Ascites Health Dictionary

An abnormal accumulation of ?uid beneath the skin, or in one or more of the cavities of the body.

Causes Oedema is not a disease, it is a sign – usually of underlying local or systemic disease. It may sometimes be visible as a swelling. Oedema occurs when the normal mechanisms for maintaining a balance between ?uid in the tissues and in the blood are upset. That balance depends mainly on the blood pressure that keeps the blood ?owing through the circulatory system – thus forcing ?uid out of the capillaries

– and the osmotic drawing force of the blood proteins which pulls water into the bloodstream. The KIDNEYS also have an essential role in maintaining this balance.

Among the disorders that may disturb this balance are heart failure, NEPHROTIC SYNDROME, kidney failure, CIRRHOSIS of the liver and a diet de?cient in protein. Injury may also cause oedema and ascites (?uid in the abdominal cavity) can occur as a result of cirrhosis of the liver or cancer in the abdominal organs.

Treatment The underlying cause of oedema should be treated and, if this is not feasible or e?ective, the excess ?uid should be excreted by boosting the output of the kidney. Restriction of sodium in the diet and the administration of DIURETICS are e?ective methods of achieving this.... oedema

Raised blood pressure in the PORTAL VEIN entering the LIVER. This results in increased pressure in the veins of the oesophagus and upper stomach and these grow in size to form varices – dilated tortuous veins. Sometimes these varices rupture, causing bleeding into the oesophagus. The raised pressure also causes ?uid to collect in the abdomen and form ASCITES. The commonest reason for portal hypertension is cirrhosis (?brosis) of the liver (see LIVER, DISEASES OF). THROMBOSIS in the portal vein may also be a cause. Treatment requires the cause to be tackled, but bleeding from ruptured vessels may be stopped by injecting a sclerosant or hardening solution into and around the veins. Sometimes a surgical shunt may be done to divert blood from the portal vein to another blood vessel.... portal hypertension

In?ammation of the PORTAL VEIN. A rare but serious disorder, it usually results from the spread of infection within the abdomen – for example, appendicitis. The patient may develop liver abscesses and ASCITES. Treatment is by ANTIBIOTICS and surgery.... pylephlebitis

Croton tiglium

Euphorbiaceae

San: Jepalah, Dantibijah

Hin: Jamalgota

Ben: Jaypal Mal: Nirvalam

Tam: Nervalam, Sevalamkottai

Tel: Nepala

Importance: Purging croton or croton oil plant, a small evergreen tree with separate male and female flowers, is one among the seven poisons described in Ayurveda. The drug is well known for its drastic purgative property. The drug is found to be useful in ascites, anasarca, cold, cough, asthma, constipation, calculus, dropsy, fever and enlargement of the abdominal viscera. The seed paste is a good application for skin diseases, painful swellings and alopacia. The seed-oil is useful in chronic bronchitis, laryngeal affections, arthritis and lock jaw. Misraka-sneham is an important preparation using the drug (Nadkarni, 1954; Dey, 1980; Sharma, 1983).

Distribution: It is distributed throughout North India. It is cultivated in Assam, West Bengal and South India.

Botany: Croton tiglium Linn. belongs to the family Euphorbiaceae. It is a small evergreen tree, 4.5-6.0m in height with ash coloured smooth bark and young shoots sprinkled with stellate hairs. Leaves are oblong to ovate-lanceolate, obtuse or rounded at the 2-glanded box, acuminate, membraneous, yellowish green and minutely toothed. Flowers are small, unisexual, males on slender pedicels, females larger and on short thick pedicels. Fruits are ovoid or oblong trigonous capsules. Seeds are smooth, testa black and enclosing reddish brown oily endosperm (Warrier et al,1994). Other species belonging to the genus Croton are as follows:

C. aromaticus Linn. C. caudatus Geisel C. jouera Roxb.

C. malabaricus Bedd.

C. oblongifolius Roxb.

C. polyandrus Roxb. syn. Baliospermum montanum Muell-Arg.

C. reticulatus(Chopra et al, 1980)

Agrotechnology: The plant is propagated by seeds. Seeds are to be sown on seedbeds and about 2 months old seedlings are used for transplanting. Pits of size 50cm cube are to be taken at 3m spacing and filled with dried cowdung, sand and topsoil and formed into a mound. The seedlings are to be planted on these mounds. Irrigation during summer months is beneficial. Application of organic manure after every 6 months is desirable. Weeding is to be carried out one month after transplanting. The plant is not attacked by any serious pests or diseases. Fruits are formed at the end of first year. Fruits when ripen and start to crack are to be collected, dried in sun, then the outer shell is removed and again dried for one day before marketing (Prasad et al,1997).

Properties and activity: Oil contains phorbol myristate acetate (Husain et al, 1992). Seeds contain upto 20% protein and 30-50% lipids. Iso-guanine-D-ribose (crotoniside) and saccharose were isolated from the seeds. In fractionation of croton oil, liquid-liquid distribution procedures proved to be the separation tools of choice. The per hydrogenated parent hydrocarbon of phorbol is a perhydrocyclopropabenzulene called tigliane and phorbol is 1, 1a , 1b , 4, 4a, 7a , 7b, 8, 9, 9a-decahydro-4a , 7 , 9 , 9a - tetrahydroxy-3-(hydroxymethyl)-1, 1, 6, 8 tetramethyl-5-H-cyclopropa[3,4] benz [1.2-e]azulen-5- one. Phorbol, a tetracylic diterpene with a 5, 7, 6 and 3- membered ring has 6 oxygen functions. Phorbol accounts for 3.4% and 4- deoxy- 4 - phorbol for 0.29% of the weight of croton oil. Twenty- five phorbol-12, 13-diesters have been detected (Hecker et al, 1974). A toxin croton 1, mol. wt 72,000 has been isolated from the seeds (Lin et al, 1978).

Phorbol myristate acetate activates nitroblue tetrazolium reduction in human polymorphs. Seed and oil is purgative, rubefacient and anti-dote for snakebite. The seeds and oil are acrid, bitter, thermogenic, emollient, drastic purgative, digestive, carminative, anthelmintic, antiinflammatory, vermifuge, deterent, diaphoretic, expectorant, vesicant, irritant and rubefacient.... purging croton

A condition of the liver arising from long-term damage to its cells. In cirrhosis, bands of fibrosis (internal scarring) develop, leaving nodules of regenerating cells that are inadequately supplied with blood. Liver function is gradually impaired; the liver no longer effectively removes toxic substances from the blood (see liver failure). The distortion and fibrosis also lead to portal hypertension. The most common cause of cirrhosis is heavy alcohol consumption. Other causes include forms of hepatitis and, more rarely, disorders of the bile ducts, haemochromatosis, Wilson’s disease, cystic fibrosis, and heart failure.

Cirrhosis may go unrecognized until symptoms such as mild jaundice, oedema, and vomiting of blood develop. There may be enlargement of the liver and spleen and, in men, enlargement of the breasts and loss of body hair due to an imbalance in sex hormones caused by liver failure. Complications of cirrhosis include ascites, oesophageal varices, and hepatoma. Treatment is focused on slowing the rate at which liver cells are being damaged, if possible by treating the cause. In some cases, however, the condition progresses and a liver transplant may be considered.... cirrhosis

See under STOMACH, DISEASES OF; INTESTINE, DISEASES OF; DIARRHOEA; LIVER, DISEASES OF; PANCREAS, DISEASES OF; GALL-BLADDER, DISEASES OF; KIDNEYS, DISEASES OF; URINARY BLADDER, DISEASES OF; HERNIA; PERITONITIS; APPENDICITIS; TUMOUR.

Various processes that can occur include in?ammation, ulceration, infection or tumour. Abdominal disease may be of rapid onset, described as acute, or more long-term when it is termed chronic.

An ‘acute abdomen’ is most commonly caused by peritonitis – in?ammation of the membrane that lines the abdomen. If any structure in the abdomen gets in?amed, peritonitis may result. Causes include injury, in?ammation of the Fallopian tubes (SALPINGITIS), and intestinal disorders such as APPENDICITIS, CROHN’S DISEASE, DIVERTICULITIS or a perforated PEPTIC ULCER. Disorders of the GALLBLADDER or URINARY TRACT may also result in acute abdominal pain.

General symptoms of abdominal disease include:

Pain This is usually ill-de?ned but can be very unpleasant, and is termed visceral pain. Pain is initially felt near the mid line of the abdomen. Generally, abdominal pain felt high up in the mid line originates from the stomach and duodenum. Pain that is felt around the umbilicus arises from the small intestine, appendix and ?rst part of the large bowel, and low mid-line pain comes from the rest of the large bowel. If the diseased organ secondarily in?ames or infects the lining of the abdominal wall – the PERITONEUM – peritonitis occurs and the pain becomes more de?ned and quite severe, with local tenderness over the site of the diseased organ itself. Hence the pain of appendicitis begins as a vague mid-line pain, and only later moves over to the right iliac fossa, when the in?amed appendix has caused localised peritonitis. PERFORATION of one of the hollow organs in the abdomen – for example, a ruptured appendix or a gastric or duodenal ulcer (see STOMACH, DISEASES OF) eroding the wall of the gut – usually causes peritonitis with resulting severe pain.

The character of the pain is also important. It may be constant, as occurs in in?ammatory diseases and infections, or colicky (intermittent) as in intestinal obstruction.

Swelling The commonest cause of abdominal swelling in women is pregnancy. In disease, swelling may be due to the accumulation of trapped intestinal contents within the bowel, the presence of free ?uid (ascites) within the abdomen, or enlargement of one or more of the abdominal organs due to benign causes or tumour.

Constipation is the infrequent or incomplete passage of FAECES; sometimes only ?atus can be passed and, rarely, no bowel movements occur (see main entry for CONSTIPATION). It is often associated with abdominal swelling. In intestinal obstruction, the onset of symptoms is usually rapid with complete constipation and severe, colicky pain. In chronic constipation, the symptoms occur more gradually.

Nausea and vomiting may be due to irritation of the stomach, or to intestinal obstruction when it may be particularly foul and persistent. There are also important non-abdominal causes, such as in response to severe pain or motion sickness.

Diarrhoea is most commonly due to simple and self-limiting infection, such as food poisoning, but may also indicate serious disease, especially if it is persistent or contains blood (see main entry for DIARRHOEA).

Jaundice is a yellow discoloration of the skin and eyes, and may be due to disease in the liver or bile ducts (see main entry for JAUNDICE).

Diagnosis and treatment Abdominal diseases are often di?cult to diagnose because of the multiplicity of the organs contained within the abdomen, their inconstant position and the vagueness of some of the symptoms. Correct diagnosis usually requires experience, often supplemented by specialised investigations such as ULTRASOUND. For this reason sufferers should obtain medical advice at an early stage, particularly if the symptoms are severe, persistent, recurrent, or resistant to simple remedies.... abdomen, diseases of

Linn.

Synonym: A. acuminata Wall. ex Royle

Family: Ranunculaceae.

Habitat: Native to Europe; grows in temperate Himalayas from Hazara to Bhutan.

English: Baneberry Grapewort.

Folk: Visha-phale (Kannada).

Action: Root—antirheumatic, anti-inflammatory, nerve sedative, emetic, purgative; used in the treatment of rheumatic fever, lumbago, scrofula, nervous disorders, chorea.

The plant is reported to contain trans-aconitic acid, which shows a strong cytostatic action. Its Me ether is active against Ehrlich's ascites tumours.

In folk medicine, roots are used in cases of ovarian neuralgia, uterine tenderness and sub-involution. They are adulterant of the roots of Helleborus niger. Berries are poisonous; used topically for skin diseases. The toxic constituent is protoanemonin (lactone). It is irritant to mucous membrane.... actaea spicata

Cucurbitaceae

The family Cucurbitaceae includes a large group of plants which are medicinally valuable. The important genera belonging to the family are Trichosanthes, Lagenaria, Luffa, Benincasa, Momordica, Cucumis, Citrullus, Cucurbita, Bryonopsis and Corallocarpus. The medicinally valuable species of these genera are discussed below.

1. Trichosanthes dioica Roxb.

Eng: Wild Snake-gourd; San: Meki,Pargavi, Parvara, Patola;

Hin: Palval, Parvar

Ben: Potol;

Mal: Kattupatavalam, Patolam;

Tam: Kombuppudalai;

Tel: Kommupotta

Wild snake-gourd is a slender-stemmed, extensively climbing, more or less scabrous and woolly herb found throughout the plains of N. India, extending to Assam and W. Bengal. Tendrils are 2-4 fid. Leaves are 7.5x5cm in size, ovate-oblong, cordate, acute, sinuate- dentate, not lobed, rigid, rough on both surface and with a petiole of 2cm. Flowers are unisexual. Male flowers are not racemed but woolly outside. Calyx tube is 4.5cm long, narrow, teeth linear and erect. Anthers are free. Fruit is 5.9cm long, oblong or nearly spherical, acute, smooth and orange-red when ripe. Seeds are half-ellipsoid, compressed and corrugated on the margin (Kirtikar and Basu, 1988). The unripe fruit of this is generally used as a culinary vegetable and is considered very wholesome and specially suited for the convalescent. The tender shoots are given in decoction with sugar to assist digestion. The seeds are useful for disorders of the stomach. The leaf juice is rubbed over the chest in liver congestion and over the whole body in intermittent fevers (Nadkarni, 1998). The fruit is used as a remedy for spermatorrhoea. The fresh juice of the unripe fruit is often used as a cooling and laxative adjunct to some alterative medicines. In bilious fever, a decoction of patola leaves and coriander in equal parts is given. The fruit in combination with other drugs is prescribed in snakebite and scorpion sting (Kirtikar and Basu, 1988).

Fruits contain free amino acids and 5-hydroxy tryptamine. Fatty acids from seeds comprise elaeostearic, linoelic, oleic and saturated acids. The aerial part is hypoglycaemic. Leaf and root is febrifuge. Root is hydragogue, cathartic and tonic. Unripe leaf and fruit is laxative (Husain et al, 1992). The plant is alterative and tonic. Leaves are anthelmintic. Flower is tonic and aphrodisiac. The ripe fruit is sour to sweet, tonic, aphrodisiac, expectorant and removes blood impurities.

The other important species belonging to the genus Trichosanthes are as follows.

T. palmata Roxb. T. cordata Roxb. T. nervifolia Linn.

T. cucumerina Linn.

T. anguina Linn.

T. wallichiana Wight. syn. T. multiloba Clarke

2. Lagenaria vulgaris Ser. syn. Cucurbita Lagenaria Linn. ; Roxb.

Eng: Bottle gourd San: Alabu Hin: Lauki, Jangli-khaddu

Ben: Lau, Kodu

Mal: Katuchuram, Churakka

Tam: Soriai-kay

Tel: Surakkaya

Bottle gourd is a large softly pubescent climbing or trailing herb which is said to be indigenous in India, the Molucas and in Abyssinia. It has stout 5-angled stems with bifid tendrils. Leaves are ovate or orbiculate, cordate, dentate, 5-angular or 5-lobed, hairy on both surfaces. Flowers are large, white, solitary, unisexual or bisexual, the males long and females short peduncled. Ovary is oblong, softly pubescent with short style and many ovules. Fruits are large, usually bottle or dumb-bell-shaped, indehiscent and polymorphous. Seeds are many, white, horizontal, compressed, with a marginal groove and smooth. There are sweet fruited and bitter-fruited varieties (Kirtikar and Basu, 1988). The fruit contains a thick white pulp which, in the cultivated variety (kodu) is sweet and edible, while in the smaller wild variety (tamri) it is bitter and a powerful purgative. The seeds yield clear limpid oil which is cooling and is applied to relieve headache. The pulp of the cultivated forms is employed as and adjunct to purgatives and considered cool, diuretic and antibilious, useful in cough, and as an antidote to certain poisons. Externally it is applied as a poultice. The leaves are purgative and recommended to be taken in the form of decoction for jaundice (Nadkarni, 1998). In the case of sweet-fruited variety, the stem is laxative and sweet. The fruit is sweet oleagenous, cardiotonic, general tonic, aphrodisiac, laxative and cooling. In the case of bitter-fruited variety, the leaves are diuretic, antibilious; useful in leucorrhoea, vaginal and uterine complaints and earache. The fruit is bitter, hot, pungent, emetic, cooling, cardiotonic, antibilious; cures asthma, vata, bronchitis, inflammations ulcers and pains.

3. Luffa acutangula (Linn.) Roxb.

Eng: Ridged gourd; San: Dharmargavah, Svadukosataki;

Hin: Tori, Katitori;

Ben: Ghosha

Mal: Peechil, Peechinga;

Tam: Pikangai, Prikkangai;

Tel: Birakaya;

Kan: Kadupadagila

Ridged gourd or ribbed gourd is a large monoecious climber cultivated throughout India. It is with 5-angled glabrous stems and trifid tendrils. Leaves are orbicular-cordate, palmately 5-7 lobed, scabrous on both sides with prominent veins and veinlets. Flowers are yellow, males arranged in 12-20 flowered axillary racemes. Female flowers are solitary, arranged in the axils of the males. Ovary is strongly ribbed. Fruits are oblong-clavate with 10-sharp angles 15-30cm long, tapering towards the base. Seeds are black, ovoid-oblong, much compressed and not winged (Warrier et al, 1995). The leaves are used in haemorrhoids, leprosy, granular-conjunctivitis and ringworm. The seeds are useful in dermatopathy. The juice of the fresh leaves is dropped into the eyes of children in granular conjunctivitis, also to prevent the lids from adhering at night on account of excessive meihomian secretion (Nadkarni, 1998). Fruits are demulcent, diuretic, tonic, expectorant, laxative and nutritive. The seeds are bitter, emetic, cathartic, expectorant and purgative.

The other important species of the genus Luffa are:

L. aegyptiaca Mill.

L. acutangula var. amara Clarke

L. echinata Roxb.

4. Benincasa hispida (Thumb.) Cogn. syn. B. cerifera Savi.

Eng: Ash gourd, White gourd melon; San: Kusmandah;

Hin: Petha, Raksa;

Ben: Kumra

Mal: Kumpalam;

Tam: Pusanikkai;

Kan: Bile Kumbala;

Tel: Bodigummadi

Ash gourd or White gourd melon is a large trailing gourd climbing by means of tendrils which is widely cultivated in tropical Asia. Leaves are large and hispid beneath. Flowers are yellow, unisexual with male peduncle 7.5-10cm long and female peduncle shorter. Fruits are broadly cylindric, 30-45cm long, hairy throughout and ultimately covered with a waxy bloom. The fruits are useful in asthma, cough, diabetes, haemoptysis, hemorrhages from internal organs, epilepsy, fever and vitiated conditions of pitta. The seeds are useful in dry cough, fever, urethrorrhea, syphilis, hyperdipsia and vitiated conditions of pitta (Warrier et al,1993). It is a rejuvenative drug capable of improving intellect and physical strength. In Ayurveda, the fresh juice of the fruit is administered as a specific in haemoptysis and other haemorrhages from internal organs. The fruit is useful in insanity, epilepsy and other nervous diseases, burning sensation, diabetes, piles and dyspepsia. It is a good antidote for many kinds of vegetable, mercurial and alcoholic poisoning. It is also administered in cough, asthma or respiratory diseases, heart diseases and catarrah. Seeds are useful in expelling tapeworms and curing difficult urination and bladder stones. The important formulations using the drug are Kusmandarasayana, Himasagarataila, Dhatryadighrita, Vastyamantakaghrita, Mahaukusmandakaghrita, etc. (Sivarajan et al, 1994).

Fruits contain lupeol, -sitosterol, n-triacontanol, vitamin B, mannitol and amino acids. The fruit is alterative, laxative, diuretic, tonic, aphrodisiac and antiperiodic. Seed and oil from seed is anthelmintic (Husain et al, 1992).

5. Momordica charantia Linn.

Eng: Bitter gourd, Carilla fruit San: Karavellam

Hin: Karela, Kareli

Mal: Kaypa, Paval

Tam: Pavakkai, Paval, Pakar

Tel: Kakara

Bitter gourd or Carilla fruit is a branched climbing annual which is cultivated throughout India. It is a monoecious plant with angled and grooved stems and hairy or villous young parts. Tendrils are simple, slender and elongate. Leaves are simple, orbicular, cordate and deeply divided into 5-7 lobes. Flowers are unisexual, yellow and arranged on 5-10cm long peduncles. Fruits are 5-15cm long with 3-valved capsules, pendulous, fusiform, ribbed and beaked bearing numerous triangular tubercles. Seeds are many or few with shining sculptured surface. The roots are useful in coloptosis and ophthalmopathy. The leaves are useful in vitiated conditions of pita, helminthiasis, constipation, intermittent fever, burning sensation of the sole and nyctalopia. The fruits are useful in skin diseases, leprosy, ulcers, wounds, burning sensation, constipation, anorexia, flatulence, colic, helminthiasis, rheumatalgia, gout, diabetes, asthma, cough, dysmenorrhoea, impurity of breast milk, fever and debility. Seeds are useful in the treatment of ulcers, pharyngodynia, and obstructions of the liver and spleen. The leaves and fruits are used for external application in lumbago, ulceration and bone fractures and internally in leprosy, haemorrhoids and jaundice (Warrier et al, 1995). The drug improves digestion, calms down sexual urge, quells diseases due to pitta and kapha and cures anaemia, anorexia, leprosy, ulcers, jaundice, flatulence and piles. Fruit is useful in gout, rheumatism and complaints of liver and spleen (Nadkarni, 1954; Aiyer and Kolammal, 1966; Mooss, 1976; Kurup et al, 1979). Kaccoradi taila is an important preparation using the drug (Sivarajan et al, 1994).

The seeds give triterpene glycosides, named momordicosides A, B, C, D and E, which are glycosides of cucurbit-5-en-triol, tetraol or pentaol. Leaves and vines give tetracyclic triterpenes-momordicines I, II and III (bitter principles). Immature fruits give several non-bitter and 2 bitter cucurbitacin glycosides. Four of the non-bitter glycosides, momordicosides F1, F2, G and I and the bitter momordicosides; K and L have also been characterized. Fruits, seeds and tissue culture give a polypeptide which contained 17 types of amino acids and showed hypoglycaemic activity. Fruits also give 5-hydroxy tryptamine and a neutral compound charantin (a steroidal glucoside), diosgenin, cholesterol, lanosterol and -sitosterol. Leaf is emetic, purgative and antibilious. Fruit is stomachic, tonic, carminative, febrifuge, antirheumatic and hypoglycaemic. Root is astringent. Fruit and leaf is anti-leprotic. Fruit, leaf and root are abortifacient and anti-diabetic. Leaf and seed is anthelmintic. Seed oil possesses antifeeding and insecticidal properties. Unsaponifiable matter from seed oil exhibited pronounced inhibitory activity against gram negative bacteria. Seed and fruit are hypoglycaemic, cytotoxic and anti-feedant (Husain et al, 1992).

Other important species belonging to the genus Momordica are as follows.

M. dioica Roxb.

M. cochinchinensis Spreng.

M. tuberosa Cogn.

M. balsamina Linn.

6. Cucumis melo Linn. syn. C. melo Linn. var. cultis Kurz., C. pubescens

Willd., C. callosus (Rottl.) Cogn.

Eng: Sweet melon San,

Hin: Kharbuja

Ben: Kharmul

Mal: Mulam

Tam: Chukkari-kai, Thumatti-kai, Mulampazham

Tel: Kharbuja-doshavSweet melon is a creeping annual extensively cultivated throughout India, found wild in India, Baluchistan and tropical Africa. The stem is creeping, angular and scabrous. Leaves are orbicular-reniform in outline, 5-angled or lobed, scabrous on both surfaces and often with soft hairs. Lobes of leaves are not very deep nor acute and with 5cm long petiole. Female peduncle is 5cm. Fruit is spherical, ovoid, elongate or contorted, glabrous or somewhat hairy, not spinous nor tuberculate.

Cucumis melo includes two varieties, namely,

C. melo var. momordica syn. C. momordica Roxb.

C. melo var. utilissimus Duthie & Fuller. syn. C. utilissimus Roxb.

The fruit is eaten raw and cooked. Its pulp forms a nutritive, demulcent, diuretic and cooling drink. It is beneficial as a lotion in chronic and acute eczema as well as tan and freckles and internally in cases of dyspepsia. Pulp mixed with cumin seeds and sugar candy is a cool diet in hot season. Seeds yield sweet edible oil which is nutritive and diuretic, useful in painful discharge and suppression of urine. The whole fruit is useful in chronic eczema (Kirtikar & Basu, 1988).

Seeds contain fatty acids-myristic, palmitic, oleic, linoleic; asparagine, glutamine, citrulline, lysine, histidine, arginine, phenylalanine, valine, tyrosine, leucine, iso-leucine, methionine, proline, threonine, tryptophan and crystine. Seed is tonic, lachrymatory, diuretic and urease inhibitor. Fruit pulp is eczemic. Fruit is tonic, laxative, galactagogue, diuretic and diaphoretic. The rind is vulnerary (Husain et al, 1992).

7. Cucumic sativus Linn.

Eng: Cucumber, Common cucumber; San: Trapusah;

Hin,

Ben: Khira;

Mal: Vellari

Tam: Vellarikkai, Pippinkai;

Kan: Mullusavte;

Tel: Dosekaya

Cucumber is a climbing annual which is cultivated throughout India, found wild in the Himalayas from Kumaon to Sikkim. It is a hispidly hairy trailing or climbing annual. Leaves are simple, alternate, deeply cordate, 3-5 lobed with both surfaces hairy and denticulate margins. Flowers are yellow, males clustered, bearing cohering anthers, connective crusted or elevated above the cells. Females are solitary and thickly covered with very bulbous based hairs. Fruits are cylindrical pepo of varying sizes and forms. Seeds are cream or white with hard and smooth testa. The fruits are useful in vitiated conditions of pitta, hyperdipsia, burning sensation, thermoplegia, fever, insomnia, cephalgia, bronchitis, jaundice, haemorrhages, strangury and general debility. The seeds are useful in burning sensation, pitta, constipation, intermittent fevers, strangury, renal calculus, urodynia and general debility (Warrier et al, 1994). The leaves boiled and mixed with cumin seeds, roasted, powdered and administered in throat affections. Powdered and mixed with sugar, they are powerful diuretic (Nadkarni, 1998). The fruits and seeds are sweet, refrigerant, haemostatic, diuretic and tonic. Other important species belonging to the genus are:

C. trigonus Roxb. syn. C. pseudo-colocynthis

C. prophetarum Linn.

8. Citrullus colocynthis (Linn.) Schrader. syn. Cucumis colocynthis Linn.

Eng: Colocynth, Bitter apple; San: Visala, Mahendravaruni;

Hin: Badi indrayan, Makkal

Ben: Makhal;

Mal: Kattuvellari (Valutu), Valiya pekkummatti;

Tel: Etti-puchcha

Tam: Paitummatti, Petummatti;

Colocynth or Bitter apple is found, cultivated and wild, throughout India in warmer areas. It is an extensively trailing annual herb with bifid tendrils angular branching stems and wooly tender shoots. Leaves are deeply divided, lobes narrow thick, glabrous or somewhat hairy. Flowers are unisexual, yellow, both males and females solitary and with pale-yellow corolla. Fruit is a globose or oblong fleshy indehiscent berry, 5-7.5cm in diameter and variegated with green and white. Seeds are pale brown. The fruits are useful in tumours, ascites, leucoderma, ulcers, asthma, bronchitis, urethrorrhea, jaundice, dyspepsia, constipations, elephantiasis, tubercular glands of the neck and splenomegaly (Warrier et al, 1994). It is useful in abnormal presentations of the foetus and in atrophy of the foetus. In addition to the above properties, the root has a beneficial action in inflammation of the breasts, pain in the joints; externally it is used in ophthalmia and in uterine pains. The fruit and root, with or without is rubbed into a paste with water and applied to boils and pimples. In rheumatism, equal parts of the root and long pepper are given in pill. A paste of the root is applied to the enlarged abdomen of children (Kirtikar and Basu, 1988). The fruit is useful in ascites, biliousness, jaundice, cerebral congestion, colic, constipation dropsy, fever, worms and sciatica. Root is given in cases of abdominal enlargement, cough, asthma, inflammation of the breast, ulcers, urinary diseases and rheumatism. Oil from seeds is used for poisonous bites, bowel complaints, epilepsy and also for blackening the hair (Nadkarni, 1954; Dey, 1980). The important formulations using the root and fruit are Abhayarista, Mahatiktakam kasaya, Manasamitravatakam, Cavikasava, Madhuyastyadi taila, etc. (Sivarajan et al, 1994). The powder is often used as an insecticide. The extract should never be given without some aromatic to correct its griping tendency (Nadkarni, 1998).

Fruit contains a glycoside- colocynthin, its aglycone- -elaterin, citrulluin, citrullene and citrullic acid. Unripe fruit contains p-hydroxy benzyl methyl ester. Roots contain - elaterin and hentriacontane (Husain et al, 1992). Colocynth is, in moderate doses, drastic, hydrogogue, cathartic and diuretic. In large doses, it is emetic and gastro-intestinal irritant and in small doses, it is expectorant and alterative. Colocynthin is a cathartic and intensely bitter principle. It has a purgative action. All parts of the plant are very bitter. The fruit has been described as cathartic (Nadkarni, 1982).

9. Citrullus vulgaris Schrad. syn. C. lanatus (Thunb.) Mats. & Nakai.

Eng: Water melon; San: Tarambuja;

Hin: Tarbuj;

Ben: Tarbuz

Mal: Thannimathan;

Tam: Pitcha, Dharbusini

Watermelon is an extensively climbing annual which is largely cultivated throughout India and in all warm countries. It has thick angular branching stems. Tendrils are bifid, stout and pubescent. Leaves are long, deeply divided or moderately lobed, glabrous or somewhat hairy and hardly scabrous. Petiole is a little shorter than the limb and villous. Calyx-lobes are narrowly lanceolate, equalling the tube. Corolla is yellow within, greenish outside and villous. Lobes are ovate-oblong, obtuse and prominently 5-nerved. Fruit is sub-globose or ellipsoid, smooth, greenish or clouded, often with a glaucous waxy coating. Flesh is juicy, red or yellowish white. Seeds are usually margined. C. vulgaris var. fistulosus Duthie & Fuller. syn. C. fistulosus has its fruit about the size of small turnip, the seeds of which are used medicinally. The fruit is tasteless when unripe and sweet when ripe. The unripe fruit is used to cure jaundice. Ripe fruit cures kapha and vata and causes biliousness. It is good for sore eyes, scabies and itching. The seeds are tonic to the brain and used as a cooling medicine. An emulsion of the seeds is made into a poultice with the pounded leaves and applied hot in cases of intestinal inflammations (Kirtikar and Basu, 1988). Fruit juice is good in quenching thirst and it is used as an antiseptic in typhus fever with cumin and sugar. It is used as a cooling drink in strangury and affections of urinary organs such as gonorrhoea; in hepatic congestion and intestinal catarrh. The bitter watermelon of Sind is known as “Kirbut” and is used as a purgative.

Seeds yield a fixed oil and proteids; citrullin. Seeds are cooling, demulcent, diuretic, vermifuge and nutritive. Pulp is cooling and diuretic. Fruit-juice is cooling and refreshing (Nadkarni, 1982).

10. Curcurbita pepo Linn. syn. Pepo vulgaris et P. verrucosus Moench

Meth.

Eng: Pompion, Pumpkin, Vegetable Marrow; San: Karkaru, Kurkaru, Kushmandi

Hin,

Ben: Kadimah, Konda, Kumra, Safedkkadu;

Mal: Mathan, Matha

Tel: Budadegummadi, Pottigummadi

Pompion or Pumpkin is a climbing herb which is considered to be a native of America and cultivated in many parts of India. The stem and leaves are with a harsh prickly armature. Foliage is stiff, more or less rigid and erect. Leaves are with a broad triangular pointed outline and often with deep lobes. Corolla is mostly with erect or spreading (not drooping) pointed lobes, the tube narrowing towards the base. Peduncle is strongly 5-angled and little or much expanding near the fruit. The fruit is cooling and astringent to the bowels, increases appetite, cures leprosy, ‘kapha and vata’, thirst, fatigue and purifies the blood. The leaves are used to remove biliousness. Fruit is good for teeth, throat and eyes and allays thirst. Seeds cure sore chests, haemoptysis, bronchitis and fever. It is good for the kidney and brain. The leaves are used as an external application for burns. The seeds are considered anthelmintic. The seeds are largely used for flavouring certain preparations of Indian hemp, and the root for a nefarious purpose, viz., to make the preparation more potent. The seeds are taeniacide, diuretic and demulcent. The fruit is cooling, laxative and astringent. The leaves are digestible, haematinic and analgesic.

The other important species belonging to the genus Cucurbita is C. maxima Duchena, the seeds of which are a popular remedy for tape-worm and oil as a nervine tonic (Kirtikar & Basu, 1988).

11. Corallocarpus epigaeus Benth. ex Hook. f. syn. Bryonia epigaea Wight.

San: Katunahi;

Hin: Akasgaddah;

Mal: Kadamba, Kollankova

Tam: Akashagarudan, Gollankovai;

Tel: Murudonda, Nagadonda

Corallocarpus is a prostrate or climbing herb distributed in Punjab, Sind, Gujarat, Deccan, Karnataka and Sri Lanka. It is monoecious with large root which is turnip-shaped and slender stem which is grooved, zigzag and glabrous. Tendrils are simple, slender and glabrous. Leaves are sub-orbicular in outline, light green above and pale beneath, deeply cordate at the base, angled or more or less deeply 3-5 lobed. Petiole is long and glabrous. Male flowers are small and arranged at the tip of a straight stiff glabrous peduncle. Calyx is slightly hairy, long and rounded at the base. Corolla is long and greenish yellow. Female flowers are usually solitary with short, stout and glabrous peduncles. Fruit is stalked, long, ellipsoid or ovoid. Seeds are pyriform, turgid, brown and with a whitish corded margin. It is prescribed in later stages of dysentery and old veneral complaints. For external use in chronic rheumatism, it is made into a liniment with cumin seed, onion and castor oil. It is used in case of snakebite where it is administered internally and applied to the bitten part. The root is given in syphilitic rheumatism and later stages of dysentery. The plant is bitter, sweet, alexipharmic and emetic. The root is said to possess alterative and laxative properties (Kirtikar and Basu, 1988). Root contains a bitter principle like Breyonin (Chopra et al, 1980).

Agrotechnology: Cucurbits can be successfully grown during January-March and September- December. For the rainfed crop, sowing can also be started after the receipt of the first few showers.

Pits of 60cm diameter and 30-45cm depth are to be taken at the desired spacing. Well rotten FYM or vegetable mixture is to be mixed with topsoil in the pit and seeds are to be sown at 4-5/pit. Unhealthy plants are to be removed after 2 weeks and retained 2-3 plants/pit. FYM is to be applied at 20-25t/ha as basal dose along with half dose of N (35kg/ha) and full dose of P (25kg) and K (25kg). The remaining dose of N (35kg) can be applied in 2 equal split doses at fortnightly intervals. During the initial stages of growth, irrigation is to be given at an interval of 3-4 days and at alternate days during flowering and fruiting periods. For trailing cucumber, pumpkin and melon, dried twigs are to be spread on the ground. Bitter gourd, bottle gourd, snake gourd and ash gourd are to be trailed on Pandals. Weeding and raking of the soil are to be conducted at the time of fertilizer application. Earthing up may be done during rainy season. The most dreaded pest of cucurbits is fruit flies which can be controlled by using fruit traps, covering the fruits with polythene, cloth or paper bags, removal and destruction of affected fruits and lastly spraying with Carbaryl or Malathion 0. 2% suspension containing sugar or jaggery at 10g/l at fortnightly intervals after fruit set initiation. During rainy season, downy mildew and mosaic diseases are severe in cucurbits. The former can be checked by spraying Mancozeb 0.2%. The spread of mosaic can be checked by controlling the vectors using Dimethoate or Phosphamidon 0.05% and destruction of affected plants and collateral hosts. Harvesting to be done at least 10 days after insecticide or fungicide application (KAU,1996).... cucurbits

Terminalia spp.

Combretaceae

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

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

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

San: Arjunah, Kakubhah;

Hin: Arjun, Kahu, Kahua;

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

Tam: Attumarutu, Nirmarutu, Vellaimarutu, Marutu;

Kan: Maddi.

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

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

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

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

San: Dharaphala, Saradru, Sajada;

Hin. Ain;

Ben: Asan, Paishal;

Mal: Tehmbara;

Tam: Karramarda, Karu Murutha, Marudam, Pudavam.

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

3) T. bellirica (Craertn.) Roxb.

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

Hin: Bulla, Sagona;

Ben: Bahera, Baheri;

Tam: Akkam, Kalanduri, Tani;

Tel: Bhutavasamu Tadi, Tandra, Vibhutakamu.

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

4) T. bialata steud.

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

5) T. Catappa Linn.

San: Grahadruma;

Hin: Badam;

Ben: Bangla Badam:

Tam: Natuvdom, Vadhamkottai;

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

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

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

Tam: Anaimikkuvam, Sadagam;

Kan: Banapu;

Tel: Tani.

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

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

Ben: Panisaj; Ass: Hollock, Jhalna.

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

8) T. Pallida Brandis.

Tam: Vellai Kadukkay;

Tel: Tella Karaka, Velama Karka.

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

9) T. Paniculata Roth.

Mal: Marutu, Pe Marutu, Ven Marutu;

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

Tel: Nimiri, Pulamaddi, Putamanu, Pulanallamanu;

Kan: Maruva, Matti.

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

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

Eng: Chebulic myrobalan;

San,

Ben: Haritaki;

Hindi:Harara, Harir,

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

Mar:Habra,

Hirada;

Ori:Harida;

Guj: Hirdo;

Pun:Helela;

Tam:Amagola;

Tel: Karaka

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

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

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

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

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

The study of individual cells. Cytology’s main use in medicine is to detect abnormal cells. It is widely used to screen for cancer (as in the cervical smear test) or to confirm a diagnosis of cancer, and increasingly in antenatal screening for certain fetal abnormalities (using amniocentesis or chorionic villus sampling to obtain the sample of cells).

Examination of cells in a sample of fluid also helps to determine the cause of conditions such as pleural effusion and ascites.

Fine-needle aspiration biopsy of internal organs also involves cytology.... cytology

Excessive accumulation of fluid in body tissues. Mild fluid retention is common with premenstrual syndrome but disappears with the onset of menstruation. However, more severe fluid retention may be associated with an underlying heart, liver, or kidney disorder (see ascites; nephrotic syndrome; oedema). Diuretic drugs may be used to treat the condition.... fluid retention

A rare condition in which a tumour of an ovary is accompanied by ascites and a pleural effusion. The fluid usually disappears when the tumour is removed.... meig’s syndrome

Linn.

Family: Apocynaceae.

Habitat: Native to Central America and Brazil. Grown in Indian gardens.

English: Golden Trumpet.

Folk: Zahari Sontakkaa. (Maharashtra).

Action: Leaves—cathartic (in moderate doses; emetic in large doses). Bark—hydragogue, in ascites.

The purgative property of the aqueous extract of leaves was confirmed pharmacologically in rats. The extract also showed antifungal activity against ringworm causing fungi. Flower extract inhibits fungal growth.

EtOH extract of roots showed in- vivo activity against P-388 leukaemia in mouse and in vitro against human carcinoma cells of nasopharynx (KB). The root contains antileukaemic iri- doid lactone, allamandin and two other iridoids, allamandicin and allamdin.

The stems and leaves contain beta- amyrin, beta-sitosterol and ursolic acid. Petals gave flavonoids—kaem- pferol and quercetin.... allemanda cathartica

Buch.-Ham.

Synonym: A. lakoocha Roxb.

Family: Moraceae.

Habitat: Cultivated in Uttar Pradesh, Bengal, Khasi Hills and western Ghats.

English: Monkey Jack.

Ayurvedic: Lakuch, Kshudra Panas, Granthiphala, Pitanaasha.

Siddha/Tamil: Ilangu, Irapala, Ottipilu (Tamil).

Folk: Badhar.

Action: Bark—when applied externally, draws out purulent matter; heals boils, cracked skin and pimples. Seeds—purgative, haemagglutinating. Stems— vermifuge.

The stembark contains oxyresvera- trol, used for tapeworm.

A lectin, artocarpin, isolated from seeds, precipitates several galactoman- nans. It agglutinates rat lymphocytes and mouse ascites cells.

Dosage: Fruit—5-10 ml juice. (CCRAS.)... artocarpus lacucha

Linn.

Synonym: B. repens Linn. B. procumbens Roxb.

Family: Nyctaginaceae.

Habitat: Throughout India as a weed.

English: Horse-purslane, Hogweed.

Ayurvedic: Rakta-punarnavaa, Punarnavaa, Katthilla, Shophaghni, Shothaghni. Varshaabhu (also equated with Trianthema portu- lacastrum Linn., which exhibits anti-inflammatory, antipyretic and analgesic activity).

Unani: Itsit, Bishkhaparaa.

Siddha/Tamil: Mookkirattai.

Folk: Gadaha-purnaa.

Action: Diuretic, anti-inflammatory, antiarthritic, spasmolytic, antibacterial (used for inflammatory renal diseases, nephrotic syndrome, in cases of ascites resulting from early cirrhosis of liver and chronic peritonitis, dropsy associated with chronic Bright's diseases, for serum uric acid levels). Root—anticon- vulsant, analgesic, expectorant, CNS depressant, laxative, diuretic, abortifacient.

Key application: As diuretic, hepatoprotective. (Indian Herbal Pharmacopoeia.)

B. repanda, synonym B. chinensis Linn., roots exhibited antihepatotox- ic activity against carbon tetrachloride galactosamine-and paracetamol- induced intoxication in rats. Powdered root gave encouraging results in spermatorrhoea and leucorrhoea.

The chloroform and methanolic extracts of the roots and aerial parts of B. diffusa also exhibited antihepatotox- ic activity against carbon tetrachloride- induced intoxication in rats.

Punarnavaa is official in IP as a diuretic. The diuretic action of the drug is attributed to the presence of xanthone, beta-ecdysone. Flavonoid, arbinofura- noside, present in the drug, was found to lower serum uric acid in experimental animals, as also in humans.

Punarnavaa has been reported to increase serum protein level and reduce urinary protein extraction in clinical trials in patients suffering with nephrotic syndrome. The activity is attributed to the presence of rotenoids in various parts of the plant.

An antifibrinolytic agent, punar- navoside, has been found to stop IUCD-induced bleeding in monkeys. The drug contains quinolizidine alkaloids.

Dosage: Whole plant—20-30 g for decoction (API Vol. I); root—1-3 g powder; 10-20 ml fresh juice. (API Vol. III.)... boerhavia diffusa

A vibrating sensation felt when the flat of the hand is held against an area of the body.

Thrill is caused by turbulent blood flow in an artery or the heart.

The term is also used to describe the feeling produced by fluid within the abdominal cavity in ascites.... thrill

a rare condition that follows occlusion of the hepatic veins by thrombosis or nonthrombotic processes. In the majority of cases the cause is unknown but hypercoagulable states, local or disseminated malignancy, and infection are possible causes. It is characterized by abdominal pain, abdominal distension due to ascites, and jaundice. Clinical examination may reveal hepatomegaly, and *hepatic encephalopathy. [G. Budd (1808–82), British physician; H. Chiari (1851–1916), German pathologist]... budd–chiari syndrome

a clinical scoring system used to predict the one- and two-year survival rates of patients with chronic liver disease. The score is determined by the assessment of two clinical signs (the presence of ascites and *hepatic encephalopathy) and three biochemical markers (serum bilirubin level, serum albumin level, and prothrombin time).... child–turcotte–pugh score

(chlorthalidone) n. a thiazide *diuretic used to treat fluid retention (oedema), *ascites due to cirrhosis, high blood pressure (hypertension), heart failure, and diabetes insipidus. It may cause a fall in blood pressure on standing up, dizziness, and reduced blood potassium levels.... chlortalidone

Bacopa monnieri

Scrophulariaceae

San: Brahmi, Sarasvati;

Hin: Barami, Jalnim;

Ben: Boihim-sak;

Mal: Brahmi , Nirbrahmi;

Tam: Nirpirami, Piramiyapundu; Kan, Mar: Nirbrahmi

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

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

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

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

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

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

Linn.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout India in tropical areas; also cultivated in hedges.

English: Butterfly Pea, Winged- leaved Clitoria, Mezereon.

Ayurvedic: Girikarnikaa, Aparaa- jitaa, Aasphota, Girimallikaa, Girikanyaa, Kokilaa,Yonipushpaa, Vishnukraantaa. (Evolvulus alsi- noides Linn. is also known as Vishnukraantaa, Vishnukranti). Used as Shankhapushpi in the South.

Unani: Mezereon Hindi.

Siddha/Tamil: Kakkanam.

Folk: Koyal (Punjab).

Action: Root—cathartic like jalap. Roots cause gripe and tenesmus, hence not recommended as purgative. Used in ascites. Root bark—diuretic (infusion used in irritation of bladder and urethra). Root juice—given in cold milk to liquefy phlegm in chronic bronchitis. The root, bark, seeds and leaves—used for gastric acidity. The root is administered with honey as a general tonic to children for improving mental faculty.

The Ayurvedic Pharmacopoeia of India recommends the dried leaf in migraine, psychoneurosis and mania.

An alcoholic extract of the plant showed sedative and hypothermic effect in rodents.

Rats, fed with ethanol extract of flowers, showed a significantly lowered serum sugar level in experimentally induced diabetes.

The seeds contain a nucleoprotein with its amino acid sequence similar to insulin, but for the absence of his- tidine, threonine, proline and crystine.

Seeds gave cinnamic acid, flavonol gly- coside. Leaves contain glycosides of kaempferol.

In South India, the seeds and roots constitute the drug Shankhapushpi, used as a nervine tonic. In other regions, Canscora decussata, Convolvulus pluricaulis, Evolvulus alsinoides and Lavendula bipinnata are used as Shan- khapushpi.

Dosage: Root—1-3 g powder (API Vol. II); dried leaf—2-5 g; seed—1- 3 g. (API Vol. IV.)... clitoria ternatea

n. an alkaline milky liquid found within the *lacteals after a period of absorption. It consists of lymph with a suspension of minute droplets of digested fats (triglycerides), which have been absorbed from the small intestine. It is transported in the lymphatic system to the *thoracic duct. See also ascites.... chyle

n. see ascites.... hydroperitoneum

Ricinus communis

Euphorbiaceae

San: Erandah, Pancangulah;

Hin: Erandi, Erand;

Ben: Bherenda;

Mal: Avanakku;

Tam: Amanakku, Kootaimuttu, Amanakkam Ceti;

Kan: Haralu, Manda, Oudla;

Tel: Erandamu, Amudamu

Importance: Castor is a perennial evergreen shrub. The Sanskrit name erandah describes the property of the drug to dispel diseases. It is considered as a reputed remedy for all kinds of rheumatic affections. They are useful in gastropathy such as gulma, amadosa, constipation, inflammations, fever, ascitis, strangury, bronchitis, cough, leprosy, skin diseases, vitiated conditions of vata, colic, coxalgia and lumbago. The leaves are useful in burns, nyctalopia, strangury and for bathing and fermentation and vitiated conditions of vata, especially in rheumatoid arthritis, urodynia and arthralgia. Flowers are useful in urodynia and arthralgia and glandular tumours. Seeds are useful in dyspepsia and for preparing a poultice to treat arthralgia. The oil from seeds is a very effective purgative for all ailments caused by vata and kapha. It is also recommended for scrotocele, ascites, intermittent fever, gulma, colonitis, lumbago, coxalgia and coxitis (Warrier et al, 1996). Oil is also used for soap making. Fresh leaves are used by nursing mothers in the Canary Island as an external application to increase the flow of milk. Castor oil is an excellent solvent of pure alkaloids and as such solutions of atropine, cocaine, etc. is used in ophthalmic surgery. It is also dropped into the eye to remove the after-irritation caused by the removal of foreign bodies.

Distribution: It is a native of N. E. tropical Africa. It is found throughout India, cultivated and found wild upto 2400m.

Botany: Ricinus communis Linn. belongs to the family Euphorbiaceae. It is a monoecious evergreen shrub growing upto 4m. Leaves are alternate, palmatifid, 6-10 lobed, each 1- nerved with many lateral nerves and peltate. Lobes are lanceolate, thinly pubescent below, margin serrate and apex acuminate. Paniculate racemes are terminal with male flowers below, female ones above. Perianth is cupular, splitting into 3-5 lobes, laceolate, valvate, margin inrolled and acuminate. Filaments of stamen are connate and repeatedly branched with divergent anther cells. Sepals are 5, sub-equal, lanceolate, valvate and acute. Ovary is globose, echinate, 3-locular with 3 ovules and pendulous. Styles are 3, stout, papillose, stigmatiferous. Capsules are 3-lobed and prickly with oblong seeds having smooth testa and marbled, shiny and carunculate. R. bronze King and R. africanus are two good garden varieties which are known as Italian and East Indian Castors, respectively (Mathew, 1983, Grieve and Leyel, 1992).

Agrotechnology: Castor is cultivated both in the plains and the hills. As it has deep root system it is hardy and capable of resisting drought. It does not withstand waterlogging and frost. It requires hard dry climate for proper development of fruits and seeds. It requires a well- drained soil, preferably sandy loam or loamy sand. High soil fertility is of less importance as compared to the good physical condition of the soil. It cannot tolerate alkalinity. It is generally grown in red loamy soils, black soils and alluvial soils. The plant is seed propagated. The seed rate required is 5-12 kg/ha (pure crop) and 3 kg/ha (mixed crop). Seeds are to be sown on a hot bed early in March. When the plants come up individual plant is to be planted in a separate pot filled with light soil and plunged into a fresh hot bed. The young plants are to be kept in glass houses till early June where they are hardened and kept out. The suitable season of growing is kharif season. The crop is usually sown in April and planting is done in early July. The land is to be ploughed 2-3 times with the onset of rains and is repeated after rain. The spacing recommended is 60X90cm in case of pure crop but it is seldom cultivated pure. It is usually grown mixed with crops such as jowar, arhar, chilly, groundnut, cowpea, cotton, etc. 10-15t FYM/ha and 50kg N, 50kg P2O5 and 20kg K2O/ha will be sufficient. Addition of neem cake is beneficial as it increases oil content. There should be sufficient moisture in the field at the time of sowing. A month after planting, weeding and earthing up is to be done. The plant is attacked by hairy caterpillar, castor semi - looper, castor seed caterpillar, etc. which can be managed by integrated pest management measures. The leaf blight disease occurring in castor can be controlled by spraying with Bordeaux mixture 2-3 times at 15 days interval. Harvesting of ripe fruits can be done from the end of November till the end of February. The fruit branches are picked when they are still green to avoid splitting and scattering of the seeds. The pods are to be heaped up in the sun to dry. Then the seeds are to be beaten with stick and winnowed. Roots, leaves, flowers, seeds and oil constitute the economic parts. The average yield is 500-600kg/ha (Thakur, 1990).

Properties and activity: The beancoat yielded lupeol and 30-norlupan-3 -ol-20-one. Roots, stems and leaves contain several amino acids. Flowers gave apigenin, chlorogenin, rutin, coumarin and hyperoside. Castor oil is constituted by several fatty acids (Husain et al, 1992). Seed coat contained 1. 50-1. 62% lipids and higher amounts of phosphatides and non-saponifiable matter than seed kernel. Fresh leaves protected against liver injury induced by carbon tetra chloride in rats while cold aqueous extract provided partial protection (Rastogi et al, 1991). Root and stem is antiprotozoal and anticancerous. Root, stem and seed are diuretic. The roots are sweet, acrid, astringent, thermogenic, carminative, purgative, galactagogue, sudorific, expectorant and depurative. Leaves are diuretic, anthelmintic and galactagogue. Seeds are acrid, thermogenic, digestive, cathartic and aphrodisiac. Oil is bitter, acrid, sweet, antipyretic, thermogenic and viscous (Warrier et al, 1996). Castor oil forms a clean, light- coloured soap, which dries and hardens well and is free from smell. The oil varies much in activity. The East Indian is the more active, but the Italian has the least taste. Castor oil is an excellent solvent of pure alkaloids. The oil furnishes sebacic acid and caprylic acid. It is the most valuable laxative in medicines. It acts in about 5 hours, affecting the entire length of the bowel, but not increasing the flow of bile, except in very large doses. The mode of its action is unknown. The oil will purge when rubbed into the skin (Grieve and Leyel, 1992).... castor

n. the compartmentalization of a fluid-filled cavity into smaller spaces (locules) by fibrous septa. Loculation may occur in patients with long-standing pleural effusions, ascites, and in some cysts.... loculation

the rare combination of a benign ovarian *fibroma with *ascites and a right-sided pleural effusion. [J. V. Meigs (1892–1963), US gynaecologist]... meigs syndrome

Linn.

Family: Iridaceae.

Habitat: Cultivated in Kashmir up to 2,000 m and in Chaubattia in Uttar Pradesh.

English: Saffron, Crocus.

Ayurvedic: Kumkuma, Rudhira, Vadrika, Kaashmira, Kaashmiraka, Vaalhika, Agnishikhaa, Ghrusrrn, Rakta, Kshataja. Keshara (usually Keshara indicates Naagakeshara, Mesuaferrea Linn.)

Unani: Zaafraan.

Siddha/Tamil: Kumgumappoo (dried stigma).

Action: Stigma and style—nervine tonic, sedative, antispasmodic expectorant (in dry cough, whooping cough, bronchitis), stomachic, diaphoretic, emmenagogue.

The Ayurvedic Pharmacopoeia of India indicated the use of the stigma and style in migraine, chronic sinusitis, and in urinary obstruction, inflammation of the urinary tract.

The saffron is used in Chinese medicine for melancholia, depression, shock and menstrual disorders.

Saffron contains a volatile oil composed of terpenes, terpene alcohols and esters. The herb also contains crocin, picrocrocin, crocetin, carotenoids and riboflavin and thiamine.

Preliminary evidence suggests that crocetin may improved atherosclerosis by increasing plasma oxygen diffusion and decreasing cholesterol and triglyceride levels. In addition, cro- cetin binds to albumin, potentially increasing oxygen diffusion and improving atherosclerosis. (Natural Medicines Comprehensive Database, 2007.)

The stigma showed remarkable inhibitory effect on blood coagulation due to the presence of platelet aggregation inhibitor containing adenosine. It accelerated in vitro fibrinolytic activity of urokinase and plasmin.

Small amounts of Saffron stimulate gastric secretion; larger amounts stimulate uterine smooth muscle and exhibit emmenagogue and abortifacient effects.

Saffron extract showed cytotoxic and antimutagenic activity and antitu- mour activity against ascites tumours in mice. Chemical analysis indicated that the naturally occurring crocin may be the active principle responsible for the observed anticancer activity.

A xanthone, carotenoid glycosidic conjugate, mangi-crocin, isolated from saffron, showed significant adapto- genic activity. A natural antioxidant, isolated from saffron stem callus, showed better antioxidant activity than vitamin E. Saffron bulbs are toxic, stigmas in overdoses narcotic.

The dose of stigma and styles at 1.55.0 g is toxic. (Recommended dose : 0.5-1.5 g per day).

Dosage: Dried style and stigma—20-50 mg (API Vol. IV.)... crocus sativus

Linn.

Family: Euphorbiaceae.

Habitat: Native to South-East Asia. Now cultivated in Assam, Bengal and South India.

English: Purging Croton.

Ayurvedic: Jayapaala, Dravanti, Dantibija, Tintidiphala.

Unani: Habb-us-Salaateen, Jamaal- gotaa, Hubb-ul-Malook.

Siddha/Tamil: Nervaalam.

Action: Cathartic, rubefacient, irritant. Used in ascites, anasarca, dropsy and enlargement of abdominal viscera.

The seed oil is purgative. It produces severe symptoms of toxicity when taken internally or applied externally to the skin.

Croton oil showed tumour-promoting activity on mouse skin. The skin irritant and tumour promoting diterpene esters of the tigliane type (phorbol esters) and toxins have been isolated from the seeds. (In China, where the herb is employed for the treatment of gastro-intestinal disturbances, the highest incidence of naso- pharyngeal cancer has been reported.) 1 ml oil is usually fatal. Phorbols (terpenoids) from nonvolatile oil are toxic. Crotin, a toxic albuminous substance, is not extracted in the oil. The plant caused haematuria and swelling of lymph glands in animals.

Dosage: Seed—6-12 mg powder. (API Vol. IV.)... croton tiglium

Substances which increase urine and solute production by the KIDNEYS. They are used in the treatment of heart failure, HYPERTENSION, and sometimes for ASCITES secondary to liver failure. They may work by extra-renal or renal mechanisms.

The potential side-effects of diuretics are HYPOKALAEMIA, DEHYDRATION, and GOUT (in susceptible individuals).

Extra-renal mechanisms (a) Inhibiting release of antidiuretic hormone (e.g. water, alcohol); (b) increased renal blood ?ow (e.g. dopamine in renal doses).

Renal mechanisms (a) Osmotic diuretics act by ‘holding’ water in the renal tubules and preventing its reabsorption (e.g. mannitol); (b) loop diuretics prevent sodium, and therefore water, reabsorption (e.g. FRUSEMIDE); (c) drugs acting on the cortical segment of the Loop of Henle prevent sodium reabsorption, but are ‘weaker’ than loop diuretics (e.g. THIAZIDES); (d) drugs acting on the distal tubule prevent sodium reabsorption by retaining potassium

(e.g. spironalactone).... diuretics

a potentially life-threatening condition classically associated with ovarian stimulation using gonadotrophins in assisted conception procedures, such as in vitro fertilization (see superovulation). It is characterized by gross enlargement of the ovaries resulting in pain, bloating, nausea, vomiting, *haemoconcentration, and *ascites. The most severe cases require intensive care due to the high risk of thromboembolism and acute respiratory distress.... ovarian hyperstimulation syndrome

n. a synthetic corticosteroid that inhibits the activity of the hormone *aldosterone and is used as a potassium-sparing *diuretic to treat fluid retention (oedema) in cirrhosis, *ascites, and severe heart failure. It is also used in treating aldosteronism. Side-effects may include headache, stomach upsets, breast enlargement and impotence (in men), and menstrual disturbances (in women).... spironolactone

Gaertn.

Synonym: Phyllanthus emblica Linn.

Family: Euphorbiaceae.

Habitat: Native to tropical Southeast Asia; distributed throughout India; also planted in public parks.

English: Emblic, Indian gooseberry.

Ayurvedic: Aaamalaki, Aaamalaka, Dhaatri, Kaayasthaa, Amoghaa, Amritaphala, Amla, Aaamalaa, Dhaatriphala, Vayasyaa, Vrshya, Shiva, Hattha.

Unani: Aamalaa, Amlaj.

Siddha/Tamil: Nellikkaai, Nelli.

Action: Fruit—antianaemic, anabolic, antiemetic, bechic, astringent, antihaemorrhagic, antidiarrhoeal, diuretic, antidiabetic, carminative, antioxidant. Used in jaundice, dyspepsia, bacillary dysentery, eye trouble and as a gastrointestinal tonic. Juice with turmeric powder and honey is prescribed in diabetes insipidus. Seed—antibilious, antiasthmatic. Used in bronchitis. Bark—astringent. Leaf—juice is given in vomiting.

A decoction of powdered pericarp is prescribed for paptic ulcer.

Key application: As an antacid. (Indian Herbal Pharmacopoeia.).

The fruit is an important source of vitamin C, minerals and amino acids. The edible fruit tissue contains protein concentration threefold and vitamin C (ascorbic acid) concentration 160-fold than those of apple. The fruit also contains considerably higher concentration of most minerals and amino acids than apple.

The fruit gave cytokinine-like substances identified as zeatin, zeatin ribo- side and zeatin nucleotide; suspension culture gave phyllembin. Phyllem- bin exhibits CNS depressant and spasmolytic activity, potentiates action of adrenaline and hypnotic action of Nembutal.

The leaves contain gallic acid (10.8 mg/g dry basis), besides ascorbic and music acid. The methanol extract of the leaves is found to be effective in rat paw inflammation.

The bark contains tannin identified as mixed type of proanthocyanidin.

The fruit contains superoxide dis- mutase 482.14 units/g fresh weight and exhibits antisenescent (anti-aging) activity. Fruit, juice, its sediment and residue are antioxidant due to gallic acid. EtOH (50%) extract—antiviral.

Aqueous extract of the fruit increases cardiac glycogen level and decreases serum GOT, GPT and LDH in rats having induced myocardial necrosis.

Preliminary evidence suggests that the fruit and its juice may lower serum cholesterol, LDL, triglycerides and phospholipids without affecting HDL levels and may have positive effect on atherosclerosis. (Eur J clin Nutr, 42, 1988, 939-944; PhytotherRes, 14, 2000, 592-595.)

An aqueous extract of the fruit has been reported to provide protection against radiation-induced chromosomal damage in both pre-and postirradiation treatment. The fruit is reported to enhance natural killer cell activity and antibody dependent cellular cytotoxicity in mice bearing Dalton's lymphoma ascites tumour. The extract of the fruit and ascorbic acid prevented hepatotoxic and nephrotoxic effects induced by lead and aluminium. The toxicity could be counteracted to a great extent by the fruit extract than by an amount of ascorbic acid alone equivalent to that contained in fruits. (The fruit can be used as a dietary supplement to counteract prolonged exposure to metals in population in industrial areas.)

The fruits are reported to activate trypsin (proteolytic enzyme) activity.

The fruits can be used as coagulant in the treatment of water and can purify low turbidity water.

The fruits can be consumed safely all round the year.

Dosage: Fresh fruit—10-20 g; pulp juice—5-10 ml. (API Vol. I.)... emblica officinalis

Auct. Non Linn.

Synonym: E. ligularia Roxb.

Family: Euphorbiaceae.

Habitat: Grown as a field and boundary fence and as curious on rockeries in gardens.

English: Holy Milk Hedge, Dog's Tongue.

Ayurvedic: Snuhi, Samant-dugdhaa, Sehunda, Singhtunda, Snuk, Gudaa, Sudhaa, Vajra, Vajjri, Vajjradram, Thuuhar.

Siddha/Tamil: Ielaikkali, Perumbu- kalli.

Action: Latex—purgative, diuretic, antiasthmatic, expectorant, rube- facient. Used in ascites, polyuria, anasarca, chlorosis, tympanitis; externally on warts, cutaneous eruptions, scabies, unhealthy ulcers.

A succus compounded of equal parts of the juice and simple syrup is said to be used for giving relief in asthma.

The triterpenoids, euphol, 24-meth- ylenecycloartenol, euphorbol hexa- cosonate, glut-5 (10)-en-1-one, glut-5- en-3 beta-yet-acetate, taraxerol, friede- lan-3 alpha-ol and -3 beta-ol have been reported from the plant.... euphorbia neriifolia

Koch.

Synonym: H. helix auct. non Linn. H. himalaica Tobler.

Family: Araliaceae.

Habitat: The Himalayas; from Kashmir to Bhutan at 1,5002,000 m and Assam at 1,3502,000 m.

English: Nepal Ivy.

Folk: Baandaa, Bandaa, Lablab.

Action: Leaves and berries— cathartic, diaphoretic, febrifuge, antispasmodic, expectorant. Used in whooping cough. Leaves— used in glandular enlargements. A decoction of the leaves is used topically to destroy lice in the hair. An infusion of berries is given in rheumatism. Gum— emmenagogue.

The inflorescences contain beta- amyrin, beta-sitosterol and its D-glu- coside, oleanolic acid, triterpene gly- cosides, nepalins. Nepalins 1,2 and 3 at 0.5, 0.25 and 0.125% respectively completely immobilize human sperm.

Plant extract exhibited antitumour activity in vivo and in vitro against Ehrich ascites.... hedera nepalensis

Linn.

Family: Malvaceae.

Habitat: Native of China; grown in gardens throughout India.

English: Rose-of-China, Shoe- flower, Chinese Hibiscus.

Ayurvedic: Japaa, Javaa, Odrapush- pa, Rudrapushpa, Arunaa.

Unani: Gul-e-Gurhal.

Siddha/Tamil: Semparuthi.

Action: Flower—used in impo- tency, bronchial catarrh. Flower and bark—emmenagogue. Leaf— stimulates expulsion of placenta after childbirth; laxative, anodyne. Flower and root—used in menorrhagia.

The plant contains the cyclopro- panoids, methyl sterculate, methyl- 2-hydroxysterculate, 2-hydroxystercu- late, malvalate and beta-sitosterol.

The major anthocyanin in the flower is cyanidin 3-sophoroside. The flower nectar is rich in amino acids, mainly aspartic acid and asparagin. During pollination, the amino acid concentration increases substantially.

Flower powder exhibited anti-inflammatory activity in male albino rats with carrageenan-induced rat paw oedema. The aqueous extract of the plant showed antitumour activity against sarcoma 180 ascites.

An aqueous extract of flowers reduced the duration of oestrus cycle in experimental albino rabbits. The alcoholic extract of flowers showed antiimplantation activity. The benzene extract of flowers, on oral administration, terminated pregnancy in experimental animals.

Flower buds are used in the treatment of vaginal and uterine discharges.

Oral administration of flower extract to rats affected spermatogenesis and endocrine function of testis.

In diabetic patients, a flower bud is given daily up to 10 days or until the level of blood sugar is reduced to tolerable limits.

The white-flowered var. of Japan (cultivated all over India in garden) is equated with Hibiscus syriacus Linn. (Rose of Sharon, Shrubby Althaea). The white flower is an oriental drug used as demulcent and antidiarrhoeal. The bud yields mucilage which consists mainly of partially acetylated acidic polysaccharides. The aqueous extract of the petals causes vasorelaxation of the isolated rat arota via both endo- thelium-dependent and -independent mechanisms. The petals contain anthocyanin pigments.

The cortex and bark exhibit antifun- gal acitivity.

The bark gave canthin-6-one and a fatty acid fraction consisting of lauric, myristic and palmitic acids.

Dosage: Flower—10-20 g paste. (CCRAS.)... hibiscus rosa-sinensis

(Blume) DC.

Family: Rubiaceae.

Habitat: Gardens of Kerala and West Bengal.

Action: Leaves, flowers—cytotoxic, antitumour.

The ethanolic, extract of leaves showed cytotoxic activity against Dal- ton's lymphoma, Ehrlich ascites carcinoma and Sarcoma 180 tumour cells in vitro. The flowers have been found to contain antitumour principles, active against experimentally induced tumour models.

Jacaranda acutifolia auct. non-Humb. & Bonpl.

Synonym: J. mimosifolia D. Don J. ovalifolia R. Br.

Family: Bignoniaceae.

Habitat: Cultivated in Indian gardens.

Folk: Nili-gulmohar.

Action: Leaves' volatile oil—applied to buboes. Leaves and bark of the plant—used for syphilis and blennorrhagia. An infusion of the bark is employed as a lotion for ulcers.

The leaves contain jacaranone, ver- bascoside and phenylacetic-beta-glu- coside along with a glucose ester, jaca- ranose. Flavonoid scutellarein and its 7-glucuronide, and hydroquinones were also isolated. Fruits contain beta- sitosterol, ursolic acid and hentriacon- tane; stem bark gave lupenone and beta-sitosterol.

The flowers contain an anthocyanin. In Pakistan, the flowers are sold as a substitute for the Unani herb Gul-e- Gaozabaan.

The lyophylized aqueous extract of the stem showed a high and broad antimicrobial activity against human urinary tract bacteria, especially Pseudomonas sp.

The fatty acid, jacarandic acid, isolated from the seed oil, was found to be a strong inhibitor of prostaglandin biosynthesis in sheep.

J. rhombifolia G. F. W. May., syn. J. filicifolia D. Don is grown in Indian gardens. Extracts of the plant show insecticidal properties.

Several species of Jacaranda are used for syphilis in Brazil and other parts of South America under the names carobin, carabinha etc. A crystalline substance, carobin, besides resins, acids and caroba balsam, has been isolated from them.... ixora javanica

In?ammation of the LIVER which damages liver cells and may ultimately kill them. Acute injury of the liver is usually followed by complete recovery, but prolonged in?ammation after injury may result in FIBROSIS and CIRRHOSIS. Excluding trauma, hepatitis has several causes:

Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.

Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.

WILSON’S DISEASE.

Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).

Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.

Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.

Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.

Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.

•Hepatitis A virus (HAV) is an ENTEROVIRUS

which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.

Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.

Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.

Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.

Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic

viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.

As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.

Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around

0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).

Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:

Parenteral drug abusers.

Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.

Men who have sex with men.

Patients undergoing regular haemodialysis.

Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis

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

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

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

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

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

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

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

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

One of the ANTIMETABOLITES used to treat certain forms of malignant disease. Acting to inhibit the ENZYME dihydrofolate reductase, which is essential for purine and pyrimidine synthesis, it is given orally, intravenously, intramuscularly or intrathecally. Methotrexate is used as maintenance therapy for childhood acute lymphoblastic LEUKAEMIA, while other uses include CHORIOCARCINOMA, nonHodgkin’s LYMPHOMA, and various solid tumours. Intrathecally, it is used in the prophylaxis of childhood acute lymphoblastic leukaemia, and as treatment for established meningeal cancer or lymphoma.

Side-effects include suppression of myelocytes in bone marrow, in?ammation of mucous membranes, and, rarely, PNEUMONITIS. It should be avoided whenever signi?cant renal impairment is present, while signi?cant pleural e?usion or ascites is also a contraindication. Blood counts should be carefully monitored whenever intrathecal methotrexate is given. Oral or parenteral folinic acid helps to prevent, or to speed recovery from, myelosuppression or mucositis.

Methotrexate is used in dermatology, where it may be indicated for cases of severe uncontrolled PSORIASIS unresponsive to conventional therapy; it may also be indicated for severe active RHEUMATOID ARTHRITIS. Because of its potentially severe haematological, pulmonary, gastrointestinal, and other toxicities it should be used only by specialists and appropriate renal and liver function tests carried out before and during treatment. It should be avoided in pregnancy, and conception should be avoided for at least six months after stopping, as should breast feeding. Concurrent administration of aspirin or other NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) reduces methotrexate excretion, increasing its toxicity, and should therefore be avoided whenever possible.... methotrexate

Linn.

Family: Papaveraceae.

Habitat: Kashmir and throughout the plains of North India; cultivated in gardens.

English: Corn Poppy, Red Poppy.

Ayurvedic: Rakta Posta.

Siddha/Tamil: Sivappu, Kasakasa.

Folk: Laal Posta, Laal Kaskas.

Action: Latex from capsules— narcotic. Petal—expectorant, antitussive, sudorific. Used for diseases of the respiratory tract, for disturbed sleep and as a sedative for the relief of pain. (Included among unapproved herbs by German Commission E.)

The petals contain cyanidine derivatives. An alkaloid rhoeadine is present in leaves and flowers (0.031%), unripe capsules (0.035%) and in roots

Family: Papaveraceae.

Habitat: Native to Asia; now grown in Uttar Pradesh, Punjab, Rajasthan and Madhya Pradesh.

English: Opium Poppy.

Ayurvedic: Ahiphena, Aaphuuka. Post-daanaa (seed).

Unani: Afyum. Tukhm-e- khashkhaash (seed).

Siddha/Tamil: Kasakasa (seeds).

Action: Opium is obsolete as a drug. Narcotic, sedative, hypnotic, analgesic, sudorific, anodyne, antispasmodic. Crushed poppyheads were in use as a topical poultice for crippling pain in terminal diseases. Poppy seed—nutritive, demulcent, emollient, spasmolytic, devoid of narcotic properties. Specific against obstinate constipation, also used in catarrh of the bladder. Poppy seed oil is also free from narcotic properties. Used against diarrhoea, dysentery and scalds.

Opium contains isoquinoline alkaloids; the major one is morphine with narcotine, codeine, papaverine and thebaine. Poppy seeds, used in Indian medicine, do not contain alkaloids. The seeds contain thiamine 420, riboflavin 49, folic acid 30, pantothenic acid 2667 and niacin 1877 mcg/100 g. The seed oil (from Turkey) contains gamma-tocopherol 220, alpha-toco- pherol 40 and beta-tocopherol 20 mcg/ 100 g. Some low-molecular proteins (15% of total protein) have been isolated, along with cysteine, glutamic acid and arginine. The seeds yield a fatty oil (45%) containing palmitic, stearic, oleic, linoleic and linolenic acids.

The extract of seeds showed highly significant antisecretory (antidiarr- hoeal activity) against E. coli entero- toxin-induced secretory responses in experimental animals.

The triglycerides isolated from seeds showed anti-tumour activity against Ehrlichs ascites in mice.

The aqueous extract of seeds showed marked hypoglycaemic activity when administered to glucose-loaded and al- loxan diabetic rats.

The seeds were found to increase the activity of carcinogen detoxifying enzyme, glutathione-S-transferase by more than 78% in the stomach, liver and oesophagus in mice.

Following Papaver sp. are found in India:

P. argemone Linn. (indigenous to the Mediterranean region; commonly grown in gardens in India) contains 0.15% of alkaloids including rhoeadine, protopine, and anthocyanins. Petals are sudorific.

P dubium Linn. (North-western Himalaya form Kashmir to Garhwal; as a winter weed in North Indian plains) contains rhoeagenine as the principal alkaloid, besides rhoeadine, protopine. Petals contain cyanidin B and pelargonidin C. Petals are sudorific.

P. hybridum Linn. (gardens of Punjab and Uttar Pradesh) is diaphoretic (petals). Plant latex contains alkaloids including berberine, coptisine, pahybrine, papaverrubines A, B, D and E and sanguinarine. Plant also gave glaucine and glucamine.

P. nudicaule Linn. (Gulmarg, Kashmir, at altitudes of 3,300-3,600 m), known as Iceland Poppy, gave alkaloids including papaverrubines B and D; leave gave cyanogenic glycosides including dhurrin and triglochinin. The flower and fruit are mild diaphoretic.

P. orientale Linn. (indigenous to Mediterranean region; grown in Indian gardens), known as Oriental Poppy, contains 0.16% of alkaloids including thebaine, isothebane, protopine, glaucidine and oripavine. Latex from poppy capsule is narcotic.... papaver somniferum

Linn.

P. tomentosa Roxb. ex

Family: Rubiaceae.

Habitat: Throughout greater part of India, ascending to an altitude of about 1,500 m in the Himalayas, also recorded from the Andamans.

English: White-Pavetta.

Ayurvedic: Papata, Kathachampaa.

Siddha/Tamil: Pavattai.

Folk: Paapadi (Maharashtra).

Action: Root—bitter and aperient. Prescribed in visceral obstructions, renal dropsy and ascites. Leaves— used for fomenting piles and for haemorrhoidal pains. The root bark contains d-mannitol.... pavetta indica

(Roxb.) De Wilde.

Synonym: S. indica auct. non L.

Family: Caesalpiniaceae.

Habitat: Throughout India, except Northwestern India, up to 750 m.

English: Ashoka tree.

Ayurvedic: Ashoka, Ashoku, Hempushpa, Taamrapallava, Pindapushpa, Gandhapushpa. (Polyalthia longifolia Benth. & Hook. f., an ornamental roadside tree, is wrongly called Ashoka.)

Unani: Ashoka.

Siddha/Tamil: Asogam.

Action: Bark—uterine tonic (imparts healthy tone to uterus), used for suppressed menses, leucorrhoea, menstrual pain, menorrhagia, complaints of menopause. Also used for dyspepsia, biliousness, colic, burning sensation. Flowers—pounded and mixed with water, used in haemorrhagic dysentery, bleeding piles and retention of urine.

The Ayurvedic Pharmacopoeia ofln- dia recommends the bark in metro- hhagia, menorrhagia, chronic lymphadenitis and inflammations.

The flowers contain fatty acids and gallic acid; apigenin-7-O-beta- D-glucoside, cyanidin-3,5-diglucoside, kaempferol 3-O-beta-D-glucoside, pe- largonidin-3,5-diglucoside, quercetin and its 3-O-beta-D-glucoside and sitos- terol.

The bark yields alkanes, esters and primary alcohols. It gave n-octacosa- nol, tannin (6%), catechin, (+)-cate- chol, (-)-epicatechin, (-)-epicatechol, leucocyanidin, leucopelargonidin, pro- cyanidin derivatives, methyl-and eth- ylcholesterol derivatives.

Quercetin and its 3-O-rhamnoside, kaempferol-3-O-alpha-L-rhamnoside, amyrin, ceryl alcohol and beta-sitos- terol have been isolated from leaves and stems.

Alcoholic extract of the bark is reported to be active against a wide range of bacteria. The aqueous extract has been found to enhance the life span of mice infected with Ehrlich ascites carcinoma by 24%.

Pure phenolic glucoside (P2), isolated from stem bark, exhibited highly potent oxytocic activity on different mammals and was similar in nature to pitocin and ergometrine.

Dosage: Dried stem bark—20-30 g for decoction. (API, Vol. I.)... saraca asoca

Hoffm.

Synonym: Z. absinthifolia Link.

Family: Umbelliferae; Apiaceae.

Habitat: West Asia. Recorded from Maharashtra.

Action: Herb—used for cough and bowel disorders.

The fruits and roots yield a mixture of coumarin lactones, 1.5% and 3.2% respectively; these include two isomeric dihydrofurocoumarins—zosimin and deltonin. On saponification, zosimin yielded a hydroxyacetone called zosi- mol and cis-2,3-dimethyl acrylic acid. It showed antitumour activity against Ehrlich ascites cells in vitro.

Herbal cheese is prepared from the fresh leaves and stems in Turkey.... zosima orientalis

A primary lesion in the liver is rare. Usually invasion of carcinoma from the pancreas, gall bladder, stomach or intestines. Enlargement is rapid.

Symptoms. Jaundice. Ascites (excess fluid in the abdomen). Tenderness and enlargement of right upper abdomen; hobnail to the touch.

Alternatives: for possible relief of symptoms:–

Dandelion juice (fresh): 4 drachms (14ml) every 4 hours.

Wormwood tea freely.

Tea. Equal parts: Agrimony, Gotu Kola, Milk Thistle. Mix. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes. 1 cup freely.

Decoction. Dandelion 2; Clivers 1; Liquorice 1; Blue Flag root half. Mix. 30g (1oz) to 500ml (1 pint) water gently simmered 20 minutes. Dose: half-1 cup 3 or more times daily.

Tablets/capsules. Blue Flag root, Goldenseal, Prickly Ash.

Formula. Dandelion 2; Milk Thistle 2; Fennel 1; Peppermint 1. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-2 teaspoons. 3 or more times daily.

Biostrath artichoke formula.

Practitioner. Dandelion juice (fresh) 4oz; Wahoo bark Liquid extract 10 drops. Violet leaves Liquid extract 10.5ml. Tincture Goldenseal 10 drops. Dose: 2 teaspoons in water thrice daily. To each dose add 10 drops Liquid extract Oats (avena). (W. Burns-Lingard MNIMH)

Vinchristine. Success has been reported following use of the Periwinkle plant (Vinca rosea).

Greater Celandine has been regarded of value.

Chinese Herbalism. See: CANCER: CHINESE PRESCRIPTION. Also: Pulverised t’ien chihuang (Hypericum japonicum) 1 liang, mixed with rock sugar, with boiled water, 3 times daily. Also of value for cirrhosis.

Epsom’s salt Baths (hot): to encourage elimination of impurities through the skin. Diet. Limit fats. Protein diet to increase bile flow.

Treatment by a general medical practitioner or hospital oncologist. CANCER – LYMPH VESSELS. See: HODGKIN’S DISEASE. ... cancer – liver

Chirata. Swertia chirata, Buch. German: Driesenenzian. French: Swertie. Italian: Swertia. Indian: Chirata. Entire plant.

Constituents: xanthone derivatives, iridoids, alkaloids, flavones.

Action: bitter tonic, digestive, liver stimulant, febrifuge, antimalarial, anthelmintic.

Uses: Feeble digestion, lack of appetite. Wasting and cachetic conditions. Used for malaria before discovery of Peruvian bark. Liver damage and complaints. “Ascites due to liver involvement.” (Baiter, 1871, Ghani, 1913)

Preparations: Thrice daily.

Tea: half-1 teaspoon to each cup boiling water; infuse 15 minutes; dose: Half-1 cup. Liquid Extract BHP (1983) 1:1 in 25 per cent alcohol. Dose: 2 to 4ml.

Powder: half-2 grams. ... chiretta

Failure of the left ventricle to receive blood from the pulmonary circulation and to maintain efficient output of incoming blood to the arterial system. Failure to do so leads to congestion of blood in the lungs followed by fluid retention. If uncorrected, leads to kidney disturbance, low blood pressure, cyanosis (blueness of the skin). Onset may be tragically sudden.

Failure of the left ventricle may occur in cases of pericarditis, disease of the aortic valve, nephritis or high blood pressure.

Left ventricular failure is often of sudden onset, urgent, and may manifest as “cardiac asthma”.

Causes: blood clot, anaemia, thyroid disorder, coronary disease, congenital effects, drug therapy (beta blockers, etc), and to fevers that make heavy demands on the left ventricle.

Symptoms: breathlessness, wheezing, sweating, unproductive cough, faintness, bleeding from the lungs, palpitation. Cardiac asthma at night: feels he needs air; better upright than lying flat. Exertion soon tires. Sensation as if heart would stop. Blueness of lips and ears from hold-up in circulation of the blood through the lungs. Frequent chest colds. Awakes gasping for breath. Always tired. Cold hands and feet. Symptoms abate as compensation takes place. ‘Cream and roses’ complexion. The failure of left ventricle soon drags into failure of the right ventricle.

Right ventricular failure leads to congestive heart failure, with raised venous pressure in neck veins and body generally, causing oedema, ascites and liver engorgement.

Treatment. Agents to strengthen, support, and eliminate excess fluids from the body. BHP (1983) advises four main remedies: Hawthorn, Motherwort, Broom and Lily of the Valley. The latter works in a digitaloid manner, strengthening the heart, contracting the vessels, and lessening congestion in the lungs. Tinctures. Hawthorn 2; Stone root 1. Lily of the Valley 1. Dose: 15-45 drops thrice daily.

Broom tea. 2 teaspoons flowers, or 2-3 teaspoons tops and flowers, in cup water brought to boil and simmered one minute. 1 cup freely.

To remove fluid retention in the lungs, diuretics are indicated; chief among which is Dandelion root because of its high potassium content to prevent hypokalaemia. Dandelion coffee. As urinary excretion increases, patient improves.

Vitamin E. Not to be taken in left ventricular disorders.

Diet. See entry: DIET – HEART AND CIRCULATION.

UK Research. Researchers found that left ventricular failure was reduced by a quarter when patients were given magnesium intravenously for the first 24 hours after admission to the coronary care unit. They conclude that it should be given before any other heart therapy is commenced, and that patients should receive regular infusions if no other drug treatment is used. (The Lancet, 2.4.1994). This supports the use of magnesium sulphate (Epsom’s salts) by a past generation of herbal practitioners for the condition. ... heart – left ventricular failure (lvf)

Failure of the right ventricle to hold its own with the return flow of blood and to re-direct it through the lungs where it is re-oxygenated before entering the left ventricle for completing the circulatory cycle. Usually secondary to failure of the left ventricle. May be caused by valvular disease, especially narrowing of the orifice of the mitral valve.

Mitral disease leads to heart failure either by a narrowing of the orifice (stenosis) or a regurgitation blocks the passage of blood from the left atrium (auricle) to the left ventricle. The left atrium enlarges (hypertrophies) in an effort to counter the impediment. Real compensation – increased thrust of the blood – is provided by the right ventricle. In order to overcome a mitral impediment the right ventricle has to enlarge.

Sooner or later the right ventricle cannot enlarge any further and general heart failure sets in. Though caused primarily by a lesion of the mitral valve, it may be secondary to left ventricular failure (LVF), thyroid disorder (thyrotoxicosis), pericarditis, congenital heart disease, or any disease which weakens ventricular muscle.

Venous congestion and back pressure of RVF leads to congestion and accumulation of fluid in the lungs, cough and spitting of blood, painful swelling of the liver, nausea, loss of appetite and severe wasting.

Where the right ventricle fails to move the blood forward as it arrives from the systemic circulation, generalised dropsy sets in. Congestion of the kidneys leads to reduced urinary excretion and presence of albumin in the urine.

The picture is well known to the cardiac practitioner: blueness of the skin, congestion of the brain circulation with sleeplessness and delirium. Soon the tension of water-logged tissues results in pain and extreme anxiety. Feet are swollen and ankles pit on pressure; chest cavities fill with fluid and the abdomen swells (ascites).

Alternatives. Cardio-tonics would be given to strengthen the ventricle and diuretics to correct fluid retention: Lily of the Valley, Hawthorn, Motherwort, Broom. BHP (1983).

Due to rheumatic fever: Hawthorn.

High Blood Pressure: Mistletoe.

Effort Syndrome: Motherwort.

Tinctures. Combine, Lily of the Valley 2; Hawthorn 2; Motherwort 3. Dose: 1 teaspoon thrice daily after meals.

Diet. Low salt, low fat, high fibre. Restricted fluids, vegetarian protein foods, yoghurt. See also: DIET – HEART AND CIRCULATION.

Supplements. Potassium (bananas), Vitamin B6.

General. Stop smoking. Correction of overweight. Complete bed-rest with legs raised above level of the abdomen and patient propped-up to relieve difficult breathing. ... heart – right ventricular failure (rvf)

A disease of the liver with hardened and fibrotic patches. Scar tissue obstructs the flow of blood through the liver, back pressure causing damage. As they wear out liver cells are not renewed.

Causes: damage from gall-stones, aftermath of infections, drugs; the commonest is alcohol. Usually made up of three factors: toxaemia (self-poisoning), poor nutrition, infective bacteria or virus.

Symptoms. Loss of appetite, dyspepsia, low grade fever, nosebleeds, lethargy, spidery blood vessels on face, muscular weakness, jaundice, loss of sex urge, redness of palms of hands, unable to lie on left side. Mechanical pressure may cause dropsy and ascites. Alcohol-induced cirrhosis correlates with low phospholipid levels.

Treatment. Bitter herbs are a daily necessity to keep the bile fluid and flowing. Among other agents, peripheral vaso-dilators are indicated. Regulate bowels.

Teas. Balmony, Milk Thistle, Boldo, Bogbean. Dandelion coffee. Barberry tea (cold water). Tablets/capsules. Calamus, Blue Flag, Wild Yam.

Formula. Wahoo 2; Wild Yam 1; Blue Flag root 1. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Milk Thistle (Silybum marianum). Based on its silymarin contents: 70-210mg, thrice daily.

Practitioner. For pain. Tincture Gelsemium: 5-10 drops in water when necessary.

Enema. Constipation may be severe for which warm water injection should be medicated with few drops Tincture Myrrh.

Diet. High protein, high starch, low fat. Reject alcohol. Accept: Dandelion coffee, artichokes, raw onion juice, turmeric as a table spice.

Lecithin. Soy-derived lecithin to antidote alcohol-induced cirrhosis. (Study: Bronx Veterans Affairs Medical Center & Mount Sinai Hospital School of Medicine, New York City)

Supplements. B-complex, B12, C (1g), K, Magnesium, Zinc.

Treatment by or in liaison with a general medical practitioner or gastro-enterologist. ... liver – cirrhosis

Enlargement of the abdomen. Abdominal swelling is a natural result of obesity and growth of the uterus during pregnancy. Wind in the stomach or intestine may cause uncomfortable, bloating distension of the abdomen. Some women experience abdominal distension due to temporary water retention just before menstruation. Other causes may be more serious.

For instance, ascites (accumulation of fluid between organs) may be a symptom of cancer or disease of the heart, kidneys, or liver; swelling may also be due to intestinal obstruction (see intestine, obstruction of) or an ovarian cyst.

Diagnosis of the underlying cause may involve abdominal X-rays, ultrasound scanning, laparotomy, or laparoscopy. In ascites, some fluid between organs may be drained for examination.... abdominal swelling

A cancerous tumour in the liver. The tumour may be primary (originating within the liver) or secondary (having spread from elsewhere, often the stomach, pancreas, or large intestine). There are 2 main types of primary tumour: a hepatoma, which develops in the liver cells, and a cholangiocarcinoma, which arises from cells lining the bile ducts.The most common symptoms of any liver cancer are loss of appetite, weight loss, lethargy, and sometimes pain in the upper right abdomen.

The later stages of the disease are marked by jaundice and ascites (excess fluid in the abdomen).

Tumours are often detected by ultrasound scanning, and diagnosis may be confirmed by liver biopsy.

A hepatoma can sometimes be cured by complete removal.

In other cases, anticancer drugs can help to slow the progress of the disease.

It is usually not possible to cure secondary liver cancer, but anticancer drugs or, in some cases, removal of a solitary metastasis may be advised.... liver cancer

A collection of symptoms and signs resulting from damage to the glomeruli (filtering units of the kidney), causing severe proteinuria (loss of protein from the bloodstream into the urine). The syndrome may be a result of diabetes mellitus, amyloidosis (accumulation in tissues of an abnormal protein called amyloid), glomerulonephritis, severe hypertension, reactions to poisons, and adverse reactions to drugs.

The main symptom is swelling of the legs and face due to oedema. Also, fluid may collect in the chest cavity, resulting in pleural effusion, or in the abdomen, causing ascites. Diarrhoea, lethargy, and anorexia may occur.

Treatment is of the underlying condition.

A low-sodium diet may be recommended, and diuretic drugs may be given to reduce oedema.

If the concentration of protein in the blood is very low, protein may need to be given intravenously.... nephrotic syndrome

A malignant growth of the ovary. The cancer may be either primary (arising in the ovary) or secondary (due to the spread of cancer from another part of the body). Ovarian cancer can occur at any age but is most common after 50 and in women who have never had children. A family history of cancer of the ovary, breast, or colon, especially in close relatives under 50, is an important risk factor. Taking oral contraceptives reduces the risk.

In most cases, ovarian cancer causes no symptoms until it is widespread. The first symptoms may include vague discomfort and swelling in the abdomen; nausea and vomiting; abnormal vaginal bleeding; and ascites.

If ovarian cancer is suspected, a doctor will carry out a physical examination to detect any swellings in the pelvis. A laparoscopy will usually be performed to confirm the diagnosis.

Treatment is by surgical removal of the growth or as much cancerous tissue as possible.

This usually involves salpingooophorectomy and hysterectomy followed by radiotherapy and anticancer drugs.... ovary, cancer of

Inflammation of the pancreas, which may be acute or chronic. The main causes of acute pancreatitis are alcohol abuse and gallstones. Less common causes are injury, viral infections, surgery on the biliary system, or certain drugs. Chronic pancreatitis is usually due to alcohol abuse. Rarer causes include hyperlipidaemias, haemochromatosis, and severe acute pancreatitis. Chronic pancreatitis leads to permanent damage. Acute pancreatitis is less damaging but there may be recurrences.Symptoms of acute pancreatitis are a sudden attack of severe upper abdominal pain, which may spread to the back, often with nausea and vomiting. Movement often makes the pain worse. The attack usually lasts about 48 hours. Chronic pancreatitis usually has the same symptoms, although the pain may last from a few hours to several days, and attacks become more frequent. If there is no pain, the principal signs may be malabsorption or diabetes mellitus.

Severe acute pancreatitis may lead to hypotension, heart failure, kidney failure, respiratory failure, cysts, and ascites. Chronic pancreatitis may also lead to the development of ascites and cysts, as well as bile duct obstruction and diabetes mellitus.

A diagnosis may be made by blood tests, abdominal X-rays, ultrasound scanning, CT scanning, MRI, or ERCP. Acute pancreatitis is treated with intravenous infusion of fluids and salts and opioid analgesic drugs. In some cases, the gut may be washed out with sterile fluid, or a pancreatectomy may be performed and any gallstones that are present removed. Treatment for the chronic form is with painkillers, insulin, pancreatin, and, in some cases, pancreatectomy.... pancreatitis

a condition in which the pumping action of the heart is inadequate due to damaged heart valves, ventricular muscle, or both. This results in back pressure of blood, with congestion of organs. In left ventricular (or left heart) failure, congestion and fluid accumulation affect the lungs, resulting in pulmonary *oedema. The patient suffers breathlessness, cough, and *orthopnoea. There is reduced flow of arterial blood from the heart, which in extreme cases results in peripheral circulatory failure (cardiogenic shock). In right ventricular (or right heart) failure, the veins in the neck become engorged and fluid accumulates in the legs (peripheral oedema) or abdominal cavity (*ascites). If both left and right sides of the heart are affected then a combination of the above features is seen. This is usually referred to as congestive cardiac failure (CCF).

Diuretics (e.g. furosemide) improve symptoms. *ACE inhibitors, *beta blockers, and *spironolactone improve symptoms and life expectancy in patients with left ventricular failure. Heart surgery may be required for the correction of valve problems.... heart failure

the accumulation of fluid in fetal tissues or body cavities. This may take the form of a *cystic hygroma. In its most severe form, excessive fluid collects in the peritoneal cavity (see ascites), the pleural and pericardial cavities, and the soft tissues (see oedema). Hydrops may occur at any stage of gestation but is not usually seen until 16–18 weeks; the earlier it presents, the worse the prognosis. There are several causes of hydrops, one of which is severe anaemia associated with rhesus factor incompatibility (see haemolytic disease of the newborn). Other (nonimmune) causes include congenital heart defects, fetal arrhythmias, chromosomal abnormalities, and fetal infection with human *parvovirus B19 (erythrovirus). Treatment before birth with intrauterine blood transfusions to the fetus may be undertaken in specialized fetal medicine units; without treatment the mortality is high. Prenatal ultrasound scanning enables early recognition of hydrops fetalis and has been enhanced with the introduction of MCA Doppler (see Doppler ultrasound).... hydrops fetalis

a malignant tumour of the ovary, usually a carcinoma. Because of its wide-ranging pathology and an imperfect understanding of its causes, ovarian cancer is not readily detected in the early stages of development, when the tumour is small and produces few suspicious symptoms. Increased susceptibility to the disease is associated with raised serum levels of *CA125 (see also risk of malignancy index; BRCA1 and BRCA2). Diagnosis is based on the finding of a solid or cystic mass arising from the pelvis; there may be associated *ascites. The incidence of ovarian cancer reaches a peak in postmenopausal women; treatment involves surgery and most cases also require combined chemotherapy and/or radiotherapy.... ovarian cancer

n. acute or chronic inflammation of the membranous sac (pericardium) surrounding the heart. Pericarditis may be seen alone or as part of pancarditis (see endomyocarditis). It has numerous causes, including virus infections, uraemia, and cancer. Acute pericarditis is characterized by fever, chest pain, and a pericardial friction rub (a harsh scratching noise audible over the anterior chest wall with the aid of a stethoscope). Fluid may accumulate within the pericardial sac (pericardial effusion). Rarely, chronic thickening of the pericardium (chronic constrictive pericarditis) develops. This interferes with activity of the heart and has many features in common with *heart failure, including oedema, pleural effusions, ascites, and engorgement of the veins. Constrictive pericarditis most often results from tubercular infection.

The treatment of pericarditis is directed to the cause. Pericardial effusions may be aspirated by a needle inserted through the chest wall. Chronic constrictive pericarditis is treated by surgical removal of the pericardium (pericardiectomy).... pericarditis

n. inflammation of the *peritoneum. Primary peritonitis is caused by bacteria spread via the bloodstream: examples are pneumococcal peritonitis and tuberculous peritonitis. Symptoms are diffuse abdominal pain and swelling, with fever and weight loss. Fluid may accumulate in the peritoneal cavity (see ascites) or the infection may complicate existing ascites (see spontaneous bacterial peritonitis). Secondary peritonitis is due to perforation or rupture of an abdominal organ (for example, a duodenal ulcer, the gall bladder, or the vermiform appendix), allowing access of bacteria and irritant digestive juices to the peritoneum. This produces sudden severe abdominal pain, first at the site of rupture but later becoming generalized. Shock develops, and the abdominal wall becomes rigid; X-ray examination may reveal gas within the peritoneal cavity. Treatment is usually by surgical repair of the perforation, but in some cases conservative treatment using antibiotics and intravenous fluid may be used. *Subphrenic abscess is a possible complication. Meconium peritonitis occurs in newborn infants as a result of a perforated intestine; it is initially a sterile contamination of the peritoneum.... peritonitis

(SBP) the presence of infection in the abdominal cavity without an obvious cause (see peritonitis). SBP occurs in patients with liver disease (and occasionally in those with nephrotic syndrome) due to *portal hypertension. This leads to the build-up of large volumes of peritoneal fluid (*ascites) in which infection takes hold and propagates. Patients experience fever, nausea, abdominal pain, further accumulation of ascites, and they may develop *hepatic encephalopathy with rapid deterioration. Diagnosis is made by *paracentesis culture of the ascitic fluid to confirm the presence of bacteria. Treatment includes antibiotics.... spontaneous bacterial peritonitis