Constipation is a common problem which usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation. Other expressions of constipation include passage of unduly dry and hard faeces, sluggish action of bowel, etc. It is important to note that it is virtually impossible to define what constitutes a “normal bowel movement” in terms of frequency. Generally, frequency of bowel evacuation varies from person to person. As per a person’s tendency, lifestyle and dietary habit, frequency of defecation of 1-2 per day to thrice a week is considered as normal bowel habit for that individual, unless it creates any discomfort or disturbs his routine life. The volume of stool passed differs greatly in different races.

Unsatisfactory bowel evacuation is the chief condition for diagnosis of constipation. Some other symptoms which accompany or result from constipation are indigestion, flatulence, abdominal pain or discomfort, headache and sleeplessness. The retention of hard faecal masses may give rise to spurious diarrhoea and in extreme situations can lead to intestinal obstruction especially in frail and bed-ridden older individuals.

Various causative factors for constipation are given below.

• (1) Irritable bowel syndrome
• (2) Related to diet factors:
  • - Too bland food, e.g. with low fibre residue
  • - Too dry and astringent food
  • - Inadequate fluid intake
• (3) Intake of hard water
• (4) Metabolic disease like hypothyroidism
• (5) Obstructive diseases of lower gastrointestinal tract
• (6) Drugs: opium, iron, blood pressure medicines
• (7) Irregular bowel habit
• (8) Sedentary lifestyle
• (9) Depressive disorders
• (10) Old age
• (11) Suppression of natural urge of defecation

In Ayurveda, various laxative drugs are mentioned to treat such conditions. Out of these Haritaki powder is a simple herbal laxative which is frequently used for treating constipation following certain lifestyle changes. Some do’s and don’ts given in the Ayurvedic texts are helpful in preventing constipation:

• (1) Persons suffering from constipation should not ignore defecation urge nor should they strain for a long time to pass out stools.
• (2) Drinking of warm water and milk improves intestinal movements and is beneficial in relieving constipation.
• (3) Much deviation from the normal timing of meals and quantity of food should be avoided. It is beneficial to take soft, digestible and semi-solid food.
• (4) Heavy and untimely meals, eating food before the digestion of earlier food, and intake of dry, astringent and cold foods hamper intestinal movements adding to constipation.
• (5) Regular walking, physical activity and deep breathing and certain edibles like, ginger, lemon, resins, dates, figs and almond oil help in alleviating constipation.

Haritaki (Terminalia chebula Retz.)

Haritaki powder is a simple formulation made of its dried ripe fruits. The plant is also named as Pathya, owing to its beneficial effect for the channels (patha) of the body. It is not only used for constipation but for various gastrointestinal and systemic problems. Scientific studies have established its stomachic, laxative and anti-flatulence actions. Judicious use of Haritaki with necessary dietary and lifestyle changes can treat constipation successfully as well as improve the physiological status of the gut.

Composition

Haritaki powder is fine powder of dried ripe fruits of Terminalia chebula.

English name	Chebulic myrobalan, Ink nut
Latin name	Terminalia chebula Retz.
Family	Combretaceae
Part used	Dried fruits without seeds

Main chemical constituents

Anthraquinone, glycoside, chebulinic acid, chebulagic acid.

Quality standards

Identity, purity and potency of Haritaki fruits for its oral use is estimated on the basis of the following physical constants:

Foreign matter	Not more than 1%
Total ash	Not more than 5%
Acid insoluble ash	Not more than 5%
Alcohol soluble extractive	Not less than 40%
Water soluble extractive	Not less than 60%

Method of preparation

• (1) Take dried fruits of Haritaki, remove their seeds and dry them further in the shade avoiding direct sunlight. Fruits should not have been harvested more than six months ago.
• (2) Make fine powder in a grinder or pulverizer.
• Sieve the powder through 85 size mesh to (3) remove coarse fibers and other particles.
• (4) Keep the powder in a dry and air tight plastic or glass container and consume it within six months or before the next rainy season, whichever is earlier.

Dosage form

Brownish fine powder.

Therapeutic Properties

Haritaki has laxative, carminative, digestive, antispasmodic, anthelmintic, anti-microbial, anti-stress and endurance promoting properties.

Dose and mode of administration

To achieve laxative action of Haritaki, adult dose of powder is 3 to 6 grams and for children, the dose of Haritaki is 500 mg to 1 gram, to be taken with lukewarm water once a day on an empty stomach. It is preferably taken early in the morning or minimum three hours after dinner.

Indication and uses

Haritaki is useful in constipation, haemorrhoids, stomatitis, hyperacidity and associated gastrointestinal disorders.

Precautions and safety aspects

• (1) No side or toxic effect of Haritaki is reported in classics with its recommended dose. Clinical studies have also shown no adverse effect in patients treated with Haritaki alone or with formulations.
• (2) It should not be prescribed to pregnant women. It is safe for the baby if the nursing mother is taking this medication.
• (3) The astringent and dry property of Haritaki may induce nausea in sensitive individuals. This may be masked by consuming it in tablet form or by preparing its decoction and adding jaggery to it.
• (4) Dose of Haritaki as a laxative varies from person to person according to their constitution, digestive power and bowel habit. Administration of Haritaki should be stopped if the desired effect is not achieved.
• (5) Sudden altered bowel habit, alternate diarrhoea and constipation or persistence of the constipation in spite of proper administration of Haritaki, are the signs of some serious pathological conditions inside the gut. Therefore, the underlying cause must be properly investigated and treatment should be taken under medical supervision only.
• (6) Too dry a diet should be avoided and a diet with higher fibre content and liquids is advisable for the patient. Regular and proper lifestyle plays an important role in keeping the gut healthy.

References

• (1) Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda and Siddha, 2005. p. 283.
• (2) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 47.
• (3) Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda and Siddha, 2005. p. 284.
• (4) Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi, Central Council for Research in Ayurveda and Siddha, 2005. p. 283-284.

Further reading

• (1) Chatterjee A, Pakrashi SC. The treatise on Indian medicinal plants. Vol. 5. New Delhi: National Institute of Science Communication, Council of Scientific and Industrial Research, 1997.
• (2) Chunekar KC. Bhavaprakasha Nighantu. Varanasi: Chaukhambha Bharati Academy, 1999.
• (3) Sharma PV. Dravyaguna vijnana. Vol. II. Varanasi: Chaukhambha Sanskrit Sansthana, 1981.
• (4) Sharma PV. Classical uses of medicinal plants. Varanasi: Chaukhambha Visvabharati Academy, 1996.
• (5) Shastri AD. Bhaishajyaratnavali. Varanasi: Chaukhambha Sanskrit Santhana, 1981.
• (6) Council of Scientific and Industrial Research, National Institute of Science Communication and Information Resources. The useful plants of India. New Delhi: National Institute of Science Communication, 2000.

Source: Traditional Herbal Remedies for Primary Health Care - WHO