1.
Herbal Medicine
(Phytotherapy)

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.
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.
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.
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.
 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.
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.
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.
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.
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.
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.
Examples of Alternative or
complementary medicine
Acupuncture
Chiropractic
Ayurveda
Herbal therapy
Bioenergy
Cupping

13.
Acupuncture

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.
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.
Cupping
Fire cupping is a method
of applying acupressure
by creating a vacuum next
to the patient's skin

17.
Who Is the Practitioner?
Medical doctors
Complementry and Alternative Medicine (CAM) practitioners
Traditional healers

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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
 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.
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.
 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.
Herbal Dosage Forms
A-Oral Dosage Forms
B- Inhalation forms
C-Topical dosage forms
D-Herbal baths

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.
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.
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.
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.
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.
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.
 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.
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.
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.
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.
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.
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.
 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.
Pharmacognostic
(Pharmacopœial)
constants
( Scanning Electron Microscope

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.
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.
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.
-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.
-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.
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.
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.
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.
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.
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.
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.
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.