Battling summer diarrhoea in India: traditional wisdom and general and homoeopathic management

Prof Dr Sushil S. Dubey M.D (Hom)

As India descends into the sweltering heat of summer, the mercury soars and the risk of various heat-induced illnesses escalates, one of the most common being summer diarrhoeas. These seasonal gastrointestinal upsets, primarily affecting children, the elderly, and individuals with compromised immunity, are an annual public health concern, particularly in densely populated regions. Rooted in a combination of microbial proliferation, poor food hygiene, and water contamination, summer diarrhoeas can range from mild self-limiting episodes to severe, life-threatening dehydration. While pharmacological interventions are well-known, this article seeks to illuminate the often-overlooked yet profoundly effective realm of general medical management and time-tested Indian traditional practices that have guarded generations against the wrath of the Indian summer.

Understanding the Culprit: Why Diarrhoeas Peak in Summer
Diarrhoeal outbreaks in India peak during the hot months of April to July, coinciding with the intensification of ambient temperatures and an upsurge in humidity. These conditions create an ideal breeding ground for pathogenic bacteria such as Escherichia coli, Shigella, Salmonella, and Vibrio cholerae. Viral agents like rotavirus and norovirus also find favourable conditions in unhygienic surroundings, leading to explosive episodes of gastroenteritis. Food left uncovered or unrefrigerated quickly becomes a reservoir of harmful microbes. Contaminated water, ice, and beverages sold by unregulated vendors are often implicated in large outbreaks, particularly in semi-urban and rural landscapes.

Additionally, the human gastrointestinal tract, under the physiological stress of intense heat, becomes more vulnerable to microbial insults. Electrolyte loss through perspiration further compounds the severity of diarrhoea by hastening dehydration.

Marriages and Festivities: A Perfect Storm
The Indian summer is also the season of weddings, religious festivals, and family gatherings. Lavish feasts are commonplace, often prepared in bulk and stored for prolonged periods. Despite best intentions, catering services may falter in maintaining hygienic conditions under challenging climatic circumstances. Reheating practices may be suboptimal, and cross-contamination can occur easily during food handling. Desserts containing milk, creams, and sweets are particularly notorious for becoming incubators for bacterial growth when exposed to the ambient heat.

It is not uncommon to witness clusters of gastroenteritis cases following such large social events. These episodes may mimic food poisoning, often linked to poor food handling, questionable water sources, or improperly cleaned utensils used during mass cooking.

Clinical Circumstances and Symptomatology of Acute Gastroenteritis
Acute gastroenteritis is typically characterised by a sudden onset of profuse, loose or watery stools, often accompanied by abdominal cramps, nausea, vomiting, flatulence, and systemic symptoms such as weakness, headache, and low-grade fever. The condition may arise following the consumption of contaminated water or improperly stored food, particularly dairy and meat products exposed to ambient summer temperatures. Children may present with irritability, poor oral intake, and signs of dehydration such as dry tongue, sunken eyes, or reduced urination. In adults, the illness may be preceded by indiscretions in diet during festive gatherings or weddings, ingestion of uncooked street food, or ice from unhygienic sources. The severity of symptoms varies, with some patients experiencing mild discomfort, while others may deteriorate rapidly with signs of dehydration, electrolyte imbalance, and exhaustion. If neglected, particularly in extremes of age, acute gastroenteritis can escalate into a medical emergency necessitating prompt and comprehensive care.

Medical General Management: The Core Principles

The cornerstone of management for summer diarrhoeas lies not in aggressive medicinal intervention but in timely and adequate general care:

• Hydration Above All: The foremost goal in any diarrhoeal episode is the prevention and correction of dehydration. Clean, boiled and cooled water, infused with a pinch of salt and sugar, mimics an oral rehydration solution (ORS) and can be lifesaving. Coconut water, buttermilk with a dash of salt, and lime water are also excellent natural rehydrating fluids.
• Dietary Rest: A temporary shift to bland, non-spicy, semi-solid foods such as rice porridge, moong dal khichdi, or curd rice allows the gastrointestinal tract to recover. Fermented foods like curds and lightly soured rice water help restore intestinal flora.
• Hygiene Reinforcement: Frequent handwashing with soap before meals and after toilet use is essential. Vegetables and fruits must be thoroughly washed and, if possible, consumed cooked. Drinking water should be filtered or boiled. In regions without access to purified water, traditional methods such as the use of copper vessels to store water can offer additional safety.
• Rest and Recuperation: The body must not be taxed during diarrhoeal episodes. Adequate sleep and rest allow the immune system to function optimally.

Desi Wisdom: Traditional Preventive Strategies

India’s rich cultural tapestry is interwoven with traditional health practices that serve as effective prophylactics during summers. These methods, honed over centuries, are particularly relevant in rural and semi-urban settings:

• Tamarind and Mint Sharbat: Known for their cooling and digestive properties, tamarind pulp mixed with fresh mint leaves, black salt, and jeera (cumin) serves as a digestive aid and thirst quencher.
• Roasted Cumin and Dry Ginger: Powdered and consumed with warm water, this age-old remedy fortifies the digestive tract, preventing bloating and irregular bowel movements.
• Bael Fruit (Wood Apple): Widely found during Indian summers, the pulp of bael fruit, consumed with water or as a chutney, acts as a natural digestive tonic with mild anti-diarrhoeal properties.
• Clay Pots for Cooling Water: Storing drinking water in earthen pots not only keeps it cool but imparts a mild alkalinity and reduces microbial growth—an old but effective Indian practice.
• Avoidance of Heat-Inducing Foods: Traditional Indian households avoid excess intake of mango pickles, fried snacks, and red chillies during summer, which are believed to aggravate pitta and cause gastrointestinal distress.
• Curd and Buttermilk as Natural Probiotics: The daily consumption of fresh curd (dahi) and buttermilk (chaach) has long been championed in Indian households as a natural means of maintaining gut health. These fermented dairy products are rich in beneficial lactic acid bacteria that aid in restoring and preserving the delicate balance of the intestinal flora, especially after episodes of gastrointestinal distress. Buttermilk, often seasoned with roasted cumin, rock salt, and curry leaves, is not only refreshing but also gently therapeutic. Curd, when consumed with rice or as part of a meal, serves to soothe the gut lining, reduce acidity, and promote healthy digestion. These humble yet powerful dietary inclusions function as natural probiotics, aligning seamlessly with modern scientific understanding of microbiome management.

Public Health Education and Community Measures
Health authorities and media houses have a pivotal role in disseminating seasonal advisories. Educating the public on safe food preparation practices during functions, insisting on water purification, and discouraging the consumption of street-side food items during peak heat hours can prevent outbreaks.

Further, community kitchens for large gatherings must adopt stringent guidelines—use of stainless steel vessels, refrigeration of perishables, and proper segregation of cooked and raw items. Marriage and event organisers should be encouraged to procure water from certified sources and avoid serving high-risk items like ice-creams, custards, and milk-based sweets unless refrigeration is assured.

Homoeopathic Management and Therapeutics for Acute Gastroenteritis
In the realm of complementary medicine, homoeopathy has long provided individualised, gentle, and effective relief during acute episodes of gastroenteritis, particularly those aggravated by the harsh Indian summer. The principle of similia similibus curentur—like cures like—guides the selection of remedies based upon the unique symptomatology presented by each patient.

General Approach: Homoeopathic management of summer diarrhoeas includes observation of characteristic modalities, causative factors (such as spoiled food, emotional excitement, or exposure to sun), the nature of the stool, associated symptoms like nausea, thirst, and abdominal cramps, and the patient’s general disposition. Acute prescribing is typically done using low to moderate potencies, with repetition guided by the intensity and duration of symptoms.

Frequently Indicated Homoeopathic Remedies:

• Arsenicum Album: Especially suited to cases of diarrhoea from food poisoning, particularly after consuming ice-creams, milk-based sweets, or contaminated water. The stools are offensive, burning, and frequent, accompanied by extreme weakness, restlessness, and a desire for sips of cold water.
• Veratrum Album: Indicated when there is profuse, watery diarrhoea with violent vomiting and intense coldness of the body. The patient may experience collapse, cold sweat on the forehead, and an unquenchable thirst for large quantities of cold water.
• Podophyllum: Best suited to cases with gushing, offensive, painless diarrhoea, especially in the early morning. It often follows overindulgence in fruits or greasy food consumed during summer festivities.
• Aloes: For patients experiencing an urgent desire for stool, sometimes uncontrollable, with involuntary passage of flatus and mucus. A dragging sensation in the rectum and heaviness in the lower abdomen are typical.
• Croton Tiglium: Indicated in sudden, forceful diarrhoea immediately after eating or drinking. The stool is yellowish, watery, and passed with great noise and urgency.
• Chamomilla: Particularly beneficial in children suffering from diarrhoea due to teething or exposure to summer heat, especially when associated with irritability and green, foul-smelling stools.
• China Officinalis: Useful when dehydration has already set in due to chronic fluid loss. The patient feels weak, anaemic, and chilly, with distension of the abdomen from gas and a desire for sour drinks.

Conclusion
Summer diarrhoeas, though largely preventable, continue to claim lives and burden health infrastructure in India. In the absence of immediate pharmacological remedies, age-old Indian traditions and robust general management hold the key to prevention and recovery. As we embrace modern lifestyles, a mindful return to these time-tested practices, reinforced by public health awareness and responsible community conduct, can ensure a healthier summer for all.

Rubrics in Prominent Repertories 

Murphy Repertory

1. Rectum – DIARRHEA, general – hot, weather

ACON. Aeth. Aloe ambro. Ant-c. Ars. bapt. Bell. BRY. calc. CAMPH. caps. Carb-v. Cham. CHIN. chinin-ar. coff. colch. Crot-h. CROT-T. Cuph. Cupr. Cupr-ar. Ferr. ferr-p. GAMB. Hyper. Iod. Ip. iris Jatr-c. Kali-bi. lach. mag-c. mag-s. merc. Mez. mur-ac. Nat-m. nat-p. NUX-M. OLND. Ph-ac. Phos. PODO. Psor. rheum Sec. sil. Sul-ac. verat.

Phatak Repertory

1. D – Diarrhoea – children – summer, in cupr.

2. D – Diarrhoea – periodical – summer kali-bi.

3. D – Diarrhoea – weather – hot – agg : Bry. camph. castm. chin. crot-t. ferr. ferr-p. gamb. kreos. nux-m. olnd. Podo.

Synthesis Repertory Repertoy

1. RECTUM – DIARRHEA – cold – drinks – summer, in Carb-v. Nat-s. NUX-M. verat.

2. RECTUM – DIARRHEA – cold – taking cold, after – summer, in aloe ant-t. bry. Dulc. PH-AC.

3. RECTUM – DIARRHEA – weather – warm Acon. Aeth. Aloe ambro. Ant-c. Ars. bapt. Bell. benz-ac. Bism. Borx. BRY. calc. CAMPH. caps. Carb-v. CHIN. chinin-ar. cina coff. colch. Crot-h. CROT-T. Cuph. Cupr. Cupr-ar. Ferr. ferr-p. GAMB. guar. Hyper. Iod. Ip. iris Jatr-c. Kali-bi. kreos. lach. mag-c. mag-s. merc. Mez. mur-ac. Nat-m. nat-p. NUX-M. OLND. Ph-ac. Phos. PODO. Psor. rheum Sec. sil. Sul-ac. verat. verb.

4. RECTUM – DIARRHEA – summer Ambro. cyn-d. ferr. gnaph. grat. iris psor. sil.

Boericke Repertory

5. ABDOMEN – Diarrhoea, enteritis – Cause, occurrence – from – hot weather acon. aloe ambro. Ant-c. ars. Bry. camph. caps. Cham. Chin. crot-t. Cuph. ferr-p. gamb. Ip. iris merc. nux-m. Podo. sil. verat.

Boger Synoptic Key Repertoy

6. STOOL – Diarrhoea – weather agg.; hot bry. podo.

References:

• National Centre for Disease Control (NCDC), Government of India – Monthly Communicable Disease Reports.
• World Health Organization (WHO) – “Diarrhoeal disease: Key Facts,” 2023 update.
• Indian Journal of Public Health – “Outbreaks of Gastroenteritis Linked to Social Functions in India: Epidemiological Insights.”
• Ministry of Health and Family Welfare – Health Advisory Guidelines for Summer Season.
• Rituparna Dey, Traditional Indian Approaches to Digestive Health, Journal of Ethnopharmacology, 2021.

Prof Dr Sushil S. Dubey M.D (Hom)
Pt. Jawaharlal Nehru Rajkiya Homoeopathic Medical College and Hospital,
Kanpur, Uttar Pradesh
Email ID – drdubeysushil@gmail.com