DRAFT 1

2.1

Symptoms of General Nausea

2.1.1 The Cause of Nausea
2.1.1.1 Motion Sickness
Some people feel very sick while travelling in an airplane,
boat, train, or car.

This sickness is called motion sickness. The

symptom of motion sickness will start to improve as human body

adapts to the conditions causing the problem. The problems are like
queasy, nausea, vomit and headache. From all of ages, children are
more susceptible to motion sickness than adults. There are lots of
types of motion sickness divided by the transportation they drive, for
example car sickness, sea sickness and others. When we are in
transportation which moves continuously with relatively slow and
prolonged motion, the organ of balance in human ear may be affected,
causing motion sickness. In motion sickness, a discrepancy exists
between the motion that is expected to occur and the actual motion
sensed by the organ of balance in the inner ear. These unexpected
signals translate into confused message by the brain, leading to the
development of symptoms. The important roles of motion sickness are
acetylcholine and dopamine.
2.1.1.2 Pregnancy
Commonly, nausea and vomit cant be separated from
pregnancy. We often call it as morning sickness. Although this is
misnomer because the symptom will often persist throughout the day.
From the Journal of Nausea and Vomiting in Pregnancy, up to 85% of
women experience nausea in early pregnancy with approximately half
of women vomiting as well. On the other hand, gestational vomiting
results from various metabolic and endocrine factors, many of

placental origin. The most implicated factor is human chorionic

gonadotropin (hCG). In addition, nausea and vomiting are often worse
in pregnant women with conditions associated with elevated hCG
levels such as molar pregnancies, multiple gestations, and Down
syndrome. Moreover, a study by Goodwin et al. found that
concentrations of

hCG correlated positively with the severity of

nausea and vomiting in women with HG.

2.1.1.3 Post-Chemoterapy
Based on Nausea and Vomiting Journal, not all cancer patients
will experience nausea, vomiting (emesis), or both. The most common
causes are emetogenic chemotherapy drugs and radiation therapy to
the gastrointestinal (GI) tract, liver, or brain. Several patient
characteristics have also been identified, such as:
2.1.1.3.1 Incidence and severity of

nausea and vomiting

(N&v) during past courses of chemotherapy. Patients with poor

control of N&V during prior chemotherapy cycles are likely to
experience N&V in subsequent cycles.
2.1.1.3.2 History of chronic alcohol use. N&V is less likely in
patients with history of chronic high intake of alcohol
2.1.1.3.3 Age. N&V is more likely in patients younger than 50
years old.
2.1.1.3.4 Gender. N&V and more likely in women
2.1.1.4 Post-operative
Apfel and colleagues identified four risk factors, which can
trigger Post-Operative Induced Nausea, like female gender, motion
sickness, non-smoking status and use of post-operative opioids. Based
on the British Journal of Anaesthesia, the four factors which have been

mention above can increase the likelihood of PONV by 18-22%. The

causes of Post-Operative Induced Nausea are multifactorial. It can be
categorized into three factors such as patient risk factors, anaesthetic
technique, and surgical procedure. Based on the Apfel criteria, patient
risk factors include female gender from puberty, non-smoking status,
previous history of Post-Operative Nausea and Vomiting (PONV) or
motion sickness, and genetic predisposition. Anaesthetic technique
includes the use of inhalation agents, nitrous oxide, large-dose
neostigmine, and intraoperative and postoperative opioid use. The
duration of surgery and different types of surgeries, as the part of
surgical procedure, can affect the cause of PONV. From the research,
the duration of surgeries is unacceptable. However, higher doses of
opioids and longer exposure to inhalation anaesthetic are likely to
occur and are known risk factors of PONV.

Picture .Algorithm for Management of Postoperative Nausea and Vomiting

(Source: Gan, Tong J., etc. 2014. Consensus Guidelines for the Management of
Postoperative Nausea and Vomiting. Anest Analg:118:85-113)

2.1.2

Mechanism of Nausea
In central nervous system, there are three structures which are
considered as a coordination reflex centre of vomiting, which is
called Chemoreceptor Trigger Zone (CTZ), vomiting centre, and

Nucleus Tractus Solitarus (NTS). All of those structure is located in

the areas of brain stem. In case of mechanism of nausea and
vomiting, there are two anatomical regions in the medulla which
takes role in reflex of vomiting, such as CTZ and Central Vomiting
Centre (CVC). CTZ is located in the area of postrema in the caudal
part of the fourth ventricle which is labeled at bottom center, outside
the blood-brain barrier. Receptors in this region are activated by proemetic substances in blood circulation or in the Cerebrospinal Fluid
(CSF). Efferent signals from CTZ are sent to CVC. Then, through the
vagus nerve as a pathway efferent, there was a series of sympathetic
and parasympathetic reaction which ended with vomiting reflex. CVC
is located near the Nucleus Tractus Solutarus (NTS) and around the
formation reticularis of the medulla below the CTZ. Chemoreceptor
trigger zone contains receptors for various neuroactive compounds
which can lead to vomit reflex. Gag reflex stimuli is derived from
gastrointestinal, vestibule-ocular, higher afferent cortical toward
CVC. Then it causes the symptom of nausea, retching and expulsion
of gastric content. In addition, the vomiting center in medulla
oblongata is in the close proximity to other visceral center like the
respiratory and vasomotor center. Four types of receptors are
involved cholinergic, dopaminergic, histaminic and serotonergic.

Picture. Pharmacologist view of emetic stimuli

(Source: Islam, Saeda., Jain. 2004. Post-Operative Nausea and Vomiting (PONV).
Indian Journal Anaesth : 48(4): 253-258)
2.2.2

Anti-Nausea Herbs
2.2.2.1 Ginger (Zingiber officinale)

Picture. Ginger

(Source: http://www.lifehack.org/articles)
2.2.2.1.1 Gingers Habitat (Zingiber officinale)
Zingiber officinale is best known as the source of the
pungent, aromatic spice called ginger. This spice is produced
from the rhizome (underground stem) of the plant. Other spices
in the ginger family (Zingiberaceae) include cardamom
(Elettaria cardamomum) and turmeric (Curcuma longa).
Ginger has been grown in the lowlands to the mountain
700 m above the sea level. Ginger thrives near the flow of

water or wells. Indonesia is one of the best habitat for ginger to

grow.
2.2.2.1.2 Active Compounds in Ginger and Their Properties
Several compounds in ginger (e.g., [6]-gingerol, [6]shogaol, and galanolactone) have been shown to have antiserotonin (5-hydroxytryptamine) effects (Yamahara et al.,
1989; Huang et al., 1991). This may possibly suggest that the
anti-emetic action of either ginger or some of its constituents
may be mediated centrally via 5-HT3 receptors, as these
constituents have small molecular weights and could easily
cross the blood brain barrier. In Suncus murinus (a house musk
shrew), it has been shown that orally administered [6]-gingerol
completely

prevented

vomiting

in

response

to

cyclophosphamide, presumably via a central effect (Yamahara

et al., 1989)
Several authors have shown that ginger is endowed
with strong in vitro and in vivo anti-oxidant properties. The
antioxidant action of ginger has been proposed as one of the

major possible mechanisms for the protective actions of the

plant against toxicity and lethality of radiation and a number of
toxic agents such as carbon tetrachloride and cisplatin and as
an anti-ulcer drug (Siddaraju and Dharmesh, 2007).
2.2.2.13 Method of Extracting the Active Compounds in
Ginger
Based on the thesis of Extraction of Essential Oils from
Ginger Rhizome Using Steam Distillation Method, Aizam
(2006:2) said that

in Zingiber officinale Roscoe, there are

many constituents such as acids, shoagaols, gingerol, essential

oils, fiber, amino acids and minerals. There are two ways of
extraction, that is using steam distillation and solvent
extraction. In order to get oleoresin, solvent extraction
technique is used but to obtain essential oil, steam distillation
technique is used. Steam distillation method is used for
temperature

sensitive

material

like

natural

aromatic

compounds. For this method, there is no solvent is used to

extract the material but pure water is the main component to do
it.
2.2.2.2 Peppermint

Picture. Peppermint Leaves

(sources: http://thebathtubdiva.com/peppermint-power)
2.2.2.2.1 Peppermints Habitat
Peppermint also known as Mentha L. Mentha genus are
widely distributed and can be found in many environments.
Most of them grow best in wet environments and moist soils.
Mints will grow 10-120 cm tall and can spread over an
indeterminate area.
2.2.2.2.2 Active Compounds in Peppermint and Their
Properties
Medicinally, peppermint is used to aid the various
processes of digestion: to combat gas, increase bile flow, heal
the stomach and liver, etc. Its active constituents are found in
its essential oil, mainly menthol, menthone and menthyl
acetate. Menthyl acetate is responsible for peppermints minty
aroma and flavor. Menthol, peppermints main active
ingredient, is found in the leaves and flowering tops of the
plants. The menthol content of peppermint oil determines the
quality of its essential oil. This varies depending upon climate,
habitat and where the peppermint is grown. The oil's
spasmolytic, anti-ulcer, anti-inflammatory, and antibacterial
properties have been experimentally verified (Herman,
1977:2).
Various

constituents

of

peppermint

oil

as

per

monographs of Internation Pharmacopoeia are limonene (1.05.0%),

cineole

32.0%),menthofuran
10.0%),menthyl

(3.5-14.0%),

menthone

(1.0

isomenthone

(1.5-

isopulegol

(max.

acetate

-9.0%),
(2.8-10.0%),

(14.0-

0.2%),menthol (30.0-55.0%), pulegone (max. 4.0%) and

carvone (max. 1.0%). The ratio of cineole content to limonene

content should be minimum two.
More recently, its use has been advocated for transportrelated nausea1 as well as for PONV in children and adults.
Winston (1989:4) found that isopropyl alcohol inhalation
relieved PONV more rapidly than ondansetron 4 mg IV, but a
placebo group was not studied. A randomized, doubleblind,
placebo-controlled study on surgery patients indicate that
initial treatment of postoperative nausea with aromatherapy
reduces patients subjective perception of nausea and IV
antiemetic use in the PACU by nearly 50%.
2.2.2.2.3 Method of Extracting the Active Compounds in
Peppermint
Peppermint oil is extracted from the whole plant above
ground just before flowering. The oil is extracted by steam
distillation from the fresh or partly dried plant and the yield is
0.1 - 1.0 %. Recently on new method was developed by Farid
Chemet et al. for the extraction of essential oils that is much
more faster as compared with the conventional hydro
distillation process.
2.2.2.3 Chamomile

Picture. Chamomile Flower

(Source: http://globe-views.com/chamomile.html)
2.2.2.3.1 Chamomiles Habitat
Chamomile is one of the most ancient medicinal herbs
known

to

mankind.

It

is

member

of Asteraceae/Compositae family. The main natural habitats of

this species are grazed grasslands on cliff-tops, heaths,
commons and village greens with moderately acid clay soils.
At present it thrives in a number of cricket pitches, where
mowing and rolling create ideal short turf conditions
2.2.2.3.2 Active Compounds in Chamomile and Their
Properties
Based on a NCBI jurnal, Chamomile, A Herbal
Medicine of The Past with Bright Future, Srivastava (2011:1)
said that different classes of bioactive constituents are present
in chamomile, which have been isolated and used as medicinal
preparations and cosmetics. The plant contains 0.24%1.9%
volatile oil, composed of a variety of separate oils. When
exposed to steam distillation, the oil ranges in color from
brilliant blue to deep green when fresh but turns to dark yellow
after storage. Despite fading, the oil does not lose its potency.
Approximately 120 secondary metabolites have been identified
in chamomile, including 28 terpenoids and 36 flavonoids. The
principal components of the essential oil extracted from the
German chamomile flowers are the terpenoids -bisabolol and
its oxide azulenes including chamazulene and acetylene
derivatives. Chamomiles essential oil comprises 0.5% to 1.5%
of the flower head. One hundred twenty chemical constituents
have been identified in chamomile, including terpenoids,

flavonoids, and coumar. Chamazulene and bisabolol are very

unstable and are best preserved in an alcoholic tincture. It also
contains farnesene and -pinene. Among flavonoids, apigenin
is the most promising compound. It is present in very small
quantities as free apigenin, but predominantly exists in the
form of various glycosides.
2.2.2.3.3 Method of Extracting the Active Compounds in
Chamomile
From A Herbal Medicine of The Past with Bright
Future Journal, Srivastava et al. (2011: 3) explain that
chamomile is known to be used in various forms of its
preparations.

Dry

powder

of

chamomile

flower

is

recommended and used by many people for traditionally

established health problems. Medicinal ingredients are
normally extracted from the dry flowers of chamomile by
using water, ethanol or methanol as solvents and corresponding
extracts are known as aqueous, ethanolic (alcoholic) and/or
methanolic extracts. Optimum chamomile extracts contain
about 50 percent alcohol. Normally standardized extracts
contain 1.2% of apigenin which is one of the most effective
bioactive agents. Aqueous extracts, such as in the form of tea,
contain quite low concentrations of free apigenin but include
high levels of apigenin-7-O-glucoside.
2.2.2.4 Basil

Picture. Basil Leaves

(source: http://planetforward.ca/ organic-garden-journal-basilexperiment/)
2.2.2.4.1 Basils Habitat
Basil has its unique place to grow. The soil should be
light and slightly acidic. It will achieve the best growth if the
soil is well-drained and nutrient rich having lots of humus and
minerals. The basil can tolerate pH between 4.3 until 8.4.
Commonly, plant needs sunlight, so basil will grow if it get an
enough sunlight and water. Excess of water will not make the
Basil grow because it cant grow in such condition. In
conclusion, basil will grow in the garden.
2.2.2.4.2

Active Compounds in Chamomile and Their

Properties
Basil has long been made into an herbal tea to treat
digestive problems, and has also traditionally been used for its
antiseptic

and

antibacterial

properties.

Herbalists

also

recommend basil to treat a variety of ailments including insect

bites, anxiety, headaches, cramps, nausea and digestion. Basil
has a high economic value due to the presence of specific
substances such as estragol, lineol, linalool, eugenol, methyl
cinamato, limonene and geraniol. From the journal of Basil

Medicine plant, Husein (2011: 2) explain that the various basils

have such different scents because the herb has a number of
different essential oils that come together in different
proportions for various breeds. The strong clove scent of sweet
basil is derived from eugenol, the same chemical as actual
cloves (Fandohan et al., 2008).
2.2.2.43 Method of Extracting the Active Compounds in
Basil
Mostly, basil extracts into an oil for aromatic and
medicinal thing. These species are known specifically for
possessing biological activity, such as antibacterial, antifungal
and antioxidant properties. The molecules inside basil are
extremely sensitive to heat. If there is a contact with heat, the
chemical will changes and occurs some losses of volatile
compounds in higher or lower concentration. Several methods
can be used to this extraction such as conventional methods.
Conventional methods are hydro distillation, steam distillation,
solvent extraction, Soxhlet extraction. It also use the
unconventional method such as supercritical carbon dioxide
extraction.
2.4 Comparisons of Active Compounds in Anti-Nausea Herbs with Others Herbs
Types of
Ginger

Characteristic
Scientific name

Zingiber

Chemical

officinale
Zingiberene,

component

Herbs Plant
Peppermint
Chamomile

Basil

Mentha piperita

Chamaemelum

Ocimum

limonene,

nobile
Terpenoids

basilicum L.
Butylated

cineole,
menthone,

hydroxytoluene
(BHT), Linoleic

bisabolene,
-

farnesne,

menthofuran,

bisabolol,

isomenthone,

chamazulene,

menthyl acetate, acetylene,

n-

hexane,
monoterpene
hydrocarbons,

isopulegol,

farnesene,

menthol,

spiro-ether

pulegone

and quiterpene

carvone.

anhydrous
carbonate,

rins,

gingerones

ammonium
chloroform

coumarins,
apigenin,

ferrous chloride,
thiocyanate,

flavonoids,

and etc.

2,2-

(DPPH),

hydroxycouma

shogaols, and

carotene,

picrylhydrazyl

glycosides,

paradols,

diphenyl-1-

lactones,

gingerols,

acid,

and

mucilage
Anti-

and

methanol

Medicinal

anti-

Antimicrobial

properties

inflammatory,

and

antioxidant

plasmid

and

cancer, anti-viral

and

activities,

antiphlogistic

and anti-bacteria

antiproliferati

postoperative

properties,

properties.

ve activities,

nausea, against anticancer

indicating its

herpes simplex activity,

promising

virus, larvicidal common cold,

role as a

and

chemoprevent

repellent action, conditions, and

ive agent

indisgestion and etc.

Potential
effects

health treatment

anti- inflammatory

antioxidant, anti-

mosquito cardiovascular

etc.
of used in food, used to treat used

such disorders pharmaceutical

as

Antiseptic,

wounds,

supplementary

arthritis, and perfumery ulcers, eczema, treatment

stomach

and flavouring gout,

for

skin stress,

of
asthma

upset, asthma, industry.

Its irritations,

and diabetes

diabetes, and main

bruises, burns,

menstrual

constituent,

canker

irregularities,

menthol, is used neuralgia,

to

name

few.

a in

sores,

the sciatica,

Ginger manufacture of rheumatic pain,

may alleviate lozenges,

hemorrhoids,

the symptoms toothpastes,

mastitis

and

of nausea and pain balms, cold other ailments.

vomiting

balms,

Dabur

following

Pudin Hara, etc.

pregnancy,
surgery,
cancer
therapy

and

etc.
Tabel 1. Perbandingan karakteristik tanaman herbal anti-nausea
(Source: reproduced)
References
Aizam, Khairu. 2006. Extraction of Essential Oils from Ginger Rhizome Using Steam
Distillation Method. Thesis of Chemical and Natural Resources Engineering,
University College of Engineering & Technology Malaysia.
Keith. 2010. Ginger: An Overview of Health Benefits. Journal of Food and Science:
Volume 45: pp 171-183.
Alankar, Shrivastava. 2009. A Review on Peppermint Oil. Asian Journal of
Pharmaceutical and Clinical Research : Volume 2: Issue 2.
Srivasta, Janmejai K., Shankar. E, Gupta, S. 2010. Chamomile: A Herbal Medicine of
The Past With Bright Future. NCBI Journal : 3(6): 895-901

Tilebeni, Hossein Gholami. 2011. Review to Basil Medicinal Plant. International

Journal of Agronomy and Plant Production : Volume 2 (1): 5-9
Ali, Badrekin., Blunden, Gerald., Tanira, Musbah. 2007. Some Phytochemical,
Pharmacological and Toxicological Properties of Ginger (Zingiber officinale
Roscoe): AReview of Recent Research. Journal of Food and Chemical
Toxicology: 46 : 409-420.
Ernst, E., Pitler, M. H. 2000. Efficacy of Ginger for Nausea and Vomiting: A
Systematic Review of Randomized Clinical Trials. British Journal of
Anaesthesia: 84(3):367-71.
Khresheh, Reham. 2011. How Women Manage Nausea and Vomiting During
Pregnancy : a Jordanian Study. Journal of Maternal and Child Health :
27:42-45
Andrykowski MA, Gregg ME.1992. The role of psychological variables in postchemotherapy nausea: anxiety and expectation. Psychosom Med 54 (1): 4858