A randomized survey of medicinal plants used by folk medicinal practitioners in six districts of Bangladesh to treat rheumatoid arthritis.
Rheumatoid arthritis is a chronic, systemic inflammatory disorder principally attacking the synovial joints (these joints achieve movement at the point of contact of the articulating bones). It is an autoimmune disorder, which cause inflammation of the joints and can cause inflammation of the tissue surrounding the joints. It typically progresses with time leading ultimately to joint destruction and functional disability. The disease has been estimated to affect about 1% of the world's population, with women being three times more affected than men. People within the age group of 40-50 years are the most vulnerable, but the disease can affect people at any age. There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). DMARDs include methotrexate, sulfasalazine, leflunomide (Arava[R]), etanercept (Enbrel[R]), infliximab (Remicade[R]), adalimumab (Humira[R]), abatacept (Orencia[R]), rituximab (Rituxan[R]), anakinra (Kineret[R]), antimalarials, gold salts, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine (Imuran). Other forms of treatment include physical therapy and occupational therapy.
The disease is quite common in Bangladesh. In a study conducted on 101 cases of rheumatic diseases, it was observed that rheumatoid arthritis was the most common being present in 60 cases (Islam, N. and M. Kahn, 1981). Methotrexate, a drug of choice in Bangladesh to treat rheumatoid arthritis, has been reported to give adverse effects in 27 out of the 38 patients studied (Ali, M.L., 1997). The most common adverse reactions associated with sulfasalazine are anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. Leflunomide is an effective disease-modifying agent for rheumatoid arthritis. However, its use has been associated with significant and serious adverse reactions involving haematological, hepatic, immune, dermatological and respiratory systems. Adverse reactions have also been reported for the other drugs used to treat this disease.
Traditional medicinal knowledge has been a means towards the discovery of many modern medicines (Cotton, C.M., 1996). Bangladesh has a rich history of several traditional medicinal systems, among whom the most notable ones are the Ayurvedic, Unani, and the folk medicinal systems. Folk medicine is practiced by Kavirajes who utilize simple formulations of medicinal plants in most of their preparations. In our ongoing ethnomedicinal surveys throughout Bangladesh, we have observed that Kavirajes are visited by a substantial segment of both rural and urban population. It has also been observed that the Kavirajes of various regions use diverse varieties of plants for treatment of different ailments (Hossan, M.S., 2010; Rahmatullah, M., 2010; Rahmatullah, M., 2009; Rahmatullah, M., 2009; Rahmatullah, M., 2009). It was the objective of the present study to conduct a completely randomized survey of Kavirajes in six districts of Bangladesh (where rheumatoid arthritis is quite common) to learn more about medicinal plants used for treatment of this disease. The expectation was that the medicinal plants used by the Kavirajes can prove to be a useful source for further scientific studies leading to discover of more efficacious drugs.
Materials and Methods
The present randomized survey was carried out among Kavirajes of six districts of Bangladesh, namely Brahmanbaria, Bogra, Dinajpur, Khulna, Natore, and Rajshahi. Informed consent was obtained from the Kavirajes prior to the survey. Actual surveys were conducted with the help of a semi-structured questionnaire and the guided field-walk method as described by Martin (1995) and Maundu (1995). Kavirajes were asked specifically as to whether they know about rheumatoid arthritis and whether they treat the disease on a regular basis. Kavirajes were selected based on their affirmative answer to both questions. The Kavirajes mentioned the plants with which they treated rheumatoid arthritis to the interviewers and took the interviewers to spots from where they collected the plants. The plants were shown along with provision of local names and the parts used. Plant specimens were collected and dried in the field and later brought back to Dhaka for complete identification at the Bangladesh National Herbarium.
The Kavirajes of the six districts surveyed were observed to use 32 plants distributed into 23 families for treatment of rheumatoid arthritis. The Araceae and the Solanaceae families were the major contributors with three plants per family. Other families contributing two plants per family included Euphorbiaceae, Meliaceae, Piperaceae, Poaceae, and Rutaceae families. The results are shown in Table 1.
Leaves constituted the major plant part used (28.8%) followed by fruits (16.9%). Whole plant constituted 13.6% of total uses along with seeds, also at 13.6%. Barks constituted 8.5% of total uses. The results are summarized in Table 2.
The mode of administration was predominantly topical. Usually, juice from macerated whole plant or plant part was applied to affected areas. Use of both single plant part as well as a combination of plant parts was observed. For instance, the fruits of Ricinus communis L. were used alone; on the other hand, a combination of leaves and fruits of Crinum asiaticum L. was used for treatment. Of the 32 names of medicinal plants obtained, 7 were obtained from Khulna district, 16 from Rajshahi district, and 8 from Dinajpur district, suggesting that rheumatoid arthritis was more prevalent in those districts. 8 plant names were also collected from Natore district, which adjoins Rajshahi district.
The use of medicinal plants for treatment of rheumatic disorders is not new but is also practiced in the traditional medicinal systems of other countries of the world. A notable success story is that of the plant, Harpagophytum procumbens (Burch.) DC. ex Meisn. [Genus: Harpagophytum, Family: Pedaliaceae, English name: Devil's Claw], which is used in the traditional medicinal system of South Africa and Namibia to treat different forms of rheumatic disorders and back pain. A number of reports attest to the success of this plant in the treatment of the above disorders (Brien, S., 2006; Denner, S.S., 2007; Warnock, M., 2007; Vlachojannis, J., 2008).
The plants obtained in the present survey present considerable potential for discovery of new drugs for rheumatoid arthritis, a debilitating disease affecting millions of people throughout the world. Even if the plants do not prove successful in curing the disease or reversing the degenerative processes but prove successful in treatment of symptoms like severe pain and inflammation that can be considered advancement over the existing drugs, which occasionally give severe adverse effects. Since the Kavirajes have treated patients from ancient times with the medicinal plants obtained in the present survey with claims of success, it is expected that scientific research on these plants can yield fruitful results.
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(1) Mohammed Rahmatullah, (1) Rownak Jahan, (1) A.K. Azad, (1) Syeda Seraj, (1) Md. Mahbubur Rahman, (1) Anita Rani Chowdhury, (1) Rahima Begum, (1) Dilruba Nasrin, (1) Zubaida Khatun, (1) Mohammad Shahadat Hossain, (2) Mst. Afsana Khatun, (1) Z.U.M. Emdadullah Miajee
(1) Faculty of Life Sciences, University of Development Alternative, Dhanmondi, Dhaka, Bangladesh.
(2) Present address: Dept. of Pharmacy, Lincoln College, Mayang Plaza, Block A, No 1, Jalan SS 26/2, Taman Mayang Jaya, 47301, Petaling Jaya, Selangor Darul Ehsan, Kuala Lumpur, Malaysia.
Corresponding Author: Professor Dr. Mohammed Rahmatullah, Pro-Vice Chancellor University of Development Alternative House No. 78, Road No. 11A (new) Dhanmondi R/A, Dhaka-1205 Bangladesh Email: firstname.lastname@example.org Fax: 88-02-8157339
Table 1: Medicinal plants used by folk medicinal practitioners in the six districts of Bangladesh surveyed for treatment of rheumatoid arthritis. Scientific name Family Local Name Hygrophila auriculata Acanthaceae Kulekhara (Schumach.) Heine Crinum asiaticum L. Amaryllidaceae Bon piyaz, Dhako-ali Alocasia macrorrhizos Araceae Maan kochu (L.) G. Don. Lasia spinosa (L.) Araceae Joka, Kata kochu Thwaites Scindapsus officinalis Araceae Takbir gach (Roxb.) Schott Enydra fluctuans Lour. Asteraceae Helancha Cannabis sativa L. Cannabaceae Bhang Carica papaya L. Caricaceae Paypay Terminalia arjuna Combretaceae 1. Arjun (Roxb. ex DC.) Wight & Arn. 2. Arjun Costus speciosus Costaceae Keu (J. Konig.) Sm. Momordica charantia L. Cucurbitaceae Korla Euphorbia neriifolia Euphorbiaceae Kuth-raaz L. Ricinus communis L. Euphorbiaceae Bella Anisomeles malabarica Lamiaceae Raj-moni (L.) R.Br. Leea macrophylla Roxb. Leeaceae Hosti korno polash ex Hornem Gloriosa superba L. Liliaceae Ulot chondal Aphanamixis Meliaceae 1. Pitraj polystachya (Wall.) 2. Pitraj R. Parker Azadirachta indica A. Meliaceae Neem Juss. Stephania japonica Menispermaceae Moshi lota (Thunb.) Miers Ficus racemosa L. Moraceae Joggo dumur Moringa oleifera Lam. Moringaceae Sajna Piper chaba W. Hunter Piperaceae Mach machunda Piper cubeba L.f. Piperaceae 1. Kabab chini 2. Kabab chini Phragmites australis Poaceae Nol-khagra (Cav.) Steud. Zea mays L. Poaceae Bottha Paederia foetida L. Rubiaceae Paad pata Glycosmis pentaphylla Rutaceae Dard-brash (Retz.) Corr. Murraya paniculata Rutaceae Komla jasmine (L.) Jack Datura metel L. Solanaceae Kalo dhutra Datura stramonium L. Solanaceae Shada dhutra Solanum surattense Solanaceae Kontikari Burm.f. Clerodendrum inerme Verbenaceae Vana-jhai (L.) Gaertn. Scientific name Part(s) used District where information was collected Hygrophila auriculata Whole plant Khulna (Schumach.) Heine Crinum asiaticum L. Leaf, fruit Dinajpur Alocasia macrorrhizos Whole plant Khulna (L.) G. Don. Lasia spinosa (L.) Tuber Natore Thwaites Scindapsus officinalis Leaf Dinajpur (Roxb.) Schott Enydra fluctuans Lour. Whole plant Natore Cannabis sativa L. Leaf, root Rajshahi Carica papaya L. Whole plant Khulna Terminalia arjuna 1. Bark 1. Dinajpur (Roxb. ex DC.) Wight & Arn. 2. Bark, fruit 2. Natore, Rajshahi Costus speciosus Leaf, stem Dinajpur (J. Konig.) Sm. Momordica charantia L. Root, fruit, seed Rajshahi Euphorbia neriifolia Whole plant Natore L. Ricinus communis L. Fruit Brahmanbaria Anisomeles malabarica Whole plant Khulna (L.) R.Br. Leea macrophylla Roxb. Leaf Dinajpur ex Hornem Gloriosa superba L. Leaf Dinajpur Aphanamixis 1. Seed 1. Bogra polystachya (Wall.) 2. Leaf, bark, seed 2. Rajshahi R. Parker Azadirachta indica A. Leaf, bark Rajshahi Juss. Stephania japonica Stem Brahmanbaria (Thunb.) Miers Ficus racemosa L. Fruit Brahmanbaria Moringa oleifera Lam. Leaf, bark, seed Rajshahi Piper chaba W. Hunter Leaf Dinajpur Piper cubeba L.f. 1. Leaf, fruit, seed 1. Rajshahi 2. Leaf, stem 2. Dinajpur Phragmites australis Whole plant Khulna (Cav.) Steud. Zea mays L. Root, fruit Rajshahi Paederia foetida L. Whole plant Natore Glycosmis pentaphylla Stem, fruit Rajshahi (Retz.) Corr. Murraya paniculata Leaf, flower Khulna (L.) Jack Datura metel L. Leaf, fruit, seed Natore Datura stramonium L. Leaf, root, seed Natore Solanum surattense Leaf, fruit, seed Rajshahi Burm.f. Clerodendrum inerme Leaf, flower Khulna (L.) Gaertn. Table 2: Percentage use of plant parts by the Kavirajes of the surveyed districts for treatment of rheumatoid arthritis. Plant part Percent (%) use Whole plant 13.6 Leaf 28.8 Stem 6.8 Bark 8.5 Fruit 16.9 Flower 3.4 Seed 13.6 Tuber 1.7 Root 6.8