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182
Journal of Ayurvedic and Herbal Medicine 2021; 7(3): 182-187
Review Article
ISSN: 2454-5023
J. Ayu. Herb. Med.
2021; 7(3): 182-187
Received: 20-06-2020
Accepted: 01-08-2021
© 2021, All rights reserved
www.ayurvedjournal.com
DOI: 10.31254/jahm.2021.7303
*Corresponding author:
Dr. Harveer Singh Cheema
Assistant Professor, College of
Agriculture Sciences, Teerthanker
Mahaveer University, Moradabad,
Uttar Pradesh, India
Email: Harveer.agriculture@tmu.ac.in
The Use of Medicinal Plants in Digestive System Related
Disorders: A Systematic Review
Harveer Singh Cheema1*, Mitra Pal Singh2
1 College of Agriculture Sciences, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
2 College of Agriculture Sciences, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
ABSTRACT
The most prevalent forms of ailments affecting a huge number of individuals throughout the world are digestive system
problems. According to the World Health Organization (WHO), over 100 million people died globally as a result of
digestive system diseases in 2012. Despite this, most scientific bodies disregard the relevance of a healthy digestive
system and associated problems in health debates. Food and lifestyle have a direct influence on digestive health, and a
healthy diet or a change in lifestyle can address a variety of issues. Plants provide a variety of phytochemicals and
nutraceuticals that may aid in the treatment and prevention of a number of digestive problems. Plant-based remedies,
including spices, are widely used by ordinary people across the world and can help digestion without causing adverse
effects. Numerous ethnomedicinal studies show that the use of medicinal plants by traditional populations to treat
digestive problems is widespread across the world. The biological activities of traditional herbal medicine used to treat
digestive problems have been studied and generally indicate minimal side effects. However, as the demand for herbal
medicines derived from plants grows across the world, more comprehensive clinical research on the advantages and
toxicity of herbal medicines should be conducted. The goal of this study is to provide examples of research that have
established and verified the use of plant-based medicines to treat digestive problems. In particular, traditional
medicinal plant extracts or phytochemicals that have been shown to reduce symptoms of digestive system disorders
along with mode of action and safety will be discussed.
Keywords: C. scolymus, T. officinale, S. marianum, Z. officinale, P. ovata, M. piperita.
INTRODUCTION
The cornerstone to our general well-being and health is gentle digestion. Digestion is a complex process in
which large insoluble food molecules are broken down into smaller water-soluble food molecules.
Thereafter, the soluble food molecules move to the small intestine which absorbs its nutrients and are
transferred to the blood circulation from where they are transferred to different parts of the body. The
main purpose of digestion is the continuous supply of energy for growth, development, differentiation and
other body activities such as repair, reproduction and lactation etc. Digestion has a strong effect on our
entire body system and controls including the nervous, hormonal and immune systems. There are a wide
number of digestive system disorders, which have a substantial impact on morbidity and mortality
worldwide [1]. Digestive disorders, especially diarrhea, were the fifth leading cause of global mortality [2].
However, the importance of an active digestive system for overall health is rarely emphasized in health
discussions in most countries. Common digestive problems symptoms are Stomach pain, Indigestion,
Irritable Bowel Syndrome (IBS), Dyspepsia, Nausea, Vomiting, Gas, Bloating, Heartburn, Constipation,
Diarrhoea, General malaise, Fatigue, Headache and Epigastric pain. However, the role of digestion in
various disorders such as arthritis, depression, asthma, obesity, heart disease and allergic conditions
including cancer is now increasingly recognized [3].
Herbal medicine has made a significant contribution in improving human health through its health
promoting, curative and rehabilitative properties. Herbal medicine, also called botanical medicine,
phytomedicine or phytotherapy, refers to herbs, herbal ingredients, herbal preparations and prepared
herbal products that contain active ingredients of plants or other ingredients [4]. Numerous studies suggest
that the practice of herbal medicines or plant-based preparations by traditional people against digestive
system disorders is a common practice throughout the world. People can treat many problems related to
the digestive system by regularly using herbal preparations in the diet that can improve the function of the
digestive system. These digestive herbal preparations act in a variety of ways, viz., healing the lining of the
intestine, activating the digestive process and promoting easy bowel movements, increasing the
frequency of bowel movements, detoxification and elimination of toxins, helps to soothe
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Journal of Ayurvedic and Herbal Medicine|July-September|2021
an upset stomach and reduces gas, bloating and digestive discomfort.
Medicinal plants are arguably the oldest form of medicine to cure
diverse human diseases and have been used by all cultures throughout
history and still remain an integral part of our modern technology-
based civilization. Plant based drugs or natural products and their
derivatives represent about half of all drugs in clinical use today [5]
About 80% of people in developing countries rely mainly on traditional
herbal medicines for their health care that involve the use of plant
extracts or their active substances [6]. Medicinal plants contain
numerous secondary metabolites or phytochemicals and their
derivatives have various biological activities including anti-plasmodial,
anti-inflammatory, anticancer antioxidant etc [5, 7, 8]. Various plants or a
specific part of a plant, which contains the maximum number of active
components responsible for giving the desired action, are used in
Ayurveda, Siddha, Unani and traditional Chinese system of medicine.
Many plant-based medicines used in traditional African, American,
Asian, European and other indigenous medicinal systems have been
recorded in pharmacopeias as agent used to improve digestive system.
Even fennel, mint and ginger are available in an enteric-coated hard
gelatin capsule to treat discomfort, colic and gastrointestinal disease.
There are five commercial Ayurvedic products, Satpushpadi Churna,
Satpushpa Arka, Satpushpadya Ghrita, Abhayarishta and Panchsakar
Churna, which are prescribed by Ayurvedic practitioners to improve
digestion, control colic and other gastrointestinal problems.
The purpose of this review is to present some examples of studies that
have worked to document and validate plants used as digestive
stimulants or digestive tonics. In particular, traditional medicinal plant
extracts or phytochemicals that have been shown to reduce symptoms
of digestive system disorders along with mode of action and safety will
be discussed.
1. Cynara scolymus (Artichoke)
C. scolymus is native to the Mediterranean region and is now widely
cultivated in various parts of the world for its large immature
inflorescences (capitula), edible fleshy leaves and receptacles. Its
leaves are the important constituent of the Mediterranean diet and
also a ironic source of fibre, minerals and bioactive phenolic
compounds inulin [9]. C. scolymus used to reduce symptoms of irritable
bowel syndrome, improve nausea, bloating, constipation and gas. The
C. scolymus leaf extract has shown hepatoprotective [10], antioxidative
[11], anti-bacterial, anti-HIV, bile-expelling, and urinative activities [9].
The leaf extract of C. scolymus also have the ability to inhibit
cholesterol biosynthesis and LDL oxidation which can help to maintains
a healthy digestive system [12]. Hydroxycinnamic acids (caffeic acid,
chlorogenic acid, ferulic acid, dicaffeoylquinic acids), flavonoids
(luteolin, scolymoside, cynaroside), cynarin (1,5-di-caffeoylquinic acid),
are the main ingredients of C. scolymus leaf extract [13]. C. scolymus
dried leaves have long been utilised in folk medicine for their choleretic
and hepatoprotective properties, which are typically linked to the
presence of cynarin [9]. The cynarin is the active ingredient of plant that
improves appetite and also has a stimulating effect on the liver. The
wide-ranging therapeutic effects cannot be linked to a single
component, but to multiple active chemicals that collectively generate
additive or synergistic pharmacologic actions; these include mono- and
dicaffeoylquinic acids, and flavonoids like luteolin and its 7-O-glucoside
[14].
The confirmed evidence for the useful effects of C. scolymus leaf
extract on the gastrointestinal system is to promote the bile flow
secretion leading to healthy digestion and helping the body to
breakdown food more efficiently [15]. C. scolymus causes a substantial
increase in bile secretion in the duodenum by increasing the size and
quantity of secreting bile channels in liver cells [16]. A single dosage of
standardised C. scolymus extract (1.92 g as six capsules 320 mg)
significantly enhanced bile production when compared to placebo (p
0.05) in a randomised placebo-controlled double-blind cross-over
controlled trial [17]. Held et al studied the effect of leaf extract on
patients with epigastric pain, bloating, constipation, lack of appetite
and nausea and found that 70% of the patients experienced
improvement after one week of treatment [18]. In another open label
study, where 553 patients with nonspecific dyspepsia complaints were
treated with C. scolymus leaf extract and after 6 weeks of treatment,
an improvement in vomiting, nausea, abdominal pain, loss of appetite,
severe constipation, flatulence and fat intolerance was found [19].
The C. Scolymus has been used as a food in many countries since time
immemorial. The prescribed amount of leaf extract is effectively
tolerated with no negative side effects. However, further clinical
research and studies are needed to further support its biological
activities and toxicity using experimental models.
2. Taraxacum officinalis (Dandelion)
Taraxacum officinale root and leaf are used in traditional, as well as
modern herbal medical systems for gastrointestinal diseases in various
region of the world [20]. Dandelion is one of the worlds widely used and
familiar herbs. It is included in the three most commonly prescribed
digestive and liver herbs, the other two being Milk thistle (Silybum
marianum) and globe C. scolymus. Sesquiterpene lactones,
phenylpropanoids, triterpenoid saponins, and polysaccharides are the
most abundant chemicals in dandelion. Taraxacosides, taraxacolides,
dihydrolactucin, ixerin, taraxinic acids, and ainslioside are major
sesquiterpene lactones that are found as glycosides (sugars). Dandelion
root has a significant quantity of inulin [21].
The root of the dandelion plant is used as a gastrointestinal remedy
that aids in improving digestion and liver function, while the leaf
considered primarily as diuretic and bitter digestive stimulant [22].
Preclinical studies on Dandelion have confirmed various biological
properties including diuretics, digestive stimulants, a gastrointestinal
remedy, demulcent, prebiotic and inflammation modulator [23]. Due the
presence of inulin, roots have distinct demulcent action and prebiotic
properties [20]. In animal studies, sesquiterpene lactones found in the
leaf and root impart a bitter taste to the plant, responsible for
increased bile production [24]. The European Scientific Cooperative on
Phytotherapy recommends dandelion root for restoration of hepatic
and biliary function, dyspepsia and loss of appetite. The German
Commission E authorizes the use of combination products containing
dandelion root and herbs for biliary abnormalities, loss of appetite,
dyspepsia and for stimulation of diuresis [25]. Dandelion leaf is a unique
source of potassium; by dry weight, dandelion leaf contains up to 4%
potassium. The high potassium (K) content is thought to be responsible
for the diuretic activity [23].
The US Food and Drug Administration lists dandelion plant extract as
generally regarded as safe in meals and supplements [20]. In rabbits,
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Journal of Ayurvedic and Herbal Medicine|July-September|2021
dosages of dandelion up to 6 g/kg body weight were shown to be safe
[26]. Dandelion has great potential for being used in various traditional
and herbal medicines around the world. Overall, dandelion is very safe
but there are a very limited number of clinical trials on its use in
treating various diseases. In addition, preclinical and clinical research is
clearly needed on this widely used herbal medicine.
3. Silybum marianum (Milk Thistle)
Silybum marianum (L.) Gaernt plant is native to the Mediterranean
region and is probably the oldest and best studied for its
hepatoprotective effect. Silybum marianum seeds and leaves are very
popular and widely prescribed medicinal herbs for the treatment of
many diseases affecting the liver since Greco-Roman days [27]. The
Basque people used a decoction of milk thistle seeds as a digestive aid,
aphrodisiac, anti-inflammatory, antineoplastic, hypotensive, general
tonifier, venous tonifier, styptic and diuretic [28].
Research studies on S. marianum was started in 1929 based on the use
of this plant by German physicians to treat jaundice and liver ailments.
Later in the 1950s, silymarin was isolated from the seeds and is a
complex of bioflavonoids consisting of seven flavonolignans including
silybin, silibinin A and B, silicristin, silidianin, apigenin, dehydrosilybin,
deoxycillin cristin, deoxysilyn dianin, among others [27, 28, 29]. The dried
seed extract of this plant contains up to 4% silymarin. Silybin is the
most active and predominant material of biologically complex extracts
(60–70%), followed by silicristin (20%), silidianin (10%) and isosilybin
(5%) [30]. Clinical studies on silymarin have been shown to maintain the
health of liver cells and neutralize the effects of various toxins,
promote the flow of bile in liver diseases, aid in the relief of upset
stomach or dyspepsia. Based on clinical studies, the German
Commission E approves the use of S. marianum standardized extracts
for the treatment of toxic liver damage, inflammatory liver diseases
and cirrhosis. The use of S. marianum seed tea to treat dyspepsia has
also been recommended by the German Commission E. [31]. Long term
use of this herb is safe with no incidence of abnormality. Silymarin has
been shown to be safe in animal tests at maximal oral dosages of 1200
and 1500 mg/kg. [32]. Despite the fact that silymarin is benign, nothing
is known regarding its mode of action or drug-food interactions. More
clinical and scientific research is needed to confirm and validate S.
marianum various pharmacological characteristics.
4. Zingiber officinale Roscoe (Ginger)
Ginger (Zingiber officinale), undoubtedly one of the most consumed
household spices in human history [33]. It is a major medicinal herb of
Asian medicine, where it has been used as a remedy for many ailments,
including those affecting the digestive system, such as dyspepsia,
flatulence, colic, vomiting, diarrhea. Includes cramps, nausea,
abdominal pain, etc. [34, 35]. The rhizome is the main part of ginger that
is consumed. Of the more than 100 chemical constituents identified
from ginger by various analytical methods, gingerols are the major
constituents. Ginger has been fractionated into 14 bioactive chemicals,
including [6]-gingerol, [8]-gingerol, [6]-paradol, [10]-gingerol, [14]-
shogaol, [4]-gingerol, 1-dehydro-[10]-gingerdione, [6]-shogaol, [10]-
gingerdione, Tetrahydrocurcumin, Gingerenone A, hexahydrocurcumin,
1,7-bis-(4′ hydroxyl-3′ methoxyphenyl)-5-methoxyhepthan-3-one, and
Methoxy-[10]-gingerol [36].
The well-studied application of ginger is its use in improving the
symptoms of nausea and vomiting. Ginger contains essential oils (1-4%)
and a pungent resin that is known to stimulate the flow of saliva, bile
and gastric secretions [37]. Ginger enhanced the secretion of digestive
enzymes including pancreatic lipase, sucrase, maltase and stimulate
trypsin and chymotrypsin. In clinical studies, ginger has been shown to
be as effective as dimenhydrinate [38] and even more effective than
vitamin B6 [39] in treating nausea and vomiting in pregnancy. It has also
been recommended for the treatment of nausea associated with
chemotherapy [40], gynecological laparoscopy [41] and postoperative
prophylactic antiemetics [42]. Ginger has also been recommended for
preventing sea sickness [43] and motion sickness [44]. The mechanism of
action of ginger is unknown. However, research suggests that it inhibits
serotonin receptors and has antiemetic effects on the gastrointestinal
and central neurological systems [45].
The US Food and Drug Administration (FDA) recommends ginger as a
generally recognised as safe food ingredient. Various research and
statistics suggest that ginger intake is quite safe, with few adverse
effects [46]. Male and female rats were given ginger powder (500, 1000,
or 2000 mg/kg bw) for 35 days and showed no signs of death or
aberrant behaviour, growth, or food and water consumption [47].
Ginger has been proven to have a variety of therapeutic qualities,
according to current data, however its particular biological targets are
mostly unknown and still to be discovered.
Table 1: Most common plants used in digestive system problems.
Plant Name
Key Ingredients
Action / applications
Ref.
Cynara
scolymus
Cyanaroside, sesquiterpene lactones,
flavonoids, polyphenols etc.
Antitoxic, Liver restorative, used for liver and renal diseases for its cholagogue and choleretic action,
Assist digestion of fats
13,
14
Taraxacum
officinalis
Sesquiterpene lactones, Triterpenoid
saponins, Sterols etc
Diuretic, cholagogue, pancreatic and bile duct stimulant, urinary antiseptic, detoxicant, used in kidney
and liver disorders, for rheumatism and general tonic.
21
Silybum
marianum
Silymarin (silybin A, silybin B), Taxifolin,
quercetin, dihydrokaempferol, kaempferol
Liver and gallbladder protective, antioxidant. Used in jaundice and other
biliary affections, fevers, uterine trouble, galactagogue. Sudorific and aperient.
Diabetes.
27,
29,
30
Zingiber
officinale
Gingerols, Shogaol, Gingerdione etc.
Antiemetic, antispasmodic, Antiflatulent, expectorant, anti-inflammatory, circulatory stimulant,
diaphoretic, increases bioavailability of prescription drugs. Used for irritable bowel and diarrhoea,
colds and influenza. Loss of appetite, constipation. Throat infections. Migraine and cluster headache.
36,
37
Plantago
ovata
Mucilaginous polysaccharide
Laxative, diuretic, demulcent, cholinergic. Used in inflammatory conditions of the mucous membrane
of gastrointestinal and genitourinary tract, chronic amoebic and
49
Mentha
piperita
Menthol
Digestive, Carminative, Chloretic, Antispasmodic, Diuretic, Antiemetic, Mild sedative, Diaphoretic,
Antiseptic, Antiviral, used in many mixtures of indigestion and colic, also used in cough and cold
remedies.
57
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Journal of Ayurvedic and Herbal Medicine|July-September|2021
5. Plantago ovata Forsk (Ispaghula, Isabgol,)
Plantago ovata (psyllium) plant was native to Persia and is now
cultivated in many parts of the world including India [48]. Psyllium is the
common name for many species of the Plantago genus, whose seeds
are used commercially to produce mucilage and are an excellent
source of soluble and insoluble fibre [49]. Mucilage is defined as a group
of clear, colourless, gelling agents derived from the seed coat and often
called the husk or psyllium husky. It has been used as a home remedy
in different culture systems in conditions like constipation, diarrhea,
inflammatory bowel disease, colitis, colon cancer, diabetes and
hypercholesterolemia [50]. The primary ingredient of the seeds and husk
is mucilaginous polysaccharide composed mainly of xylose, arabinose,
galacturonic acid, rhamnose and galactose. The seeds also contain fatty
acids mainly linoleic (40.6%), oleic (39.1%) and linolenic acids (6.9%).
The dietary fibre extracted from Plantago ovata has medicinal
properties and would be a good source of low-calorie food production
[49].
Psyllium husk is popularly used as therapeutic agent for the treatment
of chronic constipation, mild diarrhea, improving digestion, cleansing
the colon, duodenal ulcer, hemorrhoids, demulcent, inflammatory
bowel disease (ulcerative) and gastro esophageal reflux disease (GERD)
etc [51]. Psyllium husk has been recommended as a natural non-irritant
laxative, which aids in facilitating digestion. When soaked in water, it
becomes gelatinous and viscous and absorbs water to perform a
specific function. Constipation is commonly treated with psyllium husk
fibre, which is frequently used as a fibre supplement. It has been
repeatedly reported in clinical trials that it can increase the moisture
level of the stool, resulting in the stool becoming softer and heavier
thus making the process of bowel movement easier [52]. On the other
hand, because of its water-holding capacity, psyllium has also been
shown to slow gastric emptying and colon transit, which is beneficial
for individuals with stool incompatibility with liquid stools or diarrhea.
It increases bowel movements and reduces the pressure on the
gastrointestinal walls. Psyllium husk is also useful for treating
hemorrhoids and diverticulitis [53]. The FDA has permitted the use of
psyllium husk in food products because of its associated health claims
of benefits [54].
Several studies indicate that the therapeutic application of psyllium
husk is safe with negligible side effects [50]. However, advance research
is essentially necessary to approve its pharmacological properties and
proposed mechanism of action for human health benefits.
6. Mentha piperita L. (Peppermint)
Mentha piperita is the oldest medicinal plant that was used in Eastern
and Western traditional systems of medicine. It has been used by
herbalists as an astringent, antiseptic, antipruritic, antispasmodic,
antiemetic, carminative, diaphoretic, analgesic, anticatarrhal,
antimicrobial, rubefacient, stimulant and emmenagogue [55].
Traditionally it was used as a spasmolytic for various digestive
problems such as colic in infants, flatulence, diarrhea, dyspepsia,
nausea, vomiting, and to reduce gas and cramps [56]. Menthol is the
primary ingredient of peppermint oil, while others include limonene,
cineole, menthone, menthofuran, isomethone, mentyl acetate,
isopulegol, pulegone, and caron [57]. The piperita leaf was used to treat
indigestion, flatulence, intestinal colic and biliary disorders, as
documented by the British Herbal Compendium [58]. The German
Commission E, ESCOP recommended its use as a carminative,
cholagogue in disorders of the gastrointestinal tract, gallbladder and
bile ducts disorder.
M. Piperita oil is the main ingredient of Ayurvedic medicines like
Dabur’s “Pudina Hara” which is used in the treatment of various
stomach problems e.g., indigestion, gas problem, acidity etc. The oil is
currently used to treat irritable bowel syndrome, ulcerative colitis, liver
complaints, gallbladder and biliary tract disorders. In a blindly
controlled study, gastric emptying rate is improved in both normal and
dyspepsia patients after administration of M. piperita oil [59]. It shows a
statistically significant effect on patients undergoing gynaecological
surgery to reduce nausea [60]. Mechanism of Action Studies show that
M. piperita relaxes gastro-intestinal smooth muscle by reducing
calcium flux to the large intestine and jejunum [61]. In in-vivo studies,
menthol and related terpenes show choleretic effects and are helpful
in the treatment of a patient with cholesterol stones in the gallbladder
and bile ducts [62].
Piperita is listed on the FDA and documented as safe but care should
be taken in patients with GI reflex and it can cause bile duct blockage,
inflammation of the gallbladder [56]. With regard to its health benefits,
M. Piperita has significant promise for treating a variety of human
diseases, including digestive problems. However, further research is
needed to learn more about M. piperita cellular and molecular modes
of action.
CONCLUSION
Disorders related to the digestive system have a significant impact on
morbidity and mortality worldwide. The situation is worse in most rural
areas, as there is a lack of awareness about proper sanitation and
disease prevention. People in low- and middle-income countries still
use medicinal herbs as first aid in the treatment of various diseases or
as preventive measures. Various studies have confirmed the traditional
use of the medicinal plant in the treatment of digestive system
disorders by examining the biological activity of various plant extracts,
which have carminative effects, antispasmodic effects, delay intestinal
transit, effects on gut motility, stimulate adsorption or reduce
electrolyte secretion. With regard to traditional medicines used to
treat digestive system problems, such drugs will continue to be used as
long as there are communities with limited access to modern
treatments. Current scientific evaluation of medicinal herbs is primarily
concerned with validating the traditional uses of plants and identifying
the active components of extracts and other preparations. Some
herbal preparations or active ingredients of medicinal plants can be
toxic in certain situations. Therefore, continuous examination of
traditional plant medicines is required to established the scientific basis
for activity as well as better assessed the quality, efficacy and safety of
such preparations. For validation of herbal remedies, well-designed
clinical trials will provide the necessary evidence to support efficacy.
Few clinical trials have evaluated the safety and tolerability of
traditional and herbal medicines used to treat digestive system
disorders and generally indicate that minimal side effects have been
observed. The evidence provided by recent studies of traditional plant-
based therapies encourages further investigation in anticipation that
alternative treatments for digestive diseases will be developed.
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Journal of Ayurvedic and Herbal Medicine|July-September|2021
Acknowledgments
The authors are thankful to the Principal, College of Agriculture
Sciences, TMU and Director Student Welfare, TMU, Moradabad for the
motivation, innovative ideas and selfless support.
Conflict of interests
None declared.
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HOW TO CITE THIS ARTICLE
Cheema HS, Singh MP. The Use of Medicinal Plants in Digestive System
Related Disorders: A Systematic Review. J Ayu Herb Med 2021;7(3):182-187.
DOI: 10.31254/jahm.2021.7303
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