The research study is conducted to understand interaction of illness, symptoms, context, patients response and the clinical skill vis a vis better management of secretory diarrhea. Specific aim of this study is to determine the impact of intensive medical intervention with herbal drug “Dirasif” (Test) and allopathic drug “Furoxone” (Control) to treat secretory diarrhea. This is randomized controlled clinical trial in primary care with an open intervention. All patients judged by the physician to need either herbal or allopathic medicine for secretory diarrhea are randomized in treatment therapy. Clinical trial was conducted on hundred patients from both groups i.e.50 patient from control and 50 from experimental group having age between 12-40 year.Comparison of data recorded by participants relating to these variables showed significant differences between test and control groups (p &lt; 0.05) despite the fact that no side effects were recorded in test group. Overall clinical success was observed in both treatment groups however the efficacy of the test treated medication (Dirasif) was superior as p=0.03. Dirasif is more effective than the Furoxone in the treatment of secretory diarrhea in Gadap community Karachi, Pakistan.Keywords: Secretory diarrhea, efficacy, dirasif, furoxon

Ahmed, Khalil

Akhtar, Naveed

Akram, Muhammad

Asif, H.M.

Jabeen, Qaiser

Rehman, Riazur

Saeed, Tariq

Shah, S.M. Ali

Usmanghni, Khan

English

Advanced Research Journals

International Journal of Phytomedicine 2 (2010) 425-429 
http://www.arjournals.org/ijop.html 
 
Research article 
                                                            
ISSN: 0975-0185 
Herbal treatment of secretory diarrhea 
 
H.M. Asif1,2, Khan Usmanghni1, Muhammad Akram1, Naveed Akhtar2 , Qaiser Jabeen2, S.M. Ali 
Shah2*, Riazur Rehman2, Khalil Ahmed2, Tariq Saeed3
 
*Corresponding author: 
 
Syed Muhammad Ali Shah 
 
1Department of Basic 
Medical Sciences, Faculty of 
Eastern Medicine, Hamdard 
University. Karachi, Pakistan 
2Faculty of Pharmacy and 
Alternative Medicine, The 
Islamia University of 
Bahawalpur, Pakistan 
email: smalishah(at)hotmail.com 
3University College of 
Pharmacy, Punjab University 
Lahore, Pakistan 
 
 
 
 
 
 
 
 
 
 
Abstract 
 
The research study is conducted to understand interaction of illness, 
symptoms, context, patients response and the clinical skill vis a vis better 
management of secretory diarrhea. Specific aim of this study is to determine 
the impact of intensive medical intervention with herbal drug “Dirasif” (Test) 
and allopathic drug “Furoxone” (Control) to treat secretory diarrhea. This is 
randomized controlled clinical trial in primary care with an open intervention. 
All patients judged by the physician to need either herbal or allopathic 
medicine for secretory diarrhea are randomized in treatment therapy. Clinical 
trial was conducted on hundred patients from both groups i.e.50 patient from 
control and 50 from experimental group having age between 12-40 year. 
Comparison of data recorded by participants relating to these variables 
showed significant differences between test and control groups (p < 0.05) 
despite the fact that no side effects were recorded in test group. Overall 
clinical success was observed in both treatment groups however the efficacy 
of the test treated medication (Dirasif) was superior as p=0.03. Dirasif is 
more effective than the Furoxone in the treatment of secretory diarrhea in 
Gadap community Karachi, Pakistan.  
 
Keywords:  Secretory diarrhea, efficacy, dirasif, furoxone 
 
Introduction 
Diarrhea diseases are one of the leading causes of 
morbidity and mortality in developing countries. 
According to UNICEF, diarrhea kills some 1.5 
million children under the age of 5 year annually 
[1]. Infectious diseases contribute significant role 
in mortality and morbidity both to adult and child 
in Pakistan. Infection is the most common cause 
of secretory diarrhea in which there is increase in 
the active secretion, or inhibition of absorption. 
The most common cause of this type of diarrhea 
is a cholera toxin and E.coli those stimulate the 
secretion of anions, especially chloride ions. In  
 
secretory diarrhea stool osmotic gap is less than 
50 mOsm/kg. It is mediated by a cyclic adenosine  
monophosphate (cAMP) pathway best described 
in Vibrio cholerae enterotoxin [2, 3, 4, 5]. In 
chronic secretory diarrhea patients may present 
with large volumes of watery diarrhea. 
The clinical presentation and course of illness 
depend on the etiology of the diarrhea and on the 
host. 
Complementary and alternative medicine (CAM) 
is a group of diverse health care systems. There 
are many CAM therapies used to treat secretory 
diarrhea. It has been previously reported that 
Myrtus communis and Aegle marmelos have 
antidiarrheal effect and is commonly used for the doi:10.5138/ijpm.2010.0975.0185.02060 
©arjournals.org,  All  rights reserved. 
Asif et al. International Journal of Phytomedicine 2 (2010) 425-429 
 
 426
treatment of secretory diarrhea [5, 6]. Aegle 
marmelos was assessed for its antibacterial, 
antigiardial and antirotaviral activities. The effect 
of decoction of its fruit on adherence of 
enteropathogenic Escherichia coli and invasion of 
enteroinvasive E. coli and Shigella flexneri to 
HEp-2 cells were assessed as a measure of its 
effect on colonization. Major constituents are 
aegelin.,marmorosin, imperatorin. 
altoimperatorin, xanthotoxin, scopoletin and 
tembamide. It significantly reduced bacterial 
adherence and invasion of HEp-2 cells. Some 
previous observations confirm the modes of 
action safety of Aegle marmelos in infectious 
forms of diarrhoea [7]. Recent research on 
Myrtus communis has revealed a substance in the 
plant that has an antibiotic action against E. coli, 
streptococcus and Vibrio cholera etc [8]. The 
plant is taken internally in the treatment of 
urinary infections, digestive problems, vaginal 
discharge, bronchial congestion, sinusitis and dry 
coughs and infectious diarrheal diseases [9]. 
Myrtenol, myrtucommulone-A, 
myrtucommulone-B, semimyrtucommulone, 
limonene (23%), linalool (20%), pinene (14%), 
cineol (11%) are the major constituents found in 
fruit extraction of Myrtus communis. Punica  
granatum and Phyllanthus emblic have also been 
reported as having antidiarrheal, antidysenteric, 
antibiotic, antiseptic, aromatic, astringent 
properties [10]. 
 
Materials and Methods 
Study design 
The study was based on an experimental, 
randomized, clinical trial. The study has been 
conducted according to the principal of good 
clinical practice i.e. an informed consent was 
obtained from the patients before the enrollment 
then proper history and clinical examination was 
done. The study was carried out from 1st April 
2007 to 30th April 2009 
Patients and dosage form design 
Sample size estimated in clinical assessment on 
secretory diarrhea has been carried out based on 
general physical examination, general appearance 
of the patients, age, sex, and local examination of 
the abdomen in a pilot study at Shifa ul Mulk 
Memorial Hospital Karachi. Clinical trial was 
conducted on 100 patients. One hundred patients 
of secretory diarrhea from both groups (50 patient 
from control and 50 from experimental group) 
between the age of 12-40 years irrespective of 
socioeconomic status.  
The case group was presented herbal formulation 
Dirasif (500mg) which comprises of different 
herbal medicinal plants components such as 
Myrtus communis(150mg), Aegle 
marmelos(150mg), Punica  granatum(75mg), 
Phyllanthus emblica(75mg) and Berberis 
vulgaris(50mg).. The control groups are 
subjected to allopathic dosage form design 
Furoxone (500mg). 
 
Setting 
The therapeutic evaluations of these medicines 
were conducted after the diagnoses of secretory 
diarrhea on clinical and biochemical evaluation at 
Shifa-ul-Mulk Memorial Hospital, for Eastern 
Medicine, Hamdard University. The patients 
were registered from the general O.P.D. and 
hospitalized to the clinical Research ward of the 
Hospital. All the patients selected for the study, 
were thoroughly examined and clinical history 
was recorded. 
 
Sample selection 
The sample was selected from the out patient 
department registered and enrolled in Shifa ul 
Mulk Memorial Hospital and on the basis of stool 
D/R and inclusion and exclusion criteria the 
patient fulfilling the secretory diarrhea criteria as 
candidates were selected. The study period 
include was from 2007 to 2009. Among this 
population all the patient suffering from secretory 
diarrhea were interviewed immediately and upon 
their consent to participate they were grouped as 
test and control groups. 
Data collection 
Data collected for this research work included 
filling of clinical trial proforma through personal 
interview, personal observation and use of case 
record, file and documents. The designed clinical  
Asif et al. International Journal of Phytomedicine 2 (2010) 425-429 
 
Table 1: Improvement response in symptoms after 
treatment 
 
 
trial proforma specified the clinical feature and 
information to be filled by the physician for 
record and utilized in statistical assessment. 
 
Assessment 
Primary analysis was based on a stool D/R. Other 
important parameters include watery diarrhea, 
abdominal pain, tenesmus, dehydration, anorexia, 
nausea, vomiting, general weakness; irritability. 
The data was adjusted based on the number of 
cases in the light of demographic factor using 
statistical methods like multinomial logistic 
regression. The data was composed in separate 
groups. Statistical analysis were performed using 
SPSS and excel software, the Chi Square Test 
was determined. All differences were considered 
statistically significant by generating a ‘p-value’ 
from test statistics. The significant result with ‘p-
value’ less than 0.05 was considered as 
statistically significant. 
 
Patient characteristics 
There are no significant differences in the mean 
ages between the treatment groups at the start of 
clinical trial. The mean age of patients prescribed 
Dirasif as calculated was 27.41 and 26.10 years 
of males and females respectively. The mean age 
of patients prescribed Furoxone as calculated was 
26.60 and 28.45 years of males and females 
respectively  
 
 
0
20
40
60
80
100
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ot
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n
D
eh
yd
ra
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n
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se
a 
an
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Figure 1: Improvement Response in symptoms after 
treatment 
 
Results 
Dirasif was prescribed to 50 patients for the 
reduction of loose motion, 45 patients showed 
reduction in their loose motion but five patients 
did not respond. Fifty patients were treated with 
Furoxone. Loose motion of 37 patients out of 50 
reduced to normal. The reduction of loose motion 
and relief of abdominal pain, nausea and 
vomiting, dehydration, tenesmus general 
weakness and anorexia by both test and control 
drug is shown in Table 1 and Fig 1. 
Chi-square test was applied and “p” value was 
calculated for the purpose of comparison so as to 
obtain a statistical significant data. According to 
the statistical analysis a significant difference was 
observed between two treated groups (p<0.05) at 
the end of therapy. All differences that were 
equal to or more than the set cut-off values were 
considered clinically significant. The evaluation 
of treatment was significantly improved in the 
Dirasif (test group) compared with furoxone 
(control group) at the end of therapy. So it can be 
concluded that the efficacy of the Dirasif is 
highly significant and has long lasting effects 
 
Discussion 
Furoxone (Furazolidone) is commonly used in 
patient with secretory diarrhea but it exerts some 
side effects like headache, malaise, 
gastrointestinal intolerance and some allergic 
reactions etc. In order to overcome this problem, 
there is a great need to find new medicinal 
Treatment Group 
Complaints 
Test (n) Control (n) 
P value 
Loose motion 90% 74% 0.037 
Dehydration 87.5% 29.7% 0.00 
Nausea & vomiting 92.59% 33.33% 0.00 
Abdominal pain 100% 20% 0.00 
Tenesmus 94.87% 27.03% 0.00 
General weakness 100% 33.33% 0.05 
Anorexia 100% 20% 0.016 
 427
Asif et al. International Journal of Phytomedicine 2 (2010) 425-429 
 
agents, which have good efficacy and less 
adverse effects. The different medicinal herbs 
used in this study were selected on the basis of 
their traditional use in Unani system of medicine. 
The study was conducted for comparing the 
efficacy and safety of two different treatment 
modalities, coded herbal formulation Dirasif as 
test drug and allopathic treatment Furoxone as 
control drug for the treatment of secretory 
diarrhea. The collected data of 100 patients, the 
frequency of male patients were 60 while, 40 
were of female patients were enrolled into the 
study. These 100 patients have been selected at 
baseline after the adjustment made out of 125 
patients. The clinical assessment included loose 
motion, watery diarrhea, bloody diarrhea, nausea, 
vomiting, tenesmus, dehydration, abdominal 
pain, anorexia, general weakness, irritability, as 
well as physician and patient’s opinions on 
improvement. 
It has been previously reported that Myrtus 
communis and Aegle marmelos have antidiarrheal 
effect and is commonly used for the treatment of 
secretory diarrhea. So by taking advantage the 
coded herbal formulation Dirasif, contains a total 
five ingredients in which Myrtus communis, 
Aegle marmelos, Punica  granatum, Phyllanthus 
emblic and Berberis vulgaris  for the treatment of 
secretory diarrhea [7-10]. 
Basis improvement in the subjective signs and 
symptoms, clinical observations and pathological 
investigations at periodic intervals during the 
course of treatment were evaluated. Dirasif 5ml 
twice daily compared to Furoxone 5ml twice 
daily was prescribed on a total of 100 patients 
suffering from secretory diarrhea. Both 
preparations led to a decrease in the frequency of 
loose motion. Dirasif is more efficacious in 
reducing the frequency of loose motion than 
Furoxone. Reducing loose motion was due to 
antidiarrheal effect of Dirasif because Dirasif 
contain Myrtus communis and Aegle marmelos 
which acts as active ingredients and has 
antidiarrheal effect particularly against E. coli 
and V. cholera infection which are the major 
etiological factors. The effect of Aegle marmelos 
is on the adherence of enteropathogenic 
Escherichia coli and invasion of enteroinvasive 
E. coli and Shigella flexneri to HEp-2 cells. 
Mrytus communis have also been evaluated as an 
antibacterial and antidiarrheal plan. Other 
ingredients of Dirasif also have antidiarrheal and 
antibacteraial effect reducing the infection caused 
by E. coli and V. cholera. Tolerance of Dirasif 
was generally good and no serious side effects 
were observed. However further citations are 
required to observe the safety, toxicity and 
pharmacological actions of these medicinal plants 
 
Conclusion 
Dirasif is more effective than the Furoxone in the 
treatment of secretory diarrhea in Gadap 
community Karachi, Pakistan as determined by p 
value <0.03. Control drug showed lesser efficacy 
than the test drug in its compliance to treat 
secretory diarrhea. The control drug exhibited 
side effects like gastrointestinal intolerance, 
headache and malaise where the test drug did not 
show any untoward manifestation associated with 
the use of this medication and found acceptability 
by all treated patients. 
 
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