Ethnopharmacological survey of medicinal plants used by traditional healers in Bangladesh for gastrointestinal disorders

Journal of Ethnopharmacology 147 (2013) 148–156

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Ethnopharmacological survey of medicinal plants used by traditional healers in Bangladesh for gastrointestinal disorders Mohammad Fahim Kadir a,n, Muhammad Shahdaat Bin Sayeed b, M.M.K. Mia c a

Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh Department of Clinical Pharmacy and Pharmacology, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh c Former Principal Scientific Officer and Consultant, Bangladesh National Herbarium, Bangladesh b

a r t i c l e i n f o

a b s t r a c t

Article history: Received 15 October 2012 Received in revised form 11 February 2013 Accepted 16 February 2013 Available online 28 February 2013

Ethnopharmacological relevance: Gastrointestinal diseases are common worldwide, including Bangladesh where majority of the rural people depend on water from unprotected sources. The people from Bangladesh use medicinal plants as their first line of health care to cure and prevent different types of gastrointestinal disorders. Aim of the study: To compile plants used for the treatment of different gastrointestinal disorders in Bangladesh. Materials and methods: The field survey was carried out in a period of 18 months. Fieldwork was undertaken in total of eleven districts of Bangladesh. Open-ended and semi structured questionnaire were used to interview a total of 1280 people including traditional healers, Ayurvedic/Unani drug manufacturers and local people. Results: A total of 250 plant species of 93 families were listed. Leaves were the most cited plant part used against gastrointestinal disorders. Most of the reported species were tree in nature and decoction is the mode of preparation of major portions of the plant species. Most of the plant species were very common and were cultivated or planted in homestead or roadsides. The doses of the plants for different treatments varied widely. Conclusion: In view of the fact that the plants were selected based on their medicinal usage for treating different kinds of gastrointestinal diseases including diarrhoea, the activities reported here need more works for validation and could be rationalised by the presence of active compounds found in those plants. The documentation represents the preliminary information in need of future phytochemical investigation and is important for the conservation of these plants. & 2013 Elsevier Ireland Ltd. All rights reserved.

Keywords: Bangladesh Ethnopharmacological survey Gastrointestinal disorders Medicinal plants Traditional healers

1. Introduction There are different types of gastro-intestinal diseases which are associated with the inflammation of the gastro-intestinal tract resulting in abdominal pains and cramps of varying degrees (Barbara, 1998; Naik and Sketh, 1976) and infection from different bacterial strains is the most common gastrointestinal disorders. It has been reported that infections are responsible for the deaths of up to 3 million pre-school children each year (Farthing and Kelly, 2007). WHO estimated approximately 2 billion cases of diarrhoea worldwide per year in 2009, causing 6.9% of deaths overall (WHO, 2009). In 2004, diarrhoeal disease was the third leading cause of death in low-income countries (Thapar and

n Corresponding author. Tel.: þ880 2 9664953, þ 880 1816572691 (Mobile); fax: 880 2 9664950. E-mail addresses: [email protected], [email protected] (M.F. Kadir).

0378-8741/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jep.2013.02.023

Sanderson, 2004). In Bangladesh WHO estimates that the disease still kills more than 50,000 children in Bangladesh annually (BHSR, 2010). For the last couple of years, there has been a global trend for the renewal of interest in the traditional system of treatments. Simultaneously the need for basic scientific investigation of medicinal plants using indigenous medical systems has become ever more pertinent for accelerating better and effective treatment. WHO has also recognised the role of traditional medicine in the primary health care system (Akerele, 1984). A number of tribal people with diverse cultural backgrounds reside in Bangladesh and practice their own system of traditional medicine for primary healthcare. Reportedly more than 80% of the Bangladeshi use non-allopathic (Ayurveda, Siddha, Unani and Homoeopathy) medicines for their healthcare and herbs constitute a major ingredient of these alternative systems of medicine (Yusuf et al., 2009). Therefore, synergistic botanical preparations used by the traditional health practitioners (THPs) may be considered as one

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149

Fig. 1. Location of Bangladesh in Asia and area of collection of the plants used in gastrointestinal disorders in Bangladesh with number of plants collected from the area as indicated in the map.

of the prime strategies in drug discovery (Patwardhan and Mashelkar, 2009). Heterogeneous ecologic and geographic conditions have made Bangladesh to house more than 6000 species of indigenous and naturalised plants out of which more than 1000 contain medicinally useful chemical substances (Banglapedia, 2003; Mia, 1990). The knowledge on medicinal plants usage is very often passed on from one generation to the next only verbally (Nadembega et al., 2011) and most of this knowledge has not been documented (Sofowora, 1993; Asase et al., 2008, 2010). Moreover due to aberrant climate, man-made hazards in the forest and migrations of traditional medicinal healers to other jobs contributed to the rapid loss of this rich knowledge on medical treatment through natural ways. Several ethnobotanical investigations have been carried out at different parts of the world to explore the traditional treatment against gastrointestinal disorders (Heinrich et al., 1992; Appidi et al., 2008; Tetali et al., 2009; de Wet et al., 2010; Vera-Ku et al., 2010; Ribeiro et al., 2010). But no ethnobotanical survey was carried out in Bangladesh to explore the medicinal plants used in the treatment of gastrointestinal diseases. Because of geographical position, life style of people, lack of proper sanitation and awareness about disease prevention have lead to different types of gastrointestinal diseases. Current study was conducted in order to document the traditional knowledge of the plants used by the traditional healers of Bangladesh for treating different gastrointestinal disorders.

2. Materials and methods 2.1. Study area Bangladesh, a sovereign state located in South Asia and bordered by India and Myanmar and by the Bay of Bengal to the south (latitudes 201 and 271N and longitudes 881 and 931E,

with population over 162 million having 35 smaller groups of indigenous people covering about 2% of the total population living in different pockets of the hilly zones and some areas of the plane lands of the country (CIA World Factbook, 2012). Fig. 1 shows the area covered in our study (Dhaka, Chittagong hill tracts, Rangamati, Bandarban, Cox’s bazaar, Mymensingh, Sylhet, Sundarbans, Rangpur, Rajshahi and Barishal) and the number of plants collected as specimen from there for deposition in Bangladesh National Herbarium, Dhaka (DACB). 2.2. Informants and ethnomedicinal data collection The objectives of the study were clearly explained in Bengali language and verbal consent was obtained by the interviewer from each informant who met in social gatherings arranged by local people familiar with traditional healers and who could communicate with native communities. Current ethnobotanical survey was conducted between January 2010 and June 2012 with an aim to cover at least six Kabiraj/Ayurved/Hakim/Unani practitioners in each area. The experts in alternative and complementary medicine and reputed Hakims and/ or Ayurvedic drug manufacturers namely Hamdard, Ayurvedio Pharmacy, Shakti, Sadhana and Kundeshwari were also consulted. Special focus was given to the people having practical or empirical knowledge on medicinal plants. A total of 1280 people were interviewed for this purpose whose gender, age, educational background and experience on the use of traditional medicinal plants were also documented. Open-ended and semi structured questionnaire (Cotton, 1996; Bruni et al., 1997) were used for the purpose. The record of questionnaires used included the following information: (a) the local name, (b) plants part/s used, (c) the method of preparation, (d) solvent/ adjuvant used, (e) mode of application, (f) gastrointestinal and other medicinal uses, (g) voucher specimen number and (h) dose and dosage forms. Scientific names, family names, habit, habitat, nature and relative abundance were documented either consulting with Botanist Mr. Md. Manzur-ul-Kadir Mia, former Principal Scientific

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Officer and Consultant of Bangladesh National Herbarium, Dhaka or by literature search. The specimens were pressed, preserved and later identified by Botanist Mr. Md. Manzur-ul-Kadir Mia. The voucher specimens of the plants were deposited in Bangladesh National Herbarium, Dhaka (DACB). 2.3. Data analysis The species were listed in alphabetical order by their scientific name, family, local name, general name, plants parts used, mode of preparation, habit, habitat, relative abundance, geographical distribution, nature, general name, solvent used and frequency of citation (FC). The FC of the species of plants being utilised was evaluated using the formula: FC ¼(Number of times a particular species was mentioned/total number of times that all species were mentioned)  100. Frequency distribution was then calculated using the IBM SPSS Statistics 19 software.

3. Results

Table 2 Adjuvants used in traditional treatments of gastrointestinal disorders. Atap rice

Curd

Opium

Babla leaves Bark of Butea sp. Barley Betel Black berry Black peeper Butter

Cyperus rotundus Egg Fenugreek seeds Fern lygodium Ghee Ginger Holarrhena antidysenterica

Butter milk

Jaiphal (seeds of Myristica fragrans) Juice of cyperus rotundus Juice of pomegranate fruit Mango stem bark

Pepper Phyllanthus emblica Puffed paddy Rice Rice water Rock salt Root of Ficus benghalensis Saccharine

Cardamom Centella asiatica Cheera (pressed rice) Chutney Cinnamon Cloves Coconut Cumin

Molasses Mustard oil Mustard seeds Native spirit Nutmeg

Saffron Sago Salt Sesame oil Sugar Sugar candy Terminalia chebula Vinegar

3.1. Informants Among the 1280 interviewees, major informants were male (67%), aged (regardless of gender) 50–60 years (35.6%), mostly with 10 years of institutional education (32.81%) and having 10– 20 years of relevant experience (33.36%) (Table 1). 3.2. Plants for gastrointestinal disorders and other relevant information 250 plant species belonging to 93 plant families have been identified as being used in the gastrointestinal disorders by Table 1 Demographic Data of the informants. Variable

Categories

Frequency (n ¼1280)

Gender

Male Female

859 421

Age (years)

o20 20–30 30–40 40–50 50–60 460

73 128 169 317 456 137

Education (years)b

0a 5 8 10 12 16 416

75 142 255 420 215 115 58

Experiencec

o2 2–5 10–20 20–30 420

105 290 427 320 138

Hakim Unani Ayurvedic Independent healer Otherd

152 127 122 448 431

Profession

a

These people do not have any formal educational training. Year completed through formal educational institution. c Relevant to treating people. d People who acquired medicinal knowledge by themselves and usually involved in profession not relevant to medicine. b

traditional healers in Bangladesh. The largest number of species was noted from the family Fabaceae (20 species), followed by Rubiaceae (11 species), Asteraceae (11 species), Euphorbiaceae (9), Malvaceae (8 species), Rutaceae (7 species), Moraceae (7 species), Caesalpiniaceae (6 species), and Zingiberaceae (6 species). For a species, different parts were used—among these leaves (35.6%) were the most frequent used plant parts, followed by roots (30%) and barks (22.8%). The major mode of preparation is decoction (52.2%) followed by juice (24%) and infusion (19.6%). Preparations were made with water, honey, wine, lime water and milk as solvent. The list of adjuvants used is presented in Table 2. The mode of administration was oral (96.4%), topical (1.6%), oral & topical (1.2%), oral & rectal (0.4%) and rectal (0.4%). 36.4% of the reported species were herb which was followed by tree (36%), shrub (17.6%) and climber (8.8%). Of these plants, 39.2%, 31.6% and 12.4% of the species grow in forest, garden and hill forest respectively. There are significant portions that grow in village thicket (10.8%) and road side (10.4%) effortlessly. On the basis of availability of the species, they are categorised as common (70.8%), less common (22.4%) and rare (6.8%). Most of the plants are wild (47.2%) and some are either cultivated or planted; some are both cultivated and wild and others are cultivated and planted. The species Aegle marmelos (L.) Corr, Andrographis paniculata (Burm.f.) Wall ex. Nees, Averrhoea carambola (L.), Cannabis sativa L., Carica papaya L., Citrus limon (L.) Burm.f., Musa paradisiaca L. were the most frequently cited in the study area. The doses of the available plants are presented in Table 3.

4. Discussion Most of the medicinal plants listed in the current investigation belonged to the Fabaceae family. This predominance could be explained by world-wide prevalence of the species from this family (Kadir et al., 2012a; Marles and Farnsworth, 1995). The major plant parts used were leaves solely or mixed with other plant parts. Similar kind of results have also been reported in other studies (Mahishi et al., 2005; Abo et al., 2008; Gonzalez et al., 2010; Telefo et al., 2011; Kadir et al., 2012a). Ease of collection of leaves in comparison to roots, flowers and fruits is another prime reason (Giday et al., 2009; Telefo et al., 2011). Herbs and trees were the most common plants which might be attributed to the huge number of trees or herbaceous plants

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Table 3 Doses of the available plants.

Table 3 (continued ) S/L

S/L

1

2

3

4

5

6

7

8

9

10

11

12

Name of the plants

151

Name of the plants

Doses

Doses

It is used as a tonic in diarrhoea in combination with aromatics such as Acacia catechu Willd. cinnamon and nutmeg in doses of 5–20 grainsa. The tender leaves (3–4 g) in 1–2 poabs of water are boiled and reduced to one chatakc, and then used once or twice with a little Acacia nilotica L. sugar to enhance the efficacy. 3–4 g of bark of Holarrhena antidysenterica is added at the time of boiling. It is given as a hot infusion in doses of two ouncesd twice or thrice a day. A decoction is made by boiling together two ounces of rhizome, one drachme of coriander and half Acorus calmus L. a drachm of black pepper in a pint of water till the liquid is recluced to 12 ounces. One ounce of the decoction is given three times a day to adults and 1–3 drachms with sugar two or three times a day to a child. Pulp of green fruit, softened by roasting and sweetened with sugar candy is useful in chronic diarrhoea and dysentery (dose: 2–6 Aegle marmelos L. fluid drachms, 3–4 times in 24 h). Unripe fruit cut into slices, sun-dried and heated before eating with a little sugar. lt is given in doses of 1–2 drachms. In case of dysentery and dyspepsia one small part of bulb (qua) is chewed every morning Allium sativum L. and if tolerable one qua of bulb is taken every morning and evening. 1–2 fluid ounces of the infusion of bark are given 2–3 times a day. In bowel complaints, 3–5 grains of the powdered bark are Alstonia scholaris R.Br. prescribed. In catarrhal dyspepsia 15 grains are given at night. The doses are 10–15 grains with sugar every Areca catechu L. three or four hours. In dysentery, the powder of the root in doses of about 45 grains is given with milk. In diarrhoea the dose is half tolaf. The juice Asparagus racemosus from the fresh root is given orally in Willd dysentery. In blood dysentery, the juice of the powdered root (about 4 teaspoonsg) is mixed with 7–8 teaspoons of milk and taken internally twice a day for one or two days. An emulsion of the astringent bark made Bauhinia variegata L. with rice water is given with a little ginger in diarrhoea. The dose of the powdered gum is 5–20 grains or 10–30 grains with a few grains of cinnamon or 5–30 grains with a few grains Butea monosperma Lamk. of aromatics. In doses of 5 grains, it is most useful in checking serious cases of diarrhoea. 4 grains being an average dose for children of 4 years. 15 grains of the powder root bark combined with a grain of opium is substitute for ipecacuanha. The dried and powdered pistils and stamens in doses of 2–3 grains are repeated hourly to check or moderate Calotropis gigantea L. vomiting in cholera. The flower buds in doses of 5 grains combined with black pepper and salt are useful in dyspepsia with palpitation and in cholera; in later disease especially to check vomiting. The preparation made specially from dried leaves and flowers known as bhang, siddhi or hashis is given to check diarrhoea, dyspepsia and bowel complaints. The smoke of dried pistillate of flowering tops which are coated Cannabis sativa L. with resinous exudation (known as ganja) is passed through the rectum for relief from strangulated hernia and griping pains of dysentery.

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27 28 29 30 31

The bark extract is given in empty stomach with cow’s milk once daily for 3 days in case Careya arborea Roxb. of blood dysentery. For more effectiveness ‘cheera’ (pressed rice) and jaiphal (seeds of Myristica fragrans) are also added. In dysentery one teaspoon of the raw latex of the fruit mixed with 30 drops of lime Carica papaya L. water are taken internally with milk (once only) to relieve colic pain. The water obtained by distillation of the seeds called omum warer, exercises considerable power; especially in the early stage of diarrhoea and vomiting. At the same time stimulate the system. The dose taken internally in chronic dyspepsia is: jowan of Carum copticum Benth the weight of 2 ounces; haritaki (dried fruit of Terminalia chebula) of the weight of 2 ounces; rock salt of the weight of 1 ounce; administered with lime juice, every morning. 20–30 grains of the gum are given to Ceiba pentadra L. children in diarrhoea. The juice of the leaves is efficacious in empty stomach. The whole plant mixed with Drymaria cordata and Oxalis cornicultais boiled and taken or 2–3 spoonfuls of leaf paste given in empty stomach for 2–3 days Centella asiatica L. to cure dysentery. The paste of 3–4 leaves with cumin and sugar is used as poultice on the abdomen or the juice taken internally to give relief against blood dysentery and diarrhoea. It is dried and taken at breakfast time with Corchorus capsularis L. boiled rice in case of dysentery or blood dysentery. 15 g of coriander, 25 g of cow ghee, boiled until almost dried then strained and is used Coriandrum sativum L. twice in the morning and evening for two days. The two year old tubers should be washed and freed from rootlets cut in slices by a wooden knife and dried in the shade. For Curculigo orchioides dysentery and diarrhoea a powder of the Gaertn. rootstock is taken with butter milk or rice water. It is given in doses of 3–6 drops with sugar Cymbopogon citratus or as an emulsion. A tea made from leaves is (DC.) Stapf. a stomachic. Two leaves of lndian black berry (Sygyzium cumini) together with 5–7 g of this grass are crushed and the juice after straining mixed Cynodon dactylon Pers with a little hot milk and administered to cure any type of dysentery. Cyperus rotundus L. They are scraped and pounded with honey. 20–25 g of carrot, cut into pieces and soaked in 4 cupsh of water until the amount of Daucus carota L. water is reduced to approximately half, are used 2–3 times after properly straining in cases of diarrhoea. The powered seeds 250 mg doses is taken Drypetes roxburghii Wall. every 4 h with a little sugar and water. One or two teaspoons of the bark juice warmed a little with 2–4 teaspoonful of milk Erythrina variegata L. and is administered for 2–3 days to cure blood dysentery. The juice is given in doses of half teaspoon Evolvulus alsinoides L. twice a day. Powder of the leaves is given in 1/2–1 Feronia limonia L. drachm. A small quantity of the milk juice is taken Ficus benghalensis L. early in the morning in dysentery. The milk juice or latex is administered in Ficus racemosa L. piles and diarrhoea in 2–3 drops. Flacourtia jangomas Paste of about 7 g of bark with 2 mg of (Lour,) Willd mustard seeds is heated in an earthen pot

152

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Table 3 (continued ) S/L

32

33

34

35

36

37

38

39

40

41

42

43

44

Name of the plants

Table 3 (continued ) Doses

S/L

Name of the plants

and given with curd twice everyday in dysentery.

45

Ocimum tenuiflorum L.

46

Oroxylum indicum Vent.

47

Oxalis corniculata L.

48

Piper betle L.

49

Piper longum L.

50

Plumbago zeylanica L.

51

Portulaca oleraceae L.

52

Psidium guajava L.

53

Raphanus sativus L.

54

Ricinus communis L.

The juice of the leaves in doses of 1–2 drachms or their infusion with the addition of lime water is given in diarrhoea and Gossypium herbaceum L. dysentery. The leaf juice with a teaspoon of juice of the rhizomes of Cyperus rotundus mixed with little honey is very efficacious in diarrhoea. A paste prepared of 15 g of plant in 1.5–2 cups of hot water, kept for an hour, strained and taken internally a little quantity every 15–20 min is very efficacious for strong diarrhoea. Alternatively 6–7 g of dry plant is Hedyotis corymbosa made inot a paste and boiled with 3 cups of (L) Link. water until the liquid is reduced to approximalely 2 cups. This decoction is strained and 4–5 tea spoonfuls are administered every 15–20 min. The root powder is given in doses of 10–60 grains with milk, or its decoction in doses of 2–3 ounces thrice a day. The root (5 g) along Hemidesmus indicus (L.) with Talmuli (Curculigo orchioides), root of Elephantopur scaber, motha (rhizome of R.Br. Cyperus rotundus) fennel and cumin seeds is given to children 2–3 times a day in diarrhoea. In the cases of dysentery and blood dysentery the juice of the plant is taken one Hemigraphis hirta (Vahl) or two teaspoonfuls according to age. The Ander. dried and powdered plant is also used in 5– 7 g doses. The liquid extract is given in doses of 15–30 drops for children and one to two1–2 Holarrhena drachms for adults. The decoction is given in antidysenterica (Heyne doses of 1–3 ounces; the daily doses of the ex Roth.) powder are 60–120 grains divided into 3–4 portions. In dysentery, 2 tolas of the flowers fried in ghee, rubbed down with a little cumin and Ixora coccinea L. nagkesar, made into a bolus with butter and sugar candy and administered twice a day. Kalanchoe pinnata (Lam). The dose is 45–180 grains or 1/4–1 tola mixed Persoons, with twice its quantity of melted butter. Decoction of bark is given in 1/2–1 ounces dose in dyspepsia and general debility, gout Lannea coromandelica and dysentery. 10 g of bark is boiled in 4–5 (Houtt.) Merr. cups of water until the liquid is reduced to one cup, cooled and strained before use. The fried kernel is given to children and to expected mothers suffering from diarrhoea in doses of 1–3 grains. In dysentery, with slime the kernel powder is taken with curds. The powdered kernel with resin and kurchi is also Mangifera indica L. given in dysentery. Dose: equal quantities of each ingredient mixed together and about 15 grains are given twice or thrice a day to adults; in case of children, 1–3 grain dose alone or with dried bael (Aegle marmelos). Powdered leaves are taken alone or with leaves of Hedyotis and Ageratum in decoction Melastoma for dysentery. A paste made from 2–3 roots malabathricum L. of this plant and 3–5 roots of Antidesma diandrum. The leaf is useful in stomachic pain and Mikania cordata dysentery; about 150 ml of leaf sap is given (Burm.f.) Robins. three times a day. The decoction of the leaves and stem (dose: of the weight of 2 ounces) are used internally in chronic dysentery. ln cases of Mimosa pudica L. amoebic dysentery leaves (5–6 g only) are boiled and after straining the decoction is taken internally. They are given in doses of 1–2 drachms to Ocimum basilicum L. adults and 4–5 grains to infants administered in syrup.

Doses The leaf juice is stomachic and is given in doses of 180 grains every morning in dysentery and dyspepsia. Its infusion is given in doses of two ounces three times a day or its powder in doses of 5–15 grains. The juice expressed from the root bark is heated in a container of leaves plastered with layer of clay outside. The juice is then mixed with the gum of Bombax ceiba and given in dysentery and diarrhoea. Leaves boiled in butter milk and taken thrice a day or leaves reduced to a paste together with ghee and curdled milk or leaf juice made into a sherbet with a little sugar. The juice with honey is given to children in coiic indigestion, diarrhoea and fever in one drachm doses twice a day. Tlre mature spikes (pipul), mixed with haritaki (dried fruits of Terminalia chebula) are used in dysentery. The dose is 1 part of pipul and 4 parts of haritaki in 3 g of hot water. It is given only in small doses of 10–20 grains in dyspepsia and diarrhoea. 15 drops of warm juice is mixed with 2–4 drops of honey and given twice a day morning and evening. To prepare the decoction, half an ounce of the root bark is boiled with 6 ounces of water and evaporated to reduce the liquid to 3 ounces. It is administered in doses of one or more teaspoonfuls 3 or 4 times a day for children. The young leaves with the buds of the pomegranate and babla leaves, given in the form of a cold infusion are useful in diarrhoea of children. 10 grains of dried radish is boiled in 4 cups of water until the mixture is reduced to one cup. The decoction is then strained and administered 4–5 times in a day. The purgative effect is obtained with doses of 1–2 drachms taken in empty stomach; larger doses frequently induced diarrhoea. The roots of the plants are also used against colic and blood dysentery. 25 g of roots are first boiled in a mixture of half poa of milk and half seeri of water until the decoction is reduced to half poa and used after straining.

a

One grain ¼0.0647989 g. One poa ¼233.25 g. c One chatak ¼ 58.32 g. d One ounce [troy] ¼31.1034768 g. e one drachm ¼3.8 g. f One tola ¼ 11.6638125 g. g teaspoons ¼5 ml. h Cups¼ 250 ml. i seer ¼933.105 g. b

naturally abundant in the locality (Tag et al., 2012) and accessible to the communities of traditional healers (Tabuti et al., 2003; Uniyal et al., 2006). Deforestation and selective cutting are the main factors for the species being rare. In the study area, deforestation is proceeding at alarming rate due to agricultural expansion and urbanisation (Kadir et al., 2012b). Also there is a tendency of using particular types of plants excessively for its popularity in some particular healings, without concerning its vulnerability. We have documented the local unit for the dose suggested by the THPs as conversions of local unit to international unit makes the calculation unnecessarily complicated. However, the conversion scale is given in Table 3. We noticed the lack of precision of doses among the informants on certain remedies due to rough

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estimation of the doses. THPs prescribed the dose customarily based on their observations of the type of ailments, seriousness of the illness and age of the patient. Doses of liquid remedies administered to humans were usually measured using tea or coffee cups, teaspoons or by number of drops. It was noticed that THPs used concoction of different adjuvants including another plant parts for the preparation of medication in the treatment of single ailments. Several researchers also reported the similar findings (Teklehaymanot et al., 2007; Ignacimuthu et al., 2008; Tabuti et al., 2010; Upadhyay et al., 2010). The frequent use of multiple plant remedies might be attributed due to the fact of synergistic actions where two or more plants produce an effect greater than the sum of their individual effects (Giday et al., 2010). Poly-herbal treatment might attain better healing power than single medicinal plant treatment, since each medicinal plant contains ample of pharmacologically active compounds (Teklehaymanot et al., 2007). The species with high FC values reflect the popular plants with strong and versatile healing power and further pharmacological, toxicological and phytochemical analysis of these plants should be carried out for the discovery of potential novel antidiarrheal drugs. Explaining the mode of actions of 250 plants individually is beyond the scope of this study. To generalise the mechanism on the other hand means excluding a lot of important information. Most of the plants documented in our study are used not only to treat gastrointestinal disorders but also in many other diseases like sore throat, astringent, menorrhagia, haemoptysis, malaria, liver disorder, snake bite, gout, rheumatism, bronchitis, piles, kidney disease, heart burn, emesis, palpitation, hernia, vomiting of bilious remittent fever, insomnia, vomiting, dysuria, depression, loss of appetite, haemoptysis, wounds, scurvy, intermittent fevers, emmenagogue, bilious pepsia, flatulence, hiccup, febrifuge, infestation by worms, mucus stools etc. This trend indicates the tradition of developing local healing system through trials and errors for optimal treatment practices as mentioned elsewhere also (Dey and De, 2012). In order to find the specific compound responsible for the rationale of use, several studies have been conducted for active principles in the plants used to cure gastrointestinal disorders (Kumar et al., 2001; Chitme et al., 2004; Gilani et al., 2008). Among 250 plants in our study, the phytochemical investigations were not conducted in most of the plants and therefore the compounds founds therein are still unknown. Extensive phytochemical investigations on the plants mentioned in our study could be another mammoth task. As most of the plants in our

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study did not undergo phytochemical investigations, information provided here is very limited. Most of the plants in our study with earlier report contain phytochemicals like glycosides and flavonoids that are considered to have anti-diarrhoeal properties (Palombo, 2006). Lectin from Aegle marmelos (L.) (Raja et al., 2011); asiaticoside from Centella asiatica L. (Cheng et al., 2004; Guo et al., 2004); alkaloid from Holarrhena antidysenterica (Heyne ex Roth.) Conessi. (Raj et al., 2010); flavonoids and terpenoids from Vitex negundo L. (Nagarsekar et al., 2010); phenol from Tamarindus indica L. (Escalona-Arranz et al., 2010); zingerone (vanillylacetone) from Zingiber officinale Roscoe (Chen et al., 2007) possess different properties that are relevant to use in different gastrointestinal disorders. Also a trace of quercetin aglycone together with five glycosides (quercetin 3-O-alpha-Larabinoside (guajavarin); quercetin 3-O-beta-D-glucoside (isoquercetin); quercetin 3-O-beta-Dgalactoside (hyperin); quercetin 3-O-betaL-rhamnoside (quercitrin) and quercetin 3-Ogentobioside ) was isolated from the Psidium guajava leaf that shows spasmolytic activity (Lozoya et al., 1994). Several unidentified compounds from different parts of Carica papaya L. (Chen et al., 1981; Ezike et al., 2009) also possess the property for being used in gastrointestinal disorders. Several investigators have reported about the pharmacological relevance to the plants used in gastrointestinal disorders (Caceres et al.,1990; Rojas et al.,1995; Johns et al.,1995; Longanga et al., 2000; Diehl et al., 2004; Maniyar et al., 2010; Imran et al., 2011; Kozan et al., 2011; Rani and Khullar, 2004; Ahmad and Aqil, 2007; Dey et al., 2011; Mukherjee et al., 2012) but most of the 250 plants included in our study do not have much information regarding pharmacological relevance. Some of the plants have extensive information regarding their phytochemical compounds and mechanism of action which is related to substantiate their properties to have application in gastrointestinal disorders and possess hepatoprotective, gastro-protective, anti-enteric bacterial, anti-helmintic, anti-amoebic, anti-diarrhoeal, anti-cholera, antiulcer and purgative activities. Holarrhena antidysenterica (Heyne ex Roth.) Conessi. prevents adhesion of the enteric bacteria Escherichia coli on host epithelial cells (Gilani et al., 2010), activates histamine receptors and blocks calcium channel for mediation of antidiarrheal and spasmolytic properties (Kavitha and Niranjali, 2009); Aegle marmelos L. Corr. inhibits colonisation of enteric bacteria in the gut epithelia (Mazumder et al., 2006; Brijesh et al., 2009); Alstonia scholaris R.Br. works against fore stomach carcinogenesis (Jagetia et al., 2003; Nersesyan, 2004; Shah et al., 2010); papain from Carica papaya L. decreases acid secretion (Chen et al., 1981); Centella asiatica L.

Table 4 Literature study of the plants surveyed having toxicity. Scientific name

Toxic compounds

Toxic effects

Acorus calamus L.

Beta asarone

Procarcinogenic

Argemone mexicana L.

Sanguinarine, Dihydrosanguinarine

Epidemic dropsy

Azadirachta indica A. Juss.

Azadirachtin

Encephalopathy, Ophthalmopathy Suppress spermatogenesis and fertility, Digestive problem Ocular toxicity Carcinogenic Azoospermia

Annona squamosa L.

Abortifacient, eye irritant

Bacopa monieri (L.) Pennell Calotropis procera (Ait) Ait.f. Cannabis sativa L. Carica papaya L.

Catotoxin, Calotropine, Calcilin, Gigantin

Cassia occidentalis L.

Pyrrolizidine alkaloid

Hepatotoxic

Cuscuta reflexa Roxb. Ricinus communis L.

Ricin

Abortifacient Abortifacient

Reference Weisburger (1979); Paneru et al. (1997) Ajesh et al. (2012) Meaker (1950); Verma et al. (2001); Sharma et al. (1999); Das and Khanna. (1997) Gandhi et al. (1988); Bhaskar et al. (2010) Pravina et al. (2007); Singh and Singh (2009) Kuriachen et al. (1989); Basak et al. (2009) Moir et al. (2008) Lohiya et al. (2002) Huxtable et al. (1989); Vanderperren et al. (2005); Vashishtha et al. (2007) Katewa et al. (2008) Araga~ o et al. (2009)

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controls myeloperoxidase activity (Cheng et al., 2004) and inhibits nitric oxide synthase (Guo et al., 2004) in the ulcer tissues; Emblica officinalis Gaertn. possesses antisecretory, antiulcer and cytoprotective activites due to its effect on mucosal factors such as acid, pepsin, mucin secretion etc. (Sairam et al., 2002; Al-Rehaily et al., 2002); Hedyotis auricularia L. possesses hepatoprotective and gastroprotective properties (Singh and Handa, 1995; Shanmugasundaram and Venkataraman, 2006); Tamarindus indica L. decreases gastric juice volume and acidity which is comparable with standard drug (Kalra et al., 2011); Vitex negundo L. possess anti- ulcerative colitis properties (Zaware et al., 2011). Through literature study, we 11 eleven plants having toxic potentiality (Table 4). Unless epidemic dropsy and ocular toxicity caused by seed oil of Argemone mexicana L. (Meaker, 1950; Verma et al., 2001; Sharma et al., 1999; Das and Khanna, 1997) and latex of Calotropis procera (Ait) Ait.f (Kuriachen et al., 1989) respectively, the rest are toxic only due to high doses ingestion.

5. Conclusion Current inventory represents the contribution of natural flora of Bangladesh to the global approach in the treatment of different gastrointestinal disorders. This knowledge will aid in the development of novel plant based treatment. Although, preliminary studies undertaken on these medicinal plants have confirmed their efficacy, but further investigations should be carried on especially in order to ensure safe therapy concerning medicinal plants.

Acknowledgements The authors acknowledge the contribution of all the tradition medicine practitioners and ayurvedic drug manufacturers for providing relevant information regarding medicinal plants and their practices. We also express appreciations to all the government and non-government authorities for their help and the administrative facilities during the survey.

Appendix A. Supporting information Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.jep.2013.02.023.

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