A comparative analysis of medicinal plants used by three tribes of Chittagong Hill Tracts region, Bangladesh to treat leukorrhea.
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.
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.
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(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
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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|Author:||Rahmatullah, Mohammed; Jahan, Rownak; Hossan, Shahadat; Seraj, Syeda; Rahman, Mahbubur; Chowdhury, A|
|Publication:||Advances in Natural and Applied Sciences|
|Date:||May 1, 2010|
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