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A comparative analysis of medicinal plants used by three tribes of Chittagong Hill Tracts region, Bangladesh to treat leukorrhea.

Introduction

Leukorrhea is the flow of a whitish, yellowish or greenish discharge from the vagina of women and which could be normal or due to infections in the vagina or reproductive tract of women. It has been reported that while most cases of infectious vaginitis can be due to non-specific causes, candidiasis and trichomoniasis can account for respectively, 20-30% each of this infections (Eschenbaeh, 1983). Another study has implicated bacterial vaginosis as the most prevalent microbiological cause of vaginal discharge (Hoyme, 1989). In a study carried out in Abidjan, Cote d Ivoire, it has been observed that the most frequent microbial species found in infectious leukorrhea are Gardnerella vaginalis (47%), Candida albicans (29.4%), Chlamydia trachomatis (13.7%), Trichomonas vaginalis (6.9%), and Neisseria gonorrhoeae (2.9%) (Abauleth et al., 2006). Ureaplasma urealytycum and Mycoplasma hominis have also been implicated in vaginal infections leading to vaginal discharge (Onvural et al., 1991). A clinicobacteriological study on leukorrhea found that Trichomonas vaginalis, Neisseria gonorrhoeae, and Candida albicans were exclusively present in leukorrhea. There was also conspicuous association of Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Chlamydia trachomatis, Candida-like organisms, and Actinomyces with leukorrhea (Chaudhuri et al., 1998). However, not all cases of leukorrhea, especially among women in South Asia (where the complaint of vaginal discharge seems to be very common) can be attributed to microbiological causes. The women of South Asia regard even normal vaginal discharge with a sense of distress and associate it with a variety of somatic symptoms like dizziness, backache, and weakness (Trollope-Kumar, 2001).

The objective of the present study was to conduct an ethnomedicinal survey among the Chakma, Murong, and the Tonchonga tribes who reside in the densely forested regions of Chittagong Hill Tracts in the southeastern part of Bangladesh. These tribal groups lack access to modern medicinal facilities and rely for their primary health-care needs on medicinal plants provided by the tribal medicinal practitioners (TMPs). Possibly because of their living in hot and humid conditions in densely forested regions and absence of proper sanitation facilities, the tribal people residing in different areas of Bangladesh suffer from a variety of ailments like urinary tract infections, respiratory disorders, and gastrointestinal disorders (Mohammed Rahmatullah et al., 2009; Abu Hanif et al., 2009; Md.Shahidullah et al., 2009; Md. Shahadat Hossan, 2009; Md. Manzur-ulKadir Mia, 2009). Since the TMPs have a long tradition of usage of medicinal plants, they have developed considerable expertise in their uses. As such, it was of interest to determine the species of plants used by the TMPs used for the treatment of leukorrhea, which is reported frequently by the tribal women. Such documentation can enable modern research to conduct appropriate scientific studies on the medicinal plants towards discovery of new anti-microbial drugs against which the microorganisms involved in infectious leukorrhea may prove more susceptible.

Materials and Methods

The survey was conducted among the Chakma, Murong, and Tonchonga tribes who reside in the districts of Bandarban, Rangamati and Khagrachari districts in the Chittagong Hill Tracts region, which falls in the southeastern part of Bangladesh. Informed consent was obtained from the TMPs of the three tribes prior to commencement of survey. The TMPs were informed in detail as to the nature and the purpose of the survey and consent obtained as to dissemination of survey results in national or international publications. Interviews were conducted with the help of a semi-structured questionnaire and the guided field-walk method as described by Martin (1995) and Maundu (1995). In this method, the TMPs took the interviewers to spots from where they collected their medicinal plants and pointed out the plants, along with providing their local names and a description of their uses. All interviews were conducted through an interpreter, who usually was the Headman of the tribe and was fluent in both the tribal language as well as Bangla, the language spoken by the interviewers. Plant specimens were collected and dried in the field, and later brought back to Bangladesh National Herbarium at Dhaka for complete identification.

When questioned, it was noted that the TMPs did not distinguish between normal leukorrhea and leukorrhea arising out of microbial infections. Their primary treatment was towards stopping of vaginal discharges, which was intensely disliked by the tribal women and considered as 'unhealthy' or due to 'disease(s)'. However, in some cases, the TMPs distinguished vaginal discharges with no accompanying symptoms and vaginal discharges accompanied by pelvic pain, irritations during urination, or passing of blood with urine.

Results and Discussion

It was observed that the TMPs used 13 plants distributed into 12 families for treatment of leukorrhea. The results are summarized in Table 1. The Fabaceae family contributed two plants, with the other eleven families contributing one plant each. The various plant parts utilized to prepare the formulations included whole plant, leaves, stems, barks and roots. Roots constituted the plant part most frequently used (53.3%), followed by leaves (20.0%), barks (13.3%), and whole plant and stems (6.7% each). In all instances, a single plant was used for treatment. The use of plant parts varied. While in ten formulations, a single plant part was used, in three instances, more than one plant part was used in combination. Asparagus racemosus Willd. (whole plant comprising of leaves, stems and roots) was used by the Chakma TMPs. The leaves and barks of Samanea saman (Jacq.) Merr. were used in combination for treatment of leukorrhea as were the leaves and roots of Acrostichum aureum L.

Only two instances of common use of a plant species was found among the Chakma and Tonchonga tribes, that of Elephantopus scaber L. and Costus speciosus (J. Konig.) Sm. The Chakma TMPs had two formulations of the same plant for treatment of leukorrhea, one of which being commonly shared with the Tonchonga TMPs. None of the plants used by the Chakmas or the Tonchongas were used by the Murongs. Overall, the Chakma TMPs used more plants than the Murong or Tonchonga TMPs for treatment of leukorrhea.

With one exception the mode of administration of formulations was oral. The exception was that of Mimosa pudica L., where the juice squeezed from roots was used to wash the vaginal area. When queried, the TMPs mentioned that this was done when the vaginal area was inflamed or showed signs of infections. As to the use of a number of species for treating leukorrhea, the TMPs of both the Chakma as well as the Murong tribe mentioned that this was because not all plants were available in the same season. As a result, they have developed different formulations based upon using separate plant species depending on the availability of the plant.

The mode of preparation of formulations was found to be simple among the TMPs of all three tribes surveyed. The juice was either taken from squeezed or crushed plant part, or the plant part was soaked in water for a time period followed by oral administration of the strained water, or the plant part was boiled in water followed by oral administration of the water. However, the upper portion of the roots of Nymphaea nouchali Burm.f. were burned followed by oral administration of the ashes; the leaves of Acrostichum aureum L. were cooked and eaten as vegetable.

Discussion:

Since leukorrhea may arise from microbial infections, and inflammation of vaginal and other relevant areas may be part of the body conditions leading to white discharge from the vagina, it was of interest to peruse the scientific literature as to whether any of the plants used by the TMPs have been reported for their anti- inflammatory or anti-microbial properties. The anti-inflammatory activity of leaves from Acanthus ilicifolius L. has been reported (Mani Senthil Kumar, 2008). Anti-bacterial steroid alkaloids have been isolated from the stem bark of Holarrhena pubescens Wall. ex G. Don (Chakraborty and Brantner, 1999), and anti-bacterial properties demonstrated in methanol extract of roots of Asparagus racemosus Willd. (Mandal et al., 2000). Anti-inflammatory activity has also reportedly been demonstrated in aqueous extract of leaves of Melastoma malabathricum L (Zakaria et al., 2006).

Since the TMPs were not able to determine and vaginal infections leading to leukorrhea through appropriate microbial culture studies, it may be presumed that at least a certain percentage of leukorrhea reported by tribal women are normal discharges. Even if it is such a case, overall the plants used by the TMPs are important for conducting further scientific research in case they contain relevant phytochemicals for combating leukorrhea arising from infective or other conditions. A number of microorganisms observed in cases of leukorrhea have developed resistance to existing antibiotics and so the plants used by the three tribes surveyed may prove useful for development of better drugs. Further scientific studies establishing the validity of the medicinal plants used by the TMPs can form a basis of immediate treatment of leukorrhea in the absence of modern medicinal facilities.

References

Abu Hanif, Md. Shahadat Hossan, Md. Manzurul Kadir Mia, Mohammad Jahirul Islam, Rownak Jahan & Mohammed Rahmatullah, 2009. Ethnobotanical survey of the Rakhain tribe inhabiting the Chittagong Hill Tracts region of Bangladesh. American Eurasian Journal of Sustainable Agriculture, 3(2): 172-180.

Chaudhuri, M., B.D. Chatterjee and M. Banerjee, 1998. A clinicobacteriological study on leucorrhoea. Journal of Indian Medical Association, 96: 46-50.

Chakraborty, A. and A.H. Brantner, 1999. Antibacterial steroid alkaloids from the stem bark of Holarrhena pubescens. Journal of Ethnopharmacology, 68: 339-344.

Eschenbach, D.A., 1983. Vaginal infection. Clinical Obstetrics and Gynecology, 26: 186-202.

Hoyme, U.B., 1989. Bacterial vaginosis. Zentralblatt fur Gynakologie, 111: 1589-1598.Abauleth, R., Boni, S., Kouassi-Mbengue, A., Konan, J., and Deza, S., 2006. Causation and treatment of infectious leucorrhea at the Cocody University Hospital (Abidjan, Cote d Ivoire). Sante, 16: 191-195.

Mohammed Rahmatullah, Md. Shahadat Hossan, Abu Hanif, Prozzal Roy, Rownak Jahan, Mujib Khan, Majeedul H. Chowdhury & Taufiq Rahman, 2009. Ethnomedicinal Applications of Plants by the Traditional Healers of the Marma Tribe of Naikhongchhari, Bandarban District, Bangladesh. Advances in Natural and Applied Sciences, 3(3): 392-401.

Md. Shahidullah, Md. Al-Mujahidee, SM Nasir Uddin, Md. Shahadat Hossan, Abu Hanif, Sazzadul Bari & Mohammed Rahmatullah, 2009. Medicinal plants of the Santal tribe residing in Rajshahi district, Bangladesh. American Eurasian Journal of Sustainable Agriculture, 3(2): 220-226.

Md. Shahadat Hossan, Abu Hanif, Mujib Khan, Sazzadul Bari, Rownak Jahan & Mohammed Rahmatullah, 2009. Ethnobotanical survey of the Tripura tribe of Bangladesh. American Eurasian Journal of Sustainable Agriculture, 3(2): 253-261.

Md. Manzur-ul-Kadir Mia, Mohammad Fahim Kadir, Md. Shahadat Hossan & Mohammed Rahmatullah (2009) Medicinal plants of the Garo tribe inhabiting the Madhupur forest region of Bangladesh. American Eurasian Journal of Sustainable Agriculture, 3(2): 165-171.

Martin, G.J., 1995. Ethnobotany: a 'People and Plants' Conservation Manual, Chapman and Hall, London, 268 pp.Maundu, P., 1995. Methodology for collecting and sharing indigenous knowledge: a case study. Indigenous Knowledge and Development Monitor, 3: 3-5.

Mani Senthil Kumar, K.T., Gorain, B., Roy, D.K., Zothanpuia, Samanta, S.K., pal, M., Biswas, P., Roy, A., Adhikari, D., Karmakar, S., and Sen, T., 2008. Anti-inflammatory activity of Acanthus ilicifolius. Journal of Ethnopharmacology, 120: 7-12.

Mandal, S.C., A. Nandy, M. Pal and B.P. Saha, 2000. Evaluation of antibacterial activity of Asparagus racemosus Willd. root. Phytotherapy Research, 14: 118-119.

Onvural, A., M. Cognat, N. Demir and H. Yetimalar, 1991. Infections by Mycoplasma hominis and Ureaplasma urealytycum in vaginal discharge. Incidence and treatment. Revue Francaise de Gynecologie et d'Obstetrique, 86: 34-38.

Trollope-Kumar, K., 2001. Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women. Tropical Medicine & International Health, 6: 260-266.

Zakaria, Z.A., R.N. Raden Mohd Nor, G. Hanan Kumar, Z.D. Abdul Ghani, M.R. Sulaiman, G. Rathna Devi, A.M. Mat Jais, M.N. Somchit, and C.A. Fatimah, 2006. Antinociceptive, anti-inflammatory and antipyretic properties of Melastoma malabathricum leaves aqueous extract in experimental animals. Canadian Journal of Physiology and Pharmacology, 84: 1291-1299.

(1) Mohammed Rahmatullah, Rownak Jahan, Md. Shahadat Hossan, Syeda Seraj, Md. Mahbubur Rahman, Anita Rani Chowdhury, Rahima Begum, Dilruba Nasrin, Zubaida Khatun, Mohammad Shahadat Hossain, (2) Mst. Afsana Khatun, Farhana Israt Jahan

(1) Faculty of Life Sciences, University of Development Alternative, Dhanmondi, Dhaka, Bangladesh.

(2) 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: Dr. Mohammed Rahmatullah. Pro-Vice Chancellor University of Development Alternative House No. 78, Road No. 11A (new) Dhanmondi R/A, Dhaka-1205 Bangladesh

Fax: 88-02-8157339

Email: rahamatm@hotmail.com
Table 1:  Medicinal plants used by various tribal medicinal
practitioners of Chittagong Hill Tracts to treat leukorrhea.

Scientific         Family            Local name       Parts used
name

Acanthus           Acanthaceae       Vewkada          Root
ilicifolius L.

Holarrhena         Apocynaceae       Koruj gach       Bark
pubescensWall
ex G. Don

Asparagus          Asparagaceae      Shotomuli        Whole plant
racemosus Willd.

Elephantopus       Asteraceae        Akfoila          Root
scaber L.

Costus             Costaceae         Tiatui           Root
speciosus
(J.
Konig.) Sm.

Dehaasia           Euphorbiaceae     Modon-bocchu     Leaf
kurzii
King ex
Hook.f.

Cassia             Fabaceae          Ichri            Root
sophera L.

Samanea            Fabaceae          Koroi            Leaf, bark
saman
(Jacq.)
Merr.

Melastoma          Melastomataceae   Aksio            Root
malabathricum L.

Stephania          Menispermaceae    Muicchani lota   Stem
japonica
(Thunb.)
Miers

Mimosa             Mimosaceae        Pinuch-rurai     Root
pudica L.

Nymphaea           Nymphaeaceae      Krapao           Root top
nouchali
Burm.f.

Acrostichum        Pteridaceae       Moun shak        Leaf, root
aureum L.

Scientific         Formulation(s)                     Tribe name
name

Acanthus           One teaspoonful of juice           Chakma
ilicifolius L.     obtained from crushed
                   roots is taken with sugar
                   twice daily till cure

Holarrhena         Dried and powdered barks           Chakma
pubescensWall      are mixed with molasses
ex G. Don          and made into pills in bean-
                   seed sizes. One pill is taken
                   twice daily for 7-10 days.

Asparagus          Juice from squeezed whole          Chakma
racemosus Willd.   plant is orally administered

Elephantopus       Roots from 2-3 plants are          Chakma,
scaber L.          washed thoroughly                  Tonchonga
                   mixed with % teaspoonful
                   of sugar, and taken every
                   morning on an empty
                   stomach for 7-10 days.

Costus             1. Root juice is mixed with        Chakma
speciosus          equal amount of water in
(J.                which rice has been washed.
Konig.) Sm.        One teaspoonful of the mixture
                   is taken twice daily for 1 week.

                   2. About an inch portion of root   2. Chakma,
                   is crushed, mixed with molasses,   Tonchonga
                   and taken in the morning on an
                   empty stomach for 5-7 days.

Dehaasia           Two handfuls of leaves are         Chakma
kurzii             sliced into small pieces,
King ex            crushed slightly and soaked
Hook.f.            in a glass of water overnight.
                   The water is strained the
                   following morning and taken
                   on an empty stomach with a little
                   sugar. This is continued
                   for 5-6 days.

Cassia             Roots are crushed to extract       Chakma
sophera L.         juice. % teaspoonful of juice
                   is taken twice daily for 2 weeks.

Samanea            One handful                        Chakma
saman              each of leaves and barks is
(Jacq.)            crushed and the juice extracted.
Merr.              Three drops of the juice is taken
                   once daily for 1 week.

Melastoma          Juice squeezed                     Murong
malabathricum L.   from roots, alternately
                   2 handfuls of roots are cut
                   into small pieces, slightly
                   pulverized and boiled in 1
                   liter of water till volume is
                   reduced to 1 glass. The juice
                   or water is orally administered.

Stephania          Juice from                         Chakma
japonica           crushed stems is taken
(Thunb.)           with a little sugar or molasses
Miers              (one teaspoonful twice daily for 3-5
                   days).

Mimosa             Vaginal area is washed with        Murong
pudica L.          juice squeezed from roots.

Nymphaea           The upper portion of roots         Murong
nouchali           are burned and ashes orally
Burm.f.            taken for 3 days.

Acrostichum        Leaves are cooked and              Chakma
aureum L.          eaten as vegetable;
                   alternately, juice is extracted
                   from the top portions of crushed
                   roots. One teaspoonful
                   (two teaspoonfuls in case of
                   severe helminthic infections) is
                   taken daily for 14-16 days.
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Article Details
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Author:Rahmatullah, Mohammed; Jahan, Rownak; Hossan, Shahadat; Seraj, Syeda; Rahman, Mahbubur; Chowdhury, A
Publication:Advances in Natural and Applied Sciences
Article Type:Report
Geographic Code:9BANG
Date:May 1, 2010
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