Aznan LeloDep. Farmakologi & Terapeutik,

Fakultas KedokteranUNIBA

7 September 2011, UNIBA, Batam

Relationship between herbal and modern medicine

Herbal Medicines

................. Not all that is natural is harmless

Why do people use herbal medicines?

• Used in developing countries where cost of drugs is prohibitive, poor accessibility to drugs in rural areas, shortage of physicians

• Perception that natural = safe• “More” ADRs reported with conventional

medicines than herbal preparations• Provide a sense of control, a mental comfort from

taking action e.g. cancer, AIDS• Cultural & religious beliefs• Use differs by ethnic group, income, age &

educational level

PROBLEMS FACED BY THE TRADITIONAL MEDICINE

1. Pharmaceutical assessment (crude plant material, plant preparations, finished products, stability).

2. Safety assessment (toxicological studies, documentation of safety based on experience).

3. Assessment of efficacy and intended use (pharmacological activity, evidence required to support indication).

4. Product information to consumers.5. Marketing

Fig. 1 Patient INR Values

8/18

7/27

4/5

2/16

11/1010/8

11/7

8/29 9/7

8/7

8/26/30

5/26

12/15/991/12/00

0

1

2

3

4

5

10/17 12/6 1/25 3/15 5/4 6/23 8/12 10/1 11/20Date

INR

val

ue

Tea Taken

/99 /00

From: Lam AY, Mohutsky MA and Elmer GW. Probable herbal/drug interaction between warfarin and a common Chinese herb, Lycium barbarum. Ann Pharmacother 2001;35:1199-1201

The Herbal Treatment of Diseases

• Phytotherapy (Herbal medicine), the natural therapies, by contrast, aims not to ‘cure’ disease by a technological fix.

• The nature in totality, is the expression of a universal harmony and equilibrium the rupture of which gives rise to numerous ill effects.

8

Medicinal HerbsThe Whole better than part.

• Powerful ingredients.• Only 15% of estimated plant

species on earth have been investigated for possible Medicinal uses.

• The world Health organization estimates that 80% of the earth population today depends on plants to treat common ailments.

• Traditional Healers are good resources for scientific based research.

POISONOUS PLANT AND SAFE MEDICINE

*Straightforward definition of a “poisonous plant”.

*The major poisonous principles found among plants are organic compound.

*Herbal medicines are to be prescribed with greatest care.

How would you advise?

• More than 95 % of the population in the least developing countries use herbs for health and other purposes.

• More than one third of Americans and Europeans use herbs for health purposes, spending over 7.0 billion annually.

• More than 25 % of modern pharmaceutical drugs have botanical origins.

WHAT – IF?

What if a patient who has the human immunodeficiency virus has an increasing viral load and ask your advise about a medicinal herb for his case?

What if you don’t have access to Amanatadine for prevention and treatment of Influenza A?

What if you are located in an area where medicinal herbs are used intensively by public?

Herbal Materia Medica <4>ST JOHN’S WORT

• Constituents: *Red pigment, Resin, Volatile oil

Carotenes,Taninnin, Flavanoide(inc.hypericin).• Common use : Antidepressant.• Investigational uses:Anticancer , antiviral (including

human immunodeficiency virus).• Side effects : photosensitivity (rare,with large dose.• It is named after St John’s the Baptist because it

blooms around his feast day.

Sources of information and acknowledgments

• This lecture draws extensively from material presented on the European Journal of Herbal Medicine , the British journal of phytotherapy and the America’s guide to natural Health.

• In particular, the summaries of information on materia medica is gratefully acknowledged.

• Students are encouraged to explore the Supercourse site (I.prevention).

Anxiety complementary and alternative interventions are

currently being used to treat anxiety and anxiety disorders will be grouped (in this article)as follows:

• herbal interventions• nutritional supplements and aromatherapy• cognitive interventions, including mindfulness-

based stress reduction (MBSR) and meditation• physical interventions such as acupuncture

Herbal Interventions, Nutritional Supplements and Aromatherapy

• Werneke et al. conducted an extensive database search and identified 2007 studies of herbal remedies and nutritional supplements in the treatment of psychiatric disorders.

• The authors found that kava (Piper methysticum) was the most researched remedy for anxiety and that there was good evidence for its anxiolytic effect.

• A Cochrane review reported by Pittler and Ernst which included 11 RCTs involving 645 patients, showed that kava is the only herbal remedy that has been proven to be effective in reducing anxiety

Depression Complementary and alternative treatments

for depression and depressive disorders discussed in this report are grouped into the

following categories:• herbal interventions• nutritional supplements and aromatherapy• cognitive interventions including

hypnotherapy, CBT and mindfulness-based cognitive therapy

• physical interventions, including acupuncture and light therapy.

Herbal Interventions, Nutritional Supplements and Aromatherapy

A recent review reported by Ernst indicated that St John's wort (Hypericum perforatum) is the only herbal remedy found to be effective as a treatment for mild to moderate depression. The

author discussed a previous meta-analysis published in German language by Roder et al. In five trials involving 2231

patients that compared St John's wort with conventional antidepressants, Roder et al. found both approaches to be equally effective. St John's wort was significantly effective

when compared with placebo in 25 trials involving a total of 2129 patients.

Ernst cautioned against using St John's wort with other medications because it can increase the plasma levels of a

range of drugs and there is a possibility that it can occasionally trigger psychosis in patients who are using selective serotonin

reuptake inhibitors.

CAMHerbal remedies in cancer

HAI conference 2007Patricia Fox

School of Nursing, Midwifery & Health Systems, UCD

CAM prevalence in haematological cancers (Molassiotis et al. 2005)

• European study:12 countries (n=68) Lmts*– 26.5% use some form of CAM– Most common therapies used:

• homeopathy (38.9%), • herbal medicine (22.2%)• various psychic therapies, such as use of mediums,

healers, rebirthing (22.2%)• Reasons for use:

– Increase ability of their body to fight cancer and improve physical/emotional well-being.

Herbal supplements: potentially dangerous misconceptions

• Some patients may believe – that if a practice or product has been in use for hundreds

of years, it must be effective

• Many also believe– that if a product is ‘natural’, it must be safe

(Smith & White 2001)

Herbal supplements

• Herbs and Natural Products– With potential to decrease cancer growth or as adjuvants

(preliminary evidence only often based on in vitro/animal studies) no recommendations can be made to patients at this time.

– With potential to decrease side effects – That may increase cancer growth or recurrence– That can interact with conventional treatment and

medications

Patricia Fox, UCD, 2007

Herbal supplements Some Key points

• Just because it is labelled ‘natural’ • does not mean it is safe or without side effects

– Can act in the same way as drugs →• may cause medical problems if taken incorrectly or in

large amounts.

– Where herbal supplements are used,• it is preferable to do so under guidance of a medical

professional, properly trained in herbal medicine (NCCAM 2004)

Patricia Fox, UCD, 2007

Herbal supplements Some Key points

• Herbal supplements– not subject to the same rigorous standards as mainstream

medications• The active ingredient(s) in many herbs/ herbal supplements

– are not known• Published analyses have found differences

– between what is on label and what is in the bottle• Some herbal supplements may be contaminated

– with metals, unlabelled prescription drugs, micro-organisms (NCCAM 2004)

Herbal laxatives• Decrease blood levels of drugs by shortening

gastrointestinal transit time• Increase potassium loss• Common herbal laxatives:

– aloe, – cascara sagrada, – rhubarb, – Senna

Abebe W, 2003. J Dental Hygiene 77(1):37-46

HERBAL DRUG/NATURAL FOODS

A BIG BUSINESS

Herbal Food SupplementsHerbal Food Supplements

What is the basis of these Rules?What is the basis of these Rules? Foods shall not be adulteratedFoods shall not be adulterated

Russo A, Troncoso N, Sanchez F, Garbarino JA, Vanella A.Propolis protects human spermatozoa from DNA

damage caused by benzo[a]pyrene and exogenous reactive oxygen species.

Life Sci. 2006 Feb 23;78(13):1401-6.

• Many environmental, physiological and genetic factors have been implicated in defective sperm function, the most common cause of infertility.

• Our experimental evidence demonstrated that the natural drug under investigation is able to protect genomic DNA by damage induced by benzo[a]pyrene, hydrogen peroxide (H2O2) and hydrogen peroxide in combination with adenosine 5'-diphosphate (ADP) and ferrous sulfate (FeSO4), determining a significant reduction of the intracellular oxidants.

• The propolis extract was shown to possess the capacity to protect sperm membrane from the deleterious action of oxidative attack, reducing TBARS formation and LDH release.

• In summary, our results evidence that the protective effect exhibited by this natural compound in human spermatozoa is correlated, at least in part, to the antioxidant capacity of its active components, and suggest that propolis may have a role in protection against male infertility.

Miyata T. Pharmacological basis of traditional medicines and health supplements as curatives.

J Pharmacol Sci. 2007 Feb;103(2):127-31.

• Traditional Oriental medicines and health supplements have been empirically used to treat various ailments but most of them have not been evaluated objectively to prove their efficacies. All of its actions are based on the restoration of normal molecular and cellular functions through DNA transcriptional regulation.

• In other previous studies, we showed that a health supplement, royal jelly (RJ) has weak estrogenic activity. RJ competes with 17beta-estradiol for binding to the human estrogen receptors alpha and beta, although it is much weaker than diethylstilbestrol in binding affinity.

• Furthermore, subcutaneous injection of RJ restored the expression of vascular endothelial growth factor gene in the uteri of ovariectomized rats.

• We suggest that the diverse pharmacological functions of RJ can be ascribed, in part, to its estrogenic effects.

Honey Beeone of Beneficial Insects

Great Pollinator Produces honey & beeswax Protects against pests

Medical uses for honey Antibacterial properties of honey are the result of :

– Osmotic effect,• high concentration of sugar, very few extra water molecules remain

available to microorganisms and so presents a very undesirable environment for their growth.

– Hydrogen Peroxide effect• activated by dilution, it is present in a concentration of only 1 mmol/l in

honey. • iron in honey oxidize the oxygen free radicals released by the hydrogen

peroxide. – glucose + H2O+ O2 → gluconic acid + H2O2

• when used topically as, for example a wound dressing, hydrogen peroxide is produced by dilution with body fluids.

• as a result, hydrogen peroxide is released slowly and acts as an antiseptic.

– High acidity. • The pH of honey is commonly between 3.2 and 4.5 • This relatively acidic pH level prevents the growth of many bacteria

responsible for infection

Madu (honey)Efek Farmakologi : sumber energi / kalori antimikroba

o French VM, Cooper RA, Molan PC. The antibacterial activity of honey against coagulase-negative staphylococci. J Antimicrob Chemother. 56(1):228-31,2005.

antiseptik meningkatkan stamina membantu pencernaan dan penyembuhan tukak

peptik membantu pemulihan fungsi syaraf aman pada penderita DM