Review of Medicinal Plants Traditionally Used to Treat Diarrhea by the People in the Amhara Region of Ethiopia

Background Diarrheal illness is the second-most common cause of death in under-five children. Worldwide, it results in about 1.7 billion illnesses and 525,000 deaths among under-five children annually. It is the leading cause of malnutrition among under-five children. Different people use medicinal plants to treat diarrhea. The present study aimed to review the medicinal plants used to treat diarrhea by the people in the Amhara region and to diagnose whether the antidiarrheal activities of the medicinal plants have been confirmed by studies using animal models. Methods The author searched 21 articles from worldwide databases up to December 2022 using Boolean operators (“AND” and “OR”) and the terms “ethnobotanical studies,” “ethnobiology,” “traditional medicine,” “ethnobotanical knowledge,” and “Amhara region.” Results From the 21 studies reviewed, 50 plant species grouped into 28 families were reported to treat diarrhea by the people in the Amhara region. The top most used families were Lamiaceae (12%), Fabaceae (8%), Asteraceae, Cucurbitaceae, Euphorbiaceae, and Poaceae (6% each). The modes of administration of the plant parts were orally 98.88% and topically 1.12%. The different extracts of 18 (or 36%) of the medicinal plants traditionally used to treat diarrhea by the people in the Amhara region have been proven experimentally in animal models. Conclusions The people in the Amhara region use different medicinal plants to treat diarrhea. Most of them take the medicinal plants orally. The traditional claim that 60% of medicinal plants are antidiarrheal has been confirmed in in vitro studies.


Background
Diarrhea is the second leading cause of under-fve mortality in the world [1].In 2019 alone, diarrheal diseases resulted in 6.58 billion incident cases, 99 million prevalent cases, 1.53 million deaths, and 80.9 million disability-adjusted life years (DALYs) [2].Among under-fve children, diarrheal diseases resulted in 45.5 million DALYs and 370,000 deaths in 2019 [1,2].Tere are three clinical types of diarrhea, namely, acute watery diarrhea, which may last several hours or days and includes cholera; acute bloody diarrhea, also called dysentery; and persistent diarrhea, lasting 14 days or longer [1].
Te Amhara region in Ethiopia experiences varying rates of diarrhea prevalence among under-fve children, as indicated by several studies.A systematic review and metaanalysis published in PLOS ONE found that the overall prevalence of diarrhea in the region was 21%, which closely aligns with the national prevalence of 22% [3].However, individual studies conducted in specifc areas within the Amhara region showed diferent prevalence rates.For example, studies in Bahir Dar city reported a prevalence of 14.5% [4], while Farta district showed a higher prevalence of 29.9% among under-fve children [5].Other areas such as Jawi district, Debre Berhan town, Woldia town, Bahir Dar Zuria district, the rural area of the North Gondar zone, and food-prone villages of the Fogera and Libo Kemkem districts also exhibited varying prevalence rates ranging from 15.5% to 29.0% [6][7][8][9][10].Interestingly, a report suggested that there was no signifcant variation in prevalence between high and low hotspot districts in the region [11].By integrating the wisdom and methodologies of traditional and modern medicine, a comprehensive and holistic healthcare approach can be established to prevent and treat diarrheal diseases in the Amhara region.Tis collaborative approach has the potential to improve the overall efectiveness of the healthcare system and advance the well-being of the local population.
Herbal medicines are believed to be efective in curing diarrhea, and for many years, plants and plant extracts have been used to treat various gastrointestinal ailments, including diarrhea [12,13].However, herbal medicines used in the treatment of diarrhea in African rural communities are unlikely to be replaced soon by modern medicines [14].
Nowadays, the integration of herbal medicine into modern medical practices is highly advocated [15].Furthermore, herbal medicines have active components that serve as prototype leader compounds for the development of new drugs [16].Documenting herbal medicines is thus documenting future drugs.Its ecological and cultural diversity make Ethiopia a rich source of herbal medicine [17].However, due to environmental degradation, deforestation, a lack of recordkeeping, and potential acculturation, the plants and related indigenous knowledge in the nation are steadily diminishing [18].Terefore, documentation of traditional knowledge regarding the usage of medicinal herbs is crucial to ensure its use by both present and future generations [19].Hence, the present study aims to document medicinal plants from the Amhara region of Ethiopia that is traditionally used to treat diarrhea.

Research Methodology
2.1.Purpose.Documentation of medicinal plants of antidiarrheal importance is essential for local knowledge conservation, formulating antidiarrheal drugs from plant extracts, and the isolation of interesting compounds to synthesize future efective antidiarrheal drugs.

Eligibility Criteria.
Te present study included articles written in English and published until December 2022 dealing with the documentation of indigenous knowledge and articles that possess the scientifc names, family names, local names, plant parts used, routes of administration, the way of using plants, and the modes of preparation.

Quantitative Analysis of Ethnobotanical Data.
Since the study is a review study, the author faced problems searching for data to compute many of the quantitative parameters.Accordingly, only relative frequency of citation (RFC) and family use value (FUV) are found to be applicable to this study.Tey were calculated using the following formulae: RFC � Number of citations to a species Total number of citations to all the species , FUV � The number of species in each family used to treat diarrhea Total number of species in all the families used to treat diarrhea . (1)

Identifcation of Relevant Articles.
A literature search by the authors turned up a total of 120 published papers.21 articles were chosen for this review after removing duplicates and irrelevant articles (Figure 1).

Gap Analysis of Whether the Traditional Claims
Evidence-Based Complementary and Alternative Medicine  Te juice of the root is taken orally [34] Evidence-Based Complementary and Alternative Medicine    2).Terefore, future research studies can test their effectiveness against castor oil-induced diarrhea in animal models.

Discussion
Traditionally, the people in the Amhara region use diferent plants to treat diarrhea.In the following paragraphs, the plants used to treat diarrhea, their active components, their mechanisms of action, and, if confrmed, in vivo trials are discussed.
Acacia etbaica Schweinf and Acacia abyssinica may contain a variety of secondary metabolites, including alkaloids, favonoids, tannins, saponins, anthraquinones, triterpenes, and glycosides, as shown in Acacia etbaica [59].Acacia nilotica Willd's bark methanol extract demonstrated in vivo antidiarrheal activity against castor oil and magnesium sulfate-induced diarrhea, as well as barium chlorideinduced peristalsis, using Swiss albino mice.It also exhibited in vitro antimicrobial activity against common diarrheacausing microorganisms [60].Similar efects could be attributed to Acacia etbaica and Acacia abyssinica extracts.Te antidiarrheal activity of Acacia etbaica and Acacia abyssinica is likely attributed to their ability to modulate intestinal motility, preserve intestinal mucosal integrity, promote fuid absorption, activate antioxidant pathways, exert antiinfammatory efects, demonstrate antimicrobial activity against diarrheal pathogens, suppress intestinal secretion, and modulate gut microfora.
Anogeissus leiocarpa (A.Rich) Guill and Perr's bark decoction is drunk to treat diarrhea [23].Its aqueous leaf extract signifcantly inhibited castor oil-induced diarrhea in rats through the inhibition of intestinal transit and reduction of the volume of the intestinal content [62].Tis efect may be attributed to the activities of its components such as alkaloids, favonoids, saponins, tannins, phenols, and glycosides [63], which act as its active constituents.
Te fresh leaves of Balanites aegyptiaca (L.) Delile are crushed, and the juice is swallowed to treat diarrhea [21].Te antidiarrheal activities of this plant may be attributed to its phytochemicals such as saponins, coumarins, triterpenes, tannins, and steroids [65].
Te leaves, seeds, and fruits of Calpurnia aurea (Ait) Benth (Fabaceae) are applied to treat diarrhea.Te antidiarrheal activity of the 80% methanol extract of this plant has been proven by its efect on castor oil-induced diarrhea in mice, which signifcantly reduced the time of onset of diarrhea, the frequency of defecation (total number of fecal output), and the weight of feces.Te extract also showed good antimicrobial activity against all tested organisms [41].Te antidiarrheal activities of this plant may be attributed to its secondary metabolites, including alkaloids, tannins, favonoids, saponins, steroids, and phlobatannins [66].
Te roots and leaves of Carissa spinarum L. (Apocynaceae) are utilized for managing diarrhea.Its potential antidiarrheal properties may be attributed to its bioactive constituents, such as acids, glycosides, terpenoids, alkaloids, tannins, and saponins [67].Te juice of the fresh leaves of Clutia abyssinica Jaub and Spach is taken orally as a remedy for diarrhea.Tis practice is supported by an in vivo study, where its hydromethanolic root extract signifcantly delayed the onset of diarrhea and reduced the number of wet and total stools in a castor oil-induced diarrheal model [42].Conversely, the crushed roots of Clutia  Evidence-Based Complementary and Alternative Medicine Evidence-Based Complementary and Alternative Medicine lanceolata Forssk (Euphorbiaceae) are applied to the neck to treat diarrhea [20].Te antidiarrheal activities of this plant may be attributed to its secondary metabolites, including 5methylcoumarins, diterpenes with a secolabdane skeleton, essential oils, alkaloids, anthraquinones, cardiac glycosides, favonoids, phenolics, saponins, steroids, tannins, and terpenoids [68].
Te dried seeds and fruits of Cofea arabica L. are used in cofee preparations mixed with honey, which is taken orally to treat diarrhea.Te antidiarrheal activity of C. arabica was confrmed by an in vivo study against castor oil-induced diarrhea in Swiss albino mice [43].Cofee's antidiarrheal efects are likely attributed to its bioactive constituents, such as chlorogenic acids and catechins [69].
Te dried root bark of Cordia africana (Boraginaceae) is macerated and taken orally once daily to treat diarrhea.Tis practice has been supported by an in vivo study, where C. africana prevented castor oil-induced diarrhea and regulated intestinal motility [44].Tis efect may be due to the individual, additive, or synergistic activities of its active components, such as favonoids, alkaloids, tannins, terpenoids, saponins, steroids, anthraquinones, carbohydrates, and proteins [70].
Te dry leaves of Croton macrostachyus De. (Euphorbiaceae) are powdered, mixed with water, and taken orally to treat diarrhea [34].In the castor oil-induced model, the chloroform and methanol fractions of this plant signifcantly delayed diarrheal onset and decreased stool frequency and weight of feces [45].Its activity may be due to individuals or combinations of its active components, such as favonoids, alkaloids, tannins, saponins, terpenoids, and phenols [71].
Te fresh root juice of Cucumis fcifolius (Cucurbitaceae) is taken orally to treat diarrhea.Te Cucurbitaceae family is rich in terpenoids, glycosides, alkaloids, saponins, tannins, and steroids [72].Te antidiarrheal activities of this plant may be attributed to the mentioned secondary metabolites.
Chewing the dry roots of Ficus thonningii Blume is practiced to treat diarrhea.Te antidiarrheal activity of this plant may be due to its phytochemicals such as tannins, favonoids, saponins, and anthraquinone glycosides [46].
Heteromorpha arborescens (Spreng.) is utilized to treat diarrhea which may be due to its active components such as phenols, proanthocyanidins, favonoids, alkaloids, and saponins [74].Justicia schimperiana (Hochst.ex Nees) T. Anders is used for the treatment of diarrhea that may be due to its active components, such as favonoids, alkaloids, glycosides, phenols, saponins, steroids, and terpenoids [75].
Te traditional application of Leonotis ocymifolia for diarrhea treatment is supplemented by a study conducted in Ethiopia.According to this study, 80% methanol leaf and fruit extracts of L. ocymifolia reduced the frequency of wet stools, the watery content of diarrhea, and delayed the onset of diarrhea [47].Its antidiarrheal activity may be attributed to its chemical constituents, such as phenolics, favonoids, and alkaloids [76].Linum usitatissimum L. has traditionally been used to treat diarrhea, and this may be due to its components such as methyl linolenate, methyl linoleate, α-linolenic acid, α-terpinene, terpinen-4-ol, 4-cymene, and α-pinene [77].
Similarly, the leaves of Myrtus communis L. [34] are utilized for the treatment of diarrhea.Te traditional claim was confrmed by a study where the 80% methanol extract, as well as the chloroform (CF) and methanol (MF) fractions, of this plant signifcantly prolonged the onset of diarrhea, reduced the frequency of bowel movements, and decreased fecal output weight [49].Tese antidiarrheal properties can be attributed to the presence of active components, including polyphenols, myrtucommulone, semimyrtucommulone, 1,8-cineole, α-pinene, myrtenyl acetate, limonene, linalool, and α-terpinolene [80].
Te fresh leaves of Ocimum lamiifolium L. are used to manage diarrhea by boiling them with tea and consuming a cup of the prepared infusion.Tis was corroborated by an in vivo study in which the 80% methanol extract and fractions of this plant demonstrated a substantial impact on the fuid content of feces across all tested doses.Additionally, the n-butanol and distilled water fractions exhibited signifcant efects on the onset of diarrhea, whereas the nhexane fraction displayed noteworthy efects on the number of wet feces, onset of diarrhea, and fuid content of feces at all tested doses [50].Te antidiarrheal activities of this plant may be attributed to its phytocomponents, such as tricyclene, bornyl acetate, α-pinene, α-terpinene, isoledene, and β-pinene.
Te roots and leaves of Plectranthus lactiforus (Vatke) Agnew are mixed with water, and the fltrate is consumed to treat diarrhea.Te antidiarrheal activities of this plant may be attributed to its active components such as carvacrol, c-terpinene, caryophyllene, p-cymene, transα-bergamotene, and thymoquinone [81].Te fesh fruit bark of Punica granatum is consumed to combat severe diarrhea [32].Its aqueous extract displayed antidiarrheal activities against castor oil-induced diarrhea in rats [51] which may be due to its chemical components, such as hydrolyzable tannins (punicalin, punicalagin, ellagic acid, and gallic acid) and favonoids (anthocyanins and catechins) [82].
Te crushed dry roots of Rumex nepalensis (Spreng) are taken orally to treat diarrhea [38].In an in vivo study, its hydromethanolic extract markedly delayed the onset of 14 Evidence-Based Complementary and Alternative Medicine diarrhea and reduced the weight of wet and total feces at the test doses in a castor oil-induced diarrheal model [83].Te possible antidiarrheal activities of this plant may be related to its active components such as anthraquinones, naphthalenes, stilbenoids, favonoids, terpenoids, phenols, and their derivatives [84].
Te fresh leaves of Ruta chalepensis L. together with salt are chewed to treat diarrhea.Its hydromethanol (80% ME) extract prolonged the onset of diarrhea in mice and signifcantly reduced the frequency of stooling and weight of feces in a castor oil-induced diarrheal model [52].Te antidiarrheal activity of this medicinal plant may be ascribed to its chemical constituents such as 2-undecanone, piperonyl piperazine, 2-decalone, 2-dodecanone, decipidone, and 2tridecanone [85].Te fresh roots of Salvia nilotica Jacq.are crushed and taken orally to treat diarrhea.Te hydroalcoholic extract of another Salvia species (S. schimperi) exerted signifcant and dose-related antidiarrheal activity [86].Te antidiarrheal activity of this plant may be related to its constituents, including β-phellandrene, δ-3-carene, and caryophyllene oxide, which may have antidiarrheal properties [87].
Te dried leaves of Solanum nigrum L. are crushed and chewed, and the juice is swallowed to treat diarrhea.Te methanol extracts of the roots and leaves of another Solanum species (S. asterophorum Mart) signifcantly and doserelatedly inhibited the frequency of both solid and liquid stools in mice [90].Its components, such as steroidal saponins, steroidal alkaloids, favonoids, coumarin, lignin, organic acids, volatile oils, and polysaccharides [91], may contribute to the antidiarrheal activity of S. asterophorum.
Traditionally, the seed powder of Sorghum bicolor (Moench) is taken orally to treat diarrhea.An in vivo evaluation of the 80% methanol crude extract of the seeds of this plant in mice demonstrated inhibitory activity against castor oil-induced diarrhea, castor oil-induced enteropooling, and castor oil-induced gastrointestinal transit [53].Te antidiarrheal activity of this plant may be linked to its active constituents such as proteins, lipids, ash, calcium, copper, iron, zinc, gallic acid, and ferulic acids [92].
Te dry roots of Stephania abyssinica (Dillon and A. Rich) Walp are chewed to treat diarrhea.Te traditional claim was also evaluated in an in vivo study in mice using castor oil-induced diarrhea, which signifcantly prolonged the time of diarrheal induction, increased diarrhea-free time, reduced the frequency of diarrhea episodes, decreased the weight of stool, and decreased the general diarrheal score in a dose-dependent way [54].Te antidiarrheal activities of S. abyssinica could be attributed to the active components, including alkaloids, favonoids, lignans, steroids, terpenoids, and coumarins [93].
Te dry root of Verbascum sinaiticum Benth and Verbena ofcinalis L. is crushed and drunk with water to halt diarrhea.Te traditional claim for the antidiarrheal activity of this plant has not yet been tested.Te antidiarrheal activities of this plant may be attributed to its active compounds, such as sterols, saponins, favonoids, phenylethanoids, and iridoid glycosides [95].To treat diarrhea, the root decoction of Vernonia adoensis Sch.Bip.exWalp is taken orally [23].Its active components phenols, saponins, favonoids, glycosides, and tannins [96] may contribute to the antidiarrheal activities of this plant.
Fresh/dry leaves of Withania somnifera (L.) Dunal are crushed or squeezed and taken orally to treat diarrhea [29,38].In Swiss albino mice, an 80% methanol extract and solvent fractions of the leaves of this plant have been found to signifcantly delay the onset of diarrhea, decrease the number and weight of stools, reduce the volume and weight of intestinal contents, and decrease the motility of charcoal meal [56].Te antidiarrheal activity of this plant may be attributed to its active compounds, such as withanolides, condensed tannins, favonoids, glycosides, free amino acids, alkaloids, steroids, volatile oils, and reducing sugars [97].
Acacia etbaica, Acacia abyssinica, Anogeissus leiocarpa, Balanites aegyptiaca, Calpurnia aurea, Carissa spinarum, Clutia lanceolata, Cordia Africana, Croton macrostachyus, Cucumis fcifolius, Ficus thonningii, Punica granatum, Senna didymobotrya, Vernonia adoensis, and Withania somnifera contain tannins in their active components.Subsequently, they treat diarrhea by preserving intestinal mucosal integrity.Tannins are known for their astringent properties, which allow them to bind and precipitate proteins.Tis astringency can potentially result in the reduction of infammation and mucosal irritation.Te astringent properties of tannins have been suggested as a possible mechanism underlying their antidiarrheal efects.By decreasing intestinal secretions and promoting the tightening of the intestinal mucosa, tannins may contribute to the alleviation of diarrhea [105,121].
Essential oils in medicinal plants exhibit antimicrobial properties, targeting pathogens involved in diarrhea, while their anti-infammatory efects can reduce gut infammation.Furthermore, essential oils with antispasmodic activity relax smooth muscles, thereby reducing bowel spasms and the frequency of bowel movements.Some essential oils enhance fuid absorption, resulting in frmer stools and decreased diarrhea.Additionally, essential oils may have a modulating efect on the gut microbiota [127][128][129][130][131].
Cofee is rich in various polyphenols, such as chlorogenic acids and catechins, which possess antioxidant and antiinfammatory properties [69].Tese polyphenols demonstrate notable antidiarrheal properties through diverse mechanisms.One signifcant mechanism involves their antimicrobial activity [132], as well as their antiinfammatory efects within the gastrointestinal tract, which help attenuate gut infammation, a contributing factor to the occurrence of diarrhea.Additionally, polyphenols can modulate intestinal motility [133].
Phenols in Croton macrostachyus, Eragrostis tef, Heteromorpha arborescens, and Leonotis ocymifolia possess antimicrobial properties and can alleviate infammation in the gastrointestinal tract, which is a contributing factor to diarrhea.Tey also infuence intestinal motility, help mitigate 16 Evidence-Based Complementary and Alternative Medicine toxin-induced diarrhea, and contribute to restoring the balance of fuid and electrolytes by enhancing their absorption [69,[132][133][134][135].Certain steroids, including glucocorticoids in Justicia schimperiana, have been demonstrated to possess antiinfammatory properties [136].Tese properties can be advantageous in the management of conditions associated with diarrhea, such as infammatory bowel disease.By mitigating infammation within the gastrointestinal tract, steroids contribute to the modulation of diarrhea symptoms.
Unsaturated fatty acid methyl esters (methyl-9-octadecenoate, methyl-8,11-octadecadienoate, and methyl-9,12,15octadecatrienoate) in Momordica foetida Schumach have shown potential anti-infammatory efects and the ability to modulate infammatory pathways [140,141].Tese compounds thereby have the potential to ameliorate gastrointestinal infammation commonly associated with diarrhea.Additionally, they may possess antioxidant properties [142], which can safeguard the gastrointestinal mucosa, mitigate oxidative stress, and modulate immune responses.Tese combined efects have the potential to contribute to the management of diarrhea.
Hydrolyzable tannins in Punica granatum (punicalin, punicalagin, ellagic acid, and gallic acid) and favonoids (anthocyanins and catechins) have shown antimicrobial properties, potentially aiding in the elimination of bacteria, viruses, or parasites that can cause diarrhea [150,151].Additionally, their anti-infammatory efects [152][153][154] may help alleviate infammation in the gastrointestinal tract, which can be a contributing factor to diarrhea.Furthermore, their antioxidant activity [152,155] could play a role by protecting the gastrointestinal mucosa from oxidative damage and helping to prevent or manage diarrhea.
Anthraquinones in Rumex nepalensis exert their antidiarrheal efects predominantly through the inhibition of intestinal motility [156], thereby reducing the frequency and intensity of bowel movements associated with diarrhea.
Phytochemicals in Ruta chalepensis such as 2-undecanone, piperonyl piperazine, 2-decalone, 2-dodecanone, decipidone, and 2-tridecanone [85] may exhibit notable antimicrobial properties, thereby exerting inhibitory efects against diarrhea-causing pathogens, encompassing bacteria, viruses, or parasites.Moreover, these compounds could modulate intestinal motility, potentially ameliorating hypermotility and reducing the frequency of bowel movements associated with diarrhea.Additionally, the presence of antispasmodic properties among these compounds might contribute to the attenuation of intestinal spasms, thereby alleviating abdominal cramping and ameliorating diarrhea-related symptoms.Furthermore, their anti-infammatory properties could potentially play a role in mitigating infammation within the gastrointestinal tract, consequently aiding in the management of diarrhea.Lastly, the possibility of interference with ion transport in the intestines by these compounds may infuence fuid balance regulation, thus afording relief from diarrhea symptoms.
Lignin in Solanum nigrum possesses insoluble fber characteristics, thereby enhancing stool bulk and viscosity, which in turn promotes regular bowel movements and potentially reduces the incidence of loose stools [160].Te increased fecal bulk facilitates the expulsion of toxins and pathogens from the intestines.Moreover, lignin acts as a prebiotic [161], providing nourishment to benefcial gut bacteria that produce short-chain fatty acids (SCFAs), including butyrate.Tese SCFAs are pivotal in maintaining intestinal integrity and mitigating intestinal infammation.Furthermore, lignin exhibits antioxidant properties [162], enabling it to scavenge harmful free radicals, potentially ameliorating oxidative stress in the gastrointestinal tract, and safeguarding the integrity of the intestinal mucosa.
Zinc in Sorghum bicolor exhibits diverse mechanisms in its potential antidiarrheal activities.It plays a vital role in preserving the integrity of the intestinal barrier by facilitating the repair of damaged intestinal epithelial cells [163] and reinforcing tight junctions, thus preventing the escape of water and electrolytes into the intestinal lumen and consequently reducing the severity and duration of diarrhea.Additionally, zinc regulates ion transport across the intestinal epithelium, curbing excessive fuid secretion by modulating the activity of specifc ion channels and transporters involved in fuid secretion [164].Tis restoration of ion transport balance normalizes fuid absorption and diminishes stool volume during diarrhea.Furthermore, zinc exerts immunomodulatory efects which are frequently elevated during diarrheal episodes [92].Trough the mitigation of the infammatory response [165], zinc contributes to the resolution of diarrhea.Additionally, zinc exhibits direct antimicrobial properties [166], particularly against Evidence-Based Complementary and Alternative Medicine enteropathogens such as Escherichia coli, rotavirus, and Giardia lamblia, efectively inhibiting their proliferation and growth.Tus, zinc aids in the management of infection and alleviation of diarrhea symptoms.
Caryophyllene oxide in Syzygium guineense exerts potential antidiarrheal activity through various mechanisms.Its anti-infammatory properties [167] reduce gastrointestinal tract infammation, thereby alleviating diarrhea symptoms.Caryophyllene oxide also exhibits antimicrobial efects [159] against specifc bacteria and parasites, aiding in infection control and diarrhea resolution.Additionally, its antioxidant properties [168] counteract harmful free radicals, mitigating oxidative stress and safeguarding intestinal cells, thus contributing to diarrhea management.
Withanolides in Withania somnifera are recognized for their anti-infammatory and immunomodulatory properties [169], which have the potential to mitigate infammation in the gastrointestinal tract and modulate immune responses implicated in the pathogenesis of diarrhea.

Conclusion
Many plants from the Amhara region in Ethiopia exhibited potential antidiarrheal activities, which can be attributed to their diverse secondary metabolites, including alkaloids, favonoids, tannins, saponins, terpenoids, glycosides, and phenolics.Among the top ten cited plants, Calpurnia aurea contains alkaloids that interact with opioid receptors, reducing bowel movement frequency.Verbena ofcinalis contains favonoids that modulate intestinal motility, promote fuid absorption, activate antioxidant pathways, exert anti-infammatory efects, and exhibit antimicrobial activity against diarrheal pathogens.Cofea arabica is rich in polyphenols (chlorogenic acids and catechins) with antimicrobial and anti-infammatory properties, which modulate intestinal motility and attenuate gut infammation.Lepidium sativum contains terpenoids that modulate intestinal motility, promote fuid absorption, exert anti-infammatory efects, exhibit antimicrobial activity against diarrheal pathogens, suppress intestinal secretions, and modulate gut microfora.Artemisia abyssinica's germacrene D exhibits antimicrobial efects against diarrhea-causing pathogens.Carissa spinarum contains alkaloids, favonoids, glycosides, and terpenoids, which may modulate intestinal motility and promote fuid absorption.Leonotis ocymifolia contains terpenoids that modulate intestinal motility, promote fuid absorption, exert antiinfammatory efects, and possess antimicrobial activity against diarrheal pathogens.Ruta chalepensis contains 2undecanone, piperonyl piperazine, and other compounds with antimicrobial properties, antispasmodic efects, antiinfammatory properties, and potential interference with ion transport in the intestines.Verbascum sinaiticum contains favonoids, saponins, glycosides, and terpenoids, which may modulate intestinal motility, promote fuid absorption, exert anti-infammatory efects, and exhibit antimicrobial activity against diarrheal pathogens.Withania somnifera's withanolides exhibit anti-infammatory and immunomodulatory properties, mitigating infammation in the gastrointestinal tract and modulating immune responses involved in diarrhea.

Figure 1 :
Figure 1: Flowchart of the screening process for this review.

30 ]
leaf, mix it with A. sativum and R. chalepensis, and then drink are boiled with tea, and then one cup of the mixture is drunk [

32 ]
in water and allowed to germinate before being dried, roasted, and pulverized.Te powder is then heated in water and drunk till the pain subsides soaked in water and made to germinate, dried, roasted, and powdered.Ten the powder is boiled in water and drunk until relief is obtained [Eragrostis tef.(Zucc.)Trotter is roasted, powdered, mixed with honey, and one or two spoons are taken in the morning for three days is roasted, powdered, mixed with honey, and one or two spoons are taken in the morning for three days . Plant parts used (Fb � fruit bark, Fr � fruit, L � Leaf, R � root, Rb � root bark, S � seed, and Sb � stem bark).

Figure 3 :
Figure 3: Family use values of 12 of the 28 families.

Figure 4 :
Figure 4: Plant parts used for the treatment of diarrhea.Note: plant parts used (Fb � fruit bark, Fr � fruit, L � Leaf, R � root, Rb � root bark, S � seed, and Sb � stem bark).

Table 1 :
List of plants identifed and reported to be used to treat diarrhea in the study area.

Table 2 :
In vivo trials of medicinal plants to confrm the traditional claim of their utilization in treating diarrhea.