Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India

Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

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Original Research Article

Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India S. Esakkimuthu a, 1, S. Mutheeswaran a, 1, P. Elankani b, P. Pandikumar a, *, S. Ignacimuthu a, ** a b

Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai, Tamil Nadu, 600 034, India Siddha Clinical Research Unit, Government Siddha Medical College Campus, Palayamkottai, Tirunelveli, 627 002, India

a r t i c l e i n f o

a b s t r a c t

Article history: Received 19 July 2018 Received in revised form 15 October 2018 Accepted 5 November 2018 Available online xxx

Background: Siddha is one of the traditional medical systems of India; previous ethnobotanical survey in Virudhunagar district indicated a high consensus for treating musculoskeletal ailments. Objectives: This study was aimed to quantitatively document the medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India. Materials and methods: This work was the outcome of free-list interviews conducted among 45 informants between April 2016 and January 2017. Sampling sufficiency was assessed by plotting Shannon eWiener's index and cumulative number of UR. Informant consensus was assessed using Informant Consensus Factor (Fic) and Informant Agreement Ratio (IAR). Results: This study recorded the data regarding 116 plant species which were used to prepare 129 formulations; analysis of the data yielded 490 UR. Among these, 65.3% of UR dealt with internal applications and 34.6% dealt with external applications. In the case of internally used formulations, pain and general musculoskeletal ailments had high Fic values. In the case of externally used formulations, headache and pain had high Fic values. Conclusion: Important species prescribed by the informants to treat various musculoskeletal ailments were: Azima tetracantha, Ricinus communis, Sesamum indicum, Moringa oleifera, Cardiospermum halicacabum (internal application), Calophyllum inophyllum, Justicia adhatoda, Curcuma longa, Calotropis gigantea, Zingiber officinale, Withania somnifera, Strychnos nux-vomica, Dodonaea viscosa (external application), Azadirachta indica, Clerodendrum phlomidis, Delonix elata, Pergularia daemia and Vitex negundo (internal and external applications). Robust studies on these local claims will help to improve the community healthcare and will yield some novel agents to treat musculoskeletal ailments. © 2019 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Keywords: Traditional medicine Siddha Non-communicable diseases Topical anti-inflammatory Pain ta  ailments Va

1. Introduction Traditional medicine system is defined as the accumulated therapeutic experiences of generations [1]; it is still used by about

* Corresponding author. ** Corresponding author. Fax: þ91 44-2817 5566. E-mail addresses: [email protected] (P. Pandikumar), eri@ loyolacollege.edu (S. Ignacimuthu). Peer review under responsibility of Transdisciplinary University, Bangalore. 1 Authors of equal contribution.

75e80% of the world population for primary health care [2]. In India various traditional healthcare systems are available and it includes the use of about 7000 species of flowering plants [3]. Siddha is one of the important traditional medical systems of India majorly practiced in Tamil Nadu and its fringes [4]; it is also practiced in other countries such as Sri Lanka, where the Tamil people live. According to the siddha doctrine, the human body is made up of  ta  96 principles (thattuvam). Among them, three humors namely va (x air), pitta (x fire) and kapa (x water) are considered as important principles for health. Any imbalance among them causes

https://doi.org/10.1016/j.jaim.2018.11.005 0975-9476/© 2019 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

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S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

 ta  humor maintains all the movements of the body illnesses. The va such as movement of organs, reflexes, functional co-ordination, etc. Any derangement in this humor in a particular organ will show the characteristics of pain, debility, tremor, rigidness and loss of func ta  tion in the related organs and these changes are termed as va  ta  ailments. Siddha literature describe about eighty fives types of va diseases [5,6]; most of them were the musculoskeletal ailments and few other illnesses like hernia were also categorized under this group in the traditional literature. These ailments are one of the important illnesses treated by the siddha system of medicine; our previous study in the same area showed high informant consensus for this illness category [7]. Musculoskeletal disorders (MSD) are the second largest cause of disability [8], impacting the individuals and their prevalence is increasing with age [9].The prevalence of MSD in India was calculated as 6.4e23.6% [10] and it was the most common self-reported illness. Two-third of MSD subjects in India were reported to suffer from non-specific pain and arthralgia [11]. An US based survey between 1992 and 2010 indicated that MSD accounted for about 29e35% of all occupational illnesses involving days away from work [12]. According to a survey musculoskeletal pain nearly affects one in every four adults and the annual cost of managing pain ranged from 560 to 635 billion dollars for the United States [13]. Further, MSD was identified as one of the most common causes for seeking self-medication. The use of complementary and traditional therapies in the management of MSD is reasonably common globally and a survey in India conducted among dentists indicated that about 70% of subjects with MSD use only these alternate therapies [14]. The importance of training traditional healers for the management of MSD in India was also reported by previous studies [15]. In this survey, we quantitatively documented the medicinal plants used by the non-institutionally trained siddha practitioners of Virudhunagar district to treat the musculoskeletal ailments. It also documented the formulations for few non-MSD like hernia, testicular  ta  pain since they were also considered as one among the va ailments. 2. Methodology

with the help of the elders in the study area. Only the practitioners who were treating musculoskeletal ailments for more than five years and gave consent to participate in the interview were included in the survey. The aims and objectives of the study were explained in lay terms before the start of the interview and the informants were explained that they had the right to stop the interview at any time. The first two visits were used to explain these details and the formal interviews were conducted from the subsequent visits [16]. All the protocols were reviewed and approved by the Institutional Ethics Committee for Ethnobiology Research (ERI/IEEC/15/02) and the field surveys were conducted by SE, SM and PP. This interview includes the ethnomedical data obtained from 45 non-institutionally trained siddha practitioners of Virudhunagar district who gave written consent to share their knowledge. The methodology used for this study is successive free-listing method [17] to collect the data. The questionnaire consisted of two parts. The first part dealt with the demography of the informants and the second part dealt with their knowledge on the medicinal plants used for treating musculoskeletal ailments. In the second part, the informants were asked about the formulations given to treat musculoskeletal ailments, their ingredients, parts used with measures, mode of preparation, illnesses treated with their symptomatology, dose and duration; all these were documented. The interviews and the data were gathered through the local language, Tamil and the data were translated into English in the laboratory. Equivalent English terms for the illnesses were fixed by correlating the Tamil terminologies and symptoms with the biomedical literature by one of the authors of this communication (PE), who is an institutionally trained siddha practitioner. 2.3. Specimens Collected plant specimens or raw drugs were identified through examination of voucher specimens and the binomial names for the species were fixed using local floras [18e21] and the valid correct names were confirmed with a website (http://www.theplantlist. org/). The plant specimens and raw drugs were stored at the herbarium of Entomology Research Institute, Loyola College, Chennai.

2.1. Study area 2.4. Data analysis Virudhunagar district is located in Tamil Nadu with an area of 4288 km2 (Fig. 1). It is bounded by Madurai, Thoothukudi and Theni districts in Tamil Nadu and by Kerala state in the west. The district has a mixture of rural and urban populations; the rural population is 49.5%. This district comprises eight taluks (sub-districts) namely Aruppukkottai, Kariapatti, Thiruchuli, Rajapalayam, Srivilliputtur, Sivakasi, Sattur and Virudhunagar. The population density of this district is 458 inhabitants/km2 and the gender ratio for females to males is 1.7:1.0. The total literacy rate of Virudhunagar district is 80.1%; the female literacy rate is 65.5%. Forests in this district are found on the eastern slopes of the Western Ghats and they occupy only 6.3% of geographical area of this district. Agriculture is the major source of revenue in rural parts, while printing and cracker industries are the major source of revenue in the urban areas. The State Government is providing siddha treatment in nine hospitals and 16 Primary Health Centers with 31 institutionally trained siddha practitioners (Anonymous, 2010). Nearly 126 noninstitutionally trained siddha practitioners and 97 folk healers are practicing in this district [7]. 2.2. Interviews The field survey was conducted from April 2016 to January 2017. The non-institutionally trained siddha practitioners were identified

The illnesses were grouped into illness categories on the basis of siddha literature. The data on medicinal plants were converted into use-reports (UR) in accordance with the previously published methodology [22]. Sampling sufficiency of the survey was assessed by plotting Shannon Wiener's index, which was calculated using PAST3 program; cumulative number of use-reports and attaining a clear asymptote of the curve are considered as indicators of sampling sufficiency. The data were grouped into external and internal formulations. Informant consensus factor (Fic) was calculated for external and internal formulations separately under each illness category using the following formula. Fic ¼ (Nur e Nt) / (Nur e 1) Where Nur is the number of UR for a particular illness category, and Nt is the total number of species mentioned for that particular illness category. This factor ranges from zero to one, where increasing values indicate high rate of informant consensus. To assess the importance of individual species in each illness category Index of Agreement on Remedies (IAR) was calculated using the following formula Index of Agreement on Remedies (IAR) ¼ nur  na/ nr e 1

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

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Fig. 1. Map of the study area.

Where nur is the total number of UR registered for species and na is the number of illness categories that are treated with that species.

3. Results 3.1. Demography of the informants Analysis of the demography of the informants indicated that 78% of the informants were above 50 years of age and all are belonging to male gender. All informants completed only primary or secondary school education. The major way of non-institutional knowledge transmission was master and disciple method; all the informants were full time practitioners and 67% of the informants had >20 years of experience (Table 1).

3.2. Quantification of the data This survey is the outcome of 45 interviewing noninstitutionally trained siddha practitioners of Virudhunagar district of Tamil Nadu. The data regarding the different musculoskeletal ailments closely related English terms and illness categories under which they are grouped are given in Table 2. The data regarding the formulations used by the informants to treat various musculoskeletal ailments are given in Table 3. Plotting species richness curve indicated that the sampling was sufficient for data analysis (Fig. 2). This study recorded the data regarding 129 traditional siddha formulations used to treat various musculoskeletal ailments and analysis of the data yielded 490 UR. Among these UR, 320 (65.3%) dealt with internal applications and 170 (34.6%) dealt with external applications. Conversion of UR to claims yielded 345 claims and 231 (66.9%) claims dealt with internal uses. Only 25

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

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Table 1 Demographic profile of the informants shared their knowledge for this study. Attributes Age 45e50 51e60 61e65 Above 66 Gender Male Education Primary school Secondary school Mode of learning From family members From traditional practitioners Experience 20 years 21e30 30e45 Occupation Full time practitioners

Number

Percentage

10 18 10 7

22.22 40 22.22 15.55

45

100

16 29

35.55 64.44

12 33

26.66 73.33

15 10 20

33.33 22.22 44.44

45

100

(10.8%) and 20 (17.5%) claims had minimum two URs for internal and external uses, respectively. The rest of the claims were singletons (see Tables 4 and 5). This study recorded the use of 116 species to treat various musculoskeletal ailments. Among them, 49 (42.2%) species were

reported for internal uses; 32 (27.5%) were reported for external uses and 35 (30.1%) were reported for both external and internal uses. In the case of species used only internally, Plumbago indica had high number of UR. In the case of species used only for externally usage, Cocos nucifera had high number of UR. Zingiber officinale had high number of UR in the case of plants used both externally and internally. The illness categories were grouped arbitrarily into three groups viz., illness categories having high, average or low Fic values [23,24]. The illness category, pain had highest overall Fic value, followed by general musculoskeletal ailments. 3.3. Quantification of internally used formulations In this category, pain and general musculoskeletal ailments had obtained high Fic values, compared to the others. The illness cate ta  of scrotal region, paresis and spasm gories like flatus, stiffness, va had average Fic values. Z. officinale obtained 12 UR for pain followed by Allium sativum. In the illness category of pain, the plants such as Saussurea costus, Senna auriculata and Delonix elata had high IAR values. In the case of plants given to treat general musculoskeletal ailments Piper nigrum, Z. officinale and A. sativum also got high number of citations. In this category, Clerodendrum phlomidis, D. elata and Vitex negundo had high IAR values. The plants with high number of citations for illness categories with average Fic values ta  of scrotal were: P. nigrum (flatus and stiffness), A. sativum (va

Table 2 Local terminologies of various musculoskeletal ailments reported by the informants with equivalent English terms. S. No.

Local Name

Equivalent English terms

Illness category

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

tam Aṇṭava  tano y Arampa va

Inflammation and swelling of the testicles Early stage of musculoskeletal ailments Lumbosacral pain Poliomyelitis Body pain Hemicrania Pain in the neck Pain in the leg Arthralgia Hernia Nagging pain Nagging pain of all the limbs Pain in upper and lower limbs Quadriplegia Lancinating pain Headache Spasm resulting from numbness Rheumatism of the Shoulder Parkinsonism Contraction of a nerve or muscle Hemiplegia Paresis Spasm in the shoulder Pain in occipital region Stiffness Boring headache Chest pain Arthritis Pain in the knees Pain during breathing Pain in the joints ta  humour Inflammation due to vitiated va ta  humour Pain due to vitiated va  ta  humour Swelling due to vitiated va ta  humour Pain due to vitiated va  ta  ailments All types of va Stiffness due to flatus Testicular Swelling Pain in testicles Oedema

ta  of scrotal region va General musculoskeletal ailments Pain Poliomyelitis Pain Pain Pain Pain Arthritis Hernia Pain Pain Pain Paresis Pain Pain Spasm Rheumatism Parkinsonism Spasm Paresis Paresis Pain Pain Stiffness Pain Pain Arthritis Pain flatus Pain Inflammation Pain Swelling Pain General musculoskeletal ailments flatus ta  of scrotal region Va ta  of scrotal region Va Swelling

Iṭuppuvali tam Iḷampiḷḷai va Uṭalvali Orupakkat talaivali Kaḻuttuvali lvali Ka tam Kılva tam Kuṭalva Kuṭaiccal l kuṭaiccal Kai, ka l vali Kai, ka ṅka va tam Carva  lai Cu Talaivali tam Timirva ḷpaṭṭaippiṭippu To tam Naṭukkuva Narampuppiṭippu tam Pakkava ricava yu Pa Piṭari icivu Piṭarivali Piṭippu Maṇṭaikkuttu rpuvali Ma tam Muṭakkuva l vali Muḻaṅka  ccuppiṭippu Mu  ṭṭuvali Mu ta aḻaṟci Va ta vali Va ta vıkkam Va takkaṭuppu Va tam aṉaittum Va yuppiṭippu Va Vitai vıkkam tam Vitaiva Vıkkam

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

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Table 3 List of formulations used by the informants for treating musculoskeletal ailments. S.No

Ingredients

Mode of preparation

Doses & Duration

Illnesses

1

Seeds of Abrus precatorius L. [SM-103]

2

Seeds of Abrus precatorius L.

Applied externally, when needed Applied externally, once daily for a week

Rheumatism of the shoulder Pain in the joints

3

Leaf juice of Abutilon indicum (L). Sweet (100 mL) [SM-090], Leaf juice of Acalypha indica L. (100 mL) [SM-023], Leaf juice of Aloe vera (L.) Burm.f. (100 mL) [SM-205], Leaf juice of Cleome gynandra L. (100 mL) [SM-224], Leaf juice of Coccinia grandis (L) Voigt. (100 mL) [SM-089], Oil of Azadirachta indica A.Juss. (750 mL) Leaves of Abutilon indicum (L.) Sweet (10 g), Bulbils of Allium sativum L. (5 g), Seeds of Piper nigrum L. (2 g), Palm sugar (q.s.) Leaves of Acalypa fruticosa Forssk. (50 g) [SM-021], Shells of Anacardium occidentale L. fruits (80 g) [SM-011], Cotyledons of Pongamia pinnata (L.) Pierre (100 g) [SM-059], Roasted borax (30 g), Oil of Azadirachta indica A.Juss. (250 mL) Leaves of Acalypha indica L. (100 g), leaves of Albizia lebbeck (L.) Benth (100 g) [SM-017], bulbils of Allium sativum (50 g), leaves of Cardiospermum halicacabum L. (100 g), barks of Crateva religiosa G.Forst. (50 g), rhizomes of Cynodon dactylon (L.) Pers. (100 g) [SM-075], Leaves of Delonix elata (L.) Gamble (100 g), resin of Ferula foetida (Bunge) Regel (50 g) [SM-116], roots of Indigofera parviflora Heyne ex Hook. & Arn. (100 g) [SM-076], roots of Jatropha curcas L. (50 g) [SM-321], bark of Moringa oleifera Lam. (100 g), roots of Pongamia pinnata (L.) Pierre (100 g), leaves of Vitex negundo L. (100 g), dried rhizome of Zingiber officinale Roscoe (50 g), sugar from the inflorescence of Borassus flabellifer L. (1 kg) [SM-054] Leaves of Achyranthes aspera L. [SM-117], Leaves of Azadirachta indica A.Juss., Leaves of Clerodendrum phlomidis L.f., Leaves of Justicia adhatoda L., Leaves of Leucas aspera (Willd). Link. [SM019], Leaves of Vitex negundo L. (q.s.) Rhizome of Acorus calamus L. (1 g) [SM-115], Leaves of Saussurea costus (Falc.) Lipsch. (2 g) Leaves of Albizia lebbeck (L.) Benth. (20 g), Bulbils of Allium cepa L. (2 g), Seeds of Cuminum cyminum L. (2 g) [SM-023], Leaves of Delonix elata (L.) Gamble (20 g) Root barks of Albizia lebbeck (L.) Benth. (100 g), Root barks of Azadirachta indica A.Juss. (100 g), Root barks of Azima tetracantha Lam. (100 g), Root barks of Cardiospermum halicacabum L. (100 g), Root barks of Clerodendrum phlomidis L.f. (100 g), Root barks of Crateva religiosa G.Forst. (100 g), Root barks of Indigofera parviflora Heyne ex Hook. & Arn. (100 g), Roots of Phyla nodiflora (L.) Greene (100 g), Roots of Pergularia daemia (Forssk.) Chiov. (100 g), Root barks of Moringa oleifera Lam. (100 g), Root barks of Vitex negundo L.(100 g), Stems of Sarcostemma acidum (Roxb.) Voigt (100 g) [SM-190], Root barks of Volkameria inermis L. (100 g) [SM-201] Bulbils of Allium sativum (20 g), Bark of Moringa oleifera Lam. (20 g), Seeds of Piper nigrum L. (20 g), Rhizome of Zingiber officinale Roscoe (20 g) Bulbils of Allium sativum L. (1 g), Leaves of Moringa oleifera Lam. (5 g), Rhizome of Zingiber officinale Roscoe (2 g) Bulbils of Allium sativum L. (15 g), Rhizomes of Alpinia calcarata (Haw.) Roscoe (15 g) [SM-018], Stem bark of Cedrus deodara (Roxb. ex D.Don) G.Don (15 g) [SM-222], Gum of Commiphora wightii (Arn.) Bhandari (15 g), Roots of Plumbago indica L. (15 g) [SM-094], roots of Rotheca serrata (L.) Steane & Mabb. (15 g) [SM-099], Roots of Ricinus communis L.(15 g), Roots of Sida rhombifolia L. (15 g) [SM-191], Smilax china L. (15 g) [SM-192], Seeds skin of Terminalia chebula Retz. (15 g) [SM-052], Roots of Vitex negundo L.(15 g) [SM-056], Dried rhizome of Zingiber officinale Roscoe (15 g) [SM-020] Bulbils of Allium sativum L. (3 g) [SM-045], Barks of Crateva religiosa G.Forst.(5 g) [SM-124], Seeds of Piper nigrum L. (2 g) [SM-003] Bulbils of Allium sativum L. (5 g), Seeds of Caesalpinia crista L.(15 numbers) [SM-053], Seeds of Cuminum cyminum L. (2 g), Oil of Ricinus communis L.(10 mL), Rhizome of Zingiber officinale Roscoe. (2 g)

The seeds are made into a paste with little water and applied externally The seeds are soaked in water overnight and ground into a paste. The paste is warmed and applied externally The ingredients are mixed together, boiled under small flame and filtered

Applied externally in the affected part, twice a day for 2e3 days.

 ta  Pain due to vitiated va humour

The ingredients are pounded and made into paste The ingredients are pounded, mixed with neem oil, boiled under small flame and filtered

Once in the morning with milk for three days Applied externally, till cure

Stiffness due to flatus

The ingredients are made into a jam

5e10 g, once daily in the morning with warm water

Pain in the knees

These ingredients are boiled in water

The water is used for massaging, once a day, for a month

Musculoskeletal ailments

The ingredients are made into paste with water, added with honey and given The ingredients are crushed and the juice is consumed in empty stomach.

Twice a day for three days Once in the morning, for five days

Pain in the joints

The ingredients are crushed, added with three liters of water and boiled. When the water is concentrated to one liter and the decoction is filtered. Then, it is concentrated in small flame to 500 mL

½ - 1 teaspoon/time with warm water; once in the morning till cure.

Musculoskeletal ailments

The ingredients are ground well, made into pills weighing approximately 500 mg, airdried and stored The ingredients are pounded well and given with warm water The ingredients are coarsely powdered and 15 g of the powder are made into decoction

1e2 tablets, twice a day for a week

Lumbosacral pain

3 g, once in the morning for three days. 15 g/time, twice a day, till cure

Lumbosacral pain

The ingredients are ground well with little water and consumed

Once in the morning before food, for a week

Arthritis

The ingredients are mixed and made into gravy

The gravy is consumed, once a day with lunch for three days

Inflammation and swelling of the testicles

4 5

6

7

8 9

10

11

12 13

14

15

Swelling due to vitiated ta  humour va

Quadriplegia

Musculoskeletal ailments, Nagging pain, Swelling due to vitiated ta  humour va

(continued on next page)

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

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S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

Table 3 (continued ) S.No

Ingredients

Mode of preparation

Doses & Duration

Illnesses

16

Bulbils of Allium sativum L. (90 g), Seeds of Brassica juncea (L.) Czern. (90 g) [SM-221], Leaf juice of Delonix elata (L.) Gamble 500 mL), Seeds of Piper nigrum L. (35 g), Dried fruits of Piper longum L. (35 g) [SM-051], Oil of Sesamum indicum 500 mL), Dried rhizome of Zingiber officinale Roscoe (175 g) Bulbils of Allium sativum L., Seeds of Strychnos nux-vomica L., (each 150 g), Oil of Azadirachta indica A.Juss (1 L)

The ingredients are pounded, mixed with the juice and oil, boiled under small flame and filtered

10 mL of oil consumed with milk, once in the morning for 10 days

Musculoskeletal ailments, Lumbosacral pain, Pain in the joints

The ingredients are pounded well, mixed with the oil, boiled under small flame and filtered

Musculoskeletal ailments

Juice from the bulbils of Allium cepa L. (100 mL) [SM-022], Honey (100 mL) Gel of Aloe vera L. (3 g), Seeds of Brassica juncea (L.) Koch. (1 g), Young stem of Cissus quadrangularis L. (3 g), Leaves of Datura innoxia Mill. (3 g), Leaves of Delonix elata (L.) Gamble (3 g), Seeds of Tamarindus indica L. (3 g), Seeds of Trigonella foenum-graecum L. (1 g) Leaf juice of Aloe vera (L.) Burm.f. (4.5 L), Leaf juice of Elytraria acaulis (L.f.) Lindau (1 L) [SM-300], Leaf juice of Justicia adhatoda L. (1 L) [SM-042], Leaf juice of Vitex negundo L. (1 L), Seeds of Nigella sativa L. (100 g) [SM-097], Oil of Sesamam indicum L. (7.5 L) Rhizome of Alpinia calcarata (Haw.) Roscoe (100 g), Stems of Saussurea costus (Falc.) Lipsch. (100 g) [SM-277], Juice from the rhizomes of Zingiber officinale Roscoe (150 mL)

The ingredients are made into syrup.

This oil is used for massaging, once a day in the morning for 15 days 10 mL, twice a day for 15 days This paste is applied externally once a day, for a week

17

18 19

20

21

22

Rhizome of Alpinia calcarata (Haw.) Roscoe (15 g)

23

Leaves of Andrographis paniculata (Burm.f.) Nees (25 g) [SM210], Leaves of Delonix elata (L.) Gamble (25 g), Leaves of Cardiospermum halicacabum L. (25 g), Dried rhizome of Zingiber officinale Roscoe (25 g), Seeds of Piper nigrum L. (25 g) Roots of Argyreia nervosa (Burm.f.) Boj. (20 g) [SM-004], Dried rhizome of Zingiber officinale Roscoe (15 g)

24

25

Latex of Artocarpus heterophyllus Lam. [SM-100] (q.s.)

26

Leaf juice of Azadirachta indica A.Juss. (50 mL) [SM-013], Stem juice of Cissus quadrangularis L. (150 mL) [SM-114], pulp of Terminalia chebula Retz. (10 g), oil of Ricinus communis L. (200 mL) Oil of Azadirachta indica A.Juss.

27

The ingredients are ground and made into a paste

Musculoskeletal ailments Swelling due to vitiated ta  humour va

The leaf juices and oil are mixed together and powdered N. sativa seeds are mixed. The ingredients are boiled under small flame and filtered.

Oil is used for massaging; once a day for a week

Musculoskeletal ailments

The ingredients are ground well in the ginger juice and made into tablets weighing approximately 500 mg. The tablets are then air dried and stored The rhizomes are crushed, made into decoction, added with milk and palm sugar These ingredients are crushed, boiled in 500 mL of water and concentrated to 250 mL

1e2 tablets, twice a day with warm water for 2 e3 days

Lumbosacral pain, Contraction of a nerve or muscle, Stiffness due to flatus Pain in the joints

The ingredients are ground into paste and approximately five grams of the paste are given with warm water Mixed with warm water and applied externally

5 g/time, twice a day for 15e30 days

Musculoskeletal ailments

Applied externally, once in the morning till cure 5e20 mL, of oil is consumed once in the morning, for 3 days

Swelling due to vitiated ta  humour va

The ingredients are mixed with oil, boiled under small flame and filtered.

Twice a day, for a month 50 mL/time, twice a day till cure

Hemiplegia

Hernia

The oil is applied on the head before taking bath

Twice a week; for a month

Oil of Azadirachta indica A.Juss. (1 L), Oil of Brassica juncea (L.) W.D.Koch (1 L), Oil Sesamam indium L. (1 L), Leaf juice of Pergularia daemia (Forssk.) Chiov. (100 mL), Leaf juice of Cleome gynanda L. (100 mL), Bark juice of Moringa oleifera Lam. (100 mL), Powdered rhizomes of Acorus calamus L. (100 g), Powdered seeds of Trachyspermum ammi (L) Sprague. (100 g), Dried rhizomes of Zingiber officinale Roscoe. (100 g) Oil of Azadirachta indica A.Juss. (175 mL), Oil of Pongamia pinnata (L.) Pierre (175 mL), Oil of Ricinus communis L.(325 mL), Cow's milk (325 mL), Root bark of Plumbago indica L. (17.5 g), Seeds of Piper nigrum L. (17.5 g), Rhizome of Acorus calamus L. (17.5 g), Picrorhiza sp. (17.5 g) [SM-088], roasted Ferula foetida (Bunge) Regel (17.5 g), Seeds of Anethum graveolens L. (17.5 g) [SM-006], Dried rhizome of Zingiber officinale Roscoe (17.5 g), Seeds of Piper longum L. (17.5 g), Bulbils of Allium sativum L. (17.5 g), Flower buds of Syzygium aromaticum (L.) Merr. & Perry (17.5 g) [SM-196], Seeds of Trachyspermum ammi (L.) Sprague (17.5 g), Dried fruits of Embelia ribes Burm.f. (17.5 g) [SM-007] Oil of Azadirachta indica A.Juss. (600 mL), Leaf juice of Calotropis gigantea (L.) Dryand. (200 mL), Powdered seeds of Strychnos nux-vomica L. (300 g)

The ingredients are mixed together, boiled under small flame and filtered

The oil is used to massage the affected part; twice a day for 48 days

The ingredients are crushed, mixed with the oil and milk, boiled under small flame and filtered

2e5 mL, consumed orally, once daily for 12 days

Musculoskeletal ailments, Spasm resulting from numbness, Parkinsonism, Stiffness, Lancinating pain

The ingredients are mixed together, boiled under small flame and filtered

Pain in the joints

31

Oil of Azadirachta indica A.Juss. (q.s.), Fresh leaves of Dodonaea viscosa (L.) Jacq. (q.s) [SM-216]

The leaves are cut into small pieces, slightly fried in the oil and tied in a cotton cloth

32

Oil of Azadirachta indica A.Juss. (q.s.), Stem of Cissus quadrangularis L. (50 g), Leaves of Pergularia daemia (Forssk.) Chiov (50 g),

The plant materials are crushed, slightly fried in the oil and tied in a cotton cloth as bundle

The oil is massaged over the affected part; twice a day for 3e5 days The bundle of leaves is used to foment the affected part, once a day for 10 days The bundle is used to foment the affected part, once a day for five days

28

29

30

Musculoskeletal ailments, Spasm in the shoulder, Arthritis

ta  Pain due to vitiated va humour

ta  Pain due to vitiated va humour

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

7

Table 3 (continued ) S.No

Ingredients

Mode of preparation

Doses & Duration

Illnesses

33

Oil of Azadirachta indica A.Juss. (1 L), Rhizome of Acorus calamus L. (100 g), Oil of Sesamum indicum L. (1 L), Egg yolk of Gallus domesticus (100 g), Seeds of Piper nigrum L. (100 g), Seeds of Trachyspermum ammi (L.) Sprague (100 g) [SM-102]

The ingredients are pounded, mixed together, boiled under small flame and filtered

Musculoskeletal ailments

34

Oil of Azadirachta indica A.Juss., Oil cake of Madhuca longifolia (J.Koenig ex L.) J.F.Macbr. [SM-330] (q.s.)

The oilcake is powdered, slightly fried in neem oil and tied in a cotton cloth

35

Leaves and barks of Azima tetracantha (each 15 g) [SM-037]

The ingredients are crushed and made into decoction with 50 mL of water.

36

Leaves and roots of Azima tetracantha Lam. (in equal amounts)

The leaves and roots are ground well with little water

37

Leaves of Bacopa monnieri (L.) Wettst. [SM-209]

38

Leaves of Bambusa bambos (L.) Voss [SM-106]

39

Leaves of Bambusa vulgaris Schrad. (10 g), Leaves of Mukia maderaspatana (L.) M.Roem. (10 g) [SM-012], Whole plants of Mollugo cerviana (L.) Ser. (10 g) [SM-265] Roots of Boerhavia diffusa L. (50 g) [SM-054], Roots of Hemidesmus indicus (L.) R. Br. ex Schult. (50 g) [SM-218]

The leaves are ground and made into a paste The leaves are ground with fermented rice water and applied externally The ingredients are crushed and made into decoction with 100 mL of water

1 g, with milk consumed orally, twice a day for a week, This can also be applied externally This bundle is used to foment the affected part, once a day for three days 30 mL/time; once in the early morning for 15 days 3 g/time with warm water, twice a day, for 45 day Applied externally, once a day for 15 days Applied externally, till cure 50 mL/time, once a day for 10 days Once a day in the morning before food, for 45 days

Parkinsonism

Applied externally for 1 e2 times

Pain in the joints

Once a day for three days

 ta  Pain due to vitiated va humour, Pain in the joints Hemiplegia

40

The roots are cleaned and coarsely powdered. Approximately 10 g, of the powder is made into decoction and consumed with milk The ingredients are mixed, added with small amount of warm water and made into a paste. This paste is applied on a cotton cloth and tied externally for 5 min The ingredients are made into powder. The powder is mixed with warm water and applied externally The ingredients are dried and powdered

Testicular swelling, Oedema

Hemiplegia, Lumbosacral pain, Nagging pain Hemiplegia

Arthralgia Lumbosacral pain Chest pain, Pain during breathing

41

Powdered seeds of Brassica juncea (L.) Koch. (10 g), Rice flour (20 g)

42

Seeds of Brassica juncea (L.) Koch. (10 g), Rhizome of Withania somnifera (L.) Dunal (50 g)

43

Seeds of Brassica juncea (L.) Koch. (10 g), Root barks of Pongamia pinnata (L.) Pierre (20 g), Root barks of Plumbago indica L. (20 g) Outer rind of Terminalia chebula Retz. Fruits (10 g), Dried fruits of Piper longum L. (10 g) Seeds of Brassica juncea (L.) Koch. (5 g), Dried rhizome of Curcuma longa L. (5 g), Leaves of Gmelina asiatica L. (150 g) [SM134] The fruits of Brassica juncea Retz. (20 g), Camphor (10 g), Oil of Ricinus communis L. (100 mL)

The ingredients are made into a paste and applied on the forehead

Applied externally, once a day, for two days

Headache

The ingredients are mixed together, boiled under small flame and filtered

Pain in the joints

46

Cotyledons of Calophyllum inophyllum L. (q.s.) [SM-060]

The crushed cotyledons are boiled in water

47

Barks of Calotropis gigantea (L.) Dryand. (15 g) [SM-032], Dried rhizome of Curcuma longa L (5 g) [SM-045] Barks of Calotropis gigantea (L.) Dryand. (35 g), meat of Paratelphusa hydrodromous (Herbst) (35 g), Pheretima posthuma Linnaeus, 1758 (10 g), Oil of Cocos nucifera L. (175 g)

The ingredients are powdered, burnt and the smoke is inhaled The ingredients are crushed, mixed with the oil, boiled under the small flame and filtered. The oil is applied on the head before taking bath The leaves are crushed and made into bundle. The bundle is soaked in the oil and warmed

The oils is used for massaging; once in the morning for 10 days The decoction is used to massage the affected part; once in the morning for seven days Once a day, when needed Twice a week; for a month

The bundle is used to foment the affected part; twice a day for 10 days 5e10 mL, consumed with milk once in the morning for 48 days. Also applied externally

Pain in the joints

44

45

48

49

Leaves of Calotropis gigantea (L.) Dryand. (100 g), Oil of Azadirachta indica A.Juss. (q.s.)

50

Root barks of Calotropis gigantea (L.) Dryand. (100 g), Leaf juice of Gynandropsis gynandra (L.) Briq. (1 L) [SM-340], Leaf juice of Moringa oleifera Lam. (1 L) [SM-083], Root bark of Pongamia pinnata (L.) Pierre (100 g), Oil of Ricinus communis L.(1 L), Goat's milk (1 L) Leaf juice of Cardiospermum halicacabum L. (1 L) [SM-050], Oil of Ricinus communis (500 mL), Sugar (1 kg) Leaves of Cardiospermum halicacabum L.

51 52

53 54 55

Leaves of Cardiospermum halicacabum L. (50 g), bulbils of Allium sativum L. (5 g) Leaves of Cardiospermum halicacabum L., Leaves of Dodonaea viscosa (L.) Jacq. (in equal amounts) Fruits of Cassia fistula L. [SM-139]

The roots are pounded mixed with the juices and oil, boiled under small flame and filtered

The ingredients are boiled under small flame and made into a jam The leaves are made into chutney

The ingredients are crushed and made into decoction with 100 mL of water The ingredients are made into paste The pulp is extracted with warm water, filtered, boiled under small flame till we get a cream like consistency

2 g/time with cow's milk, once in the morning for a week

5 g, once in the morning for a week The chutney is consumed, thrice a month 50 mL/time, twice a day for 15 days Applied externally, twice a day till cure Applied externally, once a day for three days

Arthralgia

Boring headache Hemicrania, Headache

Musculoskeletal ailments

Pain in the knees Arthritis

Pain in the knees Pain in the joints Swelling due to vitiated ta  humour va (continued on next page)

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

8

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

Table 3 (continued ) S.No

Ingredients

Mode of preparation

Doses & Duration

Illnesses

56

Powdered root barks of Catunaregam spinosa (Thunb.) Tirveng. (6 g) [SM-276], Distillate from the seeds of Trachyspermum ammi (L.) Sprague (q.s.) Fresh leaves of Clerodendrum phlomidis L.f. (500 g), Fresh leaves of Delonix elata (L.) Gamble (500 g) [SM-057], Fresh leaves of Vitex negundo L. (500 g) Leaf juice of Clerodendrum phlomidis L.f. (100 mL) [SM-041], Leaf juice of Delonix elata (L.) Gamble (100 mL), Oil of Ricinus communis L. (100 mL), Leaf juice of Vitex negundo L. (100 mL) Leaf juice of Clerodendrum phlomidis L.f. (100 mL), Oil of Ricinus communis L. (50 mL), Terminalia chubula Retz. Powder (10 g), Leaf juice of Vitex negundo L. (100 mL) Leaves Clerodendrum phlomidis L.f. (5 g)

The root powder is soaked in the distillate T. ammi seeds are air-dried and powdered

2 g, once in the morning for a week

Musculoskeletal ailments

The leaves are boiled in about 20 L of water. This warm water is used for massaging and to take bath for three days The ingredients are boiled under small flame and filtered

Once a day; thrice a week till cure

Musculoskeletal ailments

Applied externally in the affected part till cure Applied externally in the affected part till cure Once a day in the morning, till cure Used to foment the affected part; twice a day for three days The bundle is fomented over the affected part, once a day till cure Cooked and consumed for 7 days. 50 mL, once in the morning, till cure

Musculoskeletal ailments

57

58

59

60

The ingredients are boiled under small flame and filtered The leaves are crushed and made into decoction with 50 mL of water The leaves are cut into small pieces, slightly fried in the oil

61

Leaves of Clerodendrum phlomidis L.f. (q.s.), Oil of Ricinus communis L. (q.s.)

62

Leaves of Clerodendrum phlomidis L.f., Leaves of Delonix elata (L.) Gamble, Leaves of Pergularia daemia (Forssk.) Chiov., Leaves of Morinda pubescens Sm. (q.s.) Coccinia Tender fruits of Coccinia grandis (L) Voigt. (5 g), Leaves of Trichosanthes cucumerina L. (5 g) [SM-120] Roots of Clitoria ternatea L.(25 g) [SM-107], Seeds of Piper nigrum (5 g), Leaves of Vitex negundo L.(25 g), Dried rhizome of Zingiber officinale Roscoe (5 g) Roots of Cocculus hirsutus (L.) W. Theob. (5 g) [SM-028], Seeds of Piper nigrum L. (5 g), Dried rhizome of Zingiber officinale Roscoe (5 g) Endosperm of Cocos nucifera L. [SM-015], Oil of Ricinus communis L. (q.s.)

The leaves are pounded, slightly warmed and made into a bundle

67

Resin of Commiphora wightii (Arn.) Bhandari (25 g) [SM-227]

68

Roots of Corallocarpus epigaeus (Rottler) Hook.f. (150 g) [SM095], Bulbils of Allium ceba L. (150 g), Seeds of Cuminum cyminum L. (25 g), Oil of Ricinus communis L. (500 mL) Seeds of Coriandrum sativum L. (25 g) [SM-047], Dried rhizome of Curcuma longa L. (10 g)

The resin is cleaned, steam boiled in the decoction of Azadirachta indica stem barks and the resin is dried. Then, the resin is ground in cow's urine and made into pills weighing approximately 500 mg. The pills are air-dried and stored The ingredients are crushed, mixed with the oil, boiled under small flame and filtered

63 64

65

66

69

The ingredients are stream boiled and consumed. The ingredients are crushed and made into decoction with 200 mL of water

Musculoskeletal ailments Pain in the joints

Musculoskeletal ailments Musculoskeletal ailments ta  Early stage of va diseases

The ingredients are crushed and made into decoction

Once a day, till cure

ta  Pain due to vitiated va humour

Coconut flour is slightly fried in the oil and tied in a cotton cloth

The bundle of leaves is used to foment the affected part, once a day for 3 days 1-2 pills/time, twice a day, for a week

Testicular swelling

Applied externally, till cure

Arthralgia

Applied externally, when needed

Headache

Once a day, till cure

Swelling due to vitiated ta  humour va Lancinating pain, Poliomyelitis

The ingredients are made into paste with little water and applied on the forehead in the evening and kept overnight The leaves are crushed and applied externally The seeds of C. bonplandianus are crushed to extract the oil

70

Leaves of Crateva religiosa G.Forst.

71

Oil extracted from the seeds of Croton bonplandianus Baill. Seeds [SM-085]

72

Roots of Croton bonplandianus Baill. (50 g)

The roots are crushed, added with a liter of water and concentrated into 250 mL

73

Seeds of Croton bonplandianus Baill.

Powdered seeds are given with warm water

74

Seeds of Croton bonplandianus Baill. (50 g), Sugar (250 g)

The seeds are powdered and mixed with powdered sugar

75

Leaves of Cucumis sativus L. (100 g) [SM-290]

The leaves are cleaned with water, airdried and powdered

76

Dried rhizome of Curcuma longa L. (5 g), Leaves of Gmelina asiatica L. (150 g) Leaf juice of Datura metel L. (250 mL) [SM-293], Oil of Ricinus communis L. (250 mL)

The ingredients are made into a paste and applied on the forehead The ingredients are mixed, boiled under small flame and filtered

78

Leaves of Datura innoxia Mill.

79 80

Leaves of Datura innoxia Mill. (q.s.), oil of Sesamum indicum L. (q.s.) Leaves of Datura innoxia Mill. [SM-291]

The leaves are ground and made into a paste The leaves are gently fried in the oil and fomented on the affected part The juice of the leaves is applied externally

81

Leaves of Delonix elata (L.) Gamble (100 g)

Leaves are air-dried and powdered

77

ta  Pain due to vitiated va humour

1 - 2 drops of the oil with sugar and consumed twice a day, for 10 days 50e75 mL/time, once in the morning for three days 500 mg/day, once in the morning as purgative 1e2 g, with warm water, once a day, for 10 days 1e2 g, once a day with clarified butter, for 10 days Applied externally, once a day, for two days The oil is used for massaging; twice a day till cure Applied externally, once a day for 3e5 days 1 -2 times, till cured Twice a day, for 15 days 2e3 g, with warm water, once a day for 15 days

Swelling due to vitiated ta  humour va

Swelling due to vitiated ta  humour va Musculoskeletal ailments Hemiplegia, An inflammation and swelling of the testicles An inflammation and swelling of the testicles Headache Swelling due to vitiated ta  humour, Pain in va upper and lower limbs Swelling due to vitiated ta  humour va ta  Pain due to vitiated va humour Swelling due to vitiated ta  humour va Musculoskeletal ailments

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

9

Table 3 (continued ) S.No

Ingredients

Mode of preparation

Doses & Duration

Illnesses

82

Leaves of Delonix elata (L.) Gamble (20 g), Seeds of Piper nigrum L. (1 g), Salt (q.s.)

The ingredients are ground well and the juice is extracted

Once in the morning, for 10 days

83

Leaves of Delonix elata (L.) Gamble, Leaves of Pergularia daemia (Forssk.) Chiov. (in equal amounts)

The leaves are added with water and boiled

84

Leaves of Dichrostachys cinerea (L.) Wight & Arn. (50 g) [SM216], Seeds of Sesamum indicum L. (50 g) [SM-315], Palm sugar (25 g)

The ingredients are pounded together

85

Leaf juice of Dicliptera paniculata (Forssk.) I.Darbysh. (50 mL) [SM-274], Cow's milk (100 mL) Juice of Eclipta alba (L.) L. leaves (q.s.) [SM-295], Dried leaves of Senna alexandrina Mill. (100) [SM-005], Dried leaves of Solanum trilobatum L. (100 g) [SM-039]

The juice is mixed with milk and given

The decoction is used for massaging and bathing; twice e thrice a week 35 g/time, twice a day, for 4 days. Salt and chicken should be avoided from food Once in the morning for three days 2 g/time, twice a day for 15 days with warm water

Swelling due to vitiated ta  humour, Nagging va pain Body pain

86

87

The leaves of S. alexandrina and S. trilobatum are mixed together, soaked in the juice of E. alba and sun-dried. This process is repeated three times and the leaves are powdered and stored The ingredients are crushed and made into decoction with 200 mL of water

92

Whole plants of Enicostema axillare (Poir. ex Lam.) A.Raynal (25 g) [SM-158], Seeds of Cuminum cyminum L.(2 g), Seeds of Piper nigrum (2 g), Dried rhizome of Zingiber officinale Roscoe (2 g) Whole plants of Enicostema axillare (Poir. ex Lam.) A.Raynal (50 g), Seeds of Cuminum cyminum L. (15 g), Seeds of Piper nigrum L. (5 g), Dried rhizome of Zingiber officinale Roscoe (5 g) Bark of Ficus benghalensis L. (50 g) [SM-111], Root bark of Senna auriculata (L.) Roxb. (50 g) [SM-132], Root bark of Nyctanthes arbor-tristis L. (50 g) [SM-068] Tender leaves and flowers of Gynandropsis gynandra (L.) Briq. (10 g), Leaves of Piper betel L. (10 g) [SM-093] Whole plants of Gynandropsis gynandra (L.) Briq., Palm sugar (q.s.) Fresh roots of Hemidesmus indicus (L.) R. Br. ex Schult.

93

Leaves of Lawsonia inermis L. (100 g) [SM-220]

94

Leaves and flowers of Melia azedarach L. (100 g) [SM-335]

95

Leaves of Mimosa pudica L. [SM-140]

The leaves are made into a paste

96

Leaves of Morinda pubescens L. [SM-063]

The leaves are crushed with a pinch of table salt and applied externally

97

Leaves of Moringa oleifera Lam. (q.s.), Oil of Ricinus communis L. (q.s.)

98

Leaves of Moringa oleifera Lam. (30 g)

99

Roots of Moringa oleifera Lam. (10 g)

100

Cotyledons of Mucuna pruriens (L.) DC. (100 g), Fruit juice of Phyllanthus emblica L. (q.s.) [SM-038] Cotyledons of Mucuna pruriens (L.) DC. [SM-101], Roots of Withania somnifera (L.) Dunal [SM-208]

The leaves are slightly warmed in the oil and fomented externally on the affected part The leaves are crushed, added with 150 mL of water and made into decoction. The roots are crushed, added with 250 mL of water and made into decoction The cotyledons are soaked in P. emblica juice, sun-dried and powdered The roots are cut into small pieces, cooked in milk, sun dried, powdered and mixed with the powder of M. pruriens The ingredients are mixed together, boiled under small flame and filtered

88

89

90 91

101

These ingredients are crushed, boiled in one liter of water and concentrated to 250 mL The ingredients are air dried and powdered

The ingredients are crushed and the juice is consumed The whole plants are ground into paste and mixed with palm sugar The roots are crushed and made into a paste

The leaves are pounded and made into a paste The leaves and flowers are crushed and made into a paste

102

Leaf juice of Nerium oleander L. (25 mL) [SM-081], Oil of Cocos nucifera L. (250 mL)

103

Seeds of Nigella sativa L. (10 g), Bulbils of Allium sativum L.(2 g)

104

Leaves of Ocimum tenuiflorum L. [SM-014], Leaves of Vitex negundo L., (in equal amounts)

105

Stems of Opuntia stricta (Haw.) Haw. (35 g) [SM-087]

106

Stems of Opuntia stricta (Haw.) Haw. (q.s.), Oil of Ricinus communis L. (q.s.)

Thorns and skin are removed from the stem, mixed with small amount of table salt and consumed The fleshy inner part of the stems is boiled in the oil and made into a bundle

107

Fresh leaves of Pavetta indica L. (100 g), Oil of Sesamam indium L. (q.s.)

The leaves are cut into small pieces, slightly fried in the oil and tied in a cotton cloth

The ingredients are ground well and mixed with honey The leaves are added with water and boiled

Quadriplegia

Swelling due to vitiated ta  humour va  ta  Pain due to vitiated va humour

100 mL/time, twice a day, till cure

Hernia

75e100 mL/time, twice a day for 15 days till cure 2e3 g, with milk, once in the morning, till cure

Musculoskeletal ailments

Once in the morning, for 10 days 10 g/day, once in the morning, for three days The paste is applied externally, once a day for a week Applied externally, till cure Applied externally, once a day for three days Applied externally, once a day till cured Applied externally, once a day, for three days Twice a day for a week

Pain in the joints

Chest pain

Inflammation and swelling of the testicles Pain in the joints

Headache Headache

ta  of scrotal region va Lumbosacral pain

 ta  Pain due to vitiated va humour

Once a day in the morning, till cure 50e75 mL/time; once a day for a week 2 g/time, twice a day for 15 days 2e3 g, with milk twice a day, till cure

Body pain

Applied externally in the affected part for 2 e3 days Thrice a day for 15 days

 ta  Pain due to vitiated va humour, Swelling due  ta  humour to vitiated va Inflammation and swelling of the testicles Nagging pain of all the limbs

The decoction is used for massaging and bathing; twice a week 35 g are consumed once a day in the morning, for 25 days Used to foment the affected part; twice a day for 15 days The bundle of leaves is used to foment the affected part, once a day for 10 days

Paresis Parkinsonism Pain in the neck

Lancinating pain

Pain in the joints

 ta  Pain due to vitiated va humour

(continued on next page)

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

10

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

Table 3 (continued ) S.No

Ingredients

Mode of preparation

Doses & Duration

Illnesses

108

Tender fruits of Pavetta indica L. (100 g) [SM-141]

The fruits are pickled

109

Juice from the leaves of Pergularia daemia (Forssk.) Chiov. (q.s.) [SM-026], Endosperm of Piper nigrum L. (100 g)

Musculoskeletal ailments Musculoskeletal ailments

110

Juice of Pergularia daemia (Forssk.) Chiov. Tender leaves (15 mL)

111

Leaf juice of Pergularia daemia (Forssk.) Chiov. (50 mL), Oil of Azadirachta indica A.Juss. (75 mL), Juice of Zingiber officinale Roscoe. Rhizomes (25 mL) Leaves of Pergularia daemia (Forssk.) Chiov.

White pepper seeds are soaked overnight in the juice of P. daemia and sun-dried. This process is repeated for seven times. Then the seeds are powdered and stored The juice is mixed with table salt and warmed slightly. The ingredients are mixed together, boiled under small flame and filtered

Used daily with food, till cure 0.5e1 g/time, before food, with warm water, twice a day, for a month 15 mL/day, once in the morning for three days Applied externally in the affected part, twice a day for 15 days The bundle is fomented over the affected part, once a day for 3 days Applied externally, twice a day for 3e5 days 50 mL/time, twice a day for seven days

Headache, Pain in occipital region Pain in the leg

112

113

114

115

Leaves of Pergularia daemia (Forssk.) Chiov. (25 g), Dried rhizomes of Zingiber officinale Roscoe. (3 g), Resin of Ferula foetida Regel (3 g) Leaves of Phyla nodiflora (L.) Greene (50 g) [SM-105], Bulbils of Allium sativum L. (5 g), Seeds of Piper nigrum L. (5 g), Dried rhizome of Zingiber officinale Roscoe (5 g) Roots of Plumbago zeylanica L. (50 g) [SM-109], Oil of Cocos nucifera L.

The leaves are pounded, made into a bundle and slightly warmed The ingredients are made into a paste

The ingredients are crushed, mixed with about 100 mL of warm water and filtered The root barks are ground well in milk, mixed with coconut oil, boiled under small flame and filtered. The oil is applied on the head before taking bath The roots are dried in the room temperature and made into powder

116

Roots of Plumbago indica L. (50 g)

117

Roots of Plumbago zeylanica L. (2 g), Cow's milk (100 g)

118

Seeds of Ricinus communis L. (q.s.)

119

Seeds of Semecarpus anacardium L.f (20 g) [SM-002], Oil of Ricinus communis L. (100 mL)

120

Whole plants of Senna auriculata (L.) Roxb.

121

Leaves of Strychnos nux-vomica L.(200 g) [SM-194]

122

Seeds of Strychnos nux-vomica L., Seeds of Piper nigrum L., Flower buds of Syzygium aromaticum (L.) Merr. & Perry, Dried rhizome of Zingiber officinale Roscoe, (in equal amounts), Fruit juice of Citrus limon (L.) Burm.f (q.s.) [SM-223]

123

Leaves of Tamarindus indica L. (q.s.) [SM-084]

The seeds of S. nux-vomica are boiled with cow's urine; the skins are removed and charred in an earthen pot by frying. Powdered other ingredients are added with charred S. nux-vomica seeds and pounded and ground well in the juice of C. limon. It is then made into pills having approximately 50 mg, air-dried and preserved The leaves are boiled in two liters of water

124

Aerial parts of Trianthema decandra L. (q.s.) [SM-200], Oil of Ricinus communis L. (q.s.) [SM-040]

The plant material is crushed, slightly fried in the oil

125

Whole plants of Trichodesma indicum (L.) Lehm. (100 g) [SM283] Seeds of Trigonella foenum-graecum L. (50 g) [SM-284], Seeds of Vigna mungo (L). Hepper. (50 g) [SM-065]

Crushed plant material is added with a liter of water and concentrated into 250 mL These seeds are ground into powder, added with 100 g of palm sugar and made into jam

127

Leaves of Vitex negundo L. (100 g), Rhizomes of Zingiber officinale Roscoe. (10 g), Oil Sesamam indium L. (200 mL)

128

Leaves of Vitex negundo L. (2 g), Seeds of Piper nigrum L. (5 No)

129

Young leaves of Vitex negundo L. (50 g), Seeds of Piper nigrum (20 g), Oil Sesamam indium L. (200 mL)

The leaves and rhizomes are crushed, mixed with the oil, boiled under small flame and filtered. The oil is applied on the head before taking bath The ingredients are consumed with warm water The ingredients are crushed, mixed with the oil, boiled under small flame and filtered. The oil is applied on the head before taking bath

126

The roots are made into paste, mixed with milk and gently warmed The seeds are crushed, boiled with water and cooled. The oil floating on water is collected carefully, dried and stored. The oil (25e30 mL) is given with milk orally The seeds are crushed, mixed with the oil, boiled under small flame and filtered The leaves, flowers, seeds, stem and root barks are powdered and approximately 10 g, of the powder is made into decoction and consumed The leaves are added with three liters of water and boiled

Nagging pain of all the limbs Swelling due to vitiated ta  humour va Stiffness due to flatus

Twice a week; for a month

Boring headache, Headache

1 g, of powder, once a day with milk for three days. Once in the morning for three days Once a week in the morning, for 3 weeks as purgative

Pain in the joints

Applied externally on the affected part till cure Once a day in the morning for six days

ta  Pain due to vitiated va humour

The decoction is used for massaging; 1e2 times a day 1e2 tablets, twice a day with water/buttermilk

Body pain

The decoction is used for massaging the affected part; once a day for a week Applied externally in the affected part, Once in the morning for a week 50e75 mL/time, twice a day for 7 days This jam consumed twice a week

Pain in the joints

Twice a week; for a month

Once in the morning, for three days Twice a week; for a month

Pain in the joints, Oedema Pain in the joints

Body pain

Body pain, Chest pain, Stiffness

Pain in the joints

Pain in the joints Musculoskeletal ailments, Lumbosacral pain Headache

Stiffness due to flatus Pain in the neck

The voucher numbers of the representative specimens were given within the square brackets.

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

Shanon index

4 3 2 1 0

0

100

200

300

400

500

Cumulative number of UR Fig. 2. Assessing sampling sufficiency using species accumulation curve.

region), Azima tetracantha (paresis) and Z. officinale (spasm). The remaining illness categories got low Fic values. 3.4. Quantification of externally used formulations In the case of externally applied formulations, headache got high Fic value followed by pain and general musculoskeletal ailments. Swelling and arthritis had average Fic values. In the case of headache, coconut oil was used to prepare many formulations and got high number of UR. The plants such as Curcuma longa, Gmelina asiatica, V. negundo, Sesamam indium, Z. officinale and Calotropis gigantea had high IAR values in this group. In the case of pain, the oils of Ricinus communis and Azadirachta indica had high Fic values for external applications. The plants such as Withania somnifera, Dodonaea viscosa and C. phlomidis had high IAR values for the treatment of pain. In the case of plants prescribed for general musculoskeletal ailments, C. phlomidis had high number of UR and Justicia adhatoda had high IAR value. 4. Discussion Many ethnobiological surveys indicated a positive correlation between the age and increased knowledge on traditional medicine. The informants of this survey indicated that most of the informants were above 50 years of age and had above 20 years of experience. Our previous survey in the same study area documented that this

11

practice was majorly a male dominant domain and it was also reflected in this survey. The master to disciple mode of knowledge transmission was predominant in this system than father to son knowledge transmission. During the field work, it was noticed that few disciples were working with the informants and they were allowed to observe and assist the informants in collecting herbs, preparing the formulations and treatment. Low back pain and chronic joint pain were reported as the most common musculoskeletal conditions [25] and their prevalence was increasing with age [26]. An UK based study showed that NSAIDs were taken by one in every five people between the ages 65 and 74 for the management of pain [27]. In India, the use of analgesics particularly herbal based were reported as the first choice by the patients for the management of pain [28]. This survey reported the high use of P. nigrum, Z. officinale and A. sativum for the management of general musculoskeletal ailments, pain, stiffness of joints and flatus. Ginger is also reported as an anti-inflammatory herb in Ayurveda and Chinese systems of traditional medicine. The major phytochemical constituents of ginger such as gingerols and shogalos were reported to interfere with leukotriene, interleukins, cyclooxygenase and TNF-a metabolisms [29]. A small, randomized controlled trial with 43 subjects with osteoarthritis indicated that the supplementation with ginger based combination significantly reduced the pain and had gastro protective effect, compared to diclofenac [30]. Another doubleblinded randomized clinical trial with 440 patients with systematic osteoarthritis also indicated that the supplementation of a ginger containing formulation for 24 weeks significantly reduced pain and improved knee function [31]. Short term study with normal subjects indicated that ginger supplementation did not affect the visual analog scale of pain [32]. Though studies showed a reduction in the subjective experience of pain with ginger supplementation, robust studies are needed to establish the analgesic activity of ginger [29]. No clinical reports were available for the analgesic effect of garlic. Some studies were conducted on the species such as P. nigrum, Moringa oleifera and R. communis cited by the informants for the management of pain. A small, double-blinded randomized clinical trial with 54 patients with systematic osteoarthritis indicated that the supplementation of essential oil of P. nigrum for nine weeks significantly reduced pain [33]. Some preclinical experiments also reported the analgesic effect of pepper and piperine [34]. Likewise, few animal reports indicated the analgesic effect of M. oleifera [35,36]; however no clinical report was available. A small, randomized clinical trial with 30 patients with systematic osteoarthritis indicated that the supplementation of root powder of

Table 4 Informant Consensus Factor (Fic) for different musculoskeletal ailments. Illness categories

Total

Internal

External

NUR

NS

Fic

NUR

NS

Fic

NUR

NS

Fic

Arthritis Flatus General musculoskeletal ailments Headache Hernia Pain Paresis Parkinsonism Poliomyelitis Rheumatism Spasm Stiffness Swelling ta  of scrotal region Va

20 15 107 28 8 177 20 19 1 1 18 37 24 15

19 11 49 14 8 81 18 19 1 1 17 29 23 13

0.052 0.285 0.547 0.535 0.000 0.542 0.105 0.000 0.000 0.000 0.058 0.222 0.043 0.071

4 15 75 1 8 112 20 19 1 0 18 37 0 10

4 11 49 1 8 59 18 19 1 0 17 29 0 9

0.000 0.285 0.351 0.000 0.000 0.477 0.105 0.000 0.000 e 0.058 0.222 e 0.111

16 0 32 27 0 65 0 0 0 1 0 0 24 5

15 0 20 13 0 37 0 0 0 1 0 0 23 5

0.066 e 0.387 0.538 e 0.437 e e e 0.000 e e 0.043 0.000

NUR e Number of Use Reports; NS e Number of Species; ‘–’ indicates Fic values were not calculated for that illness categories.

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

12

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

Table 5 List of important plant species cited by the non-institutionally trained Siddha practitioners of Virudhunagar district, Tamil Nadu to treat musculoskeletal ailments. S.No Illness categories

Internal

External

1 2 3

Arthritis Flatus General musculoskeletal ailments

Calophyllum inophyllum (1.00) e Clerodendrum phlomidis (0.86), Vitex negundo (0.73), Azadirachta indica (0.62), Delonix elata (0.77), Ricinus communis (0.67), Justicia adhatoda (1.00)

4

Headache

– Piper nigrum (0.64), Allium sativum (0.60), Zingiber officinale (0.65) Piper nigrum (0.64), Zingiber officinale (0.65), Allium sativum (0.60), Azadirachta indica (0.62), Trachyspermum ammi (0.29), Vitex negundo (0.73), Acorus calamus (0.17), Clerodendrum phlomidis (0.86), Delonix elata (0.77), Pergularia daemia (0.60), Piper longum (0.37), Plumbago indica (0.33), Ricinus communis (0.67), Sesamum indicum (0.73) –

5

Pain

6 7 8

Paresis Spasm Stiffness

9 10

Swelling ta  of scrotal region Va

Cocos nucifera (0.50), Curcuma longa (1.00), Calotropis gigantea (0.60), Gmelina asiatica (1.00), Plumbago zeylanica (0.33), Sesamam indium (0.67), Vitex negundo (0.73), Zingiber officinale (0.66) Zingiber officinale (0.66), Allium sativum (0.60), Piper nigrum (0.64), Delonix Ricinus communis (0.67), Azadirachta indica (0.62), Pergularia daemia (0.60), Brassica juncea (0.50), Vitex elata (0.77), Moringa oleifera (0.62), Ricinus communis (0.67), Alpinia negundo (0.73), Sesamam indium (0.64), Withania somnifera calcarata (0.33), Cardiospermum halicacabum (0.50), Piper longum (0.37), (1.00), Strychnos nux-vomica (0.60), Dodonaea viscosa (1.00), Plumbago indica (0.33), Syzygium aromaticum (0.43), Azima tetracantha Clerodendrum phlomidis (0.86), Calotropis gigantea (0.60) (0.50), Brassica juncea (0.50), Citrus limon (0.50), Ferula foetida (0.17), Pongamia pinnata (0.25), Saussurea costus (1.00), Senna auriculata (1.00), Sesamum indicum (0.73), Strychnos nux-vomica (0.60), Vitex negundo (0.73) Azima tetracantha (0.50), Delonix elata (0.77) e Zingiber officinale (0.66) e Piper nigrum (0.64), Zingiber officinale (0.67), Allium sativum (0.60), Plumbago e indica (0.33), Ricinus communis (0.67), Syzygium aromaticum (0.43), – Azadirachta indica (0.62) Allium sativum (0.60) e

The plant species under each illness category were arranged in descending order on the basis of UR for that particular illness category; Values given between parentheses indicate the IAR value.

R. communis for 30 days significantly reduced pain [37]. In the illness category pain, S. costus and S. auriculata had high IAR values; however no clinical data is available on the efficacy of these two species. Some anti-inflammatory constituents such as 3,4dihydrobenzoic acid from V. negundo [38], 3-hydroxy, 2-methoxysodium butanoate [39] and hesperidin from D. elata [40] were also reported; however these plants lack rigorous studies. A preclinical experiment with nitroglycerine induced migraine in rats indicated the beneficial effect of oral curcumin treatment [41]. In a double blind placebo controlled study with 60 adult migraine subjects indicated the use of oral ginger treatment [42]. In subjects with chronic osteoarthritis, topical ginger application relieved the symptoms and increased the independence [43]. In many traditional systems of medicine the uses of V. negundo [41] and Calotropis procera [44] to treat headache were reported. A double blind study with sixty subjects with knee pain indicated the efficacy of W. somnifera [45]. Topical anti-inflammatory drugs and painkillers have been reported as one of the widely used formulations, having better pain relief with minimal adverse events compared to the oral anti-inflammatory agents [46]. This study indicated the use of many plants topically for the management of musculoskeletal ailments. There were scientific evidences and traditional literature support for these species; however scientific studies were limited for their external usage.

-

-

-

-

and Cardiospermum halicacabum (pain) were reported to be used internally to treat various musculoskeletal ailments. The species such as Calophyllum inophyllum (arthritis), Justicia adhatoda (general musculoskeletal ailments), Curcuma longa, Calotropis gigantea, Zingiber officinale (headache), Withania somnifera, Strychnos nux-vomica and Dodonaea viscosa (pain) were reported for external applications to treat musculoskeletal disorders. The species such as Azadirachta indica, Clerodendrum phlomidis, Delonix elata, Pergularia daemia and Vitex negundo were reported for both internal as well as external uses. This study showed that many of the claims had limited clinical evidences and it is important to conduct well-planned, scientifically robust studies to establish the efficacy and safety of these treatments. This study documented that a considerable portion of plants were used externally. Scientific evidences were little for their external application and further robust studies on these claims will yield some novel topical agents for the management of musculoskeletal ailments.

Conflicts of interest None.

5. Conclusion - Studies showed that the global mortality rates were fallen while the rate of disability adjusted life years (DALF) is increasing dramatically. Musculoskeletal disorders such as low back pain are the important causes for the increase of DALF, which in turn impaired the quality of life and loss in working ability. - The use of complementary therapies for the management of musculoskeletal health conditions were reported as high, particularly among the veterans and there is a need to scientifically evaluate the traditional claims. - The species such as A. tetracantha (paresis), R. communis, Sesamum indicum (general musculoskeletal ailments), M. oleifera

Source of funding Financial support from Entomology Research Institute. Grant No: ERI/EP/07. Acknowledgments We are grateful to the ‘Siddha Vaithiyar Sangam’ of Virudhunagar district and the informants for their constant support, participation and sharing of their valuable knowledge. We sincerely thank the editor and reviewers for their comments which helped immensely to improve the quality of our work.

Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005

S. Esakkimuthu et al. / Journal of Ayurveda and Integrative Medicine xxx (xxxx) xxx

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Please cite this article as: Esakkimuthu S et al., Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by noninstitutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India, J Ayurveda Integr Med, https://doi.org/10.1016/ j.jaim.2018.11.005