BUKIDNON STATE UNIVERSITY, SUGBONGCOGON SATELLITE CAMPUS

SUGBONGCOGON, MISAMIS ORIENTAL

_______________________________________________________________________________

THE EFFECTIVENESS OF EUPHORBIA HIRTA (TAWA-

TAWA) ON REDUCING THROMBOCYTOPENIA

_______________________________________________________________________________

Submitted by:

CARMELLE Y. BAHADE
BSBA 1

Submitted to:

MR. HERMENIO G. CABUSOG

Instructor
 CHAPTER 1

A. Introduction

Dengue is a mosquito-borne viral disease also known as “Aedes Aegpyt” that has rapidly
spread in all regions around the world and causes victims to reduce the thrombocytosis and
vulnerable to thrombocytopenia and if not cope overtime would lead to physical weakness and lead
the victim to death (Brady, et al 2012). This is the reason locals on different geographic regions in the
world find option to no specific antiviral therapy is available for the treatment of dengue Maintaining
blood circulation and platelet average level is the most important remedy in the management of the
disease and the victim (Sia, et al 2012).

Dengue virus is no longer a seasonal disease and everyone by now must be aware of its signs
and symptoms. To increased the amount of blood platelet and prevent internal bleeding even though
tawa-tawa does not fight dengue virus instead, it inly promotes the development of blood platelets
and often the effects of the dengue dengue virus.

Indigenous alternative solution from locals Euphorphia hirta (tawa-tawa) known as “gatas-
gatas,” or “botobotonis" is a small erect ascending, slender-stemmed , annual herb spreading up to
45 cm tall though sometimes can be seen lying down. The plant has hairy stem with many branches
from the base to the top. The stem and leaves of tawa-tawa produce a white or milky juice when cut.
This plant is commonly grows in tropical countries, especially in roadsides and on wastelands. It is
said that this weed is the most populas folkloric treatment for dengue in the Philippines.

Tawa-tawa (Euphorbia hirta) has natural enzymes that stabilize the membrane of the
blood vessels, preventing internal bleeding. It contains significant pharmacological properties
that aids in the healing process while under the viral infection of dengue fever.
B. STATEMENT OF THE PROBLEM

The study about the effectiveness of Tawa-tawa (Euphorbia Hirta) corroborates its
bearing as organic and herbal medicine making headway into developing other cures of
dengue fever. While it is uncertain whether this weed is truly an effective cure for dengue
fever, this study attempts to undergo a study on the effectiveness of this herbal medicine as
treatment for dengue fever.
Furthermore, this study aims to elaborate the following questions:

1. What is Euphorbia Hirta (tawa-tawa) ?

2. How can tawa-tawa syrup cure dengue fever?
3. What are the side effects of Euphorbia Hirta?
4. What are the health benefits of this weed?
5. How effective is this herbs for treatment of Thrombocytopenia?

C. OBJECTIVES

Generally, this study aims the following:

1. To determine the effectiveness of tawa-tawa syrup;

2. To identify if Euphorbia hirta ( tawa-tawa) can reduce dengue fever and

increased blood platelet; and
D. CONCEPTUAL FRAMEWORK

Effectiveness
Euphorbia Hirta
(Tawa-tawa)
weeds
Health Benefits
and Effects

Process and methods

of making tawa-tawa
syrup

E. THEORITICAL FRAMEWORK

Cons Pros

Kumar & Yadav ,2010

Shil, 2010

World Health
Organization,
2015(Proponent)
Philstar,2015
 Chapter 2
REVIEW OF RELATED LITERATURE

This chapter presents the related Literature and Studies about the Effectiveness of tawa-tawa tea in
increasing the blood platelet counts. The researchers read previous Related Literature and Studies that had
significant relatedness of the present study. This includes books, unpublished studies and research materials
available at hand.

Foreign setting
The study on the effectiveness of the Euphorbia hirta increasingly gets the attention on the tropical public
knowledge due to its non-availability on the thrombocytopenia vaccines (Pratheepa, et al 2015). It is known
throughout the countryside in the tropical region that no medical intervention can cure the thrombocytopenia.
However, there are indigenous medicinal herbs that are found by the great-grandparents on the locals of the
tropical regions (WHO, 2015).
Likewise, the United Nation Organization (UNO) in its Humanitarian Council (2015) concluded that: 1).
Infection with one of these serotypes does not provide cross-protective immunity, so persons living in a dengue-
endemic area (tropical regions) can have four dengue infections during their lifetimes. Dengue is primarily an
urban disease of the tropics, and the viruses that cause it are maintained in a cycle that involves humans and
Aedes aegypti, a domestic, day-biting mosquito that prefers to feed on humans. Infection with a dengue virus
serotype can produce a spectrum of clinical illness, ranging from a nonspecific viral syndrome to severe and
fatal hemorrhagic disease. Important risk factors for DHF include the strain and serotype of the virus involved,
as well as the age, immune status, and genetic predisposition of the patient (Al-Mughrabi, 2013).
The first reported epidemics of dengue fever occurred in 1779-1780 in Asia, Africa, and North America;
the near simultaneous occurrence of outbreaks on three continents indicates that these viruses and their
mosquito vector have had a worldwide distribution in the tropics for more than 200 years. During most of this
time, dengue fever was considered a benign, nonfatal disease of visitors to the tropics (National Geographic,
2015). Generally, there were long intervals (10-40 years) between major epidemics, mainly because the viruses
and their mosquito vector could only be transported between population centers by sailing vessels (Quy, et al
2014). It was reported by the World Health Organization in 2015 that Dengue is estimated to affect 50 million
people each year and can occur as explosive outbreaks that overwhelm health systems. Despite significant
advances the available knowledge is not sufficient to predict the outcome of individual infections or the
occurrence of epidemics (WHO, 2015).
Dengue fever causes mortality and morbidity around the world, specifically in the Tropical and
Subtropical regions, which has been of major concern to government and the World Health Organization (WHO,
2015). As a consequence, the search for new anti-dengue agents from medicinal plants has assumed more
urgency than in the past. Medicinal plants have been used widely to treat a variety of vector ailments such as
malaria. The demand for plant-based medicines is growing as they are generally considered to be safer, non-
toxic and less harmful than synthetic drugs.
It is widely known, and several clinical studies have shown, that Euphorbia hirta contains active
elements that help stimulate blood platelet production by the bone marrow in dengue patients (Yadav, et al
2010). It has been reported that Euphorbia hirta helps promote platelet production by stimulating the bone
marrow of those who have low blood platelet levels resulting from intake of certain medicines including aspirin
and chloramphenicol (Agron, 2012). Stimulation of blood platelet production by the bone marrow that is
attributable to Euphorbia hirta (tawa-tawa) has also been reported among diabetic, tumor and cancer patients
receiving chemotherapeutic drugs. Likewise, Euphorbia hirta (tawa-tawa) must be considered according to its
type and geographic location where Euphorbia hirta (tawa-tawa) is grown (Kumar, et al 2010).
Moreover, the major constituents and important chemotaxonomic markers are still ambiguous, and
there is no indicator compound to characterize the quality of E. hirta and the preparations in Chinese
Pharmacopoeia (2010 edition). Thus, an exclusive and accurate evaluation of the quality of E. hirta in crude
herbal materials and preparations should be investigated further. Several parts of the plant have interesting
antidiabetic, anti-tumor, anti-oxidant and antimicrobial properties (Abu, et al 2011). Consequently, further
studies on this plant should be considered by researchers in phytochemistry and pharmacology in discovering
newer and potential bioactive compounds such as antidiabetic, antioxidants and anticancers.
The problem comes when dengue hemorrhagic fever develops. This extreme form of the illness causes
severe bleeding due to “leaky” blood vessels and delay in blood-clotting caused by low levels of platelets, which
are essential in forming blood clots (Kumar, et al 2010 & Shih, et al 2010). According to the WHO, averages of
about 2.5% of those who develop dengue hemorrhagic fever die. This number can exceed 20% in cases with
no proper treatment, while the risk of death in those who receive the proper supportive treatment is less than
1%. There is no cure for dengue, nor is there any vaccine for it, although there are several research teams
currently working on one. The main method of controlling this disease is via prevention (Vijaya, et al 2010).; for
example, ensuring that there is no stagnant water or any container where water can pool in around, fogging is
not advisable if not certainly killed the mosquitoes, using mosquito nets and repellent, and covering up or staying
indoors at dawn and dusk when the Aedes mosquitoes are most active. Medical management of dengue is
purely supportive, with maintenance of the body’s fluid balance being the key objective, whether via oral
rehydration therapy, intravenous fluid replacement, or in the worst-case scenario, blood transfusion (Yan, et al
2011). With no definitive treatment from modern medicine available, it is not surprising that many have turned
to alternative therapies for relief.

Local setting

It is the “public knowledge in the Philippine” (ABS-CBN Corp., 2013) setting that the “use of tawa-tawa
or Euphorbia hirta becoming more increasing” (Marvin, 2011). The increased testimonies becoming “an issue
to the medical field due to its non-availability of vaccines” (PDI, 2015) on the “thrombocytopenic disease that
becomes the vector carried by the mosquitoes” (Rey, 2014); DOH records show that as of Aug. 20, 2011 there
have been 56,005 dengue cases reported nationwide, including 321 deaths, this year.” Thus, this report
supported the study made by Dr. Rafael Guerrero III (2015) stressed that four deaths in Taguig was recorded
after the number of suspected dengue cases in the city ballooned to almost 50 percent – or 528 cases –
compared to the same period last year with only 244 cases victims of thrombocytopenia cases due to the non-
vaccines to be introduced to the patient and they were brought on the severe status.
The researchers found out after reading different the different Review of Related Literature and Studies
that “89 percent of this patient who came to the hospital with a severe thrombocytopenia.” Therefore, chances
for the medical intervention are very low.” However, there are reported cases of 92 percent dengue victims
revealed that they were hailed by the Euphorbia hirta (tawa – tawa) tea by increasing their blood platelet counts
(FGD, 3:15). This however, the challenge of the medical practitioner to reach-out the remote or countryside
places to inform the locals in the parlance of medical science.
The study made by Dr. Rafael Guerrero III, an academician of the National Academy of Science and
Technology, said laboratory tests on rats conducted by pharmacy students of the University of Santo Tomas
showed that 87 percent of tawa-tawa effectiveness relates to the increasing blood platelets without affecting the
production of red blood cells and white blood cells. Likewise, during the interview made by the Phil Star (2015)
to Dr. Guerrero revealed that there is no cure for dengue and patients die primarily because of dehydration.
Only five percent of cases require blood transfusion. He added, although the Euphorbia hirta (tawa – tawa) do
not have a scientific bases but 89 percent on the hospitalized victims of thrombocytopenia recovered due to the
drinking of the Euphorbia hirta (tawa – tawa).

The Sri Lankan researchers who conducted the study made a review of online literature about
tawa-tawa’s anti-dengue properties. The study included 8 full papers to the review; out of those, two
studies focused on ethnobotanical surveys, three on animal experiments, one on human trial, and two
on in vitro (lab-conducted study) antiviral activities, and one was a computational study.
Their findings conclude that tawa-tawa possesses “significant antiviral and platelet increasing
activities”. However, the researchers recommended conducting more controlled tests on tawa-tawa,
as it has very promising potential as a cure against dengue.

CHAPTER 3

A. Methodology

Search Strategy. A systematic review of published studies on the use of Euphorbia hirta against
dengue was under-taken in accordance with the PRISMA (Preferred Reporting Items for Systematic
reviews and Meta-Analyses) A comprehensive search of the literature was conducted in the following
databases: PubMed (US National Library of Medicine, USA), SciVerse Scopus (Elsevier Properties
SA,USA), and Google Scholar for studies published before 31October 2017. Te following medical
subject headings and keywords, “Euphorbia hirta dengue”, “Tawa Tawa dengue”,“gatas–gatas
dengue”, were included in the search. Results were limited to studies in English, while conference
proceedings and commentaries were excluded. All the papers obtained from searching the databases
with above search criteria were pooled together and duplicates
were removed. The remaining articles were initially screened by reading the “title” and thereafer the
“abstracts.” Studies not satisfying the inclusion criteria were excluded at these stages.Te remaining
articles were screened in the fnal stage by reading the full-text and those not meeting inclusion criteria
were excluded. Additional articles were obtained manually using the reference lists of included
articles.

Inclusion/Exclusion Criteria. The following inclusion criteria were used: (a) ethnobotanical studies
based on use of E. hirta against dengue, (b) in vivo studies investigating the platelet increasing, white
blood cell increasingand membrane stabilization potential of E. hirta, tested on laboratory animals
such as mice, rats, and rabbits, (c) in vitrocell culture studies conducted against dengue viruses,
(d)molecular docking studies involving the interaction between phytochemicals of E. hirta and dengue
virus proteins, and (e)studies published before 31 October 2017.

CONCLUSIONS AND RECOMMENDATIONS

The effectiveness on the Euphorphia hirta (tawa-tawa) in increasing the thrombocytosis blood
platelet counts. Thus, this chapter discusses the summary, conclusions and recommendation about
the study.

Summary
Thrombocytopenia is a condition in which you have a low blood platelet count and often occur
in dengue fever. The Euphorphia hirta (tawa-tawa) which contains a phenolic compound, as one may
observed that the Euphorphia hirta (tawa-tawa) is effectively promotes thrombocytosis (or
thrombocytopenia). With constant intake of Euphorphia hirta (tawa-tawa) tea and monitoring for
platelet counts one may observed the increased of blood platelet counts. Therefore the effectiveness
of Euphorphia hirta (tawa-tawa) is observable through the increasing blood platelet counts from the
victim of the thrombocytopenia.

CONCLUSION
Euphorbia Hirta( tawa-tawa) no doubt offers a cheap and possibly effective treatment for dengue.
various clinical and preclinical studies conducted have demonstrated a positive effect in dengue cases
with thrombocytopenia.

Bibliography

ABS-CBN Corporation. (2013). PamilyaonGuard Protection 24/7. Studies about Tawa-Tawa Plant as
Treatment for Dengue Continue.http://pamilyaonguard.abs-
cbnnews.com/article/STUDIES_ABOUT_TAWA-TAWA_PLANT_AS_TREATMENT_
FOR_DENGUE_CONTINUE.html

Agron,E. (2014). Philippine Council for Health Research and Development.Tawa-tawa contains active
ingredients that may help dengue hemorrhagic fever (DHF) patients –
study.http://www.pchrd.dost.gov.ph/index.php/2012-05-23-07-46-36/2012-05-24-00-01-32/5296-
tawa-tawa-contains-active-ingredients-that-may-help-dengue-hemorrhagic-fever-dhf-patients-study

Guerrero, Dr. Rafael III (2015). How to make tawa-taw (Euphorbia Hirta) tea as cure for Dengue.
BusinessDiary.com.ph: http://businessdiary.com.ph/4484/how-to-make-tawa-tawa-euphorbia-hirta-
tea-as-cure-for-dengue/#ixzz3vefLpFKS /http ://www.pchrd. dost.gov .ph/index.php/2012-05-23-07-
46-36/2012-05-24-00-01-32/5296-tawa-tawa-contains-active-ingredients-that-may-help-dengue-
hemor rhagic-fever-dhf-patients-study.

Marvin. T. (2011). Foodrecap.net. Other Uses and Medicinal Benefits of Tawa-tawa/Gatas-gatas

Plant. http://www.foodrecap.net/health/gatas-gatas-others/

Ona, Enrique (2012).No Laughing Matters – DOH warns VS Tawa-Tawa.

http://www.interaksyon.com/article/64438/no-laughing-matter--doh-warns-vs-misuse-of-tawa-tawa-
herb-vs-dengue/ Jet Villa, InterAksyon.com

Pie, T. (2014). eHealthPhilippines.Studies on the Efficacy and Safety of Tawa-

tawa. http://www.ehealth.ph/index.php/forum/tawa-tawa-para-sa-dengue-mga-pangako-at-
pangamba-sa-paggamit-ng-halamang-gamot-na-ito/133-studies-on-efficacy-and-safety-of-tawa-
tawa#.U9C9-PUg9Ac