Concise Review: Herbal remedies for the treatment of nausea and vomiting

Mohsenzadeh et al. Biomedical Research and Therapy 2018, 5(5):2252-2259 Biomed. Res. Ther 2018, 5(5):2252-2259 2252


Introduction
Vomiting occurs when the contractions of stomach muscle walls cause a large amount of stomach contents to push upward and flow back into the esophagus, exiting through the mouth (or nose). Since the food is traveling upward, some of the foods and liquids will involuntarily flow back into the mouth [1][2][3]. Vomiting or spitting up food is very common among infants and not too worrying of an issue. However, vomiting can be dangerous if it causes loss of a lot of fluids, leading to dehydration in the baby [2][3][4]. If the baby vomits immediately after eating, it may reflect a more serious problem. Reflux occurs when the muscles between the esophagus and the stomach do not work properly and thus the contents of the stomach flow back into the pharynx [5]. Vomiting can be caused many various factors, including viral or bacterial infection, stomach infections, urinary tract infections, pneumonia, meningitis, strep throat, and even ear infections. Crying, toxic substances, and intestinal obstruction are also other factors which may cause vomiting [4,5].
In spite of significant progress in the prevention and treatment of nausea and vomiting, their effective management is still a major problem. It should be noted that severe vomiting can lead to development of many complications, such as dehydration, weight loss, fluidelectrolyte imbalance, anorexia, esophageal tears, weakness, wound dehiscence, fractures, prerenal azotemia, or decline in behavioral and mental status [6]. The adverse effects of vomiting can deteriorate the patient's self-care, physical and mental status, as well as functional abilities. This can increase the patient's anxiety and dissatisfaction with the hospital experience, which in turn can contribute to future anticipatory nausea [7].
Prevention and treatment of vomiting by safe remedies are, therefore, essential. Complementary therapies have been widely used worldwide; moreC than 80% of the world's population rely on complementary and alternative therapies for their health care [8][9][10]. Currently, people all over the world, especially in developing countries, pay attention to medicinal plants [11][12][13][14]. These plants have been shown to be reliable in the treatment of various diseases as well as in the preparation of new medicines [15,16]. The active ingredients of these herbal remedies (drugs) are being extensively investigated due to the popularity and acceptance of herbal remedies [14,17].
In this regard, medicinal plants have been mostly used in various traditional systems and have been in use for a long time [9,18]. Traditional knowledge on the use of medicinal plants have contributed to the development of antiemetic remedies. Since the prevalence of vomiting in infants and children is high, in this review, traditional medicine and phyto-medicine for vomiting are investigated; the study herein evaluates how herbal remedies affect vomiting in children.

Materials and Methods
In the current review, articles were indexed from certain databases, including ISI, PubMed, Scopus, Islamic World Science Citation Center, Scientific Information Database, and Magiran. They were retrieved by using the search terms 'vomiting', 'nausea', 'ulcer', 'medicinal plants', and 'traditional medicine'.   Zingiberaceae The root of Zingiber officinale is used to treat some of the stomach disorders, including vomiting. In fact, Z. officinale is one of the most effective natural herbal drugs for vomiting. Z. officinale contains phenols that relieve stomach muscles and their effects on the stomach tissue is similar to those of relaxants. Phenols also accelerate the movement of toxins and digestible foods in the digestive system and thus prevent nauseation [19].

Results
Mentha piperita soothes the stomach that has already been stimulated. M. piperita is also one of the most famous home remedies for vomiting, which quickly eliminates nausea and vomiting. Inhaling M. piperita aroma reduces nausea [20].

Cinnamomum verum (cinnamon)
Lauraceae Cinnamomum verum, with its extraordinary nature and pleasant aroma, reduces the feeling of nausea and vomiting. C. verum is the best choice to treat nausea especially when it has been caused by indigestion. For best use, its tea should be prepared [21] (www.naturestemple.net).

Rutaceae
To treat nausea and vomiting using Citrus limon, cut it into small pieces and leave them nearby for the aroma to take effect [22].

Matricaria chamomilla (chamomile)
Asteraceae Due to its immune nature, Matricaria chamomilla is widely used in many cultures as a mild sedative to treat stomach disorders. M. chamomilla is usually combined with other types of beneficial plants to prepare a good treatment for heartburn, stomach discomfort, vomiting, and nausea [23].

Foeniculum vulgare
Apiaceae Foeniculum vulgare contains large amounts of bioactive compounds that can help to relax digestive muscles, thus limiting problems such as bloating, nausea, and flatulence [26].

Apiaceae
Cuminum cyminum seeds and powder are useful to relieve nausea. C. cyminum is almost the most well-known treatment for vomiting and nausea among the main home remedies. Pour half a teaspoon of C. cyminum seeds in a glass of warm water, let it brew, and then smooth it. Finally, drink the resulting tea to prevent vomiting [27].

Myrtaceae
If you suffer from nausea while traveling, you can have a can of Eugenia caryophyllata flowers always with you, so when you get nausea, eat a little E. caryophyllata to get rid of nausea. Since it is difficult for children to use E. caryophyllata in this way, it is better not to do this for children (www.globalherbalsupplies.com).

Elettaria cardamomum
Zingiberaceae Elettaria cardamomum is from the Zingiberacea family, so this aromatic seed is one of the best home remedies for vomiting (The Useful Plants of India).

Apiaceae
To treat nausea, rub the seeds of Pimpinella anisum a little, or pour some of them into a cup of boiling water and drink the tea after it brewed for 10 minutes (www.globalherbalsupplies.com).

Apiaceae
Ferula assa-foetida can fight viruses and bacteria and thus reduce symptoms of diarrhea and vomiting, and it exert its effect fast. In addition, this spice helps digestion and stimulates the gastrointestinal tract. Add a teaspoon of F. assa-foetida powder to a glass of warm water and stir well. Take this mixture twice a day for a few days. To prevent diarrhea, vomiting, and other digestive problems, add a little F. assa-foetida to curry powder and everyday foods (www.globalherbalsupplies.com).

Lamiaceae
Ocimum basilicum, which has anti-spasmodic properties, is also a good drug for diarrhea and vomiting. It can make the stomach stronger and prevent many diseases of diarrhea and vomiting (www.globalherbalsupplies.com).

Musa sapientum
Musa sapientum, both ripe and raw, also helps in treating diarrhea and vomiting. The presence of amylase in M. sapientum helps to reduce the symptoms. M. sapientum also contains potassium and magnesium, two important electrolytes needed for the proper functioning of the digestive tract. In addition, M. sapientum is a sweet and desirable food that makes digestion easy [28].

Discussion
In this review article, medicinal plants used against vomiting are reported. Traditional knowledge of these plants can contribute to development of antiemetic remedies. Chronic nausea is usually multifactorial in origin. High intracranial pressure, dehydration, gastroduodenal ulcers, bowel obstruction, and metabolic abnormalities (including uremia, hyponatremia and hypercalcemia) can contribute to nausea and vomiting. Psychological parameters also can induce or exacerbate it [29]. Vomiting and nausea both are mediated and controlled through central nervous system, however, by different mechanisms. Vomiting is mediated through stimulation of a complex reflex which is coordinated through a putative true vomiting center; nausea, however, results from the stimulation of autonomic nervous system. The vomiting center usually receives afferent stimuli through various central neurologic pathways. For example, various sensory stimuli of psychological response (e.g. taste, smell, and pain) from the limbic system are able to stimulate the chemoreceptor trigger zone (CTZ) and cause vomiting. Motion sickness, however, occurs through impulses from the labyrinthine apparatus. Endogenous biochemical and exogenous substances which accumulate during irritation, ischemia and inflammation can stimulate spinal and vagal nerves to cause nausea and vomiting. Intestinal damage or irritation also cause substantial generation and release of serotonin by the enterochromaffin cells in the enteric nervous system of serotonin, which stimulates 5HT3 receptors and causes severe vomiting [30]. The central pathway is also stimulated by substance P, which in turn stimulates the neurokinin-1 receptors and the gastrointestinal vagal afferent nerve fibers. Several other receptors such as CB1 (canabinoid-1), H1 (histamine-1), D2 (dopamine-2), D3 (dopamine-3), M3 (muscarinic-3), M5 (muscarinic-5), and GABAB (gamma amino butyric acid-B) contribute to vomiting [30,31]. Thus, medicinal plants with antiemetic activities can act through various pathways. The mechanisms of action of these plants should be investigated; the modes of actions of only some of these plants have been studied so far.
Studies have also suggested the association of oxidative stress and clinical severity of vomiting and nausea [32]. This is an important issue in the use of medicinal plants as antiemetic agents. Plants, including the medicinal plants presented in this review article, mostly have antioxidant activity [33][34][35]. Antioxidants can scavenge the free radicals and return the imbalance between antioxidant activity and oxidative stress, which are induced by various diseases [13,36,37]. Therefore, each medicinal plant should be studied not only for their mode of action but also for their ability to reduce oxidative stress. Furthermore, each medicinal plant may have its own effects on a wide range of diseases [38][39][40][41]. Therefore, these herbal remedies may benefit the patient (adult or child) in treating emesis as well as other diseases. Moreover, the use of these herbal remedies would be associated with lower cost and greater safety than non-herbal remedies.

Conclusion
Although the mechanisms of action for some of these plants have been understood, there are many other plants (reviewed in this article) whereby the mechanism of action has not been elucidated. All the plants discussed in this article are beneficial against vomiting and nausea. However, future investigations are needed to explore the most effective of these medicinal plants for use in treating nausea/vomiting in the clinic.

Open Access
This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.