A randomized survey of medicinal plants used by folk medicinal practitioners in ten districts of Bangladesh to treat leprosy.
Leprosy, otherwise known as Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. It is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract. The disease is characterized by the formation of skin lesions. For purposes of treatment, the disease is divided into two types. For persons with 1-5 skin lesions, the disease is named pauci-bacillary leprosy and the patient is treated with a regimen of two drugs--rifampicin and Dapsone (diamino-diphenyl sulfone). For persons having greater than 5 skin lesions, it is termed multi-bacillary leprosy and is treated with a regimen of three drugs--rifampicin, clofazimine, and Dapsone.
Dose-related hemolysis is the most common adverse effect reported for Dapsone. Rifampicin side-effects may include stomach upset, heartburn, nausea, headache, and dizziness. Common side-effects of clofazimine include loss of appetite, diarrhea, nausea, vomiting, dry skin and discoloration of skin. Less common sideeffects with clofazimine include black or bloody stools, severe stomach pain, yellowing of the skin or eyes, unusual weakness, and depression. Leprosy causing nerve function impairment is increasingly treated with cortocosteroids. Minor adverse events of corticosteroid treatment include moon face, fungal infections, acne, and gastric pain. Major adverse effects have been reported as psychosis, peptic ulcer, glaucoma, cataract, diabetes, and hypertension (Richardus, J.H., 2003). Quite obviously, if any drugs are discovered with less adverse effects, that would prove to be beneficial to the patients.
The World Health Organization (WHO) estimated the global number of registered leprosy patients at about 5.5 million in 1991. Additionally there were 2-3 million people with deformities due to leprosy. A 1983 estimate of registered cases showed that Bangladesh is one of the 5 countries in the world contributing 82% of cases (Noordeen, S.K., 1992). Clearly, leprosy is a global disease and particularly prevalent in Bangladesh. In a study conducted on 2,517 patients in Dhaka, Bangladesh, it was observed that 2.1% patients suffered from Indeterminate form of leprosy, 52.7% suffered from tuberculoid form, 17.4% suffered from borderline tuberculoid form, 4.4% suffered from borderline lepromatous form, and 23.4% suffered from the lepromatous form of the disease (Choudhury, A.M., 1991). It has been estimated that about 173,196 patients suffer from leprosy in Bangladesh (Richardus, J.H. and R.P. Croft, 1995). However, the prevalence of previously undiagnosed leprosy may be six times higher than the registered prevalence, at least in northwest Bangladesh (Moet, F.J., 2008). It has been reported that that the risk of leprosy was highest within 1 kilometer of rural town centers and that rural towns in Bangladesh may play an important role in the epidemiology of leprosy in that district (Hossan, M.S., 2010).
Lepers are shunned in Bangladesh and the general population reaction to lepers is almost one of 'dread'. As a result, lepers, particularly in the rural areas try to avoid contact with people and among the poorest sections of the population, live a life of destitution. Interventional programs conducted by both Governmental and non-Governmental agencies sometimes do not reach these people. At the same time, the rural population of Bangladesh in particular relies on traditional medicinal practitioners (Kavirajes) for treatment of leprosy, who do so with administration of medicinal plants. Since the Kavirajes possess considerable expertise in the use of medicinal plants and traditional treatment with medicinal plants has its origin hundreds of years ago, it was of interest to conduct ethnomedicinal surveys to gather knowledge on medicinal plants used by the Kavirajes for treatment of leprosy. We had been conducting ethnomedicinal surveys in various areas of Bangladesh for quite some time (Rahmatullah, M., 2010; Rahmatullah, M., 2009; Rahmatullah, M., 2009; Rahmatullah, M., 2009). It was the objective of the present study to conduct randomized surveys in ten different districts of the country towards obtaining data on medicinal plants used for leprosy treatment.
Materials and Methods
The present randomized survey was carried out among Kavirajes of ten districts of Bangladesh, namely Bogra, Jhalokathi, Khulna, Mymensingh, Naogaon, Natore, Netrakona, Panchagarh, Rajshahi, and Rangpur. 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 leprosy 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 leprosy 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 names of a total of 16 plant species were obtained from the Kavirajes of the ten districts surveyed. The plant species belonged to 11 families. The Combretaceae family contributed three plants followed by the Apocynaceae, Fabaceae, and the Lythraceae families with two plants each. The results are summarized in Table 1.
Whole plants as well as plant parts like leaves, barks, roots and seeds were used for treatment. It was observed that in several instances, a single plant part (like bark of Terminalia chebula Retz.) was used. However, the Kavirajes also used combinations of two or more plant parts for treatment. A combination of leaves and roots of Nerium indicum Mill. was used by the Kavirajes of Netrakona district. A combination of leaves, roots, and seeds of Cassia occidentalis L. was used by the Kavirajes of Panchagarh district. Overall, the maximum number of plants for treatment of leprosy was obtained from the Kavirajes of Netrakona district, which suggests that the disease is quite prevalent in that district.
An interesting observation was that the Kavirajes of the various districts, with one single exception, mentioned different plants for treatment of leprosy. The only exception was that of Alstonia scholaris (L.) R.Br., which was used in both Naogaon as well as Rangpur district. However, the whole plant was used in Naogaon district versus use of bark in Rangpur district.
Bangladesh is not the only country in the world where folk medicine or usage of medicinal plants occurs for the treatment of leprosy. Four medicinal plants have been reported for Mali, West Africa for treatment of this disease. The plants are Cola cordifolia Sim., Opilia celtidifolia Endl. ex Walp., Parkia biglobosa Benth., and Ximenia americana L. (Granhaug, T.E., 2008). Extracts of Nerium oleander L. and Nerium odorum Sol. roots are used in Indian traditional medicine for treatment of leprosy. A common Indian herb, Mandukaparni is also used for treatment of this disease (Chaudhuri, S., 1979; Chowdhury, S., and S. Ghosh, 1979). An Ayurvedic drug "samshodhan-karm" is also used in India in the treatment of leprosy (Ojha, D. and G. Singh, 1967). Acacia catechu Willd., a plant also present in Bangladesh has been clinically evaluated in the treatment of lepromatous leprosy (Ojha, D., 1969). Anti-mycobacterial activities have been reported for the plants Psoralea corylifolia L. and Sanguinaria canadensis L. and active constituents isolated from the plants (Newton, S.M., 2002).
From just a brief survey of the literature, it appears that the plants used by the Kavirajes in ten districts of Bangladesh present considerable potential in the treatment of leprosy. Further scientific studies need to be conducted on these plants towards discovery of lead compounds, which can lead to formulation of new drugs for treatment of leprosy with giving less or no side-effects. Leprosy is a disease loathed among a number of cultures of the world; the patients are simply treated as "social outcasts". It is important that folk medicinal plants be also utilized in completely getting rid of this disease.
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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, Farhana Israt Jahan.
(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 ten districts of Bangladesh surveyed for treatment of leprosy. Scientific name Family Local Name Alstonia scholaris (L.) Apocynaceae 1. Chitan R.Br. 2. Chatian Nerium indicum Mill. Apocynaceae Rokto korobi Calotropis gigantea (L.) Asclepiadaceae Lal-akondo Ait.f. Blumea lacera DC. Asteraceae Shiyal-muthri Terminalia arjuna (Roxb. Combretaceae Arjun ex DC.) Wight & Arn. Terminalia belerica Roxb. Combretaceae Bohera Terminalia chebula Retz. Combretaceae Horitoki Commelina benghalensis L. Commelinaceae Kananga Pedilanthus tithymaloides Euphorbiaceae Bera chita (L.) Poit. Cassia occidentalis L. Fabaceae Kulka-sunda Cassia tora L. Fabaceae Jongli badam Gynocardia odorata R.Br. Flacourtiaceae Chal-moghra Lawsonia inermis L. Lythraceae Mehedi Punica granatum L. Lythraceae Dalim Artocarpus heterophyllus Moraceae Kathal gach Lam. Solanum xanthocarpum Solanaceae Sial kata, Schrad. & Wendl. Kontikari Scientific name Part(s) used District where information was collected Alstonia scholaris (L.) 1. Whole plant 1. Naogaon R.Br. 2. Bark 2. Rangpur Nerium indicum Mill. Leaf, root Netrakona Calotropis gigantea (L.) Whole plant Natore Ait.f. Blumea lacera DC. Leaf, root Netrakona Terminalia arjuna (Roxb. Bark Rajshahi ex DC.) Wight & Arn. Terminalia belerica Roxb. Bark Panchagarh Terminalia chebula Retz. Bark Mymensingh Commelina benghalensis L. Whole plant Khulna Pedilanthus tithymaloides Whole plant Natore (L.) Poit. Cassia occidentalis L. Leaf, root, seed Panchagarh Cassia tora L. Leaf, seed Khulna Gynocardia odorata R.Br. Leaf, bark Khulna Lawsonia inermis L. Leaf, bark Netrakona Punica granatum L. Leaf, bark Netrakona Artocarpus heterophyllus Leaf Bogra Lam. Solanum xanthocarpum Root Jhalokathi Schrad. & Wendl.