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Home , Cerbera manghas, Ciguatera fish poisoning, Maitotoxin

Journal of Etlinopharniacology, 36 (1992) 163-174 163 Elsevier Scientific Publishers Ireland Ltd.

Traditional remedies used in the Western Pacific for the treatment of ciguatera

G. Bourdy”, P. Cabalionb, P. Amadea and D. Laurenta

‘Laboratoire de Pharmacologie, Centre ORSTOM, B.P. A5, Nouinia (New Caledonia) and b9, rue Suètone, 67200 Strasbourg (France)

(Received June 23, 1991; accepted January 27, 1992)

Ciguatera is a specific type of food poisoning associated with the ingestion of tropical fish, which, although normally safe for con- sumption, may at times contain high amounts of , as well as other chemically related . Widespread in tropical regions where coral reefs are present, constitutes a major hindrance for local fishing industries, local economies and foreign trade. Because no symptomatic treatment has been totally satisfactory, folk remedies remain of great interest. In this paper, a list of used in treating ciguatera poisoning in the Western Pacific region is presented; with emphasis on species whose exact utilization (part of used, preparation, dosage) has been determined.

Key words: traditional remedies; ciguatera poisoning; Western Pacific

Introduction viscera of herbivorous and bottom-feeding fish (Yokoyama et al., 1988). The ciguatera toxins are produced by the ben- Symptoms of poisoning appear 2-30 h after in- thic Garnbierdiscus toxicus (Bagnis gestion of toxic fish. Early signs include numbness, et al., 1980). This single-celled is in- a prickling sensation in the lips, tongue and throat, gested by herbivorous ‘fish along with the general weakness and . These symptoms macrophytic algae on which it grows. The toxins soon give way to digestive (cramps, abdominal are then passed up the until they reach pains, and profuse ) and neuro- sufficient concentration to provoke a type of logical disorders: itching (pruritus), articular pains human poisoning known as ichthyosarcotoxism. and asthenia. In severe cases, cardiovascular and This condition is difficult to prevent, since tainted respiratory symptoms may also occur. fish cannot be identified by,appearance, odor or The severity of the symptoms varies according taste. All largc species of fish associated with coral to the amount of ingested (based on the fish reefs can be toxic, particularly those at the upper size and the part of the fish consumed) and in- end of the food chain (barracudas, , sea dividual susceptibility. , moray eels, sharks, etc). In most cases of ciguatera fish poisoning, com- Several ‘ciguateric’ toxins, some not yet iden- plete recovery may be expected, but exceptionally tified, are involved in the etiology of ciguatera fish severe poisoning can lead to paralysis, coma and poisoning. The two major toxins are ciguatoxin death. (CTX) and (MTX) (Ohizumi, 1987). The chemical structure of ciguatoxin has recently Mode of action of ciguatoxin been determined (Murata et al., 1989). It is one of CTX modifies cell membrane permeability to the most potent marine toxins with a 50% lethal sodium ions: it opens Na+ channels in the nerves dose (LD,,) in mice of 0.45 pg/kg when injected of intact mammals, leading to an influx of intra- intraperitoneally (i.p.) and cannot be destroyed by cellular sodium and depolarization of the nerve or freezing. Maitotoxin, which can be fibre (Capra and Cameron, 1985). biosynthesized in cultures of tox- Studies by Bidard et al. (1984) and Lombet et al. icus (Yasumoto et al., 1987), is particularly toxic (1987) have further clarified CTXs mode of action: (LD50 = 0.13 pg/kg, i.p.) and is found only in the it acts at sites of -sensitive Correspondence to: G. Bourdy, Laboratoire de Pharmacologie, sodium channels. The activation of these sites Centre ORSTOM, B.P. A5, Nouméa, New Caledonia. leads to the opening of fast sodium channels. ,, QRSTOM Fonds DoWWntai[@. 164

Ciguatoxin and (toxin implicated in preparations appear to have effective therapeutic neurotoxic poisoning) share the same site properties. of action, which has been shown to be distinct Folk remedies, therefore, remain of great in- from that used by other toxins acting on fast terest. In many places, there are no clinics close to sodium channels (tetrodotoxin, , vera- villages and people must treat themselves with tridine, , , grayanotoxin, their own time-honoured recipes. It is these type of and sea anemone toxins, pyrethroids and treatments which we have attempted to document. DDT). Membrane depolarization resulting from the Methodology influx of sodium brings about an opening of calcium channels and therefore an influx of Ca2+, The ethnobotanical data was gathered over a which in turn activates the release of sympathetic period of 18 years (1980-1990) by way of general noradrenaline and parasympathetic (acetylchol- ethnopharmpcological surveys conducted on the ine) transmitters. various islands in the Vanuatu archipelago (G. Disorders observed after ingestion of CTX, Bourdy, A. Walter and P. Cabalion) and in New therefore, result from an intermingling of adren- Caledonia (D. Bourret, P. Amade and D. ergic and cholinergic effects of variable intensity. Laurent). People from all walks of life were invited to contribute their recipes for remedies used to e1 Treatment prevent or treat ciguatera fish poisoning. In this In most cases, ciguatera fish poisoning has no way, some recipes came from ordinary men and ‘i lasting effect. When the condition is identified, women, whereas others were volunteered by tradi- however, patients are advised to avoid ingestion of tional doctors or by specialists. Specimens of the fish or other as well as alcoholic bever- plant species listed below were collected with the ages, nuts and grains, since these can aggravate help of these informants. Wherever possible, four symptoms or slow down recovery. specimens of each species were prepared and sent Up to now, treatment for ciguatera poisoning to each of the following institutions: National has consisted of methods aimed at reducing symp- Museum of Natural History (Paris, France), the toms: stomach pumping and early administration ORSTOM Herbarium (Nouméa, New Caledonia), of apomorphine. Subsequent treatment depends the Kew Gardens Herbarium (Surrey, England) on the severity of each case and may include an- and the National Collection (Port Vila, Vanuatu). tispasmodics and antiemetics, for digestive dis- All identifications were confirmed by specialists. orders and vitamins BI, Bg, BI, complex, col- chicine, acetylsalicylic acid and calcium gluconate Results injections, for neurological symptoms. Pruritus is treated with synthetic antihistamines. The results of the 10-year survey are sum- In severe cases, cardiovascular stimulants are ad- marized in Table 1. In this table, we have indicated ministered to counter shock or collapse. the plants’ species and family names and their Alongside this approach of treatment, recent ad- common French names, as well as their Herbarium vances in knowledge of CTXs mode of action have reference numbers, whenever these could be ob- led to treatments using various antagonists. tained. Plants used to treat ciguatera fish - Among the most promising are atropine-type ing are clearly indicated and distinguished from substances, which counteract the effects associated those used to treat other types of fish poisoning. with acetylcholine secretion. Such substances in- The mode of preparation and the dosage, if clude and (contact anesthetics known, are also indicated. with membrane stabilizing action which act as Some of the information gathered here has al- competitive antagonists with the sodium ion), ready been’published; when this is the case, the phentolamine (an alpha-blocking substance) and source reference is given in parentheses. If the calcium gluconate (Legrand et al., 1985; Lange et source of data is our own observations, this is in- al., 1988). Clinical tests using intravenous man- dicated by an asterisk. nitol have also been conducted with promising In addition to methods used to treat ciguatera results (Palafox et al., 1988). fish poisoning in Vanuatu and New Caledonia, No symptomatic treatment has been totally those used in other Pacific countries (French satisfactory and many people continue to resort to , Guam, Samoa, Tonga, Fiji) were also healers and traditional medicines. Some of these considered. TABLE 1.

PLANTS USED FOR THE TREATMENT OF CIGUATERA FISH POISONING

Species (Family) Isea Plant part Preparation, dosage (References) Frequency IOther usesC(References) French name used in New used Caledonia :*) = Data derived from field observations and English common name interviews observations and interviews Herbarium number

Achyranthes aspera L. 'iguatera Whole plant Decoction (Rageau, 1973) N.C. (Rageau, 1973)' "Queue de rat" GB507 'iguatera Root Macerate in a bottle of water (3) Antispasmodic (Rageau, 1973); relief Drink one bottle a day until recovery is complete (*) N.C. of dysenteric symptoms (*) Van.

Aglaia elaeagnoidea liguatera Used in mixture with the following : (1) (Jussieu) Bentham Maesa ambrymensis, Erythrina variegata,Metrosideros collina Van. (MELIACEAE) var. villosa, Pandanus sp., Terminalia catappa, Dysoxylum "Bois rose" iijugum, Dysoxylum gaudichaudianum (Cabalion 1984e) PC1462

Aglaia saltatorum liguatera Stem fie stem is scraped and squeezed into water in the preparation (1) A.C. Smith If a remedy for fish poisoning (Weiner, 1985) Fiji W=IACEAE) Argusia argentea liguatera Leaf 3ne laige leaf in an infusion or decoction. Use internally and (3) Muscle pain relief; antirheumatic &.f.) Heine aternally (baths) (Bourret, 1981)(*) N.C. (Rageau, 1983); antipruritic (Geremie, (BORAGINACEM) Van. 1988; Rageau, 1973); depurative "Faux tabac" Pol. @&d, 1986) PC2282 'ish poisoning Leaf Leaf infusion is taken as an antidote for poisoning caused by Tonga Antipruritic (Bourret, 1981) :ating tainted fish (Whistler, 1991)

liguatera Stembark Boil a piece of the stembark the size of the palm of the hand in a litre of water for 10 minutes (Bourret, 1981; Cabalion, 1984b; Wtard, 1986)(*)

liguatera Root (Rageau, 1983) (1) N.C. TABLE 1 (continued) Artocarpus altilis 3guatera xaf bud and Chew and swallow from one to five fresh leaf buds ;then (3) ln infusion of the leaf ashes, rubbed (Parkinson) Fosberg atex drink one small glaSsful'of fresh latex. Repeat one to three Fiji )n skin rashes (Whistler, 1985) (MORACEAE) times per day, until recovery is complete (Bourret, 1981) Kir. "Arbre h pain" This potion is made from the fresh leafbuds together with N.C. "Bmdhit" coconut oil (Lobel, 1979) Fluidpressed from the shoots (Weiner, 1985) lashes (Whistler, 1985)

3guatera 3alk (Rageau, 1973) (2) ;or facial rashes (Whistler, 1991) N.C.

Barringtonia ariatica 3guatera jtembark Infusion (Haddock, 1973) (2) (L.) Km Guam (LECY THIDACEAE) :ish poisoning(a) itembark The bark of the tree is boiled into a strong tea that is taken intemally (McMakin and Moore, 1977)

Canavalia rosea (Sw.) DC. 3guatera loot (Rageau, 1973) (1) (PAPLIONACE AE) N.C. Capsicumfrutescens L. Ziguatera hit Swallow a handful of small raw chilies at once (Bourret, 1981) :u (SOLANACEAE) V.C. "Piment", "chili pepper"

Caricapapqa L. 3guatera Æaf Boil three chopped leaves in half a litre of water. Drink this :3) mtiemetic (Bourdeau, 1985); (CARICACEAE) decoction three times a day (Rageau, 1973; Bourret, 1981) V.C. ardiac action, depurative (Bourret, "Papayer", "papaw" Van. 981; Rageau, 1973)

5guatera Bower Boil approxhatively ten male in one litre of water. :3) Drink one litre per day until the recovery is complete V.C. (Cabalion, 1984b)(*) Van. 5guatera hit Boil unripe ; eat the cooked or drink the cooking :u water (Pktard, 1986) ?ol. manghas L. 'ish poisoning (Weiner, 1985) :u intirheumatic (Weiner, 1985) [) 3ji 'Faux manguier"

Chenopodium ambrosioides L. Xguatera Jaf Decoct 3 to 5 leaves in one litre of water (Bourret, 1981; :3) intispasmodic (Rageau, 1973); :CHENOPODIACE AE) Rageau, 1973) 'J c. iaphoretic (Rageau, 1973); 'Herbe h puce" ntirheumatic (Rageau, 1973; Bourret, 'Mexican tea, wormseed" 981)

7itrullus lanatus liguatera 'eel Cut the melon peel into small pieces. Boil in seawater (Pktard, 2) 'urgative (Pktard, 1986) munb.) Matsum. et Tanaka 1986) '01. :CUCURBITACEAE) 'Pastique", "watermelon" Clerodendrwninerme Fish poisoning seed Decoct freshly pounded seeds (Weiner, 1971) (1) (L.) Gaertner (VERBJZNACEAE

Cocos nucifera L. Fish poisoning Fruit Coconut milk, produced by grating and squeezing the flesh, is (3) (ARECACEAE) used to treat fish poisoning (Weiner, 1985) Fiji "Cocotier", "coconut tree" Mix coconut cream (obtained by scraping two coconuts) with Samoa cocoa and sugar to a consistency of molasses. Drink one cup (McCuddin, 1974)

Ciguatera Fluff Drink during three days the juice hmthe fluff (mesocarp) of (1) (mesocarp) the coconut ("ovisi" or "nia" stage). This drink is claimed to Pol. induce vomiting, which increase the elimination of the poison (Pktard, 1986)

Coir lacryma-jobì L. Ci gu at e ra Root Infusion (Rageau 1973) (1) - POACE=) N.C. "Larmes de Job

Crinum spp. Ciguatera Bulb (Rageau, 1973) Purgative,(Rageau, 1973) diuretic, emetic, diaphoretic (AMARYLLIDAEAE) "Lys sauvage"

Dmallia epiphylla Ciguatem Rhizome Use a 30 cm piece of rhizome, cleaned of soil :chew and (3) Analgesic (Vienne, 1981) J.R. et G. Forster swallow the juice, spit the fibrous part out. Repeat the N.C. (DAVALLIACEAE) treatment the following day if symptoms persist (Vienne, Van. 1981 ;Cabalion, 1984b)(*) Boil the rhizome pulp in 1 litre of water for 3 minutes; drink the decoction within 24 hours ;repeat the following day, if necessary (Vienne, 1981 ;Cabalion, 1984b)(*)

Dmallia solida Ciguatera. Rhizome Same recipes as for D. epiphylla (Same references) (3) Analgesic (Vienne, 1981); purgative (J.R. et G. Forster) Swartz N.C. I(Whistler, 1985) (DAVALLIACEAE) PC1012

Duboisia myoporoides R. Br. Ciguatera Leaf Infuse young leaves (Barrau, 1950 ;Dufva et al., 1973) (2) (APOCYNACEAE) N.C. "Bois bouchon"

Dysoxylum bijugum Ciguatem See Aglaia elaeagnoidea (Labill.) Seemann PC1963b and I Dysmylum gaudichaudianum Ciguatera Stembark Use the stembark of these two Dysoxylum spp. together with (1) (Juss.) Miq. Ithe stembark of Pandanus sp. and the twigs- of Terminalia (Van. PC2268 catuppa (*) (MELIACEAE) TABLE 1 (continued) Elattostachysfalcata (A. Gray) sh poisoning ?af 'uice pressed from the leaves is used as an antidote to Ra& ngestion of (Weiner, 1985) [SAPWACEAE) Flephantopus mollis H.B. K. guatera )ecoction (Vienne, 1981) (ASTERACEAE) ntirheumatic, muscle pain relief Entadaphaseoloides MeniU sh poisoning tem :rush the stem with a small amount of water (Weiner, 1985) 6.) Veiner, 1985) (MIMOSACEAE) "Water vine" urgative (Rageau, 1973) Erythrinaficsca Lour. guatera tembark &cerate (Rageau, 1973) (PAPEIONACEAE) urgative (Rageau, 1973) Erythrina variegata L. iguatera tembark &cerate (Rageau, 1973) (PAPLIONACEAE) Jse with the bark of Pterocarpus indicus. Grind the barks, add "Peuplier canaque", "coral tree" Vater and drink the juice (Cabalion, 1984e) see Aglaia elaeagnoidea ntispasmodic, relief of dysenteric Euphorbia L. iguatera lecoction. Do not exceed 1 g of dried plant per day (Rageau, hirta ymptoms (Rageau, 1973) (EUPHORBIACEAE) 1973; Rageau, 1983) "Herbe 51 dysenterie" "Hajlspurge"

Ficus habrophylla iguatera eaf clook the fish with the leaves: their sap is said to detoxify the G. Bennett ex Seemann and 3sh poison (Bourret, 1981) Ficus aspera Forster f.

Ficus sp. iguatera eaf Warm the leaves over a fire then press to extract the juice; (MOR ACEAE) irink this juice (Cabalion, 1984e)

Hernandia nymphae#olia ish poisoning :oot ?hew the roots (Pktard, 1986) (Presl) Kubitzki (HERNANDIACEAE)

Inocarpusfagifer (Parkinson) ah poisoning Æaf Press the juice of the leaves (Weiner, 1985) Fosberg (PAPEIONACEAE) "Chataîgnierde Tahiti", "Tahitian chestnut tree"

Ipomoea pes-caprae iguatera Æaf Drink the juice extracted from the nearly wilted leaves (L.) R. Brown (Cabalion, 1984e) (CONVOLVULACEAE) "Liseron de mer" "Beach moming glory vine"

t i Maba buxiyolia Iiguatera Leaf, Prepare a decoction from the leaves and bark (Rageau, 1973) Pers. (Doubtfull name) Stembark (EBENACEAE)

Macropiper Iatifolium Ziguatera Fruit Eat 4 to 5 uncooked fruits. Repeat if symptoms persist (*) (L.f,) Mique1 (PIPERACEAE) "Faux kava" Awl26

Maesa ambrymensis Guillaumin Ziguatera See Aglaia elaeagnoidea (MYRSINACEAE)

Maesa insularis Gillespie ;ish poisoning Stembark l'he bark is scraped, mixed with mille from the red-Skinned (MYRSINACEAE) coconut and drunk (Weiner, 1985)

Metrosideros collina Ziguatera See Aglaia elaeagnoidea (J.R. et G. Forster) A. Gray var. villosa (L.f.) A. Gray (MYRTACEAE)

Microsonam punctatum 3guatera (Rageau, 1973) (L.) Copeland pOLYFClDIAC33AE) mtidianfieal (Bagnis, 1973) Morinda citrifolia L. 3guatera Fruit , Crush together 3 uMpe and 3 ripe fruits, then extract the (RUBIACEAE) juice. Mix with coconut milk and drink (Pktard, 1986) "Fromager" "Indian mulberry" Pandanus tectorius Parkinson 3guatem Aerial root Scrape the inside of an aerial root and press out a teaspoonfull 4uscle pain relief, cardiac action (PANDANACEAE) of juice. Drink a teaspoonfull of juice three times a day, until Weiner, 1985) "andanus" recovery is complete (*) "Screw pine" Awl04 3guatera Leaf Drink the juice pressed from young leaves (*) :metic (*) Iiguatera See Aglaia elaeagnoidea

Pandanus sp. 3guatera Bark See Dysoxylum bijugum and (FANDANACEAE) D. gaudichaudianum PC2262 ìish poisoning Aerial root Fluid is pressed from the above ground prop root (Weiner, 1985)

Phaleria glabra ìish poisoning Leaf luice is pressed from the leaves (Weiner, 1985) (Turrill) Domke (THYMJ2LAEACEAE)

. =3 TABLE 1 (continued) Phymatosorus nigrescens ish poisoning Stem Eltrate of stem. Drink and pour in ears and nose (Weiner, Antispasmodic (Weiner, 1985) (Blume) Copland 985) (FOLYPODIACEAE)

Phymatosorus scolopendna iguatera maf tash the fish in macerated fronds which have been previously Skin inflammation (to infants) (Burman f.) Pichi-SennoIli eated over a flame (Rageau, 1973) (Weiner, 1971 ; Bloomfield, 1986; (FOLYPODIACEAE) Whistler, 1991) iguatera (b) Ulizome (ash the toxic fish with the foamy juice of the rhizomes Against skin inflammation (to infants, Bourret, 1981) mereferences) at the rhizome in cases of ciguatera ("la gratte ") caused by Purgative (Bourret, 1981; Whistler, oconut crab (Rageau, 1973) 1985), antipruritic (Rageau, 1973)

Pithecellobium dulce ish poisoning aaf lrushing the leaves produces a liquid claimed to be purgative (Roxburgh) Bentham ;oison, 1955) (MIMOSACEAE) "Pois doux", "Madras thom"

Plectranthus parvìjlorus Wdd. iguatera Stem loil 4 to 5 leaves in 3/4 litre of water. Reduce to half a litre. 1 (L.4BIAl.W hink one litre within 24 hours (*) AL1

Polyscias guiljoylei iguatera Stembark (Bull.) L.H.Bailey (ARALIACEAE) AL2 Polyscias scutellaria iguatera tacerate the bark (Rageau, 1973)(*) (Burman f.) Fosbkrg (ARALIACEAE) AL3 iguatera repare a decoction using 4 to 5 leaves in 3/4 litre of water ; duce to half-a-litre. Drink this decoction within 24 hours (*)

Pterocarpus inaïcus WilIdenow iguatera , aaf repare a decoction using a handful of leaves. Drink the water. (PAPILIONACEAE) :epeat the following day if symptoms persist (*) "Narra tree, New guinea ee Erythrina variegata rOSeWood" GB879, PC1308

Santalum austro-caledonicum iguatera Stembark Jse the aromatic essence of this plant (Rageau, 1973) Relief of dysenteric symptoms Vieillard (Rageau, 1973) (SANTALACEAE) "Bois de santal". "sandalwood" Scaevola montana hbillardikre Iiguatera Æaf Use the young leaves (Rageau, 1973) (GOODENIACEAE)

Scaevola neoebudica Guillaumin Iiguatefi Æaf Crush a handful of leaves until you obtain a small glassful of (GOODENL4CEAE) juice. Drink one glass per day :repeat if necessary (*) 1. PC2594

Scaevola sericea Vahl lguatera hit Crush the hit :mix with coconut milk. Drink this (GOODENIACEAE) preparation @tard, 1986)

Schinus terebenthifoliusRaddi 3guatera Æaf Prepare an infusion from a bunch of leaves in one litre of ntirheumatic mgeau. 1973) (ANACARDIACEAE) water (*) "Faux poivrier","Christmas berry" AL4

Senna occidentalis (I-,.)Link :iguatera Æaf Eat the uncooked leaves (Bourret, 1981) Uaphoretic (Bourret, 1981) (CAESALPINIACEAE) epurative (*) "Casse puante''

Sophora tomentosa L. 5guatera Eat 3 to 7 seeds (Pktard, 1986) antidiarrheal, relief of dysenteric (PAF'ILIONACE AE) Imptoms, antiemetic (Pktard, 1986)

Spondias cytherea Yiguatera &-if Maceration (Vienne, 1981) metic (Vienne, 1981) Sonnerat Express the juice from the leaves to obtain a small glassful of (ANACARDIACEAE) juice. Drink one-half glass per day until recovery is complete "Pomme cythkre", (*) "Polynesian plum" Prepare a decoction from the leaves. Drink one-half glass per AW21, PC572, CS355 day until recovery is complete (*) 'iguatera tembark Grind the inside of the bark and express the juice from it. Drink from 3 to 4 small glassfuls of juice per day until recovery is complete (Weher, 1985)

Stachytarpheta wticadolia 'iguatera oot Maceration (Bourret, 1981) iaphoretic (Bourret, 1981) (Salisb.) Sims (VERBENACEAE) "Herbe bleue" AL9

Syzygium malaccense iguatera tembark Decoction (Rageau, 1973) epurative, laxative (Bourret, 1981), (L.) Merrill et Perry Prepare a small glassful of the concentrated juice from the itirheumatic (*) (MYRTACEAE) inner bark drink three small glassfuls per day ;repeat if CS376 nece- (*I "pomme canaque", "malay apple" 1.

TABLE 1 (continued) Teminalia catappa L. :iguatera See Aglaia elaeagnoidea hdiac action (Bourret, 1981), emetic (COMBRETACEAE) n infants (WhistlerJ991) "Badamier", 3guatem Stembark See Dysoxylum bijugum and D. gaudichaudianum "tropical almond tree" Cut out a sheet of stembark 5 by 10 cm in size; boil in one (2) litre of water until a light red decoction is obtained; drink one N.C. glassful 2 to 3 times a day (Bourret, 1981) Van.

Thespesia populnea (L.) Jiguatem Fruit, Juice of the unripz fruit and decoction of the bark oraUy (2) teelief of dysenteric symptoms Solander ex Com Bark (Rageau, 1973) N.C. Rageau, 1973) (MALVACEAE) "Bois de rose", "milo tree" 3guatera Decoction (Bourdeau 1985)

Vitex rotundifolia Xguatera Leaf Maceration and decoction; use intemally and extemally (baths) (3) Intiallergic (Rageau, 1973); L.f Moldenke (Rageau, 1973; Bourret, 1981; Vienne, 1981; Cabalion, N.C. liaphoretic (Burkill, 1935) (VERBENACEAE) 1984e)(*) Van. PC3092 "Gattilier" 3guatera Root Decoction; use intemally (same references) (1) N.C.

Wikstroemia indica Jiguatera Stembark Rub the entire body with the inside part of the bark. Repeat (1) )urgative, emetic; species reputed to (L.)C.A. Meyer these body rubs several times a day (*) Van. E highly toxic (Rageau, 1983 ; (THYMELAEACEAE) %tard, 1986) GB1218 lguatera Leaf, bark (Rageau, 1983; Pktard, 1986) p. Ximenia americana L. 3guatera Bark (Legrand et al., personal communication) -- (OLACACEAE) "prune de mer" AL8

Zingiber zerumbet :ish poisoning Rhizome Huid pressed from the rhizome (Weiner, 1985) (1) 6.)Roscoe ex J. E. Smith Fiji (ZINGIBER4CEAE) "Gingembre". "shampoo ginger" "Use column: We made a distinction between ciguatera and other fish poisoning. (a) In some references, the term 'fish poisoning' appears; in such a case, it is not possible to state whether or not the poisoning is due to the ciguateric toxin: for this reason. we have retained the term 'fish poisoning'. (b) In other cases, ciguatera poisoning may be caused by non ciguateric toxins, despite the author's use of the term 'la gratte'. or ciguatera. bFrequency and Origin column: We noted in this column a rough estimation of the frequency of use of the remedies listed and their geographical origin. (1) Recipe mentioned only once during the interviews or in the literature: (2) recipe mentioned twice or more; (3) recipe in general use. Kir., Kiribati; N.C., New Caledonia; Pol., Polynesia; Van., Vanuatu. CotherUses column: We noted in this column other properties of the plants when they were also used to treat some symptomatic effects of ciguatera (antiemetic, antispasmodic, relief of dysenteric symptoms, antidiarrheal. against skin inflammation, antiallergic, analgesic. muscle pain relief, antirheumatic, against rashes/antipruritic, cardiac action) or were likely to increase the elimination of the toxin (depurative. diaphoretic. emetic, purgative, diuretic, laxative properties).

L I73

Plant uses other than for treating ciguatera thifolius (this one used as a liniment) and Syzygiuin poisoning were also noted when related to the malaccense. symptomatic effects of ciguatera fish poisoning. Other uses of the plants listed include cardiac activity (four species), antiallergic and local Discussion and Conclusions analgesic activity (six species), depurative, general detoxifying or diaphoretic activity (nine species). The names of 64 different species reputed to be Considering each species individually, the com- effective in treating ciguatera poisoning have been parison of its ethnobotanical uses suggests that presented. These folk remedies are of two types: some species may act on the symptoms caused by preventive and curative. For example, the leaves of the ciguatera toxin and thus have antidiarrheal, Ficus spp. (Moraceae) may be used to wrap the antispasmodic, antipruritic or cardiac tonic fish, or are cooked along with it; alternatively, the effects. fish may be rinsed in an infusion prepared by using On the other hand; pharmacological tests are a plant, such as Phymatosorus scolopendria necessary in order to determine whether or not (Polypodiaceae). This is claimed to destroy the these plants indeed have direct ‘detoxifying’ action toxin during cooking. on the ciguatoxin itself. That is our program’s ‘Preventive’ methods are questionable, since the goal, which is to evaluate these remedies’ thera- peutic potential by studying their effects in mice 4 ciguatera toxin is known to be heat-resistant and water-insoluble. intoxicated with liver extracts of a carnivorous fish r Among other remedies administered as cures, (moray eels) containing ciguatoxin. some are used much more often than others. The following plants are used in remedies that are Acknowledgements popular throughout Polynesia and/or Melanesia: Argusia argentea, Artocarpus altilis, Carica We wish to extend special thanks to the men and papaya, Syzygium malaccense and Vitex rotun- women of New Caledonia and Vanuatu who difolia. welcomed us and offered their time, their patience These remedies consist mostly of single plants and their knowledge during our ethnobotanical and in some cases there is no special preparation surveys. involved; the plant is simply eaten in its natural state.’ When preparation is necessary, three References methods are commonly employed: extraction of the juice using a mortar and pestle, infusion and Bagnis, R. (1973) L’ichtyosarcotoxisnie dans le Pacifique sud. Commission du Pacifique Sud, Nouméa, Nouvelle- decoction. Dosage is rarely precise. In many cases, Calédonie, 112 pp. a 1-1 bottle of the remedy is prepared, which must Bagnis, R., Chanteau, S., Chungue, E., Hurtel, J. M., be drunk during the course of the day; the quantity Yasumoto, T. and Inoue, A. (1980) Origins of ciguatera fish . is replenished until symptoms disappear. poisoning: a new dinoflagellate, Remedies are taken internally,’except those in- .Adachi and Fukuyo, definitely involved as a causal agent. Toxicon 18, 199-208. volving Argusia argentea and Vitex rotundifolia, Barrau, J. (1950) Une plante médicinale de la Nouvelle- which may also be used as a bath to relieve itching Calédonie, Duboisia myoporoides R. Br. Revue Agricole de and Wikstroemia indica which is used externally. Nouvelle-Calédonie 1 (7-8), 13-14. Information on other medicinal uses of the Bidard, J.N., Vijverberg, H.P.M., Freln, C., Chungue, E., species used to treat ciguatera poisoning is also Legrand, A.M., Bagnis, R. and Lazdunski, M. (1984) Ciguatoxin is a novel type of Na+ channel toxin. Journal of listed in the table. Eight species are thus also Biological Chemistry 259, 8353-8357. known for their anti-diarrheal, anti dysenteric or Bloomfield, S.A. (1986) Is health what we want? A conceptual antispasmodic intestinal effects. These are: Achy- view of traditional health practices in Tonga with special em- ranthes aspera, Chenopodium ambrosioides, Euph- phasis on maternal child health and family planning. M.S. orbia hirta, Morinda citrifolia, Phymatosorus Thesis, School of Social Economic Development, University of South pacific, Suva, Fiji. nigrescens, Sophora tornentosa, Spondias cytherea Bourdeau, P. (1985) Etude des Poissons Ciguatoxiques et de la and Thespesia populnea. Ciguatera aux Antilles Françaises. Epidémiologie sur le Five species are alleged to have a soothing effect plateau de St Barthelemy, St Martin. Anguilla. Thèse, on rheumatism and other pains, including muscle Université de Pans Sud, Centre d’Orsay, 289 pp. pains and pains of the joints. These are: Argusia Bourret, D. (1981) Bonnes plantes de Nouvelle-Calédonie et des Loyautés. Les éditions du lagon, 107 pp. argentea, Chenopodium aínbrosioides, Entada Burkill I.M. (1935) A Dictionary of the Economic Products of phaseoloides, Pandanus tectorius, Schinus tereben- the Malay Peninsula. Crown Agents for the Colony, 2 vols. 174

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