Sunday April 13, 2014
BY TAN
SHIOW CHIN
DENGUE
fever is a problem that just does not seem to want to go away in Malaysia. And
even worse, it seems to be escalating.
The latest
report from the Health Ministry states that as of March 22, both the number of
cases and deaths nationwide for the year have increased by 314% compared to the
same period last year.
The number
of dengue cases in the latest report totalled 23,633, while the number of
deaths was 58.
The
problem is not just limited to Malaysia, although we are considered an endemic
dengue hotspot.
The World
Health Organisation (WHO) estimates there may be 50-100 million dengue
infections globally every year, with two-fifths of the world population, or 2.5
billion people, at risk of this mosquito-borne infectious disease.
While
being infected with dengue is an unpleasant experience – it is also known as
breakbone fever – with typical symptoms being fever, headache, rashes, and
muscle and joint pains, a healthy person’s immune system usually has no
problems fighting the virus off.
The
problem comes when dengue haemorrhagic fever develops.
This
extreme form of the illness causes severe bleeding due to “leaky” blood vessels
and delay in blood-clotting caused by low levels of platelets, which are
essential in forming blood clots.
According
to the WHO, an average of about 2.5% of those who develop dengue haemorrhagic
fever die.
This
number can exceed 20% in cases with no proper treatment, while the risk of
death in those who receive the proper supportive treatment is less than 1%.
There is
no cure for dengue, nor is there any vaccine for it, although there are several
research teams currently working on one.
The main
method of controlling this disease is via prevention; for example, ensuring
that there is no stagnant water or any container where water can pool in
around, fogging, using mosquito nets and repellent, and covering up or staying
indoors at dawn and dusk when the Aedes mosquitoes are most active.
Medical
management of dengue is purely supportive, with maintenance of the body’s fluid
balance being the key objective, whether via oral rehydration therapy,
intravenous fluid replacement, or in the worst-case scenario, blood
transfusion.
With no
definitive treatment from modern medicine available, it is not surprising that
many have turned to alternative therapies for relief.
Papaya leaf juice
This is
probably the most well-known alternative treatment for dengue.
Several
small scientific studies have been carried out in dengue-endemic countries like
India and Malaysia, looking into the efficacy of this herbal remedy.
While the
results cannot be said to be definitive, due to their small study size, they
are certainly promising.
The main
effect of this juice lies in raising the level of platelets in dengue patients
– a critical aspect of this viral infection.
One study,
conducted by the Institute for Medical Research and Hospital Tengku Ampuan
Rahimah, Klang, Selangor, reported that patients given papaya leaf juice showed
a significant rise in their platelet levels 40 hours after first receiving the
juice, compared to patients in the control group who were only on standard
supportive therapy.
The
open-label randomised controlled trial, published in Evidence-Based
Complementary and Alternative Medicine last year, had a total of 228
participants recruited from the hospital’s dengue ward, divided almost equally
between the control group and the juice group.
The
patients in the juice group took the pure fresh juice extracted from 50gm of
clean papaya leaves of the sekaki variety once daily for three consecutive
days.
Pharmacist
and holistic medicine practitioner Datuk Dr Rajen M adds that a blend of raw
young papaya and papaya leaves made into a juice, taken two to three times a
day, is one of the alternative therapies for dengue in Ayurvedic medicine.
He notes
that consuming papaya in general is safe, and taking it does not contradict
medical advice.
Tawa-tawa
This hairy
herb is commonly used in the Philippines as an alternative treatment for dengue
fever.
Also known
as gatas-gatas or by its scientific name Euphorbia hirta, it is said to increase
the platelet levels in dengue patients.
A 2012
animal study conducted by pharmacy students from the University of Santo Tomas,
Manila, showed that a decoction of tawa-tawa did indeed increase platelet
levels and decrease bleeding time in rats with induced thrombocytopenia (i.e.
an abnormally low platelet level).
The
Philippine’s Department of Science and Technology is currently researching the
effect of this plant on dengue fever, and have stated their concern over
possible toxicity resulting from overdosing on tawa-tawa.
Meanwhile,
Philippine Star columnist Dr Willie T Ong said in a 2009 article that Filipino
doctors in general allow dengue patients to take tawa-tawa as long as they
clear it with them first.
He also
explained how to prepare the herb: “Take five whole tawa-tawa plants. Cut off the
roots, then wash and clean.
“Boil
tawa-tawa in a pot of clean water. Pour the liquid and then let cool. Sip one
glass three to four times a day.”
Traditional Chinese medicine
Inti
International University Center for Traditional Chinese Medicine director and
head of the traditional Chinese medicine (TCM) programme Dr Yong Kian Fui says
that there is no cure for dengue fever in TCM either, and treatment is usually
supportive based on the stage of the disease.
The
acupuncturist and Chinese physician notes that because of the vague symptoms of
dengue fever, most people are only diagnosed with the disease about four days
after their fever starts.
TCM
therapy at that stage consists of a herbal concoction based on the formulation
called qin wen bai tu san.
“This
helps to clear the plaque and detox the body,” he says.
Patients
have to take one dose daily for three days. If their platelet levels are still
low by the end of that period, Dr Yong says they would be referred to the
hospital for further management.
He adds
that he personally also prescribes a bitter gourd and meat soup, which should
be double-boiled for two hours.
While the
meat can be from any animal, including fish, it is crucial that the seeds in
the bitter gourd must be included in the soup.
“According
to TCM theory, bitter gourd is used to clear ‘fire’ and to detox the body.
“The meat
neutralises the bitter gourd, so that it doesn’t become too ‘cooling’.”
Ayuverdic medicine
Dr Rajen
explains that there are four ways to treat dengue patients according to
Ayuverdic medicine.
Two
methods are targeted at boosting the patient’s blood production and providing
an antiviral effect: the papaya fruit and leaf juice mix mentioned earlier, and
juice made from pegaga leaves, also known as India pennywort or Centella
asiatica.
According
to Dr Rajen, one dose of the pegaga juice is the amount obtained from juicing
one handful of leaves.
The other
two treatments are mainly applied for their general antiviral properties.
One is cow
or goat colostrum, which can be drunk as often as desired. Colostrum is the
first secretion from the animal’s mammary glands before the milk comes out.
The other
is turmeric, which can be added to the patient’s food or milk.
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