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A survey from the literature of plants used to treat scorpion stings
Journal of Ethnopharmacology 60 (1998) 97 – 110
Review article
A survey from the literature of plants used to treat scorpion stings M.J. Hutt, P.J. Houghton * Pharmacognosy Research Laboratories, Department of Pharmacy, King’s College London, Manresa Road, London SW3 6LX, UK Received 14 October 1997; received in revised form 31 October 1997; accepted 2 November 1997
Abstract A catalogue of plants used to treat envenomation by scorpions has been compiled from a comprehensive range of over 30 reference books and review papers. Details of the parts used and the method of use are given, as well as the geographical source. The possible pharmacological and chemical basis of the use of some of the plants listed is discussed and compared with plants used to treat envenomation by snakes. © 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Scorpion; Envenomation; Traditional remedies; Plants
1. Introduction Although envenomation by insects such as ants, bees and wasps is painfu1 and frequently causes inconvenience, it rarely has serious consequences, except in sensitised individuals and is rarely fatal. The majority of serious cases of envenomation are caused by snakes, but those which are the result of stings from scorpions also have a reputation for producing extreme pain which can last for many hours and which, not infrequently, results in death. * Corresponding author.
The human race has used plants to relieve the effects of scorpion stings in many parts of the world where scorpions are found. These plants are referred to in many publications dealing with the medicinal plants of a particular area but a search of the literature failed to reveal any collation, appraisal or relevant scientific investigation of these plants. This review seeks to accomplish, to some degree, the first two points in the hope that the activity in the third area will be stimulated. Similar collections dealing with plants used to treat snakebite have been published in recent years (Mors, 1991; Martz, 1992; Houghton and Osibogun, 1993).
0378-8741/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S 0 3 7 8 - 8 7 4 1 ( 9 7 ) 0 0 1 3 8 - 4
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M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
2. Scorpions and envenomation Scorpions belong to Arthropoda of the class Arachnida (order Scorpiones) and 1400 species exist, belonging to nine living families, namely, Bothriuridae, Buthidae, Chactidae, Chaerilidae, Diplocentridae, Ischnuridae, Iuridae, Scorpionidae and Vaejovidae. The Buthidae is the only family whose members are capable of causing clinically significant envenomation, hence of medical importance. Important genera in the Buthidae are Centruroides, Tityus, Androctonus, Buthus, Buthotus, Leirus and Parabuthus. Scorpions occur in tropical and temperate regions of the world, within 50° north and south of the Equator. They live in forests, savannas and deserts and some species may even be found in mountainous regions. All scorpions are nocturnal and hide during the day under stones, logs, tree bark and in termite hills. They are frequently encountered inside dwellings, hiding in dark corners, and many cases of envenomation occur in a domestic setting. The incidence of envenomation and resulting fatalities differ widely. In Mexico there are thought to be about 300 000 cases of scorpion stings each year with 1000 – 2000 deaths being attributable to the Centruroides species (WHO, 1981). Hospital data from Brazil (Bu¨cherl, 1978; Freire-Maia et al., 1994) shows that a high incidence of scorpion stings, mainly caused by T. serrulatus, occurs with fatality cases ranging from 1% in adults to 20% in young children. ln Trinidad, an average of 175 stings by Tit6us trinitatis and eight mortalities are recorded each year (Waterman, 1950). In Algeria, there is an average of about 1300 stings and 24 mortalities each year, most attributable to Androctonus australis 6 (Balozet, 1964). In southern Libya 900 stings and seven deaths for each 100 000 members of the population were reported in 1979 (WHO, 1981). In Saudi Arabia, in 1989, in the Madina Maternity and Children’s Hospital, 96 children were studied (El-Amin, 1992); even after conventional treatment, two patients still died and these were ones that actually managed to reach medical help in time. A further
study in Saudi Arabia showed a mortality rate of 4.8% amongst paediatric cases of scorpion envenomation (El-Amin et al., 1994; El-Amin and Berair, 1995). Reports from India (Das et al., 1995) also show that there is a high percentage of mortality, even amongst adults, following stings by Buthotus tamulus as well as other species of scorpion. Over a 4-year period, 152 children were admitted to the Calcutta Medical College Hospitals and a mortality of 11.8% was recorded (Bhattacharyya et al., 1992).
3. Scorpion venoms and their effect The venom of scorpions is produced by glands in the tail of the organism and envenomation is effected by direct injection of a venom-containing fluid from these glands. Scorpions usually inject their venom subcutaneously, which is then distributed to other parts of the body by the circulatory system. Elimination of venom occurs mainly through urinary excretion, although bile secretion may play an important role (El-Asmar et al., 1974). The venom consists of a solution of toxic polypeptides which are responsible for the symptoms noted in humans and experimental animals. In Centruroides venoms, for example, there are two groups of similar peptides; one is composed of long chain peptides that affect sodium channels, the other consists of short chain peptides which block potassium channels of excitable membranes, mainly nervous and muscular tissues. This binding to the cation channels causes most of the toxicological symptoms of the venom (Meier and White, 1995). There is considerable variation in the toxicity of scorpion venoms, depending on the species of the animal victimised, the route of injection and the species of scorpion. The actual amount of venom contained in an individual scorpion is generally very small, in the range of 100–600 mg per specimen, which, in many cases, will not be sufficient to produce any of the potential major toxicological effects.
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
The symptoms arising from scorpion sting and the prognosis for the victim depend on several factors, such as the scorpion species itself, the condition of the venom glands at time of sting, the number of stings and the quantity of venom injected. The age, weight and health of the victim are also important, as is the treatment given. The onset of symptoms from the time of envenomation is generally between 5 and 30 min. Local evidence of a sting is often minimal or absent, but the great majority of patients report intense pain or a burning sensation with intense pruritis and hyperesthesia which can be local or general. The pain sometimes lasts for 7 days, with other symptoms sometimes present for several weeks, before eventually fading. Sometimes redness, inflammation and local oedema can occur at the sting site. Excess tears, dilation of the pupil nasal secretion, cough and dysphagia are other common effects of envenomation. In more severe cases, cardiovascular shock and respiratory failure may occur, the latter being the chief cause of death. There is considerable experimental and clinical evidence which indicates that scorpion venoms cause these effects through the release of catecholamines from the sympathetic nervous system (Meier and White, 1995). The venom exerts its effects primarily to the cardiovascular and respiratory systems, but there is also stimulation of both the sympathetic and parasympathetic peripheral activities.
4. Treatment of scorpion envenomation Preventative measures to minimise the risk of envenomation are widely employed in all societies where it is likely to occur. The most effective preventive measure is good housekeeping, including regular cleaning and removal of places in which scorpions are likely to hide. Physical barriers, such as nets, or placing the legs of tables, chairs and beds in cans containing kerosene, are often used, as well as performing behavioural measures, such as the wearing of shoes when walking in the dark. Chemical control using organochlorine pesticides, such as lindane or DDT, has been used but many species have now
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become resistant. Some plants have a reputation for repelling scorpions and may be grown near dwellings for this purpose, for example, Calotropis procera (Abbiw, 1990). Treatment of envenomation varies according to the environment and facilities available. In countries where scorpions are common, antivenins are manufactured and are available in hospitals and clinics. These antivenins tend to be polyvalent, thus, they are useful, in view of the existence of a number of species and the difficulty in the identification of any particular species by laypersons. An antivenin is often given in conjunction with an antihistamine, in order to reduce the pruritis associated with envenomation. In many situations, however, help is not immediately available and recourse has to be made to first aid. Tourniquets are sometimes used but are not recommended (Meier and White, 1995), although a pressure bandage may be of help. Cold compress and immobilisation of the patient are the standard recommended treatment (Meier and White, 1995). In rural environments and in urban conditions where sophisticated medical help is not easily available, plants or their extracts are frequently used. Information about these plants comprises the main part of this paper.
5. Plants used to treat scorpion stings Various types of literature sources were consulted in the construction of the list of plants shown in Table 1. It should be noted that most of the references cited are not first hand observations, but compilations based on tradition or copied from other books. In cases of scorpion sting, the species of scorpion is almost never stated and the information concerning the part of the plant used for treatment, time of collection and formulation of the treatment is not always detailed. Over 30 references were consulted and a reasonably comprehensive coverage of the parts of the world where scorpions present a health risk has been achieved. The list includes only the flowering plants, which are arranged alphabetically by family (Brummit, 1992).
Wrightia tomentosa Roem. Et Schult. sp = 1/2 Araceae a Acorus calamus L. b Alocasia wenzelii Merrill sp= 1/2 Apraliaceae b Panax ginseng C.A. Mey. sp= 1/2 Aristolochiaceae a,b Aristolochia bracteata Retz.
a
Rau6olfia ligustrina Willd. ex. Schult. a Rau6olfia serpentina (L.) Benth.
a
a,b
Rhus succedanea L. Semecarpus anacardium L.f. Annonaceae Annona senegalensis Pers. Subsp. Onlotricha Pers. sp = 1/2 Apocynaceae Adenium oleifolium Stapf a Ichnocarpus frutescens R.Br. Mande6illa stephanotidifolia Woodson ex Roemet Schult.
b
Anacardiaceae a Mangifera indica L. a Pistacia integerrima Stewart
Amaranthaceae a Achyranthes aspera L.
Scientific name
Table 1 Plants used to treat scorpion stings
Roots
Perry and Metzger (1980); Duke (1982) Jayaweera (1981)
Root Petiole
Root
Root
Roberts (1931) Perry and Metzger (1980)
Duke (1982)
Irvine (1961), Ghazanfar (1994)
Stembark and rootbark
Root
Whole plant Root Leaf
Galls Whole plant
Leaf Leaf not stated
Root, stembark
Part used
Ayensu (1981)
Neuwinger (1996) Anon (1976) Schultes and Raffauf (1990)
Abbiw (1990)
Kapoor (1990) Anon (1976)
Anon (1976); Jayaweera, (1981)
Dalziel (1937); Lewis and ElvinLewis (1977); Jayaweera (1981), Abbiw (1990), Ghazanfar (1994)
References
Ghana
Nepal Nepal imported into Ceylon (introducted) India Nepal
Ceylon. India, West Tropical Africa, Arabia
Geographical area
Applied locally
In water Juice applied to bite
India
Ghana
China
India, Ceylon Southeast Asia
India
Southwest Africa Nepal Crushed with Styrax yapobodensis Northwest Amazon (Idrobo et R.E. Schult.) Steyermark leaf, in poultice West Indies Infusion drunk
Poultice
Not induced Not indicated as a mixture with other plants Not indicated Ashes with other drugs
Paste with water
Preparation and administration
100 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
Aristolochia grandifolia Swartz Aristolochia grandifolia Swartz
a
Calotropis procera (Aiton) Aiton
sp = 1/2 Cecropiaceae Cecropia peltata L.
a Heliotropium strigosum Willd. sp= 1/2 Burseraceae b Commiphora africanam Endl. sp= 1/2 Campanulaceae a Lobelia nicotianaefolia Heyne sp =1/2 Cannabaceae a Humulus scandens (Lour.) Merr. sp =1/2 Carcicaceae a Carica papaya L.
Stembark
Root
Fruit
Abbiw (1990)
Lewis and Elvin-Lewis (1977)
Perry and Metzger (1980)
Ayensu (1981) Morton (1981); Seaforth (1988)
Rootbark Stembark and root
Root of male plant
Whole plant
Herb Plant
Abbiw (1990)
Chandrasena (1934) Ayensu (1981); Morton (1981)
Bruised fresh, mixed with ox urine and applied Rubbed on hands or site of sting
Tea
Juice used topically Juices used
Infusion rubbed on skin
Applied to bite
Chewed
Heated with coconut oil, used as plaster
Stem Nepal Flower and fruit Imported into Nepal
Root
Root, stembark, leaf Latex
Roberts (1931) Abbiw (1990)
Root Leaf
Ayensu (1981) Schultes and Raffauf (1990)
West Indies West Indies
Indian, Ceylon, Trinidad West Indies
Southeast Asia
India
Ghana
Ghana
Europe West Indies
Nepal
Ghana
Nepal, India, Ceylon
West Indies Northwest Amazon
Central America and Mexico Trinidad
Root Root Decoction or infusion infusion drunk
Ceylon, Tibet
Bruised and applied
Roberts, 1931; Jayaweera (1981); Dash (1987) Morton (1981) Morton (1981)
Root
Southeast Asia
Perry and Metzger (1980)
Hemidesmus indicus R.Br. Anon (1976) sp =1/2 Bignoniaceae a Oroxylum indicum Vent Anon (1976) Stereospermum tetragonum DC. or Anon (1976) a S. Chelonoides DC. sp =1/2 Boraginaceae a Duke (1982) Heliotropium europaeum L. a Ayensu (1981) Heliotropium indicum L.
f.
Aristolochia sp. sp= 1/2 Asclepiadaceae Calotropis gigantea Dryand.
b
a,b
a,b
Aristolochia cucurbitifolia Sieb. et Zucc. a,b Aristolochia indica L.
a,b
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 101
sp =1/2 Convolvulaceae E6ol6ulus alsinoides L. Merremia tridentata (L.) Hallier subsp. Angustifolia (Jacq.) Ooststr. Operculina turpethum (L.) Silva Manso
a
Mikania guaco Humb. et Bonpl. Mikania micrantha HBK. (M. congesta DC) a,b Vernonia cinerea Less
a
Mikania cordifolia Willd.
a
sp = 1/2 Combretaceae Combretum karijonorum R.E. Schultes a,b Terminalia arjuna Wight et Arn. sp= 1/2 Commelinaceae Commelina nudifora L. sp = 1/2 Compositae a,b Artemisia arborescens L. Centratherum anthelminticum (Willd.) Kuntze. Cosmos sulphureus Cav. Cotula cinerea Del. b Eclipta prostrata Roxb. or aE. Alba Hassk. a Gynrua formosana Kitam. a Gynura japonica (Thunb.) Juel. a Lactuca serriola L. Mikania cordata (Burm.) B.L. Robinson
Scientific name
Table 1 (continued)
Whole plant Root Root
Anon (1976)
Whole plant Fresh leaf
Kapoor (1990) Ghazanfar (1994)
Abbiw (1990) Abbiw (1990)
Leaf, branches
Morton, 1981 Morton (1981)
Plant
Fresh leaf Fresh leaf Sap Leaf
Perry and Metzger (1980) Perry and Metzger (1980) Boulos (1983) Dalziel (1937); Abbiw (1990)
Neuwinger (1996) Morton (1981)
Leaf
Decoction Eaten with bran
Rubbed on bite
Crushed and used in poultice or vines in tourniquet
Decoction with Aristolochia sp. and Peperomia sp.
Applied externally
Decoction
Southeast Asia
India
Ghana
India, Bengal Arabia
Brazil Trinidad and West Indies
Tonga South central Africa West Indies
Southeast Asia North Africa Ghana
Mexico North Africa Nepal
Flower
Morton (1981) Boulos (1983) Anon (1976)
Decoction
North Africa India
Crushed leaf plaster
Leaf Seed
India
Boulos (1983) Kapoor (1990)
Ash
Amazon
Geographical area
Malaysia
Stembark
Kapoor (1990)
Crushed as poultice
Preparation and administration
Zakaria and Mohammed (1994)
Leaf
Part used
Schultes and Raffauf (1990)
References
102 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
Scirpus aureiglumis Hopper
sp= 1/2 Gentianaceae b Swertia chirata Buch.-Ham. sp= 1/2 Gramineae Setaria 6erticillata Beauv. Guttiferae a,b Mesua ferrea L. Ochrocarpus longifolius Benth. et Hook f. sp = 1/2 Labiatae b Coleus amboinicus Lour. Coleus aromaticus Benth. Hyptis sua6eolens (L.) Poit. a Ocimum basilicum L. a Ocimum sanctum L.
b Euphorbia con6ol6uloides Hochst. Ex Boiss a,b Euphorbia hirta L. a,b Euphorbia neriifolia L. a,b Euphorbia tirucalli L. b Euphorbia sp. a Glochidion molle Blume a Mareya micrantha (Benth.) Muell.-Arg. a Phyllanthus niruri L. a Ricinus communis L.
sp = 1/2 Euphorbiaceae b Croton ciliatoglanduliferus Ort. a Elaeophorbia drupifera L.
b
sp =1/2 Cyperaceae a,b Cyperus rotundus L.
sp = 1/2 Cucurbitaceae a Citrullus colocynthis (L.) Schrad.
Bruised and applied locally Poultice Bruised
Whole plant
Leaf Leaf and flower Fruit and flower
Leaf Leaf Leaf Whole plant
Dalziel (1937) Anon (1976) Kapoor (1990)
de Tavera (1892) Lewis and Elvin-Lewis (1977) Zakaria and Mohammed (1994) Quisumbing (1951) Anon (1976)
Seed
Milky juice Used externally Drink Powdered and applied externally
Sap Latex Sap Root
Kapoor (1990)
Zakaria and Mohammed (1994) Anon (1976); Ayensu (1978) Duke (1982); Boulos (1983)
Pulverised leaf
Leaf
Philippines Asia Malaysia Philippines Nepal
Nepal India
Africa
Himalayas
Malaysia North and West Africa, Nepal
Mali Malaysia Ceylon Turkey Southeast Asia Ghana
Mexico (West) Africa
Ghana
Ceylon, India, North Africa
India
Neuwinger (1996) Zakaria and Mohammed (1994) Jayaweera (1981) Tabata et al. (1986) Perry and Metzger (1980) Irvine, 1961
Pounded in water, applied externally
Paste with lime juice
Oil extract
North Africa
Ghana
Sap Latex and leaf
Whole plant
Tuber
Sap of unripe green fruit Seed
Morton (1981); Burlage (1968) Dalziel (1937); Irvine (1961); Boulos (1983) Abbiw (1990)
Jayaweera (1981); Boulos (1983); Kapoor (1990) Abbiw (1990)
Jayaweera (1981)
Boulos (1983)
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 103
References
sp= 1/2 Lythraceae Lawsonia inermis L.
Allium sati6am L.
a
sp= 1/2 Liliaceae a Allium cepa L.
Leucaena leucocephala (Lam.) de Wit sp= 1/2 Leguminosae a Mimosa pudica L. a Mucuna pruriens DC a Phaseolus mungo L. a Pterocarpus santalinus L.f. a Saraca indica L. a Sesbania aegyptica Pers. Tamarindus indica L.
Glycyrrhiza glabra L. a Indigofera tinctoria L.
a,b
a
Bauhinia excisa Hemsl. Butea monosperma (Lam.) Taub. Desmodium gangeticum DC Desmondium uncinatum DC Dichrostachys glomerata (Forsk.) Chiov.
a
Zakaria and Mohammed (1994)
Applied as paste
Crushed as compress
Applied locally
Wood Stembark Root Bruised into passe Fruit, seed, leaf, Mashed into paste and used in stembark dressing
Leaf and stem Seed
Roots
Leaf Root
Chewed (root)
Infusion Infusion mixed with ginger
Malaysia
Malaysia, Philippines, Cuba
Philippines
Nepal Ceylon Ceylon Imported into Nepal Nepal Ceylon Belize, India
S. Africa Nepal India India Malaysia
West Indies Indo China Nepal Venezuala Ghana
Guatemala and Mexico India, Ceylon
Stembark Stembark, leaf, flower and seed Root Stembark Root Root Root, leaf
Geographical area
Nepal Decoction In water
Preparation and administration
Leaf
Part used
Quisumbing (1951); Morton Bulb (1981) Brown (1951); Quisumbing Bulb (1951); Perry and Metzger (1980); Morton (1981); Zakaria and Mohammed (1994);
Anon (1976) Jayaweera (1981) Jayaweera (1981) Anon (1976) Anon (1976) Jayaweera (1981) Kapoor (1990), Arvigo and Balick (1993)
Williamson (1954) Anon (1976) Jayaweera (1981) Duke (1982) Zakaria and Mohammed (1994)
Ayensu (1981) Perry and Metzger (1980) Anon (1976) Morton (1981) Abbiw (1990)
sp = 1/2 Lauraceae a,b Cinnamomum zeylanicum Blume Anon (1976) Leguminosae b Acacia hindsii Benth Morton (1981) a lbizia lebbek Benth Roberts (1931)
Scientific name
Table 1 (continued)
104 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
sp= 1/2 Primulaceae a Lysimachia sikokiana Miq.
Vanda roxburghii R.Br. (syn. V. tessellata Hook ex G. Don) sp = 1/2 Oxalidaceae Oxalis stricta L. sp = 1/2 Papaveraceae a Argemone mexicana L. sp= 1/2 Piperaceae a Piper longum L. sp= 1/2 Portulaceae a Portula cooleracea L.
a
sp = 1/2 Melastomataceae Melastoma malabathricum L. sp= 1/2 Meliaceae b Azadirachta indica A.Juss. or Melia azadirachta L. sp= 1/2 Menispermaceae b Cissampelos owariensis Beauv. ex DC Cissampelos mucronata A.Rich. Coscinium blumeanum Miers. sp= 1/2 Musaceae a Alusa acuminata Colla a Musasapientum L. sp= 1/2 Myrtaceae Myrtus communis L. sp= 1/2 Orchidaceae Oberonia longibracteata Lindl. Most parts Leaf Whole plant
Seed
Root
Root and fruit
Fresh plant
Lewis and Elvin-Lewis (1977) Perry and Metzger (1980) Kapoor (1990)
Bolyard (1981)
Jayaweera (1981)
Anon (1976); Kapoor (1990)
Quisumbing (1951) Perry and Metzger (1980)
Herb
Leaf
Ghazanfar (1994)
Perry and Metzger (1980)
Rhizome
Morton (1981) Ayensu (1981)
Dried root
Abbiw (1990) Zakaria and Mohammed (1994)
Crushed and juice applied to skin
Paste
In water or wine
Crushed and applied locally
Decoction as vermifuge Infusion
Applied externally
Taiwan
Philippines China and indochina
India, Bengal, Nepal
Ceylon
Appalachia, USA
Cambodia Indochina India
Arabia
Trinidad West Indies
Ghana
Ghana
Dried root
Abbiw (1990)
Applied externally
Nepal, India, Ceylon
Stembark, gum, leaf and seed
Roberts (1931); Anon (1976)
Bruised fresh leaf
Malaysia
Zakaria and Mohammed (1994)
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 105
Randia dumetorum Lam.
b
Solanum indicum L. Solanum pectinatum Dun. b Solanum sessiliflorum Dun.
a,b
a,b
Hyoscyamus album L. Nicotiana tabacum L.
a
Haplophyllum tuberculatum (Forssk) A. Juss. a Lu6anga scandens Ham. b Ruta chalepensis L. Scrophulariaceae a Picrorrhiza kurroa Royle ex Benth. sp= 1/2 Simaroubaceae Eurycoma longifolia Jack Solanaceae Datura stramonium L.
a
Rubia cordifolia L. Schumanniophyton magnificum Harms sp= 1/2 Rutaceae Citrus aurantifolia Swingle
a
a,b
sp = 1/2 Ranunculaceae Consolida ambigua (L.) P.W.B. Heywood sp= 1/2 Rhamnaceae Zizyphus jujuba Lam. sp = 1/2 Rubiaceae Canthium hispidum Benth. b Coffea arabica Benth.
Scientific name
Table 1 (continued)
Stembark Root
Abbiw (1990) Morton (1981) Ayensu (1981) Kapoor (1990)
Leaf Leaf Whole plant Drink
India Amazon Amazon
North Africa Nepal
Ghana
Abbiw (1990) Boulos (1983) Anon (1976) Duke (1982) Kapoor (1990) Schultes and Raffauf (1990) Schultes and Raffauf (1990)
Malaysia
Zakaria and Mohammed (1994) Crushed mixed with oil applied externally
Nepal
Root
Anon (1976); Kapoor (1990)
Leaf or seed
Malaya North Africa
Root and fruit Fresh plant
Trinidad West Indies North Africa
Lewis and Elvin-Lewis (1977) Boulos (1983)
Infusion Dried powdered in poultice
India Nigeria
Ghana Trinidad West Indies India
Burma
North America
Geographical area
Root Leaf
Applied to bite
Charred, pulverised in palm oil Decoction
Preparation and administration
Morton (1981) Ayensu (1981) Boulos (1983)
Anon (1976) Neuwinger (1996)
Leaf
Perry and Metzger (1980)
Fruit, stembark, seed Stem, roots Juice of stembark
Seed
Part used
Duke (1982)
References
106 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
b
a
Root, leaf
Seed, oil Sap
Anon (1976); Kapoor (1990) Lewis and Elvin-Lewis (1977); Perry and Metzger (1980) Perry and Metzger (1980)
China
Eastern Nepal, Bengal Southeast Asia
Southeast Asia
Infusion
Root
India Turkey Malaysia
Perry and Metzger (1980)
Boiled in milk, applied
Nepal
Fruit and leaf Root
Anon (1976)
Kapoor (1990) Tabata et al. (1986) Zakaria and Mohammed (1994) Perry and Metzger (1980)
Species used to treat snakebite (Houghton and Osibogun, 1993). Genus listed as having anti-inflammatory activity (Lewis, 1989).
Zingiber mioga (Thunb.) Rose
sp = 1/2 Umbelliferae a,b Coriandrum sati6um L. a Eryugium sp. Kyllinga bre6ifolia Rottb. a Oenanthe ja6anica (Blume) DC sp= 1/2 Verbenaceae a Gmelina arborea L. sp= 1/2 Vitaceae Cayraitia japonica (Thunb.) Gagnep. sp =1/2 Zingiberaceae a Amomum subulatum Roxb. Elettariopsis sumatrana Val.
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 107
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M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
6. Efficacy of plants used traditionally to treat scorpion envemonation Unlike studies of plants used to treat snakebite, no scientific reports on clinical or pharmacological studies to test the efficacy of plant extracts against the effects of scorpion venom could be found, although some anecdotal reports exist of remedies claimed to be effective in certain situations. In Table 1, some indication of efficacy is given by the use of the same species, or closely-related species, in different cultures and geographical areas. Selected genera which display such a pattern are shown in Table 2. Any effect of the plant claimed to be efficaceous against scorpion sting may be due to a variety of biological activities associated with the plant species or its constituents, while symptomatic relief may be due to analgesic, anti-inflammatory and anti-pruritic effects. Among the plants listed in Table 1, members of the Solanaceae which contain tropane alkaloids, namely, Datura and Hyoscyamus, may indeed have such an effect, since these compounds are known to produce such a response. In other instances, an extract of the plant has been shown to exert an analgesic effect, but the active constituent still awaits elucidation, for example, in the case of Elaeophorbia drupifera 6 (Boulos, 1983). Scorpion venom, when injected, exerts a strong inflammatory response. Therefore, it is not surprising that a number of the species listed in Table 1 belong to genera listed in a recent monograph dealing with plants known to possess anti-inflammatory properties (Lewis, 1989). These genera are marked on the table by the letter b. Table 2 Genera used for treatment of scorpion envenomation in broad geographical areas Achyranthes (Amaranthaceae) Allium (Liliaceae) Aristolochia (Aristolochiaceae) Calotropis (Asclepiadaceae) Carica (Caricaceae) Cyperus (Cyperaceae) Euphorbia (Euphorbiaceae) Mikania (Compositae) Solanum (Solanaceae)
The chemical compounds responsible for such an effect are expected to be unusual but Pereira et al. (1994) have shown that, in the case of snakebite, common constituents present in some plants used traditionally for this purpose in Brazil, such as b-sitosterol and some flavonoids, e.g. quercetin, have been shown to be the anti-inflammatory agents responsible for the alleviation of snakebite effects. These compounds may well be present in sufficient concentration in a number of species listed in Table 1, which would cause an observable effect, when a scorpion envenomation is treated using these plants. A more direct anti-venom activity would entail complexation of the compounds with venom constituents, thus rendering them unable to act on receptors or to elicit competitive blocking of the receptors. Alternatively, the catecholamines released as a result of venom–receptor interaction may be antagonised or metabolised more quickly. Reduction in the intensity of the effects of envenomation could also be achieved by a non-specific stimulation of the immune system leading to phagocytosis and neutralisation of the venom peptides. It is interesting to note that some plants used to treat envenomation by snakes are also used to give relief when scorpion sting occurs. These are marked on Table 1 with an a. Aristolochia species are prominent in this category and aristolochic acid, a common constituent of this genus, has been shown to inhibit the activity of phospholipases (Vishnawath and Gowda, 1987). Since phospholipase enzymes play an important part in the cascade leading to the inflammatory and pain response, their inhibition could result in the relief of problems from scorpion envenomation.
7. Conclusions There is obviously much still unknown about plants to treat scorpion envenomation. The validation by scientific method of the usefulness of various species could form the basis for their use as alternative treatments or when conventional therapy by Western medicine is unavailable. This applies to many parts of the world. Since scorpion
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
envenomation is not a great problem in the present industrialised world, it is unlikely that any isolated compounds with biological activity would come into clinical use but, since scorpion venoms contain compounds with biological effects of interest to many important disease states, compounds which interact with them may provide useful tools for pharmacological investigations. The rich heritage of plants used for this purpose is, therefore, worthy of more detailed scientific investigation.
References Abbiw, D., 1990. Useful Plants of Ghana West African Uses of Wild and Cultivated Plants. Intermediate Technology Publications and Royal Botanic Gardens Kew, ew, pp. 219 – 221. Anon, 1976. Medicinal Plants of Nepal. His Majesty’s Government of Nepal, Ministry of Forests. Department of Medicinal Plants, Thapathali, Kathmandu. Arvigo, R., Balick, M., 1993. Rainforest Remedies—One Hundred Healing Herbs of Belize. Lotus Press, WI, p. 175. Ayensu, E.S., 1978. Medicinal Plants of West Africa. Reference Publications. Algonac, MI, p. 28. Ayensu, E.S., 1981. Medicinal Plants of the West lndies. Reference Publications, Algonac, MI, pp. 67–112. Balozet, L., 1964. Le scorpionisme en Afrique de Nord. Bullatin de la Societe´ Pathologique Exotique, 57, 37–38. Bhattacharyya, B., Das, D.C, Mukherjee, H., Hati, A.K., 1992. A retrospective study on scorpion sting in the paediatric age group in a hospital in Calcutta. Indian Journal of Medical Sciences 46, 205–208. Bolyard, J.L., 1981. Medicinal Plants and Home Remedies of Appalachia. Thomas, Springfield, IL, p. 102. Boulos, L., 1983. Medicinal Plants of North Africa. Reference Publications, Algonac, MI. Brown, W.H., 1951. Useful Plants of the Philipines. Brummit, R.K., 1992. Vascular Plant Families and Genera. Royal Botanic Gardens Kew, London, p. 754. Bu¨cherl, J.A., 1978. Venoms of Tityinae in arthropod venoms. In: Bettini, S. (Ed.), Handbook of Experimental Pharmacology, 48. Springer, Berlin, pp. 371–379. Burlage, H.M., 1968. Index of Plants of Texas, with reputed Medicinal and Poisonous Properties. Burlage, Austin, TX, p. 72. Chandrasena, J.P.C., 1934. The Chemistry and Pharmacology of Ceylon and Indian Plants. HPC Press, Colombo, p. 3. Dalziel, J.M., 1937. The Useful Plants of West Tropical Africa. Crown Agents, London, p. 612. Das, S., Nalini, P., Ananthakrishnan, S., et al., 1995. Scorpion envenomation in children in Southern India. Journal of Tropical Medicine and Hygiene 98, 306–308.
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Dash, V.B., 1987. Illustrated Material Medica of Indo-Tibetian Medicine. Indo-Tibetan Medicine Series, vol. 1. Classics, Delhi, India, pp. 349 – 350. de Tavera, T.H.P. 1892. Plantas Medicinales de Filipinas. Madrid. Duke, J.A., 1982. Handbook of Medicinal Herbs. CRC Press, Boca Raton, FL. El-Amin, E.O., 1992. Issues in managment of scorpion sting in children. Toxicon 30, 111 – 115. El-Amin, E.O., Berair, R., 1995. Scorpion stings in children. Saudi Arabian experience. Archives de Pediatrie 2, 766 – 773. El-Asmar, M.F., Soliman, S.F., Ismail, M., Osman, O.H., 1974. Glycemic effect of venom from the scorpion Buthus minox. Toxicon 12, 249 – 251. El-Amin, E.O., Sultan, O.M., Al-Magamci, M.S., Elidrissy, A., 1994. Serotherapy in the managment of scorpion sting in children in Saudi Arabia. Annals of Tropical Paediatrics 14, 21 – 24. Freire-Maia, L., Campos, J.A., Amaral, C.F., 1994. Approaches to the treatment of scorpion envenoming. Toxicon 32, 1009 – 1014. Ghazanfar, S.A., 1994. Handbook of Arabian Medicinal Plants. CRC Press, Boca Raton, FL. Houghton, P.J., Osibogun, I.M., 1993. Flowering plants used against snakebite. Journal of Ethnopharmacology 39, 1 – 29. Irvine, F.R., 1961. Woody Plants of Ghana. Oxford University Press, London, p. 878. Jayaweera, D.M.A., 1981. Medicinal Plants used in Ceylon. National Science Council of Sri-Lanka, Colombo. Kapoor, C.D., 1990. Handbook of Ayurvedic Medicinal Plants. CRC Press, Boca Raton, FL. Lewis, D.A., 1989. Anti-inflammatory Drugs from Plant and Marine Sources. Birkha¨user, Basel, pp. 231 – 283. Lewis, W.H., Elvin-Lewis, M.P.F., 1977. Medical Botany — Plants Affecting Man’s Health. Wiley, Chichester. Martz, W., 1992. Plants with a reputation against snakebite. Toxicon 30, 1131 – 1142. Meier, J., White, J., 1995. Handbook of Clinical Toxicology of Animal Venoms. CRC Press, Boca Raton, FL, pp. 221 – 238. Mors, W.B., 1991. Plants active against snakebite. In: Wagner, H., Hikino, H., Farnsworth, N.R. (Eds.), Economic and Medicinal Plant Research, vol. 5. Academic Press, London, pp. 352 – 382. Morton, J.F., 1981. Atlas of Medicinal Plants of Middle America: Bahamas to Yucatan. Thomas, Springfield, IL, pp. 75 – 76. Neuwinger, H.D., 1996. African Ethnobotany. Chapman and Hall, London. Pereira, N.A., Pereira, B.M.R., do Nascimento, M.C., Parente, J.P., Mors, W.B., 1994. Pharmacological screening of plants recommended by folk medicine as snake venom antidotes; IV. Protection against Jararaca venom by isolated constituents. Planta Medica 60, 99 – 100. Perry, L.M., Metzger, J., 1980. Medicinal Plants of East and Southeast Asia. MIT Press, Cambridge, MA.
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Quisumbing, E., 1951. Medicinal Plants of the Philippines. Technical Bulletin 16. Republic of the Philippines, Department of Agriculture and Natural Resources. Manila Bureau of Printing, Manila. Roberts, E., 1931. Vegetable Materia Medica of India and Ceylon. Colombo Plate, Colombo. Schultes, R.E., Raffauf, R.F., 1990. The Healing Forest: Medicinal and Toxic Plants of the Northwest Amazonia. Dioscorides Press, Portland, OR. Seaforth, C.E., 1988. Natural Products in Caribbean Folk Medicine. University of the West Indies, Trinidad, p. 40. Tabata, M., Honda, G., Sezik, C. (Eds.), 1986. A Report on Traditional Medicine and Traditional Plants in Turkey. Faculty of Pharmaceutical Sciences, Kyoto University, pp. 46, 53.
.
Vishnawath, B.S., Gowda, T.V., 1987. Interaction of aristolochic acid with Vipera russelli phosphohpase A2: its effect on enzymatic and pathological activities. Toxicon 25, 929 – 937. Waterman, J.A., 1950. Two cases of scorpion poisoning characterised by convulsions with electrocardiograms. Caribbean Medical Journal 12, 127 – 129. Williamson, J., 1954. Useful Plants of Nyasaland. The Government Printer, Zonba, Nyasaland, p. 48. World Health Organization, 1981. Progress in the Characterization of Venoms and Standardization of Antivenoms. WHO Offset Publication, vol. 58. WHO, Geneva. Zakaria, M., Mohammed, M.A., 1994. Traditional Malay Medicinal Plants. Penerbit fajar Bakti sdn. BHD, Kuala Lumpar, pp. 149, 174.
Review article
A survey from the literature of plants used to treat scorpion stings M.J. Hutt, P.J. Houghton * Pharmacognosy Research Laboratories, Department of Pharmacy, King’s College London, Manresa Road, London SW3 6LX, UK Received 14 October 1997; received in revised form 31 October 1997; accepted 2 November 1997
Abstract A catalogue of plants used to treat envenomation by scorpions has been compiled from a comprehensive range of over 30 reference books and review papers. Details of the parts used and the method of use are given, as well as the geographical source. The possible pharmacological and chemical basis of the use of some of the plants listed is discussed and compared with plants used to treat envenomation by snakes. © 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Scorpion; Envenomation; Traditional remedies; Plants
1. Introduction Although envenomation by insects such as ants, bees and wasps is painfu1 and frequently causes inconvenience, it rarely has serious consequences, except in sensitised individuals and is rarely fatal. The majority of serious cases of envenomation are caused by snakes, but those which are the result of stings from scorpions also have a reputation for producing extreme pain which can last for many hours and which, not infrequently, results in death. * Corresponding author.
The human race has used plants to relieve the effects of scorpion stings in many parts of the world where scorpions are found. These plants are referred to in many publications dealing with the medicinal plants of a particular area but a search of the literature failed to reveal any collation, appraisal or relevant scientific investigation of these plants. This review seeks to accomplish, to some degree, the first two points in the hope that the activity in the third area will be stimulated. Similar collections dealing with plants used to treat snakebite have been published in recent years (Mors, 1991; Martz, 1992; Houghton and Osibogun, 1993).
0378-8741/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S 0 3 7 8 - 8 7 4 1 ( 9 7 ) 0 0 1 3 8 - 4
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M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
2. Scorpions and envenomation Scorpions belong to Arthropoda of the class Arachnida (order Scorpiones) and 1400 species exist, belonging to nine living families, namely, Bothriuridae, Buthidae, Chactidae, Chaerilidae, Diplocentridae, Ischnuridae, Iuridae, Scorpionidae and Vaejovidae. The Buthidae is the only family whose members are capable of causing clinically significant envenomation, hence of medical importance. Important genera in the Buthidae are Centruroides, Tityus, Androctonus, Buthus, Buthotus, Leirus and Parabuthus. Scorpions occur in tropical and temperate regions of the world, within 50° north and south of the Equator. They live in forests, savannas and deserts and some species may even be found in mountainous regions. All scorpions are nocturnal and hide during the day under stones, logs, tree bark and in termite hills. They are frequently encountered inside dwellings, hiding in dark corners, and many cases of envenomation occur in a domestic setting. The incidence of envenomation and resulting fatalities differ widely. In Mexico there are thought to be about 300 000 cases of scorpion stings each year with 1000 – 2000 deaths being attributable to the Centruroides species (WHO, 1981). Hospital data from Brazil (Bu¨cherl, 1978; Freire-Maia et al., 1994) shows that a high incidence of scorpion stings, mainly caused by T. serrulatus, occurs with fatality cases ranging from 1% in adults to 20% in young children. ln Trinidad, an average of 175 stings by Tit6us trinitatis and eight mortalities are recorded each year (Waterman, 1950). In Algeria, there is an average of about 1300 stings and 24 mortalities each year, most attributable to Androctonus australis 6 (Balozet, 1964). In southern Libya 900 stings and seven deaths for each 100 000 members of the population were reported in 1979 (WHO, 1981). In Saudi Arabia, in 1989, in the Madina Maternity and Children’s Hospital, 96 children were studied (El-Amin, 1992); even after conventional treatment, two patients still died and these were ones that actually managed to reach medical help in time. A further
study in Saudi Arabia showed a mortality rate of 4.8% amongst paediatric cases of scorpion envenomation (El-Amin et al., 1994; El-Amin and Berair, 1995). Reports from India (Das et al., 1995) also show that there is a high percentage of mortality, even amongst adults, following stings by Buthotus tamulus as well as other species of scorpion. Over a 4-year period, 152 children were admitted to the Calcutta Medical College Hospitals and a mortality of 11.8% was recorded (Bhattacharyya et al., 1992).
3. Scorpion venoms and their effect The venom of scorpions is produced by glands in the tail of the organism and envenomation is effected by direct injection of a venom-containing fluid from these glands. Scorpions usually inject their venom subcutaneously, which is then distributed to other parts of the body by the circulatory system. Elimination of venom occurs mainly through urinary excretion, although bile secretion may play an important role (El-Asmar et al., 1974). The venom consists of a solution of toxic polypeptides which are responsible for the symptoms noted in humans and experimental animals. In Centruroides venoms, for example, there are two groups of similar peptides; one is composed of long chain peptides that affect sodium channels, the other consists of short chain peptides which block potassium channels of excitable membranes, mainly nervous and muscular tissues. This binding to the cation channels causes most of the toxicological symptoms of the venom (Meier and White, 1995). There is considerable variation in the toxicity of scorpion venoms, depending on the species of the animal victimised, the route of injection and the species of scorpion. The actual amount of venom contained in an individual scorpion is generally very small, in the range of 100–600 mg per specimen, which, in many cases, will not be sufficient to produce any of the potential major toxicological effects.
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
The symptoms arising from scorpion sting and the prognosis for the victim depend on several factors, such as the scorpion species itself, the condition of the venom glands at time of sting, the number of stings and the quantity of venom injected. The age, weight and health of the victim are also important, as is the treatment given. The onset of symptoms from the time of envenomation is generally between 5 and 30 min. Local evidence of a sting is often minimal or absent, but the great majority of patients report intense pain or a burning sensation with intense pruritis and hyperesthesia which can be local or general. The pain sometimes lasts for 7 days, with other symptoms sometimes present for several weeks, before eventually fading. Sometimes redness, inflammation and local oedema can occur at the sting site. Excess tears, dilation of the pupil nasal secretion, cough and dysphagia are other common effects of envenomation. In more severe cases, cardiovascular shock and respiratory failure may occur, the latter being the chief cause of death. There is considerable experimental and clinical evidence which indicates that scorpion venoms cause these effects through the release of catecholamines from the sympathetic nervous system (Meier and White, 1995). The venom exerts its effects primarily to the cardiovascular and respiratory systems, but there is also stimulation of both the sympathetic and parasympathetic peripheral activities.
4. Treatment of scorpion envenomation Preventative measures to minimise the risk of envenomation are widely employed in all societies where it is likely to occur. The most effective preventive measure is good housekeeping, including regular cleaning and removal of places in which scorpions are likely to hide. Physical barriers, such as nets, or placing the legs of tables, chairs and beds in cans containing kerosene, are often used, as well as performing behavioural measures, such as the wearing of shoes when walking in the dark. Chemical control using organochlorine pesticides, such as lindane or DDT, has been used but many species have now
99
become resistant. Some plants have a reputation for repelling scorpions and may be grown near dwellings for this purpose, for example, Calotropis procera (Abbiw, 1990). Treatment of envenomation varies according to the environment and facilities available. In countries where scorpions are common, antivenins are manufactured and are available in hospitals and clinics. These antivenins tend to be polyvalent, thus, they are useful, in view of the existence of a number of species and the difficulty in the identification of any particular species by laypersons. An antivenin is often given in conjunction with an antihistamine, in order to reduce the pruritis associated with envenomation. In many situations, however, help is not immediately available and recourse has to be made to first aid. Tourniquets are sometimes used but are not recommended (Meier and White, 1995), although a pressure bandage may be of help. Cold compress and immobilisation of the patient are the standard recommended treatment (Meier and White, 1995). In rural environments and in urban conditions where sophisticated medical help is not easily available, plants or their extracts are frequently used. Information about these plants comprises the main part of this paper.
5. Plants used to treat scorpion stings Various types of literature sources were consulted in the construction of the list of plants shown in Table 1. It should be noted that most of the references cited are not first hand observations, but compilations based on tradition or copied from other books. In cases of scorpion sting, the species of scorpion is almost never stated and the information concerning the part of the plant used for treatment, time of collection and formulation of the treatment is not always detailed. Over 30 references were consulted and a reasonably comprehensive coverage of the parts of the world where scorpions present a health risk has been achieved. The list includes only the flowering plants, which are arranged alphabetically by family (Brummit, 1992).
Wrightia tomentosa Roem. Et Schult. sp = 1/2 Araceae a Acorus calamus L. b Alocasia wenzelii Merrill sp= 1/2 Apraliaceae b Panax ginseng C.A. Mey. sp= 1/2 Aristolochiaceae a,b Aristolochia bracteata Retz.
a
Rau6olfia ligustrina Willd. ex. Schult. a Rau6olfia serpentina (L.) Benth.
a
a,b
Rhus succedanea L. Semecarpus anacardium L.f. Annonaceae Annona senegalensis Pers. Subsp. Onlotricha Pers. sp = 1/2 Apocynaceae Adenium oleifolium Stapf a Ichnocarpus frutescens R.Br. Mande6illa stephanotidifolia Woodson ex Roemet Schult.
b
Anacardiaceae a Mangifera indica L. a Pistacia integerrima Stewart
Amaranthaceae a Achyranthes aspera L.
Scientific name
Table 1 Plants used to treat scorpion stings
Roots
Perry and Metzger (1980); Duke (1982) Jayaweera (1981)
Root Petiole
Root
Root
Roberts (1931) Perry and Metzger (1980)
Duke (1982)
Irvine (1961), Ghazanfar (1994)
Stembark and rootbark
Root
Whole plant Root Leaf
Galls Whole plant
Leaf Leaf not stated
Root, stembark
Part used
Ayensu (1981)
Neuwinger (1996) Anon (1976) Schultes and Raffauf (1990)
Abbiw (1990)
Kapoor (1990) Anon (1976)
Anon (1976); Jayaweera, (1981)
Dalziel (1937); Lewis and ElvinLewis (1977); Jayaweera (1981), Abbiw (1990), Ghazanfar (1994)
References
Ghana
Nepal Nepal imported into Ceylon (introducted) India Nepal
Ceylon. India, West Tropical Africa, Arabia
Geographical area
Applied locally
In water Juice applied to bite
India
Ghana
China
India, Ceylon Southeast Asia
India
Southwest Africa Nepal Crushed with Styrax yapobodensis Northwest Amazon (Idrobo et R.E. Schult.) Steyermark leaf, in poultice West Indies Infusion drunk
Poultice
Not induced Not indicated as a mixture with other plants Not indicated Ashes with other drugs
Paste with water
Preparation and administration
100 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
Aristolochia grandifolia Swartz Aristolochia grandifolia Swartz
a
Calotropis procera (Aiton) Aiton
sp = 1/2 Cecropiaceae Cecropia peltata L.
a Heliotropium strigosum Willd. sp= 1/2 Burseraceae b Commiphora africanam Endl. sp= 1/2 Campanulaceae a Lobelia nicotianaefolia Heyne sp =1/2 Cannabaceae a Humulus scandens (Lour.) Merr. sp =1/2 Carcicaceae a Carica papaya L.
Stembark
Root
Fruit
Abbiw (1990)
Lewis and Elvin-Lewis (1977)
Perry and Metzger (1980)
Ayensu (1981) Morton (1981); Seaforth (1988)
Rootbark Stembark and root
Root of male plant
Whole plant
Herb Plant
Abbiw (1990)
Chandrasena (1934) Ayensu (1981); Morton (1981)
Bruised fresh, mixed with ox urine and applied Rubbed on hands or site of sting
Tea
Juice used topically Juices used
Infusion rubbed on skin
Applied to bite
Chewed
Heated with coconut oil, used as plaster
Stem Nepal Flower and fruit Imported into Nepal
Root
Root, stembark, leaf Latex
Roberts (1931) Abbiw (1990)
Root Leaf
Ayensu (1981) Schultes and Raffauf (1990)
West Indies West Indies
Indian, Ceylon, Trinidad West Indies
Southeast Asia
India
Ghana
Ghana
Europe West Indies
Nepal
Ghana
Nepal, India, Ceylon
West Indies Northwest Amazon
Central America and Mexico Trinidad
Root Root Decoction or infusion infusion drunk
Ceylon, Tibet
Bruised and applied
Roberts, 1931; Jayaweera (1981); Dash (1987) Morton (1981) Morton (1981)
Root
Southeast Asia
Perry and Metzger (1980)
Hemidesmus indicus R.Br. Anon (1976) sp =1/2 Bignoniaceae a Oroxylum indicum Vent Anon (1976) Stereospermum tetragonum DC. or Anon (1976) a S. Chelonoides DC. sp =1/2 Boraginaceae a Duke (1982) Heliotropium europaeum L. a Ayensu (1981) Heliotropium indicum L.
f.
Aristolochia sp. sp= 1/2 Asclepiadaceae Calotropis gigantea Dryand.
b
a,b
a,b
Aristolochia cucurbitifolia Sieb. et Zucc. a,b Aristolochia indica L.
a,b
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 101
sp =1/2 Convolvulaceae E6ol6ulus alsinoides L. Merremia tridentata (L.) Hallier subsp. Angustifolia (Jacq.) Ooststr. Operculina turpethum (L.) Silva Manso
a
Mikania guaco Humb. et Bonpl. Mikania micrantha HBK. (M. congesta DC) a,b Vernonia cinerea Less
a
Mikania cordifolia Willd.
a
sp = 1/2 Combretaceae Combretum karijonorum R.E. Schultes a,b Terminalia arjuna Wight et Arn. sp= 1/2 Commelinaceae Commelina nudifora L. sp = 1/2 Compositae a,b Artemisia arborescens L. Centratherum anthelminticum (Willd.) Kuntze. Cosmos sulphureus Cav. Cotula cinerea Del. b Eclipta prostrata Roxb. or aE. Alba Hassk. a Gynrua formosana Kitam. a Gynura japonica (Thunb.) Juel. a Lactuca serriola L. Mikania cordata (Burm.) B.L. Robinson
Scientific name
Table 1 (continued)
Whole plant Root Root
Anon (1976)
Whole plant Fresh leaf
Kapoor (1990) Ghazanfar (1994)
Abbiw (1990) Abbiw (1990)
Leaf, branches
Morton, 1981 Morton (1981)
Plant
Fresh leaf Fresh leaf Sap Leaf
Perry and Metzger (1980) Perry and Metzger (1980) Boulos (1983) Dalziel (1937); Abbiw (1990)
Neuwinger (1996) Morton (1981)
Leaf
Decoction Eaten with bran
Rubbed on bite
Crushed and used in poultice or vines in tourniquet
Decoction with Aristolochia sp. and Peperomia sp.
Applied externally
Decoction
Southeast Asia
India
Ghana
India, Bengal Arabia
Brazil Trinidad and West Indies
Tonga South central Africa West Indies
Southeast Asia North Africa Ghana
Mexico North Africa Nepal
Flower
Morton (1981) Boulos (1983) Anon (1976)
Decoction
North Africa India
Crushed leaf plaster
Leaf Seed
India
Boulos (1983) Kapoor (1990)
Ash
Amazon
Geographical area
Malaysia
Stembark
Kapoor (1990)
Crushed as poultice
Preparation and administration
Zakaria and Mohammed (1994)
Leaf
Part used
Schultes and Raffauf (1990)
References
102 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
Scirpus aureiglumis Hopper
sp= 1/2 Gentianaceae b Swertia chirata Buch.-Ham. sp= 1/2 Gramineae Setaria 6erticillata Beauv. Guttiferae a,b Mesua ferrea L. Ochrocarpus longifolius Benth. et Hook f. sp = 1/2 Labiatae b Coleus amboinicus Lour. Coleus aromaticus Benth. Hyptis sua6eolens (L.) Poit. a Ocimum basilicum L. a Ocimum sanctum L.
b Euphorbia con6ol6uloides Hochst. Ex Boiss a,b Euphorbia hirta L. a,b Euphorbia neriifolia L. a,b Euphorbia tirucalli L. b Euphorbia sp. a Glochidion molle Blume a Mareya micrantha (Benth.) Muell.-Arg. a Phyllanthus niruri L. a Ricinus communis L.
sp = 1/2 Euphorbiaceae b Croton ciliatoglanduliferus Ort. a Elaeophorbia drupifera L.
b
sp =1/2 Cyperaceae a,b Cyperus rotundus L.
sp = 1/2 Cucurbitaceae a Citrullus colocynthis (L.) Schrad.
Bruised and applied locally Poultice Bruised
Whole plant
Leaf Leaf and flower Fruit and flower
Leaf Leaf Leaf Whole plant
Dalziel (1937) Anon (1976) Kapoor (1990)
de Tavera (1892) Lewis and Elvin-Lewis (1977) Zakaria and Mohammed (1994) Quisumbing (1951) Anon (1976)
Seed
Milky juice Used externally Drink Powdered and applied externally
Sap Latex Sap Root
Kapoor (1990)
Zakaria and Mohammed (1994) Anon (1976); Ayensu (1978) Duke (1982); Boulos (1983)
Pulverised leaf
Leaf
Philippines Asia Malaysia Philippines Nepal
Nepal India
Africa
Himalayas
Malaysia North and West Africa, Nepal
Mali Malaysia Ceylon Turkey Southeast Asia Ghana
Mexico (West) Africa
Ghana
Ceylon, India, North Africa
India
Neuwinger (1996) Zakaria and Mohammed (1994) Jayaweera (1981) Tabata et al. (1986) Perry and Metzger (1980) Irvine, 1961
Pounded in water, applied externally
Paste with lime juice
Oil extract
North Africa
Ghana
Sap Latex and leaf
Whole plant
Tuber
Sap of unripe green fruit Seed
Morton (1981); Burlage (1968) Dalziel (1937); Irvine (1961); Boulos (1983) Abbiw (1990)
Jayaweera (1981); Boulos (1983); Kapoor (1990) Abbiw (1990)
Jayaweera (1981)
Boulos (1983)
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 103
References
sp= 1/2 Lythraceae Lawsonia inermis L.
Allium sati6am L.
a
sp= 1/2 Liliaceae a Allium cepa L.
Leucaena leucocephala (Lam.) de Wit sp= 1/2 Leguminosae a Mimosa pudica L. a Mucuna pruriens DC a Phaseolus mungo L. a Pterocarpus santalinus L.f. a Saraca indica L. a Sesbania aegyptica Pers. Tamarindus indica L.
Glycyrrhiza glabra L. a Indigofera tinctoria L.
a,b
a
Bauhinia excisa Hemsl. Butea monosperma (Lam.) Taub. Desmodium gangeticum DC Desmondium uncinatum DC Dichrostachys glomerata (Forsk.) Chiov.
a
Zakaria and Mohammed (1994)
Applied as paste
Crushed as compress
Applied locally
Wood Stembark Root Bruised into passe Fruit, seed, leaf, Mashed into paste and used in stembark dressing
Leaf and stem Seed
Roots
Leaf Root
Chewed (root)
Infusion Infusion mixed with ginger
Malaysia
Malaysia, Philippines, Cuba
Philippines
Nepal Ceylon Ceylon Imported into Nepal Nepal Ceylon Belize, India
S. Africa Nepal India India Malaysia
West Indies Indo China Nepal Venezuala Ghana
Guatemala and Mexico India, Ceylon
Stembark Stembark, leaf, flower and seed Root Stembark Root Root Root, leaf
Geographical area
Nepal Decoction In water
Preparation and administration
Leaf
Part used
Quisumbing (1951); Morton Bulb (1981) Brown (1951); Quisumbing Bulb (1951); Perry and Metzger (1980); Morton (1981); Zakaria and Mohammed (1994);
Anon (1976) Jayaweera (1981) Jayaweera (1981) Anon (1976) Anon (1976) Jayaweera (1981) Kapoor (1990), Arvigo and Balick (1993)
Williamson (1954) Anon (1976) Jayaweera (1981) Duke (1982) Zakaria and Mohammed (1994)
Ayensu (1981) Perry and Metzger (1980) Anon (1976) Morton (1981) Abbiw (1990)
sp = 1/2 Lauraceae a,b Cinnamomum zeylanicum Blume Anon (1976) Leguminosae b Acacia hindsii Benth Morton (1981) a lbizia lebbek Benth Roberts (1931)
Scientific name
Table 1 (continued)
104 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
sp= 1/2 Primulaceae a Lysimachia sikokiana Miq.
Vanda roxburghii R.Br. (syn. V. tessellata Hook ex G. Don) sp = 1/2 Oxalidaceae Oxalis stricta L. sp = 1/2 Papaveraceae a Argemone mexicana L. sp= 1/2 Piperaceae a Piper longum L. sp= 1/2 Portulaceae a Portula cooleracea L.
a
sp = 1/2 Melastomataceae Melastoma malabathricum L. sp= 1/2 Meliaceae b Azadirachta indica A.Juss. or Melia azadirachta L. sp= 1/2 Menispermaceae b Cissampelos owariensis Beauv. ex DC Cissampelos mucronata A.Rich. Coscinium blumeanum Miers. sp= 1/2 Musaceae a Alusa acuminata Colla a Musasapientum L. sp= 1/2 Myrtaceae Myrtus communis L. sp= 1/2 Orchidaceae Oberonia longibracteata Lindl. Most parts Leaf Whole plant
Seed
Root
Root and fruit
Fresh plant
Lewis and Elvin-Lewis (1977) Perry and Metzger (1980) Kapoor (1990)
Bolyard (1981)
Jayaweera (1981)
Anon (1976); Kapoor (1990)
Quisumbing (1951) Perry and Metzger (1980)
Herb
Leaf
Ghazanfar (1994)
Perry and Metzger (1980)
Rhizome
Morton (1981) Ayensu (1981)
Dried root
Abbiw (1990) Zakaria and Mohammed (1994)
Crushed and juice applied to skin
Paste
In water or wine
Crushed and applied locally
Decoction as vermifuge Infusion
Applied externally
Taiwan
Philippines China and indochina
India, Bengal, Nepal
Ceylon
Appalachia, USA
Cambodia Indochina India
Arabia
Trinidad West Indies
Ghana
Ghana
Dried root
Abbiw (1990)
Applied externally
Nepal, India, Ceylon
Stembark, gum, leaf and seed
Roberts (1931); Anon (1976)
Bruised fresh leaf
Malaysia
Zakaria and Mohammed (1994)
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 105
Randia dumetorum Lam.
b
Solanum indicum L. Solanum pectinatum Dun. b Solanum sessiliflorum Dun.
a,b
a,b
Hyoscyamus album L. Nicotiana tabacum L.
a
Haplophyllum tuberculatum (Forssk) A. Juss. a Lu6anga scandens Ham. b Ruta chalepensis L. Scrophulariaceae a Picrorrhiza kurroa Royle ex Benth. sp= 1/2 Simaroubaceae Eurycoma longifolia Jack Solanaceae Datura stramonium L.
a
Rubia cordifolia L. Schumanniophyton magnificum Harms sp= 1/2 Rutaceae Citrus aurantifolia Swingle
a
a,b
sp = 1/2 Ranunculaceae Consolida ambigua (L.) P.W.B. Heywood sp= 1/2 Rhamnaceae Zizyphus jujuba Lam. sp = 1/2 Rubiaceae Canthium hispidum Benth. b Coffea arabica Benth.
Scientific name
Table 1 (continued)
Stembark Root
Abbiw (1990) Morton (1981) Ayensu (1981) Kapoor (1990)
Leaf Leaf Whole plant Drink
India Amazon Amazon
North Africa Nepal
Ghana
Abbiw (1990) Boulos (1983) Anon (1976) Duke (1982) Kapoor (1990) Schultes and Raffauf (1990) Schultes and Raffauf (1990)
Malaysia
Zakaria and Mohammed (1994) Crushed mixed with oil applied externally
Nepal
Root
Anon (1976); Kapoor (1990)
Leaf or seed
Malaya North Africa
Root and fruit Fresh plant
Trinidad West Indies North Africa
Lewis and Elvin-Lewis (1977) Boulos (1983)
Infusion Dried powdered in poultice
India Nigeria
Ghana Trinidad West Indies India
Burma
North America
Geographical area
Root Leaf
Applied to bite
Charred, pulverised in palm oil Decoction
Preparation and administration
Morton (1981) Ayensu (1981) Boulos (1983)
Anon (1976) Neuwinger (1996)
Leaf
Perry and Metzger (1980)
Fruit, stembark, seed Stem, roots Juice of stembark
Seed
Part used
Duke (1982)
References
106 M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
b
a
Root, leaf
Seed, oil Sap
Anon (1976); Kapoor (1990) Lewis and Elvin-Lewis (1977); Perry and Metzger (1980) Perry and Metzger (1980)
China
Eastern Nepal, Bengal Southeast Asia
Southeast Asia
Infusion
Root
India Turkey Malaysia
Perry and Metzger (1980)
Boiled in milk, applied
Nepal
Fruit and leaf Root
Anon (1976)
Kapoor (1990) Tabata et al. (1986) Zakaria and Mohammed (1994) Perry and Metzger (1980)
Species used to treat snakebite (Houghton and Osibogun, 1993). Genus listed as having anti-inflammatory activity (Lewis, 1989).
Zingiber mioga (Thunb.) Rose
sp = 1/2 Umbelliferae a,b Coriandrum sati6um L. a Eryugium sp. Kyllinga bre6ifolia Rottb. a Oenanthe ja6anica (Blume) DC sp= 1/2 Verbenaceae a Gmelina arborea L. sp= 1/2 Vitaceae Cayraitia japonica (Thunb.) Gagnep. sp =1/2 Zingiberaceae a Amomum subulatum Roxb. Elettariopsis sumatrana Val.
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110 107
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6. Efficacy of plants used traditionally to treat scorpion envemonation Unlike studies of plants used to treat snakebite, no scientific reports on clinical or pharmacological studies to test the efficacy of plant extracts against the effects of scorpion venom could be found, although some anecdotal reports exist of remedies claimed to be effective in certain situations. In Table 1, some indication of efficacy is given by the use of the same species, or closely-related species, in different cultures and geographical areas. Selected genera which display such a pattern are shown in Table 2. Any effect of the plant claimed to be efficaceous against scorpion sting may be due to a variety of biological activities associated with the plant species or its constituents, while symptomatic relief may be due to analgesic, anti-inflammatory and anti-pruritic effects. Among the plants listed in Table 1, members of the Solanaceae which contain tropane alkaloids, namely, Datura and Hyoscyamus, may indeed have such an effect, since these compounds are known to produce such a response. In other instances, an extract of the plant has been shown to exert an analgesic effect, but the active constituent still awaits elucidation, for example, in the case of Elaeophorbia drupifera 6 (Boulos, 1983). Scorpion venom, when injected, exerts a strong inflammatory response. Therefore, it is not surprising that a number of the species listed in Table 1 belong to genera listed in a recent monograph dealing with plants known to possess anti-inflammatory properties (Lewis, 1989). These genera are marked on the table by the letter b. Table 2 Genera used for treatment of scorpion envenomation in broad geographical areas Achyranthes (Amaranthaceae) Allium (Liliaceae) Aristolochia (Aristolochiaceae) Calotropis (Asclepiadaceae) Carica (Caricaceae) Cyperus (Cyperaceae) Euphorbia (Euphorbiaceae) Mikania (Compositae) Solanum (Solanaceae)
The chemical compounds responsible for such an effect are expected to be unusual but Pereira et al. (1994) have shown that, in the case of snakebite, common constituents present in some plants used traditionally for this purpose in Brazil, such as b-sitosterol and some flavonoids, e.g. quercetin, have been shown to be the anti-inflammatory agents responsible for the alleviation of snakebite effects. These compounds may well be present in sufficient concentration in a number of species listed in Table 1, which would cause an observable effect, when a scorpion envenomation is treated using these plants. A more direct anti-venom activity would entail complexation of the compounds with venom constituents, thus rendering them unable to act on receptors or to elicit competitive blocking of the receptors. Alternatively, the catecholamines released as a result of venom–receptor interaction may be antagonised or metabolised more quickly. Reduction in the intensity of the effects of envenomation could also be achieved by a non-specific stimulation of the immune system leading to phagocytosis and neutralisation of the venom peptides. It is interesting to note that some plants used to treat envenomation by snakes are also used to give relief when scorpion sting occurs. These are marked on Table 1 with an a. Aristolochia species are prominent in this category and aristolochic acid, a common constituent of this genus, has been shown to inhibit the activity of phospholipases (Vishnawath and Gowda, 1987). Since phospholipase enzymes play an important part in the cascade leading to the inflammatory and pain response, their inhibition could result in the relief of problems from scorpion envenomation.
7. Conclusions There is obviously much still unknown about plants to treat scorpion envenomation. The validation by scientific method of the usefulness of various species could form the basis for their use as alternative treatments or when conventional therapy by Western medicine is unavailable. This applies to many parts of the world. Since scorpion
M.J. Hutt, P.J. Houghton / Journal of Ethnopharmacology 60 (1998) 97–110
envenomation is not a great problem in the present industrialised world, it is unlikely that any isolated compounds with biological activity would come into clinical use but, since scorpion venoms contain compounds with biological effects of interest to many important disease states, compounds which interact with them may provide useful tools for pharmacological investigations. The rich heritage of plants used for this purpose is, therefore, worthy of more detailed scientific investigation.
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Vishnawath, B.S., Gowda, T.V., 1987. Interaction of aristolochic acid with Vipera russelli phosphohpase A2: its effect on enzymatic and pathological activities. Toxicon 25, 929 – 937. Waterman, J.A., 1950. Two cases of scorpion poisoning characterised by convulsions with electrocardiograms. Caribbean Medical Journal 12, 127 – 129. Williamson, J., 1954. Useful Plants of Nyasaland. The Government Printer, Zonba, Nyasaland, p. 48. World Health Organization, 1981. Progress in the Characterization of Venoms and Standardization of Antivenoms. WHO Offset Publication, vol. 58. WHO, Geneva. Zakaria, M., Mohammed, M.A., 1994. Traditional Malay Medicinal Plants. Penerbit fajar Bakti sdn. BHD, Kuala Lumpar, pp. 149, 174.