Tylophora indica-A multicentric clinical verification study

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Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
1 1 1 1 1 10 11 2, 12
C. Nayak , Vikram Singh , Krishna Singh , P.S. Chakraborty , Subhash Kaushik , R.K. Ray , R.P. Yadav , M.K. Rai ,
6 5 11, 12 9 8 4 2,10 10
Darshan Singh , A.K. Bhakat , V.K. Singh , M.D. John , K.C. Das , V.G. Prasad , S.S. Nain , Mohan Singh , P.K.
8 3,11 10 2, 3, 12 7 3 3 5,9 9
Chandra , D.K. Singh , Y. Rai , Pramodji Singh , Ojit Singh , A.K. N. Singh , M. Shah , P.K. Pradhan , R.Bavaskar , L.
5 1 1
Debata , C.D. Lamba , S. A. Ali
1Central Council for Research in Homoeopathy. New Delhi
2Central Research Institute, Noida (U.P.)
3Homoeopathic Drug Research Institute, Lucknow (U.P.)
4Regional Research Institute, Gudivada
5Regional Research Institute, Puri
6Regional Research Institute, Shimla
7Regional Research Institute, Imphal
8Regional Research Institute, Kolkata
9Clinical Research Unit, Portblair
10Clinical Verification Unit, Ghaziabad (U.P.)
11Clinical Verification Unit, Patna (Bihar)
12Clinical Verification Unit, Vrindaban (U.P.)
Tylophora indica is a lesser known remedy in Homoeopathy. Council had conducted a thorough proving
followed by a multi-centric clinical verification study was undertaken to verify the drug pathogenesis. It has
been found that Tylophora indica is a useful medicine for various clinical conditions like cough, constipation,
diarrhoea, earache, headache, rhinitis, fearful dreams and lumbago. It has also relieved vertigo, flatulence,
profuse perspiration, bitter taste in mouth etc. have also been relieved and thereby / thus unfolding a vast
area of it's clinical application.
A total of 340 subjects (175 males and 165 females) had participated in this study at various Institutes /Units
under the Central Council for Research in Homoeopathy to verify the symptoms of Tylophora indica, that
were reported in the homoeopathic proving of this drug carried out under the Council.
homoeopathy; clinical verification; tylophora indica Keywords:
12
CLINICAL VERIFICATION
Introduction
Tylophora indica is available in literature but nowhere a
full proved picture of this drug is available. Although
some short provings were conducted by Varma P.N.
1
et.al. and by Kishore, J. but no where a thorough
proving has been reported. Keeping in view of this
aspect, Central Council for Research in Homoeopathy
has conducted a thorough and systematic proving of
this drug and introduced it in Homoeopathic practice.
The proving picture that was obtained has been
verified under the Clinical Verification (CV)
Programme of the Council. This helps in identifying the
uncommon, peculiar and characteristic indications of
the drug from the verified and clinical symptoms
observed during the study.
Tylop hora ind ica, syno nymed as Tyloph o ra
asthmatica Wight & Arn. and botanical name is
Tylophora indica (Burn. f.) Merrillis. It is distributed in
Assam, West Bengal, Orissa and peninsular India,
ascending to an altitude of 900m and also in Car
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13 Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
C. Nayak et al
Nicobar Island. It is also found in Ceylon (Sri Lanka),
1,2
Siam (Thiland), Malay Islands and Borneo.
1
The family of Tylophora indica is Asclepiadaceae and
it's vernacular names are: Bengali- Antomul,
ananthamul; English- Emetic swallowwort, Indian or
country- Ipecacuanha; Gujarati- Damni vel; Hindi-
Jangli-pikvam, antamul; Kannad-Adumuttadha gida,
aiitmula, nayelate; Malayalam- Vallipaala; Marathi-
Khodiki, raasna, pitkari; Oriya-Mendi, mulini; Tamil-
Nach-churuppam, nanja-murich-chaaan, nayppalai,
peyppalai, kondachani; Telugu-Verripaala, vettipaala
kaakpaala, kukkapala, tellayadala, tellavedavela
1,2
neelataapiri.
It consists of about 60 species from tropical and
subtropical Asia, Africa and Australia, most of which
are perennial. The name is derived from the ancient
Greek word ‘tylos’ which means ‘knot’ and phoros
3
means ‘bearing’.
The plant has been traditionally used as a folk remedy
in certain regions of India for the treatment of bronchial
asthma, bronchitis, rheumatism, and dermatitis. In the
latter half of 19th century, it was called Indian
Ipecacuanha, as the roots of the plant have often been
employed as an effective substitute for Ipecac. Its use
to induce vomiting led to the inclusion of Tylophora in
3
Bengal Pharmacopoeia of 1884.
The dried leaves are emetic, diaphoretic and
expectorant, useful in over-loaded states of the
stomach and other cases requiring the use of emetics.
It has also been found useful in dysentery, catarrh, and
other affections in which Ipecacuanha has been
employed. It may be regarded as one of the best
2
indigenous substitutes for Ipecacuanha.
These historical and laboratory findings have been
supported by several human clinical trials using
differing preparations of Tylophora, including the crude
leaf, tincture, and capsule. One clinical trial with
asthmatic patients, found that Tylophora leaf chewed
and swallowed daily in the early morning for six days
led to moderate or complete relief of asthma
4
symptoms.
Patients using Tylophora may experience temporary
nausea and vomiting, soreness of the mouth, and loss
of taste for salt, particularly with the fresh leaf and
tincture. The safety of it's usage during pregnancy and
4
breast-feeding has not been established.
In Homoeopathy, the leaves are used for preparation
1
of mother tincture.
The Plant
Active constituents
Pharmacological activity
Description: A twinning perennial herb. Stem densely
tomentose, slender, longitudinally striated with
branches arising from axil of leaves. Leaves thick,
cauline, opposite, simple entire, acute and base
cordate; glabrous ventrally and pubescent dorsally.
Flowers greenish-yellow outside, purplish within, in
many flowered umbels (dichasial cyme). Fruit a
follicle, fusiform, divaricate, up to 10 cm, striate; seed
ovate, elongated into a coma, 2 to 2.5 cm; silky hairs at
1
one end.
Microscopy: Dorsiventral. Stomata and multicellular
hairs absent on upper epidermis but present on lower
epidermis. Trichomes striated, upper epidermal cells
longer than lower epidermal cells. Palisade 2 to 4 cell
wide followed by isodiametric parenchymatous cells.
In mid-rib arc-shaped, stele conjoint, collateral, open,
encircled by sclerenchyma patches; cambium 2 to 3
layered with phloem towards dorsal side; numerous
scattered aggregates of microcrystals, collenchymas
present below the epidermis in the midst and at the
margins below the epidermis. Laticiferous ducts also
present below palisade tissue. Lateral vein bundles
surrounded by parenchymatous sheath but without
cambium. Stomata paracytic. Stomatal index 88.76 to
91.68; vein islet number 10 to 13 per sq.mm. Palisade
ratio 4.25 to 6.00. Petiole circular in outline in
transection. Epidermis 1 layered with 2 to 4 celled
hairs. Collenchymas 5 to 7 layered followed by
isodiametric parenchymatous tissues. Vascular
bundle arc-shaped and dorse-convex; sclerenchyma
1
patches on both sides.
The major constituent in Tylophora is the alkaloid
tylophorine. Laboratory research has shown that this
isolated plant extract exerts a strong anti-inflammatory
action. Test tube (in vitro) studies suggest that
tylophorine is able to interfere with the action of mast
cells, which are key components in the process of
inflammation. These actions seem to support
Tylophora’s traditional use as an anti- asthmatic and
4
anti- allergenic medication by Ayurvedic practitioners.
The plant is known to exhibit anti-asthmatic activity by
the direct stimulation of adrenal cortex. It has been
found to antagonize dexamethasone/hypophy-
sectomy-induced suppression of pituitary on activity of
the adrenals. Alcoholic extract of the plant inhibited
5
phagocytosis in mice.
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Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
C. Nayak et al
14
The plant exhibits in vitro anti-amoebic activity against
axenic and polyxenic strains of Entamoeba
5
histolytica.
Tylophorine is found to be equally effective in intestinal
as well as hepatic amoebiasis in experimental
5
animals.
Study settings
In this multi-centric trial of the medicine, 340 patients
(175 males and 165 females) were prescribed
Tylophora indica on the basis of the similarity of
symptoms, during the period from October 2005 to
March 2010. The medicine was procured from the
licensed pharmacy in various potencies viz. 6C, 30C,
200C and 1M.
Patients for the study were drawn from the OPDs of
respective Institutes / Units of the Council. Their
presenting symptoms and signs were recorded in the
predefined case recording proforma to prescribe a
medicine from the list of medicines assigned for
clinical verification study. The medicine, which was
found suitable for the patient on the basis of similarity,
was prescribed either in 6C potency and the changes
in presenting symptoms and signs were recorded
during the follow-up visits. If there was no change in
symptoms and signs for a significant period, next
higher potencies like 30C, 200C potencies were
prescribed and in case, no change was observed,
even after change of potencies, the case was closed.
Methodology
Study sites
Central Research Institute, Noida, (U.P.)
Homoeopath ic Drug Research Institute,
Lucknow (U.P.)
Regional Research Institute, Puri, (Orissa)
Regional Research Institute, Shimla, (H.P.)
Regional Research Institute, Gudivada, (A.P.)
Regional Research Institute , Imphal,(Manipur)
Regional Research Institute, Kolkata, (W.B.)
Clinical Research Unit, Port Blair, (Andaman
and Nicobar Island)
Clinical Research Unit, Ghaziabad (U.P.)
Clinical Verification Unit, Patna (Bihar)
Clinical Verification Unit, Vrindaban (U.P.)
The data of all the cases were collected, compiled and
analyzed. The clinically verified symptoms are given in
Table-1 along with the number of patients prescribed
on the basis of symptoms available in literature and
also the number of patients who were relieved after
application of medicine. Numerical superscribed
alongside the symptoms denotes the literature cited.
Some parts of the main symptom (character,
modalities, concomitants etc.) which are not
mentioned in the literature but were relieved in the
patients have also been mentioned along with the
main symptom, but in italics. In the column
‘Improvement observed’ the first figure denotes the
number of patients who had the symptom and to whom
the medicine was prescribed and the second figure
denotes the number of patients who got relief of the
same symptom.
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Results
Location Symptom Improvement
status
2,2
2,2
34,21
40,30
3,3
42,31
4,3
1,1
Head
Ear
Nose
Throat
Throbbing pain in left supra orbital region; agg. While
6
reading
6
Headache; in frontal region; agg. while reading
6
Pain in ear
6
Sensitive to cold air ; with frequent nasal discharge
6
Fluent nasal catarrh
Pain in throat with cough; agg. at night, while talking;
6
amel. from hot drinks
6
agg. from cold drinks
6
agg. on empty swallowing
Table: 1 Symptoms verified clinically during the study
Contd. ...
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15 Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
C. Nayak et al
Contd.
Location Symptom Improvement
status
2,2
8,8
1,1
31,27
13,12
1,1
25,24
3,1
1,1
16,12
16,12
1,1
17,15
2,2
38,33
26,20
42,36
26,19
2,2
27,17
17,10
15,9
2,2
18,14
2,2
26,21
1,1
2,1
Abdomen
Rectum
Stool
Urinary Organs
Chest
Respiratory
Organs
Back
Extremities
Sleep and dreams
Cramping pain in right iliac region; amel. by lying
6
down; agg. on empty stomach
Pain in left lower abdomen; amel. from hard pressure
6
with constipation; dry, hard stool
6
Swelling around anus with pain; and pus like discharge
Swelling around anus; with burning sensation; amel.
6
applying cold water
6
Intense burning in anus while passing stool
agg. while cycling
6
Itching in anus; agg. from washing
6
Constipation; first part of stool hard and later soft
6
Constipation; stool hard; agg. in morning;
with ineffectual desire for stool
6
Stool hard, brown, scanty with burning in anus
Diarrhoea after taking cold food; stool watery, brown,
6
offensive; agg. at night
Diarrhoea; agg. at night; associated with much flatus
6
during stool
6
Dull pain in bladder; agg. on micturition
6
Urine pale; burning in urethra during micturition
6
Pain in chest with dyspnoea
6
Constricting pain in chest
Cough; dry, agg. on exertion, amel. by rubbing chest
6
gently
6
Dull aching pain in lumbar region
in right side
6
agg. on motion; amel. from pressure
6
agg. bending forwards
6
agg. lying on back
agg. sitting; amel. lying on back and on walking
6
better by heat
6
Pain between scapulae; agg. in morning; on movement
Cramping 6
pain in calf muscles
6
agg. on walking amel. from pressure
6
Fearful dreams of murder
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16
Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
C. Nayak et al
Location Symptom Improvement
status
Vertigo Vertigo 1,1
Face Perspiration profuse on face and forehead 2,1
Mouth Bitter taste in mouth 2,2
Tongue white coated 1,1
Abdomen Flatulence in upper part of abdomen;
stomach; amel. lying down.
agg. empty 2,2
Extremities Stinging pain in knee joints 1,1
Dreams Dreams of falling from mountain 1,1
Table 2: Clinical symptoms
Repertory
A concise repertory of the verified symptoms based on
Kent's Repertory has been compiled for the purpose of
quick reference. Rubrics / sub rubrics in italics are new
rubrics, i.e. not mentioned in the above referred
repertory while rubrics / sub rubrics in ROMAN letters
are the existing rubrics of the said repertory which
were reconfirmed by this study.
Physicians may include these rubrics in their personal
repertories for their day to day reference in practice.
VERTIGO
HEAD
PAIN
Forehead, in
reading, while
PULSATING
Forehead (supra orbital region)
reading, while
PERSPIRATION
Forehead, profuse
EAR
PAIN
NOSE
CATARRH, fluent
SENSITIVE, cold to
DISCHARGE, frequent
sensitive cold air, to
THROAT
PAIN
night
cold, drinks
coughing, on
drinking, hot, amel.
swallowing, empty on
talking
FACE
PERSPIRATION, profuse
MOUTH
DISCOLORATION, tongue, white
TASTE, bitter
ABDOMEN
PAIN, cramping
Sides, right, iliac region
empty stomach, agg.
lying down, amel.
FLATULENCE
empty stomach, agg.
lying sown, amel.
PAIN, lower, left
hard pressure, amel.
constipation, from
RECTUM
CONSTIPATION
ineffectual urging and straining
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17 Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
C. Nayak et al
DIARRHOEA
night
cold food
ITCHING, around anus
walking, agg.
PAIN, burning
cycling, agg.
stool, during
SWELLING, of anus
pain burning, with
cold application, amel.
pus like discharge, with
STOOL
BROWN
HARD, first, then soft
ODOR, offensive
SCANTY
WATERY
BLADDER
PAIN, aching
urination, during
URINE
PALE
URETHRA
PAIN, burning
urination, during
CHEST
CONSTRICTION
PAIN
RESPIRATION
DIFFICULT
COUGH
DRY, exertion, violent, from
rubbing chest gently, amel.
BACK
PAIN, aching, Lumbar region
right side
bending, forward
lying on the back
motion, on
pressure, agg.
sitting amel., while
walking
warm application, amel.
ABDOMEN
FLATULENCE ( see RUMBLING)
RUMBLING
stool diarrhoeic, during
BACK
PAIN, Dorsal region, scapulae between
morning
moving, on
EXTREMITIES
CRAMPS, calf
pressure, amel.
walking, on
PAIN, cutting, Knee
SLEEP
DREAMS
falling of, from high places (mountains)
murder
Tylophora especially acts upon the mucous
membranes of nose, throat and rectum producing an
inflammatory and catarrhal state. It has been useful in
cases of otalgia, coryza, sore throat, diarrhoea,
constipation and lumbago.
In respiratory complaints, it is mostly indicated in
coryza and pain in throat with cough which is worse
from cold drinks, on swallowing and better from warm
drinks. It is a very useful medicine for dry cough which
is better by gently rubbing the chest. The medicine also
relieves constrictive pain in chest with dyspnoea.
The rectal complaints are associated with burning
sensation, better by applying cold water.
Tylophora indica has an analgesic property which is
found in relieving earache, cystitis and lumbago.
Lumbago is aggravated by bending forward and
ameliorated by pressure and heat.
Cramping pain in the left calf muscle which is
aggravated on walking is another indication for
Tylophora indica.
Discussion
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18
Indian Journal of Research in Homoeopathy
Vol. 4, No. 4, October-December 2010
Tylophora indica-A multicentric clinical verification study
C. Nayak et al
Vertigo, bitter taste in mouth, a white coated tongue
and flatulence worse on empty stomach are the
clinical symptoms of Tylophora indica.
It is equally important for constipation as well as
diarrhoea. In constipation, the stools are scanty, hard
and brown with burning in the anus. The diarrhoea is
characterized by watery, brown, offensive stool and is
worse at night. The medicine may be thought of for
diarrhoea after taking cold food.
Fearful dreams of murders and falling from mountains
are its important symptoms.
The general modality is agg. at night and among the
particular modalities aggravation in morning while
reading and amelioration on lying down and from
pressure are important to note.
The symptoms verified so far, indicate that Tylophora
indica is a tri-miasmatic medicine with predominance
of Psora.
The results obtained show that Tylophora indica can
be considered as a medicine for coryza, sore throat,
earache, diarrhoea and constipation.
Its characteristic properties are cramping, burning
pains that are manifested in different areas under
different clinical conditions.
The number of symptoms verified and clinical
symptoms that have emerged have paved the way for
its wider therapeutic application.
Council gratefully acknowledges the efforts taken by
all the Programme officers, Incharges of the
Conclusion
Acknowledgements
respective Institutes/Units where the study was
conducted, for their good will and cooperation for
carrying out this challenging task which could not have
been completed without them. Much as we may like
thanking them individually, may not be possible but
Council gratefully acknowledges their help.
Thanks are also extended to Dr. N.R. Mondal & Dr. S.
S. Ramteke, both Assistant Directors of HDRI,
Lucknow and RRI (H), Shimla respectively, for
preparing the concluding reports of the study of the
respective Institutes. Special thanks to Dr. A.K.
Prusty, Research Officer (H) of the Council, for
assisting in data compilation in the concluding report.
1. Govt. of India. Ministry of Health and Family Welfare.
Homoeopathic Pharmacopoeia of India, Vol. 6,
1990:100.
2. Kirtikar KR & Basu BD. Indian Medicinal Plants.
Reprinted edition. L.M. Basu Publications, Allahabad
1989, 3:1630-33.
3. http://wikepedia.org/wiki/Tylophora. Accessed on-
10/2/11
4. http: / / w w w.ind i a n e t z o n e.com/2/ty l o p h o r a . h t m .
Accessed on-10/2/11
5. The Wealth of India. National Institute of Science
Communication and Information Resources, CSIR,
New Delhi, Vol. 5: R-Z, 2008.
st
6. Homoeopathic Drug Proving, 1 ed. Central Council for
Research in Homoeopathy, New Delhi, 2005:124-125.
Reference
An article under Clinical Research Section, entitled “To explore the utility of homoeopathic medicine
Lycopodium clavatum in urinary calculi” was published in IJRH, Volume-4, No.3, July-September 2010. The
other authors of the same article are:
1. Dr. MN Sinha, AD (H), RRI (H), Jaipur
2. Dr. AK Gupta, AD (H), RRI (H), Lucknow
3. Dr. Yogendra Rai, AD (H), CRI (H), Noida
4. Dr. Paul Sumithran, AD (H), CRI (H), Kottayam
5. Dr. Rajakumar, AD (H), RRI (H), Gudivada
6. Dr. Jaya Gupta, AD (H), CCRH Headquarters.
ERRATUM
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