Lecture 1: Dr.

Dina El-Kersh
Gastro-intestinal disorders
Liver
disorders

Stomach &
Intestinal
disorders
 GIT disorders
• Many botanicals used for GIT disorders among
which Ginger & Peppermint are included in
the top 10 natural products reported in a
national survey of adults in USA.
Common botanicals for GIT disorders
Chamomile flower heads:
Two species of Chamomile are
“Roman” Anthemis nobilis &
“German” Matricaria chamomilla
“M. rucetita”, family Astreaceae.

• Some people use dog fennel

flowers as roman chamomile
“Anthemis cotula”
 Chamomile flowers
• Volatile oil (0.3-2.0 %), major volatile α-bisabolol and its
oxides, azulene class (chamazulene) has anti-
inflammatorty, anti-bacterial effects.

• Upon hydro or steam distillation of chamomile oil, its

color is bright blue to deep green.!!!

chamazulene

• Flavonoids including Apigenin, luteolin, quercetin.

• Dog fennel flowers contains higher concentrations of

anthecotulide, a sesquiterpene lactone.
Chamomile flowers can be
used for treatment of
kinetosis
Kinetosis:
✓ A problem arises due to disconcordance between the
sensory inputs “visual perceived movement” and
“vestibular system sense of movement”.
✓ So the brain will rise to a conclusion, that is
hallucination do exist. The hallucination is due to
poison indigestion which in turn will stimulate the
area postrema in the brain for the vomiting reflex.

✓ Stimulation of vomiting centers of area postrema due

to increase of 5HT Nt. (vagal stimulation).
• Calming effect of chamomile “ mild
tranquilizer & sleeping inducer” due to the
flavonoid Apigenin which serve as a BZDP
receptor-binding ligand.
• Chamomile generally safe, but patients taking
warfarin (Coumadin), aspirin or anti-platelet
drugs should use chamomile with caution.
• Chamomile flowers contain coumarins which
are natural blood thinning agents which
increase the risk of bleeding.
• Coumarins inhibit Vitamin K recycling..!!!

4 hydroxy coumarin
• Chamomile products containing dog fennel
may have higher rate of allergic reactions
related to the anthecotulide content “skin
allergen.”

• Standardization:
A 400 mg chamomile flowers/capsule:
standardized to 1% apigenin & 0.5 % essential
oil.
 A. cotula

A. nobilis

https://www.google.com.eg/search?dcr=0&q=anthecotulides+%2B+ant
hemis+cotula&oq=anthecotulides+%2B+anthemis+cotula&gs_l=psy-
ab.3...4544.9014.0.10006.17.17.0.0.0.0.235.2696.0j8j6.14.0....0...1.1.64.
psy-ab..3.9.1744...33i160k1j33i21k1.0.xzlmJKhSAA8
 Underground Ginger
Some clinical studies suggest the use of rhizomes and
roots of ginger as anti-inflammatory & also reveal
nausea & vomiting associated with
http://www.sciencedirect.com/science/article/pii/S0049384803004912
 Ginger
Volatile oil (1-3%):
• Sesquiterpene components: zingiberene & β-
bisabolene. (Aromatic constituents)
• Phenolic components:gingerol & shogaol.
(Pungent constituents).
 Licorice roots & rhizomes
• Glycyrrhiza glabra belongs to family Fabaceae. Its
below ground parts contain the active
ingredients.
• Liquorice was recommended by the Greeks to treat
stomach ulcers and by Arab physicians to treat coughing.

1. Liquorice contains a saponin glycoside Glycyrrhizin

(50 times sweeter than sucrose).
2. Flavonoid glycosides (liquiritigenin, liquiritin
(liquiritoside), rhamnoliquiritin)
 Glycyrrhizin

• The licorice extract ( flavonoids) stimulates the

secretion of secretin: A substance which promote
intestinal mucosa proliferation, in addition to
antibiotics (anti Gram –ve H. pylori+ Proton pump
inhibitors to decrease gastric secretions).
• Prolonged use of Licorice result in
Hypertension & Hypokalemia
• Sodium & water retention= Hypertension (due to inhibition of 11-
 hydroxysteroid dehydrogenase present in high concentration in
the kidneys and converts cortisol to cortisone “inactive”) and
inhibition of 5 β-reductase (break down of aldosterone) with a
consequent increase in cortisol “hydrocortisone” and aldosterone
promoting sodium reabsorption, an associated passive
reabsorption of water & urinary excretion of potassium (via
binding to mineralcorticoid receptors) = Hypokalemia “Ms.
Twitches, Ms. Pain, lethargy”
 Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a disturbed state of
intestinal motility for which no anatomic cause can
be found.
IBS has many symptoms including: bloating, intestinal
spasms, constipation and diarrhea.

In some individuals attacks seem to be brought on by

stress or emotional difficulties.
Peppermint oil can be used as anti-spasmodic agent.
 Peppermint oil
• The oil preparation should be standardized to
contain not less than 44% menthol.
• Dosing: 0.2-0.4 ml enteric coated capsule/3
times daily between meals.
• Safety: Peppermint oil can cause heartburn
due to the relaxation of the lower esophageal
sphincter (gastroesophageal reflux=GERD)
Mechanism of action of
peppermint oil
“menthol”
Menthol
• Cyclic monoterpene which is a Ca+2 channel
blocker.
• Mechanism of action:
✓ Antispasmodic property which allows the
contracted intestinal smooth muscles to return to
their proper tone .
✓ Due to reduction of Ca++ influx into the excited
muscle cells leading to muscle relaxation.
 Constipation
• Constipation:
(< three bowel movements / week)
• Chronic constipation: Infrequent bowel
movements or difficult passage of stools that
persist for several weeks.
Etiology:
❖Poor dietary habits (low fiber content).
❖Lack of physical activity.
❖Over use of laxatives for many years
❖Disturbances in intestinal motility.
 A-Bulk laxatives (Dietary fiber & mucilage).
•They include indigestible parts of fruits, vegetables & wheat bran. (fibers content).
•Similar actions are produced by psyllium & linseeds (Mucilage content).
•They form a bulk in the large intestine, causing water retention and intestinal
distention, thereby increasing peristaltic activity.
•Used in chronic constipation. (Should be taken with plenty of WATER

intestinal obstruction)
B-Irritant or Stimulant laxatives (Purgatives)
•Most of them contain anthraquinones that act on mucosal cells &/or enteric nerves,
thus affecting motility leading to laxative effect.
•In acute occasional constipation, pre/post operative surgery & X-ray imaging.

C-Osmotic laxatives
Organic acids & sugars (osmotic effect that draws water into the bowel)

D-Lubricant laxatives
Example: Castor oil
 B- Examples of stimulant laxatives (purgatives)

Anthraquinones containing plants

Drug Nature Plant name Constituents Photo

Senna Leaves & Cassia acutifolia Sennosides A & B
fruits & C. angustifolia and free
(Fabaceae) anthraquinones

Cascara Bark of Rhamnus Cascarosides

trunk or pursiana A,B,C&D
branches (Rhamnaceae)

Rhubarb Rhizomes & Rheum Free & combined

roots palmatum anthraquinones
(Polygonaceae) e.g. rhein &
emodin
Tamarind pulp
is obtained from the fruit of the Tamarindus indica
(Fam. Fabaceae), an evergreen tree found in India and
tropical Africa.

The pulp contains about 20% organic acid in the free

form and as potassium salts, mucilaginous substance
(20-30%) and sugar.

The dose is 20-40 g diluted in water 3 times per day for

adults and 1-2 g for children, in the case of chronic
constipation.
 D-Lubricant laxatives
Mineral oils e.g. Castor oil

Fixed oil from the seeds of Ricinus communis

(Euphorbiaceae)
The seeds contain 50 % of the fixed oil,
Active constituents of the oil Triglycerides
(mainly ricinolein) It is of special service in
temporary constipation and is extremely not for
children, early pregnant and old aged patients.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384204/
Castor oil is known as a stimulant
https://en.wikipedia.org/wiki/C laxative. It works by increasing the
The United States Food and Drug movement of the intestines, helping
Administration (FDA) has categorized castor oil as the stool to come out.
"generally recognized as safe and effective" Allergic reaction due to skin & mucosa
(GRASE) for over-the-counter use as irritation in case of Enema & oral
astor_oil

a laxativewith its major site of action the small preparations, respectively.

intestine where it is digested into ricinoleic acid. Miscarriage & abortion.
 Herbal treatment for liver disorders
St. Mary’s thistle (Leaves & seeds)
• Milk Thistle used in Europe to treat poisoning by
mushroom Amanita phalloides (death cap).
• Protective agent after liver exposure to alcohol,
acetaminophen & CCL4 intoxication.
• Seeds containing several compounds Silymarin
Flavonolignans “silybin, silychristin & silydianin ”.

http://www.smart-publications.com/articles/silymarin-a-potent-antioxidant-liver-protector-and-anti-cancer-agent.
Dosing:
• The avarege daily dose is 12-15 gm (eqi. 200-
400 mg silymarin).
Safety:
• Patients who are allergic to ragweed or
members of family Asteracea should be
cautious not to use milk thistle.
Standardization:
• Milk thistle capsules are standardized to
flavonolignans 80 % calculated as silybin.
 Case study
J.L, 39 years female, suffers from continuous
epigastritis. She went to a community pharmacy
seeking a medication. The dialogue was as
follows:
Ph: Good morning Madam…
Pt: Oooooh good morning..
Ph: Good day today…
Pt: Sureee….please I need a medication for my stomach.
Ph: what do you feel????
Pt: A continuous burning pain in my stomach.
Ph: ooooh….I can describe a herbal remedy for you…
Pt: Yes please.
Ph: But you will not buy it from here………
Pt:??????
Ph: You can buy it from herbalism…..
Ph: Guess what is its name????
Pt: Will you please mention its name doctor???
Ph: Glycyrrhriza glabra dear…
Pt: excuse me>>>>>>>
Ph: Haahaa..i mean Liquorce…you will take 10 gm on cup of water 3 times
per day for a whole month…..and enjoy…..
Pt: there is no side effects of liquorce??
Ph: Never ever. It is only a herb….
Ph: there is a herbal store in the next street Md. Good day for you…& get
well soon.
Pt: Okay, I need to buy also Co-tareg 160/12.5 2 boxes please. I cant live
without it.
Ph: sureeeeeee.
AFTER 2 WEEKS
I wonder how is the Md. Whom I
prescribed her liquorce….. Probably
she is eating all she likes now…….
1. Send your proposal pdf file to the following e-mail
phytotherapyproposals@yahoo.com
3. Entitle Subject in your email:
“Lecture (1) GIT”
4. Dead line of proposal: 31/10/2017: It wont
be marked, so please do not overload….
A. nobilis, A. cotula and their sesquiterpene lactones.
Discuss with special influence on the Pros & Cons of
cotula species.
A. cotula

A. nobilis