The therapeutic efficacy of neem must have been known to man since antiquity as a result of constant experimentation with nature. Ancient man observed the unique features of this tree: a bitter taste, non-poisonous to man, but deleterious to lower forms of life. This might have resulted in its use as a medicine in various cultures, particularly in the Indian subcontinent and later on in other parts of the world.
- 1 Ayurveda
- 2 Neem in Unani Tibb
- 3 Neem in Homoeopathy
The word neem is derived from Sanskrit Nimba, which means “to bestow health”; the various Sanskrit synonyms of neem signify the pharmacological and therapeutic effects of the tree. It has been nicknamed Neta — a leader of medicinal plants, Pichumarda — antileprotic, Ravisambba — sun ray-like effects in providing health, Arishta — resistant to insects, Sbeetal — cooling (cools the human system by giving relief in diseases caused by hotness, such as skin diseases and fevers), and Krimighana — anthelmintic. It was considered light in digestion, hot in effect, cold in property.
In earlier times, patients with incurable diseases were advised to make neem their way of life. They were to spend most of the day under the shade of this tree. They were to drink infusions of various parts of the tree or stem sap, if available, when thirsty, eat tender leaves as salad and cooked leaves as a vegetable. Young twigs were to be used for oral hygiene and gum as lozenges for dryness of the throat and to allay thirst. Whenever mature, ripe fruits were available, they were to be sucked for their sweetish tasty pulp.
Occasionally the seed were also swallowed. While on neem therapy, patients were to avoid all products of animal origin, such as egg, flesh, milk and alcohol, which were considered “hot” in nature. It was considered that the diseases for which neem was specified were caused by hot conditions prevailing in the body, and they were mitigated by the cooling effect of neem and other herbs.
The above observations led to the widespread use of neem, from the era of Carak Samhita (200 BC–200 AD) to recent times in the Indian subcontinent and adjoining countries. It became so popular in ancient India that some scholars believe that it was an ingredient of up to fifty percent of Ayurvedic preparations. Physicians at that time advised Panchang of neem, i.e. five parts of the tree, the leaves, bark, fruit, flower and root. With further development in Indian medicine, the raw single-plant-part therapy was replaced by compound preparations. In these, many ingredients were incorporated; some had a complementary effect, some had a supplementary effect, some were considered antagonistic to the deleterious effects of certain herbs and some were nutritive.
Neem preparations were prescribed in various forms: Churn — powder, Kwath — decoction, Khand — mixed with sugar, Kshara — alkali, obtained by burning the plant part, Vatika — pills, Asav and Arishta — fermented decoctions, Ghritam — butter fat extract, Malham — ointment, Dhupan — fumigant, Lep — poultice and Nasayam — nasal drops.
Ayurvedic Pharmacopoeial Products
Some of the important polyherbal neem preparations of the Ayurvedic Pharmacopoeia and their main uses are:
- Aparjith Dhttp — fumigant for purification of air (air sterilizer)
- Erhamanisthadih kwath — skin diseases
- Dhattur tailam — oil for skin diseases and muscular pain
- Jatyadi tailam — oil for ulcer
- Jeevanti adi Kashyam — for smallpox
- Laghu Manjishtadi kwath — decoction for skin diseases
- Kandavadu Lepah — poultice for itching
- Maha tikatam ghritam — butter fat for skin diseases
- Maha tikatam kashyam — a bitter tonic
- Naryana tailam — oil for rheumatic disorders
- Nimbadi Kashyam — for skin diseases
- Nimbadijatailam palit — for baldness
- Palit Nasyam — nasal drops for alopecia
- Panch titktam ghritam — butter fat for latent fevers
- Panch nimba churnam — powder for skin diseases
- Patoladi kvath — decoction for fevers
- Phaladi kvath — decoction for expelling worms
- Punravadi kshyam — for skin diseases
- Punravadi kvath — decoctions for swellings
- Sudarshan churnam — powder for fevers
- Thiktakam ghritam — butter fat for skin diseases
- Thiktakam kashyam — for skin diseases
- Varanejatayidi ghritam — butter fat for ulcers
- Yograjaguggulu — for rheumatoid arthritis
All the above are polyherbal compounds, having many herbs and a special method of preparation in each case, which may not be of interest to all readers. As an example, details of Nimbadi kashyam are given here to give some idea of these products. This is prepared by making a decoction of 50 gm each of Azadirachta indica, Tinospora cordifolia, Zingiber officinale, Curcuma longa, Adhatoda vasica, Trichosanthes dioica, Solanum indicum, Terminalia chebula, T. belerica, and Phyllanthus emblica. This herbal mixture is boiled in 8L of water, until reduced to 1L. Usually 60ml of this decoction is taken twice daily on an empty stomach.
As an Antimalarial
In the nineteenth century, European physicians practicing in India and Indian practitioners of the orthodox system of medicine (allopathy) found neem bark an effective therapeutic agent for fevers, particularly for malaria, which was very common in some parts with a tropical or sub-tropical climate. The powdered bark and fresh leaves were made official in the Pharmacopoeia of India (). It was also included in Practical Materia Medica (). In due course of time, during the first world war or thereabout, cinchona or salts of quinine were introduced into India from England but these could not reach most of Indian population living in remote areas. Neem bark was tried as a substitute for cinchona; it did not have any direct effect on the malarial parasite, yet patients obtained relief in most cases.
The use of a decoction of bark as an antipyretic is well known, particularly for malaria. For making the decoction, 15gm of bark should be boiled in fifty times that amount of water, until it is reduced to 50 ml. It is strained and then 10 ml of this filtrate is given thrice daily.
In Venereal Diseases
Before the arrival of the Portuguese and other European colonizers, venereal diseases were not known in India. These diseases, particularly syphilis, were noticed in some cosmopolitan areas but local physicians could not diagnose them as there was no mention of the symptoms of these diseases in their texts and they nicknamed them “Firang rog”, or foreign diseases. As per the concept prevailing at that time, the evident symptoms were due to hotness in the body and impure blood, as for other skin diseases like leprosy, eczema, leucoderma, etc. and they prescribed neem as a cooling agent and a blood purifier.
In Ayurveda, as mentioned earlier, use of all five parts of the tree together was considered the best, but later, on the basis of experience, physicians used one or two parts together, so details of each part are given separately here. Recently Lok Parampara Samvardhan Samithi has given a data base for neem, and the interested reader may consult the data base, in addition to the following details.
Uses of Plant Part
When peeled it has two different zones; the outer one is dry, scaly, darker in color, and the inner one is smooth and brown in color. For medicinal purposes, the inner portion of the bark should be used, preferably when it is fresh. Root bark is considered better, but is now very difficult to get, because of the damage that may be caused to the tree during collection. The outer portion of the bark is rich in tannins and is astringent, whereas the inner region is rich in secondary metabolites. The inner bark contains a bitter principle of a resinous nature, which when moistened emits the smell of sulfur compounds like those found in garlic.
Bark exerts a strong antimicrobial and astringent effect due to the presence of phenolic compounds and tannins, which have a strong healing effect on the skin. For this reason it is an ingredient of preparations for pimples, piles, wounds, bleeding gums, etc.
In the case of pimples, a decoction of bark with the pod of Cassia fistula is applied, while for piles, 3gm of bark powder with 5gm of cane sugar is administered three times a day and neem oil is applied externally. A tooth powder made from a fine powder of bark and alum (sodium aluminium sulfate) is used for spongy gums, particularly when they are bleeding. This mixture also has a good anti-inflammatory effect.
The decoction of bark was also prescribed for plague.
In the nineteenth century, European physicians in India considered neem bark to be a bitter tonic and prescribed it in place of gentian or quassia, in the form of an infusion or tincture.
Sap from the Tree
It is said that after the tree reaches a hundred years of age, on a day which cannot be predicted, it begins to exudate a nectar or sap from the crevices of the bark. The sap is thick, sweet in taste and fetid in smell. Great virtues are ascribed to this sap and it is said to be a panacea, particularly for leprotic ulcers and skin diseases of various etiology, particularly those which, as per the Ayurvedic concept, are associated with heat in the body.
A pestle and mortar made from neem wood is preferred for pounding herbs. The wood is rubbed on a wet stone to form a paste. This paste is used for dressing wounds.
The tender leaves were cooked like spinach in ancient India and sometimes fried in butter oil (the fat obtained after heating butter and discarding the fat insoluble part). To remove the bitterness from the leaves, they were boiled in water, and the leaves so obtained were cooked with some sour fruit like those of Embelica officinalis. Leaves in the form of an infusion, a decoction or as a chutney by grinding with black pepper were also used. These preparations were often prescribed for skin diseases, inflammation etc. and recently for diabetes. In the case of smallpox and measles, a decoction of neem leaves was given to quench thirst and to prevent dehydration. To make the surroundings of the patient aseptic and humid, the head was placed on a pillow made from neem leaves and small branches were hung all around and on the windows. In serious cases, instead of a decoction, leaf juice was prescribed and the whole body was smeared with a paste of neem leaves with or without neem oil. When pustules appeared, neem with liquorice (Glycyrrhiza glabra) root was made into a paste and applied.
For hemorrhoids, a paste of the leaves of neem and Nerium mdicum, when applied, caused the shrinkage of inflammed tissues. For ulcers, neem paste acted the same way.
Neem was also used for snake bites, particularly the bite of a russel viper. It was said to destroy venom, but the effect appears to be due to delay in the clotting time of the blood.
In gynecological practice, the use of neem is quite popular in post-parturition disorders. It induces labor by uterine muscle contraction. As an anti-inflammatory and antiseptic agent, a decoction of neem is used for washing and douching the vagina. It induces the formation of milk, so was given for three days after delivery before meals. The same practice is followed by the dairy industry in some places in India even now. The effect appears to be hormonal because a neem branch is said to attract fish during the spawning period.
For oral hygiene and dental care, young twigs are cut into piece 15–20cm long; one end of this twig is chewed to form a fibrous brush and the teeth are cleaned with it. During this process the juice of the twig gets mixed with the saliva in the mouth and the mixture clears the throat by irritating the mucus membrane and causing the expulsion of phlegm from the throat.
This practice is present even now, and it is a common sight to see fresh neem twigs being sold in the marketplaces in India (Fig. 15A), but this is proving disastrous for neem plantations, where even young plants are being destroyed for their twigs ().
In the Siddha system (the traditional system practiced in some parts of south India), dried and cured neem leaves are used. The curing is said to make leaves more effective, more palatable and less toxic. These dry leaves are called Vaipilla, and a well-known Siddha medicated oil preparation is Vaipilla tailam.
Flowers as an item of diet were used in India and the other east Asian countries as a spinach and chutney. The flowers are said to expel worms, give relief from coughing and are considered good for the eyes. In cataracts, a suggested formulation is to make a very fine powder of equal parts of neem flower and potassium nitrate. The mixture is applied to the eyes.
Fruit and Seed
Unripe fruits are used in the same ways as leaves, but are considered useful for bleeding piles, worm infestation and urinary disorders. The ripe fruit is considered a blood purifier and anthelmintic and it makes the bowel soft.
For premature greying of hair, neem juice boiled several times in the juice of Eclipta alba is used as a nasal drop.
It was a common practice in some parts of south India to give a few drops of oil orally to infants regularly to keep them fit.
For skin diseases, the oil has always been considered a drug of choice and often used along with that of karanj (Pongamia pinnata) oil. It was applied on pustules, hard abscesses, obstinate types of wounds, leprotic lesions, ringworm, eczema and itch. It is particularly recommended for hair care problems such as psoriasis and dandruff, for killing lice and for giving relief in itching.
The oil destroys worms and may be useful in anal itching in infants caused by nematodes like the pin worm. It is a stimulative cerebral tonic and is used as a massage oil for rheumatism and joint pains.
Well-known Preparations of Neem
As given earlier, neem preparations have been prescribed for a very long time, but were not very much liked by patients because of their bitter taste. Recently, in some herbal patent preparations, neem extracts in the form of gelatin capsules are being sold, but the classical preparations are manufactured and supplied in the traditional way. The important ones are:
- Nimba ghrit — general tonic in debility
- Nimba asav — for fevers, particularly in malaria
- Nimbadi anjan — antiseptic for eyes
- Nimba arisht — tonic for building resistance in the body
- Nimbadi kwath — decoction for fevers
- Nimba Haridra — with turmeric and sugar, for throat problems
- Nimbadi tail — oil for massage in dry eczema, leucoderma, and rheumatism
- Panchnimba churn — for skin diseases like white patches, ringworm, etc.
- Panchnimba gutika or Panchamrit — in leprosy and white patches
- Panchnimba avleh — for skin diseases of different etiology, headache, diabetes and obesity
- Panchtikata ghrit — in chronic skin diseases
- Panchtikata ghrit guggal — for obstinate diseases, respiratory and heart problems
Neem in Unani Tibb
In the Greco-Persian system of medicine (Unani tibb), which was patronized by Muslim rulers in the medieval era in the Indian subcontinent, the leaves and fruit were in the pharmacopoeia. As per this system, neem is cold 1°, dry 2°, a resolvent and blood purifier (). Neem leaves, called “burgh-i-neem”, are said to expel foul wind from the body and heal ulcers in the urinary passage; it is an emmenagogue and good for skin diseases.
Well-known Unani Tibb Preparations
Neem leaves, bark, seed and oil are incorporated in some of the Unani preparations (Said, 1970), which are as follows:
- Arq Gaz — a distillate from all five parts of the neem tree, used for fevers due to inflammation of the spleen.
- Arq Harabhara — a distillate from the seed coat, a tonic for the lungs
- Arq Murakkab Musaffa khun — a distillate, has a cooling effect on the body, used for purification of blood in venereal disease
- Hab Musaffi Khun — blood purifier for boils, itching etc.
- Hab Narkachur — anti-inflammatory for children
- Hab Bawasir Badi — for bloodless piles
- Hab Siyah Chatham — for application inside the eyelid in conjuctivitis.
- Majun Juzam — blood purifier for venereal diseases, leprosy etc.
- Marham bawasir Jadid — ointment for external application on piles
- Roghan Neem — neem oil for external application on sores and wounds, and for killing ectoparasites like lice
- Zimad Bawasir — whole fruit powder, for application on hemorrhoids
- Zimad Mobasa — for application on pimples, and other minor skin eruptions
Neem in Homoeopathy
Neem under the name Melia azadirachta or Melia Azadirachta is well known in Homoeopathy for its bark, called Margosa. It was included in the Pocket Manual of Homoeopathic Materia Medica (). According to Ghose (), the tincture of bark was introduced by Dr P.C.Majumdar, after proving by him and his pupil. A full report on this proving was published in the Indian Homoeopathic Review. Later on, two more provings were made and published. It was also included in New, Old and Forgotten Remedies (), Pathogenesis de Azadirachta indica (), Indian Homoeopathic Pharmacopoeia (1971) and Materia Medica of New Homoeopathic Remedies ().
The Indian Homoeopathic Pharmacopoeia has described both the macroscopic and microscopic character of the bark. As per the pharmacopoeia, the bark is dark grey to greyish black externally, while the inner surface is pinkish brown and fibrous. In old bark there is a well-defined outer rind formed of alternating strips of cork layers and dead secondary bast. The cork cells have reddish brown contents. Phellogen is not very distinct and a secondary cortex is normally not present. The secondary bast is formed of sclerenchyma. Medullary rays are 2–5 seriate.
In the Indian Homoeopathic Pharmacopoeia, the drug has been introduced on the authority of Drugs of Hindoostan by Dr S.C.Ghose. The mother tincture (one liter) can be prepared by taking 125gm of fresh bark (25 gm moisture and 100 gm solid matter), distilled water 375ml, strong alcohol 635ml. The fresh bark is pounded to pulp and macerated into alcohol. Potency 2x with dilute alcohol, 3x and higher with dispensing alcohol.
Findings of the Symptoms
A brief summary of the findings of the symptoms, as given by Ghose are:
- Mind: oppressed, forgetfulness, dull and loss of memory
- Head: giddiness, headache
- Eye: burning, dull and heavy, painful, red
- Ear: buzzing in the ear
- Face: flushing
- Stomach: thirst, appetite very acute
- Abdomen: great uneasiness with flatulence
- Stool: insufficient bowels, constipation, stool hard
- Genitourinary organs: great excitement of sexual organs
- Respiratory organs: very troublesome cough, sputa white
- Pulse: quick and hard
- Extremities: numbness of the limbs, burning of hands and soles
- Sleep and dreaming: sleeplessness, dreams of quarrels
- Fever: glowing heat and burning, copious sweat, itching
Julian () has also given the symptomatology, according to which neem acts in active, depressed and forgetfulness states, right-sided headache, insomnia, thirst, constipation, fevers, tendency to miscarriage. The clinical diagnoses are senile dementia, amnesia, hypochondria, acute articular rheumatism, acroparesthesia, typhoid fever, recurring of miscarriage and metritis of the cervix.
Selections from the book: “Neem: The Divine Tree Azadirachta indica”. Edited by H.S.Puri. Series “Medicinal and aromatic plants – industrial profiles”. 1999.