Diarrhoea is defined as the passage of abnormally liquid or unformed stools at an increased frequency, and denotes a change in the usual bowel movement. It is a symptom of various disease conditions of the gastrointestinal system and is often considered as a disease itself. Diarrhoea can be acute and chronic as per its causes.

Acute diarrhoea lasts for hours or days and the number of bowel movements usually exceeds three per day. The causes of acute diarrhoea can be infectious or non-infectious. The usual clinical features of acute infective diarrhoea are frequent stools, sometimes with blood and mucous, pain during passing stools, abdominal pain, vomiting and fever. Severe diarrhoea leads to dehydration, which manifests itself as apprehension, cold clammy skin, rapid pulse, deep and rapid respiration, inelastic skin, sunken eyeballs, dry tongue, scanty urine and low blood pressure. Untreated acute diarrhoea can be fatal. The non-infectious category of diarrhoea can be caused by drugs such as antibiotics, certain antidepressants, antacids, bronchodilators, chemotherapeutic agents, laxatives, non-steroidal anti-inflammatory drugs, etc., and spurious diarrhoea, which follows chronic constipation especially in older people and in association with psychological stress.

Chronic diarrhoea lasts for weeks or months and may be either persistent or recurrent. The aetiology of chronic diarrhoea is usually related to structural and functional disorders of the gastrointestinal tract. The clinical features of chronic diarrhoea are either persistent or recurrent with intervening periods of normalcy or constipation. Stool volume may be large or small and may be watery, loose, bulky or frothy. Diarrhoea may be accompanied by abdominal pain or discomfort and abdominal distension. Systemic symptoms such as fever, anorexia, weight loss, generalized weakness and malaise may also be present. Untreated chronic diarrhoea can lead to malabsorption syndrome and malnutrition.

It is always important to understand the underlying cause of diarrhoea so that the right treatment can be planned. However, uncomplicated diarrhoea due to indigestion and infection can be managed with Ayurvedic formulation such as Kutaja powder along with necessary dietary precautions.

Kutaja [Holarrhena antidysenterica (Roxb. ex Flem.) Wall.]

Kutaja powder is a simple formulation prepared from the stem bark of Holarrhena antidysenterica (Roxb. ex Flem.) Wall., a small to medium-sized tree, found throughout India. The stem bark is collected from 8-12 years old trees during the middle of rainy season (July to September) and again at the end of winter by hewing and peeling and separating it from the attached wood. The stem bark is bitter in taste and used in Ayurveda for the treatment of gastrointestinal disorders, particularly diarrhoea and dysentery. Most of the Ayurvedic formulations described in literature and various commercially marketed formulations for diarrhoea essentially contain Kutaja as one of their ingredients. Kutaja is mentioned in the Indian Ayurvedic Pharmacopeias1 as well as Formulary. Apart from the preferred use of Kutaja in the treatment of diarrhoea, scientific studies have established its anti-protozoal, anti-giardia and antiamoebic properties.

Composition

Kutaja powder is prepared from the stem bark of Kutaja.

English name	Kurchi, Tellicherry bark
Latin name	Holarrhena antidysenterica Roxb. ex Flem. Wall.
Family	Apocynaceae
Parts used	Stem bark

Main chemical constituents

Conessine, conessemine, kurchine, kurchicine, etc.

Quality standards

Identity, purity and potency of Kutaja Churna for its oral use are estimated on the basis of the following physical constants:

Foreign matter	Not more than 2%
Total ash	Not more than 7%
Acid insoluble ash	Not more than 1%
Alcohol (60%) soluble extractive	Not less than 18%
Water soluble extractive	Not less than 10%

Method of preparation

• (1) Take 50 grams of dried stem bark of Kutaja and further dry it in the shade to remove moisture for easy powdering.
• (2) Grind stem bark in a grinder or pulverizer till fine powder is obtained.
• (3) Filter the powder through 85 mesh to remove coarse particles and fibers.
• (4) The shelf life of the powder is four months but it can retain its potency for at least six months, if kept in an air tight container and protected from direct sunlight and heat.

Dosage form

Bitter brownish powder.

Therapeutic properties

The bark of Kutaja has anti-diarrhoeal, constipating, astringent, antidysenteric, anthelmintic, carminative and digestive properties.

Dose and mode of administration

The adult dose of Kutaja powder is 3-5 g and for children 500 mg to 1 g, twice or thrice daily with warm water, before meals.

Indication and uses

Kutaja bark is useful in various kinds of diarrhoea and dysentery.

Precautions and safety aspects

• (1) No side effect or toxic effect of Kutaja powder has been mentioned in the classical Ayurvedic literature. Clinical studies have also shown no adverse effects in patients treated with Kutaja powder within the recommended dose alone as well as in combination with other home remedies. Kutaja may cause distension of the abdomen after using for a few days.
• (2) As prolonged use of Kutaja powder may produce constipation, hence as soon as the diarrhoea is checked the dose of Kutaja powder should be tapered off.
• (3) A study on the side effects of Holarrhena antidysenterica in patients has revealed that it can lead to subjective symptoms as well as hypertension7. Hence hypertensive patients should take Kutaja powder under medical supervision.
• (4) Prolonged use of Kutaja powder during pregnancy should be done under medical supervision. However, it is safe for the baby if a nursing mother is taking this medication.

References

• (1) 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, MoHFW, 2001. p. 78-79.
• (2) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part-II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2000. p. 66.
• (3) Sharma PC, Yelne MB,& Dennis TJ. Data base on medicinal plants used in Ayurveda. Vol. II. New Delhi: Central Council for Research in Ayurveda & Siddha, 2002. p. 349.
• (4) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopeia of India. Part I, Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2001. p. 79.
• (5) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopeia of India. Part I, Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, MoHFW, 2001. p. 78.
• (6) Sharma PC, Yelne MB, Dennis TJ. Data base on medicinal plants used in Ayurveda. Vol. II. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 348.
• (7) Sharma PC, Yelne MB & Dennis TJ. Data base on medicinal plants used in Ayurveda. Vol. II. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 350.

Further reading

• (1) Bhattacharjee SK. Handbook of medicinal plants. Jaipur: Pointer Publishers, 1998.
• (2) Chopra RN, Chopra IC, Varma BS. Supplement to glossary of Indian medicinal plants. New Delhi: Publications and Information Directorate, Council of Scientific and Industrial Research, 1992.
• (3) Chunekar KC. Bhavaprakasha nighantu. Varanasi: Chaukhambha Bharati Academy, 1982.
• (4) Dinesh Chandra, Dixit SK, Sen PC, Joshi D. An experimental study of Kutajarishta with special reference to amoebiasis. Ancient Sci. Life. 1988; 8(2).
• (5) Warrier PK et al. Eds. Indian medicinal plants. Vol. III. Madras: Orient Longman Ltd., 1966.
• (6) Janot MM, Cavier R. Anthelmintic properties of conessine hydrochloride. Ann. Pharm. Franc. 1949; 7: 549-552; Chem. Abstr., 44(5), 1950.

Source: Traditional Herbal Remedies for Primary Health Care - WHO