoterapia. 67(4), 1996. (2) Chopra RN, Nayar SL, Chopra LC. Glossary of Indian medicinal plants. New Delhi: Council of Scientific and Industrial Research, 2002. (3) Chunekar KC. Bhavaprakasha nighantu. Varanasi: Chaukhambha Bharati Academy, 1982. (4) Warrier PK et al. Eds. Indian medicinal plants. Vol. I. Madras: Orient Longman Ltd., 1994. (5) Nadkarni AK. K.M. Nadkarni’s Indian materia medica. Vol. 1. Bombay: Popular Prakashana, 1976. (6) Nagatsu A, Sugitani T, Mori Y, Okuyama H, Sakakibara J, Mizukami H. Antioxidants from grape (Brassica campestris viv. Japonica hara) oil cake. Nat. Prod. Res. 18(3), 2004.  41 (7) Rastogi RP, Mehrotra BN. Compendium of Indian medicinal plants (1960-1969). Vol. 1. Lucknow: Central Drug Research Institute, and New Delhi: Publications and Information Directorate, Council of Science and Industrial Research, 1993. (8) Rastogi RP, Mehrotra BN. Compendium of Indian medicinal plants (1970-1979). Vol. II. Lucknow: Central Drug Research Institute and New Delhi: Publications and Information Directorate, Council for Science and Industrial Research, 1993. (9) Sharma PV. Classical uses of medicinal plantsi: chaukhamba vishvabharati. Varanasi: Orient Publishers and Distributors, 1996. (10) Sharma PV. Dravyaguna-vijnana. Vol. II. Varanasi: Chaukhamba Sanskrit Bharati Academy, 1978. (11) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2000. Traditional Herbal Remedies for Primary Health Care  43 8 Shirisha powder for eczema Eczema is a term that denotes different types of allergic skin inflammation usually of chronic origin. The symptoms of eczema commonly include itching, reddened and dry skin. Since the skin is itchy, prolonged scratching leads to a leathery thickening of the skin. Cracking and weeping of the skin may also occur and open sores may become infected. Causes of eczema Though the causes of eczema have not been fully determined, the following list provides some insight as to the triggers for eczema: (1) Family history: there is a genetic component to this disease. (2) Irritants: exposure to industrial solvents, chemicals, vehicle lubricants, soaps, cement, detergents, cleaning products, rubber gloves and even cosmetic lotions and creams, etc. (3) Allergy: strong reactions to some allergens can cause violent skin eruptions. (4) Chronic dry skin: dry skin that is left un-moisturized can develop into eczema especially in cold weather. (5) Poor circulation: more common in the elderly and affecting lower limbs. (6) Obsessive compulsive disorder: habitually rubbing or scratching skin. (7) Reaction to an infection: some fungal, parasitic, bacterial and viral infections can cause localized eczema. (8) Stress: stress causes the immune system to be compromised causing increased susceptibility to skin conditions. Traditional Herbal Remedies for Primary Health Care 44 (9) Diet: some have found modification to diet extremely useful in maintaining remission periods. (10) Unknown factors: some forms of eczema are triggered by unknown reactions of the immune system. Though eczema is very difficult to control, allergic component of eczema can be controlled to an extent by regular internal and external use of Shirisha, which is widely mentioned in Ayurvedic classics and used in clinical practice at large by traditional practitioners. Some do’s and don’ts include: (1) Excessive intake of sour, salty and pungent foods and drinks, curd, milk, jaggery, sesame seeds, black gram and alcoholic beverages should be avoided. (2) If there is oozing from the eczema site, efforts should be made to keep the site clean and dry. Whereas in dry eczema it is always advisable to keep the affected area moist and smooth with vaseline or an oily preparation. (3) Avoidance of aggravating factors of eczema, and eating simple, soft, easily digestible food helps. Edible items of bitter taste; regular use of honey and peace of mind help in management of eczema. Shirisha (Albizzia lebbeck Benth.) Shirisha consists of the powder of the bark of Albizzia lebbeck, a large, deciduous tree, which is found all over India up to 900 meters in the Himalayas. It grows wild especially in the moist and dry deciduous forests. The bark of the tree is thick and dark or brownish grey with numerous short irregular cracks. The seeds are oval or oblong, pale brown, smooth with a hard testa. Shirisha is described as one of the best Vishaghna (anti-toxin) drugs in Ayurvedic texts1. Clinical studies show that Shirisha acts as an antidote to animal poisons which are histaminic in nature and are also responsible for the production of allergic dermatitis, urticaria and anaphylactic shock2. Composition Shirisha powder is prepared from its bark for oral use and decoction for washing the affected skin.  45 English name Siris tree, East Indian walnut, Kokko Latin name Albizzia lebbeck Benth. Family Fabaceae Plant part used Stem bark Leafy branches of a Dried stem bark of Shirisha. Shirisha tree. Main chemical constituents2 Condensed tannins and d-catechin, lebbecacidin, isomers of leucocyanidin, friedelin-3-one. Quality standards3 The Ayurvedic pharmacopoeia of India provides quality standards of Shirisha which are based on the following physical constants: Foreign matter Not more than 1% Total ash Not more than 8% Acid insoluble ash Not more than 1% Acid-soluble extractive Not less than 12% Water-soluble extractive Not less than 6% Method of preparation (1) The powder of the bark is prepared by grinding dried bark in a grinder or pulverizer and then filtering it through mesh size 85. (2) The powder should be kept in a dry container and stored in a moisture-free area. Properly kept powder holds its potency for 4-6 months. (3) For making decoction, coarse powder is used. (4) It is good to use the powder within four months of its preparation. Traditional Herbal Remedies for Primary Health Care 46 Dose and mode of administration (1) Shirisha bark powder is given orally to adults in a dose of 3 to 6 g and to children in a dose of 1 to 2 g twice daily after meals with lukewarm water. (2) The decoction is prepared by adding 16 times water to 10 g coarse powder of bark of Shirisha and then boiling on slow fire till about one fourth of water remains. The dose of the freshly prepared decoction is 40 ml twice a day after meals. For better relief add 5 g of turmeric powder in the decoction of Shirisha just before taking it. To mask the taste sugar may be added to the decoction. Fresh decoction is to be prepared for every dose. (3) The lesions may be washed with the decoction prepared from the bark of Shirisha. (4) The treatment may be continued for 3 to 4 weeks or till cure is achieved, if relief of the symptoms is sustained. (5) If the condition gets worse, seek doctor’s advice and check for allergic reactions. Dosage form Grayish-brown powder or warm dark brown liquid having bitter taste. Therapeutic properties2 Shirisha bark is anti-protozoal, anti-histaminic, anti-allergic, anti- fungal, analgesic, anti-anaphylactic, anti-bacterial, central nervous system depressant and bronchodilator. Indications and uses The bark is useful in allergic and chronic skin diseases including various kinds of eczema. Precaution and safety aspects (1) Clinical and experimental studies have indicated the absence of any serious toxicity if normal dose of Shirisha is used. (2) Its safety in pregnancy is not proven. Therefore, it must be used cautiously. However, it is safe for the baby if a nursing mother is taking this medication. (3) As it has mild spermicidal activity, its use in oligospermic persons should be avoided.  47 (4) The following measures can help to prevent and treat eczema (a) Moisturize your skin regularly. (b) Protect skin from strong winds. (c) Protect skin from temperature extremes (hot or cold). (d) Keep the area clean especially if skin cracks. (e) Keep bathing and shower times short. (f) Keep your diet healthy and add vitamins. (g) Use medications strictly as directed. (h) Try to reduce stress. (i) Do not vigorously scratch or irritate skin. (j) Do not bathe with hot water. (k) Do not expose skin to harsh chemicals, solvents, vehicle lubricants, etc. (l) Do not wear woolen clothing. (m) Avoid wearing tight fitting clothing especially made of synthetic fibers. (n) Do not apply hydrocortisone creams without medical advice for long periods. References (1) Shastri KN et al. Charaka samhita commentary. Sootrasthana 25, 40. Varanasi: Chaukhambha Bharati Academy, 2005. p. 468. (2) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 1. New Delhi: Central Council for Research in Ayurveda and Siddha. 2002. p. 447. (3) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. III. New Delhi: Department of Indian Systems of Medicine & Homeopathy. 2001. p. 202. Further reading (1) Chatterjee A, Prakashi SC. The treatise on Indian medicinal plants. Vol. 2. New Delhi: Publications and Information Directorate, Council of Science and Industrial Research, 1992. (2) Chopra RN et al. Glossary of Indian medicinal plants. New Delhi: Publications and Information Directorate, Council of Science and Industrial Research, 1956. (3) Chunekar KC. Bhavaprakasha nighantu. Varanasi: Chaukhambha Bharati Academy, 1982. Traditional Herbal Remedies for Primary Health Care 48 (4) Ganguli NB, Bhatt EM. Mode of action of active principles from stem bark of Albizzia lebbeck (L.) Benth. Indian Journal of Exptl. Biol. 31(2), 1993. (5) Warrier, PK et al. Eds. Indian medicinal plants. Vol. 1. Madras: Orient Longman Ltd., 1994. (6) Indian Council of Medical Research. Medicinal plants of India. Vol. I. New Delhi: ICMR, 1976. (7) Mitra Roma. Bibliography on pharmcognosy of medicinal plants. Lucknow: National Botanical Research Institute, 1985. (8) India, Ministry of Health and Family Welfare. Pharmacological investigations of certain medicinal plants and compound formulations used in Ayurveda and Siddha New Delhi: Central Council of Research in Ayurveda and Siddha, 1996. (9) India, Ministry of Health and Family Welfare. Phytochemical investigations of certain medicinal plants used in Ayurveda. New Delhi: Central Council of Research in Ayurveda and Siddha, 1990. (10) Sharma AD. Bhaishajyaratnavali, chaukhambha. Varanasi: Sanskrit Sansthana, 1981. (11) Council of Scientific and Industrial Research. The Wealth of India: raw materials. Vol. I, A (Rev.). New Delhi: CSIR, 1985. (12) Tripathi P. Steriodgenic effect of Albizzia lebbeck Benth. in Guinea pigs. Ancient Science of Life. 2(3), 1983. (13) Tripathi RM, Sen PC, Das PK. Studies on mechanism of action of Albizzia lebbeck, an Indian indigenous drug in the treatment of atopic allergy. Journal of Ethnopharmacology. I(4), 1979. (14) Tripathi RM, Sen PC, Das PK. Further studies on the mechanism of anti-anaphylactic action of Albizzia lebbeck, an Indian indigenous drug. Journal of Ethnopharmacology. I(4), 1979.  49 9 Triphala decoction for eye discharge Liquid discharge from the eye other than tears, with or without burning and itching, is found in many eye conditions and can also be due to environmental pollutants. Mostly, eye discharge is a common symptom in the inflammatory and allergic conditions of the eye. In viral conjunctivitis, the eye becomes red or bloodshot and irritation causes discharge but this condition does not last more than 10 days or so, if uncomplicated and proper hygienic care is taken. Bacterial conjunctivitis is not common, but when it develops as thick eye discharge of white, yellow or greenish colour; it is advisable to seek medical advice. Cigarette smoke, chlorine in swimming pool water and chemicals in make-up materials are some of the uncommon causes of eye discharge. In such cases, eye discharge and other associated symptoms appear on contact with the irritant and do not last long. Specific medication is not required but the cause of eye irritation should be avoided. Thin watery discharge coupled with itching and burning in the eyes is due to allergy and it is sometimes very uncomfortable. This condition necessitates determination of the cause of allergy. For eye discharge, the simple principle of treatment recommended in Ayurvedic literature is to avoid the causative factor and palliate the symptom with medicines having antagonistic properties. Triphala decoction is one such medicine which is widely popular and considered to be quite effective in alleviating various eye symptoms including discharge, inflammation and irritation. Traditional Herbal Remedies for Primary Health Care 50 Triphala decoction Fruits of three myrobalans are collectively designated as Triphala in Ayurveda, meaning the three specific fruits put together. This formulation is included in the Ayurvedic Formulary of India1 and the ingredients are described in Ayurvedic pharmacopoeia2. It finds vivid description in Ayurveda literature and is frequently used by practitioners inter alia in the treatment of eye diseases, particularly conjunctivitis and vision disorders. Both Kvatha (decoction) and Churna (powder) of Triphala are indicated respectively for external and internal use in eye disorders. Triphala decoction is mainly used for washing inflamed eyes with purulent discharge or as eye drops in controlling conjunctivitis. Apart from providing relief in inflammation-induced eye symptoms with its decongestant, anti-inflammatory and soothing effects, instillation of Triphala decoction in eyes is proven to have prophylactic value for preventing viral conjunctivitis during epidemics. Composition Decoction of Triphala is prepared by boiling together in water the coarse powder of dried fruits of the following three medicinal plants.