Plants used in traditional treatment against diarrhea in Turkey

Turkey is one of the richest countries in the world in terms of flora with its extraordinary plant diversity. Its flora consists of about 10,000 vascular plants and approximately one third of them (34.4 %) are endemic to the country. In recent years, the use of ethnobotanical information obtained from medicinal plant research has gained attention all around the world. For this rea- son, numerous ethnobotanical studies have recently been published and much has been written about medicinal plants in our country. This study deals with 133 taxa used in traditional treatments against diarrhea in Turkey and it aims to give information about scientific and local names of these taxa, families, used parts and usage in diarrhea.

lead to lethal dehydration, diarrhea, toxic megacolon or shock. Asymptomatic infections may go unnoticed, but they have durable results for children's growth and development. Most are acquired through contaminated food or water; however, only few pathogens (such as Shigella, Cryptosporidium, Giardia, rotaviruses, or noroviruses) can cause infection (Pawlowski et al. 2009).
Rotavirus is the leading cause of diarrhea hospitalization among children in the world. In 2003, a world-wide estimate of rotavirus-related deaths was published, based on a review of published literature on deaths from diarrhea and rotavirus hospitalizations in children from 1986to 1999. Studies published between 1986and 1999 showed that rotavirus causes ≈22% (range 17%-28%) of diarrheal hospitalizations in childhood. From 2000 to 2004, this rate increased to 39% (range 29%-45%). Application of this ratio to the recent World Health Organization estimates of diarrhea-related childhood deaths gave a predicted 611,000 (range 454,000-705,000) rotavirusrelated deaths (Parashar et al. 2006).
In mass tourism, traveler's diarrhea is one of the most common health problems in long-distance journeys. Globally, there are 40 million cases per year. For this reason, travelers to risky areas should be informed in advance of what measures they should take in case of acute diarrhea and which medicines to include in the first aid kit (Jelinek et al. 2017).
The first choice of treatment of acute uncomplicated traveler's diarrhea -more than 90% of all cases -is the secretion inhibitor racecadotril. Usual practice, which recommends the antimotility drug loperamide as the first option, should be rethought in favor of the last active ingredient racecadotril. Antibiotics should be used only in complicated cases. Generally, anticipation of a large number of passengers demanding antibiotic treatment should be impaired. Other therapeutic measures currently available for the treatment of acute diarrhea while traveling play a minor role (Jelinek et al. 2017).
Several studies have shown that antibiotics can reduce the rates of diarrhea in travelers to resource-limited countries. However, preventive antibiotic therapy is not recommended because of its side effects and so, if necessary, rapid-acting, single-dose antimicrobial therapy is used. In some studies, probiotics have shown benefit (Pawlowski et al. 2009).
There are a lot of kinds of diarrhea shown in this study and the drugs used for the treatment of diarrhea have many side effects. Medicinal plants have traditionally been used for the treatment of diarrhea for many decades.
In this study, we have compiled 133 taxa used in traditional treatments of diarrhea in Turkey. The aim is to give information about scientific and local names of these taxa, families, used parts and usage in diarrhea (Table 1).

MATERIALS AND METHODS
In this study, a thesis search was carried ot at the National Higher Education Center alongside an analysis of ethnobotanical studies conducted in various parts of Turkey with selecting regional plants used for the treatment of diarrhea.

RESULTS AND DISCUSSION
Plants have always been an important source for not only nutrition but also therapeutic use against a considerable number of human diseases. Recent phytochemical studies on medical plants have supported the effectiveness of folkloric medicines. Since ancient times, plants have been used for curing various diseases and infections (Singh et al. 2017).
Turkey has an extraordinary plant diversity and varies by region. Its flora consists of about 10,000 vascular plants and approximately one third of its flora (34.4 %) is endemic to the country (Demirci and Özhatay 2012;Gürdal and Kültür 2013).
Recently, the use of ethnobotanical information obtained from medicinal plant research has gained attention all around the world. For this reason, numerous ethnobotanical studies have recently been published and much has been written about medicinal plants in our country (Gürdal and Kültür 2013). Since these medicinal plants have been used in folk medicine by the public for many years, the information about how to use these plants in the treatment of illnesses has been passed down for generations.
In this study, we compiled 133 plant species used in folk medicine for the treatment of diarrhea in Turkey from the ethnobo-   In Figure 1, there is a graph of the main families used in the treatment of diarrhea in Turkey. The plants used for the treatment of diarrhea are mainly from Rosaceae, Asteraceae, Lamiaceae, Fabaceae, Anacardiaceae, Orchidaceae, Cupressaceae, Fagaceae and Solanaceae families ( Figure 1). The plants of these families mainly take bioactive molecule groups in their different parts such as fruit, seed, root, aerial parts (Bilaloğlu and Harmanar 1999).
Phytomedicines have a significant role, both as traditional home remedies and as galenic preparations, in the symptomatic treatment of diarrhea. Three groups of preparations are particularly important: tannin-containing herbs, pectins, and a special strain of live dried yeast (Schulz et al. 2004).
Since diarrhea may occur because of fungal, bacterial, viral, and non-infectious causes and many of the plants reported in this study contain pharmaceutically bioactive compounds, including flavones, flavonoids, phenolic acids, tannins, anthocyanin compounds, volatile oil, minerals, vitamins, and polysaccharides (Bilaloğlu and Harmandar 1999). In these molecule groups, tannins especially are medicinally significant because of their astringent properties. Inwardly tannins are administered in cases of diarrhea, intestinal catarrh and as an antidote in cases of heavy metal poisoning (Adhikari and Kundu 2017). They can provide short-term healing and anti-inflammatory effects on the gut wall, though they are likely to rapidly reduce in transit through the tract unless they are in a slowly dispersing solid form. Effects on the bowel, can be significant if the symptom is a reflex consequence of irritation in the gastric or upper enteric passages. The use of tannins is not to be recommended as a long-term solution.
Because when they are used as long-term therapy, they can cause constipation, iron deficiency anemia and malnutrition. Therefore long-term therapy with high doses of tannins is to be avoided (Bone and Mills 2013). In this study, Potentilla, Quercus, Camellia, Vaccinium and Alchemilla sp. are known as plant remedies traditionally used for tannin constituents (Schulz et al. 2004;Bone and Mills 2013).
For centuries, physicians have used preparations containing flavonoids as basic physiologically active components and lay healers attempt to treat human diseases (Cushnie and Lamb 2005). Up till today, plant-derived flavonoids have showed nu-merous biological activities, including antiallergic, antibacterial, antidiabetic, antiinflammatory, antiviral, anti-proliferative, antimutagenic, antithrombotic, anticarcinogenic, hepatoprotective, oestrogenic, insecticidal, and antioxidant activities (Cushnie and Lamb 2005;Orhan et al. 2010). Flavonoid containing poultices, infusions, spices and balms have been used in many cultures based on ethnomedicinal use for centuries (Cushnie and Lamb 2011). As stated above, there are many kinds of diarrhea and some are caused by infections. In this way, flavonoids in terms of having antimicrobial activities might show a strong ability to cure the pathogenesis. As a result, flavonoids can also be used as a drug to treat diarrhea.
Consequently, these compounds should be investigated in order to determine the main component which is effective against diarrhea and produce natural-based and effective drugs used for this common disease with fewer side effects than chemical drugs. We assume that this study would lead to the development and optimization of new antidiarrheal drugs with no side effects.