Sabah Snake Grass




Sabah Snake Grass
Clinacanthus nutans (Burm.f.) Lindau


Synonyms 
Justicia nutans Burm.f., Fl. Ind. (1768) 10, t. 5, f. 1; Justicia fulgida Blume, Bijdr. (1826); Clinacanthus burmanni Nees in DC., Prodr. 11 (1847) 511; Clinacanthus siamensis Bremek.

Vernacular Names:
Malaysia:
Belalai Gajah
Indonesia:
Ki tajam (Sunda); Dandang gendis (Java); Gendis (Central Java)
Thailand: 
Saled pangpon tua mea (Saliva of the female mongoose) 

General Information
Description
Herbs, tall, erect, sometimes rambling shrubs. Stems cylindric, yellow when dry, densely striate, subglabrous. Petiole 5--7 cm or more; leaf blade lanceolate to ovate-lanceolate, 5--11 X 1--4 cm, papery, secondary veins 5 or 6 on each side of midvein and convex on both surface when dry, base oblique, margin subentries, apex caudate-acuminate. Inflorescences ca. 1.5 cm, glandular; bracts linear, ca. 8 mm, apex acute. Calyx segments ca. 8 mm, apex acuminate. Corolla dark red, 4 or 6 cm, pubescent. Stamens and pistil glabrous. Capsule not seen. 

Plant Part Used
Whole plants
Chemical Constituents
No documentation.

Traditional Use :
Clinacanthus nutans is a well known anti-snake venom amongst the traditional healers of Thailand. The mechanism of action of this plant is believed to be attributed to its anti-cell lysis property rather than as an anti-neuromuscular transmission blocker. They also use the plant to treat scorpion bites and nettle rash. In China the whole plant is used in various manner to treat inflammatory conditions like haematoma, contusion, strains and sprains of injuries and rheumatism.

Gastrointestinal Diseases :
Indonesian and Thai traditional healers make use of Clinacanthus nutans to treat dysentery. The Indonesians take a handful of the the fresh leaves, boiled them in 5 glasses of water until the water level recedes to about 3 glasses and the decoction is given in a dose of 1 glass each time.

Other uses :
In Indonesia the plant is used to treat diabetes by boiling 7 – 21 fresh leaves in 2 glasses of water until the water level recedes to 1 glass and this is given twice daily. Dysuria is treated by taking 15 g of fresh leaves and boiling them for 15 minutes. The decoction is consumed once daily.

Thai traditional healers make use of the plant to treat fever. Chinese healers on the other hand consider the plant as effective in regulating mentrual function, relieving pain, anaemia, jaundice and setting of fractured bones.

Pre-Clinical Data Pharmacology

  • Antiviral activity:
In Thailand the leaves of C. nutans had been used by traditional healers to treat herpes infections. Jayavasu et al did a study to compare the ability of C. nutans leaves to inactivate herpes simplex virus type-2 (HSV-2) against that of acyclovir. They found that the extracts of the leaves of C. nutans was able to inhibit plaque formation by HSV-2 in baby hamster kidney cell line. However, the study done by Yoosook et al on the anti HSV-2 stains against oragnic solvent extracts of C. nutans did not show any anti-HSV-2 viral activity. This contradictory results may be attributed to differing laboratory factors and plant material as clinical trial done on the extracts of C. nutans did show significant antiviral properties.

With the recent outbreak of Influenza A (H1N1) globally, Wirotesangthong studied the effectiveness of Clinacanthus siamensis leaf extract on influenza virus infection. They studied its effects against the following viruses: influenza virus A/New Caledonia/20/99 (H1N1), mouse-adapted influenza virus A/Guizhou/54/89 (A/G)(H3N2) and mouse-adapted influenza virus B/Ibaraki/2/85 (B/I) were used in the NA inhibition assay, and mouse-adapted influenza viruses A/PR/8/34 (H1N1), A/G and B/I were used in the in vitro antiviral assay. They found that the extract was superior in its ability to protect the mouse against influenza virus infection as compared to oseltamivir. 


  • Immune response activity:
C. nutans had been used traditionally to treat inflammatory conditions whether infective or non-infective. Sriwanthana et al looked for the activity of this plant extract on the immune system. They found that it was able to increase lymphocyte proliferation significantly and reduce the activity of natural killer cells (NK Cells). They also found the IL-2 release was suppressed while IL-4 was increased. This shows that the Cell-mediated Immune Response (CMIR) activity of C. nutans extract was partially due to the release of IL-4 from the peripheal blood mononuclear cells. 


  • Anti-inflammatory activity:
Panthong et al found the extracts of the leaves of C. nutans to possess a strong anti-inflammatory activity corroborating further its extensive used as an anti-inflammatory medicine. This effect they said was partly due to its ability to inhibit the neutrophil responsiveness as evidenced by the significant inhibtiion of myeloperoxidase (MPO) activity. 


  • Antivenom activity:
C. nutans is a plant used extensively by traditional healers of southern Thailand and North-western Malaysia as a remedy for envenomation be it snakes or venomous insects like scorpions and bees effectively. The methods of using it is yet to be documented. Cherdchu et al did not find any antivenin activity. What they test against was its ability to neutralise the inhibitory effects of neurotoxins of Naja naja siamensis on neuromuscular transmission. However, there are other components in the venom of the snake upon which the plant could neutralise as reported by Watson in Botanical Medicine in Clinical practice where he cited the possiblity of anti-cell lysis as an explanation.


  • Antioxidant activity:
The role of free radicals in the pathophysiology of diseases has been very well established. Today many researchers are looking into plants as a source of antioxidants. Amongst the subject of study is C. nutans. Pannangpetch et al looked into the antioxidant properties of ethanolic extract of the leaves of C. nutans. They found that this extract had an antioxidant activity and protective effect against free radical-induced haemolysis. This is evidenced by the fact that it could scavange DPPH with a maximum scavenging activity of 67.65±6.59% and with IC50 of 110.4±6.59 μg/ml; the FRAP value was 17 mg ascorbate equivalent to one gram of the extract. The extract demonstrated a significant inhibition of peroxide production in rat macrophages stimulated by phorbol myristate acetate (PMA) and protected red blood cell against AAPH-induced hemolysis with an IC50 of 359.38±14.02 mg/ml.
Toxicities
No documentation
Clinical Data
Clinical Trials
Antivaricella-zoster virus infection
A randomised, placebo-controlled trial of efficacy of topical formulation of Clinacanthus nutans extract was done on 51 patients with varicella-zoster virus infection. The results obtained showed that lesion crusting occurs within 3 days of application and healing within 7 days. The medication was applied 5 times per day for 7 – 14 days until lesion healed. Pain scores were also reduced significantly. No side effects were observed during the course of treatment.

Treatment of Recurrent Aphthous ulcer
Timpawat and Vajrabhaya did a double blind controlled trial to evaluate the efficacy of Clinacanthus nutans Lindau in orabase in the treatment of recurrent aphthous stomatitis. Forty three (43) patients were recruited for this trial and the efficacy was tested against triamcinolone acetonide in orabase and placebo. They found that Clinacanthus nutans Lindau in orabase provide better healing of the ulcer as compared to placebo but was less so when compared to triamcinolone acetonide in orabase. 

Adverse Effects in Human:
No documentation

Use in Certain Conditions
Pregnancy / Breastfeeding
No documentation

Age Limitations
Neonates / Adolescents
No documentation
Geriatrics
No documentation

Chronic Disease Conditions
No documentation
Interactions 
Interactions with drugs
No documentation
Interactions with Other Herbs / Herbal Constituents
No documentation
Contraindications
No documentation
Case Reports
No documentation


References


1.   R. Watson, Ronald R. Watson, Victor R. Preedy Botanical Medicine in Clinical Practice 

      CAB  International   Cambridge 2008 pg. 819.

2.   Andrea Pieroni, Ina Vandebroek Traveling cultures and plants: the ethnobiology and 
      ethnopharmacy of migrations Berghahn Books New York 2007 pg. 112.
3.   Flora of China ACANTHACEAE 
      http://flora.huh.harvard.edu/china/mss/volume19/Acanthaceae-CASminus_Strobilanthes_
      edited.html. [Accessed on: 21st January 2010]
4.   H. Arief Hariana Tumbuhan Obat dan Khasiatnya 2 Penebar Swadaya Jakarta 2008 pg. 56.
5.   Chuinradee Jayavasu; Thaweephol Dechatiwongse; Kroavon Balachandra Virucidal activity 
      of Clinacanthus nutans Lindau extracts against herpes simplex virus type-2:In vitro study
      Bulletin of the Department of Medical Sciences (Thailand); Warasan Krom Witthayasat 
      Kanphaet Oct-Dec 1992 v. 34(4) p. 153-158.
6.   Yoosook C, Panpisutchai Y, Chaichana S, Santisuk T, Reutrakul V. Evaluation of anti-HSV
      -2 activities of Barleria lupulina and Clinacanthus nutans. J Ethnopharmacol.1999 Nov 1;
      67(2):179-87.
7.   Mali Wirotesangthong, Takayuki Nagai, Haruki Yamada, Surattana Amnuoypol and 
      Chutichot Mungmee Effects of Clinacanthus siamensis leaf extract on influenza virus 
      infection Microbiol Immunol 2009; 53: 66–74.
8.   Busarawan Sriwanthana, Pranee Chavalittumrong,Laor Chompuk Effect of Clinacanthus
      nutans on Human Cell-mediated Immune Response in vitro. Thai J. Pharm. Sci., 
      1996 Vol 20(4):261-267.
9.   Wanikiat P, Panthong A, Sujayanon P, Yoosook C, Rossi AG, Reutrakul V. The anti-
      inflammatory effects and the inhibition of neutrophil responsiveness by Barleria lupulina
      and Clinacanthus nutans extracts. J Ethnopharmacol. 2008 Mar 5;116(2):234-44.
10.  Cherdchu C, Poopyruchpong N, Adchariyasucha R, Ratanabanangkoon K. The absence 
       of antagonism between extracts of Clinacanthus nutans Burm. and Naja naja siamensis 
       venom. Southeast Asian J Trop Med Public Health. 1977 Jun;8(2):249-54.
11.  Patchareewan Pannangpetch, Pisamai Laupattarakasem, Veerapol Kukongviriyapan, Upa 
       Kukongviriyapan, Bunkerd Kongyingyoes and Chantana Aromdee Antioxidant activity 
       and protective effect against oxidative hemolysis of Clinacanthus nutan (Burm.f) Lindau
       Songklanakarin J. Sci. Technol., March 2007, 29(Suppl. 1) : 1-9.
12.  Sangkitporn S, Chaiwat S, Balachandra K, Na-Ayudhaya TD, Bunjob M, Jayavasu C.  
       Treatment of herpes zoster with Clinacanthus nutans (bi phaya yaw) extract. J Med 
       Assoc Thai. 1995 Nov;78(11):624-7.
13.  Siriporn Timpawat, La-ongthong Vajrabhaya. Clinical evaluation of clinacanthus nutans 
       lindau in orabase in the treatment of recurrent aphthous stomatitis Mahidol Dental 
       Journal Vol 14(1): 10 – 16



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