REVIEW OF RELATED LITERATURE

This chapter presents the related literature and studies about

the level of acceptability of the Euphorbia hirta (tawa-tawa) and
Carica (papaya) as syrup against dengue. The researchers read
previous related literature and studies that had significant
relatedness of the present study. This includes books,
unpublished studies and research materials available at hand.

EUPHORBIA HIRTA
Euphorbia hirta has been reported in several parts of the world
as an herbal remedy for febrile illnesses particularly dengue,
malaria, and typhoid fever. The aqueous extracts have been shown
to strongly reduce the release of prostaglandins I2, E2, and D210
and have antipyretic properties.11 Its antimalarial use has also
been documented in the Democratic Republic of Congo.12 Further
studies elucidated that the methanolic extracts of the plants
yielded ant plasmodium flavonolglycosides.13 Studies revealed the
widespread use of the plant for dengue.14,15,16 There are no
studies yet to show its effect on hemoglobin but it exerts an
inhibitory effect on platelet aggregation10 and significantly
reduces the plaque-forming capacity of the dengue virus serotypes
1 and 2.16 It is also used to treat sore eyes, cough, diabetes,
gastritis, and diarrhea as previously documented in the
Cordilleras15,16 and in other areas like India,17,18,19,20,21
Africa,22,23 Fiji,24 Cameroon,25 Spain,26 and Bangladesh.27 Its
use in diabetes is supported by the improvement in blood glucose
levels of albino mice with streptozocininduced diabetes after
treatment with its aqueous extracts.28 The antispasmodic effect
and decrease in gastrointestinal motility29 supports its use for
digestive disorders. The parts of the plant that are commonly
used are the leaves, roots, and stem. The route of administration
is either topical or oral. The methods of preparation include
crushing or macerating the leaves, squeezing to obtain the latex,
or boiling the leaves, stems, and/or roots depending on the
illness it is used for. There are no known contraindications for
its use and the only known side effect of this plant is increase
in urinary frequency or diuresis. (Johnson et al30) concluded
that it increases urine output in the same way as acetazolamide.

CARICA (PAPAYA)
Carica (papaya) leaves Papaya Leaf is a herbaceous tree with a
stem of spongy, soft wood that is hollow in the center and bears
melon-like fruit. It is an interesting tree, in that the male and
female parts exist in different trees, and trees may grow to a
height of twenty to thirty feet. The Papaya Tree needs a tropical
climate that is dry when cold and wet when warm; consequently,
its greatest success appears in the equatorial zone with its
warm, wet season and cool dry season. It is extremely sensitive
to frost, and water-logging will kill the taproot within forty-
eight hours. The Papaya is especially susceptible to Parasites,
pests and diseases. This fussy plant needs a lot of water but
must have good drainage, and it bears most fruit in light,
porous, slightly acidic soils that are rich in organic matter.
Said to be a native of the Caribbean and Central America, the
Papaya is the true papaw that now grows abundantly throughout
tropical America, Hawaii and many other tropical countries.
Although grown to some extent in south Florida, the true papaw is
not related to the North American papaw. The fruits, leaves and
latex are all used medicinally. The fruit is usually pear-sized
and has a central cavity filled with edible, pea-sized seed,
which are said to have a similar flavor as capers. Papaya Leaves
are cooked and considered a green vegetable and are a rich source
of gummy, milky, white latex that contains the powerful enzyme,
papain. This protein-dissolving substance is an excellent remedy
for stomach and digestive disorders. The leaf contains beta-
carotene, calcium, carpaine, fats, flavonols, niacin, papain,
tannins, and vitamin C (in higher concentration in the leaf than
in the fruit). The leaf, unlike the fruit, is not a source of the
protein-dissolving enzyme papain, but the latex (sap) in the leaf
stem is. Papain remains in leaf preparations that have been dried
over low heat, but it may be destroyed in products that are dried
at high heat. Papaya leaf is used in herbal medicine to remove
intestinal worms. Papaya leaf has less of the protein-dissolving
papain than the fruit, so it is less likely to “dissolve” the
worms, but it contains tannins that the fruit does not. These
tannins protect the intestine from reinfection by “tanning”
proteins in the lining of the intestinal wall so that worms
cannot attach themselves. The papaya plant is lactiferous as it
contains specialized cells known as lactifers that occur in most
tissues and secrete latex. Lactifiers secrete latex and are
dispersed throughout most plant tissues. The papaya-latex is well
known for being a rich source of the four cysteine endopeptidases
namely papain, chymopapain, glycylendopeptidase and caricain.
Leaves contain an alkaloid called carpaine and a glucoside named
carposide. Different parts of the papaya plants including fruit,
dried fruit, leaves, dried leaves, stems, seeds and roots have
long been used as ingredients in alternative medicine. For
instance, the seeds are used for expelling worms and roots and
seeds are used as an abortifacient agent. The leaves (especially
fallen ones) are used variously for the treatment of fevers,
pyrexia, diabetes, gonorrhea, syphilis, inflammation and as a
dressing for septic wounds. Untested herbal medicines could be
potentially injurious to human health. Many plants used in
traditional and folk medicines are potentially toxic, mutagenic,
and carcinogenic. Toxicological studies of extracts from
different parts of C. papaya plants such as seeds, fruit, roots
and leaves have been carried out using several animal models.
Acute and chronic toxicities of unripe fruit of the C. papaya
have been documented. Some of the traditional claims of efficacy
that have been investigated scientifically using animal models
and their efficacy have been proven. Recent studies showed that
C. papaya leaf extract has potential anti-sickling (inhibition of
sickle cell formation) properties. (Indran et al.) have shown
that there is a protective effect against gastric ulcers in rats.
Moreover, C. papaya flowers are known to have antibacterial
activities. The contraceptive efficacy of the seeds of C. papaya
has been earlier demonstrated in rats, mice and rabbits. Oral
administration of C. papaya seed extract could induce reversible
male infertility and could be used for pharmaceutical development
of a male contraceptive. Today, many tropical and subtropical
countries are engulfed by dengue infection which is caused by
viruses belonging to the Flaviviridae family. There is no
specific therapy for dengue even though the infection has a
significant mortality. Sri Lanka is no exception where; dengue
infection is a priority for the national health services for
prevention and reducing mortality. In desperation, many people
have resorted to use papaya leaf extract covertly. This is
applicable even to hospitalized dengue patients. However,
recommending C. papaya leaf extract for dengue infection is
unethical until it is proven by scientific research. Therefore,
in the present study, we have investigated the effects of oral
intake of pure extract of C. papaya leaves on
hematological/biochemical parameters and toxicological changes in
the murine model.