Chronic and acute constipation The herbal treatment of constipation by : 1- Increase stool bulk ex. ulmus (slippery elm) and Plantago ovata (ispaghula). 2- Improve gastrointestinal lubrication. ex. Linseeds are particularly suitable because of their oil and mucilage content 3- Use of Antiabsorptive and hydragogue ex. rumex, taraxacum, senna and cascara. 4- Improve motor function with gastrointestinal spasmolytics such as matricaria (chamomile) or Viburnum opulus (cramp bark). 5- Improve liver function with choleretic and cholagogue herbs, e.g. taraxacum (dandelion root) and silybum.

1. Herbal medicine
Digestive system II
By
Dr. Mostafa Mahmoud Hegazy ( PH.D.)

2. • Chronic and acute constipation
• The herbal treatment of constipation by :
1- Increase stool bulk
ex. ulmus (slippery elm) and Plantago ovata (ispaghula).
2- Improve gastrointestinal lubrication.
ex. Linseeds are particularly suitable because of their oil and mucilage content
3- Use of Antiabsorptive and hydragogue
ex. rumex, taraxacum, senna and cascara.
4- Improve motor function with gastrointestinal spasmolytics such as matricaria
(chamomile) or Viburnum opulus (cramp bark).
5- Improve liver function with choleretic and cholagogue herbs, e.g. taraxacum
(dandelion root) and silybum.

3. • Antiabsorptive and hydragogue laxatives
• - The "drastic" effects can be attributed to their anthranoid content.
- It is designed for short-term use (why ? 1. rebound constipation and melanosis coli )
and should never be used for extended periods of time.
• Mechanism of action:
• Anthranoids  intestinal motility and  the reabsorption of electrolytes (fluid from the
colon)  the vol. of the intestinal contents and the intestinal filling pressure 
induces propulsive contractions.
• Indications for anthranoid laxatives:
• - Atonic constipation, - Obesity as slimming tea.
• Contraindications for anthranoid laxatives:
• - Constipation associated with bowel irritability or intestinal obstruction.
• Pregnancy: Aloe in high doses has drastic and abortifacient effects.

4. Senna (Cassia acutifolia)
Constituents:
Dianthrone (Sennasoides A, B, C and D),
Anthranol (aleo-emodin, and rhein aglycones), Flavonoid and
Mucilage.
Action and uses:
- Atonic constipation,
- Obesity as slimming tea. .
Dosage of senna:
1-2 g softens the stool to a pasty consistency within five to seven hours;
2-4 g works faster;
8-12 g has more severe side effects, such as severe colicky pain, nausea, and vomiting.
Frangula bark, senna leaves, chamomile, and fennel combine to make a very effective and
pleasant tasting laxative tea.

6. Cascara (Rhamnus purshiana)
Constituents:
Anthraquinone glycosides (anthrone C-glycosides).
Cascarosides A & B converted by Intestinal flora into
aloe-emodin (active form).
Barbaloin and Chrysaloin are Less active than Cascarosides A&B.
Action and uses:
- Atonic constipation (Stronger than senna).
N.B.
Cascara and frangula barks must be stored for a year before use ?.
1- Fresh bark is unsuitable for drug use → nausea and vomiting.
2- Anthraquinone converted by Enzymatic hydrolysis and oxidation into Active anthrone.

7. Frangula, Buckthorn (Rhamnus frangula)
Constituents:
Anthraquinone glycosides (anthrone O-glycosides)
Glucofrangulin A & B and Frangulin A & B converted by Intestinal flora into emodin,
Physcion and chrysophanol (active form)
Action and uses:
- Atonic constipation

8. Aloes (Aloe sp.)
Aloe barbadensis (curacao aloes), Aloe ferox (cape aloes)
Aloe perryi (socotrine aloes)
Constituents:
Anthraquinone glycosides (anthrone C-glycosides)
- Barbaloin - Aloinoside A & B
Action and uses:
- Atonic constipation
N.B. The plant can be separated into two products:
1- Aloe latex or aloe juice is the bitter yellow exudate from the outer skin of the leaves. The
major and active constituents of aloe latex are hydroxyanthracene derivatives (15–40%).
2- Aloe gel is a fresh mucilaginous gel from Aloe vera (= Aloe barbadensis ) mainly
carbohyrates in nature (pectin and glucomannans) , does not contain anthraquinones
derivatives
This gel is widely used in wound healing and skin cosmotics

9. Bulk laxatives and lubricants
1- Slow onset of effect (take a few days) c.f. chemical laxatives or herbal drastic laxatives
(anthranoid drugs).
2- virtually free from side effects ( more suitable for long-term or even continuous use) except
dietary fibers (binding of minerals due to phytic acid).
3- Require an adequate supply of fluids.
4- ex. linseed, Plantago ovata (ispaghula), Plantago psyllium (psyllium seed and husk) and wheat
bran (how to solve mineral problem ?).
Indications for bulk laxatives:
1- Constipation
-bulk laxatives  absorb water stool volume stretch reflex Intestinal peristalsis
2- Diarrhea
- Paradoxically may be used in diarrhea if given with very little fluid  absorb the fluid from the
lumen (consistency of the stool) + adsorb toxins + protect mucosa
3- Inflammatory bowel disease  mucoprotection

10. 4- Hyperlipidemia
- adsorb lipids on their surface lipid absorption
- Also  are fermented in colon short fatty acid liver cholesterol biosynthesis
5- Blood sugar disturbances
- including the dietary management of diabetes adsorb sugar on their surface sugar
absorption.
6- Alimentary Obesity adsorb lipids and sugar on their surface lipid and sugar absorption.
7- Some dyspeptic and gastric inflammatory conditions mucoprotection+ (binds
hydrochloric acid + the decomposition products (irritate the stomach).
- Topically: inflamed lesions and pruritus.
Contraindications for bulk laxatives:
Iron deficiency anemia ?; osteoporosis ? and chronic malnutrition.

11. Psyllium (Plantago psyllium) and Ispaghula
(Plantago ovata) seeds and Husk
‫بذور‬‫قطونا‬Constituents:
Mucilage.
Action and uses:
Chronic constipation (irritable colon), Crohn's disease.
Dosage:
The dose is 1 teaspoons 2 times daily, swallowed whole
followed by adequate fluids, 1-2 glasses of water, or 1-2
liters per day.

12. Osmotic laxatives
Drawing water into gut  softening of stool
e.g. magnesium sulfate (Epsom salt) and sugars (grape and lactulose)
Lactulose  (don’t split by human enzymes)  bacterial metabolism of galactose in colon 
lactic and acetic acids (have osmotic effect)   amount of stool
Irritating laxatives Castor oil (Ricinus communis)
‫بذ‬‫و‬‫ر‬‫الخروع‬
Constituents:
Fixed oil 35-55 % of seed. Its fatty acid includes (80-90 % ricinoleic acid) which is responsible of
activity

13. Action and uses:
1- Purgative
2- Cosmetic products hair antidandruff and skin as a moisturizer, for Seborrhea (acne) and for
wound healing.
Toxicity:
Ricins are thermo-labile a toxic lectin (a carbohydrate-binding protein) which cause sever
irritation and haemorrhage in the GIT  vomiting and bloody diarrhoea  convulsion and
circulatory collapse
One seed contains about 250 μg ricins  may be fatal
Heating of seeds during the production of oil is enough for decomposing and removing of these
proteins
Can Castor Oil Be Used To Induce Labor? noooooooooooooo
laxative strain

14. Gastrointestinal infections and diarrhea
The most common causes of acute and chronic diarrhea are
1- Infectious agents. 2- Drugs or toxins 3- Food additives 4- idiopathic diarrhea
5- Inflammatory bowel diseases 6- Malabsorption
Natural products and conservative measures in diarrhea.
1- Tannin-containing herbs act as astringents will also gently control diarrhea without risk of
aggravating the infection by reducing intestinal motility. They also reduce mucosal damage.
2- polysaccharides (e.g. pectin and starch)
Rice starch  glucose (by enzymatic hydrolysis in GIT) enhance absorption of water and Na+
(by co-transport of sugar and Na+).
Eat more foods containing starch. Starchy foods are easily digested during diarrhea. Examples
are rice and mashed potatoes.
3- Opiates  reduce GIT motility
4- Normal conservative measures such as adequate fluid and electrolyte intake should also be
implemented.

15. - Restoring water and electrolyte balance in cases of severe diarrhea
The world health organization formula:
Sodium chloride 3.5 g
Sodium bicarbonate 2.5 g
Potassium chloride 1.5 g
Glucose 20.0 g
1 liter of water
Oral rehydration solution (ORS) for treatment of diarrhea relies on enhancement of
small intestinal sodium and fluid absorption to correct dehydration.

16. Bilberry (Vaccinium myrtillus)
‫األويسة‬ ‫أو‬ ‫األحراج‬ ‫عنب‬ ‫أو‬ ‫األحراش‬ ‫عنب‬
Constituents:
Anthocyanins, tannins (7%)
Action and uses:
- Diarrhea, dysentery - Gastrointestinal inflammation
- Maintaining healthy CVS
- Vision disorders due to altered microcirculation of the retina
-Antiplatelet agent

17. Common tormentil
(Potentilla tormentilla)
‫انجبار‬ ‫عرق‬
Constituents:
Tannic acid (20%), pigment, tormentil red.
Action and uses:-
- Internally  diarrhea
- Externally conditions affecting the mucous membranes of the
mouth and throat

18. Diseases of the rectum
Hemorrhoids
Hemorrhoids, also called piles, are vascular structures in the anal canal. They become a disease
when swollen or inflamed
Hemorrhoids are aggravated by pelvic congestion (e.g. constipation and pregnancy). Some
degree of loss of elasticity of the anal sphincter may play a role. Lifting heavy weights may
aggravate the condition.
Treatment could include the following:
I- Any associated constipation should be treated.
II- Oral treatment using herbs to
1- Increase dietary fiber, both soluble and insoluble ex. psyllium.
2- Mucilage-containing herbs such as ulmus (slippery elm).
3- Improve venous and connective tissue tone such as aesculus (horsechestnut), ruscus
(butcher's broom) and crataegus.
4- Relieve tissue congestion such as Melilotus (sweet clover).

19. 5- A bitter tonic is added to tone the portal veins, to relieve the plexus hemorrhoidalis.
6- Choleretic and hepatoprotective herbs should be applied if liver congestion.
7- Topical treatment with healing, anti-inflammatory, astringent and venous and connective
tissue tone herbs such as chamomile, calendula, hamamelis, comfrey and aesculus.
N.B.
Aesculus works well topically, especially in gel formulations, but should not be applied if the
piles are bleeding.

20. Astringents
- Tannins and related polyphenols curdling protein molecules into which they come in contact.
- Plants are rich in tannin such as coffee, hamamelis, tormentil root, quercus (oak bark), krameria
and Geranium maculatum (American cranesbill root).
Mechanism of action
The aim here was to produce a sealing eschar over the exposed tissues formed from coagulated
protein on the surface.
Indications for tannins:
- Inflammation of the upper digestive tract,
- Diarrhea following gastrointestinal inflammation.
- Topically: open, discharging lesions, wounds, hemorrhoids and third-degree burns.
Contraindications for tannins:
- Constipation
- Iron deficiency anemia
- Malnutrition.

21. WitchHazel, winter bloom (Hamamelis virginiana)
‫لحاء‬ ‫و‬ ‫أوراق‬‫الهماميليس‬
Constituents:
Tannins (3-10 %)( hamamelitannin (hydrolysable tannin),
condensed catechins (proanthocyanidins or condensed tannin),
gallotannins and procyanidins) , v. oil, flavonoids.
Action and uses:-
- Diarrhea, mucous colitis (ulcerative colitis and Crohn's disease)
- Topically: Hemorrhoids, varicose veins, bruises and
- localized inflamed swellings, mild abrasions and skin inflammation.
- In antiageing or antiwrinkle skin preparations
- Inflammation of prostate (supp.)
Mechanism of action
. leukotriene and PAF ttt of asthma, ulcerative colitis and Crohn's disease.

22. Butcher's broom (Ruscus aculeatus)
‫مدبب‬ ‫سفندر‬‫او‬‫البري‬ ‫األس‬
Constituents:
Steroid saponins (ruscogenin and neoruscogenin)..
Action and uses:-
- Hemorrhoids
- Varicose veins
Mechanism of action:-
Ruscogenins are veinotonic,  inflammation, vasoconstrictor,
and  hemorrhages.
Horse-chestnut seed
Rue (Ruta graveolens)

23. Diseases of the liver
Liver is one of the most important organs of the digestive system. It is the principal organ of
metabolism of carbohydrates, proteins, fats and bile; the main organ of detoxification of harmful
foreign substance e.g. most chemicals numerous therapeutic drugs, toxic substances and
environmental pollutants.
Diseases of liver and biliary tract
As the liver is closely associated with the gall-bladder, problems of these organs are usually
considered in association.
1- choleretic action (stimulating the production of bile, and thus working directly on the liver
itself).
2- cholagogue action (increasing the release of bile from the gall bladder).

25. Hepatitis (inflammation of the liver): Long term hepatitis may lead to cirrhosis (fibrosis)
and death.
1- Certain viral infection (viruses A, B, C – viral hepatitis).
2- Parasitic infections (e.g. bilharziasis and amebic desentery).
3- Excessive inhalation of chlorinated hydrocarbons, (e.g. DDT, CHCl3 and CCl4).
4- Ingestion of industrial pollutants (radioactive material), contaminated food (e.g. aflatoxin or
peroxides in oxidized edible oil), much alcohol and poor nutrition, Medication with antibiotics,
chemotherapeutic agents and possibly plant materials such as those contains pyrrolizidine
alkaloids.
Symptoms
1- Fever often accompanied by vomiting. 2- Pain around the liver, Nausea, anorexia, impairment
of fat digestion 3- Fatigue 4- Alcoholics can not tolerate alcohol.
5- jaundiced skin and dark urine (yellow discoloration of the skin or sclerae by bilirubin, when its
serum concentration exceeds 2 – 3 mg/100ml).
6- High levels of SGPT and SGOT enzymes, which are elevated in acute hepatitis.

26. Biochemical tests:
1. Blood glucose level falls leading to a fatal hypoglycemia.
2. Blood urea falls and ammonia? level rises.
3. Bilirubin accumulates in blood and jaundice develops.
4. Blood clotting is impaired by a fall in prothrombin and fibrinogen.
5. A fall in overall plasma proteins leading to decrease in osmotic pressure of plasma proteins
and this may result in edema.
7. Reduction of fat absorption due to decrease of bile salts.
Immunological tests:
- Hepatitis markers (in viral hepatitis).
- Antinuclear factor and smooth muscle antibodies " in chronic active hepatitis".
- Antimitochondrial antibodies (in biliary cirrhosis).
- alpha-fetoprotein (afp) (in liver cancer).

27. 1- Fatty liver: Excessive lipid in parenchyma cells .
2- Poor liver function
3- Acute viral hepatitis: the hepatitis A, B and C viruses.
4- Chronic viral hepatitis: usually results from infection with hepatitis B or C.
5- Cirrhosis of the liver: widespread death of liver cells, which can result from many causes but is
most commonly due to alcohol abuse (Europe ) Hepaitis C (Egypt) and B is accompanied and
followed by progressive fibrosis and distortion of liver architecture.
Treatment is based on the following:
- Hepatoprotective and hepatic trophorestorative herbs, Principal herbs include silybum,
artichoke and dandelion root, schisandra is particularly useful since it also enhances the
detoxifying capacity of the liver.
- Most of the hepatoprotective herbs listed above have a gentle choleretic activity
- Cholerctic herbs to boost liver function are particularly indicated if digestive symptoms are
predominant. They will also boost detoxification by the bile and therefore can be valuable in
conditions such as psoriasis and cancer.
- Strongly choleretic herbs include hydrastis, barberry, chelidonium and bitter herbs. These
strongly choleretic herbs will cause nausea and irritability in a patient who has some history of
liver damage ?.

28. - Antiviral agents, which for hepatitis include Hypericum perforatum (St John's wort), phyllanthus
and thuja.
- Immune-enhancing herbs, especially Nigella sativa, echinacea and picrorrhiza. but also
consider astragalus for any chronic infection.
Hepatics (Hepatoprotective and hepatic trophorestorative)
- Hepatics are remedies which are claimed to help reduce damage caused to the liver from
hepatic stressors and disease. ex. Silybum marianum (milk thistle), cynara (artichoke and
schisandra.
Indications for hepatics: - Viral and other hepatitis.
- Adverse effects of alcohol and excess fat consumption.
- Exposure to industrial pollutants. - In anticipation with the powerful medications.
- Cirrhosis and other chronic liver diseases.
Contraindications for hepatics: Liver carcinoma (Because of its use of secondary plant
products, particular caution is necessary in applying phytotherapy to primary and secondary liver
carcinoma).

29. Milk Thistle (Silybum marianum)
‫برى‬ ‫حرشف‬=‫الجمل‬ ‫شوك‬
constituents:
Flavolignan 1.5-3 % Collectively referred to as Silymarin. It is a
mixture of isomeric flavolignans, namly Silybin (silibinin),
Silychristin and silidianin
Mechanism of action
-  intracellular glutathione;
- Stabilizes hepatocyte membrane against injury and regulates its
permeability,
- cellular regeneration by  syn. of ribosomal RNA and proteins
- Choleretic
- Antioxidant

30. Action and uses:-
- In liver and gallbladder problems - diabetic neuropathy
- Antiallergic and anti-inflammatory agent.
- Prophylactic for
. oxidative stress
. Liver problems (pregnancy, oral contraceptive use or
envi. Pollu. )
. Prevent gallstone formation;
- Topically protective
. Against chemical carcinogen
.UVB induced skin tumors..
The absorption of silymarin is enhanced by lecithin and simultaneous dosing with a lecithin
supplement is recommended. Silymarin is not soluble in water, and is therefore ineffective when
taken in the form of a tea.

31. Schizandra (Schisandra chinensis)
‫الشيزاندرا‬
Constituents:-
Lignans: Schisandrins isoschisandrin; schisandrol, Pregomisin .
Action and uses:-
- Regenerate liver tissue damaged
- Adaptogen,
- Excites the central nervous system and  brain efficiency
- Regulates the CVS to improve blood cir.
DDB Diphenyl Dimethyl Bicarboxylate: is a synthetic analogue of
schizandrin C, being active against liver damage.
O
O
COOCH3
COOCH3
OCH3
OCH3
O
O

32. Hypericum, St John's wort (Hypericum perforatum)
‫جونز‬ ‫سانت‬ ‫نبتة‬ ‫أو‬ ‫المثقوب‬ ‫العرن‬‫يحيى‬ ‫سيدي‬ ‫نبتة‬ ‫أو‬
Constituents:
Naphthodianthrones (hypericin and pseudohypericin); flavonoids, v. oil.
Action and uses:-
- Antiviral (cold sores, herpes genitalis, chicken pox, CMV and viral
hepatitis)
- Antidepressant (mild antidepressant activity);
- Anti anxiety - Sleep disorders
- Psychological symptoms of menopause.
- Vulnerary, antiseptic wound healing.
- Oil of hypericum
Internally (dyspepsia)
Externally (wounds, bruises, myalgia , burns)..

33. Mechanism of action
- Hypericin and pseudohypericin also interfere
with more than one stage in the virus
replication cycle.
- The antiviral activity was enhanced by
exposure to light.
-The ring structure, the quinone and phenolic
groups are necessary for the antiviral activity.
Interactions:
Selective serotonin reuptake inhibitors SSRI
and MAO inhibitors, leading to excess serotonin
availability in the CNS.

34. Globe artichoke, Cynara (Cynara cardunculus var.
scolymus)
‫الخرشوف‬
Constituents:-
Sesquiterpene lactones: cynaropicrin - chlorogenic acid, cynarin
- Flavonoids,
Action and uses:-
- Hepatoprotective
- Choleretic, Cholagogue
- Antiemetic - Bitter
-Hypocholesterolemic
Mechanism of action
- Diuretic (ascites). - Antioxidative
- regeneration of liver cells;
-  bile flow from the liver;
-  blood lipids, cholesterol biosynthesis

35. Dandelion (Taraxacum officinale)
Constituents:
Sesquiterpene lactones: taraxinic acid (germacranolide) eudesmanolides;
Bitter principle (taraxacin).
Carotenoids (traxanthin);
Choline; phytosterols; triterpenes; flavonoids; caffeic acid.
Action and uses:-
-Hepatoprotective - Antioxidant
- Choleretic, Cholagogue - Laxative - Bitter
- Antihypercholesterolemia (LDL & TG, HDL)

36. Mechanism of action:
- Diuretic (ascites)( BP)
- Antirheumatic .- The high choline content of the root "tonic" to the liver.
- Choline derivatives are known to effect parasympathetic stimulation and vasodilation  BP
- Diuretic and high levels of potassium  elevated SBP
The leaves can be used at the following dosages three times daily:
As mild diuretic and weight loss agent

37. Boldo (Peumus boldus)
Constituents:
- Alkaloids: Boldine (major), isoboldine,
- Flavonoids; volatile oils (linalool,cineole) coumarin; resin; tannin.
- Glycoside (boldoglucin).
Action and uses:-
- Hepatoprotective,
- Cholagogue
- Sedative
- Diuretic, mild urinary demulcent, and antiseptic properties.
- Cystitis specifically for cholelithiasis with pain.
- Rheumatism
- Boldine has cytoprotective and anti-inflammatory properties (used in skin care
products as anti-aging agent).
Contraindications:
Individuals with an existing kidney disorder.
N
OCH3
OH
OCH3
OH
CH3
H

38. Picrorrhiza (Picrorhiza kurroa)
‫بيكروريزا‬
Constituents:
Iridoid glycosides: picroside I, picroside II and
kutkoside.
Action and uses:-
- Hepatoprotective
- Choleretic, Cholagogue.
- Bitter
- Immune-stimulant
Turmeric, Curcum (Curcuma longa)
Constituents:
-Cucuminoids (curcumin, demethoxycurcumin,
bis demethoxycurcumin)
- Volatile oils
Action and uses:-
-Hepatoprotective
- Antioxidant
- Anti-inflammatory

39. Diseases of the biliary tract
Phytotherapeutic strategies include the treatment of cholecystitis (biliary infection), minor or
early cholelithiasis (biliary stones) and conjugated hyperbilirubinemia and management of
established cholelithiasis and chronic and moderate hepatobiliary diseases.
The essential elements of treatment are as follows:
- Bitter herbs to improve digestive and gallbladder function, e.g. gentiana or picrorrhiza.
- Choleretic herbs to improve bile production, e.g. chelidonium, artichoke, dandelion root and
silybum .
- Cholagogue herbs to improve gallbladder motility, e.g. chelidonium, cynara and peppermint.
- A terpene mixture similar to oil of peppermint has been shown to dissolve gallstone.
- Spasmolytic herbs, e.g. cramp bark, chamomile and Mentha, can help to relieve gallbladder
pain.
- A short course of olive oil and lemon juice is often recommended to discharge gallstones.
(Therapy should only be effective if the gallstones are not calcified, the cystic duct is patent,
the gallbladder is functional)
- Cholagogue (choleretic) + spasmolytic + carminative. In some cases a mild laxative may be
added, a tonic will be added if conjunction with lack of tone in the stomach.

40. Indications for choleretics and cholagogues:
- Non-impacted gallstones
- Moderate cholecystitis (gallbladder infection)
- Conjugated hyperbilirubinemia (jaundice due to decreased excretion of conjugated bilirubin
through the bile duct)
- Bilious conditions associated with heaviness in the epigastrium, nausea
- Constipation (not due to intestinal spasm nor responding to conventional measures);
- Inflammatory bowel disease
Contraindications for choleretics and cholagogues (sever and complicated conditions):
- Obstructed bile ducts (due to impacted gallstones
- Cancer of bile duct, pancreas or liver
- Unconjugated hyperbilirubinemia
- Acute or severe hepatocellular disease (e.g. following viral hepatitis, cirrhosis, adverse reactions
to drugs, e.g. anesthetics, steroids, estrogen, chlorpromazine)
- Septic cholecystitis - Intestinal spasm
Application:
- Choleretics and cholagogues are best taken before meals, preferably about 30 min.
- They should be taken in fluid form.

41. Chelidonium, Greater celandine (Chelidonium majus)
‫الصباغين‬ ‫عروق‬
Constituents:
alkaloids: chelidonine (major), berberine.
Action and uses:-
- Spasmolytic
- Choleretic, Cholagogue
- Mild laxative
- Anti-inflammatory
- Anti-platelet
- Antiviral.
- Topical antimicrobial effect against fungal infections and warts
- Inhibition of keratinocyte proliferation in psoriasis (topical use).