Kutaja Powder for Diarrhea

            Diarrhea 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. Diarrhea can be acute and chronic as per its causes.

            Acute diarrhea 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 diarrhea are frequent stools, sometimes with blood and mucous, pain during passing stools, abdominal pain, vomiting and fever. Severe diarrhea 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 diarrhea can be fatal. The non-infectious category of diarrhea can be caused by drugs such as antibiotics, certain antidepressants, antacids, bronchodilators, chemotherapeutic agents, laxatives, non-steroidal anti-inflammatory drugs, etc., and spurious diarrhea, which follows chronic constipation especially in older people and in association with psychological stress.

           Chronic diarrhea lasts for weeks or months and may be either persistent or recurrent. The aetiology of chronic diarrhea is usually related to structural and functional disorders of the gastrointestinal tract.  The clinical features of chronic diarrhea 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. Diarrhea 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 diarrhea can lead to malabsorption syndrome and malnutrition.

            It is always important to understand the underlying cause of diarrhea so that the right treatment can be planned. However, uncomplicated diarrhea 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 the 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 diarrhea and dysentery. Most of the Ayurvedic formulations described in literature and various commercially marketed formulations for diarrhea essentially contain Kutaja as one of their ingredients. Kutaja is mentioned in the Indian Ayurvedic Pharmacopeias1 as well as Formulary2. Apart from the preferred use of Kutaja in the treatment of diarrhea, scientific studies have established its anti-protozoal, anti-giardia and antiamoebic properties.3

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 constituents4

              Conessine, conessemine, kurchine, kurchicine, etc.

Quality standards5
              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 properties6

                 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 diarrhea 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 diarrhea 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.

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