Herbal medicine case study in cambodia

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This short paper is a small paper that is written to fulfill the course of introduction to Anthropology at University Cambodia.

This paper is not a research paper, but it can serve as a basic information for those who are interested in Herbal medicine.

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Herbal medicine case study in cambodia

  1. 1. University of Cambodia College of Social Science Herbal Medicine: A Case Study in Cambodia Submitted for the course of Introduction to Anthropology Instructor: Group members: Mr. kep Bunly 1. Keo Chanosophea 2. Mun Thim 3. Ngoem Sophanny 4. Sao Layhour 5. Set Soriya 20 May, 2014
  2. 2. Content Page I. Introduction ............................................................................................................................2 1.1 Background......................................................................................................................2 1.2 Problem Statement...........................................................................................................3 1.3 Objectives ........................................................................................................................3 1.4 Significance of the Study.................................................................................................3 1.5 Outline..............................................................................................................................4 II. Herbal Medicine....................................................................................................................5 2.1 Definition.........................................................................................................................5 2.2 History..............................................................................................................................5 2.3 Herbalism.........................................................................................................................6 2.3.1 Chinese herbalism: history and Yin & Yang.. ..........................................................6 2.3.2 Ayurvedic medicine..................................................................................................9 2.3.3 Western Herbalism....................................................................................................9 2.4 Herbal Treatment ...........................................................................................................10 2.4.1 Plants.......................................................................................................................11 2.4.2 Animal or micro-organisms....................................................................................13 2.5 Positive and Negative Effects of Herbal Medicines ......................................................13 2.5.1 Positive effects of herbal medicines. ......................................................................13 2.5.2 Negative effects of herbal medicines......................................................................14 2.6 Ensuring Safety Herbal Medicine..................................................................................15
  3. 3. III. Herbal Medicine in Cambodia...........................................................................................16 3.1 Overview........................................................................................................................16 3.2 History............................................................................................................................17 3.3 Cambodian Herbal Treatment........................................................................................20 3.3.1 Provider of herbal medicine....................................................................................20 3.3.2 Illness identification................................................................................................21 3.3.3 Concept of Cambodian herbal treatment ................................................................21 3.3.4 Herbal medicine preparation...................................................................................22 3.4 Effect of Cambodian Herbal Medicine..........................................................................23 3.4.1 Positive effects........................................................................................................23 3.4.2 Negative effect........................................................................................................23 3.5 Ensuring Safety and Efficacy of Herbal Medicine in Cambodia...................................24 IV. Discussion..........................................................................................................................26 Conclusion ...............................................................................................................................28
  4. 4. Running head: HERBAL MEDICINE 1 Herbal Medicine: A Case Study in Cambodia Keo Chanosophea Ngoem Sophanny Mun Thim Sao Layhour Set Soriya University of Cambodia
  5. 5. HERBAL MEDICINE 2 I. Introduction 1.1 Background Long time ago, people were completely living naturally by just extracting non-timber product for their living. One of remarkable products that has been existed even before recoded history and still followed until now is using plants for medical purpose (Bayalan, Villa, & Landicho, 2008). The practices of using plants including leaf, root, bark or the whole plant for curing illness is called herbal medicine. Herbal medicine was the major medicine available for people; however, since early 19th century, the evolution of technology has transferred the raw herbal into synthetic pharmaceuticals, and this has led to the decline in using herbal medicine. The decline has not been very dramatic, for instant, in 2000 around 75%-80% of world population still deeply relay on the medicine for their health care (Pal & Shukla, 2003). Despite of the fact that modern medicine seems to be more reliable, Pal and Shukla (2003) believe that medical herb is still very popular because it is available for immediate need, not costly, not time consuming, and because it is believed that a certain disease always accompany with a certain plant for treatment. Similarly, herbal medicine is also widely used in Cambodia. Cambodian herbal medicine is well known as traditional medicine and usually provided through traditional healer. The medicine has been widely used since Angkor era until present time. Ministry of Health (2012) estimated that about half of Cambodian population relies on herbal medicine for health care, but they are still in the need of modern medicine and pharmacies. The ministry also states that living standard and culture influent the use of herbal medicine. In Cambodia, people using herbal medicine are people who are poor and living in the area that is covered much with cultural and customary spirit. The popularity of herbal medicine in the world as well as in Cambodia has raised questions about its quality, safety and efficacy. Understand this kind of medicine well would
  6. 6. HERBAL MEDICINE 3 be useful for us to decide whether or not to continue using herbal medicine, and to raise this awareness we need to preview it deeply in term of how people use it for treatment, its quality, safety, and efficacy. This paper, therefore, will gather theories related to herbal medicine and use the way it is practiced in Cambodia as case study to make our final conclusion be critical. 1.2 Problem Statement Based on the above-mentioned background, the problems necessary to be studied are: 1. How herbal medicine has been used in societies? 2. What are the positive and negative effects of herbal medicine? 3. Should herbal medicine be used in this contemporary society? 1.3 Objectives The study on “Herbal Medicine: A Case Study in Cambodia” has the following objectives: - Explore origin of herbal medicine - Understand the use of medicinal plants for treatment - Understand quality, safety, and efficacy of using herbal medicine for treatment - Find out whether or not herbal medicine should be used in this contemporary society 1.4 Significance of the Study Health care is very important for all people living wherever. This research is a combination of theories supported with a case study of Cambodia, so it can provide basic understanding of herbal medicine to people interested in the field and maybe it can lead to a further research with better scope and methodology. In the same time, people in Cambodia, whose about half of population relies on this kind of medicine, will have a better understanding of the medicine in both general context and Cambodian context. The awareness can help our citizen to flash back to what they have practiced in term of medicinal
  7. 7. HERBAL MEDICINE 4 treatment and decide whether they should rely on traditional medicine or modern medicine, which is a result of pharmaceutical evolution. The discussion in section IV will definitely help people to be even more critical in choosing certain medicine for curing. Lastly, the paper will also suggest some feasible solutions to overcome some negative sides associated with the use of medicinal plants. 1.5 Outline This paper is divided into five main sections ranging from introduction, theory related herbal medicine, the practice of herbal medicine in Cambodia, discussion on reliability of herbal medicine, and conclusion. Introduction will give you a brief background related to the topic, and inform you the objectives and significance of the study. Section II will give you a basic concept of herbal medicine ranging from definition and its origin to its effects on users. After understanding the basic concepts of herbal medicine, Section III will let you look deeply into a specific practice of the medicine in Cambodia as a case study. Section IV will discuss on what we have found in section II and section III in order to drag the conclusion whether or not herbal medicine should be continued using, and what the challenges we have to deal with. Finally, conclusion will be the last part of this short paper, and it will wrap up the key messages the paper aim to find out.
  8. 8. HERBAL MEDICINE 5 II. Herbal Medicine 2.1 Definition Herbal medicine is the study or practice of the medicinal and therapeutic use of plants; herbalism. Remedies and medicines made from plants. Also, herbal medicine made from the kind of animal (wild life) or combined the insects with the plants. They are traditional doctors prescribe herbal medicine for the prevention and treatment of illness (Qi, 2014) 2.2 History Herbal medicine was known as traditional herbal medicine that implies substantial historical use, and this is certainly true for many products that are available as „traditional herbal medicines‟. Plants had been used for medicinal purposes long before recorded history. Archaeological evidence indicates that the use of medicinal plants dates at least to the Paleolithic, approximately 60,000 years ago. Written evidence of herbal remedies dates back over 5,000 years, to the Sumerians, who created lists of plants. A number of ancient cultures wrote on plants and their medical uses. In ancient Egypt, herbs are mentioned in Egyptian medical papyri, represented in tomb illustrations, or on rare occasions found in medical jars containing trace amounts of herbs. The earliest known Greek herbals were those of Diocles of Carystus, written during the 3rd century B.C, and one by Krateuas from the 1st century B.C. Only a few fragments of these works have survived intact, but from what remains scholars have noted that there is a large amount of overlap with the Egyptian herbals. An example of using herbal medicine is Seeds likely used for herbalism have been found in the archaeological sites of Bronze Age. China is one of countries that used the herbal medicine. Ancient Chinese describe medicinal uses for plants as early as 3,000 BC. Herbs were also common in the medicine of ancient India, where the principal treatment for
  9. 9. HERBAL MEDICINE 6 diseases was diet Materia Medica by Pedanius Dioscorides, a Roman physician, is a particularly important example of such writings. The documentation of herbs and their uses was a central part of both Western and Eastern medical scholarship through to the 1600s, and these works played an important role in the development of the science. 2.3 Herbalism 2.3.1 Chinese herbalism: history and Yin & Yang. Chinese herbal medicine has been practiced for thousands of years. Chinese people started to use the benefit of the plants since the Stone Age when Chinese converted from hunter-gatherers to farmers. Traditional Chinese medicine (TCM) dated back to the period of The Huang Di. The Nei Jing (The Yellow Emperor‟s Canon of Internal Medicine) that is the greatest and the oldest Chinese medical classic is milestone, which has established the theoretical foundation for the medical system and philosophical theory. The theory of Chinese herbalism is dramatically improving since the development of Chinese nation; for example, in Tang dynasty, King Sun Simiao was named the Herbal King. In addition, during Jin-Yuan dynasty, there are four branches of Chinese herbalism. Each branch has its own characteristic and thesis which improved the theory of TCM more clearly. The Ming dynasty, Li Shizhen and Zhang Jingyue, promoted TCM development. Later on, the Wen Bing School was founded in the Qing dynasty. Traditional Chinese herbalism has taken shape unique its own system and theory in practice, which develops its own way according to internal theories. Since the beginning of the 19th century, western medicine started entering and developing rapidly in China and traditional Chinese medicine development was affected severely, which was between the devil and the deep sea.
  10. 10. HERBAL MEDICINE 7 After the Opium Wars in China, Chinese had the incorrect belief that traditional Chinese medicine is unscientific and feudal. Therefore, TCM had always been in investigation, examined, queried and reform, and develop on thin ice. After the foundation of the People‟s Republic of China, the Government affirms the policy to protect TCM. Then, it developed noticeably. However, in the latest 20 years, the policy of the Party Central Committee and the gist of the Constitution haven‟t been carried out conscientiously, and TCM has been in a difficult position. Over the past thousands years, TCM has developed both practical and theory universal systematic healthcare system which is characterized by simplicity, convenience, affordability, safety, efficacy and effectiveness. Yin-Yang has become a universal philosophical concept. The concept of Yin and Yang is deeply rooted in Chinese philosophy (Miller, 2003; Watts, 1999). This Yin-Yang concept appeared at least 2500 years ago, and it is the important role in the formation of the Chinese ancient civilization. The Yin and Yang describes the formula of balance and harmony. Nowadays, the Yin and Yang does not only access to the principle of medicine, but also access to arts, religion, sports or politics. According to the Chinese philosophical concept, there are two opposing forces in the world, namely Yin and Yang, which are constantly trying to gain the upper hand over each other. However, neither one will ever succeed in doing so, though one force may temporarily dominate the other one. Both forces cannot exist without each other; it is rather the constant struggle between both forces that defines our world and produces the rhythm of life. Yin and Yang are not only believed to be the foundation of our universe, but also to flow through and affect every being. For example, typical Yin-Yang opposites are night/day, cold/hot, rest/activity.
  11. 11. HERBAL MEDICINE 8 Chinese philosophy does not confine itself to a mere description of Yin and Yang; it also provides guidelines on how to live in accordance with Yin and Yang. The central statement is that Yin and Yang need to be in harmony. Any imbalance of an economical, biological, physical, or chemical system can be directly attributed to a distorted equilibrium between Yin and Yang. For example, an illness accompanied by fever is the result of Yang being too strong and dominating Yin. On the other hand, for example, dominance of Yin could result in a body shivering with cold. The optimal state every being, or system, should strive for is therefore the state of equilibrium between Yin and Yang. It is this state of equilibrium between Yin and Yang that Chinese philosophy considers the most powerful and stable state a system can assume. Yin and Yang already carry the seed of their opposites: A dominating Yin becomes susceptible to Yang and will eventually turn into its opposite. On the other hand, a dominating Yang gives rise to Yin and will turn into Yin over time. This defines the perennial alternative cycle of Yin or Yang dominance. Only the equilibrium between Yin and Yang is able to overcome this cycle.
  12. 12. HERBAL MEDICINE 9 2.3.2 Ayurvedic medicine. Ayurveda is a medical system primarily practised in India that has been known for nearly 5000 years. . The term “Ayurveda” combines the Sanskrit words ayur (life) and veda (science or knowledge). Thus, Ayurveda means “the science of life.” It includes diet and herbal remedies, while emphasizing the body, mind and spirit in disease prevention and treatment (Morgan, 2002). Ayurveda is designed to promote good health and longevity rather than to fight disease and was practiced by physicians and surgeons (called bheshaja or vaidya). Until 700 BC, this science was orally discussed between sages and physicians. Thereafter, two different textbooks were assembled: one by „„Charaka‟‟ is called Charaka Samhita, and the other by „„Sushruta‟‟ is called Sushruta Samhita. Whereas Charaka Samhita deals with the etiology, symptomatology, pathology, prognosis, and medical management of disease, Sushruta Samhita deals with various surgical instruments and procedures. 2.3.3 Western Herbalism. Western herbalism is a form of healing art that draw from herbal traditions of Europe and the Americas and that emphasizes the study and use of European and Native American herbs in the treatment and prevention of illness. Western herbalism is based on physicians and herbalists clinical experience and traditional knowledge of medicinal plant remedies preserved by oral tradition and in written records over thousands of years. Western herbalism, like the much older system of traditional Chinese medicine, relies on the synergistic and curative properties of the plant to treat symptoms and disease and maintain health. Western herbalism is based upon pharmocognosy, the study of natural products. Pharmocognosy includes the identification, extraction methods, and applications of specific plant constituents responsible for specific therapeutic actions, such as the use of digoxin from digitalis leaf for heart failure. These constituents are extracted, purified and studied in vitro, in vivo, and in clinical research. They may be concentrated to deliver standardized, set doses. Sometimes, the natural constituent can be synthesized in the lab, or
  13. 13. HERBAL MEDICINE 10 changed and patented. Practitioners may choose to use fresh medicinal plants, simple extracts, or standardized extracts. In standardized extracts, a specific quantity of a constituent is called a marker compound, and it may or may not be the active constituent(s) in the plant medicine. There are preparations with standardized active constituent quantities, and preparations with greater emphasis on quality of crude plant material and traditional preparation methodology than on finalized total quantity of marker compounds. The preference between the two for precision dosing is philosophical, practical and variable. When using plant extracts in which the active constituents and their cofactors are well established, or the therapeutic and lethal dose are close, standardized products are often preferred. When using plant extracts whose active constituents remain obscure, or the active constituents when purified produce weaker therapeutic results or more undesirable side effects, the products produced under good manufacturing processes and according to the traditional National Formulary U. S. Dispensatory or U. S. Pharmacopeia are preferred. 2.4 Herbal Treatment Herbal medicine had function of important role in Cambodia based on historical, cultural, and economical. Since ancient time, there are largely important of natural products for medicine and health care. People usually used TM that is tradition medicine to treat or reveal the disease which could found in several places such as forest, mountain, lake, or other place that have several kinds of this herb in term of those on regions. In addition, many people believe that are always safe and food for them. Base on cultural, they also became the first medicine that were wild popular plant and cultivated medicinal plant which useful to treat the disease or illness especially they are found easily around living area or in forest. For example, during the past, our ancestors used herbs that are plant around living area to treat illness by using their tooth to chew on certain herb to relieve pain, or wrapped leaves around
  14. 14. HERBAL MEDICINE 11 wounds to improve healing. Then in term of economic is also important. If traditional medicine didn‟t have in around living area or forest, they would have acceptable price for every usage even poor or rich family. Since natural products have often used to treat diseases and injuries, they were well known how to find, to use and to treat by using experimental treatment and innovation treatment. Moreover, herbal medicine used of natural products that are derived from natural source, has found prehistory around thousands of years, as plants, animal or micro-organisms. 2.4.1 Plants. Cambodia treat illness with traditional strategy based on plants that have ability to sate of being different of illness such as fever, diarrhea, urinary troubles, respiratory problems, tiredness, muscle pains, rheumatism etc… they are also regarded as the medicines that have their own ability to synthesize a wide variety of chemical compounds. They are also used to perform important function, and to defend our health and body against attack from predator such as insect, fungi and herbivorous mammals. There are chemical compound that occur naturally in plants, is called phytochemical. Most of these plants that contain phytochemical have effectively benefit to care long-term health when they are used by human, and they can be used effectively for treat human diseases. At least 12000 such compounds have been isolated so far, and a number estimate to be less than 10% of the total. These phytochemicals are divided into two. First are primary metabolites such as sugars and fats, which are found in all plants, and second are secondary metabolites. Compounds which are found in a smaller range of plants, are serving a more specific function. For example, some secondary metabolites are toxins, which are poison, used to defend predatory and other pheromones used to attract insects for pollination. However, there are three important differences usages of plants in herbal medicine such as whole plant using, herb combining and diagnosis.
  15. 15. HERBAL MEDICINE 12 Whole plant using- Generally, herbalists use unpurified plants that contain many different of Constituents. They said that poison is reduced when whole of the medicine‟s substance are made component, and they also emphasize that poison is reduced when whole herbs are used instead of isolated active Ingredients (“buffering”). Due to research, they use two sample of herbals drug that may contain constituent compound in different proportion; however, practitioners claim that this does not generally cause clinical problems. There is some evidence for synergy and buffering in certain whole plant preparations, but how far this is applicable to all herbal products is not known (Vickers and Zollman, 1999). For example: For thousands of years, when people face problem acne that appeared on their skin, they have relied on aloe Vera to treat various skin conditions. It can also be very effective against acne. Aloe Vera is also better sources which contain vitamins A and C. These natural sources can protect the body and the skin from damage and also with skin repair and maintenance. Aloe vera Aloe Vera Aloe Vera using Herbs Combining- It refers to all several different herbs are used together by herbal practitioners. They say that the principles of synergy and buffering apply to combinations of plant, and they also claim that herb which is combining to improve efficiency and reduce impact. In contrast, they aren‟t similar to conventional practice, where polypharmacy is generally avoided whenever possible (Vickers and Zollman, 1999). For example: Diagnosis- Herbalists generally use different diagnostic principles from conventional practitioners. For example, when treating arthritis, they might observe, “Under functioning of
  16. 16. HERBAL MEDICINE 13 a patient‟s symptoms of elimination” and decide that the arthritis results from “an accumulation of metabolic waste products”. A diuretic, cholerectic or laxative combination of herbs might then be prescribed alongside herbs with anti-inflammatory properties (Vickers and Zollman, 1999). 2.4.2 Animal or micro-organisms. Animals also are regarded as the medicines that have their own ability to treat a variety of illness such as gout to blood loss. Due to recording in Yuan Shih, there are many incidents where the freshly or clear blood can treat the disease, and it usually contain a cow or an ox. Transfusion, which an act of donate blood, or other fluid into the circulatory system of person or animal, was place a person in the stomach of an animal. In addition, on the battlefield, when solider became unconscious because of massive among of blood loss, he uses freshly killed animal by stripping and placing into the stomach until he become better or conscious again. Moreover, they also found the skin of a freshly killed ox was combined with the masticated grass in a cow's stomach to present as the bandage to battle wounds in order to make it heal because it they believe that not only stomach and fat of the fleshy killed animal could absorb the bad or no fresh blood, but it also restore the wounded to be health. 2.5 Positive and Negative Effects of Herbal Medicines There are numerous positives and negative sides of Herbal Medicines. The Herbal Medicine can treat well or not depends on its quality. 2.5.1 Positive effects of herbal medicines. Herbal medicines can reduced risk of side effects because most of herbal medicines tolerate by the patients than pharmaceutical drugs. Another positive of the herbal medicines is cost. If we compare herbal medicine‟s price with that of drugs we will see that the herbal medicines are not as expensive as drugs. It is easy for the poor and medium people to buy for curing their ill health. On the other hand, medicinal
  17. 17. HERBAL MEDICINE 14 plants are widespread availability. Hers are available without a prescription from doctor; moreover, you can grow many kinds herbal medicine at home. 2.5.2 Negative effects of herbal medicines. Although herbal medicine is proved to be effective, it is not appropriate in all situations. For example, the serious illness or accidents can‟t be cured herbal medicine. Herbal medicine is not applicable for many ill health such as broken legs, cancer, heal an appendix or heart attack. These injuries and illness can only be treated by doctors using modern diagnosis tests, surgery, drug and so on. One more thing, lack of dosage instruction mean that herbal medicine is made by them, and most of them are not clear about method of preparation. Additionally, herbal medicines are not hygiene because when they treat they don‟t control themselves. Some infection can transmit from medical practitioner to the patients, and sometime can transmit from the patients to the person who treats. Moreover, if they use overdose of herbal medicines, it can affect the patients too. On the other hand the main point focuses on that herbal medicine are poison risk associate with wild herbs. Herbal medicine practitioners usually do experiment by using medicinal herbs curing real patients. In this case, patients take very high risk to be treated in herbal medication, and if they really have problems, they just can‟t sue or punish those practitioners since herbal medicine practitioners will only regard themselves as unprofessional so they are not obliged to ensure safety of their treatment. Lastly, herbal medicines are lack of regulation. Of cause herbal medicines is illegal because it is not checked properly by the doctor, and its quality is not good for our body. For example, many Asian and Indian herbal remedies have been found to contain heavy mental such as lead, arsenic and mercury (Capriotti, 1999). Furthermore, herbal medicine can result in hypersensitivity reaction. For example tea tree oil is widely used as a topical disinfection or chamomile can cause allergic reaction (knight and, 1994; Bussuyt and Dooms-Goossens,
  18. 18. HERBAL MEDICINE 15 1994). And herbal medicines are not check as conventional that is why it can be contaminated. 2.6 Ensuring Safety Herbal Medicine Although Herbal Medicines are very good, there is need for practitioner to ensure that the medicines are safe before they administer it to people. Moreover, they need to do experiment over it many times before they bring it to the markets. Most of people like Herbal Medicines because it is made from natural and affect a bite to the humans‟ life. Herbal Medicines treatment is the most popular form of traditional medicines and was very lucrative on the international markets; for instance, in China the sale of Herbal Medicines products is totally 14 billion USD in 2005, adding that the worldwide annual mark for traditional Herbal Medicines/product was about 60 billion USD (Dominic, 2013).
  19. 19. HERBAL MEDICINE 16 III. Herbal Medicine in Cambodia 3.1 Overview Herbal Medicine is strongly belief and well-know of remedy in curing illness from natural of wild plants and animals for all Cambodians ill-health (NCTMT, 2010). The knowledge of herbal medicine is documented only in Pali language, which makes general people having desire to learn find difficult to learn. The knowledge about medicinal plants is usually pass through family when young people start going to forest to get non-timber forest products. However, the knowledge comes to limitation due to overexploitation of forest and illegal deforestation (Savajol, Toun, & Sam, 2011). Herbal medicine has played a very important role in health care of Cambodian citizens since the time before Angkorian Era until present time. Around half of Cambodian population relies heavily on the medicine, especially, people living in the area that is strongly influenced by custom and tradition and poor people (WHO & MOH, 2012). People tend to use herbal medicine, asides from efficacy issue, sine it is more accessible than biomedicine or Western medicine. To illustrate, in Mondulkiri Province, western medicine is almost inaccessible (Savajol et., 2011). To get western medicine service, people have to travel in far distance on red road, and in rainy season, the road is almost impossible to travel by motorbike. As a result, people continue accessing herbal medicine because the service can be found in their neighborhood or in any place which they just need to spend a short period of time arriving there. Some Cambodian people receive both medicinal herbs and western medicine to cure their illness and mostly they switch from one medicine preparation to another when they feel their illness is not effectively cured by the medicine they are receiving. Many Cambodians, however, are very hesitant to let western medical providers know that they are using traditional medicine to cure their health, since they think the providers will not be happy to
  20. 20. HERBAL MEDICINE 17 cure them (Wetzel & Jennifer, 1996). Hence, this might affect to the tracing of illness by modern doctor, and this would affect the medicine that they will be prescribed to consume. 3.2 History Traditional Khmer Medicine is being used long before in Angkorean period of Cambodia history, and it is influenced by Chinese and Indian herbalism. It is believed that herbal medicine concept is brought into Cambodia since the first century of Christian era during Indianization period. Indian has brought “Ayurveda” concept of medicinal plants which associate with kinds of plants to be used and how to use it in to Cambodia. In Sanskrit, Ayur means longevity or life, Veda means knowledge or science, so Ayurveda refers to knowledge or science about having a long life (Kham, 2004). Herbal medicine also has a strong relationship with Buddhism and Hinduism. Buddhist and Brahmin priests had been experience full and high knowledge (about medicinal plants) herbal medicine practitioners. Some of the knowledge might be obtained from learning from previous practitioners; however, since Angkorian era, they learnt more about herbal medicine from Chinese. Chinese traders and Cambodian has good relationship as well as trade cooperation. Chinese traders had order many kinds of plants from Cambodia, and one of among the purpose of importing is to use plant for medicinal purpose. Through this trade, Cambodian had chance to get to know more plants and other natural products that are used for curing people, and hence they applied the knowledge in treating illness. Although, Cambodian herbal medicine seems to be influenced by both Ayurveda and Chinese, the practice of herbalists can be viewed as influenced more by Ayurvedic herbalism; whereas, Chinese practice is just an additional knowledge since during Jayavarman VII dynasty, health care of his people was set as a priority sector, and the king, as a result, created a medical science which is called Vaidyas Vedic derived from Ayurveda. Through this establishment 102 hospitals were created using
  21. 21. HERBAL MEDICINE 18 traditional medicine, and in each hospital there were 32 workers working to help people from illness (Jan & Ing, 2010). Cambodia was remarkably introduced to new kind of medicine, modern medicine or western medicine or biomedicine during French protectorate and colony in 1950. Under control of French, western medicines were widely used for curing disease in Cambodia; however, only the rich people can have access to the medicine. Despite of the fact that western medicine is practiced in Cambodia, traditional medicines were still widely used in every corner in the country. Later in 1970s, during Khmer Rouge regime, traditional medicine had gained its popularity again in Cambodian society. During the regime, western teaching, including medicinal teaching, were banned, so there were almost no western medicinal doctor to treat people, and herbal medicine has been promoted and encouraged to use. There were hospitals, but the medicine provided to patients were not varies. Most people were cured by offering a kind of pill called “Rabbit Dropping”, and taking rest from hard physical labour (Jan & Ing, 2010). Nevertheless, according to experience of people alive from Pol Pot regime proves that the medicine provided sometimes are very effective; to illustrate, diarrhea and swollen has been the most common illnesses that old people raise to prove that medicine in Pol Pot regime is effective. In 1979, after falling of Pol Pot‟s regime, in order to support and promote the use of Traditional Medicines, the Government has officially integrated the law into the National Health System. After Pol Pot‟s regime, we found that Cambodian herbal practice is also influenced by Vietnamese. For instance, people in Mondulkiri, during 1970s, their villages were destroyed, and they migrated to Koh Nhek in Vietnam. In the same time as making their living there, Cambodian people learnt about herbal medicine in that area, and when they came back in
  22. 22. HERBAL MEDICINE 19 1980s they adapted those knowledge because they have already lost the home knowledge about herbal medicine (Savajol et al., 2011). Later, Royal Government of Cambodia has tried very hard to promote herbal medicine in Cambodia. In 1998, due to lack of western medicine available, traditional or herbal medicine has formally encouraged to completely use in area where western medicine is not available and areas where western medicine existed, herbal medicine should be used as an alternative health care. In 2004 the Royal Government committed to continuing to encourage the use of traditional medicines with appropriate information and control in conjunction with the use of modern medicine. The government released their Policy on Traditional Medicine of Kingdom of Cambodia in 2010. In 2011 the Traditional Medicine Taskforce was established to implement the 2010 Policy on Traditional Medicine. Yet, there is no national expert committee for traditional medicine. Traditional medicine is not yet included in the National Health Strategic Plan and is not covered by health insurance. Cambodian Herbal medicine has such a long history starting from the main source of medicine for health care to just an alternative health care strategy. The number of people using herbal medicine, however, is still great. Ministry of Health (2012) estimated that around 40-50% of Cambodian population still relies on herbal medicine. Large population of people still use this kind of herbal medicine because of it is more accessible, affordable, and effective. On one hand, traditional medicine is the most affordable medicine that even poor people don‟t find difficult to have it (Kaing, 2010). Besides buying it from market, people can even obtain the plants by themselves around their house. Differently, western medicine is not this accessible; for example, in Mondulkiri Province, people have to travel in far distance to arrive at health care center to receive western medical service. Additionally, in rainy season, the road is almost impossible to travel by motorbike since the road was red pave road (Savajol et al., 2011)
  23. 23. HERBAL MEDICINE 20 3.3 Cambodian Herbal Treatment In Cambodia today, there are 1,000 plant species used for treatment in Khmer herbal medicine, and those plants can be obtained by either going directly into the forest to find or buying from market (Kaing, 2010). To ensure the effectiveness of medicinal plants, we need to cut the plants in right time. Ly Bunnarith, one of famous Khmer traditional medicine practitioners whose medicine is recognized by Ministry of Health, explains that a medicinal plant is divided into 3 main parts such as trunk, leaves, and root. Some trees, its trunk must be cut in the morning, leaves must be cut in the afternoon, and root must be ditch up at night. For some trees, it is fine to cut in any time, but for some trees, if we don‟t take it in the right time, effectiveness of it will be affected (Se, 2002). 3.3.1 Provider of herbal medicine. Herbal remedy is also practices directly by patient himself or his family. Sometimes, people try to cure themselves without any consultation with medicine practitioners. They just try to find medicinal plants they know around their house or in the village, and prepare them for curing their ill-health directly by themselves. The practice has been passing on from generation to generation in accordance with their family‟ habit, knowledge obtaining from family or prescription they get from healer sometime in the past when they were sick (WHO & MOH, 2012). In Cambodia during 1890s, there were two herbal medicine providers such as “Kru thnam” and “Kru thump”. “Kru Thnam” are traditional herbalists; their skill is in the proper way of combining the various roots and herbs; the mixture is boiled and the decoction is given to the patient to drink. “Kru thump” were plain sorcerers, ignorant healers with no professional decency who would often sell medicines that they knew were ineffective. Nevertheless they were said to know medical secrets that enable them to
  24. 24. HERBAL MEDICINE 21 cure diseases that the “Kru Pet” or “Kru Thnam could not cure”. (Jan & Ing, 2010, p. 135) Similarly, in present time, Ministry of Health in collaboration with World Health Organization has identified herbal medicine is provided by only private sector usually Kru Khmer, Kru Chol Ruup, and Buddhist monks. Kru Khmer simply has the same meaning as Kru Thnam in the past, and Kru Chol Ruup are spirit mediums, mostly female, who are possessed by their spirits who make diagnosis or direct the exorcism. The mediums frequently recommend the use of material objects, such as amulets for protection and to ward off bad spirits (Jan & Ing, 2010, p. 135) . 3.3.2 Illness identification. Cambodian herbal treatment is still influenced by superstition. For instance, the identification of illness in this traditional medicine can be conducted in to main techniques including inquiry technique and magical-religious technique. Inquiry technique refers to the process of diagnostic identification which medical practitioner tries to ask patient questions in order to get information about ill-health history and examining the patient. The magical-religious technique is the process of identifying ill-health and making explanation to patient by predicting (NCTMT, 2010). 3.3.3 Concept of Cambodian herbal treatment. It is true that Cambodian herbal medicine is influence by Ayurvida from India, but in curing illness, providers tend to follow the “Yin and Yang” concept of health originating from China. Professor Chheng Sun Kaing (2010) argue that concept of treatment of illness in herbalism in Cambodia is often associated with “hot” and “cold” notions. Hot illnesses such as fever, constipation, hyperthermia, and so forth should be treated by a cold medication using plants with acid, bitter or astringent taste. For example, hyperthermia can be effectively treated by Andrographis paniculata Nees (in Khmer it is called Smao Promatmanus). Hyperthermia can be treated by dried powder of this
  25. 25. HERBAL MEDICINE 22 plant in a dose of 3-6 gm or decoction in dose 150ml-300ml orally taken for the specified indications. Cold illness such as diarrhea, hypothermia, and so forth should be treated by a Andrographis paniculata Nees (Smao Promatmanus). hot medication using plants with spicy or sweet taste, or essential oils. For example, Cocos nucifera or in English we call it coconut palm. 3.3.4 Herbal medicine preparation. Just about all Khmer medicine used nowadays is derived from mostly herbal plants, bark, roots and leaves from various trees, but there are also some minerals and other natural ingredients. Usually, herbal medical preparation is prepared in solid form, powder form, herbal tea, fresh herb, decoction, and fluid extract (Kaing, 2010). - Solid form: small pills are prepared from the mixture of extracts from different plants, especially for treatments such as blood purifiers, indigestion and liver diseases. The plant resins itself forms the binding agent that combines the pill. The mix is kneaded into a thick paste, rolled and cut into pills. The pill can be taken orally with water or honey. - Powder form: prepared from fine powders that are administered orally and some powders are prepared for external use only. - Herbal teas: this is most common form of medicinal preparation in Cambodia. A single dried herb or a mixture of dried herbs are sliced, infused in hot water and brewed.
  26. 26. HERBAL MEDICINE 23 - Fresh herb: some herbs are treated with water and triturated freshly. The water extracted is drunk as a tea. - Decoction: a decoction may constitute a single herb or a mixture of herbs for oral administration to treat a variety of disorder. Either the fresh or dry herbs are used in preparing decoctions. - Fluid Extract: this method is used for ingredients that are water soluble and the most common ration used is 10:1. These preparations are normally reserved for the treatment of tuberculosis and sexually transited. 3.4 Effect of Cambodian Herbal Medicine Herbal medicine has been said to be very effective in curing by many herbal medicine practitioners; however, in Cambodia we haven‟t had a standard criteria for assessing the efficacy of herbal medicine. The idea of effectiveness seems to be claimed by only the practitioners. Like other thing, there is positive and negative effect of herbal medicine. 3.4.1 Positive effects. The biggest positive side of herbal medicine is its efficacy. Not only herbalist themselves prove the medicine effective but also patients experience this process of treatment claim that it is very effective and can help them to recover very quickly (Kounilia, 2010). In addition to its effectiveness, the medicine usually doesn‟t have side effect which can be harmful to health as western medicine does. It is true that some herb is poisonous, but its toxicity is always much lower than western medicine if it is well prepared. On another hand, unlike western medicine, herbal medicine is more accessible since it is cheap and widespread everywhere (Se, 2002). 3.4.2 Negative effect. The herbal medicine itself naturally doesn‟t have bad impact, and negative part of it come from external factors. Although medicinal plants are said to be effective, but there is no any criteria for assessing that the medicine is really like that. Unlike herbal medicine, western medicine quality is obviously inspected and controlled (Savajol et
  27. 27. HERBAL MEDICINE 24 al., 2011). Due to loose in administration, people using herbal medicine have greater chance in facing problems arising from improper combination and preparation. The chance to have trouble with the medicine is high in Cambodia because anybody can proclaim himself as traditional healer (Wetzel & Jennifer, 1996). In the same time as loose administration over the medical practice, royal government of Cambodia has never allocate any budget for improving herbalism in Cambodia. On another view, herbal medicine harvesting and cultivation threaten plant species. If the medicine is widely used and promoted, more people extract more plants and animal which might lead to extinction of plants and species. Lastly, herbal medicine practice is closely related to skill development of practitioner; however, until now Cambodian herbal medicine is written only Sanskrit language which can‟t be generally understood by all people, so researching would be very difficult (Jan & Ing, 2010). 3.5 Ensuring Safety and Efficacy of Herbal Medicine in Cambodia To ensure the effectiveness of herbal medicine, royal government of Cambodia begins to take an initial step to develop a comprehensive national policy in which incorporate the traditional medicine policy and national strategy which include the following sectors: 1. The National Policy on Drugs was passed which states that traditional should be boosted, particularly within primary health care, through training, scientific research and technology to develop traditional medicine (1998). 2. Cambodia‟s Forestry Law on Forestry By-products includes, among other non- timber forest products, the plants and animals harvested for traditional medicine. Local communities are permitted to use such by products provided the impact on the forest is only. It is prohibited to harvest “rare tree species” or to hunt, possess, transport, trade and export “rare and endangered wildlife species”. Those who are caught doing so are supposed to be fined three times the commercial value of the item and the item is confiscated (2002). However, the Ministerial Decree that will determine the criteria by which each animal and
  28. 28. HERBAL MEDICINE 25 plant species is categorized and that will name those species categorized as rare and outline the corresponding levels of protection. 3. Cambodia‟s Prime Minister declared that “The Royal Government will continue to encourage the use of traditional medicines with appropriate information and control in conjunction with the use of modern medicine”, in July 2004. Another sub-decree, on the production, import, export and commerce of traditional medicine in the public sector defines legal guidelines for the manufacture and trade of traditional medicine.
  29. 29. HERBAL MEDICINE 26 IV. Discussion In both theory and case of Cambodia, using herbal medicine associates with both advantages and disadvantages. The most important positive side of herbal medicine is its effectiveness. Although herbal medicine seems to be practiced in traditional way rather than standard-modern way, it can make patients recover very quickly with no any side effect like modern medicine. Despite of the fact that some medicinal plants contains poisonous sustain which can be dangerous for health, its toxicity can be minimized even lower than that of western medicine. In addition to effectiveness, herbal medication cost patients very low, so it is affordable by all kind of persons, both rich and poor. For the negative side, based on case of Cambodia, most negative impacts derived from poor administration. It can be caused by unprofessional healers, or herbal medical store or clinic is not well inspected by the authority. People hesitate to trust herbal medicine since there is no any standard criteria to examine whether or not its quality, safety and effective is good enough for curing people. Another serious concern relating to herbal medicine is extinction of plants species. The need for medicinal plants might lead to extinction of certain plants or species. In theory, negative side seem to be heavier than positive side, but if we base on the picture we see in Cambodia, those negative side would be reduced if the doctor and medicinal plants using for treatment are well controlled and tested before using. Base on the effects associated with herbal medicine as mentioned above, we believe that herbal medicine should be promoted. The herbal medicine itself has no bad impact on human health, but the bad impacts that some people experience or are afraid of mostly come from administration and controlling which is a responsibility of practitioner and authority. If herbal medicine is welled controlled, health care of human being will be promoted effectively.
  30. 30. HERBAL MEDICINE 27 The need to improve herbal medicine administration has already been strongly paid attention by the government, and some stake holder. There are policies and law has been adopted to promote and control herbal medicine; however, in reality as raised in section III, the enforcement of those policies and law is ineffective. In this situation, the most prioritized action needed to be taken is strengthening law enforcement.
  31. 31. HERBAL MEDICINE 28 Conclusion Herbal medicine refers to the natural medication using natural plants and animal to cure ill health of people. The medicine has been used since 60,000 years ago, and there are three main kinds of herbalism in the world including Ayurvedic herbalism, Chinese herbalism and Western herbalism. Herbal medicine can be obtained by either going directly to the forest or buying from stores at the market. Herbalists can cure ill-health with plants, by using the whole plants, herbs combining and diagnosis, and animals. Herbal medicine has been identified as a very effective medicine with no side effects to patients being cured by it. Asides from its efficacy, in comparison to western medicine, herbal medicine is more accessible to people since it is cheap and widespread everywhere. Along with its goodness, the safety issue of herbal medicine is still a big concern in health care nowadays. The safety issue is worried due to the practice of herbalism is not well controlled. It is practiced under the lawless control, and everyone can just claim themselves as a herbalist. Medicinal herbs are not inspected with appropriate criteria, and no one check whether or not the medicinal herbs are stored well with good hygiene standard. This loose administration makes herbal medicine be a dangerous for health of patient. Herbal medicine has both positive and negative effect; however, through discussion we believe that herbal medicine should continue being used since it is very effective with no side effect and can be accessed by even poor people. In the same time as promoting herbal medicine, there is an urgent need to strengthen the control over this kind of medication.
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