Preparation of Decoction of Medicinal Plants: A Self-Help Measure?

Abstract

Dear Editor: Ethnobotanical studies have shown use of decoction (hot aqueous extract) of local plants to be a preferred mode.1,2 In fact, preparation of plant-based remedies at the household level is often seen as a self-help measure. However, our recent field experiences with Psidium guajava (guava) leaf decoction (PGLD) as an antidiarrheal remedy revealed that preparation of a home-based remedy could be a limiting factor toward use of local medicinal plants. We had identified PGLD as an efficacious antidiarrheal plant through an ethnobotanical survey of Parinche valley, Pune, India3 followed by laboratory studies.4 Subsequent to the popularization of PGLD in the valley through community health workers (CHW), patients with diarrhea willing to share their experiences (n=23) were interviewed. A number of reasons for using and not using PGLD were identified (Box), most of which are similar to those reported elsewhere. These include dissatisfaction with other available treatments,5–7 recommendations from relatives or friends,5 financial constraints,8,9 and a pluralistic approach for faster and/or better cure.5 To the best of our knowledge, the preparation of a decoction restricting the use of local medicinal plants has not been reported. Hence, this parameter was analyzed in detail. The CHW prepared PGLD on a kerosene stove and on a chulha (traditional earthen stove with wood as a fuel). Approximately 170 mL of kerosene was required to prepare PGLD for an adult per day, and time required was 38 minutes. The cost for preparing PGLD using kerosene for an adult for 5-day treatment, the recommended duration, was $0.19–$0.48 ($0.04–0.09 per day), depending on whether it was purchased from government-subsidized ($0.22 per liter) or privately owned ($0.56 per liter) shops. On the other hand, the amount of wood for preparing PGLD for an adult/day was estimated to be approximately 514 g, and the time required was 1 hour 10 minutes. The cost of wood (if purchased) is $0.09 per kg. Thus, the cost for preparing PGLD using wood for an adult for 5 days would be $0.22 ($0.04 per day). It is not feasible to prepare and store the decoction for 5 days since it is prone to bacterial and fungal contamination in the absence of adequate storage facilities such as refrigerator. The average household income in the valley ranged between $2.23 and $6.68 per day. As a result, the preparation of decoction may cost up to 4% of the daily income, which is relatively high for people living under the poverty line. Hence, at times, subject to accessibility/availability of transport, going to a government-run primary health center (PHC) where treatment cost would be minimal ($0.04 per case paper) would be preferred over spending the estimated amount for preparing PGLD. However, compared to the cost, the time taken for preparing PGLD (40–60 minutes) seems to be a greater concern. Other problems encountered during the preparation such as smoke, irritation of the eyes, constant stirring to avoid spillage, and need for arranging the wood in the chulha every 5–10 minutes further contribute to this. Box. Reasons for Using and Not Using Psidium guajava Leaf Decoction (PGLD) Based on Interviews with Patients with Diarrhea Reasons for using PGLD Reasons for not using PGLD Presence of P. guajava trees in immediate vicinity Absence of P. guajava trees in immediate vicinity Impact of dissemination programs Taste of PGLD Word of mouth: encouragement by good experiences of others Lack of time Faith in alternative medicine and willingness to spread information Lack of faith in alternative medicines Anticipation of a faster cure Dependence on others for preparing the decoction Treatment expenses/limited household income Poor memory: failure to recollect the “recipe” for preparing the decoction Time spent on traveling to government-run primary health center (PHC) Problems encountered during preparation of the decoction including cost of fuel and time taken for its preparation Inaccessibility of PHC Accessibility of PHC View it in a separate window Our observations have shown that preparation and use of plant decoctions at the household level can have several limitations. The standard procedure mentioned in Ayurveda10 for decoction preparation requires that the plant material be boiled until the original volume is reduced to one fourth. Alternate methods such as cold infusion, heating at lower temperature (e.g., 60°C), or chewing of plant material may be considered. However, if these methods are to be employed, they need to be tested before they are advocated, since any change in the recommended method of preparation may alter its efficacy and/or toxicity profile. A single-dose formulation prepared from standardized plant material can also be considered, but problems related to its distribution/availability in PHCs (as in the case of allopathic drugs) may be rewitnessed.