CHAPTER II

REVIEW OF RELATED LITERATURE

RELATED LEGAL BASES

Alhassan AM, Ahmed QU. (2016) Averrhoa bilimbi Linn. is principally cultivated for medicinal
purposes in many tropical and subtropical countries of the world. Literature survey about this plant shows
that A. bilimbi is mainly used as a folk medicine in the treatment of diabetes mellitus, hypertension, and
as an antimicrobial agent. The prime objective of this review is to accumulate and organize literature
based on traditional claims and correlate those with current findings on the use of A. bilimbi in the
management of different ailments. Through interpreting already published scientific manuscripts (1995
through 2015) retrieved from the different scientific search engines, namely Medline, PubMed,
EMBASE, and Science Direct databases, published articles and reports covering traditional and scientific
literature related to A. bilimbi's potential role against various ailments have been thoroughly evaluated,
interpreted, and discussed. Several pharmacological studies have demonstrated the ability of this plant to
act as antidiabetic, antihypertensive, thrombolytic, antimicrobial, antioxidant, hepatoprotective, and
hypolipidemic agent. A. bilimbi holds great value in complementary and alternative medicine as
evidenced by the substantial amount of research on it. Therefore, we aimed to compile an up-to-date and
comprehensive review of A. bilimbi that covers its traditional and folk medicine uses, phytochemistry,
and pharmacology.

Hence, this paper presents an up-to-date and comprehensive review of the ethnomedicinal uses,
different chemical constituents, and pharmacological activities of A. bilimbi. So far, the biologically
active agents have not been isolated from this plant and this can be a good scientific study for the future
antidiabetic, antihypertensive, and antimicrobial implications. Hence, this review targets at emphasizing
the diverse traditional claims and pharmacological activities of A. bilimbi with respect to carrying out
more scientific studies to isolate active principles through advanced technology. The plant has been an
important source of medicine since antiquity. The oldest known record of the plant being used for a
therapeutic purpose is found in Egyptian medical papyrus written in the fourteen century. Since then,
preparations of plant materials in the form of decoction, infusion, powder, or paste have been used in
traditional medicine for prevention and treatment of different diseases and for improving the general
well-being. According to the World Health Organization (WHO), about 80% of people living in Africa
and Asia use traditional medicine to help meet some of their primary health-care needs. People in Europe,
Australia, and North America increasingly embrace the use of herbal medications to complement
orthodox medicine. In this regard, Averrrhoa bilimbi Linn. is one of the important medicinal plants of
many tropical and subtropical countries of the world which has been widely used in the traditional system
of medicines for the treatment of a variety of ailments, particularly as an antidiabetic, antihypertensive,
and antimicrobial agent. The key emphasis of this review article is to establish the utilitarian side and
medicinal characteristic of A. blimibi and turn that into a drug for future diabetic and hypertensive
patient's management. The methodology followed was to methodically collect, organize, and chart the
recent advances in the use of A. bilimbi in different chronic disorders. Data were retrieved from Medline,
PubMed, EMBASE, and Science Direct databases covering traditional and scientific literature related to
A. bilimbi's potential role for the treatment of various diseases that have been thoroughly evaluated and
discussed. Moreover, this review aims at highlighting the diverse traditional claims and pharmacological
activities of A. bilimbi.

RELATED LITERATURE

Astillo, Jessica. (2022). Bilimbi Fruit (Averrhoa bilimbi) Juice: Nutritional Analysis and
Microbial Analysis. International Journal of Environment, Agriculture and Biotechnology. Volume 7.
158-162. 10.22161/ijeab.76.18. Food's nutritional analysis guarantees that it contains the correct number
of vitamins and minerals while also allowing for a better understanding of the food's fat, carbohydrate
dilution, protein, fiber, sugar, etc. Identifying pathogens and food spoilage microorganisms is essential to
food microbiology because it ensures consumer safety, prevents brand desecration, and reduces the cost of
remediation after failed inspections or food poisoning outbreaks. This study's primary objective was to
determine the nutritional content and identify the hazardous microbes in the Bilimbi Fruit (Averrhoa
bilimbi) Juice. The study used an experimental methodology and underwent careful analysis to get
detailed results regarding the product. To ascertain the product's nutritional value, samples of the three
treatments-plain, grapes, and apple-were sent to the F.A.S.T. Laboratory. Analysis revealed that Bilimbi
Fruit (Averrhoa bilimbi) Juice contains Vitamins and minerals that benefit consumers; it includes Crude
Fiber, Calcium, Vitamin C, and phosphorus. The result is that each of the three treatments' nutritional
contents of "Bilimbi Fruit Juice" is within the recommended dietary requirement for Filipinos. Microbial
Analysis reveals no hazardous microbes and bacteria found in the products. Therefore, Bilimbi Fruit Juice
is an organic and nutritional juice safe for consumption and an excellent alternative to existing fruit juice
on the market.
 The anti-diarrhea effect of AA was associated with restoration of the gut microbiota and BA
metabolism-related homeostasis. The results of this study provide insights into the application of AA and
the treatment of diarrhea.

REVIEW OF RELATED STUDIES

Zhang, Dandan & Cheng, Hao & Zhang, Yuxi & Zhou, Yaochuan & Wu, Jing & Liu, Juan & Feng,
Wuwen & Peng, Cheng. (2023). Ameliorative effect of Aconite aqueous extract on diarrhea is associated
with modulation of the gut microbiota and bile acid metabolism. Frontiers in pharmacology. 14. 1189971.
10.3389/fphar.2023.1189971. Introduction: Aconite is a form of traditional Chinese medicine (TCM) that
has been widely used to treat diarrhea for thousands of years. However, it is not clear whether the
anti-diarrhea role of aconite aqueous extract (AA) is associated with regulation of the gut microbiota or
with bile acid (BA) metabolism. This study aimed to confirm whether AA exerts its anti-diarrhea effects
by regulating the gut microbiota and BA metabolism.

The therapeutic effect of AA in a mouse model of diarrhea was measured based on analysis of body
weight, fecal water content, diarrhea scores, intestinal propulsion rate, colonic pathology, and colonic
immunohistochemistry. In addition, 16S rRNA high-throughput sequencing was conducted to analyze the
effect of AA on the gut microbiota, and targeted metabolomics was employed to analyze the effect of AA
on metabolism of BAs.

The results showed that treatment with AA reduced fecal water content and diarrhea scores,
inhibited intestinal propulsion rate and pathological changes in the colon, and increased AQP3 and AQP4
content in the colon. In addition, AA was found to be capable of regulating the gut microbiota. Effects
included increasing its richness (according to the ACE and Chao1 indices); altering the gut microbiota
community structure (PCA, PCoA, and NMDS); increasing the relative abundance of
norank_f_Muribaculaceae, Ruminococcus, Lachnospiraceae_NK4A136_group,
Prevotellaceae_UCG-001, and norank_f_norank_o_Clostridia_UCG-014; and decreasing the relative
abundance of Escherichia-Shigella, unclassified_f_Ruminococcaceae, Ruminococcus_torques_group, and
Parasutterella. More importantly, AA significantly increased fecal TCA (a primary BA) and DCA, LCA,
GDCA, dehydro-LCA, and 12-keto-LCA (secondary BAs), thus restoring BA homeostasis. Moreover,
AA increased the ratios of DCA/CA, DCA/TCA, and LCA/CDCA and decreased the ratios of
TLCA/LCA, GLCA/LCA, and TUDCA/UDCA.
 CHAPTER 3
MATERIALS AND METHODS

This chapter presents the materials, equipment, and procedures that will be used and done to perform
the study. Moreover, this will highlight the data gathering procedure that will be utilized to do the
research.

General Procedure

Preparation of Materials and Equipment

The researchers will gather the raw material, Kamias and will utilize a blender machine to produce its
extract. Furthermore, antidiarrheal OTC drugs will be prepared by the researchers to conduct the study
and find the significance between the two treatments. Also, laboratory mice will be needed to perform the
study and test the effectiveness of the treatments. Lastly, the researchers will look for a laboratory that
will assist them in doing the study.

Procedures in Conducting the Antidiarrheal Test

The raw material, Kamias will be extracted and its juice will be filtered to remove residue. Three groups
of laboratory mice experiencing diarrhea will be observed for at least 1 to 2 days using different
treatments given every 12 hours. The first group will receive Kamias extract as treatment, the second one
will be induced by an antidiarrheal OTC drug, and the last one will remain untreated.

Data Gathering Procedure

For the Antidiarrheal Test, the effect on every group of lab mice in random hours passed by will be
recorded. The following quantitative data will be used to describe the effect of each treatment on the
diarrheal cases:
0 - No effect
1 - Slightly Recovered
2 - Moderately Recovered
3 - Completely Recovered
To analyze the data, the researchers will use the necessary statistical tools to answer the hypotheses.
 BIBLIOGRAPHY

● Alhassan, A. M., & Ahmed, Q. U. (2016). Averrhoa bilimbi Linn.: A review of its ethnomedicinal
uses, phytochemistry, and pharmacology. Journal of Pharmacy and Bioallied Sciences, 8(4), 265.
https://doi.org/10.4103/0975-7406.199342

● Diarrhea - NIDDK. (n.d.). National Institute of Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea#:~:text=Diarrhea%20is
%20loose%2C%20watery%20stools,than%20persistent%20or%20chronic%20diarrhea.

● Kamias / Averrhoa bilimbi / Cucumber Tree / Huang gua shu: Philippine Medicinal
Plants / Philippine Alternative Medicine. (n.d.). http://www.stuartxchange.org/Kamias

● MacGill, M. (2023, January 10). What you should know about diarrhea.
https://www.medicalnewstoday.com/articles/158634

● Philippine News Agency. (August 2022).Pangasinan acute gastro cases up 121%.

https://www.pna.gov.ph/articles/1182600

● Statista. (2023, January 16). Diarrhea case count in the Philippines 2009-2020.
https://www.statista.com/statistics/1120200/philippines-number-diarrhea-cases/

● Statista. (2023b, January 16). Number of deaths from diarrhea Philippines 2009-2020.
https://www.statista.com/statistics/1120210/philippines-number-death-from-diarrhea/