Herbal Medicine

Prof. Dr. GHAZALA H. RIZWANI (Meritorious)

B. Pharm, M. Pharm, Ph.D., DHMS,
MSCFPTN, MPPS, Post Doc. (Japan)
Facualty of Pharmacy,
Hamdard University
A highly comprehensive definition of traditional medicine has
been arrived at by a group of WHO experts:
“….the sum total of all the knowledge and practices whether
explicable or not, used in diagnosis, prevention and elimination of
physical, mental or social imbalance and relying exclusively on
practical experience and observation handed down from
generation to generation, whether verbally or in writing.
….Traditional medicine might also be considered as a solid
amalgamation of dynamic medical know-how and ancestral
experience….”
There are many different systems of traditional
medicine, and the philosophy and practices of each
are influenced by the prevailing conditions,
environment, and geographic area within which it
first evolved.
 MAJOR TRADITIONAL MEDICAL SYSTEMS
• Ayurveda-widely practiced in India, Pakistan, Sri Lanka,
Nepal, Tibet, Burma and other countries. Ayurvedic
practices include the use of herbal medicines, mineral or
metal supplementation, surgical techniques and application
of oil by massages.
• Siddha-a variant of Ayurveda being practiced in sections of
southern parts of India.
• Unani Tibb or Greco-Arabian Medicine-being practiced in
India, Pakistan, Bangladesh, the Middle East and a number
of other countries.
• Yoga-practiced for a long time all over India, Tibet, China
and a few other countries and now spread to the Western
countries.
 MAJOR TRADITIONAL MEDICAL
SYSTEMS
• Homoeopathy is not a traditional system as it was proposed
by a German doctor about 200 years ago but it forms a
complete therapeutic system with its own unique philosophy
and a wide range curing propositions for all type of disorders.
• Accupuncture: a significant contribution of the Chinese
Medicine, along with its variants like Japanese Shiatsu,
Finger Massages etc.
• Chinese, Tibetan and related systems of medicine.
• Naturopathy or Nature Cure including various techniques like
Hydrotherapy, Magnetotherapy, Electrotherapy, Osteopathy
and Psychotherapy.
 MAJOR TRADITIONAL MEDICAL SYSTEMS
• Folk Medicine (including tribal medical practices) of different
parts of the world.
• Herbal remedies of various countries (China, Japan, Africa,
India, etc.).
• Marginal or Fringe Medicine: including faith healing,
specialized therapies like treatment of snake bites (by drugs
and charm); Tantric medicine including medico-religious
practices in different parts of the globe; Occult medicine
including astrology, parapsychology, hypnosis etc.
•
Herbal Medicine
The study or use of medicinal herbs to prevent and treat diseases and
ailments or to promote health and healing.
• It is also called botanical medicine or phytomedicine.
• It is an integral part of Ayurveda and some indigenous medical systems.
• Currently, herbs are applied to the treatment of chronic and acute
conditions and various ailments such as cardiovascular disease, prostate
problems, depression, inflammation, and to boost the immune system
• Medical practices based on the use of Plant‘s:
• Seeds
• Leaves
• Roots Chamomile
• Berries Cinnamon Bark
• Bark
• Flowers
Valerian Roots
Indian gooseberry Fennel seeds
 A Brief History of Herbalism
• Plants have been used for medicinal
purposes long before recorded history.
• Ancient Chinese and Egyptian papyrus
writings describe medicinal uses for plants
as early as 3,000BC.
• Hippocrates (460-377 B.C.), Aristotle
(384-322 B.C.) and Theophrastus (372-287B.C.) essentially
started the science of botany.
• Dioscorides (c. 40-c. 90) and Galen (131-200 A.D.), both
Greek surgeons in the Roman army, compiled herbals that
remained the definitive materia medica texts for 1500 years.
 A Brief History of Herbalism
• Through the Middle Ages, herbalism was preserved in the
monasteries of Britain and mainland Europe. Monks copied
and translated many of the works of Hippocrates,
Dioscorides, and Galen.
• Persian physician Ibn Sina, also known as Avicenna (980-
1037 A.D.), combined the herbal traditions of Greek with
Islamic medicine, as well as Indian medical teachings of
Sushruta and Charaka in The Canon of Medicine (al-Qanun
fi al-tibb).
• One of the most influential medical texts ever written, The
Canon includes a description of some 760 medicinal plants
and the medicine that could be derived
from them.
 A Brief History of Herbalism
• In the early 19th century, when chemical analysis first
became available, scientists began to extract and
modify the active ingredients from plants

• Chemists began making their own version of plant

compounds and, over time, the use of herbal medicines
declined in favor of drugs. Almost one fourth of
pharmaceutical drugs are derived from botanicals.
 HERBAL FORMULATION
• Herbal formulation obtained by subjecting herbal
substances to treatments such as extraction, distillation,
expression, fractionation, purification, concentration or
fermentation.

• These include powdered herbal substances, tinctures,

extracts, essential oils, expressed juices and processed
exudates.
 Methods of administration
• Capsules
• Fresh vs. dry
• Teas, infusions, decoctions
• Tinctures, glycerites
• Infused oils
• Essential oils
• Sprays
• Tablets
• Standardized extracts
• Simple or formula
 Herbal Preparations
• Herbal teas, or tisanes, are the resultant liquid of extracting herbs
into water, though they are made in a few different ways.
• Infusions are hot water extracts of herbs, such as chamomile or
mint, through steeping.
• Decoctions are the long-term boiled extracts, usually of harder
substances like roots or bark.
• Maceration is the old infusion of plants with high mucilage-content,
such as sage, thyme, etc.
• Tinctures are alcoholic extracts of herbs, which are generally
stronger than herbal teas. Usually obtained by combining 100%
pure with the herb.
• Extracts include liquid extracts, dry extracts, and nebulisates. Liquid
extracts are liquids with a lower ethanol % than tinctures. Dry
extracts are extracts of plant material that are evaporated into a dry
mass.
Renewed Interest in Herbal Medicine
• A resurgence of interest in herbal medicine originated in the 1970’s.
• The effectiveness of plant medicines.
• The preference of consumers for natural therapies, a greater
interest in alternative medicines and a commonly held erroneous
belief that herbal products are superior to manufactured products.
• A dissatisfaction with the results from synthetic drugs and the belief
that herbal medicines might be effective in the treatment of certain
diseases where conventional therapies and medicines have proven
to be inadequate.
• The high cost and side effects of most modern drugs.
• Improvements in the quality, efficacy, and safety of herbal
medicines with the development of science and technology.
• A movement towards self-medication
 Prevalence
• 25,000 Plant based formulations are available.
• 1.5 Million Practioners of Traditional Medicinal system.
• In Africa up to 90%, and in India 70% of the population
depend on traditional medicine to help meet their health
care needs.
• Over 20,000 herbal and other natural products available
in the US.
• More than 700 therapeutic herbs and phytomedicines
sold in German Pharmacies. Approximately 70%
Physicians prescribe registered herbal remedies.
Use of Herbal Medicine
 Prevalence
• In China, traditional medicine accounts for around 40%
of all health care delivered and more than 90% of
general hospitals in China have units for traditional
medicine.
• More than 25 % of modern pharmaceutical drugs have
botanical origins.
• 60% of antitumour and antimircobial medicines are
derived from plants.
 Some of Plant based drugs
Drug/Chemical Action/Clinical use Plant Source
Salicylic acid
analgesic willow bark (Salix spp.)
(Aspirin precursor)
Digoxin cardiac stimulant Digitalis purpurea
Antipsychotic and
Reserpine Rauvolfia serpentina
antihypertensive
Quinidine, Antiarrhythmic, Cinchona bark
Emetine Amoebicide, emetic Cephaelis ipecacuanha
Codeine Analgesic,antitussive Papaver somniferum
Atropa belladonna L.
Atropine Anticholinergic
(Belladonna)
Cocaine Local anaesthetic Erythroxylum coca
Morphine Analgesic Papaver somniferum
Pilocarpine Parasympathomimetic Pilocarpus jaborandi
Scopolamine Sedative Datura species
Topotecan Antitumor, anticancer agent Camptotheca acuminata
• More than one third of Americans and Europeans use herbs
for health purposes, spending billions of US$ annually.
U.S. herb and botanical sales
 Global Herbal Market
• Herbal medicine has become a topic of increasing global
importance, with both medical and economic implications.
• The global Herbal Supplements and Remedies market is
projected to exceed $105 billion by 2017 and US$115 billion by
2020.
• Europe alone annually imports about US$ 1 billion in MAPs from
Africa and Asia.
• Asia-Pacific is poised to emerge as the fastest growing market
with a CAGR of 9.1%.
• China is emerging as one of the largest suppliers of herbal
supplements to the United States and West European markets.
• Multi-herbs constitute the largest as well as the fastest growing
product market.
 World Market for Herbal Medicin in 2002
(In US$ Billion)

2.2 1.4 US
4
Asia
5.1 19.4 North America
Japan
Rest of the world

 Global Market
 Category
US $

Herbal dietary supplements $11 billion

Herbal functional foods 14 billion

Herbal pharmaceutical industry 44 billion

Herbal beauty products 14 billion

Global market for herbal products in 2008

 Herbal Practice in Pakistan
• Herbs have always been major form of medicine in Pakistan
• The overall trend in Pakistan shows that 51.7% chose
Traditional and complementary and alternative medicine (TCAM)
while 48.3% chose biomedicine.
• Pakistan is among the eight leading exporters of medicinal plant.
• There are approx. 45,799 Hakims / Tabibs and 537 Vaids
registered with NCT and about 28 recognized Tibbia colleges.
• Pakistan is the only country in the eastern Mediterranean region
where formal Unani teaching institutions are recognized.
• There are two Universities who are imparting five years BEMS
degree along with M. Phil and PhD degrees.
 Use of Traditional/Complementary and Alternative medicines in Pakistan
Aromatherapy 0.02%

Traditional Chinese Medicine 0.05%

Reiki 0.05%

Biologically based practices 0.09%

Mind-body Medicine (faith healing) 2.10%

Unani Medicine 12.40%

Homeopathy 16.00%
Modern Medicine with Unani Medicine and 6.10%
Homeopathy
Modern Medicine with Homeopathy 8.60%

Modern Medicine with Unani Medicine 5.30%

Modern Medicine 48.30%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00%

Percentage of Population
 Herbal Practice in Pakistan
There are many companies including ten leading
Dawakhanas in Pakistan that are making Herbal Medicine
and products.

• Hamdard
Hamdard Laborites is serving the national since 1960s. It
is most famous name in herbal products and medicines in
Pakistan. Rooh Afza, ispaghol, Joshinda, Safi, Suduri,
Sualin, Sharbat Faulad, Toot Siyah are some of their
herbal products.
 Herbal Practice in Pakistan
• Qarshi
Qarshi is engaged in promoting healthy living since seven decades. It has
been offering blend of age-old Oriental and Greek herbal preparations with
the latest advancements in science and technology . Qarshi Research
International was the First ISO 17025 and ISO 17043 lab in Pakistan. Jam e
Shirin , gesto fill , johar joshanda, Sharbat Toot Siyah, Lal Sharbat, Ispaghol
Husk, Surficol Tablets are some of their herbal products.

• Tayyebi Dawakhana
Established in the year 1815 with an aim to alleviate disease and improve
health, Tayyebi has earned the trust of its customers through generations.
Sharbat Banafsha, Burhani Pills, Hab-be Sooranjan, Khamira Marwarid,
Chhinkni, Shahi, Kasirin are some of their prominent herbal products
 Biodiversity Of Pakistan
• The flora of Pakistan is very rich due to her diverse
climatic, soil conditions and multiple ecological regions.
• The country has about 6,000 species of wild plants of
which about 400-600 are considered to be medicinally
important.
• Twelve percent of Pakistani flora is used in medicines.
• A survey by Pakistan Forest Institute concludes that 75
crude herbal drugs are extensively exported and more
than 200 are locally traded in Pakistan.
• Pakistan exports of high value plants generate over
US$10.5 million annually in 2012.
 Herbal Medicine Research in Pakistan
• Pakistan has not been able to develop a coordinated institutional
infrastructure and human resource to add value to the medicinal
plants resources for its sustainable use of floral wealth.
• The research is being conducted mainly in universities.
• Recently the work on various medicinal plants were carried out in
various institutes to establish their
– antimicrobial, antiplatelet and acetylcholinesterase
– inhibitory constituents
– inflammatory
– analgesic
– gut modulatory
– antidiarrheal effects
– constipation effects
 Some of the institutions involved in research of various
aspects of medical plants are as follows;
• Taxonomy, collection, herbarium
Pakistan Forest Institute, Peshawar National Institute of Health, Islamabad
National Agriculture and Research Council, Islamabad. Hamdard University, Bait-ul-Hikmah, Karachi
Quaid-i-Azam University, Islamabad. Herbarium, University of Karachi, Karachi
Pakistan Museum of Natural History, Islamabad. Botany Department of Various Universities of Pakistan

• Phyto-chemistry
International Center for Chemical Research, Institute of Chemistry, University of Karachi;
Pakistan Council for Scientific and Industrial Laboratories, Peshawar
Chemistry and Pharmacology Departments of various Universities of Pakistan

• Pharmacology
National Institute of Health, Islamabad.
HEJ Research Institute, University of Karachi, Karachi
The Aga Khan Medical University, Karachi.
Hamdard University, Karachi
Al-Majeed College of Eastern Medicines, Hamdard
University, Karachi
University of Agriculture, Peshawar
University of Veterinary and Animal Sciences, Lahore.
University of Veterinary and Animal Sciences, Lahore.
University of Agriculture, Faisalabad.
Pharmacology and Pharmacognosy Departments of
various Universities of Pakistan.
• Standardization, Quality Control and Safety Assurance
National Institute of Health, Islamabad.
Hamdard University, Karachi
Pharmacognosy Department, University of Karachi, Karachi.
HEJ Research Institute, University of Karachi, Karachi .

• Medicinal Plants Cultivation, Tissue Culture

Hamdard University Karachi. PMNH, Islamabad.
National Institute of Health, Islamabad. Hamdard Laboratories, Karachi.
Qarshi Industries, Hattar. PARC, Islamabad
University of Malakand, KPK. NARC, Islamabad

• Propagation
University of Malakand, KPK NIAB, Faisalabad.
NARC, Islamabad. PCSIR laboratories, Karachi
NIBGE, Faisalabad.  

Conservation
•Forest Department, Peshawar, KPK. SDC/IC, Pakistan
MACP, Pakistan AKRSP, Pakistan
WWF, Pakistan IUCN, Pakistan
Palas Conservation and Development Project  
(PCDP) Kohistan, KPK, Pakistan
 Laws and Regulations
• The diversity among countries with the long history and holistic approach
of herbal medicines makes evaluating and regulating them very
challenging.
• In the United States, under the Dietary Supplement Health and Education
Act (DSHEA) of 1994, any herb, botanical and natural concentrate,
metabolite and constituent of extract, is classified as a dietary
supplement.
• Dietary supplements do not need approval from the Food and Drug
Administration (FDA) before they are marketed.
• In Europe, the European Directive 2004/24/EC released in 2004 by the
European Parliament and by the Council of Europe provides the
guidelines for the use of herbal medicines
• In Canada, all herbal remedies require a product license under the
Natural Health Products Regulations before they can be sold.
• In China new herbal drugs have to be investigated and approved
according to the Drug Administration Law.
 Laws and Regulations
• Traditional/Complementary medicines practiced in Pakistan were
regulated under Unani, Ayurvedic and Homoeopathic (UAH) Act of
1965 which had been amended in 1970 and 2002.
• The practitioners of these systems have to be registered by their
respective councils i.e. National Council for Tibb (NCT) and National
Council for Homoeopathy (NCH).
• National Council for Tibb (NCT)
– It is responsible for developing curriculum, education and
examination of Tibb-e-Unani and Ayurvedic system of medicine
and for registration of Tabibs who have passed the examination.
• In Pakistan, herbal medicines are sold in pharmacies as over the
counter drugs and in special outlets without any restrictions.
• Drug Act 1976 dealt with allopathic drugs only and here was no
proper law to check ‘Unani’, herbal, bio-chemic and homeopathic
medicines.
 The Drug Regulatory Authority of
Pakistan
• The Drug Regulatory Authority of Pakistan (DRAP) was
formed by the passage of the Drug Regulatory Authority
of Pakistan Act, 2012 by the Parliament of Pakistan
• In a bid to discourage heavy influx of counterfeit and
spurious alternative medicines, DRAP has promulgated
Alternative Medicines and Health Products (Enlistment)
Rules, 2014, on which implementation was started in
May 2014, to regularize the undocumented sector.
The Drug Regulatory Authority of Pakistan

• The manufacturers and dealers of Unani medicine, imported

medicinal product, homeopathic medicines, herbal preparation,
herbal substance, proprietary medicines, herbal medicinal
product, phyto-medicines were asked to get license from
DRAP for sale of these products.
• The neutaceutical products like vitamins, minerals, amino
acids, enzymes, fatty acids, baby milk and foods, cereals, pre-
biotic and pro-biotic would also be registered under the Act.
• The herbal companies, which have not applied for registration
of their products, were not allowed to sell their products after
December 31, 2015.
 The Drug Regulatory Authority of Pakistan
• Over 10,000 herbal companies had applied for
registration of their over 85,000 products.
• A punishment of imprisonment from seven to 10 years
besides fines will be awarded to violators of the Herbal
Act.
• Practitioners of various categories of alternative
medicines like Hakim Vaid and Homeopath do not come
under the DRAP Act 2012 and not to be regulated under
these rules. 
• Under the Herbal Bill, provincial drug inspectors had
launched a crackdown to seize unregistered products of
unregistered companies.
 The Drug Regulatory Authority of
Pakistan
• The DRAP has imposed complete ban on import and
export of alternative medicine, health products and their
ingredients without prior approval of authority
concerned.
• To avoid illegal imports and spurious manufacturing and
to ensure sales of regulated products.
• The DRAP will issue certification which is mandatory for
export to Europe and other companies
• Export of Pakistan’s herbal medicines will increase 10
times which currently is PRs. 25 billion.
 Herbal medicines: Challenges
• The traditional medicines sector not only in Pakistan but also
globally is confronted with challenges like
– Uniform quality standard
– Education and training standards
– Evidence based research
– Methods to evaluate safety and efficacy
• No cultivation practices for medicinal plants are observed in
Pakistan.
• Local collectors are unaware of the best collection procedures
• It has been reported that nearly 37% (266 species) of the total
of 709 endangered species are endemic to Pakistan.
• Deforestation due to lack of water and repeated droughts.
 Herbal medicines: Challenges
• Lack of accountability results in untrained quacks
practicing medicine in different names, thus giving
traditional medicines practitioners a bad name and
lowering respect for them in the community.

• The no. of fake herbal practitioners is five times higher

than that of the qualified doctor.
 Quality Control of Herbal Drugs
• Identity
• Purity
• Content or assay – very challenging for herbal drugs
• Parameters for Quality Control of Herbal Drugs
– Microscopy
– Foreign matter determination
– Determination of ash
– Determination of heavy metals
– Determination of Microbial Contaminants and Aflatoxins
– Determination of Pesticide Residues
– Determination of Radioactive Contamination
– Analytical method and its validation
Quality of Herbal Medicine: Affecting Factors
Herbal medicines are typically chemically rich and complex products
and not isolated single compounds. A number of factors can
influence the qualitative and quantitative chemical profile including:
• Geographical origin
– climate, soil, photoperiod.
• Genotype.
• Parts of the plant
– leaves, stems, root, root bark, etc.
• Harvesting time (year, season, time of day) and conditions.
• Storage, processing, extraction.
• Combinations of herbs and/or processing of the combined herbs
as medicines.
 Safety
• Although approximately 80 percent of people today depend upon
herbal medication as a component of their primary healthcare
according to the WHO, there is still great concern about the
safety and efficacy of herbal use. Because :
– They are unregulated mislabeled.
– May contain additives and contaminants. May cause allergic
reactions .
– Interact with conventional drugs.
– Toxic if used improperly or at high doses.
• There are two aspects of safety evaluations:
– to ensure right quality of material and right processes;
– to ascertain that there is no contamination, adulteration or
spiking.
 Unsafe Herbal Therapies
• Licorice • Ephedra (ma haung)
– Glycyrrhiza glabra – Ephedra sinica
– Peptic ulcers – Anorexiant, decongestant
– High doses – 1% ephedrine
(pseudoaldosteronism) – Palpitations, MIs, death
– Use no longer than 6 – Maximum recommended
weeks dose: 100 mg/24 hours
– Contraindications – Contraindications
– Drug interactions – Drug interactions
• Digoxin, furosemide • Theophylline, digoxin,
caffeine
 Herb Drug Interaction
• Majority of people who use herbal medicines do not
inform their physicians about their consumption.
• When Herbal Medicinal Products and Western drugs
administered together may interact with each other in
body leading to kinetic and dynamic alterations.
• Drug herb interactions can results in unexpected
concentration of therapeutic drug.
• Contrary to popular belief that “natural are safe”, herbal
medicines can cause significant toxic effects, drug
interaction and even morbidity or mortality
Echinacea
(Echinacea angustifolia, pallida, purpurea)

Medicinal Uses:
• Immune system stimulatory effects
• Echinacea is possibly effective for
– Reducing symptoms associated with influenza-like upper
respiratory infections such as the common cold and flu.
– Evidence suggests reduction in duration and severity of
symptoms if started when symptoms are first noticed and
used for 7 to 10 days.
• Possibly ineffective for preventing the common cold or
influenza when taken prophylactically.
Echinacea
(Echinacea angustifolia, pallida, purpurea)

Adverse Effects:
• Allergic reactions
– ragweed, daisies, marigolds
• Fever, nausea, vomiting, unpleasant taste, and dizziness
• Atopy; more likely to experience allergic reaction
Drug Interactions:
• Immunosuppressant: Interfere with therapy
• Medications used for transplant patients, cancer patients,
and patients with multiple sclerosis
Garlic
Medicinal Uses:
There are many conditions garlic has been used for:
• To reduce cholesterol and triglycerides,
• To prevent cancer,
• To lower blood sugar levels, and
• To reduce menstrual pain,
• To treat fungal infections, warts, and corns. 
• Hardening of the arteries (atherosclerosis).
Garlic
Adverse Effect:
• Garlic can cause bad breath, a burning sensation in the mouth or
stomach, heartburn, gas, nausea, vomiting, body odor, and
diarrhea.
• Garlic may also increase the risk of bleeding
Drug Interaction:
• Blood thinning agents like aspirin, warfarin, or clopidogrel (Plavix)-
affect blood clotting and blood sugar levels.
• HIV protease inhibitors (PI) - may decrease the PI blood levels.
• Antihyperglycemic effect when it was co-administered with
chlorpropamide
• Decreases – bioavailabilty of saquinavir – induction of P-
glycoprotein (P – gP)
St. John’s Wort
(Hypericum perforatum)
Medicinal Uses:
• For the treatment of mild-to-moderate
depression, data demonstrate that St. John’s wort is:
– Superior to placebo
– As effective as low-dose tricyclic antidepressants (TCAs; Elavil ® and Pamelor®),
– Possibly as effective as selective serotonin reuptake inhibitors (SSRIs; Prozac ®,
Zoloft®, Celexa®, and Lexapro®)
• Treat bruises and scrapes, inflammation and muscle pain, scaly
and itchy skin (psoriasis), first degree burns, wounds, tooth pulling, bug
bites, hemorrhoids.
Adverse Effects:
• Sun-exposure: Photosensitivity/Phototoxicity (hypericin component;
watch if taking antibiotics)
• Insomnia, vivid dreams, headache, dizziness
Drug Interaction of St. John’s Wort (Hypericum perforatum)
Amitriptyline Induction of CYP3A4
Cyclosporine Induction of CYP3A4 and P - gP leading to decrease in drug concentration
and rejection of transplanted organ

Digoxin Induction of P – gP
Fexofenadine Inhibition of P - gP
Indinavir, Saquinavir Induction of CYP 3A4
Loperamide Acute delirium
Methadone Induction of CYP 3A4, 2C8 and CYP 2D6 leading to decrease in drug
concentration
Oral Contraceptives Failure of contraception due to induction of CYP3A4
Piroxicam Photosensitizing drugs Increased risk of phototoxicity
Quazepam Induction of CYP 3A4
Sertraline Inhibits vesicular uptake of monoamines leading to serotonergic syndrome
Simvastatin Induction of CYP3A4
Tacrolimus Immuno graft rejection due to induction of CYP enzymes

Theophylline Induction of CYP1A2 leading to decreased concentration of drug

Thyroid stimulating hormone Elevation of TSH levels

Venlaxafine Serotonin syndrome – Inhibition of serotonin reuptake and MAO Inhibition

Verapamil Induction of CYP3A4, leading to decreased bioavailabilty

Warfarin Induction of CYP3A4 and CYP2C9 
 
Ginkgo (Ginkgo biloba)
Medicinal Uses:
• Improves blood flow (brain and heart)
• Protects against oxidative damage from free radicals
(antioxidant)
• Inhibits effects of platelet activating factor (PAF)
• Data demonstrate ginkgo leaf extract can stabilize or
improve some measures of cognitive function and social
functioning in patients with multiple types of dementia.
• No direct comparisons to conventional medications for
dementia.
• Modestly improve visual memory and speed of cognitive
processing in non-demented patients with age-related
memory impairment.
Ginkgo (Ginkgo biloba)

Adverse Effects:
• Hypersensitivity reactions, gastrointestinal disturbances
• Spontaneous bleeding (few case reports)
Drug Interactions:
• slow blood clotting too much and increase the chance of
bruising and bleeding when taken with:
– Anticoagulants (Coumadin®)
– Antiplatelets (aspirin, Plavix®, Ticlid®)
• Insulin: increase or decrease insulin and blood sugar
(type 2 diabetes).
Aloe Vera

Medicinal Uses:
• Aloe gel improves acne.
• It can be used against sunburn, kitchen burns, itching
and reduce skin picking.
• Aloe latex can reduce constipation and also cause
diarrhea.
• It is used against ulcerative colitis.
• A specific aloe product (147 mg of aloe gel) can
reduces fat mass in overweight diabetes or prediabetes.
Aloe Vera
Adverse Effect:
• Aloe latex can cause stomach pain and cramps.
• Long-term use of large amounts of aloe latex cause
diarrhea, kidney problems, blood in the urine, low
potassium, muscle weakness and heart disturbances.
• Taking aloe latex 1 gram daily for several days can be fatal. 
Drug Interaction:
• Increase the risk of side effects of digoxin (Lanoxin).
• Decreases blood sugar too low along with diabetes
medications
• Oral drugs - decrease the effectiveness
• Increase the effects of warfarin and increase the risk of
bleeding.
Green tea (Camellia sinensis)

Medicinal Uses:
• Improve mental alertness and thinking
• Reduces total cholesterol and low-density lipoprotein
(LDL or "bad") cholesterol
• inflammatory bowel disease
• weight loss
• to treat stomach disorders, vomiting, diarrhea,
• headaches
Green tea (Camellia sinensis)
Adverse Effect:
• long-term use or in high-doses can cause headache,
nervousness, sleep problems, vomiting, diarrhea, irritability,
irregular heartbeat, tremor, heartburn, dizziness, ringing in the
ears, convulsions, and confusion.
Drug Interaction:
• Stimulant drugs (Amphetamines, Cocaine)- increase heart
rate and high blood pressure.
• Increases effects and side effects of theophylline
• Decreases effect of coronary vasodilator drugs
• Decreases effects of warfarin
Fenugreek (Trigonella foenum-graecum)

Medicinal Uses:
• Digestive problems such as loss of appetite, upset
stomach, constipation, inflammation of
the stomach (gastritis).
• Lowers blood sugar levels
• Used for painful menstruation, polycystic ovary
syndrome, and obesity.
• It is also used for conditions that affect heart
health such as atherosclerosis and for high blood levels
of cholesterol and triglycerides.
Fenugreek (Trigonella foenum-graecum)
Adverse Effect:
• Diarrhea, stomach upset, bloating, gas
• Nasal congestion, coughing, facial swelling, and
severe allergic reactions in hypersensitive people
Drug Interaction:
• Antidiabetic drugs- decrease blood sugar
• Anticoagulant / Antiplatelet drugs- slow blood clotting.
• Warfarin (Coumadin)-  increase the chances of
bruising and bleeding
Ginseng Panax
Medicinal Uses:
• Improve mental performance in people with Alzheimer's
disease.
• Taking Panax ginseng by mouth improve s lung
function and some symptoms of COPD.
• Improve thinking and concentration.
• Reduce the risk of getting a cold or the flu.
• Reduces Multiple sclerosis-related fatigue.
Ginseng Panax
Adverse Effects:
• Insomnia
• Less commonly increased heart rate, high or low blood pressure,
headache, loss of appetite, diarrhea, itching, rash, dizziness.
Drug Interaction:
•  decrease how well furosemide (Lasix) works.
• decrease blood sugar  when taken along with Insulin
• Medications changed by the liver (Cytochrome P450 2D6
(CYP2D6) substrates)
Peppermint
Medicinal Uses:
• Used for the common cold, cough, inflammation of
the mouth and throat, sinus infections, and respiratory
infections.
• Crushed leaves rubbed on the skin help soothe and
relax the muscles.
• Infused peppermint leaves are used to reduce irritable
bowel syndrome, against upset stomachs
• To treat fevers and flatulence.
• An inhalant to loosen phlegm
Peppermint
Adverse Effects:
• Peppermint can cause heartburn, and allergic reactions including
flushing, headache, and mouth sores
Drug Interaction:
• The peppermint will decrease the metabolism of cyclosporin
(Neoral, Sandimmune)
• Some medications that are changed by the liver such as
amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran),
propranolol (Inderal).
• Medications changed by the liver (Cytochrome P450 2C19
(CYP2C) substrates) 
Ginger

Medicinal Uses:
• It works by neutralizing stomach acid.
• It also has anti-inflammatory properties.
• It is used for upset stomach, motion sickness, and
nausea.
• Pain relief from arthritis or muscle soreness
• Menstrual pain
• Upper respiratory tract infections, cough, and bronchitis.
• Ginger is also sometimes used for chest pain
Ginger
Adverse Effect:
• Mild side effects including heartburn, diarrhea, and general
stomach discomfort.
Drug Interaction:
• Increase bleeding with anticoagulants
• Decrease effect of antacids
• Ginger might decrease blood sugar Insulin
(Chlorpropamide , Glipizide, Tolbutamide)
• High blood pressure (Calcium channel blockers) interacts
with Ginger (verapamil , felodipine , amlodipin).
Plants, herbs, and ethnobotanicals have been used since the early
days of humankind and are still used throughout the world .
People have been consulting traditional healers for ages and they
will keep on doing so for various reasons. The solution lies only in
bringing these herbal medicinal healers into the mainstream by
providing them with proper training, facilities and back-up for
referral.
Law & Order, Herbal manufacturers and Prescribers, together
could bring a new horizon of remarkable revolution by reforming
and reshaping the herbal medicines to face the challenges of the
21st century by providing an equivalent effective, economical and
safe treatment by utilizing mostly our own resources.