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International Journal of Pharma and Bio Sciences A COMPREHENSIVE REVIEW ON TRIVRIT [OPERCULINA TURPETHUM SYN. IPOMOEA TURPETHUM] KOHLI K R1, *NIPANIKAR S U2 AND KADBHANE K P3
1. Director of Ayurveda, Maharashtra State, Govt. Dental College Building, 4th Floor, St. George Hospital Compound, Mumbai, Pin-400001, Tel: +9122-24947144, Email: krkohli@rediffmail.com 2. *R. A. Podar Medical College (Ayu) and M. A. Podar Hospital, Dr. Annie Besant Road, Worli, Mumbai400018. Tel: +91-9321749026, Email: drsunipanikar@rediffmail.com 3. R. A. Podar Medical College (Ayu) and M. A. Podar Hospital, Dr. Annie Besant Road, Worli, Mumbai 400018. Tel: +91-9049871585, Email: inspirekk@rediffmail.com *Corresponding Author drsunipanikar@rediffmail.com
ABSTRACT
Trivrit (Operculina turpethum syn. Ipomoea turpethum) is commonly used since centuries in Ayurvedic system of Medicine to treat fevers, edema, ascites, anorexia, constipation, hepatosplenomegaly, intoxication, haemorrhoids, fistula, anemia, obesity, abdominal tumors, ulcers/wounds, worm infestation, pruritus and other skin disorders. It is the best amongst the herbs used for Virechana (i.e. therapeutic purgation), one of the procedures of Ayurvedic Panchakarma therapy. This review comprehensively incorporates the phramacognosy, medicinal uses, and pharmacology of O. turpethum. Few preclinical studies done on Operculina turpethum have shown that it possesses anti-inflammatory, anticancer, cytotoxic, antisecretory, ulcer protective, hepatoprotective, & antibacterial activities. Some preliminary clinical studies have reported laxative, anti-inflammatory, analgesic, anti-helminthic and anti-arthritic effects of its crude root powder. The herb merits further research as it may be a source of potential anticancer and anti-rheumatic agent(s). As the plant Operculina turpethum is endangered, also prompt attention needs to be given to protect it from extinction.
KEY WORDS
Trivrit, Operculina turpethum, Purgative, Anticancer, Antirheumatic.
INTRODUCTION
Trivrit is an important herb, used in ayurvedic system of medicine since ages. Root bark, root, stem, and leaves of this herb have high medicinal value.[1] Root of Trivrit is the vital ingredient of Avipattikar Churna, which is used in South East Asia on large scale for the treatment of skin www.ijpbs.net P 443
disorders, acid peptic disorders, & constipation. In Ayurveda, Trivrit has been included in the group of ten purgative herbs (i.e. Bhedaniya Mahakashaya), group of ten antidote herbs (i.e. Vishaghna Mahakashaya), group of ten herbs supportive for therapeutic enema (i.e. Ashthapanopag Mahakashaya),[2] group of colon cleanser, antitumor & antidote herbs
Pharmacognosy
ISSN 0975-6299 (i.e. Shyamadi Gana), and in the group of herbs eliminating the toxins (i.e. vitiated Doshas) from lower half of the body (i.e. Adhobhagahar Gana).[3] Root bark of Trivrit is typically administered in powder form with number of vehicles such as fermented rice water (Kanji) , milk, cereal water, Triphala, black paper, sugarcane juice, cows urine, goats urine, sheeps urine etc [4] as a therapeutic purgative agent for the treatment of GI disorders, skin disorders, ascites and various cancers.[5] Trivrit has two varieties as Aruna or Shweta (i.e. having whitish or reddish coloured root) & Shyama (i.e. having blackish root).[1] The botanical name of Aruna or Shweta Trivrit is Operculina turpethum (L.) Silva Manso (syn. Ipomoea turpethum), while that of Shyama is Ipomoea petaloides chois.[6] Aruna or Shweta Trivrit is the best amongst the herbs used for Virechana (therapeutic [7] purgation). Shyama, with its drastic purgative action, can treat the conditions like intoxication & abdominal tumors.[8] However, Shyama is inferior in properties and can cause fainting, burning sensation, giddiness, confusion, chest pain and roughness of throat and hence is rarely used in medicine.[6] In spite of consistent use of Trivrit in Ayurvedic medicine since centuries, the herb is little known to the research community. It may be due to lack of availability of adequate information on the plant on global level. Though few researches have been done, Operculina turpethum is under explored herb.
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Binomial name: Operculina turpethum (L.) Silva Manso.[9-10] Synonyms Latin- Ipomoea turpethum (L.) R. Br., Convolvulus turpethum L. (basionym), Convolvulus ventricosus Bertero [ Operculina turpethum var. ventricosa], Merremia turpethum (L.) Rendle, Operculina ventricosa (Bertero) Peter;[9] Sanskrit- Shveta, Tribhandi, Trivruta, Triputa, Sarvanubhuti, Sarala, Nandi, Kalameshi, Nishotra, Kalaparni, Rechani, Kutarana, Bhandi, Palindi, Ardhachandra, Sushenika, Masurvidala, Kaulkaushiki, Kalameshika, Shyama;[1] English-Turpeth root, Indian jalap,[8] [9] French- Turbith Transparent wood-rose; [8] vegetal; German- Turpeth Trichterwinde;[8] Hindi- Pithori, Nakpatra, Nishut, Nishoth;[8] Arabic- Turband, Thurbud;[8]Chinese- he guo teng.[10] Geographical distribution: O. turpethum is native to Asia (India, Nepal, Bangladesh, Pakistan, Shri Lanka, China, Taiwan, Myanmar, Thailand, Indonesia, Malaysia, Papua New Guinea, & Philippines), Africa (Kenya, Tanzania, Mozambique, Zimbabwe, Madagascar, Mauritius & Reunion) & Australia while is naturalised in West Indies.[9, 11-12] Unfortunately, with the rapidly shrinking natural habitat, this important medicinal plant is dying out in many parts of the world.[12-16] Morphology: O. turpethum is a stout perennial climber that exudes a milky juice when cut, with long fleshy roots and long twisting pubescent stems that are angled, winged which become very tough and brown when old. The leaves are simple, pubescent on both sides and variable in shape, cordate or truncate at base 5-10 cm long and 1.3- 7 cm wide. The flowers are white, campanulate, sepals long, borne in cymes of few flowers, giving way to globose capsules enclosed within overlapping brittle sepals. The capsules is rounded, being 1 to 1.5 centimeters Pharmacognosy
BOTANICAL DESCRIPTION
Taxonomical ClassificationKingdom: Plantae Subkingdom: Tracheobionata, vascular plants Superdivision: Spermatophyta, seed plants Division: Angiosperma Class: Dicotyledons Order: Solanales Family: Convolvulaceae Genus: Operculina Species: O. turpethum (L.) Silva Manso www.ijpbs.net P 444
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in diameter, and contains normally 4 black, smooth seeds. Roots of Trivrit occur in pieces, 1.5-15 cm long, 1-5 cm in diameter, usually unbranched, cylindrical, elongated, bearing thin rootlets; thicker pieces, occasionally split and show central wood portion; surface dull grey, reddish-grey to light brown, showing deep furrows or longitudinal wrinkles giving a rope-like or columnar appearance; transversely cut surface shows thick, whitish bark and light yellow centre; fracture in bark, short; in wood, fibrous. [11]
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and fructose in presence of hydrochloric acid.[8] Trivrit also contains Turpethinic acids- A, B, C, D, & E,[17] some ether soluble resin, volatile oil, albumin, starch, lignin salts, ferric oxide, Scopoleptin, Betulin, lupiol & beta- sitosterol.[8, 17-18] Turpethin is mainly responsible for purgative action of Trivrit and is an excellent & relatively safer substitute for jalap.[8]
AYURVEDIC PHARMACOLOGY
In Ayurveda, Charaka have devoted a separate chapter on description of Trivrit including method of its collection, processing, contraindications, indications, dosage and therapeutic use of its one hundred & ten purgative formulations.[4] Properties Described in Ayurvedic Texts: As per Ayurvedic Pharmacopoeia of India, Trivrit has sweet (Madhura), pungent (Katu), bitter (Tikta), & astringent (Kashay) tastes (Rasa); is hot in potency (Veerya); gives pungent (Katu) effect after metabolism (Vipaka); and possesses properties (Guna) like lightness (Laghu), dryness (Ruksha), & warmth (Ushna). With these properties, it eliminates Kapha & Pitta and exaggerates the Vata. It also easily and safely eliminates the body wastes (Sukhavirechan), and pacifies fever (Jvarahar).[1, 4, 11] Medicinal Uses: In Ayurveda, root of Trivrit is used internally to treat fevers, anorexia, edema, anemia, ascites, constipation, hepato-splenomegaly, hepatitis, intoxication, abdominal tumors, ulcers, wounds, worm infestation, pruritus and other skin disorders.[11] Root is also administered to treat obesity, haemorrhoids, cough, asthma,[5] dyspepsia, flatulence, paralysis, gout, rheumatism, melancholia, scorpion sting, and snake bites.[8] The paste of root powder of Trivrit is used topically to treat vitiligo & other skin disorders, alopecia, cervical lymphadenitis, haemorrhoids, fistulas, ulcers, & chancres.[20- 21] Oil extracted from the root bark of Trivrit is used in skin diseases of a scaly Pharmacognosy
STANDARDIZATION
Organoleptic properties Odour of roots is indistinct, taste is slightly pungent and nauseating when kept in mouth for some time. Mature roots of O. turpethum give grayish to light brown coloured powder. [11] Physical properties Fine powder of Trivrit root bark should give nil foreign matter, total ash not more than 10 %, acid-insoluble ash not more than 1.5 %, alcoholsoluble extractive not less than 10 % and watersoluble extractive not less than 8 %.[11] Thin Layer Chromatography (TLC) TLC of the alcoholic extract of O. turpethum on Silica gel 'G' plate using Toluene: Ethylacetate (9:1) shows under UV (366 nm) three fluorescent zones at Rf. 0.08, 0.21 (both light blue) and 0.58 (blue). On exposure to Iodine vapour seven spots appear at Rf. 0.21, 0.41, 0.49, 0.58, 0.71, 0.90 and 0.97 (all yellow). On spraying with Vanillin Sulphuric acid reagent and heating the plate for ten minutes at 110C seven spots appear at Rf. 0.21, 0.41, 0.49 (all light violet), 0.58, 0.70, 0.90 and 0.97 (all violet).[11] PhytochemistryRoot bark of Trivrit is rich in turpeth resin consisting of 10% turpethin which is a glycoside analogue of Jalapine and Convolvulin and is insoluble in ether, benzine, carbon sulphide and essential oils. Under the action of alkaline bases, thurpethin is transformed into turpethic acid, while it gets converted into turpetholic acid, Glucose www.ijpbs.net P 445
ISSN 0975-6299 nature.[19] A processed ghee with Trivrit or fresh juice of Trivrit leaves is dropped into the eyes to treat diseases like corneal opacity or ulcer and conjunctivitis. Root powder of Trivrit mixed with ghee and honey is also used to treat hematemesis, tuberculosis & herpes.[1]
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Ayurvedic Formulations: There are at least 135 herbal and herbomineral formulations used in Ayurvedic medicine, which contain Trivrit as their vital ingredient.[4] The concise list of commonly used formulations and their indications[22-27] is given in Table 1.
Dosage as per Ayurveda: For therapeutic purgation (viz. Virechana), maximum 10-12 gm paste of root bark of Trivrit is administered in the morning on empty stomach, along with fermented rice water or milk.[28] This dose generally produces 10 to 30 loose motions www.ijpbs.net P 446
as a part of body cleansing.[29] As a palliative therapy, 1-3 gm of drug is used in powder form.[1] However, the dose needs to be individually tailored as severity of purgative action can vary from person to person and
Pharmacognosy
ISSN 0975-6299 overdosing may lead to serious complications.[28] Safety aspects, contraindications & precautions Trivrit should not be used in pregnancy, in children below 12 years of age, in elderly, in physically or mentally weaker persons, and in persons suffering from diarrhea, bleeding per rectum, rectal prolapse, or fecal incontinence.[30] Trivrit may act as an abortificient when used in pregnant ladies. Use in children or in physically or mentally weaker persons or overdose of Trivrit may lead to complications like excessive purgative activity, bleeding per rectum, vomiting, abdominal pain, chest pain, dehydration, hypotension, vertigo, confusion, shock, & unconsciousness.[31]
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Rajashekar M., et.al. (2006) found that oral administration of O. turpethum and its polyherbal formulation Avipattikar churna is effective in reducing gastric acid content, gastric ulcer, hyperacidity & related GIT disturbances in albino rats.[32]
TOXICITY STUDIES
In an acute toxicity study (Rajashekar M et al; 2006), healthy albino mice of either sex were divided into eight different groups of six animals each. Animals of the group 1 received acacia suspension (0.5 ml orally) while the animals of group 2 to 8 received suspension of root of O. turpethum at 10, 30, 100, 200, 400, 600, 800 mg/kg dose levels respectively. The animals were observed at 0, , 1, 2 and 4 hours after the administration for acute effect and mortality. The observation was continued for one week for the delayed effects and mortality. Results revealed that there were no treatment related deaths or any toxic effects in any of the groups.[32] In another acute toxicity study (S. V. Suresh Kumar et al; 2006), an ethanolic extract of O.turpethum, when administered in different groups of Wistar rats of either sex in doses ranging from 100-2000 mg/kg, produced no lethality in any of the groups. Also the extract did not produce any alterations in liver function markers like SGOT, SGPT, serum alkaline phosphatage and serum bilirubin[33]
Anti-inflammatory activityAn experimental study was carried out (Rajashekar M et al; 2006) to evaluate the effect of oral administration of root powder of O. turpethum and its polyherbal formulation Avipattikar churna on rat paw edema in albino rats. Results indicated that pretreatment with the root powder of O. turpethum and Avipattikara churna (100 mg/kg body weight) reduced the formalin induced edema volume to the extent of 36.45% and 27.11% respectively.[32] Hepatoprotective activity In an experimental study (S. V. Suresh Kumar et al; 2006), effect of ethanolic extract of O. turpethum was assessed in paracetamol (PCM) induced hepatotoxicity in Wistar rats. PCM intoxication in normal rats elevated the serum levels of SGOT, SGPT, Alkaline phosphatage and bilirubin significantly, indicating acute centrilobular necrosis. The rats treated with ethanolic extract of O. turpethum showed a significant reduction in all four biochemical parameters which was comparable with that of silymarin. The histopathological profile of the rat treated with ethanolic extract showed no visible deteriorations confirming the safety of the extract at 200 mg /kg body weight.[33] In other three experimental studies (Vaidya Balendu Prakash et al; 2010), an Ayurvedic herbomineral formulation (i.e. Prak-20) containing O. turpethum root powder as one of its ingredients showed significant hepatoprotective activity against CCl4 induced liver toxicity in Rats.[34] Antimicrobial activity Pharmacognosy
PHARMACOLOGICAL ACTIVITIES
Antisecretory and Ulcer protective activitywww.ijpbs.net P 447
ISSN 0975-6299 Three compounds H-1 ($-sitosteryl-$-D glucoside), H-2 (22, 23-dihydro-"-spinosteryl glucoside) & CH-2 (salicylic acid) isolated from the chloroform extract of stem of Ipomoea turpethum (Synonym- O. turpethum) and the crude extracts of the same plant prepared in petroleum ether, chloroform and ethyl acetate were screened (Md. Harun-or-Rashid et al; 2002) against thirteen pathogenic bacteria for their antibacterial activities. The minimum inhibitory concentration (MIC) of the isolated compound CH-2 was also measured against Bacillus subtilis, Shigella dysenteriae, Sarcina lutea and Escherichia coli. The values were found to be between 128 and 256 g/ml. In this investigation, crude extracts and isolated compound CH-2 of O. turpethum showed significant antibacterial activity but were less potent than that of standard kanamycin whereas compound H-1 & H-2 showed little activities. The results of this study justify the traditional use of this plant in the management of microbial infection. [35] Another study (M. Jahangir Alam et al; 2010) was done to evaluate the antibacterial activities of ethanol extract and petroleum ether extracts of O. turpethum leaves on two Gram positive (viz. Bacillus subtilis, Streptococcus haemolytica), and three Gram negative bacteria (viz. Pseudomonas aeruginosa, Shigella sonnei & Shigella dysenteriae). Antibacterial activity was tested by disc-diffusion method. Activity was compared with those of ampicillin, neomycin as positive control and with ethanol & petroleum ether as negative control. Findings revealed that ethanol extracts showed a significant inhibition against pathogenic bacteria while petroleum ether extract did not show significant zone of inhibition. The MIC value of extracts ranged from 0.13 to 0.75 mg / ml; ethanol extracts had lower MIC values than petroleum ether extract.[19]
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Sprague-Dawley rats (C. Anbuselvam et al; 2007). A significant increase in lipid peroxidation levels were observed in tested samples of cancer induced rats while the activities of enzymatic antioxidants such as Superoxide dysmutase, catalase, glutathione peroxidase and nonenzymatic antioxidants like glutathione, ascorbic acid and alpha tocopherol were decreased in cancer bearing animals when compared to controlled animals. A significant (P- 0.05) increase in breast tumor weight was observed in DMBA group while breast tumor weight decreased significantly in combination of DMBA and O. turpethum extract group. Investigators of this experiment recommended the use of the bioactive compounds from O. turpethum as a supplementary to anticancer medicines.[36] Cytotoxic activity Alluri V. Krishnarajua et al (2005) carried out Brine shrimp (Artemia salina) lethality bioassay to investigate the cytotoxicity of aqueous extract of O. turpethum. The extract showed moderate brine shrimp lethality and the LC 50 value was found to be 81 (lower than 100). This significant lethality is an indicative of the presence of potent cytotoxic components in the herb which merit further investigation for its antitumor activity.[37] In another study (Md. Harun-or-Rashid et al; 2002), the cytotoxic activity of the crude, chloroform and ethyl acetate extracts of Ipomoea turpethum and its isolated compound CH-2 was determined by the Brine shrimp lethality bioassay. The LC50 values of these substances were found to be 56.23, 199.53 and 31.62 g/ml, respectively. Ethyl acetate extract was found to be much more cytotoxic than chloroform extract. The cytotoxic action of a drug was exhibited by disturbing the fundamental mechanisms concerned with cell growth, mitotic activity, differentiation and function. Although the exact mechanism of cytotoxic action of these extracts could not be explained by the study, the results indicate that
Anticancer and Antioxidant activities: Antioxidant activity of methanolic extract of O. turpethum stems (100 mg/kg for 45 days) on 7,12 dimethylbenz(a)anthracene (DMBA) induced breast cancer was investigated in female www.ijpbs.net P 448
Pharmacognosy
ISSN 0975-6299 the Ipomoea turpethum extract may be a potential chemotherapeutic agent.[35]
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and group C. No major side effects were reported in any subjects during the period of this study.[39] In a clinical study (Nusrat Parveen et al; 2004), administration of Unani Remedy- Qurs Deedan (having Ipomoea turpethum as its main ingredient) in a dose of two tablets daily at bedtime for 30 days in patients of ascariasis caused clearance of A. lumbricoides ova from the stool samples and relief from clinical signs & symptoms of worm infestation in most of the patients.[40]
CLINICAL TRIALS
Some open label clinical studies have reported laxative, anti-inflammatory, analgesic, antiarthritic and anti-helminthic effects of root powder of O. turpethum.[38-40] However, authors of this review could not trace electronically published randomized comparative clinical trial on the herb. In an open, uncontrolled clinical study (Shailej Gupta; 2009), powder of Trivrit roots administered as a single dose of 30 gm with fermented rice water (Kanji) for Virechana procedure produced strong purgation in 30 patients of Amavata i.e. Rheumatoid Arthritis. This purificatory procedure produced statistically significant improvement in the subjective parameters like joint pain, stiffness, swelling, tenderness, and in global assessment for overall improvement. Also there was a statistically significant reduction in the ESR values in the study patients.[38] However it should be noted that Virechana with Trivrit powder cant be recommended for each and every patient of Rheumatoid arthritis as there are number of contraindications for the procedure. Many patients may not tolerate one time dose of 30 Gms Trivrit powder. Shyju Ollakkod (2004) evaluated the effect of Alambushadi Yoga (polyherbal formulation having Trivrit as its main ingredient) in 27 subjects of Rheumatoid arthritis (RA). Subjects were equally divided in three groups. Subjects from group A received oral Alambushadi yoga, subjects from group B received Dhanyamla Kayaseka (fomentation with fermented cereal water) while subjects from group C received combination of oral Alambushadi yoga & Dhanyamla Kayaseka for 21 days. The complete remission in the symptoms of RA was registered in 3 patients from group C, in 2 patients from group B and in 1 patient from group A. Good response in symptoms of RA was noted in seven patients from group A, in five patients from group B and in four patients from group C. Moderate response in the symptoms of RA was noted in one patient in group A, two patients each in group B www.ijpbs.net P 449
CONCLUSION
Trivrit (O. turpethum) is an important medicinal plant, which is safely & effectively used to treat various disorders in Ayurvedic system of Medicine since centuries. Few toxicity studies done in rodents have confirmed the safety of both crude powder and extract of O. turpethum. There are preliminary reports of antisecretory, ulcer protective, antiinflammatory, hepatoprotective, antibacterial, anticancer, & cytotoxic activities of the herb. Though few clinical studies have reported efficacy and safety of Trvrit in some patients of rheumatoid arthritis and ascariasis, there is a need of randomised, controlled clinical studies to confirm its efficacy and safety. Such evidence is needed to provide scientific credence to the folklore use of traditional Ayurvedic medicines like Trivrit and even be helpful in the development of future drugs or treatment modalities for diseases like rheumatoid arthritis and cancer. As the O. turpethum is endangered, a prompt attention needs to be given to protect the plant from extinction.
ACKNOWLEDGEMENTS
The Authors sincerely thank Dr. Gajanan Pawar (Lecturer, Dept. of Dravyaguna, Dr. D. Y. Patil Ayurvedic Medical College, Navi Mumbai) for his kind help in providing few references.
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