Leucorrhoea is a whitish mucous discharge from the female genital tract. The basic cause of this problem is overproduction of secretions from the genital tract due to continuous irritation. Mostly there is a change in the vaginal flora due to change in pH. Vaginal infection is the most common cause, which usually results from poor hygiene.

Other causes of leucorrhoea are ill health, under-nourishment, marital disharmony, psychological, and endocrine disturbances, genital tract inflammation, any growth in the uterus and use of contraceptives. Leucorrhoea without any underlying pathological condition is seen in early pregnancy, sexual excitement and at puberty. This type of leucorrhoea needs no medication but assurance as it may correct itself though excessive secretions are sometimes enough to keep the vulva moist and stain the under-clothing.

Differentiation of the underlying causes of leucorrhoea can be grossly done according to the period of a woman’s life.

• (1) Leucorrhoea at an early age, up to puberty usually occurs due to inflammation of the vagina.
• (2) Post-puberty leucorrhoea up to marriage usually occurs from poor genital hygiene, vaginal infection, ill health and anaemia.
• (3) Post-childbirth leucorrhoea occurs mainly due to vaginal or cervical tear. Leucorrhoea during the childbearing age after the birth of the first child usually occurs due to cervical erosion or chronic infective inflammation of the cervix and vagina, use of contraceptives, excessive vaginal medication or use of tampons.
• (4) Pre-menopausal leucorrhoea results from uterine polyps, fibroid, carcinoma and prolapse. Post-menopausal leucorrhoea is mainly the result of genital tract growth, uterine prolapse or senile changes in the vagina.

Leucorrhoea without severe pathologic conditions can be successfully managed with a simple remedy such as a powder made from Lodhra bark and by following certain do’s and don’ts in the Ayurvedic texts. These are:

• (1) Nutritious diet, proper physical activity, mental relaxation, regular bowel habits and local hygiene are the key to effective management of leucorrhoea.
• (2) Excessive intake of water, unripe fruits, sweet foods and drinks made of sugar, sedentary lifestyle and indulgence in fear, anger and grief are the negative factors for leucorrhoea patients and should be avoided.

Lodhra (Symplocos racemosa Roxb.)

Lodhra powder is a single-ingredient powder made from dried stem bark of an evergreen tree Symplocos racemosa Roxb., which is 6 to 8.5 metres tall, found abundantly in the plains and lower hills throughout India. The bark of Lodhra tree is used orally as well as for topical application in the form of a vaginal douche. The formulation is mentioned in classical Ayurvedic texts and in the Ayurvedic Pharmacopoeia of India for use in conditions with increased discharge like diarrhoea, dysentery, leucorrhoea, excessive menstrual bleeding, haemorrhagic disorders, conjunctivitis, etc. The bark has astringent, styptic, cooling, anti-inflammatory and anti-microbial properties and is used in various Ayurvedic formulations meant for the management of excessive vaginal discharge. Scientific studies have shown that Lodhra bark has an inhibitory effect on the growth of Micrococcus pyogenes var. aureus, E. coli, and enteric groups of microorganisms.

Composition

The formulation consists of finely powdered stem bark of Symplocos tree.

English name	Symplocos bark
Latin name	Symplocos racemosa Roxb.
Family	Symplocaceae
Part used	Dried stem bark

Main chemical constituents

Alkaloids (loturine, loturidine and colloturine) and red colouring matter.

Quality standards

The bark of Symplocos racemosa Roxb. used for making medicinal powder should adhere to the following physical constants.

Foreign matter	Nil
Total ash	Not more than 12%
Acid insoluble ash	Not more than 1%
Acid-soluble extractive	Not less than 9%
Water-soluble extractive	Not less than 15%

Method of preparation

• (1) Properly dried stem bark of Lodhra is cleaned first to remove foreign matters and then powdered and sieved through 85 mesh. Exposure to moisture should be avoided during preparation of the powder and it should be kept in an air-tight container in a dry place. Properly kept powder retains its potency for one year.
• (2) For preparing a decoction for vaginal wash, the stem-bark of Lodhra is cleaned and coarsely powdered. The decoction is prepared by boiling 20 to 30 grams of coarse powder of Lodhra bark in 300 to 500 ml of water till 100 to 125 ml remains. The decoction is filtered and the liquid thus obtained is used warm for vaginal douche. Fresh decoction should be prepared for the wash every day.

Dosage form

Grayish-brown powder for oral use and decoction for vaginal wash.

Therapeutic properties

Lodhra bark has astringent, styptic, anti-inflammatory, and antimicrobial properties.

Dose and mode of administration

• (1) Lodhra powder is given orally in the dose of 3 to 5 gram, twice a day, with rice water or warm water. Rice water is prepared by soaking one tablespoon of raw rice in 50 ml plain water for an hour and then taking out the liquid part. Alternatively, a mixture of the given dose of powder with the equal amount of honey can be swallowed with warm water or rice water.
• (2) Vaginal wash with the decoction of Lodhra bark should be done daily for two to three weeks till local symptoms are adequately controlled. Thereafter, only oral medication should be continued.
• (3) Concomitant use of powder orally and decoction for vaginal wash helps in speedy and better control of leucorrhoea.

Indications and uses

• (1) Leucorrhoea.
• (2) Menorrhagia or metrorrhagia.

Precautions and safety aspects

• (1) It is advisable to diagnose the cause of leucorrhoea before starting treatment with Lodhra.
• (2) Overdose and empty-stomach consumption of Lodhra powder may cause abdominal heaviness, nausea and constipation in individuals prone to gastro-intestinal upsets. These symptoms can be avoided by taking light or liquid diet.
• (3) Decoction of Lodhra bark for vaginal wash should be prepared fresh and should not be left uncovered for a long time. It is better to use the decoction within an hour or so of preparation.
• (4) A smaller dose of Lodhra powder may be taken, if menstrual flow gets diminished.
• (5) Excessive use of spicy and sour food items, curd and yoghurt should be avoided during medication.
• (6) Mental stress aggravates the symptoms of leucorrhoea and hence an attempt should be made to remain stress-free, relaxed and physically active.
• (7) If significant control of symptoms is not achieved in three to four weeks, medical opinion must be sought.
• (8) No adverse effect of Lodhra powder is reported when taken in recommended doses.
• (9) It is safe for the baby if a nursing mother is taking this medication. However, Lodhra powder should not be used for a long duration during pregnancy.

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, 2001. p. 83.
• (2) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda & Siddha, 2002. p. 166.
• (3) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 82.
• (4) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda and Siddha, 2002. p. 164, 166.
• (5) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda and Siddha, 2002. p. 165.

Further reading

• (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, 2001.
• (2) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda and Siddha, 2002.
• (3) Sharma PV. Dravyaguna vijnana. Vol. II. Varanasi: Chaukhamba Bharati Academy, 2001.
• (4) Pandey G.S., ed. Bhavaprakasha Nighantu. Varanasi: Sri Bhavamishra Chaukhamba Bharati Academy, 1999.
• (5) 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.
• (6) Bhattacharjee SK. Handbook of medicinal plants. Jaipur, Pointer Publishers, 1998.
• (7) Chopra RN, Chopra Nayar, SL, Chopra IC. Glossary of Indian medicinal plants. New Delhi: Publications and Information Directorate, Council of Scientific and Industrial Research, 1986.
• (8) Kirtikar KR, Basu BD. India medicinal plants. Vol. II. Allahabad: L.M. Basu, 1989.
• (9) Kurup PNV, Ramadas VNK, Joshi P. Handbook of medicinal plants. New Delhi: Central Council for Research in Ayurveda and Siddha, 1979.
• (10) Rastogi RP, Mehrotra BN. Compendium of Indian Medicinal Plants. Vol. III. New Delhi: Publications and Information Directorate, Council of Scientific and Industrial Research, 1993.

Source: Traditional Herbal Remedies for Primary Health Care - WHO