Tradational Medicine in Cam For Student Ony

TRADITIONAL MEDICINE (CAM) BY Dr Takele Achalu Dengela takeleachalu@gmail.
com
B pharm, MSc , PHD and Author

Drug
Drug means any substances that is:
Definition
 Recognized in the pharmacopeia
 Used for diagnosis, mitigation, treatment, or prevention of

disease in human or animal.
 Affect the structure or function of human or animal
 Substances of natural or synthetic origin having therapeutic

properties and chiefly used as medicines or ingredients in the
medicine.
2 1. Introduction to the Chemistry of Natural Products 6/8/2023
Crude drugs are any naturally occurring, unrefined substance
3
derived from organic or inorganic sources such as plant and animal.
 It is used for those natural products such as plants or part of plants,

extracts and exudates which are not pure compounds and used in
medicine.
 The term crude drug is also applied to include pharmaceutical

products from mineral kingdom in original form and not necessarily
only of organic origin such as kaolin, bentonite etc.
1. Introduction to the Chemistry of Natural Products 6/8/2023

 Crude drugs can also be defined as:
 The term “crude drug” indicates any natural products which

has not been advanced in value or improved in condition by:
 Grinding
 Chipping
 Crushing
 Distilling
 Evaporating
 Extracting
 Artificial mixing with other substances.
Crude drugs:
 Dried plant parts used in medicinal preparations
 Complex mixtures of cells and chemicals
 Previously mainly used in the form of alcoholic extracts

(tinctures)
 Pharmacist need basic knowledge of the ways in which how

medicinal plants can be extracted and tested for presence of
active principles

Sources of crude drugs
 Plant sources, e.g. Senna, Digitalis, Datura, Cascara, Cinchona,

Clove, Opium, etc.
 Animal sources, e.g. cochineal, cantharidin, honey, cod liver oil,

musk, thyroxin, etc.
 Marine sources, e.g. sponges, red algae, agar, etc.
 Mineral sources, e.g. talc, kaolin, kieselguhr, etc.

Natural products:
 They can be
 Entire organism (plant, animal, organism)
 Part of an organism (a leaf or flower of a plant, an

isolated gland or other organ of an animal)
 An extract or an exudate of an organism
 Isolated pure compounds

Value of natural products
 Compounds from natural sources play four significant roles in modern
medicine:
 provide a number of extremely useful drugs that are difficult or

impossible, to produce commercially by synthetic means.
 Natural sources also supply basic compounds that may be modified slightly
to render them more effective or less toxic
 Their utility as prototypes or models for synthetic drugs possessing

physiologic activities similar to the originals.
 Some natural products contain compounds that demonstrate little or no

activity themselves but which can be modified by chemical or biological
methods to produce potent drugs not easily obtained by other methods
Animal drugs
 Are collected from wild or domestic animals; mainly from

domesticated animals like vegetable drugs from cultivated
plants.
 Drugs such as lard, lanolin, and milk products, as well as

hormones, endocrine products, and some enzymes are
obtained from domesticated hogs, sheep or cattle.
 Processing and purification of animal drugs varies with the

individual drugs.

2. Animal products
 Musk: dried, distilled product of gland musk deer.

Active constituent is volatile muskone used as fixative
in class perfumes.
 Thyroid: dried cleaned powdered thyroid gland. Mainly

from ox. used as treatment of goiter and obesity.
 Pepsin: obtained from glandular layer of fresh hog used

as protein digestion.

Types of drugs derived from plants
1. Herbal drugs, derived from specific parts of a medicinal

plant
2. Compounds isolated from nature
3. Nutraceuticals, or “functional foods”

 Vegetable Drugs
 Plant drugs are collected from wild or cultivated plants;
the plants could belong to higher or lower plants but the
flowering plants taking the largest share, spermatophyta
(seed producing plants).

Introduction
13  Traditional medicine (TM) is "the total of the knowledge, skills, and practices
based on the theories, beliefs, and experiences of different indigenous
cultures, whether explicable or not.
 It includes the use of plant,
 Animal, and mineral-based medicines,
 Spiritual therapies,
 Manual techniques, and
 Exercises, applied singularly or in combination (1).
 The importance of traditional medicine as a source of primary healthcare

was first officially recognized by the World Health Organization (WHO) in
the Primary Health Care Declaration of Alma Ata (1978) (2).
 However, the history of traditional medicine is as long as the history of
human beings in this world.
 For example, the medicinal herb, Artemisia Annua, used in China for almost
2000 years and was found to be effective against resistant malaria (3).
What are “Natural Products”?
Chemical characteristics
• Naturally-occurring small organic compounds
• including heterocyclic compounds, and peptides.
• does not include proteins, carbohydrates, and nucleic
acids.
• MW: ~150 ~ <800 amu (“small molecule”)
• Methods of extraction and purification are generally
similar to the techniques used for organic compounds
(e.g., TLC, column chromatography, HPLC, GC)
• Methods of structural determination
• NMR, MS, IR, X-ray, UV
Biological characteristics
• Compounds are generally characteristic of a particular
species or family, i.e., narrow taxonomic distribution (non-
ubiquitous)
• No nutritional or structural function. Functional roles may
include:
- color (identification) - scent (attraction or repulsion)
- sexual attraction - social communication
- defense (e.g., plant toxins and antibiotics)
but many still have unknown function in the organism in
which they are found.
• Classified as “secondary metabolites” in contrast to
15 “primary1.metabolites”
Introduction to the Chemistry of Natural Products 6/8/2023
Why study Natural Products?
• Natural products are the source of the most complex and
fascinating chemical structures.
• Natural products represent biological diversity.
• Natural products are expressions of the genome.
• Natural products represent natural biological activity, whether
as single compounds or as complex mixtures.
• Natural products are part of the natural wealth of the country,
and can be an important source of livelihood, from agriculture
and food, pharmaceuticals, fine chemicals industry.
• Natural products can be an effective bridge from tradition to
modern scientific developments, including genetics, molecular
biology, biotechnology, and pharmaceutical science.

Range of products from natural products:


The market for natural products.
• Pharmaceuticals
• Traditional herbal medicines:
US and Europe: gingko biloba, St. John‟s wort, ginseng, garlic*,
echinacea, saw palmetto, soya*, kava-kava, golden seal, aloe*, gotu
kola* (*also grown in the Philippines)
India, China, Japan: Ayurverda, TCM, Kampo
Philippines: lagundi, sambong, ampalaya, banaba, malunggay
• Beverages: tea (e.g., green, chinese), herbal teas, coffee
• Food supplements and health products
• Fats and oils
• Herbs and spices, food flavor ingredients
• Perfumes and scents
• Essential oils, others …
The Changing Landscape of Herbal Medicine,
Food and Wellness
Traditional Medicine “is a comprehensive
term used to refer both to TM systems, such as
traditional Chinese medicine, Indian ayurveda and
Arabic unani medicine, and to various forms of
indigenous medicine. TM therapies include
medication therapies — if they involve use of
herbal medicines, animal parts and/or minerals —
and nonmedication therapies… such as
acupuncture, and manual and spiritual therapies.
“In countries where the dominant health care system is based on
allopathic medicine, or where TM has not been incorporated into
the national health care system, TM is often termed
“complementary”, “alternative” or “non-conventional”
medicine.” (eg, US FDA: Complementary and Alternative Medicine)
Food and Wellness
• Herbal Medicine: Makes therapeutic claim; includes

crude herbal materials, preparations and finished products,
that contain as active ingredients, parts of plants or
combinations thereof. (WHO Traditional Medicine Strategy
2002-2005). In Europe, also called “phytotherapy”.
• Dietary Supplement
• Nutriceutical
• Functional Food

Food and Wellness
• Herbal Medicine
• Dietary Supplement: A product that is intended to
supplement the diet and that bears or contains one or more
of the following dietary ingredients: a vitamin, mineral, herb
or other botanical material, an amino acid, a dietary
substance to supplement the diet by increasing the total
daily intake. (US Dietary Supplement Health and Education
Act, 1994). Philippine FDA uses a very similar definition.
• Nutriceutical
• Functional Food

Food and Wellness
• Herbal Medicine
• Nutriceutical: Term coined by Stephen DeFelice in
1989 from "Nutrition" and "Pharmaceutical". Zeisel (Science
1999): Nutraceuticals are dietary supplements administered
in large dosages in order to obtain pharmacological effects.
Nutraceuticals deliver a concentrated orm of a presumed
bioactive agent from food, presented in a non-food matrix,
in dosages that exceed those that can be obtained in
normal food.
• Functional Food
Food and Wellness
• Herbal Medicine
• Nutriceutical
• Functional Food: A food that is consumed as part of a
normal diet and which is claimed to have health-promoting or
disease-preventing properties beyond the basic function of
supplying nutrients. Examples include probiotics (fermented
foods with live cultures), prebiotics (e.g., inulin). This term
was first used in Japan in the 1980s where there is a
government approval process for functional foods called
Foods for Specified Health Use (FOSHU).

Food and Wellness
• Herbal Medicine
• Nutriceutical
• Functional Food
 Natural Products Chemistry
is key to all of these!

The study of natural products is multidisciplinary
Biology   Chemistry
Taxonomy . Botany Organic synthesis
Agriculture . Pharmacology . Pharmaceutical Science . Organic analytical chemistry
Entomology . Microbiology . Biotechnology/Molecular Biology . Biochemistry
Genomics . Proteomics
Metabolonomics

Natural products and Ecology
Animals
Antifeedant
Toxins
Toxins
Scents
Antipest
Attractants Toxins
Allelopathy Plants Insects Pheromones
Communication Communication
Antifungals
Symbiosis Symbiosis
Antifungals Chemotaxis
Chemotaxis Bacteria Communication
Communication
Fungi Antibacterials

Modern directions in natural products chemistry:
• Genomics of bacteria and plants
• Novel and efficient synthetic methods
• Genetic engineering of bacteria and plants
• Enzyme synthesis
• Computational methods and modeling
• High efficiency chromatography
• Spectroscopic methods
• High-throughput screening
• Synergism
• Biotransformation

Issues and challenges in Natural Products today
1. Loss of biodiversity
2. Intellectual Property Rights
• Patent protection (pharma companies)
• Biopiracy (source countries)
3. Western drugs:
a. High cost of drug development
b. New drug leads and targets
4. Herbal products:
a. Regulation
b. Improvement in quality
c. Elucidation of mechanism of action

Research areas in natural products today
1. Structural elucidation (speed of analysis, sample throughput complexity
of structures)
2. Metabolonomics
3. Synergy and biotransformation
4. Biosynthesis
5. Biological activity
a. Ecological
b. Pharmaceutical properties / drug discovery
c. Healthcare and cosmetic products
6. Molecular biology and Biotechnology
7. Quantitative natural products chemistry
Natural products chemistry is at the intersection of
many fields:
Ecological Biochemistry
Taxonomy
Pharmaceutical Science
Entomology
Biochemistry
Natural
Products Combinatorial
Chemistry Chemistry
Biotechnology
Chemical synthesis
Molecular Biology Microbiology

Introduction

33
A study showed that in addition to modern biomedicine, traditional medicine
provides healthcare to 65-85% of the world’s population in developing as well as
developed nations (6).
 Similarly, about 80% of the population uses traditional medicine for primary
healthcare in Africa and Ethiopia (1)(7).
 Since Africa’s disease burden is growing rapidly, indigenous African medicine can
bring affordable remedies within reach of millions who are unable to access modern
care due to its cost, access, or other reasons like to be treated in a more culturally
sympathetic and familiar way (8).

What is the meaning of traditional medicine?
Traditional medicine refers to health practices,
approaches, knowledge and beliefs incorporating plant,
animal and mineral based medicines, spiritual therapies,
manual techniques and exercises, applied singularly or in
combination to treat, diagnose and prevent illnesses or
maintain well-being

Traditional medical practitioners mostly implement herbs,
spiritual healing, bone-setting and minor surgical
procedures in treating disease. Ethiopian traditional
medicine is vastly complex and diverse and varies greatly
among different ethnic groups.Nov 3, 2009

What is the function of traditional medicine?
Traditional medicine refers to the knowledge, skills and
practises based on the theories, beliefs and experiences
indigenous to different cultures, used in the maintenance of
health and in the prevention, diagnosis, improvement or
treatment of physical and mental illness

What is the importance of traditional medicine in Ethiopia?
Ethiopian traditional medicine is concerned not only with the
curing of diseases but also with the protection and
promotion of human physical,
spiritual,
social,
mental and material wellbeing

Cont…
38
 Traditional medicine (TM)

• TM is the sum total of the knowledge, skills, and practices based on the
theories, beliefs, and experiences indigenous to different cultures,
whether explicable or not, used in the maintenance of health as well as in
the prevention, diagnosis, improvement or treatment of physical
and mental illness.

39
1. What is a drug?
 A drug is any substance that alters the normal functioning of the body.
 They can be synthetic (produced in a laboratory) or natural (found in plants,
animals or minerals).
 Drugs can be used for therapeutic or non-therapeutic purposes. Therapeutic
drugs are used to treat diseases, relieve symptoms, prevent or cure illnesses
while non-therapeutic drugs are used for recreational purposes or to
enhance performance.
 Conventional drugs are those that are approved by regulatory agencies

such as the Food and Drug Administration (FDA) and are prescribed by
medical professionals.
 They are produced in a controlled environment and undergo rigorous
testing before being approved for use.

40
 These drugs are typically used to treat specific

conditions and are prescribed based on the patient's
medical history and condition.
 Traditional drugs, on the other hand, are often derived
from natural sources such as plants, animals or minerals.
 They have been used for centuries in traditional
medicine practices around the world.
 Traditional drugs are often used to treat a wide range
of conditions and are often considered to be safer and
more natural than conventional drugs.
41
2. What is medicine?
 Medicine refers to any substance or treatment used to prevent or

cure disease, alleviate symptoms, or improve the health and well-
being of individuals.
 Medicines can be synthetic or natural and can be administered in
various forms such as pills, injections, topical creams, and inhalers.
 Conventional medicine is the mainstream approach to healthcare

and is based on scientific evidence, testing, and regulation.
 It is practiced by licensed medical professionals and includes
procedures such as surgery, chemotherapy, and prescription drugs.
 Conventional medicine is often used to treat acute and chronic
conditions and is typically covered by insurance
42
 Traditional medicine, also known as complementary or alternative medicine, is a holistic

approach to healthcare that focuses on maintaining overall health and wellness.
 It includes practices such as acupuncture, herbal medicine, and massage therapy.
 Traditional medicine is often used in conjunction with conventional medicine to treat chronic
conditions and manage symptoms.
 It is not always covered by insurance and may not have the same level of scientific evidence as
conventional medicine.
 In conclusion, drugs and medicine are both important in the treatment and prevention of
diseases.
 Conventional drugs and medicine are based on scientific evidence and are regulated by
government agencies, while traditional drugs and medicine are often derived from natural
sources and have been used for centuries in traditional medicine practices.
 Both approaches have their benefits and drawbacks, and it is important to consult with a
medical professional to determine the best course of treatment for each individual case.

43
 What is the difference between and similarities of traditional medicine and

conventional modern medicine discuss in depth
 Traditional medicine and conventional modern medicine are two different

approaches to healthcare that have some similarities and differences.
Traditional Medicine:
 Traditional medicine is the sum total of the knowledge, skills, and practices based on
the theories, beliefs, and experiences indigenous to different cultures.
 It is often referred to as complementary and alternative medicine (CAM) and
includes practices such as herbal medicine, acupuncture, and massage therapy.
 Traditional medicine is often based on the use of natural remedies and treatments
that have been passed down through generations.

44
 Similarities:
1. Diagnostic tools: Both traditional and modern medicine use diagnostic tools
such as laboratory tests, imaging studies, and physical examinations to
diagnose medical conditions.
2. Focus on prevention: Both traditional and modern medicine focus on

preventing illness and promoting wellness through healthy lifestyle choices such
as diet, exercise, and stress management.
3. Holistic approach: Both traditional and modern medicine aim to treat the
whole person, not just the disease or symptoms.
4. Use of evidence-based practices: Both traditional and modern medicine use

evidence-based practices to inform treatment decisions.

45
 Differences:
1. Philosophy: Traditional medicine is often based on a holistic and spiritual approach to

healthcare, while modern medicine is based on a scientific and evidence-based approach.
2. Treatment methods: Traditional medicine uses natural remedies and treatments, such as herbs,
acupuncture, and massage therapy, while modern medicine often relies on pharmaceuticals,
surgery, and other medical interventions.
3. Accessibility: Traditional medicine is often more accessible and affordable to people in

developing countries, while modern medicine is often more expensive and requires access to
specialized medical facilities.
4. Standardization: Modern medicine is highly standardized and regulated, with specific

guidelines for diagnosis and treatment, while traditional medicine may vary widely in terms of
treatment methods and quality.

46
In summary
traditional medicine and modern medicine have some
similarities in their focus on prevention, holistic approach,
and evidence-based practices.
 However, they differ in their philosophy, treatment
methods, accessibility, and standardization. Both
approaches have their strengths and weaknesses, and
the best approach for a given individual may depend
on their specific needs and circumstances.
 It is important for individuals to work with a healthcare
provider to determine the best approach to their care
47
list and discuss the types of rout of drug administration discuss each
 There are various routes of drug administration, which can be classified into
following categories:
1. Enteral Administration:
This category involves administering the drugs via the gastrointestinal tract,
which includes the oral, sublingual, and rectal routes.
- Oral administration involves the drug being taken through the mouth where it
goes through the stomach and small intestine before absorption into the
bloodstream.
- Sublingual administration involves placing the tablet or liquid medication
under the tongue.
- Rectal administration involves administering the drug through the rectum

48
2. Parenteral Administration:
 This category involves administering the drugs through injections or

infusions, which bypass the gut and enter the bloodstream directly.
- Intravenous administration is the most common method of parenteral

administration, which involves injecting the drug directly into the vein.
- Intramuscular administration involves injecting the drug into the

muscle.
- Subcutaneous administration involves injecting the drug under the skin.

49
 This category involves administering the drugs through
injections or infusions, which bypass the gut and enter
the bloodstream directly.
- Intravenous administration is the most common method of
parenteral administration, which involves injecting the
drug directly into the vein.
- Intramuscular administration involves injecting the drug
into the muscle.
- Subcutaneous administration involves injecting the drug
under the skin.

50
4. Inhalation Administration:
 This category involves delivering the drugs into the respiratory tract, such as through
inhalers, nebulizers, or vaporizers.
5. Others:
 There are also other non-conventional methods of drug administration such as
transmucosal, buccal, nasal, and vaginal routes.
 Each route of administration has its own advantages and disadvantages, which
depends on the drug being administered and the patient's condition.
 The choice of route of administration is also affected by the speed and duration of
drug action, drug's solubility, toxicity, stability, and formulation.
 Therefore, proper selection and administration of drugs via the most appropriate
route is critical to achieving optimal therapeutic outcomes while minimizing adverse
effects.

51
 list and discuss the types of rout of drug administration discuss each as
traditional medicine
Sure, here are the traditional medicine uses for each type of drug
administration route:
1. Enteral Administration:
- Oral administration has been used in traditional medicine for centuries.
Herbs, roots, and other natural ingredients were often taken orally as teas,
tinctures, or powders, to heal various ailments in the body.
- Sublingual administration isn't commonly used in traditional medicine, but
sublingual herbal remedies can be found in some cultures.
- Rectal administration has also been used in traditional medicine, with
suppositories or herbal enemas commonly used to treat digestive or bowel
issues.

52
- Intravenous administration is not common in traditional medicine, as it involves the use of
needles and injections.
However, some cultures have used bloodletting as a means of treating certain ailments.
- Intramuscular administration is also not common in traditional medicine, but acupuncture involves
the insertion of needles into specific points on the body for healing purposes.
- Subcutaneous administration isn't commonly used in traditional medicine.
3. Topical Administration:
- Transdermal administration has been used in traditional medicine, with poultices, salves, and
compresses made with natural ingredients applied to the skin for various ailments.
- Ophthalmic administration is used in traditional medicine, with various plant extracts or teas used
to treat eye infections, inflammation, or other issues.
- Otic administration has also been used in traditional medicine for ear infections, with herbal ear
drops or poultices used for healing

53
4. Inhalation Administration:
- Inhalation administration is commonly used in traditional medicine,
with herbal remedies or steam inhalation used to treat respiratory
issues.
5. Others:
- Transmucosal administration isn't commonly used in traditional
medicine, but some cultures have used chewing tobacco or betel nut for
healing.
- Buccal administration isn't commonly used in traditional medicine.
- Nasal administration has been used in traditional medicine, with
various herbs or essential oils used for respiratory or sinus issues.
- Vaginal administration has also been used in traditional medicine,
with herbal suppositories or douches used for women's health issues.

54
 It's important to note that traditional medicine

practices can vary greatly depending on the culture
and traditions of the region.
 While these routes of administration have been
used in traditional medicine, it's important to consult
with a healthcare professional before using any
herbal or natural remedies to treat health issues.

55
 Pharmacokinetics, commonly referred to as PK, is the study of how

drugs interact with the body, including their absorption, distribution,
metabolism, and excretion.
 In traditional medicine, the principles of pharmacokinetics are
utilized to understand the mechanisms of action of natural remedies
and herbs, and how they are processed by the body.
 One of the essential concepts in pharmacokinetics is absorption,

which refers to how the active compounds in a medicine are taken
up into the bloodstream. In traditional medicine, certain herbs may
be brewed into a tea or consumed as a tincture under the tongue to
facilitate quick absorption into the bloodstream

56
 Distribution is another important aspect of pharmacokinetics that deals with how

drugs are transported to different parts of the body.
 The principles of distribution can be applied to traditional medicine by analyzing
how the active compounds in an herb travel to specific organs or tissues to exert
their effects.
 Metabolism, the breakdown of drugs in the body, is also an essential component of

pharmacokinetics. In traditional medicine, herbs may be metabolized in the liver,
where they may be broken down into active and inactive metabolites.
 Lastly, excretion refers to how drugs are eliminated from the body. In traditional
medicine, herbs may be excreted through urine, feces, or sweat.
 Overall, understanding the pharmacokinetics of natural remedies and herbs can

provide valuable insights into their therapeutic effects and potential side effects,
which can inform safer and more effective use in holistic medicine.

57
 Generally
 Pharmacokinetics is the study of how the body affects a drug after it is administered. It
involves the absorption, distribution, metabolism, and elimination of a drug, commonly referred
to as ADME.
 Traditional medicine refers to the use of plants, animals, and minerals to treat various illnesses
and diseases.
 The pharmacokinetics of traditional medicine is complex and varied, as it depends on the
specific plant, animal, or mineral being used, as well as the preparation and dosage form.
 Absorption: In traditional medicine, the absorption of the drug is dependent on the form in
which it is administered.
 For example, some plant extracts may be taken orally, while others may be applied topically
or inhaled. The absorption of the active components of traditional medicine can be influenced
by factors such as the presence of other compounds in the preparation, the pH of the digestive
tract, and the presence of food.

58
 Distribution:
Traditional medicine may distribute throughout the body differently
than synthetic drugs.
For example, some traditional medicines may contain compounds that
are highly lipophilic, meaning they are more easily absorbed by fats
than by water. This can affect how the drug is distributed throughout the
body and may influence its efficacy.
 Metabolism: Many traditional medicines are metabolized differently

than synthetic drugs. The active compounds in traditional medicine
may be metabolized by the liver, kidneys, or other organs, and may
be transformed into other compounds that have different
pharmacological effects.

59
 Elimination:
Traditional medicine may be eliminated from the body differently than
synthetic drugs.
For example, some traditional medicines may be eliminated through the
urine, while others may be eliminated through the feces or sweat.
 Overall, the pharmacokinetics of traditional medicine is complex and

varied, and may depend on a number of factors, including the
specific plant, animal, or mineral being used, as well as the
preparation and dosage form. It is important to understand the
pharmacokinetics of traditional medicine in order to ensure safe and
effective use of these therapies.

60
 What mean Treatment ?

refers to the management, care, or administration
given to a person, animal or thing to improve their
condition or alleviate their symptoms.
It can include medical, therapeutic, or holistic
interventions to promote healing, relieve pain or
discomfort, address a health problem, or prevent the
onset or progression of a disease.

61
 In traditional medicine, treatment refers to the use of natural

remedies, plant-based medicines, and other traditional healing
practices to cure, prevent or manage health conditions.
 It is based on the principles of the traditional healing system and
focuses on restoring balance and harmony within the body.
 Traditional medicine treatment can include herbal remedies,
massage therapy, acupuncture, and other natural healing methods
that have been used for centuries by different cultures around the
world.
 The goal of traditional medicine is to treat the whole person, not just
the symptoms, and to promote wellness and balance in body, mind,
and spirit.

62
 What mean treatment failure ?

Treatment failure refers to a situation where a prescribed treatment or therapy
does not achieve the intended results or expected outcomes.
It occurs when a patient's condition does not improve or worsens after
undergoing a treatment.
In healthcare, treatment failure can occur due to various reasons such as
incorrect diagnosis, inappropriate dosages of medication, non-compliance with
treatment, drug resistance, or adverse reactions to medication.
Treatment failure can have serious consequences, such as delaying recovery,
the development of complications, or the need for more intensive and
expensive treatments.
It is therefore essential to identify and address the causes of treatment failure
to ensure the most effective and appropriate treatment for patients.

63
 what mean treatment failure in traditional medicine

?
In traditional medicine, treatment failure refers to a
situation where a traditional remedy or therapy, such
as herbal medicine or acupuncture, does not achieve
the intended results or expected outcomes.
It occurs when a patient's symptoms or condition does
not improve or worsens after undergoing a traditional
therapy or treatment.

64
 Treatment failure in traditional medicine may occur due to

various reasons, such as incorrect diagnosis, inadequate or
inappropriate use of traditional remedies, lack of potency
or efficacy of the traditional remedies, or the presence of
underlying medical conditions that require more specialized
or advanced treatments.
 It is essential to identify and address the causes of treatment
failure in traditional medicine to ensure a safe and effective
treatment for patients.
 In some cases, a combination of traditional and modern
medicine may be necessary to achieve the best outcomes.

65
 what is the deference between therapeutic failure in modern

conventional medicine VS therapeutic failure in traditional medicine
?

 Therapeutic failure in modern conventional medicine is when a

patient does not respond to a treatment that has been scientifically
studied, tested, and approved by regulatory agencies.
 It means that the medication or therapy does not produce the
intended beneficial effect or expected outcome.
 On the other hand, therapeutic failure in traditional medicine is when

a patient does not respond to a traditional remedy or therapy, such
as herbal medicine or acupuncture.

66
 Traditional medicine often utilizes natural remedies and techniques

that are not as extensively studied and tested as modern medicines.
 Therefore, therapeutic failure in traditional medicine may be due to
different factors such as the quality of ingredients used, improper
usage, or the presence of a more severe underlying medical
condition.
 In summary, therapeutic failure in modern conventional medicine is

associated with evidence-based treatments that have gone through
rigorous clinical trials before being approved for use, while
therapeutic failure in traditional medicine relates to natural
remedies and methods that may not have been studied as rigorously.

Introductin to Oraganic chemistry
67
What is organic chemistry?

What is Organic compound?
Why you study organic chemistry?
What makes carbon so special?
Atomic structure
Nucleolus of an atom
Orbital of an atom(s, p, d, f)
1. Introduction to theByChemistry of Natural Products

feteneabeje@gmaiil.com
6/8/2023 67
Organic Chemistry: The study of organic compounds
Organic Compound: Carbon containing compounds
• Reason to study organic chemistry: We study organic
chemistry because just about all of the molecules that make
life possible—proteins, enzymes, vitamins, lipids,
carbohydrates, and nucleic acids—contain carbon, so the
chemical reactions that take place in living systems, including
our own bodies, are organic reactions
• Carbon is in the center of the second row of elements. The
atoms to the left of carbon have a tendency to give up
electrons, whereas the atoms to the right have a tendency to
accept electrons
68 1. Introduction to theByChemistry of Natural Products

6/8/2023 68
• It neither readily gives up nor readily accepts electrons. Instead,
it shares electrons. Carbon can share electrons with several
different kinds of atoms, and it can also share electrons with
other carbon atoms. Consequently, carbon is able to form
millions of stable compounds with a wide range of chemical
properties simply by sharing electrons.
• When an organic compound reacts, some old bonds break and
some new bonds form. Bonds form when two atoms share
electrons, and bonds break when two atoms no longer share
electrons. How readily a bond forms and how easily it breaks
depend on the particular electrons that are shared, which, in turn,
depend on the atoms to which the electrons belong.
69 1. Introduction to theByChemistry of Natural Products

6/8/2023 69
Atomic structure
• An atom consists of a tiny dense nucleus surrounded by electrons
that are spread throughout a relatively large volume of space around
70 the nucleus. The nucleus contains positively charged protons and
neutral neutrons, so it is positively charged. The electrons are
negatively charged.
• Because the amount of positive charge on a proton equals the
amount of negative charge on an electron, a neutral atom has an
equal number of protons and electrons.
• Atoms can gain electrons and thereby become negatively charged,
or they can lose electrons and become positively charged. However,
the number of protons in an atom does not change.
• Protons and neutrons have approximately the same mass and are
about 1800 times more massive than an electron.
• Atomic number of an atom equals proton number and atomic
mas =proton number +neutron number

6/8/2023 70
Distribution of electrons in an atom
• According to quantum mechanics, the electrons in an atom can be
71 thought of as occupying a set of concentric shells that surround the
nucleus. The first shell is the one closest to the nucleus.
• The second shell lies farther from the nucleus, and even farther
• out lie the third and higher numbered shells.
• Each shell contains subshells known as atomic orbitals. Each
atomic orbital has a characteristic shape and energy and occupies a
characteristic volume of space, which is predicted by the
Schrödinger equation. An important point to remember is that the
closer the atomic orbital is to the nucleus,the lower is its energy.

6/8/2023 71
Nomenclature of Organic compounds
72
 Alkanes
 Alkenes and Alkynes
 Alcohols
 Aldehydes
 Ketones
 Amines
 Ethers
 Aromatics

6/8/2023 72
Alkanes
• Alkanes are the simplest organic molecules, they only contain
73
C and hydrogen, and only contain single bonds.
• Compounds that have the maximum number of bonded
hydrogens, are said to be saturated.
• Alkanes are saturated hydrocarbons.
• General Formula: CnH2n+2
• The simplest members of this group are the n-alkanes which
are straight chain

6/8/2023 73
Alkenes
• Sometimes called olefins a hydrocarbon that contain a carbon to
74 carbon double bond
• Occur abundantly in nature
• Ethylene and propylene the simplest alkene the two most
important organic chemicals produced industrially
• Has fewer hydrogen atom than an alkane with the same number f
carbons CnH2n refferd to as Unsaturated
• Ethylene(ethene) for example has the formula C2H4
Naming alkene-Naming using a series of rules similar to those of
alkanes with the suffix –ene instead of -ane to identify the familly. 3
steps
Step 1. Find the longest carbon chain containing the double bond and
name the compound accordingly using the suffix -ene
6/8/2023 74
Hydrocarbons
75
 A compound which consists of carbon & hydrogen

ONLY
 Are the basis for most organic compounds
 Includes alkanes, alkenes, alkynes (aliphatic
compounds), & arenes (aromatic compounds)

Counting to Ten in Organic
01 = meth Mother
76

 02 = eth Enjoys
 03 = prop Peanut
 04 = but BUTter
 05 = pent PENTagon
 06 = hex HEXagon or HEX nut
 07 = hept HEPTember (Roman sept is Greek
hept)
 08 = oct OCTober
 09 = non NONember (Roman nov is Greek non)
 10 = dec DECember

Naming side chains
77
 If there are alkyl groups (R groups) attached in isomers, the

prefix for the alkyl groups must be used
Prefix Name of Name of Alkyl Structure of

alkane group alkyl group
Meth- Methane Methyl CH3-
Eth- Ethane Ethyl CH3CH2-
Prop- Propane Propyl CH3CH2CH2-
But- Butane Butyl CH3CH2CH2C
H2-
Pent- Pentane Pentyl CH3CH2CH2C
H2CH2-
Hex- Hexane Hexyl CH3CH2CH2C
1. Introduction to the Chemistry of Natural Products H2CH2CH2-
6/8/2023
HYDROCARBONS
79
Hydrocarbons
Aliphatic Aromatic
Straight chain Cyclic Cyclic
Saturated Unsaturated
Alkanes Alkenes Alkynes

General Molecular Formula of
80
Hydrocarbons

Classes of carbon and Hydrogen
81
 Primary carbon : CH3-CH2-CH3

 Secondary carbon : CH3-CH2-CH3
 Tertiary carbon : (CH3)2-CH-CH3
 Hydrogens are also referred to as 1º, 2º or 3º
according to the type of carbon they are bonded
to.

82
CHEMISTRY OF CARBOHYDRATES

DEFINITION
83
 The word carbohydrate means ‘hydrate of

carbon’.
 Thus, carbohydrates are a group of polyhydroxy
aldehydes, ketones or acids or their derivatives,
together with linear and cyclic polyols.
 Carbohydrates are the primary fuel for our
muscles and the brain.

84
 Most of these compounds are in the form

CnH2nOn or Cn(H2O)n
 Sometimes, carbohydrates are referred to
simply as sugars and their derivatives.

 Carbohydrates are polyhydroxylated compounds
having at least 3 carbon atoms and a potentially
active carbonyl group which may be an aldose or
a ketose group.
 Examples are: glucose, ribose.

GLYCERALDEHYDE
O O
C H C H
HO C H H C OH
CH2OH CH2OH
L-GLYCEROSE
D-GLYCEROSE

GLUCOSE
HC O
H C OH
HO C H
H C OH
H C OH
CH2OH
GLUCOSE
CLASSIFICATION OF CARBOHYDRATES
Carbohydrates
Monosaccharides Oligosaccharides Derived

Disaccharides Carbohydrates
Aldoses Ketoses
Oxidation
Polysaccharides Reduction
Amino sugars
Homopolysaccharides Deoxy sugars
88
Heteropolysaccharides
1. Introduction to the Chemistry of Natural Products
6/8/2023
MONOSACCHARIDES
No of C-atoms Potentially active

carbonyl group
Trioses
Tetroses
Pentoses Aldoses Ketoses
Hexoses
Heptoses ―These carbohydrates cannot
Octoses be hydrolyzed into simpler compounds”

90
Aldehyde CHO
1. Introduction to the Chemistry of Natural Products Ketone
6/8/2023 C O
MONOSACCHARIDES
 PENTOSES
 Ribose:
 Found in nucleic acids
 Forms structural elements of nucleic acid and
coenzymes
 Intermediates of pentose phosphate pathway
 ATP, NAD, NADP, flavoproteins etc

DEOXYRIBOSE SUGARS
OH OH
CH2OH CH2OH
H H
H H
H H H H
OH OH OH H

 HEXOSES
Glucose
 Found in fruits, fruit juices, hydrolysis of starch,
maltose and lactose.

 Body sugar and the principal one used by the
tissues
 Excess in the blood is called hyperglycemia and
presence in urine (glucosuria) indicates diabetes
mellitus
 Cataract due to sorbitol

Fructose
 Latin word for fruit — "fructus"
 Found in fruit juices, honey
 Released by the hydrolysis of inulin
 Main nutritional source of energy for the
spermatozoa and is found in the seminal fluid
 Can be converted to glucose in the liver
 It is the sweetest sugar
 Lack of enzymes of metabolism can lead to
essential fructosuria
Galactose
 Greek word for milk--"galact", found as a
component of lactose in milk
 Formed by the hydrolysis of lactose
 Synthesized in the lactating mammary gland
 Constituent of glycolipids and glycoproteins
 Can be converted to glucose in the liver
 Accumulation can lead to galactosemia and
cataract (galactitol)
Lactose
 Synthesized by lactating mammary gland
 Milk sugar (lac-milk)
 β-D-galactose β-D-glucose
 β1 4 linkage
 Enzyme – lactase and lactose intolerance
 Least sweet sugar – 16% of sucrose
 Possesses one potential aldehyde group
• reducing sugar
• forms osazone crystals
POLYSACCHARIDES
 These are the condensation products of more than 10

molecules of monosaccharide units
 They include starch, glycogen.
 Stores of fuel
 Structural elements of cells

POLYSACCHARIDES
Homopolysaccharides
Heteropolysaccharides
*Starch
*Glycogen Glycoseaminoglycans
*Cellulose Mucilages
*Dextrins *Hyaluronic acid
*Heparin *Agar
*Chondoitin SO4 *Vegetable
*Serum mucoids gums
*Blood gp *Pectins
polysaccharides *Hemicellulose

OLIGOSACCHARIDES
Sucrose
 Known as table sugar
 α-D-glucose ------ β-D- fructose
 α-1 β-2
99
Sucrose
α-D-glucopyranosyl-(1 2)-β-D-fructofuranoside
HOMOPOLYSACCHARIDES
Starch
 Main storage form of glucose in plants
 Polysaccharide units
• Amylose (20—28%)
• Amylopectin 72—80%)
 Polymer of α-D-glucose
 α-1 4 glycosidic linkage
 At branching points α-1 6 linkage
 No free aldehyde group
100  Found in wheat,
1. Introduction rice,
to the Chemistry corn,
of Natural potatoes
Products 6/8/2023
Introduction
101
⚫ Carbohydrates are defined chemically as

aldehyde or ketone derivatives of the
higher polyhydric alcohols, or compounds
which yield these derivatives on
hydrolysis.
⚫ Carbohydrates are also said to be
saccharides (Latin, saccharon, sugar)

1
Introduction…
102
⚫ Carbohydrates constitute a major class of

naturally occurring organic compounds.
⚫ They include such as sugars, starch and
cellulose.
⚫ They are essential to the maintenance of
life in both plants and animals.
⚫ They provide raw materials for many
important industries including textiles,
artificial silks, paper, films, plasters, drugs,
fermentation andof Natural
1. Introduction to the Chemistry explosives.
Products 6/8/2023
1
Introduction…
103
⚫ Carbohydrates as the name implies are
composed mainly of carbon, hydrogen and
oxygen with the latter two elements in the ratio
of 2 to1as in water.
⚫ These compounds may be represented by
general formula Cx(H2O)y, where x and y may
be same or different.
⚫ For ex. We can write glucose C6H12O6
as C6(H2O)6
⚫ Because of this fact they were considered in
the early days to be hydrates of carbon and
for 1. thus reason
Introduction were
to the Chemistry called
of Natural Productscarbohydrates.
6/8/2023
1
Introduction…
104
⚫ Some carbohydrates such as rhamnose

(C6H12O5), do not contain the usual
proportions hydrogen and oxygen.
⚫ Further more some carbohydrates are
now known which contain nitrogen or
sulphur in addition to carbon, hydrogen
and oxygen.
⚫ Structurally carbohydrates
are polyfunctional
compounds.
1
Introduction…
105
⚫ They contain two types of functional

groups,the hydroxyl group and the
carbonyl group.
⚫ They are polyhydroxy aldehydes or
plyhydroxy ketones or compounds which
are converted to these on hydrolysis.

1
⚫ The formation of carbohydrates in nature
occur in green plants by a process called
photosynthesis.
⚫ Plants contain the green pigment
chlorophyll which catalyzes the
conversion of carbon dioxide and water
into sugar.
⚫ There action is the thermodynamically
unfavourable but proceeds because the
necessary energy is supplied by the sun in
106
the form of light.
7
⚫ 6CO2 + 6H2O + solar energy
C6(H2O)6 + 6O2
⚫ While plants build up carbohydrates from
carbon dioxide and water, animals
degrade carbohydrates by eating plants
and combine the carbohydrates with
oxygen from the air to carry out the
reverse of photosynthesis.

107
Classification of carbohydrates
⚫ Most of carbohydrates are characterized
by the ending “-ose”.
⚫ Thuswe have glucose, fructose, sucrose,
cellulose and soon.
Carbohydrates can be divided as:
 Sugars, which are Simple, mainly
crystalline, sweet, and soluble in water

 Polysaccharides, which are Mainly
non- crystalline (amorphous), not sweet,

and less soluble or insoluble in water
108
II. Classification
Polysaccharides
[>10 sugar units]
Carbohydrates based on number

of sugar units
Sugars
Simple sugars (monosaccharides) Oligosaccharides

[1 sugar unit] [2-10 sugar units]
based on
number of carbons functional group

(usually 3-10) combined
3carbons=trioses; aldoses aldopentose

4carbons=tetroses; ketoses aldohexose
5carbons= pentoses;
6 carbons =hexoses; etc.
109
Carbohydrates cont.
 SUGARS
 are colorless crystalline compounds
 have sweet taste
 are soluble in water
 have low molecular weight
 POLYSACCHARIDES
 are amorphous solids
 are tasteless
 are generally insoluble in water
 have high molecular weight

110
⚫ The carbohydrates are divided into three major
classes depending upon whether or not they
under go hydrolysis:
A. Monosaccharides, which are polyhydroxy aldehydes
or polhydroxy ketones which cannot be decomposed by
hydrolysis to give simpler carbohydrates.
⚫ Examples: Glucose and fructose, both of which have
molecular formula, C 6H12O6.
⚫ C6H12O6+ H2O H+ No Reaction
⚫ Monosaccharaides are the simplest sugars that
cannot be hydrolysed into smaller units.

111
⚫ Mono saccharides in turn subdivided:
i. based on the type of functional group
 Aldose–if it contains an aldehyde group
(-C-H) e.g., glucose have an aldehyde

group at one end and
 Ketose-if it contains acetone group
(C)e.g., fructose have a keto group, usually

at C-2

112
⚫ ii.Based on the number of carbons it
contains
⚫ Triose (when it contains 3 carbon atom),
⚫ Tetrose (when it contains 4 carbon atom),
⚫ Pentose (when it contains 5 carbon atom),
⚫ Hexose (when it contains 6 carbon atoms)
and so on

113
B. O ligosaccharides
⚫ Oligosaccharides (greek,oligo,few) are
carbohydrates which yield a definite
number(2-9) of monosaccharide
molecules on hydrolysis.
⚫ Are sugars that can be hydrolysed into
two to nine units (molecules)

114
They include,
I. Disaccharides-are hydrolysed to two
sugar units
II. Trisaccharides- are hydrolysed to three
sugar units
III. Tetrasaccharides- are hydrolysed to four
sugar units etc.

115
(i). Disaccharides yield two monosaccharide
molecules on hydrolysis.
⚫ Examples are sucrose and maltose,
both of which have molecular formula
C12H22O11.
⚫ C12H22O11(sucrose) + H2O H+
C 6H12O 6 + C6H12O6
glucose fructose
116
⚫ Disaccharides are 2 monosaccharides
joined by a dehydration synthesis, or
condensation, which is removal of a water
molecule.
⚫ The“H” is taken from a hydroxyl
functional group of one monosaccharide
and the “O H ” from the second.The two
molecules are then joined by a C -O -C
bond.
117
118

GLYCOSIDES
119
A glycoside is an organic compound, usually of

plant origin, that is composed of a sugar portion
linked to a non-sugar moiety. The sugar portion is
called glycone, while the non-sugar portion is
c a l l e d a g l y c o n e .

GLYCOSIDES
120
The linkage between the sugar and the
aglycone is an acetal linkage.
Types of Glycosides :
According to atoms involved in the
glycosidic linkage:
1- O-glycosides
2- C-glycosides
3- S-glycosides
4- N-glycosides
GLYCOSIDES
121
 Cardiac glycosides Digitalis useful in
Congestive cardiac failure. They contain
Steroid as aglycone.

Amine sugars
122
 In amino sugars, a non-anomeric –OH group (of common

sugars) is replaced by an amino (–NH2) group:
 for example, glucosamine,which is found in exoskeletons of
insects and crustacea, and also isolated
from heparin (anticoagulant in mast cells in arterial cell walls).
 Other amino sugars are found in antibiotics such as
streptomycin and gentamicin.

Glycoproteins and Glycolipids
123
 Glycoproteins and glycolipids are formed when sugars

combine, respectively, with proteins and lipids.
 Biologically these are important compounds
as they are an integral part of cell membranes.
 Biological membranes are composed of proteins, lipids and
carbohydrates.
 The carbohydrates in the membrane are covalently bonded to
proteins (glycoproteins) or with lipids (glycolipids).

124
BIOMEDICAL IMPORTANCE
OF CARBOHYDRATES

BIOMEDICAL IMPORTANCE
 Glucose — most important carbohydrate
 Glucose can be converted into
• glycogen
• ribose
• galactose
 Glycoproteins — molecular targeting
 Antibodies and blood clotting factors
 Structural components of cell membranes
 Neuronal adhesion in development of nervous
system (protein-glycan-heparan-sulfate)
 Constituents of extra cellular matrix
 Diseases associated with carbohydrates
• Diabetes mellitus
• Galactosemia
• Lactose intolerance
• Glycogen storage diseases

DEFINITION OF PHARMACOGNOSY
 The name “Pharmacognosy “derived from the Greek word:
“Pharmacon “a drug”, and
gignosco, “acquire knowledge”
It means „the entire meaning of drugs‟.

Definition..con‟t
 The term pharmacognosy first coined by Austrian physician Johann

Adam Schmidt in his hand written manuscript Lehrbuch der Materia
Medica (i.e., Lecture Notes on Medical Matter) which dates back
to 1811, in Vienna.
 After the above publication ‘Pharmacognosy’ appears again in 1815

in small work by Chr. Aenotheus Seydler Analetica
Pharmacognostica.
 This compilation exclusively deals with the medicinal plants and

their corresponding characteristics.
Definition..con’t
 The American Society of Pharmacognosy defines

pharmacognosy as
"the study of the physical, chemical, biochemical and

biological properties of drugs, drug substances or potential
drugs or drug substances of natural origin as well as the
search for new drugs from natural sources."

Definition..con’t
 Pharmacognosy is the oldest of all pharmacy sciences
 It is an established basic pharmaceutical science.
 It is the science of biogenic or nature-derived pharmaceuticals

and poisons
 Pharmacognosy is related to both botany and plant chemistry

“Phytochemistry”, and its history entitles it to be regarded as parent
of both.

Definition..con’t
Generally:
 It is the study of medicinal products obtained from our living

environment.
I. From living things:- like plants, animals, insects and microbes of

both terrestrial and marine origin.
II. From non living things:- like minerals
 It has changed considerably, from being largely descriptive botanical

field to having more of chemical and biological focus.
 It has also evolved to include phytotherapy and nutraceuticals.

Definition..con’t
Recently it includes:
1. Modern isolation techniques.
2. Pharmacological testing procedures to prepare purified

substances.
3. Cultivation and propagation by tissue culture.

Definition..con’t
Pharmacology
Pharmaceutics
Biochemistry
Pharmacognosy
Physiology Botany
Phytochemistry

Chemical characteristics
• Naturally-occurring small organic compounds
• including heterocyclic compounds, and peptides.
• does not include proteins, carbohydrates, and nucleic
acids.
• MW: ~150 ~ <800 amu (“small molecule”)
• Methods of extraction and purification are generally
similar to the techniques used for organic compounds
(e.g., TLC, column chromatography, HPLC, GC)
• Methods of structural determination
• NMR, MS, IR, X-ray, UV
Biological characteristics
• Compounds are generally characteristic of a particular
species or family, i.e., narrow taxonomic distribution (non-
ubiquitous)
• No nutritional or structural function. Functional roles may
include:
- color (identification) - scent (attraction or repulsion)
- sexual attraction - social communication
- defense (e.g., plant toxins and antibiotics)
but many still have unknown function in the organism in
which they are found.
• Classified as “secondary metabolites” in contrast to
135 “primary1.metabolites”
Introduction to the Chemistry of Natural Products 6/8/2023
Why study Natural Products?
• Natural products are the source of the most complex and
fascinating chemical structures.
• Natural products represent biological diversity.
• Natural products are expressions of the genome.
• Natural products represent natural biological activity, whether
as single compounds or as complex mixtures.
• Natural products are part of the natural wealth of the country,
and can be an important source of livelihood, from agriculture
and food, pharmaceuticals, fine chemicals industry.
• Natural products can be an effective bridge from tradition to
modern scientific developments, including genetics, molecular
biology, biotechnology, and pharmaceutical science.



The market for natural products.
• Pharmaceuticals
• Traditional herbal medicines:
US and Europe: gingko biloba, St. John‟s wort, ginseng, garlic*,
echinacea, saw palmetto, soya*, kava-kava, golden seal, aloe*, gotu
kola* (*also grown in the Philippines)
India, China, Japan: Ayurverda, TCM, Kampo
Philippines: lagundi, sambong, ampalaya, banaba, malunggay
• Beverages: tea (e.g., green, chinese), herbal teas, coffee
• Food supplements and health products
• Fats and oils
• Herbs and spices, food flavor ingredients
• Perfumes and scents
• Essential oils, others …
Food and Wellness
Traditional Medicine “is a comprehensive
term used to refer both to TM systems, such as
traditional Chinese medicine, Indian ayurveda and
Arabic unani medicine, and to various forms of
indigenous medicine. TM therapies include
medication therapies — if they involve use of
herbal medicines, animal parts and/or minerals —
and nonmedication therapies… such as
acupuncture, and manual and spiritual therapies.
“In countries where the dominant health care system is based on
allopathic medicine, or where TM has not been incorporated into
the national health care system, TM is often termed
“complementary”, “alternative” or “non-conventional”
medicine.” (eg, US FDA: Complementary and Alternative Medicine)
Food and Wellness
• Herbal Medicine: Makes therapeutic claim; includes

crude herbal materials, preparations and finished products,
that contain as active ingredients, parts of plants or
combinations thereof. (WHO Traditional Medicine Strategy
2002-2005). In Europe, also called “phytotherapy”.
• Nutriceutical
• Functional Food

Food and Wellness
• Herbal Medicine
• Dietary Supplement: A product that is intended to
supplement the diet and that bears or contains one or more
of the following dietary ingredients: a vitamin, mineral, herb
or other botanical material, an amino acid, a dietary
substance to supplement the diet by increasing the total
daily intake. (US Dietary Supplement Health and Education
Act, 1994). Philippine FDA uses a very similar definition.
• Nutriceutical
• Functional Food

Food and Wellness
• Herbal Medicine
• Nutriceutical: Term coined by Stephen DeFelice in
1989 from "Nutrition" and "Pharmaceutical". Zeisel (Science
1999): Nutraceuticals are dietary supplements administered
in large dosages in order to obtain pharmacological effects.
Nutraceuticals deliver a concentrated orm of a presumed
bioactive agent from food, presented in a non-food matrix,
in dosages that exceed those that can be obtained in
normal food.
• Functional Food
Food and Wellness
• Herbal Medicine
• Nutriceutical
• Functional Food: A food that is consumed as part of a
normal diet and which is claimed to have health-promoting or
disease-preventing properties beyond the basic function of
supplying nutrients. Examples include probiotics (fermented
foods with live cultures), prebiotics (e.g., inulin). This term
was first used in Japan in the 1980s where there is a
government approval process for functional foods called
Foods for Specified Health Use (FOSHU).

Food and Wellness
• Herbal Medicine
• Nutriceutical
• Functional Food
 Natural Products Chemistry
is key to all of these!

The study of natural products is multidisciplinary
Biology   Chemistry
Taxonomy . Botany Organic synthesis
Agriculture . Pharmacology . Pharmaceutical Science . Organic analytical chemistry
Entomology . Microbiology . Biotechnology/Molecular Biology . Biochemistry
Genomics . Proteomics
Metabolonomics

Natural products and Ecology
Animals
Antifeedant
Toxins
Toxins
Scents
Antipest
Attractants Toxins
Allelopathy Plants Insects Pheromones
Communication Communication
Antifungals
Symbiosis Symbiosis
Antifungals Chemotaxis
Chemotaxis Bacteria Communication
Communication
Fungi Antibacterials

Modern directions in natural products chemistry:
• Genomics of bacteria and plants
• Novel and efficient synthetic methods
• Genetic engineering of bacteria and plants
• Enzyme synthesis
• Computational methods and modeling
• High efficiency chromatography
• Spectroscopic methods
• High-throughput screening
• Synergism
• Biotransformation

Issues and challenges in Natural Products today
1. Loss of biodiversity
2. Intellectual Property Rights
• Patent protection (pharma companies)
• Biopiracy (source countries)
3. Western drugs:
a. High cost of drug development
b. New drug leads and targets
4. Herbal products:
a. Regulation
b. Improvement in quality
c. Elucidation of mechanism of action

Research areas in natural products today
1. Structural elucidation (speed of analysis, sample throughput complexity
of structures)
2. Metabolonomics
3. Synergy and biotransformation
4. Biosynthesis
5. Biological activity
a. Ecological
b. Pharmaceutical properties / drug discovery
c. Healthcare and cosmetic products
6. Molecular biology and Biotechnology
7. Quantitative natural products chemistry
Natural products chemistry is at the intersection of
many fields:
Ecological Biochemistry
Taxonomy
Pharmaceutical Science
Entomology
Biochemistry
Natural
Products Combinatorial
Chemistry Chemistry
Biotechnology
Chemical synthesis
Molecular Biology Microbiology

153
 Ethnomedicine
• Refers to the study of traditional medical practice which is concerned with the
cultural interpretation of
 Health , diseases and illness and
 Also addresses the health care seeking process and healing practices.

154
 Allopathy/Allopathic medicine
• Is the treatment of disorders and diseases by use of conventional ways.
• conventional medicine or common and usual practice

 Complementary/alternative medicine (CAM)
• The terms "complementary medicine" or "alternative
medicine" are used inter-changeably with traditional
medicine in some countries.
• They refer to a broad set of health care practices that are

not part of that country's own tradition and are
not integrated into the dominant health care
system.
155 6/8/2023
156

157
• Course Code: Phar 2083
Course EtCTS: 3
• Pre-requisite Pharmacognosy
• Course Objectives
By the end of this course the trainee is expected to be

familiar with the forms of complementary medicine and also to
be well oriented about the use of complementary medicine in
primary health care.

Five chapters
1. Introduction
158
2. Ethiopian Traditional Medicine
3. African Traditional Medicine
4. Some popular complementary medical practices
Medical Herbalism
Aromatherapy
Homeopathy
Naturopathy
Traditional Chinese Medicine

5. Traditional medicine and primary health care
Out lines
159
 What is CAM?
 Traditional medicine
 Ethiopian traditional medicine

Cont…
160
 Traditional medicine (TM)

• TM is the sum total of the knowledge, skills, and practices based on the
theories, beliefs, and experiences indigenous to different cultures,
whether explicable or not, used in the maintenance of health as well as in
the prevention, diagnosis, improvement or treatment of physical
and mental illness.

Cont…
161
 Ethnomedicine
• Refers to the study of traditional medical practice which is concerned with the
cultural interpretation of
 Health , diseases and illness and
 Also addresses the health care seeking process and healing practices.

Cont…
162
 Allopathy/Allopathic medicine
• Is the treatment of disorders and diseases by use of conventional ways.
• conventional medicine or common and usual practice

Cont…
 Complementary/alternative medicine (CAM)
• The terms "complementary medicine" or "alternative
medicine" are used inter-changeably with traditional
medicine in some countries.
• They refer to a broad set of health care practices that are

not part of that country's own tradition and are
not integrated into the dominant health care
system.
163 6/8/2023
Cont…
164
• Alternative medicine:
• used in place of conventional medicine
• Complementary medicine:
• used together with conventional medicine
• Integrative medicine:
• Combines mainstream and CAM therapies for which there is some high-
quality scientific evidence of safety and effectiveness.

Con…
 Herbal medicines
• Herbal medicines include herbs, herbal
materials, herbal preparations and
finished herbal products, that contain as
active ingredients parts of plants, or other
plant materials, or combinations.

165 6/8/2023
Major Domains of CAM
166
 Alternative medical systems
 Mind-body therapies
 Manipulative and body-based therapies
 Biologically based therapies
 Energy therapies

Alternative Medical Systems
167
 Evolved apart from conventional medicine

 Homeopathic medicine
 Developed in 1796 by Samuel Hahnemann, based on his doctrine of like cures
like (simila similibus curentur)
 A claim that a substance that causes the symptoms of a disease in healthy

people would cure similar symptoms in sick people.

 Naturopathic medicine
168
 Relies on the healing power of the body to establish, maintain, and restore health
 Traditional Chinese medicine
 Balanced qi (vital energy)
 Flow of qi along meridians (energetic pathways)
 Qi (chi) Energy travels through 72 Meridians in the body
 Acupuncture
 insertion of hollow needles along meridians
 Needles are applied to Acupoints on the Meridians to restore the flow of qi

Mind-Body Interventions
169
 Many ancient cultures assumed that the mind exerts powerful influences on
bodily functions and vice versa.
 Enhance the mind‟s capacity to affect bodily function and symptoms
 Support groups and cognitive-behavioral therapy are now part of traditional

medicine
 Scientific support
 Placebo effect – WW II
 40% of therapeutic response is due to belief
170
 Most commonly used forms of CAM
 Types
 Prayer
 Yoga
 Meditation
 Hypnosis
 Biofeedback

Meditation
171
 Stress relief/ reduce anxiety  Improved function of immune
 Relaxation system
 Decreased oxygen consumption  Reduce pain
 Slowed heart rate  Relieve symptoms of psoriasis
 Decreased blood pressure  Improve health

Biologically Based Therapies
172
 Dietary Therapies
 Herbs
 Vitamins
 Aromatherapy

Dietary Therapies
Nutraceuticals and phytonutrients
173

 Protective or healing agents found in plant and animal foods.
 Free radicals: unstable molecules that alter genetic codes and trigger the
development of cancer growth in cells.
 Antioxidants: react with free radicals, preventing their damaging effects

 Sources of antioxidants: vitamin C, beta-carotene, vitamin E

Aromatherapy
174
 Essences from oils extracted from plants & flowers.
 Conditions responsive to aromatherapy:

 Stress and anxiety
 Muscular and rheumatic pains
 Digestive disorders
 Skin conditions
 Can be used for sense of smell, but also as compresses, baths or topical

Aromatherapy cont….
175
 Lavender – promotes relaxation & sleep
 Peppermint – stimulation, concentration
 Sandalwood – ease depression
 Chamomile – relaxation
 Lemon – promotes sleep/ tx for insomnia and/or digestive disorders

Manipulative and Body-Based Methods
176
 Based on the manipulation and/or movement of one or more parts of the body
 Movement & exercise

 Strengthens circulatory & respiratory function
 Endorphins
 Helps regulate metabolism
 Enhances Immune system

 Yoga
177  “life forces in correct balance and flow
 Concentration, strength, flexibility, symbolic movements
 Breathing, movement & posture
 Tai Chi
 Promotes the flow of qi or energy throughout the body
 Used in cardiac rehab programs, can lower BP
• Dance Therapy

 Chiropractic medicine
178
 Mostly concerned with the diagnosis and treatment of mechanical disorders of the
musculoskeletal system, especially the spine.
 Manual treatments to re-align the vertebra and restore function of spinal nerves

• Massage
179
– Pressure, kneading, stroking, vibration, and tapping to positively affect health
– Effects
• Relaxation • Reduces pain/relaxes muscle spasms
• Counteracts effects of stress • Improves concentration
• Lowers heart rate and • Promotes restful sleep
blood pressure • Helps the mind relax

Energy Therapies
180 “A group of techniques that work with the body‟s energy field by the use of the
hands to direct or redirect the energy to enhance balance within the field.”
 Magnetic therapy
 Most common type
 Magnets are used to correct disturbances of electromagnetic fields and restore health
 FDA – no medical value but relatively harmless
 Avoid for patients with pacemaker or defibrillator

Reiki
181
• Based on qi ("chi"), which practitioners say is a universal life force
• A technique called palm healing or hands-on healing through which a “universal

energy” is allegedly transferred through the palms of the practitioner to the patient in
order to encourage emotional or physical healing.
 Create Energy Balance
 Patient draws Energy
 Reiki Masters & Training

Traditional Medicine Vs modern medicine
Traditional Medicine
Knowledge protection Open access Closed, patented

Modern medicine
Formulation Not Pre-determined Pre-determined
Instruction No formal testing Extremely tight
Testing Virtually none Rigorous trials
Dosage Unfixed Fixed
Consultation Lengthy Brief
Training Non-proffessional Often professional
Key differences between traditional and modern medicine

182 6/8/2023
183 6/8/2023
184

185
 Brief History of ETM

 Traditional medicine practitioners and their practice
 TM in diseases prevention
 TM in Curative practices

Historical background of ETM
186
 Recording start time is not accurately known

• Perhaps, the earliest known text is
• The Geez „Metsehafe Fews‟
• Written around the middle of the 17th C.
• Another text, „Metsehafe Medanit”,
• also written in Geez was published in the 18th C.
• It contained thousands of prescriptions for a wide range of
diseases.
ETM-History cont.
187
• Knowledge is transferred from generation to generation orally.
• The health practices that start from home remedies to specialized

healing traditions like bone setting, poison healers, and veterinary
healers are found among various
• Drugs are stored usually in containers such as bottles, papers, pieces of

cloth, leaves and horns, and were kept anywhere at home

ETM-History cont...
188
• Administrative involvement of ETM
• In 1878, Emperor Yohannes IV
 Issued a decree prohibiting the practice of witchcraft.
 He preached that
• Evil sprit is the cause of mental illness
• Treated by priests using holy water (tsebel)

ETM-History cont.
189
 Emperor Menilik II
• Was a modernizer and believer in modern health systems
• Yet, he was tolerant towards the practice of ETM.
• In fact, the last resort treatment for his debilitating illness was with the holy
waters of Debre Libanos.

ETM-History cont.
190
• Legalization of ETM
• In 1942-legalized by proclamation
• In 1948-legalization re-enforced by another proclamation
• In 1993,
 a Health policy and a national Drug Policy were drawn up, to
encourage ETM research and grant patent rights.
 The department of ETM was reorganized into the Drug Research
Department within Ethiopian Health and Research Institute.

Cont…
191
• 80% of the population in Ethiopia Uses traditional medicine

 Cultural acceptability
for primary health care.
 Low cost
 Easy accessibility to clients
 Low access to modern health facilities
• 90% of livestock in Ethiopia.
• 95% of these alternative medicine are of plant origin

Cont…
192
• Principles, methods of practice and practices

 Some beliefs in ETM
• What does health mean in ETM?

Cont…
193
Principles:
To Ethiopians, health is a state of equilibrium
• With in the body and
• Between the body and the outside
Human body Outside body

Cont…
194
This equilibrium can be disrupted by :

• Excess heat, worms and sun
• Cold
• Food or
• Drink
Human body
Outside body

Cont…
195
• Some beliefs in ETM:
• Excess sun  „mitch‟ ("sunstroke") leading to skin disease.

• Blowing winds or Cold  pain wherever they hit.
• STDs  attributed to urinating under a full moon
• People with buda, "evil eye,"  harm others by looking at them.

Cont…
196
 For example, excess sun (heat) is thought to cause

• Headache, Eye disease, Earache, and Other conditions.
 When the sun shines on soil moistened by rain or urine,

• The generated vapour is believed to cause genital sores
• Inhaling this vapour may cause
• Internal disease that can reach the heart.

Cont…
197
 When the sun strikes a part of the body that is sweating or unclean,
• „Mitch ‟, loosely translated as "sunstroke," will develop,
• „Mitch‟ may manifest as irritation, rash ...

Cont…
198
 What is the primary bodily organ for Ethiopians?
 Ethiopians believe that the heart is the primary bodily organ

• It regulates other organs by
• Producing heat that radiates throughout the body

• Prolonged excess of cardiac activity is believed to
• lead to chronic fatigue, or „lib dekam‟ (literally, "tired heart")

Cont…
199
 The heart is believed to be located

• In the lower mid-chest and upper abdomen
• When Ethiopians complain of „lib‟ or "heart," disease
• It usually indicates dyspepsia (indigestion),

• Not a cardiac problem

Childhood Medicine
200
 Newborns are fed butter, which is

• Believed to give them a soft voice
• Their eyes are often painted with „kuul‟,
• A black powder ground from lead.
• This is done to protect the eyes from disease and
• To encourage the growth of eyebrows for beauty.

Cont…
201
 Incision of eyelid
• Eye-lids are incised
• In cases of eye disease or

• Prophylactically
 Other treatment practices include

• Applying herbs to the eyes.
• Squirting milk from the mother's breast into the eye

Cont…
202  Uvulectomy („Entil Mekuret‟)
• Ethiopians believe that if a baby has
• a uvula and a sore throat develops,

• the baby will suffocate.
• Thus, many children undergo uvulectomy
• The procedure is commonly done prophylactically
• In the first weeks of life or

• When the baby has a respiratory tract infection.
Cont…
203
 A traditional healer may cut the uvula with
• Scissors, a horse hair, or with a special knife.
• Potential risk
• Tetanus, meningitis, or sepsis may result.

Cont…
204
 Teeth extraction
• Because diarrhea often begins around the time
• Milk teeth grow (age of 6 to 10 months),
• Many women believe that milk teeth cause diarrhea
• At this age, incisors are often extracted to counter this
• This procedure is performed by local healers
• Prophylactically or
• Therapeutically

Cont…
205
 Circumcision is performed on
• almost all men and
• 90% of women

Cont…
206
 B/c Ethiopians believe that some people carry buda, "evil eye."
• Ethiopian woman may keep their newborns indoors
 to shield them from buda looking at them.
• Also Ethiopian woman may
 Put a knife or other metal object in a baby's bed
 To protect the child from the evil eye or buda.
• Women often place a metal object in their hair for the same purpose

Some healthcare practices in
207
ETM
 The different practices can be grouped
in to
A. Spiritual healing practice
B. Preventative practice
C. Curative practice
D. Surgical practice
E. Midwifery
F. Home remedies

Cont…
208
 Examples of traditional healers include

• Yetirs awlakiy ("tooth extractor"),
• Wagamiy ("cupper"),
• kitab ketabiy ("amulet writer"),
• Tonk way ("seer"),
• Medhaniyt awakiy ("herbalist"), and
• Entil korach ("uvula cutter").

Cont…
209
A. Spiritual healing practice

 Based on supernatural force  cause and cure diseases
 Religion has a significant influence, eg.
• Devil is considered cause of a number of illnesses,
• God is believed to provide the healing.
 More applicable to mental illnesses and obscure conditions

Cont…
Spiritual Healers/witch doctors
210

Cont…
211
 Spiritual healers
• Are usually well respected
• They appear to play the role of psychotherapists.
• They are known by different names, depending on
 The communities where they provide their service.

Cont…
212
• The more widely-known spiritual healers are grouped into two categories
according to their religious beliefs:
 Members of the Orthodox Christian clergy - Debteras and
 Members of the Muslim community include Kalichas/Daa
• The Debteras
 Pray on behalf of patients - known as degmit
 Prepare
 “Holy water” locally known as „tsebel‟ and

 “Amulets” locally known as „kitab‟

Cont…
213
• „Tsebel‟ is commonly used to

 ward off evil spirits from patients
• „Kitabs‟ are worn for the purpose of
 protecting oneself against “Evil Eye” or buda, and snake and
scorpion bites.

Cont…
214
 Among the Christians,
i. Taking the “Holy Communion”, or Kurban, and
ii. Believing in the miracles of angels or saints are also considered important for getting
cured from illnesses.
 The latter occurs through the petitioning of a particular angle or saint and
this is locally known as silet.
• Certain hot springs or ponds of water (also known as tsebel) dedicated to and named
after special angels or saints are also believed to provide cures for a lot of ailments.

Cont…
215
 The Kalichas
• Predict causes of medical problems
• Forecast somebody‟s fate in relation to a given problem
• Conduct special ceremonies to execute their practice
 Make use of smoke (myrrh or kerbe, frankincense or itan)
• Prepare kitabs of their own kind
 To be worn by their clients.
• Have ornaments to impress patients.

Cont…
216 B. Preventative practice
 In the past, the spread of infectious diseases such as smallpox was
prevented by
• Deserting places where the epidemics occurred
• Inoculation using biological materials from infected persons has also been
used to prevent some of disease types including smallpox.

Cont…
217
• Treating infected areas with smokes/ fumigation/

• Prevent spread of other diseases (eg. typhus)
– (e.g., yeshikoko gomen or senecio gigas)
• Sweeping or covering floors with particular kinds of plants
• (eg. tej sar or cymbopogen citrates)
• kitabs
– Protecting an individual against buda, and snake and scorpion bites.

Cont…
218
C. Curative practice
 ETM is commonly used to treat a variety of disease conditions employing

medicinal substances as recommended by expert practitioners.
 Different disease conditions are claimed to be treated by ETM
 Professional traditional healers known by different names in different parts

of the country are the primary players in the curative aspect of ETM.

Cont…
219
 One of the well recognized healers are the Medhanit awakis (Kitel betashs)
mostly play the role of herbalists .
 The Medhanit awakis

 Use large number of plants as to provide treatment
 Also use other medicinal items than plants that include mineral and animal-derived
substances (eg. sulfur, honey and butter)
 May possess traditional pharmacopoeias for their references

Cont …
220
Herbalist (Medhanit awakis, kitel betashs)

Cont…
221 The Medhanit awakis
• Diagnose disease mostly by
 Making use of physical examination and
 Questioning of patients
 Sometimes based on descriptions from informants.
• Prepare their medicines in various dosage forms including

 Liquid preparations, ointments and powders.
 Also prescribe “raw” medicinal materials without any kind of formulations (eg.
as a piece of stem, root or bark).

Cont…
222
D. Surgical practice
 Traditional practices considered to be related to surgery include
 Circumcisions and Uvulectomy
 Bone-setting (in cases of fractures or dislocations)
 Cautery, Bloodletting and cupping
 Incision-making and superficial scarification and
 Tooth extraction.

Cont…
223
Bone setting
 Regarded as an important surgical procedure
 Require certain degree of skill on the part of the healer
 In most places, the local name for the healer is Wogesha

Cont…
224
Bone setting

Cont…
225
 The Wogesha usually practices

• Without aseptic conditions,
• With or without the application of medicines.
• Common materials used include
 knife, razor, and metal rod/wire, cupping horn, thread, bandages
and a pair of scissors.

Cont…
226
 Cautery
• A burning stick would be placed on the diseased part of the body,
 this lead to contraction of the local muscles.
• Used
 To disinfect the skin,
 To prevent bleeding after amputation, and
 For snake and scorpion bites.

Cont…
227
 Bloodletting
• Involves cutting of brachial vein with a razor blade to expel the "black
blood”.
• Used to treat a traditional disease known as Moygnbagegn (literally, "get a
fool")
• Moygnbagegn is poorly defined & symptoms may include
 syncope (loss of consciousness), fever, headache, abdominal cramps,
or stiff neck
 Western medicine is believed to worsen the problem

Cont…
228
 Cupping, known as wagemt
• often used to treat Chest pain
• This is done either
 By lighting cotton on fire in a glass and placing it on the painful area
or
 By making an incision with a razor or knife, placing an animal horn
over the incision, and sucking out about three horn full of blood.
 Hot springs are popular with patients with localized back pain, rheumatism, and skin
disease
• Incision-making
• Tooth extraction
Cont…
229
E. Midwifery
 This is one of the most widely practiced aspects of ETM.
 It is performed by traditional healers commonly known as
• Yelmid awalajs, meaning traditional birth attendants.
 In almost all cases, the Yelmid awalajs are women.
 Depending upon the need, they carry out their practice
• With or without the administration of medicines.

Cont …
230
Birth attendants ( yelimd awalaj' )

Cont…
231
F. Home remedies
 Are traditional medicines given at the household level.
 Most of the medicines used for this purpose are
• obtained from plants growing in the vicinity of homes.

 Among others, the diseases that are frequently treated at household level by home
remedies include
• stomach aches, infected wounds, mitch/girifta, common cold, tonsillitis and nose
bleeding
• The practitioners are not considered experts in this area in most cases and the
medicines used are claimed to be relatively less toxic

Cont…
232
 Examples include:
• Feto (Lepidium sativum) – may minimize infections
• Hareq resa (Zehneria scabra) – usually for abdominal problems
• Tena adam (Ruta chalenesis) – usually to ward of evil sprit
• Bahir zaf (Eucalyptus spp.) – for cold conditions
• Dama kese (Ocimum lamifolium) – for inflammation and infections
• Bisanna (Croton macrostachys) – for tape worm expulsion

Cont...
233
Lipidium sativum („feto‟,‟shinfae‟) Hareq resa(Zehneria scabra) Tena adam (Ruta chalenesis)
Dama kese (Ocimum lamifolium) Bisanna (Croton macrostachys) Bahir zaf (Eucalyptus spp.)

Modern drugs obtained from herbs
234
Example
• Qunnine and artimesin for malaria
Cinchona officinalis

Artemisia annua, (sweet wormwood)
Cont …
235
 Vincristin and vinblastin for tt of cancer
Vinca rosea
Cont …
236
• Digoxin for tt of heart failure
Foxglove (Digitalis purpurea).

Over lapping practices
237
 Although specialized services are widely available, there is no clear-cut

separation in the application of the d/t “specialties.”
• For example,
 Medhanit awaki may serve as spiritual healer and vice versa
 Even some traditional healers show interest to integrate some aspects of

conventional medicine in their traditional medical practice

4. Documentation, clinical trials/ scientific investigations
238
 TM in Ethiopia has been barely studied and its therapeutic potentials

as well as adverse effects have not been well explored scientifically.
 As with most other things,
Ethiopia appears to be lagging behind with respect to TM

Cont…
239  Thus, about ETM
• It seems that almost no clinical trials exist and
 National strategy and plan of action for pharmaceutical manufacturing development in
Ethiopia (2015–2025)
 2015=___, …………………2020=3, …………..2025=20
• Scientific research undertakings are mostly of academic interest only.

 Existing evidences lack organization and proper documentation
• Organized and documented information about ETM and use of medicinal plants
in Ethiopia is fragmentary.

Why do we concern more about ETM ?
240
The most obvious reasons for studying ETM include:
Is part of the primary health care need for the majority of

the people
Can potentially offer novel forms of therapy to the
modern medicine
Is part of the cultural heritage of the Ethiopian people
Some important indigenous knowledge and

medicinal plants are being lost

UNIT THREE
AFRICAN TRADITIONAL
MEDICINE
Lesson Objectives:-
242
At the end of this lesson you will be able to:
 Understand the history of African traditional
medicine
 Identify medicinal plants used in African traditional
medicine
 Describe its relationship with western medicine

1. Introduction
243  African traditional medicine

 Is the oldest, and perhaps the most assorted.
 Africa is considered to be the cradle of mankind
 with a rich biological and cultural diversity
 marked by regional differences in healing practices
 African traditional healing
 is therefore intertwined with cultural and religious
beliefs

Intro…
244
 According to traditional African belief,
 human beings are made up of various aspects –
 physical, spiritual, moral, and social.
 When these parts function together harmoniously,

 a person will be in good health
 if any of these features are out of balance,
 a person will become physically/ spiritually ill
 Illness is not viewed as just a physical disorder,
 but could also be a spiritual, moral, or social disorder.

Intro…
245
 In Africa,
 Traditional medicine is characterized by health theories
inter-mingling
 human with his social, natural, spiritual and cosmic
environment.
 According to this holistic approach,
 disease is to be considered
 a phenomenon that appears when disharmony affects the
vital powers governing the patient's health,
 which range from the most powerful deity to the smallest
living organism

Intro…
246
 To restore harmony,
 the healer combines local plants and minerals –
 used both for their medicinal properties and their symbolic
and spiritual significance
 with ritual actions, and calls on his in-depth knowledge of
the patient's kinship and social relations
 locally shared cosmologies
o
 Constitute the 1 health care for 80% of the
African population

Intro…
247  Traditional health practitioners basically follow three
principles
1. Patients must be completely satisfied
 that they and their symptoms are taken seriously
 that they are given enough time to express their fears.
2. The healer studies the patient as a whole and
 does not split the body and mind into two separate entities.
3. The healer never considers the patient as an isolated
individual
 but as an integral component of a family and a community.

2. History of African traditional medicine
248
• When the first man practiced herbalism
in Africa?
 Not known exactly
 Yet, a number of theories have
been advanced by scholars and traditional
medicine practitioners.

History…
249
1. Early man in Africa deliberately selected specific plant material

for the treatment of his ailments
2. Knowledge of medicinal plants in Africa was gained by accident.
 However, specific knowledge could have been gained by
 Watching effects of various plants when eaten by domestic
animals
 Even today, some herbalists try remedies, in front of their
patient
 On domestic animals especially when testing for toxicity,
 On themselves or their relatives

History…
250 Hunters have been reported as the original custodian of some
effective traditional herbal species.
This could be acquired by, for example, a hunter shot an elephant
 Possible observation, Elephant
• Ran away, chewed leaves from a specific plant and did not die,
• Hunter note the plant as possible antidote for wounds or for
relieving pain.

History…
251 Similar observation by scientists:
 Confirmed that chimpanzee use medicinal plants in Africa for
self-medication.
 Chimpanzees protect against pathogens by self-medicating with
various plants.
 Chimpanzee and humans co-existing in Sub-Saharan Africa
 are known to ingest Vernonia amygdalina („girawa‟) for the
control of intestinal nematode infections

History…
252
3. According to some traditional medicine practitioners,
knowledge of traditional cures come from wizards or witches.

History…
253
 Colonial Stigmas
 During the colonial period,
 the arrival of Western medicine had a negative impact on
ATM.
 For instance,
 ancestral medicine was viewed as inferior,
 stigmatized and marginalized.
 development of this branch of African knowledge was stymied
for a long time.

History…
254
Colonial Stigmas…
 In some extreme cases,
 traditional African medicine was completely banned,
 due to its association with „witchcraft.‟
 In the eyes of the colonists,
 „witchcraft‟ was regarded as „backward‟ and „superstitious‟
 something undesirable that they believed should be

eliminated.

History…
255
Modern period
 In recent years,
 gained more appreciation from researchers in Western

science.
 Developing countries have begun to realize
 the high costs of modern health care systems
 the technologies that are required
 Due to this,
 interest has recently been expressed in to integrating
traditional African medicine into the continent's national
health care systems

History…
256
 An African healer embraced this concept
 by making a 48-bed hospital, the first of its kind,
 in Kwa-Mhlanga, South Africa
 combines traditional methods with homeopathy, iridology,

and other Western healing methods,
 even including some traditional Asian medicine.
 However, the highly sophisticated technology involved in

modern medicine,
 to integrate into Africa's health care system
 could possibly destroy Africa's deep-seated cultural values.

3. ATM-Practitioners
257
 African Traditional Medicine Practitioners (ATMPs) include:

• Herbalists & herb sellers
• Traditional birth attendants
• Faith healers & diviners
• Bonesetters & traditional surgeons etc.

ATMPs …
258
Specialize in particular areas in the same way as orthodox medical
practitioners.
 For example,
• Some are experts in the use of herbs (herbalist)
• Some are experts in manual techniques (eg bone setters)
• Others are proficient in spiritual healing (eg diviners)
• Still others may have more than one skill

ATMPs…
259
 How ATMPs learned their practice?

 handed down orally, frequently in the form of stories, from
one generation to the next
 Some by undergoing treatment as a patient.
 Upon their recovery, they decided to become practitioners
themselves.
 Some through spiritual calling, in which case
 The healer‟s diagnoses and treatments are strictly
determined by the supernatural

ATMPs
260
• Some through a long formal apprenticeship under an

established practitioner.
• The trainees pay their tutor a basic fee as well as a fee for
each step of advancement.
• Some simply exhibit mastery of the art (divine

endowment?) without any prior training

ATMPs
261
 The major figures of traditional medicine in Africa
 are the diviner and the traditional healer.
 “Sangoma”
 The diviner diagnoses the cause of an illness if a supernatural

interaction is suspected.
• His tools are
 his wide knowledge of the village‟s kinship relations
 social connections and potential current conflicts.

ATMPs
262
 The traditional healer chooses and applies appropriate remedies
 he is usually a very powerful person
 with connections and respect throughout the local society,
 with indirect political power deriving

 from his ability to control illness and the linked supernatural
powers.
 The traditional healer‟s right and ability to heal are said to be
gifts from God and ancestors,
 often recognized during childhood through specific deeds.

263
Disease Treatment

ATMPs
264
 Practitioners of traditional African medicine claim to be able to
cure various and diverse conditions such as
 cancers, benign prostatic hyperplasia
 psychiatric disorders, epilepsy, anxiety, depression
 high blood pressure,
 cholera, most venereal diseases, urinary tract infections, fever
 Asthma
 eczema, gout, healing of wounds and burns.

4. Medicinal plants in Africa
265
 Africa
 is endowed with many plants
 be used for medicinal purposes to which they have taken full
advantage.
 Out of the
 approximated 6400 plant species used in tropical Africa
 more than 4000 are used as medicinal plants.
 are used in the treatments of many diseases and illnesses,

 the uses and effects of which are of growing interest to
Western societies.

Medicinal plants…
266
 Not only are plants used and chosen for their healing abilities,
 but they also often have symbolic and spiritual significance.
 For example, leaves, seeds, and twigs that

 are white, black and red are seen as especially symbolic or
magical and possess special properties.

Medicinal plants…
267
Pygeum (Prunus africana):
 Pygeum is not only used in traditional African medicine,
 but has developed a following around the world
 as a cure for mild-to-moderate benign prostatic hyperplasia,
 claimed by its users

 to increase the ease of urination
 reduce inflammation and cholesterol deposits.

Medicinal plants…
268
 In traditional African practice,
 the bark is made into tea
 elsewhere in the world

 it is found in powders, tinctures, and pills.
 Pygeum
 has been sold in Europe since the 1970s
 harvested in mass quantities in Cameroon and Madagascar

each year.

Medicinal plants…
269
Securidaca Longepedunculata:
 This is a tropical plant found almost everywhere across the
continent with different uses in every part of Africa.
 In Tanzania,
 the dried bark and root are used as a laxative for nervous
system disorders,
 with one cup of the mixture being taken daily for two weeks.
 In East Africa,
 dried leaves from the plant are used in the treatment of
wounds and sores, coughs, venereal diseases, and snakebites.

Medicinal plants…
270
 In Malawi,
 the leaves are also used for wounds, coughs, venereal
diseases, and snakebites, as well as bilharzias (parasitic worm),
and the dried leaves are used to cure headaches.
 In other parts of the continent,
 parts of the plant are used to cure skin diseases, malaria,
impotence, epilepsy, and are also used as an aphrodisiac.

5. Relationship ATM with Western medicine
271
 Although Western medicine is successful in developed
countries
 it doesn't have the same positive impact in many of the
underdeveloped African countries.
 Western practices can make an impact in health care
practices,
 in certain areas such as in the spread of various diseases,
 it cannot integrate wholly into the culture and society.
 This makes the traditional African practitioners a vital part of

their health care system.

Relationship ATM…
 South Africa
• Approximately 200,000 traditional
healers are currently practicing,
• Compared to only 25,000 medical
doctors,
• Traditional healers are consulted by
approximately 60% of the South African
population, usually in conjunction with
modern biomedical services
• Roughly 80% of the black population
uses the services of traditional healers.
Sangomas
272 6/8/2023
Relationship ATM…
 In Zimbabwe
• There are approximately 45,000
traditional healers in Zimbabwe alone,
whereas the country has only 1,400
medical doctors.
• It is estimated that as many as 90% of the
Zimbabwean people utilize the services of
the traditional healers.

273 6/8/2023
Relationship ATM…
274
 TMP Malawi  A traditional healer in

Uganda treating a patient‟s
dizziness

Relationship ATM…
275
 There are many reasons why the Western medical system does
not work in Africa.
 Medical facilities are difficult for many Africans to get to.
 With vast areas of land and poor road and transportation

systems,
 many native Africans have to travel immense distances on
foot to reach help.
 Once they arrive
 they are often required to wait in line for hours
 especially in urban areas,

 as the lack of clinics and resources cause over-crowding.

Relationship ATM…
276  Patients are oftentimes not told the cause of their illness
 Difficult to prevent or prepare for it.
 Technology used is usually of poor quality, which affects the
quality of treatment.
 Western medicine is also too expensive
 for the average African to afford,
 making it difficult for them to receive proper care.

Relationship ATM…
277  Western medicine

 removes native Africans from the culture and tradition
 forces them into a setting that they are not comfortable with,
 away from their family and traditions
 utmost importance to them.
 They do not get the proper spiritual healing
 their culture seeks and traditional ideology requires.

Relationship ATM…
278
 However,
 there has been more interest towards some of the medicinal
plants of Africa.
 pharmaceutical industry has come to consider traditional
medicine as
 source for identification of bio-active agents that can be used
in the preparation of synthetic medicine
 there are some things that can be learned from traditional
African practice.

Some Problems associated with traditional medicine
279
 Some plants used in traditional medicines, such as

 taenicides, are widely known to be toxic.
 For example,
 blindness and changes in central nervous system function
have repeatedly been found in people who took over dosage
of Hagenia abyssinica.

Some Problems…
280
 Traditional healers
 may cause delays in the treatment of communicable diseases
such as TB
 if they fail to refer patients to modern health services.
 Number of harmful practices

 female genital mutilation, ulvectomy, and milk tooth
extraction

Training & certification
281
 The field is largely unregulated.
 In Africa,
 many traditional practitioners uneducated people
 accumulated a great deal of knowledge about native plants

and their actions on the human body.

Training …
282
 There is considerable interest
 in integrating traditional African medicine more fully with
the continent's national medical systems.
 In Harare, Zimbabwe,
 a school of Traditional African Medicine opened its doors in
October, 1999.
 Students include both traditional healers and university
graduates.

ATM- Scientific Research & clinical trial
283
• In ATM there is no formal “ research” or controlled

experiments
• Yet, it is evidence based in the sense that
• A bone-setter who sets no bones will not have any patients
seeking him/her for bone-setting
• A herbalist who do not provide effective medicines will not
have any patients seeking for him/her herbal medicines
• thus, witness by customers is
• the main supporting evidence to ATM than scientific

research or clinical trial
• Therefore, ATM is on its consumer-led movement

284
HERBAL MEDICINE
For Pharmacy

Points to be known
285
 What are herbal medicines (HM)?
 Rationale for the use of plant as medicine
 D/c b/n HM & modern medicine
 Popularity of herbal medicine
 Reasons for the popularity of HM

Points to be known
286
 Advantages & disadvantages of HM

 Safety of herbal medicine
 Standardization of herbal medicines
 Roles of pharmacy in herbal medicines
 Some commonly used herbal medicines

Traditional medicine (TM):
287
TM is the sum total of the knowledge, skills, and practices based

on the theories, beliefs, and experiences indigenous to
different cultures, whether explicable or not, used in the
maintenance of health as well as in the prevention, diagnosis,
improvement or treatment of physical and mental illness.

288
• “Diverse health practices, approaches, knowledge and beliefs

incorporating plant, animals and or mineral based
medicines, spiritual therapies, manual techniques
and exercise, applied singularly or in combination to
maintain well being as well as to treat, diagnose or prevent
illness” (WHO).

289

What are Herbal medicines?
290
 Contain as active ingredients parts of plants, or
other plant materials, or combinations
 Medicinal products prepared from plants

Medicinal product
291
 “Any substance or combination of substances which may be

administered to human beings or animals with a view to
making a medical diagnosis or to restoring, correcting or
modifying physiological functions in human beings or in
animals is considered a medicinal product.”

Herbal medicine
292
 Herbal medicines include:

 Herbs
 Herbal materials
 Herbal preparations and
 Finished herbal products

Herbs:
293
• Crude materials which could be derived from lichen, algae,

and higher plant. Includes:
 leaves  Wood
 flowers  bark, roots,
 fruit  rhizomes or other plant parts, which may be entire,

fragmented or powdered.
 Seed
 stems
Herbal materials
294
 In addition to herbs, fresh juices, gums, fixed oils, essential oils,

resins and dry powders of herbs.
 Processed by various local procedures, such as
 steaming
 roasting or
 stir-baking with honey, alcoholic beverages or other materials

Herbal preparations
295
 Include:
 Comminuted or powdered herbal materials
 Extracts, tinctures and fatty oils of herbal materials
 Produced by extraction, fractionation, purification, concentration, or

other physical or biological processes.
 Preparations made by steeping or heating herbal materials in alcoholic

beverages and/or honey, or in other plant materials.
 Basis for finished herbal products

Finished herbal products
296
 Herbal preparations made from one or more herbs
 If more than one herb is used, the term mixture herbal product
 Finished herbal products and mixture herbal products may contain
excipients in addition to the active ingredients

297
NOTE:
 Finished herbal products or mixture herbal products to
which chemically defined active substances have been
added, including synthetic compounds and/or isolated
constituents from herbal materials, are not considered to be
herbal.

Rationale to use plant as medicine
298
 Produce very diverse & complex chemicals with

plethora of pharmacological activities
 One third to one half of all pharmaceutical drugs were
originally derived from plants
E.G. Quinine _ from Cinchona bark
Morphine _ Papaver sominiferum
Vincristine _Vinca rosea
Difference b/n herbal medicine and modern drugs
299
 Herbal medicines:
 Composed of mixtures of compounds
 Active principles frequently unknown
 Standardization, stability and quality control feasible but not easy
 Availability and quality of raw materials frequently problematic
 Well-controlled double-blind clinical and toxicological studies to prove their
efficacy and safety are rare

Preparation of Herbal Medicines
300
 Common solvents: water, hydroalcoholic, fat & oil

 Preparation methods
 Expressions
 Maceration
 Percolation
 Decoction & infusion
 Prepared in similar manner to modern pharmaceuticals.

Popularity of herbal medicines
301
 Global HM usage is widespread and growing
 65-80% of population depend on TM
 Global market $ 83 billion and forecasted to reach $107 billion by the

year 2017
 Herbal medicine markets in Asia and Japan reach $2.3 and 2.1 billion
 USA spent $4.2 billion in 2002 for herbs
1. Introduction to the Chemistry ofEisenberg

Natural Products
DM et al, 6/8/2023
Ann Int Med (2002) 137:965-973.
Table 1. The seven best-selling herbal medicines
S. No. Herbal drugs Annual retail sales in percent increase

mainstream US compared with
market ($US) previous year
1 Ginkgo (Ginkgo biloba) 150 million 67%
2 St. John‟s wort (Hypericum 140 million 190%
perforatum)
3 Ginseng (Panax ginseng) 96 million 11%
4 Garlic (Allium sativum) 84 million 17%
5 Echinacea (E. angustifolia, E. 70 million 42%

purpurea, E. pallid)
6 Saw palmetto (Serenoa repens) 32 million 74%
7 Kava (Piper methysticum) 17 million 462%

302
Why HM so popular?
303
 Dissatisfaction in modern medicine
 Unaffordable
 Side effects
 Lack of complete cure
 Belief that herbal drugs are free from side effects, “Nature is safe” &
provide greater efficacy

Wetzl,6/8/2023
Ann Intern Med 2003; 138: 191-6
Why HM so popular?
304
 Preference of populations for preventive medicine due to increasing

population age
 Increased tendency towards self medication
 Cultural and religious influence
 Consumer satisfaction with the level of inter‐personal care provided

Advantages of herbal medicines
305
o Affordable
o Accessible
o Culturally acceptable
o Better patient compliance
o Economical benefits
o Source of modern drugs or leads

Limitations of herbal medicine
306
 Dose usually unknown
 For most, active compounds not known
 Variability in active compounds that leads to inconsistent

therapeutic activity
 Lack of scientific data on safety and efficacy of most HM

Safety of herbal medicines
307
The general idea that herbal drugs are very safe and free from side
effects is not necessarily true.
Adverse drug reaction of HM
Intrinsic Extrinsic
factors factors
Misidentification
Over dose
Substitution
Drug-drug interaction Contamination
Adulteration
E.G. Plants with pyrrolizidine alkaloids, incorrect preparations
and/or dosage, etc
aristolochic acid 1. Introduction to the Chemistry of Natural Products 6/8/2023
Safety of herbal medicine
308
Aristolochic acids
Source : the genus
 Aristolochia (Aristolochia fangchi)and
 Asarum family Aristolochiaceae
Toxicity:
o Carcinogenic
o Mutagenic
o Nephrotoxic

Check for drug interaction
Herbal drug interaction

309
Herbs Are 'All Natural' - Why Worry About Drug

Interactions?
 Garlic interfere with the effect of saquinavir
 St John's wort (Hypericum perforatum): interact with
warfarin, cyclosporin, HIV protease inhibitors, theophylline,
digoxin and oral contraceptives
 Increased risk of bleeding when Ginkgo biloba is used
concurrently with antiplatelet agents [e.g., aspirin,
anticoagulants [e.g., warfarin, heparin]

Quality control of herbal drugs
310
 Quality control is a term that refers to processes involved in

maintaining the quality and validity of a manufactured
product.
 determined by
- identity,
- purity,
- content, and
- other chemical, physical, or biological properties, or by the
manufacturing processes.

Quality….
311
In general, quality control is based on three
important pharmacopoeia definitions:
1. Identity: Is the herb the one it should be?
2. Purity: Are there contaminants, e.g., in the form of other
herbs which should not be there?
3. Content or assay: Is the content of active constituents
within the defined limits?

Quality….
1. Identity
- Proper botanical identification
- Voucher specimens are reliable reference sources.
- Plants with similar species may lead to incorrect

identification
 Identity can be achieved by macro- and microscopical
examinations and organoleptic evaluation
1. Introduction to the Chemistry of Natural Products 6/8/2023 312

313
Macroscopic evaluations of herbal drugs are based on

plant’s special features
• Shape
• External
• Marking
Macroscopic evaluations are of primary importance before any
further testing can be carried out.

314

Quality….
Organoleptic
 Evaluation of drugs refers to the evaluation of a drug by
- color,
- odor,
- size, taste and special features including touch, texture
etc.

Quality….
316
 However judgment based on the sensory

characteristics
 like odour, taste etc., may vary
 from person to person
 time to time based on individual's nature.

Quality…
317
3. Microscopic evaluation is needed to determine the

correct species and/or that the correct part of the
species is present.
• For instance, pollen morphology may be used in the case of

flowers to identify the species, and
• the presence of certain microscopic structures such as leaf

stomata can be used to identify the plant part used.

Quality…
318
2. Content: is the most difficult one to assess, since in most

herbal drugs the active constituents are unknown.
- Sometimes markers can be used
 Marker defined as chemically constituents that are of

interest for control purposes, independent of whether they
have any therapeutic activity or not.

Factors affecting quality of
319
herbal medicines
 Plant constituents vary considerably depending on several factors that impair
the quality of phytotherapeutic agents
i. Intrinsic factors:
 Genetic variability
ii. Extrinsic factors:

 Environmental variation
 Geographical variation
 Method of collection & preparation
 Storage
 Adulteration and substitution
Challenges in Quality control of HM
320
 Usually mixtures of many constituents
 The active principle(s) is (are), in most cases unknown
 Selective analytical methods or reference compounds may

not be available commercially
 The quality of the raw material are variable

Standardization of herbal medicine
321
 Involves adjusting the herbal drug preparation to a

defined content of a constituent or a group of substances
with known therapeutic activity by adding excipients or
by mixing herbal drugs or herbal drug preparations.

322
 Is the establishment of reproducible pharmaceutical

quality by :
Comparing a product with established reference substances
and
Defining minimum amounts of one or several compounds or
group of compounds.

Standardization of herbal medicines
323
 Process of prescribing a set of

 standards or inherent characteristics
 constant parameters
 definitive qualitative and quantitative values that carry an
assurance of quality, efficacy, safety and reproducibility.
 Process of developing and agreeing upon technical standards

Why is standardization necessary?
324
 Reproducible & generally higher quality of product

 Allows comparison of clinical effectiveness,
pharmacological effects and side effects
 Give patient greater security & thus increase level of trust
in herbal medicine

Standardization of Herbal medicines
325
 Different techniques used for standardization:

 High-performance liquid chromatography (HPLC),
 Gas chromatography (GC),
 Ultra-high performance liquid chromatography (UHPLC) and
 Thin layer chromatography (TLC)
 Gas chromatography–mass spectrum analysis (GC–MS)
 HPLC–MS and HPLC–nuclear magnetic resonance (NMR)

Type of herbal extracts
326
 3 types in Europe
1. Truly standardized extracts (Type A)
- Standardized to active constituents
E.g. Senna dry extract (5.5-8% hydroxyanthracene glycosides calculated as
sennoside B
2. Quantified extracts (Type B)
- Standardized to constituents that contribute to the activity
 E.g. Gingko biloba leaf and Hypericum perforatum aerial part
3. Other extracts (Type C)

- Standardized to compounds of unknown pharmacological relevance. E.g.
Echinacea root (E. purpurea & E. pallida)
Role of pharmacists in herbal medicine
327
 Scientific evaluation including clinical trial about the safety

& efficacy of HM
 Quality control & standardization of HM
 Drug information to patients & other health professionals
 Pharmacovigilance of HM

ST.JOHN’S WORT
328
Source: Dried aerial parts of Hypericum perforatum family Hypericaceae
Constituents:
i. Anthraquinones (hypericin & pseudedohypericin, iso-hypericin & emodin-antrone)
ii. Prenylated phloroglucinol derivatives
Hyperforin (2-4.5%), adhyperforin & furohyperforin
iii. Flavonoids
Iv. Volatile oils
v. Other constituents (caffeic & chlorogenic acids, amino acids, tannin &
carotenoids) 1. Introduction to the Chemistry of Natural Products 6/8/2023
Use of ST. JOHN’S WORT
329
 Treatment of mild to moderate depression

 Represent 25% of all antidepressant prescriptions
(„ Nature‟s prozac”) in Germany.
 ≥ 78 million dollar in 1999 in USA
 Induce Cyp3A4, increased action of P-glycoprotein.
 Reduce plasma level of protease inhibitors, Cylosporin, warfarin,
digoxin, tricyclic antidepressants

GINGER
330
 Dried rhizome of Zingiber officinale Roscoe (Zingiberaceae)
Synonyms
 Amomum zingiber L., Zingiber blancoi Massk
 Constituents: Volatile oil & oleoresin
 Sesquiterpene hydrocarbons (responsible for the aroma):-(-)-zingiberene,

(+)-ar-curcumene, (-)-β- sesquiphellandrene, and β-bisabolene
 Pungent phenolics: gingerol & shogaols

MEDICINAL USE OF GINGER
331
 Uses supported by clinical data
 Antiemetic
 Prophylaxis of nausea and vomiting associated with motion sickness,

postoperative nausea, pernicious vomiting in pregnancy and seasickness

Precautions
332
 Pregnancy: teratogenic effects
 In a double-blind randomized cross-over clinical trial, ginger (250 mg by

mouth, 4 times daily) effectively treated pernicious vomiting in
pregnancy and no teratogenic aberrations were observed in infants born
during this study.
 Paediatric use
 Not recommended for children less than 6 years of age.

Silymarin
333
 Mixture of flavonolignanes
 Silybin, isosilybin, silydianin, silychristin
Source: Seeds of Silybium marianum family Asteraceae

O OH
HO O OMe
O
H
OH OH
OH O
 used Sylibin
Hepatoprotective
Antioxidant ,
anticancer
GINKGO
 Source: leaves of Ginkgo  Constituents:

biloba (Maidenhair  Diterpene lactones:
tree) (family (Ginkgolides A,B,C,J,M)
Ginkgoaceae)  Flavonoids
 Native to China & Japan  Ginkgolic acids (allergenic)
Use: Improve peripheral & cerebral

blood flaw in elderly with symptoms
of loss of short term memory &
concentration
334
GINKGO
335
Use: Memory and concentration problems, confusion,

depression, anxiety, dizziness, tinnitus and headache
 increasing blood supply by dilating blood vessels, reducing
blood viscosity, modification of neurotransmitter systems,
and reducing the density of oxygen free radicals.

c. Ginseng
336
Source: Roots of Panax ginseng C.A. Meyer (Asian or Korean

ginseng) & Panax quinquefolius (American ginseng ) (Family,
Ariliaceae)
 China, Korea & Siberia – principal producers
Constituents: triterpene saponins (medicinal part)

(Gensenosides/panaxosides)
Other constituents includes:
 Polysaccharides (panaxans (A-U) & ginsenans)
 Polyacetylenic compounds (panaxynol & panaxydol)
 Volatile oil
Ginseng
337
OH OH
Sug-O Sug-O
Sug-O Sug-O
“Adaptogen” : a substance that increases
O-Sug
resistance to physical, chemical, and
Protopanaxdiols Protopanaxatriol
biological stress and builds up general
vitality including physical and mental
capacity
Use of ginseng
 Adaptogenic ($ 60 million in 1999 in USA & Chinese market $350
million in sales in 2006 )
 Stimulate stamina, concentration, resistance to stress & diseases
 Increase libido
Ginseng
338
 Enhance cognitive performance and wellbeing for

treatment of dementia
 Possible mechanism of action
 Anti-apoptotic action of panaxydol (PND) and panaxynol(PNN)
may reduce neurodegeneration
 Attenuate -amyloid (A) induced toxicity
 Anti-oxidative effect

Ginseng
339
 Dementia: is a syndrome characterized by progressive cognitive

impairment, which leads to
 decreased ability to perform activities of daily living and it is usually accompanied

by
 the development of behavioral disturbances
 There are several forms of dementia:

 Alzheimer‟s disease (AD) being the most common form, accounting for 50%to 75%of
cases (WHO2004
 Vascular dementia (VD), caused by impaired blood supply to the brain

340
Summary
 A growing herbal market and its
 HM continues to play essential great commercial benefit - need
role in ensuring availability of to ensure sustainable use of
medicinal plant resources
medicine
Safety, quality and efficacy of HM

major challenges
GAP, GMP & standardization of HM
crucial to ensure safety, efficacy &
quality of HM
341

Indian traditional medicine
342
 Topics to be discussed
 Introduction
 History
 Underlying concepts
 Treatment

Introduction
343  Indian traditional medicine -Is also called Ayurveda
 Is originated in India
 Combines two Sanskrit (Indo-Aryan language)
words- Ayur, means life, and
Veda, means science or knowledge

 Ayurveda means „the science of life‟

INTRODUCTION
344
 India has an ancient heritage of traditional medicine.
 The materia medica of India provides a great deal of

information on the folklore practices and traditional
aspects of therapeutically important natural products.
 Indian traditional medicine is based on various systems

including Ayurveda, Siddha, and Unani.

Introduction
 It is based
345
 On theories of health and illness and
 On ways to prevent, manage or treat health problems.
 It aims
 To integrate and balance the body, mind and spirit
 Some view it as „holistic‟
 This balance is believed
 to lead to contentment and health, and
 to help1.prevent
Introductionillness
to the Chemistry of Natural Products 6/8/2023
Introduction
346 However, Ayurveda also proposes treatments
 For specific health problems (physical/ mental)
 A chief aim of Ayurvedic practices is

 To cleanse the body of substances that can cause disease,
and
 Believed to help reestablish harmony and balance.

History
347 Ayurveda ideas
 Based on ideas from Hinduism religion
 Some evolved from ancient Persian thoughts about health

and healing

History of Ayurveda
 As per the mythology Lord Brahma is considered to be the
348
founder of Ayurveda which was propagated to the people on
earth by sage Bharadwaja.
 As per the preaching of sage Bharadwaja various seers wrote

their own treatises based on their fields of interest which in
turn lead to the emergence of 8 branches of Ayurveda.

8 BRANCHES OF AYURVEDA
349
 Kayachikitsa
 Bala roga
 Graha roga
 Shalya tantra
 Shalakya tantra
 Visha chikitsa
 Jara chikitsa
 Vajeekarana chikitsa
History
 Two ancient books, written in Sanskrit on palm leaves
350
more than 2,000 years ago, are thought to be the first texts:
 Charaka Samhita
 Sushruta Samhita
 They convey many topics, including:
• Pathology, Diagnosis and Treatment
• Surgery (this is no longer part of Ayurvedic practice)
• How to care for children
• Lifestyle
• Advice for practitioners, including medical ethics
• Philosophy

 According to Ayurveda, all the living and non-living
351
things are made up of the five elementary principles
(Panchamahabhutas) which are derived from the three
effective principles/energies of nature (Prakruti):
1. Satwa - responsible for conscious manifestation
2. Rajas - responsible for the existence of energy in matter
3. Tamas - responsible for resistance and stability

The Five Elements
352  All matter is composed of the five universal elements;
namely the “panchamahabhutas” (pan cha ma ha boot
tas). They are termed as:
 ether ‐ akasha
 air ‐ vayu
 fire ‐ tejas
 water ‐ jala
 earth ‐ prithvi
The Four Forces
353
Humans are considered miniature versions of the universe,
composed of the five elements and four forces:
 atma ‐ soul
 manas ‐ mind
 kala ‐ cycles of time
 indriyas ‐ senses

The Tridosha Theory
354
 The Ayurvedic understanding of the universe is based
on a three‐fold system called the “tridosha theory.”

 The five elements integrate into physical form as the
three doshas.
 Everyone is a unique combination of the three doshas
known as:
 vata
 pitta
 and kapha.
 Vata, pitta and kapha are found in every cell, tissue and
organ in different degrees
Underlying concepts
355 About doshas ;- each dosha
1. Is made up of two of five basic elements: ether (the
upper regions of space), air, fire, water, and earth
2. Has particular relationship to bodily functions
3. Each person has a unique combination of the three
doshas
4. An imbalance of a dosha will produce symptoms
that are unique to that dosha
Underlying concepts
1. Vata Dosa
356
 Combines the elements ether and air
 Most powerful dosha because it controls very basic
body processes
 Cell division
 Breathing
 Discharge of waste
 Heart and mind
 Aggravated by fear, grief, eating dry fruit/ before the
pervious is digested
 Skin and neurological conditions, rheumatoid
arthritis, heart disease, anxiety, and insomnia
Underlying concepts
2. Pitta Dosa
357
 Combines the elements fire and water

 Hormones and the digestive system.
 Imbalance:- anger and heart burn 2-3 hrs after eating
 Upset:- eating spicy or sour food, fatigue, or
spending too much time in the sun
 Hypertension, heart disease, infectious diseases, and
digestive conditions such as Crohn‟s disease
Underlying concepts
3. Kapha Dosa
358
• Combines the elements water and earth

• Maintain strength and immunity and to control
growth
• Imbalance:- nausea after eating
• Upset:- greed, sleeping during the daytime, too much
food and salty water
• Diabetes, cancer, obesity, and respiratory illnesses
such as asthma.
Maintenance Of Health
359
The entire practice of maintaining health is raised on

the pillars of three essential concepts.
These are:
• Diet
• Sleep
• Sexual Practices & Other Behavioural patterns

Health preservation / promotion methods
360 Dinacharya
 The fundamental rules of personal and social hygiene are to be
followed regularly, building up the immunity against most of the
ailments in order to enhance the quality of life and increase
longevity, is a task achievable even in the present lifestyle.
 Right from waking up in the morning till sleeping at night, all the
daily routines have been given utmost importance in Ayurveda.

Waking Up Hours
361
Brahmi muhurta
 A healthy person should get up approximately two hours
before sunrise.
 Before coming out of sleep one should observe that
digestion of food taken on previous night should be
complete which can be elicited by following signs.

Vyayama/ Exercises

362 Regular light exercises help the body to shape up, increase muscle
strength, improve appetite and maintains health.
 It gives the body the ability to withstand exertion, fatigue, and
changes in the climate such as fluctuations in temperature.
 Exercise is most beneficial in winter and spring.
 It is best when done to the extent of half the exercising capacity.
When sweat appears on the forehead and armpits, respiration
speeds up and one starts breathing through the mouth, the
exercise should be stopped.
Abhyanga/Massage
363
 Daily Abhyanga to whole body after exercise is

indicated for maintaining proper hygiene and
functioning of tactile sensation.
 It should be done with Luke warm oil in a direction
away from heart.
 Excess pressure while massaging is to be avoided.
 Bath is indicated after half an hour of Abhyanga.

Rest and Sleep
364
 To carry out various tasks with full strength and vitality, one
should get enough amount of sleep every day.
 Before going to bed one should meditate, and critically

examine one's own conduct.
 Usually six to eight hours of sleep give sufficient rest to the

body and mind.

Scientific Laws of Personal Hygiene
365
 Regular trimming of nails, beard and hair;
 Daily cleansing of nostrils, eyes, ears and feet;
 Use of perfumes and garlands made of fragrant flowers;
 Putting on clean clothes;
 Use of umbrella and shoes to protect from heat and dust;
 Covering the mouth while sneezing, laughing or yawning;
 Avoid seeing the sun directly;
 Avoid sleeping under a tree at night, etc.

Importance of food
366
 As per Ayurveda, food affects the mind also by causing
either an increase or decrease in the three qualities of
mind, i.e., Satva guna, Rajo guna and Tamo guna.
 The food recipes can be classified as Satvika, Rajasika or

Tamasika depending upon the effects.

 A sattvic mental constitution is pure minded, compassionate,
367
clear and cooperative.
 A rajasic mental constitution is egotistical, ambitious,

aggressive, selfish, competitive, controlling and restless.
 A tamasic mental constitution is lazy, possessive, depressed,

sad and dull.

Importance of food

368 Diet plays a vital role in the maintenance of good health and
in the prevention and cure of diseases. In ancient Indian
scriptures, food has been compared with the God, (Annam
Brahmam) since it is the main factor, which sustains and
nourishes life.
 In Shrimad Bhagvad Geeta, Lord Krishna has compared

himself with the digestive fire, which assimilates and digests
a food in order to maintain the life.
Diet
369
 Diet is given maximum importance in healthy as well as in

diseased status.
 It is said in ancient Indian literature that if dietetics is

followed, medicine is not needed and if dietetics is not
observed, even medicines are not useful.

Application In Today's Scenario
370
 In today's present scenario it has become really important
for each one of us to maintain a good health.
 With so much of pollution in the environment, food

adulteration, untimely working hours and unhealthy lifestyle
it has become mandatory for everyone to look after his /her
own health.
 That's why the Dinacharya is to be followed in accordance

with the present context.
371
 Waking up in the morning is always good for health.

But if you are working late nights, then you should set
your biological clock accordingly. Six to eight hours
sleep is a must.
 Drinking a glass of Luke-warm water helps to flush

out all toxins accumulated overnight in the body.

372
 As we say 'cleanliness is next to godliness' in this case cleanliness
is also very important factor to maintain good health because
personal hygiene is really important.
 Clean teeth and mouth. Brushing of teeth should be repeated
after every meal. Cleaning of tongue freshens up the mouth and
also stimulates the secretions of digestive enzymes.
 Proper cleaning of nose, ears and washing eyes with warm water
held in mouth for moments is advised.
 Keep your hair trimmed, nails filed and wear clear, clean clothes .
373  A regular self-massage with herbal oil is necessary for every
person.
 It makes the skin supple, enhances blood circulation,

encourages quicker removal of the wastes and relaxes the
body. Along with food, hygiene, sleep exercise and
meditation is also very important.
 Regular light exercises help the body to shape up, increase

muscle strength, improve appetite and maintain health.

374
 Yoga, swimming, walking and even laughing are excellent
options.
 Your dressing is also important so always wear clean, airy and

light clothes of natural fibers like cotton, wool, linens, or silk.
 Similarly breakfast, lunch and dinner should be done on time

to maintain the regularity.

Vega dharana/udeerana
375
 For living a normal healthy life , it is necessary
that the natural urges has to be passed in time
without suppressing them.
 Non suppressible urges are urine, faeces, semen,
flatus, vomit, sneeze, yawn, tears, hunger and thirst.
If they are suppressed they cause various diseases.
 Suppressible urges are lobha (selfish desire for
wealth), shoka(sorrow), bhaya(fear), krodha(increase of
anger), irshya(jealousy), lajja (shame) and atiraga.

Treatment
Ayurvedic treatment goals
376
 eliminating impurities,
 reducing symptoms,
 increasing resistance to disease,
 reducing worry and increasing harmony in the
patient‟s life.

Treatment
377 1. Eliminating impurities (panchakarma)
• Intended to cleanse the body by eliminating ama
– Ama is described as an undigested food
• Eliminating Ama through
– Digestive tract and the respiratory system
– Enemas, massage, medical oils administered in a
nasal spray

Treatment
378
2. Reducing symptoms
• Physical exercises, stretching, breathing exercises,
meditation,
• Massage, lying in the sun, and changing the diet.
• Certain type of diet mainly with honey
• Metal and mineral preparations, such as gold or iron,

Treatment
379
3. Increasing resistance to disease
– Combine several herbs, proteins, minerals, and vitamins in
tonics
• Tonics based on formulas from ancient texts
– Improve digestion and increase appetite and immunity
4. Reduce worry and increase harmony
 Emphasizes mental nurturing and spiritual healing
 Avoiding situations that cause worry
 Promote release of negative emotions

380
HERBAL MEDICINE
For Pharmacy

Points to be known
381
 What are herbal medicines (HM)?
 Rationale for the use of plant as medicine
 D/c b/n HM & modern medicine
 Popularity of herbal medicine
 Reasons for the popularity of HM

Points to be known
382
 Advantages & disadvantages of HM

 Safety of herbal medicine
 Standardization of herbal medicines
 Roles of pharmacy in herbal medicines
 Some commonly used herbal medicines

383
TM is the sum total of the knowledge, skills, and practices based

on the theories, beliefs, and experiences indigenous to
different cultures, whether explicable or not, used in the
maintenance of health as well as in the prevention, diagnosis,
improvement or treatment of physical and mental illness.

384
• “Diverse health practices, approaches, knowledge and beliefs

incorporating plant, animals and or mineral based
medicines, spiritual therapies, manual techniques
and exercise, applied singularly or in combination to
maintain well being as well as to treat, diagnose or prevent
illness” (WHO).

385

What are Herbal medicines?
386
 Contain as active ingredients parts of plants, or
other plant materials, or combinations
 Medicinal products prepared from plants

Medicinal product
387
 “Any substance or combination of substances which may be

administered to human beings or animals with a view to
making a medical diagnosis or to restoring, correcting or
modifying physiological functions in human beings or in
animals is considered a medicinal product.”

Herbal medicine
388
 Herbal medicines include:

 Herbs
 Herbal materials
 Herbal preparations and
 Finished herbal products

Herbs:
389
• Crude materials which could be derived from lichen, algae,

and higher plant. Includes:
 leaves  Wood
 flowers  bark, roots,
 fruit  rhizomes or other plant parts, which may be entire,

fragmented or powdered.
 Seed
 stems
Herbal materials
390
 In addition to herbs, fresh juices, gums, fixed oils, essential oils,

resins and dry powders of herbs.
 Processed by various local procedures, such as
 steaming
 roasting or
 stir-baking with honey, alcoholic beverages or other materials

Herbal preparations
391
 Include:
 Comminuted or powdered herbal materials
 Extracts, tinctures and fatty oils of herbal materials
 Produced by extraction, fractionation, purification, concentration, or

other physical or biological processes.
 Preparations made by steeping or heating herbal materials in alcoholic

beverages and/or honey, or in other plant materials.
 Basis for finished herbal products

Finished herbal products
392
 Herbal preparations made from one or more herbs
 If more than one herb is used, the term mixture herbal product
 Finished herbal products and mixture herbal products may contain
excipients in addition to the active ingredients

393
NOTE:
 Finished herbal products or mixture herbal products to
which chemically defined active substances have been
added, including synthetic compounds and/or isolated
constituents from herbal materials, are not considered to be
herbal.

Rationale to use plant as medicine
394
 Produce very diverse & complex chemicals with

plethora of pharmacological activities
 One third to one half of all pharmaceutical drugs were
originally derived from plants
E.G. Quinine _ from Cinchona bark
Morphine _ Papaver sominiferum
Vincristine _Vinca rosea
Difference b/n herbal medicine and modern drugs
395
 Herbal medicines:
 Composed of mixtures of compounds
 Active principles frequently unknown
 Standardization, stability and quality control feasible but not easy
 Availability and quality of raw materials frequently problematic
 Well-controlled double-blind clinical and toxicological studies to prove their
efficacy and safety are rare

Preparation of Herbal Medicines
396
 Common solvents: water, hydroalcoholic, fat & oil

 Preparation methods
 Expressions
 Maceration
 Percolation
 Decoction & infusion
 Prepared in similar manner to modern pharmaceuticals.

Popularity of herbal medicines
397
 Global HM usage is widespread and growing
 65-80% of population depend on TM
 Global market $ 83 billion and forecasted to reach $107 billion by the

year 2017
 Herbal medicine markets in Asia and Japan reach $2.3 and 2.1 billion
 USA spent $4.2 billion in 2002 for herbs
1. Introduction to the Chemistry ofEisenberg

Natural Products
DM et al, 6/8/2023
Ann Int Med (2002) 137:965-973.
Table 1. The seven best-selling herbal medicines
S. No. Herbal drugs Annual retail sales in percent increase

mainstream US compared with
market ($US) previous year
1 Ginkgo (Ginkgo biloba) 150 million 67%
2 St. John‟s wort (Hypericum 140 million 190%
perforatum)
3 Ginseng (Panax ginseng) 96 million 11%
4 Garlic (Allium sativum) 84 million 17%
5 Echinacea (E. angustifolia, E. 70 million 42%

purpurea, E. pallid)
6 Saw palmetto (Serenoa repens) 32 million 74%
7 Kava (Piper methysticum) 17 million 462%

398
Why HM so popular?
399
 Dissatisfaction in modern medicine
 Unaffordable
 Side effects
 Lack of complete cure
 Belief that herbal drugs are free from side effects, “Nature is safe” &
provide greater efficacy

Wetzl,6/8/2023
Ann Intern Med 2003; 138: 191-6
Why HM so popular?
400
 Preference of populations for preventive medicine due to increasing

population age
 Increased tendency towards self medication
 Cultural and religious influence
 Consumer satisfaction with the level of inter‐personal care provided

Advantages of herbal medicines
401
o Affordable
o Accessible
o Culturally acceptable
o Better patient compliance
o Economical benefits
o Source of modern drugs or leads

Limitations of herbal medicine
402
 Dose usually unknown
 For most, active compounds not known
 Variability in active compounds that leads to inconsistent

therapeutic activity
 Lack of scientific data on safety and efficacy of most HM

Safety of herbal medicines
403
The general idea that herbal drugs are very safe and free from side
effects is not necessarily true.
Adverse drug reaction of HM
Intrinsic Extrinsic
factors factors
Misidentification
Over dose
Substitution
Drug-drug interaction Contamination
Adulteration
E.G. Plants with pyrrolizidine alkaloids, incorrect preparations
and/or dosage, etc
aristolochic acid 1. Introduction to the Chemistry of Natural Products 6/8/2023
Safety of herbal medicine
404
Aristolochic acids
Source : the genus
 Aristolochia (Aristolochia fangchi)and
 Asarum family Aristolochiaceae
Toxicity:
o Carcinogenic
o Mutagenic
o Nephrotoxic

Check for drug interaction
Herbal drug interaction

405
Herbs Are 'All Natural' - Why Worry About Drug

Interactions?
 Garlic interfere with the effect of saquinavir
 St John's wort (Hypericum perforatum): interact with
warfarin, cyclosporin, HIV protease inhibitors, theophylline,
digoxin and oral contraceptives
 Increased risk of bleeding when Ginkgo biloba is used
concurrently with antiplatelet agents [e.g., aspirin,
anticoagulants [e.g., warfarin, heparin]

Quality control of herbal drugs
406
 Quality control is a term that refers to processes involved in

maintaining the quality and validity of a manufactured
product.
 determined by
- identity,
- purity,
- content, and
- other chemical, physical, or biological properties, or by the
manufacturing processes.

Quality….
407
In general, quality control is based on three
important pharmacopoeia definitions:
1. Identity: Is the herb the one it should be?
2. Purity: Are there contaminants, e.g., in the form of other
herbs which should not be there?
3. Content or assay: Is the content of active constituents
within the defined limits?

Quality….
1. Identity
- Proper botanical identification
- Voucher specimens are reliable reference sources.
- Plants with similar species may lead to incorrect

identification
 Identity can be achieved by macro- and microscopical
examinations and organoleptic evaluation

409
Macroscopic evaluations of herbal drugs are based on

plant’s special features
• Shape
• External
• Marking
Macroscopic evaluations are of primary importance before any
further testing can be carried out.

410

Quality….
Organoleptic
 Evaluation of drugs refers to the evaluation of a drug by
- color,
- odor,
- size, taste and special features including touch, texture
etc.

Quality….
412
 However judgment based on the sensory

characteristics
 like odour, taste etc., may vary
 from person to person
 time to time based on individual's nature.

Quality…
413
3. Microscopic evaluation is needed to determine the

correct species and/or that the correct part of the
species is present.
• For instance, pollen morphology may be used in the case of

flowers to identify the species, and
• the presence of certain microscopic structures such as leaf

stomata can be used to identify the plant part used.

Quality…
414
2. Content: is the most difficult one to assess, since in most

herbal drugs the active constituents are unknown.
- Sometimes markers can be used
 Marker defined as chemically constituents that are of

interest for control purposes, independent of whether they
have any therapeutic activity or not.

Factors affecting quality of
415
herbal medicines
 Plant constituents vary considerably depending on several factors that impair
the quality of phytotherapeutic agents
i. Intrinsic factors:
 Genetic variability
ii. Extrinsic factors:

 Environmental variation
 Geographical variation
 Method of collection & preparation
 Storage
 Adulteration and substitution
Challenges in Quality control of HM
416
 Usually mixtures of many constituents
 The active principle(s) is (are), in most cases unknown
 Selective analytical methods or reference compounds may

not be available commercially
 The quality of the raw material are variable

417
 Involves adjusting the herbal drug preparation to a

defined content of a constituent or a group of substances
with known therapeutic activity by adding excipients or
by mixing herbal drugs or herbal drug preparations.

418
 Is the establishment of reproducible pharmaceutical

quality by :
Comparing a product with established reference substances
and
Defining minimum amounts of one or several compounds or
group of compounds.

Standardization of herbal medicines
419
 Process of prescribing a set of

 standards or inherent characteristics
 constant parameters
 definitive qualitative and quantitative values that carry an
assurance of quality, efficacy, safety and reproducibility.
 Process of developing and agreeing upon technical standards

Why is standardization necessary?
420
 Reproducible & generally higher quality of product

 Allows comparison of clinical effectiveness,
pharmacological effects and side effects
 Give patient greater security & thus increase level of trust
in herbal medicine

Standardization of Herbal medicines
421
 Different techniques used for standardization:

 High-performance liquid chromatography (HPLC),
 Gas chromatography (GC),
 Ultra-high performance liquid chromatography (UHPLC) and
 Thin layer chromatography (TLC)
 Gas chromatography–mass spectrum analysis (GC–MS)
 HPLC–MS and HPLC–nuclear magnetic resonance (NMR)

Type of herbal extracts
422
 3 types in Europe
1. Truly standardized extracts (Type A)
- Standardized to active constituents
E.g. Senna dry extract (5.5-8% hydroxyanthracene glycosides calculated as
sennoside B
2. Quantified extracts (Type B)
- Standardized to constituents that contribute to the activity
 E.g. Gingko biloba leaf and Hypericum perforatum aerial part
3. Other extracts (Type C)

- Standardized to compounds of unknown pharmacological relevance. E.g.
Echinacea root (E. purpurea & E. pallida)
Role of pharmacists in herbal medicine
423
 Scientific evaluation including clinical trial about the safety

& efficacy of HM
 Quality control & standardization of HM
 Drug information to patients & other health professionals
 Pharmacovigilance of HM

ST.JOHN’S WORT
424
Source: Dried aerial parts of Hypericum perforatum family Hypericaceae
Constituents:
i. Anthraquinones (hypericin & pseudedohypericin, iso-hypericin & emodin-antrone)
ii. Prenylated phloroglucinol derivatives
Hyperforin (2-4.5%), adhyperforin & furohyperforin
iii. Flavonoids
Iv. Volatile oils
v. Other constituents (caffeic & chlorogenic acids, amino acids, tannin &
carotenoids) 1. Introduction to the Chemistry of Natural Products 6/8/2023
Use of ST. JOHN’S WORT
425
 Treatment of mild to moderate depression

 Represent 25% of all antidepressant prescriptions
(„ Nature‟s prozac”) in Germany.
 ≥ 78 million dollar in 1999 in USA
 Induce Cyp3A4, increased action of P-glycoprotein.
 Reduce plasma level of protease inhibitors, Cylosporin, warfarin,
digoxin, tricyclic antidepressants

GINGER
426
 Dried rhizome of Zingiber officinale Roscoe (Zingiberaceae)
Synonyms
 Amomum zingiber L., Zingiber blancoi Massk
 Constituents: Volatile oil & oleoresin
 Sesquiterpene hydrocarbons (responsible for the aroma):-(-)-zingiberene,

(+)-ar-curcumene, (-)-β- sesquiphellandrene, and β-bisabolene
 Pungent phenolics: gingerol & shogaols

MEDICINAL USE OF GINGER
427
 Uses supported by clinical data
 Antiemetic
 Prophylaxis of nausea and vomiting associated with motion sickness,

postoperative nausea, pernicious vomiting in pregnancy and seasickness

Precautions
428
 Pregnancy: teratogenic effects
 In a double-blind randomized cross-over clinical trial, ginger (250 mg by

mouth, 4 times daily) effectively treated pernicious vomiting in
pregnancy and no teratogenic aberrations were observed in infants born
during this study.
 Paediatric use
 Not recommended for children less than 6 years of age.

Silymarin
429
 Mixture of flavonolignanes
 Silybin, isosilybin, silydianin, silychristin
Source: Seeds of Silybium marianum family Asteraceae

O OH
HO O OMe
O
H
OH OH
OH O
 used Sylibin
Hepatoprotective
Antioxidant ,
anticancer
GINKGO
 Source: leaves of Ginkgo  Constituents:

biloba (Maidenhair  Diterpene lactones:
tree) (family (Ginkgolides A,B,C,J,M)
Ginkgoaceae)  Flavonoids
 Native to China & Japan  Ginkgolic acids (allergenic)
Use: Improve peripheral & cerebral

blood flaw in elderly with symptoms
of loss of short term memory &
concentration
430
GINKGO
431
Use: Memory and concentration problems, confusion,

depression, anxiety, dizziness, tinnitus and headache
 increasing blood supply by dilating blood vessels, reducing
blood viscosity, modification of neurotransmitter systems,
and reducing the density of oxygen free radicals.

c. Ginseng
432
Source: Roots of Panax ginseng C.A. Meyer (Asian or Korean

ginseng) & Panax quinquefolius (American ginseng ) (Family,
Ariliaceae)
 China, Korea & Siberia – principal producers
Constituents: triterpene saponins (medicinal part)

(Gensenosides/panaxosides)
Other constituents includes:
 Polysaccharides (panaxans (A-U) & ginsenans)
 Polyacetylenic compounds (panaxynol & panaxydol)
 Volatile oil
Ginseng
433
OH OH
Sug-O Sug-O
Sug-O Sug-O
“Adaptogen” : a substance that increases
O-Sug
resistance to physical, chemical, and
Protopanaxdiols Protopanaxatriol
biological stress and builds up general
vitality including physical and mental
capacity
Use of ginseng
 Adaptogenic ($ 60 million in 1999 in USA & Chinese market $350
million in sales in 2006 )
 Stimulate stamina, concentration, resistance to stress & diseases
 Increase libido
Ginseng
434
 Enhance cognitive performance and wellbeing for

treatment of dementia
 Possible mechanism of action
 Anti-apoptotic action of panaxydol (PND) and panaxynol(PNN)
may reduce neurodegeneration
 Attenuate -amyloid (A) induced toxicity
 Anti-oxidative effect

Ginseng
435
 Dementia: is a syndrome characterized by progressive cognitive

impairment, which leads to
 decreased ability to perform activities of daily living and it is usually accompanied

by
 the development of behavioral disturbances
 There are several forms of dementia:

 Alzheimer‟s disease (AD) being the most common form, accounting for 50%to 75%of
cases (WHO2004
 Vascular dementia (VD), caused by impaired blood supply to the brain

TRADITIONAL
CHINESE MEDICINE
TCM
437
Topics to be discussed
• Definition
• History
• Theory
• Practice of TCM
• Diagnosis
• Methods of treatment

Definition of TCM
438
TCM:- refers to a broad range of medicine practices

sharing common theoretical concepts which have
been developed in China and are based on a tradition
of more than 5,000 years
These practices are a common part of medical care

throughout East Asia, but are considered
alternative in the Western world.

Definition of TCM
439
TCM:- is a discipline that deals with

 Human physiology,
 Pathology,
 Diagnosis,
 Treatment and
 Prevention of disease.
 Includes herbal medicine, acupuncture, massage
(Tui Na), exercise (qigong), and dietary therapy

Origin of Traditional Chinese Medicine
440
 Recorded history over

4,000 years old
 Earliest books on the
foundation of TCM,
originating as early as
1000 B.C.
Huang Di Nei Jing or “Yellow

Emperors Classic of Medicine”

History
• The historical documents of ancient China - contained
some legends about TCM
• But the earliest recorded history of TCM - was in the

beginning of the Shang dynasty, 1800 BC
• The notions of hygiene and preventive measures - were

appearing between 1400 and 1200 BC

History cont..,
44
2
The book of rites, a manual of ceremonies written in
Zhai Dynasty (1100 to 88 BC), records that there
were specialized doctors in four departments, namely;
 Nutrition
 Internal medicine
 Surgery
 Veterinary medicine

History cont..,
44
3
 There are also many other books that have good
indicative information about the historical nature of
TCM; and
 To date, TCM has generated
 Over 10,000 medical books
 5,000 kinds of herbal drugs, and
 A rich experience of clinical therapy

International Status of TCM
444
 Chinese medicine dates back nearly 4,000 years, and
 Asia -; especially Japan, south Korea, Malaysia, Singapore.
 Europe- used regularly
 Entered the US in 1700‟s

• But only became well known in the mid 1970‟s
• Recently reached in to the Midwest

Modern Chinese Medicine
445
 Since the 1950‟s the government of the Republic of
China and Taiwan have put great efforts into promoting
the modernization of Chinese Medicine.
 Overall, 95% of general hospitals in China have
traditional medicine departments, which treat about 20%
of outpatients daily.

Theories of TCM
446 The theory of holism (Zheng Ti Guan Nian)
Chinese approach to understanding the human body is unique,
integrated entity that interrelated with nature
Understanding Chinese philosophical idea is
 Key to understanding of TCM
 Basic philosophies include
 Yin-Yang
 Five elements
 Five substances
 Five organs

Theories of TCM cont..,
The theory of holism
Strength Weakness
 Less side effects  No standardization
 Self sufficiency (Local  No scientific bases
materials)  Not investigated by
 Effectiveness proven in modern search methods
time  Shortage of demand of
 Low toxicity medicinal materials
when demand is high

447 6/8/2023
Theories (Yin-Yang)
Emperor
448 Fu His lived in
yellow river areas of china
≈ 8,000 years ago.
According to him
• The world and all life within it comprises of opposites, each giving
meaning to the other
• They may be viewed as complementary aspects of the whole.

Theories (Yin-Yang)
Fu His – formulated two symbols
449
• a broken line (--------) and

• a solid or unbroken line (_____)
Depicted the two major forces in the universe
Creation and reception-
This duality was named Yin-Yang and represents the
foundation of Chinese medicine

Theories (Yin-Yang)
Fu His – formulated two symbols
450
• a broken line (--------) and

• a solid or unbroken line (_____)
Depicted the two major forces in the universe
Creation and reception-
This duality was named Yin-Yang and represents the
foundation of Chinese medicine

Theories (Yin-Yang)
451
Thus, the meaning of

• Night is linked to the meaning of day
• Hot with cold
 Perhaps the appropriate link might be that of
• Health and disease, often thought of as
being direct opposites
• Yin and Yang is having symbol that is entwined
symbol.

Theories (Yin-Yang)
Yang Yin
Positive state associated with Negative state associated with
 heat,  cold,
 light and  dark,
 vigor  stillness and
Sunny side of mountain  passiveness
Dark side

452 6/8/2023
Theories (Yin-Yang)
453 Chinese medical theory is founded in the concept of Yin-
Yang.
• Yin is considered feminine energy, and
• Yang is masculine energy
Chinese medicine seeks to keep the body‟s
Yin Yang

Theories (Yin-Yang)
454
Yin
Yang
Yin Yang
Disease
The goal of each treatment is

• To increase depleted yin or yang, or
• To eliminate excess yin or yang

Theories (Yin-Yang)
455
Examples
 Patient suffering from fever, i.e., an excess______
 A teenager who could not get up in the morning, too
much______
 A child suffering from colic or diarrhea would have too
much ______
A Yin-deficient patient may be hot and feverish, restless
and stresses-out.
A Yang deficient patient will fell cold and be pale and
lethargic.

Theories (Yin-Yang)
456
• Only when the opposites are in equal balance

then life will be in harmony
• In other words, an imbalance of Yin-Yang is
disease.
• Treatment would, therefore be seen as the ability
to promote the conversion of excess Yang in to
Yin and vice versa
• Allowing restoration of equilibrium between the
two.
Theories (Yin-Yang)
457
• Yang qualities: dynamic, external, upward,
ascending, brilliant, progressive, hyperactive,
superficial, heat, light, open, energy
• Yin qualities: static, internal, downward, descending,

dull, retrogressive, hypoactive, dark, wet, cold, matter

Theories (Five elements)
458
According to Chinese Philosophy, the body organs are

related to one of the five elements:
The five elements are
 jin (metal),
 mu (wood),
 shui (water),
 huo (fire),
 tu (earth)

These
459
are said to represent the cycle of life.
• Wood is burnt by fire,
• Ashes fall to support the soil,
• Earth creates metal (ore) that
becomes molten with fire

(resembling water),
• Finally water nourishes the
trees that give us wood.


460
The five elements are applied to practice of TCM in a
number of different cycles
• For example, in the Sheng (or mother and son)
cycle, organs are considered to be in familiar
relation supporting each other.
• Or else, the kidney might be the „mother‟ and the
liver her „son‟.
• Treating the „mother‟ organ might provide a route
to improving the health of a deficient „son‟ organ

Theories (Five substances)
461
In TCM five substances encompass
• Both tangible and intangible elements within the body.
The first three Qi, Jing and Shen,
• Includes qualities such as energy and spirit, and
• Are known as the three treasures
• They are believed to be the essential components of an
individuals life.
The remaining substances are: blood and body fluids

Qi
462 (Chee)
• Qi is translated simply as „energy‟ but there is no one

English word that conveys its true meaning
• It is considered to be a vital or life force.
Chinese medicine
• Works to balance qi (energy) in the body
• Believes that
 Health is a function of a balanced, harmonious
flow of qi and that
 Illness results when there is a blockage or
imbalance in the flow of qi.
Qi flows through energetic pathways called meridians.
463
 There are twelve meridians
 Six yin and six yang
 and numerous minor ones
 Form network of energy
 Major meridians correspond to specific human organs:

 kidneys, liver, spleen, heart, lungs, pericardium, bladder, gall
bladder, stomach, small and large intestines, and the triple burner
(body temperature regulator).

Qi
464 is responsible
1. Movement
2. Transformation of food and drink in to blood, body
fluid and energy
3. Maintenance of body heat
4. Protection from environmental factors
5. Containment-holding organs, blood vessels and body
tissues in their proper places.

Qi:-
465 Deficiency leads to
• Debilitation,
• Protracted recovery from illness,
• Chronic colds,
• Lethargy and other signs of weakness.

466
Jing
• Is translated as „essence‟ and underpins all aspects
of organic life.
• If jing is
Plentiful, life itself is good, full of harmony and
vitality.
Lacking, then Qi will be weak, life will be dull and
the person will be susceptible to contracting
diseases.

Jing
467
• Governs fertility, sexuality and growth.
• Is responsible for the following functions;
Governing growth, reproduction and development
Production of bone marrow
Promotion of kidney Qi
Determine the basic constitutional strength
 Deficiency of Jing is the only (not excess) disharmony and
is said to be more prevalent in men than in women.

468 Shen
• Is both spirit and mind

• Is based in the heart and governs- spiritual,
mental and emotional health.
 Disharmony can range from mild confusion and
insomnia to substantial psychiatric problems
accompanied by irrational behavior.
Blood
469 – It has the following functions
• It aids clear and stable thought processes

• It has a moistening and lubricating action
• It nourishes the body by carrying
nutrients to all tissues and structures
• it helps to fulfill the nutritive function of Qi.

470 There are three imbalances;
i) Stagnation-Produces stabbing pains and

purple lips and tongue
ii) Excessive heat in the blood can cause skin
conditions and fever
iii) Deficiency shows in pale face, dry skin, light
headedness.
Theory (Five Substances)
Body fluids (Jin Ye)
471
• Includes – external light and watery fluids, such as saliva and

tears (known as Jin), and
• The dense thicker fluids that circulate inside the body eg.,
gastric juices and joint fluids (known as Ye)
• To maintain and lubricate the body
 Deficient body fluids results in
 Dryness of the eyes, lips and hair; a dry cough and
excessive thirst.

Theory (Five Organs)
472 The organs are considered to be
• Closely related to specific emotions and virtues,
and
• If their essential requirements are not fulfilled, ill
health will result

1)The heart
473
• Governs the circulatory system, but

• It is also the center of the Shen.
• Positively associated with compassion,
love and affection, and
• Negatively with over excitement.
 Symptoms of ill health
include insomnia and hyperactivity

2. The liver
474
 Ensures that Qi flow smoothly
 Symptoms of ill health are irregular periods and bad
temper

3475
. The spleen - creates Qi and depends on
A good diet and un stressful life style.
• Symptoms of ill health include
poor appetite and diarrhea
4. The kidney is associated with long term growth

• Its positive emotion is courage;
its negative emotion is fear.
• Symptoms of ill health include lethargy,
infertility, edema and diarrhea

5.
476
The hollow organs associated with Yang are
• Gall bladder, large and small intestines, stomach
and bladder
• Invisible channels through which qi circulates
 The body has been mapped with these meridians that pass
through organs or organ systems.

477

Practice of TCM
478 TCM is based on a highly sophisticated set of practices
 These practices are designed

• To manage illness, and
• To maintain health and well being

Diagnosis in TCM
479
Diagnosis is achieved using four traditional methods
1. Enquiry
2. Auscultation and olfaction
• Listening carefully to the sound and quality of the
patient‟s voice (auscultation), and
• Evaluating any breath or body odors (olfaction)
3. Palpitation of the pulses and body
4. Inspection

Methods of Treatment
480
Acupuncture
Herbs
Tui Na
Cupping
Moxibustion

Acupuncture
481
 Points are located throughout the body
 The acupoints are stimulated to balance the
movement of energy (Qi) in the body to restore
health.
 Thin, solid, sterile, stainless steel acupuncture needles
 Inserted into acupuncture points
Ancient Acupuncture: Ten needles

Acupuncture
 Act as gateways to influence, redirect, increase
482
or decrease the vital “substance” of Qi
 To mobilize energy (Qi) flow and invigorate
the proper function of muscles, nerves,
vessels, glands and organs.
 Corrects imbalances that cause
disease
 Most patients do not feel the needles during
treatment.
Moxibustion
 Acupuncture is often accompanied by moxibustion.
 Moxibustion represents a special form of point

stimulation.
 The procedure involves burning a piece of the Chinese

drug plant, Artemisia vulgaris,

Moxibustion
Done in two ways
 On the head of the acupuncture
needle so as to conduct heat

in to the body, or
 In some cases, actually on
the surface of the skin.

Cupping
 Cupping is a type of massage, consisting of placing
several glass „cups‟ (open spheres) on the body.
 A match is lit and placed inside the cup and then removed
before placing the cup against the skin.

Cupping
 As the air in the cup is heated, it expands, and after
placing in the skin, cools, creating lower pressure inside
the cup that allows the cup to stick to the skin via suction.
 When combined with massage oil, the cups can be slid around
the back, offering „reverse-pressure massage‟.

Chinese Herbs

487 Important component of TCM
 Herbal formulas are as effective now as they were more

then 4,000 years ago when they were first introduced
 Formulas contain 2 - 18 different types of herbs
 Used to treat a wide variety of symptoms while

stimulating the body‟s natural healing process
 Not addictive, powerful nutritional agents

Chinese Herb Leaves
Tui Na
489  Relatively new to the western world
 Combines the work of massage therapy,
chiropractic
 Establishes a more harmonious flow of Qi
throughout the system of channels and
collaterals, allowing the body to naturally heal
itself.

Tui Na

490 Tui Na encompasses three techniques
1. Massage to treat the soft tissue
(muscles and tendons of the body
2. Acupressure to affect the

flow of the Qi

Tui Na
491

Tui Na
3. Adjustments for realignment of musculoskeletal and

ligamentous relationships and spine subluxations to
restore the body‟s normal functions.
Tui Na Hand Positions

Examples of TCM Uses
Acupuncture Chinese Herbs
1. Backpain 1. Cancer
2. Chemotherapy 2. Heart disease
induced nausea 3. Diabetes
3. Depression 4. HIV/AIDS
4. Oesteoarthritis

493 6/8/2023
TCM Broad Range of Treatments
494
Asthma Allergies Cold/Flu
Cough/Bronchitis Headaches Injuries
Tinnitus Arthritis Osteoporosis
Back/neck ache Sciatica Pain Mgmt
Infertility Depression Stress

Addictions Skin diseases Fibromyalgia
Trauma Rhinitis Vision

Hemilplegia Sexual dysfunction High blood pressure
Stroke High Cholesterol Children's Diseases

495
BUSHOGTU MAY 04/2023

Tradational Medicine in Cam For Student Ony

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Tradational Medicine in Cam For Student Ony

Uploaded by

Copyright:

Available Formats

TRADITIONAL MEDICINE (CAM) BY Dr Takele Achalu Dengela takeleachalu@gmail.

B pharm, MSc , PHD and Author

 Used for diagnosis, mitigation, treatment, or prevention of

 Affect the structure or function of human or animal

 Substances of natural or synthetic origin having therapeutic

 It is used for those natural products such as plants or part of plants,

 The term crude drug is also applied to include pharmaceutical

1. Introduction to the Chemistry of Natural Products 6/8/2023

 The term “crude drug” indicates any natural products which

 Dried plant parts used in medicinal preparations

 Complex mixtures of cells and chemicals

 Previously mainly used in the form of alcoholic extracts

 Pharmacist need basic knowledge of the ways in which how

5 1. Introduction to the Chemistry of Natural Products 6/8/2023

 Plant sources, e.g. Senna, Digitalis, Datura, Cascara, Cinchona,

 Animal sources, e.g. cochineal, cantharidin, honey, cod liver oil,

 Marine sources, e.g. sponges, red algae, agar, etc.

 Mineral sources, e.g. talc, kaolin, kieselguhr, etc.

6 1. Introduction to the Chemistry of Natural Products 6/8/2023

 Entire organism (plant, animal, organism)

 Part of an organism (a leaf or flower of a plant, an

 An extract or an exudate of an organism

 Isolated pure compounds

7 1. Introduction to the Chemistry of Natural Products 6/8/2023

 provide a number of extremely useful drugs that are difficult or

 Their utility as prototypes or models for synthetic drugs possessing

 Some natural products contain compounds that demonstrate little or no

 Are collected from wild or domestic animals; mainly from

 Drugs such as lard, lanolin, and milk products, as well as

 Processing and purification of animal drugs varies with the

9 1. Introduction to the Chemistry of Natural Products 6/8/2023

 Musk: dried, distilled product of gland musk deer.

 Thyroid: dried cleaned powdered thyroid gland. Mainly

 Pepsin: obtained from glandular layer of fresh hog used

10 1. Introduction to the Chemistry of Natural Products 6/8/2023

1. Herbal drugs, derived from specific parts of a medicinal

2. Compounds isolated from nature

3. Nutraceuticals, or “functional foods”

11 1. Introduction to the Chemistry of Natural Products 6/8/2023

 Plant drugs are collected from wild or cultivated plants;

the plants could belong to higher or lower plants but the

flowering plants taking the largest share, spermatophyta

(seed producing plants).

12 1. Introduction to the Chemistry of Natural Products 6/8/2023

 Manual techniques, and

 Exercises, applied singularly or in combination (1).

 The importance of traditional medicine as a source of primary healthcare

16 1. Introduction to the Chemistry of Natural Products 6/8/2023

17 1. Introduction to the Chemistry of Natural Products 6/8/2023

18 1. Introduction to the Chemistry of Natural Products 6/8/2023

• Herbal Medicine: Makes therapeutic claim; includes

21 1. Introduction to the Chemistry of Natural Products 6/8/2023

22 1. Introduction to the Chemistry of Natural Products 6/8/2023

24 1. Introduction to the Chemistry of Natural Products 6/8/2023

25 1. Introduction to the Chemistry of Natural Products 6/8/2023

Taxonomy . Botany Organic synthesis

Agriculture . Pharmacology . Pharmaceutical Science . Organic analytical chemistry

Entomology . Microbiology . Biotechnology/Molecular Biology . Biochemistry

26 1. Introduction to the Chemistry of Natural Products 6/8/2023

27 1. Introduction to the Chemistry of Natural Products 6/8/2023

28 1. Introduction to the Chemistry of Natural Products 6/8/2023

29 1. Introduction to the Chemistry of Natural Products 6/8/2023