Mangagaw? Take in moderation; think prevention

MANILA -- Effective, the number one remedy, and poor man's anti-dengue alternative medicine.

These are among the words a Facebook user will notice from search results whenever he or she types "dengue herbal remedy" on the site's search bar, and many, if not all, refer to one herb -- the Tawa-Tawa or Mangagaw in Cebuano.

Mangagaw (Euphorbia Hirta) is an herb that grows anywhere -- in roadsides, pathways, or grasslands. It has been considered "one of the most popular folkloric treatment for dengue in the Philippines," according to the Department of Science and Technology (DOST).

Rigil Kent Ynot, from Dumaguete City, encountered this herb in 2011 after suffering from dengue, which has claimed about 60 lives in Cebu province as of October 15, 2016.

The 60 fatalities were among the 6,448 cases recorded by the Cebu Provincial Health Office from January 2016 to October 15 this year. Only 10 deaths and a total of 2,461 cases were recorded in the same period of 2015.

Cebu, a province in central Philippines, has been placed under a "state of dengue calamity" since October this year because of the alarming number of dengue hemorrhagic fever cases in the locality. READ: More dengue cases in Cebu

Dengue is an infection that is transmitted by day-biting mosquito (Aedes aegypti or more rarely the Aedes albopictus mosquito). The World Health Organization said it is "a febrile illness that affects infants, young children and adults with symptoms appearing three to 14 days after the infective bite." READ: What is dengue?

In Ynot's case back in 2011, he was rushed to a hospital after feeling intense pain, particularly in his joints. His temperature was at 40-degree Celsius high, and there was no sign of abating. He had chills and severe headache, among other symptoms of the infection.

"Burning feeling, then intense chills, then a relief, and balik na pud to burning feeling and intense chills. Rotating ra. What was constant was the pain or break feeling sa bones, especially sa joints," he said.

Dengue symptoms, according to WHO, range from mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. Severe cases are characterized by fever, abdominal pain, persistent vomiting, bleeding and breathing difficulty.

"Mao na gyud to ang pinakagrabe nga sakit. Way maka-tupong. (That was the most painful disease I've ever had. It's beyond compare)," Ynot said.

Ynot's platelet count dropped from 300 to around 130, then to 78, and slowly until it reached 8 from the normal level of 150 to 400 million per milliliter (ml) of blood. He had to undergo blood transfusion -- the process of receiving blood from another person -- to be able to recover.

Platelets, according to the US National Library of Medicine at, are parts of the blood, or tiny cells that help in the blood clotting process. They are smaller than red or white blood cells. They are essential in the body as they prevent hemorrhage (bleeding from a ruptured blood vessel) from happening.

But aside from having to undergo blood transfusion, Ynot had to drink three to four glasses of mangagaw concoctions prepared by his mom, who came all the way from Negros Oriental with the mangagaw plants. He also had to consume bottles of "mangagaw juice," which has been sold by some pharmacies in Cebu City.

"I had to drink a lot of fluid or else I'll die... In my case, the mangagaw juice helped lessen the chills and increase my platelet count, but the effect was just slight," he said in Cebuano.

Roger Vallena, another mangagaw user, said he tried giving the concoction to his daughter and other members of his family several times already, but there was no significant effect.

"Daghan na ko nakatry. Di na maihap. Pirme na mi naggamit, pero wa jud epek (I have tried it several times already, but there was no effect)," he said.

Locals prepare the mangagaw by boiling the plant in a pot of clean water. The concoction is then taken orally. Some claims have it that it can help increase the platelet count in the body.

A study conducted by the University of Sto. Tomas (UST)-Faculty of Pharmacy in 2012 found out that the concoction, when administered to rat models, "helps improve their healing mechanism."

"Tawa-tawa was able to promote cell production, and prevents platelet destruction," and it has "phenolic compounds, or active ingredients suspected to be responsible in the increased platelet counts of tested animals," said the study titled "Investigation of the anti-thrombocytopenic property of euphorbia hirta linn (Tawa-Tawa) decoction in rat models." (More details on the study here).

Other researches on mangagaw are being conducted by different institutions; one of them is St. Luke's Medical Center.

No evidence yet

But Dr. Cecilia Maramba-Lazarte, director of the Institute of Herbal Medicine from the National Institute of Health-University of the Philippines (UP) Manila, said the study by St. Luke's is ongoing.

"We are just waiting for the results," she said in an interview at UP Diliman on Tuesday, November 29.

Dr. Maramba-Lazarte was one of the scientists from the UP Manila who conducted studies on herbal medicines; among those patented recently and ready to be rolled out are the Sambong, Tsaang Gubat, and Yerba Buena.

According to clinical trials, Sambong works as a diuretic in mild to moderate congestive heart failure, while Tsaang Gubat can help relieve patients with gastrointestinal problems, and the Yerba Buena was found to be safe and effective in relieving post-operative pain, like after dental surgery or circumcision.

As to mangagaw as remedy for dengue, Dr. Renan Cimafranca, chief of the Regional Epidemiology and Surveillance Unit (RESU) in Central Visayas, said it has yet to be proven.

"It has not been proven yet. Wala pay updates o resulta sa mga studies (There have been no updates on or results of the studies yet). Patients are recovering because of fluid intake," he said.

Dr. Rene Catan, Cebu Provincial Health Office chief, also said there is no enough evidence to support its efficacy.

He said the idea of using mangagaw to cure dengue is wrong. "Mangagaw is one of the folkloric medicines, and whether it can cure dengue has yet to be proven."

Experts' advice

Pending results of the trials, Dr. Cimafranca said the Department of Health (DOH) cannot say yet whether there will be misuse or overdosage in the mangagaw intake of some people who are using the herb as remedy for dengue.

His advice to the public is to drink the concoction in moderation.

"Di man sad pwede nga masobrahan sa fluid intake kay delikado. Basin magkanaa na nuoy circulatory overload. Kanang matolerate lang sa pasyente (It's also not good to drink too much fluid. It might result in circulatory overload)," he said.

"Mas maayo sad ikonsulta gyud nila sa ilang doctor (It would be better if they consult their doctor), especially those who are in the hospital already," he added.

For Dr. Catan, prevention is still better than treatment.

"We have to go back to the basics. We have to fight dengue from the grassroots. So, communities have to clean their surroundings, and then we (Cebu Provincial Health Office) will monitor them," he said.

He said Cebu Province will launch maybe in the first quarter of 2017 immunization to some children in the province.

'Mangagaw' juice for sale

As to mangagaw juice being sold in some pharmacies in Cebu City, Dr. Cimafranca said they are coordinating with the Food and Drug Administration (FDA), adding that they received a report from the Vicente Sotto Memorial Medical Center that some people are selling the product even in the hospital's vicinity.

"We received the report just last week, so we are still coordinating with the FDA. We will find out whether they were approved by the FDA, or niagi ba na nila, ug asa na gibaligya (if they passed by FDA, and where they are being sold)," he said, stressing there is no confirmation yet on whether they are safe or not.

"We also don't know if they have permit to manufacture and sell the product...We are not sure of their quality," he added. "Basin nya og contaminated na sila, maka-cause pa nuon og complications (They might be contaminated and might cause complications)."

He appealed to the public not to trust products that have no FDA approval.

Cimafranca and Catan both said that taking mangagaw concoction for dengue might not do no harm, as long as they are taken carefully.

"Pero angay gyud nga huna-hunaon nato ang prevention. Manlimpyo gyud ta aron mawala ang mga lamok (We must clean our surroundings to destroy dengue-carrying mosquitoes)," said Dr. Catan.


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