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Phytotherapy 1 2020

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Herbal medicine
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Phytotherapy 1 2020

  1. 1. Herbal Medicine (Phytotherapy)
  2. 2. Objectives After completing this course the student should be able to: 1-Discuss the history of herbal medicine . 2-Discuss the characteristics of herbal drugs. 3-Relate the indications, contraindications and side effects of the selected herbal drugs. 4-Outline herbal approaches to certain pathological diseases.
  3. 3. Introduction A herb in botany It is a plant that does not form a woody stem and in hard climates usually dies, either completely, (annual herb) or back to the roots (perennial herb) by the end of the growing season.
  4. 4. A medicinal herb It is different from botanic term “herb": It refers to a plant or plant part valued for its medicinal, aromatic or savory qualities. Herb plants produce and contain a variety of chemical substances that act upon the body. Herbal medicine = Botanical medicine= Herbalism= Phytomedicine It is the use of herbs for their therapeutic or medicinal value.
  5. 5. HISTORY OF HERBAL MEDICINE Plants had been used for medicinal purposes long before recorded history. For example, ancient Chinese and Egyptian papyrus writings describe medicinal plant uses • Indigenous cultures (such as African and Native American) used herbs in their healing rituals. Developed traditional medical systems (such as Ayurveda and Traditional Chinese Medicine) in which herbal therapies were used systematically. Scientists found that people in different parts of the globe tended to use the same or similar plants for the same purposes.
  6. 6.  In the early 19th century  Methods of chemical analysis first became available,  Scientists began extracting and modifying the active ingredients from plants.  In the U.S. Later, chemists began making their own version of plant compounds, beginning the transition from raw herbs to synthetic pharmaceuticals.  -Over time, the use of herbal medicines declined in favor of pharmaceuticals. The first U.S. Pharmacopoeia was published in 1820 (listing of herbal drugs, their properties, uses, dosages and tests of purity) .
  7. 7. Recently, the World Health Organization estimated that 80% of people worldwide rely on herbal medicines for some aspect of their primary health care.  In the last 20 years in the United States, increasing public dissatisfaction with the cost of prescription medications, combined with an interest in returning to natural or organic remedies, has led to an increase in the use of herbal medicines. In Germany, roughly 600 -700 plant-based medicines are available and are prescribed by approximately 70 % of German physicians
  8. 8. Conventional medicine: The use of pure chemicals in the treatment of disease, regardless of their origin, whether of plant, animal, micro-organism, synthetic or semi-synthetic, organic or inorganic nature. Herbal medicine or phytomedicine: Uses plants or their crude products for the treatment of diseases. It may include also animal, fungi or bacteria .
  9. 9. contains several active principles in low concentrations. is complex promoted for several divergent uses. Difference between Herbal and Conventional Medicines Conventional medicine Herbal medicine  contains one active principle in high concentration  is simple with single indication
  10. 10. Alternative medicine or complementary medicine What is Alternative Medicine? How can there be an alternative to medicine? Is there alternative chemistry, alternative physics, biology?
  11. 11. Alternative medicine:: used in place of conventional medicine using special diet to treat cancer instead of chemotherapy, surgery, etc... Complementary medicine: used together with conventional medicine using aroma therapy to relieve discomfort following surgery ...
  12. 12. Examples of Alternative or complementary medicine Acupuncture Chiropractic Ayurveda Herbal therapy Bioenergy Cupping
  13. 13. Acupuncture
  14. 14. - Focuses on the diagnosis and treatment of neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine. -It emphasizes manual therapy including spinal adjustment and other joint and soft-tissue manipulation. Chiropractic
  15. 15. A natural approach to healing, affecting a person's Bio-Energy Field. CHAKRA is an old term from the East describing elements of the body Bio-Energy Field, elements that make up a whole integrated vibratory field supporting all the body functions. While the Field is composed of many minor points, there are seven major chakras relating to the seven major nerve plexuses (branching network of nerves e.g. spinal nerve plexuses) and hormone secreting glands making up the vital control centers in the body. The Chakra’s in Bioenergy
  16. 16. Cupping Fire cupping is a method of applying acupressure by creating a vacuum next to the patient's skin
  17. 17. Who Is the Practitioner? Medical doctors Complementry and Alternative Medicine (CAM) practitioners Traditional healers
  18. 18. Why we Study Herbal medicine?  Herbs or Phytomedicines are experiencing explosive growth in pharmacies and other mass- market retail outlets.  The change in social attitudes towards natural medicine ensures continued growth in herb use in the future.  Increased efforts will be required in evaluating the quality, safety, potential benefits and effectiveness, and appropriate therapeutic and clinical guidelines for their proper use.
  19. 19. Phytopharmacy Preparation of natural drugs. either in natural forms (teas) or in pharmaceutical preparations . Phytochemistry The study of the chemical constituents in the plants. Phytopharmacology Natural drugs which have multiple effects must be tested in humans. Phytotherapy (Henri Leclerc) The branch of herbal medicine that describes the potentials and limitations of herbal drugs in the treatment of human diseases. It should be practiced by physicians trained in herbalism. Herbal medicine
  20. 20. It is the branch of herbal medicines that describes the potential and limitations of herbal drugs in the treatment of human diseases. -Phytotherapy should be practiced by physician trained in herbalism. -The term phytomedicines has also been used and proposed by the European Union (EU). Phytotherapy ( from Greek phytos = plant )
  21. 21. History of herbal medicine: 1-Primitive men treated illness by using plants, animal parts and minerals that were not part of their usual diet. 2-All cultures have long folk medicine histories that include the use of plants. 3-There are texts surviving from the ancient cultures of Egypt and India that describe and illustrate the use of many medicinal plant products. 4-The first U.S. Pharmacopoeia was published in 1820 (listing of herbal drugs, their properties, uses, dosages and tests of purity) . 5-The efficacy of many medicinal plants has been validated by scientists abroad, from Europe to the Orient.
  22. 22. Classification of Herbal Drugs According to Potency 1-Toxic:e.g. Aconite and Nuxvomica. These are not used at all. 2-Those containing useful but toxic constituents e.g. cardiac glycosides containing herbs such as Digitalis, Strophanthus and Squill. They should be prescribed by specialist (cardiologists). . Intermediately potent e.g Solanaceous herbs Gentle or mild herbs Highly safe and constitute the majority of herbal medicine. They are safe, non toxic and suitable for self-treatment. Highly potent herbs
  23. 23. Characteristics of Herbal Drugs: 1-The pharmacologically active compounds in herbal drugs are present in lower concentrations than the conventional tablets and capsules. This fact generally means that risks associated with crude herbal drugs are minimal with moderate use. Many herbal drugs have been safely used for centuries. 2-They contain a wide variety of different compounds, some pharmacologically active (2ry metabolites) and some not ( such as cellulose, starches and sugars).
  24. 24. 3-Herbs contain mixture of components that may have synergistic or antagonistic effects e.g. Rhubarb (anthraquinone & tannin). 4-Plants may also contain active and toxic compounds such as pyrrolizidine alkaloids which are converted in the liver into hepatotoxic and carcinogenic metabolites. 5- Herbal medicines are less expensive i.e. cheaper than conventional medicines. In fact the WHO is encouraging developing countries to develop their own herbal formula, from local herbs within each country. Characteristics of Herbal Drugs :(cont.)
  25. 25. How do herbs work? For most herbs, the specific ingredient that causes a therapeutic effect is not known. Whole herbs contain many ingredients, and it is likely that they work together to produce the desired medicinal effect. Many factors determine how effective an herb will be. For example, the type of environment (climate, bugs, soil quality) in which a plant grew will affect its components, as will how and when it was harvested and processed. How are herbs used? Herbal supplements are classified as dietary supplements by the U.S. Dietary Supplement Health and Education Act (DSHEA) of 1994. The FDA defines a dietary supplement as "...any product taken by mouth that contains a so-called 'dietary ingredient' and its label clearly states that it is a dietary supplement." Per the provisions of DSHEA, herbal supplements --, herbal supplements must be manufactured according to good manufacturing practices.
  26. 26. Standardized herbal supplements are the best way to ensure proper dosages and effects similar to human clinical trials. Several herbs are often used together to enhance effectiveness and synergistic actions and to reduce toxicity. Health care providers must take many things into account when recommending herbs. For example, the species and variety of the plant, the plant's habitat, how it was stored and processed, and whether or not there are contaminants (including heavy metals and pesticides). . Ask your doctor or pharmacist about which herbal supplements are the best choice for your health concerns
  27. 27. Some commonly used Standardized herbal supplements. Ginkgo (Ginkgo biloba) standardized extract improves awareness, judgment, and social function in people with Alzheimer's St. John's wort (Hypericum perforatum) antidepressant effects Saw palmetto (Serenoa repens) for the treatment of benign prostatic hyperplasia (BPH) improvement in urinary symptoms and flow compared to finasteride (Proscar), a pharmaceutical drug used in BPH.
  28. 28. Valerian (Valeriana officinalis) a sleep-inducing agent, (no hangover feeling the next day) Echinacea (Echinacea purpurea) and other Echinacea species) may improve the body's natural immunity.
  29. 29. Undesirable Effects of Herbal Medicines ( Side Effects and/or Toxic Reactions ) -No drug can be effective and simultaneously free of side effects. -The idea that herbal drugs are safe and free from side effects is false.  Mislabeling. Proper identification of the plant and labeling with common name and Latin name prevent this.
  30. 30.  Intentional addition of un-natural toxic substances Chemical analysis of some Chinese herbal remedies used for arthritis proved that they contain some synthetic anti-inflammatory drugs such as indomethacin and phenyl butazone. Thus the toxic manifestations produced through the use of such products are due to synthetic additives.
  31. 31. Undesirable Effects of Herbal Medicines( cont.)  Natural toxic contaminants. - Plant material used for herbal medicines may be contaminated with micro-organisms or their by- products that can lead to serious adverse effects.
  32. 32.  Normal toxic substance  Herbal drugs containing pyrrolizidine alkaloids have been used since long times, but the first case reported about their hepatotoxicity appeared few years ago.  Rauwolfia preparations that are used in the management of essential hypertension were found to promote breast cancer from previously initiated cells. Undesirable Effects of Herbal Medicines (cont.)
  33. 33. Herbal Dosage Forms A-Oral Dosage Forms B- Inhalation forms C-Topical dosage forms D-Herbal baths
  34. 34. A- Oral Dosage Forms 1-Liquids Advantages • Easy preparation for each individual patient. • A compact convenient formula. • Dosage flexibility (especially for small children). • Readily absorbed. Disadvantages • The taste, although in the case of bitters the taste is a part of the therapy (add flavors). • The alcohol content of some preparations.
  35. 35. 2-Tablets: Advantages No problem with taste or alcohol. Disadvantages:-  The processing required for its preparation. Excessively large tablets. ( water extracts are used instead of the powder). N.B: heat sensitive or volatile constituents can be damaged.
  36. 36. 3- Powders: Suitable for herbs containing: - Mucilage (Powders are mixed with water just before use and taken without delay as it swells forming a gel). -Tannin (herbs used for treatment of colon problems . Tannins are slowly dissolved from the herb matrix and still being in an active form when it reaches the colon). The total constituents of the herb are presented to the patient's digestive tract.
  37. 37. 4- Capsules: Advantages:- It conceals the unpleasant taste of the powder. Disadvantages:- - Many capsules need to be taken to achieve adequate doses (a large capsule holds only 300- 600 mg powder). -Sometimes concentrated extracts are used inside the capsule instead of the powder.
  38. 38. 5-Infusions and decoctions: - They are mainly used when the active constituents are water-soluble e.g. polysaccharides, some glycosides, mucilage and tannins. - Diaphoretics are better used as infusions or decoctions since they must be given hot to maximize their effects. - Disadvantages:-  The un- pleasant taste of the infusions or decoctions.  Water is not a good solvent for all active constituents.
  39. 39. 6- Medicinal teas: Combination preparations are preferred over single drug preparations as they give additive synergistic effects and leads to reduction or elimination of undesirable effects of individual components. The tea prescription includes:  A- Primary or basic ingredients (herbal drug itself): the prescription should never contain more than 2-3 ingredients. Only one basic ingredient must be used whenever possible.
  40. 40.  B- Adjuvant: it enhances or complements the effect of the basic ingredient. One or two adjuvant are generally used to keep their effect.  C- Filler (excepient): to give pleasant color or appearance to the tea (Chamomile for a white color, Calendula gives orange color and Lavender for a blue color). Their effects should be similar to those of the basic ingredient.  D- Corrigent: sometimes one corrigent is added to enhance the flavor of the tea (herbs containing volatile oils), it should have an effect similar to that of the basic herb. Medicinal teas: (cont.)
  41. 41. Instructions on the Label  The label should specify the instructions for preparing the tea { whether hot water is to be poured (infusion) or the herb is to be boiled (decoction) }  It should specify exactly how long the tea should be steeped in water. (Herbs containing volatile oil should be prepared using hot but not boiling water because boiling water may destroy a large percentage of the effective oil).  It should also specify precise instructions on doses and duration of treatment.
  42. 42. B- Inhalation forms Prepared as a tea in boiling water (infusion) and inhaling the vapor of the contained volatile oil. Few drops of the volatile oil may be added to a glass of boiling water and inhaling the vapor.
  43. 43. D- Herbal baths -Used for certain skin disorders. -Aromatic baths and other volatile oil baths for stimulation and improvement of skin complexion e.g. Chamomile baths.
  44. 44. Excessive ingestion:  Ginseng: excessive doses of Ginseng have been reported to cause agitation, insomnia, and raised blood pressure and have been referred to as abuse of the remedy. However, side-effects have also been reported for Ginseng following the ingestion of recommended doses. Undesirable Effects of Herbal Medicines (cont.)
  45. 45. Excessive ingestion (cont.)  Licorice: excessive ingestion of Licorice has resulted in typical side effects of corticosteroid type e.g; edema as a result of strong water retention and rise in blood pressure.  Parsley: Parsley volatile oil contains apiole which is structurally related to the recognized hepato-carcinogen, safrole. Ingestion of apiole has resulted in a number of cases of fatal poisoning.
  46. 46.  Hypersensitivity reactions: Chamomile: sesquiterpene lactones predominantly present in herbs of the Compositae (Asteraceae) family, (of which Chamomile is a member) possess allergic properties.  Phototoxic reactions:  Parsley: furanocoumarins, compounds known to cause phototoxic reactions, are constituents of Parsley. Excessive ingestion of Parsley has been associated with the development of photosensitive rashes which are resolved once Parsley consumption ceased. Undesirable effects of Herbal Medicines (cont.)
  47. 47. Pharmacognostic (Pharmacopœial) constants ( Scanning Electron Microscope
  48. 48.  Most people are unaware that over 40% of all pharmaceutical medications come from plant botanicals, including from common aspirin to powerful cancer-fighting medications such as tamoxifen*.
  49. 49. Example of Herbal Tea Toxic Alert by FDA The FDA (the US Food and Drug Administration) issued on 11september 2003 an advisory warning against the drinking of teas brewed from star anise. In fact, medical conditions associated with star anise teas include seizures, vomiting and rapid eye movement.
  50. 50. Chinese star anise, Illicium verum(F. Schisandraceae), is a native plant of Asia. used in traditional societies to spice food, reduce intestinal gas, aid in digestion and act as a powerful diuretic medicinal herb.
  51. 51. -Star anise ( chinese), this fragrant, licorice-spiced plant was playing a starring role in the drug : Tamiflu. -In 2005, in response to the SARS (severe acute respiratory syndrome), Avian influenza (H5N1), there was a temporary shortage of star anise due to its extensive use in creating Tamiflu. The drug company began to make shikimic acid artificially via a process of using fermented and bioengineered E. coli bacteria.
  52. 52. -One problem is that there is more than one type of star anise. -The Chinese star anise is is considered safe. - A closely related species, the Japanese star anise, contains sikimitoxin and is toxic. - Once star anise has been dried and processed, it is not possible to visually distinguish between the Chinese and Japanese forms. Some teas may actually be Japanese or a mixture of the two types. - Until the FDA has "analyzed" the situation, it recommends that the consumer avoid all teas containing star anise.
  53. 53. Japanese star anise (Illicium anisatum), a similar tree to chinese star anise , is not edible because it is highly toxic (due to containing shikimitoxin). -Instead, it has been burned as incense in Japan. -Cases of illness, including "serious neurological effects, such as seizures", reported after using star anise tea may be a result of using this species. -Japanese star anise contains anisatin, which causes severe inflammation of the kidneys, urinary tract and digestive organs. -
  54. 54. Drug Interaction and Food RiskDrugFood •Irregular heart rhythms and cardiac arrest. •dangerously low potassium levels,risk for numbing weakness, muscle pain and even paralysis. •Digoxin •Diuretics •Blood pressure medication or any calcium channel blockers Black licorice (glycyrhizin) A potentially fatal rise in blood pressure • MAO inhibitors antidepressants •Saint Johns antidepressants) Aged cheese (brie, parmesan, cheddar and Roquefort), fava beans, Italian green beans, some beers, red wine, pepperoni and overly ripe avocados •The juice modifies the body's way of metabolizing the medication, affecting the liver's ability to •calcium channel blockers •cholesterol control medications, •some psychiatric Grapefruit juice
  55. 55. RiskDrugFood •increases the absorption of the aluminum •The juice's acidity decreases the effectiveness of antibiotics, as does milk. •antacids containing aluminum •antibiotics Orange juice •antibiotics. •laxatives containing bisacodyl Milk •The fiber can interfere with the absorption of the drug. •DigoxinOatmeal and high- iber cereals •In great quantities ,these vegetables could totally negate the effects of the drug ( blood clotting). •Coumadin (anticoagulant) Leafy green vegetables •Cause excessive excitability •asthma drugs •Tagament (Cimetidine), Caffeinated beverages Drug Interaction and Food
  56. 56. RiskDrugFood •,increase the possibility of an asthma attack •cause kidney damage and, drowsness and sedation. •asthma medications (theophyllines) anti-inflammatory and arthritis medications •Grilled meat A diet high in fat •increase the depressive effects of these medications •intensify alcohol's •benzodiazepines, antihistamines, antidepressants, antipsychotics, muscle relaxants, narcotics, or any drug with sedative actions. •Alcoholic beverages
  57. 57. High comsumption of  Turnips contain two goitrogenic substances, which can interfere with the thyroid gland's ability to make its hormones. They can promote development of a goiter (an enlarged thyroid) in persons with thyroid disease.  Tomato contains small quantities of a toxic substance known as solanine that may trigger headaches and allergies.  An unidentified substance in tomatoes and tomato-based products can cause acid reflux. Individuals who often have digestive upsets should try eliminating tomatoes for 2 to 3 weeks to see if there is any improvement.
  58. 58. High comsumption of =Strawberries, Raspberries, Spinach, and Rhubarb: These contain oxalic acid, which can aggravate kidney and bladder stones in susceptible people, -They could reduce body's ability to absorb iron and calcium. =Raspberries contain a natural salicylate that can cause an allergic reaction in aspirin sensitive people. =The seeds from fruits such as Apple and apricot contain amygdalin, in the stomach --------------- HCN. Eating large amount of seeds can result in cyanide poisoning.
  59. 59. Potatoes: with a green tint; taste bitter and may contain solanine, a toxic substance that can cause diarrhea, cramps, and fatigue. Plums, Peaches, Apricots, and Cherries: -These fruits may produce allergic reaction in some individuals. -People who are allergic to aspirin may also encounter problems after they have eaten plums or peaches as they contain salicylates. Turmeric: Should be avoided by persons with symptoms from gallstones.