The branch of herbal medicine that describes the potentials and limitations of herbal drugs in the treatment of human diseases and should be practiced by physicians trained in herbalism.

1. Phytotherapy Introduction
Faculty of Pharmacy, Pharmacognosy Department
Under Supervision of
Dr. Enas Ibrahim Dr. Hayam Salah
Prepared BY:
Mona Ismail

2. Phytotherapy
Complementary and Alternative Medicine
CAM
Herbal Medicine

3.  Complementary and Alternative Medicine (CAM)
Forms of treatment that are used in addition to (complementary) or
instead of (alternative) standard treatments (conventional medicine).
Alternative medicine is used in place of conventional medicine. An
example of an alternative therapy is using a special diet to treat cancer
instead of undergoing surgery, radiation, or chemotherapy that has
been recommended by a conventional doctor.
Complementary medicine is used together with conventional
medicine. An example of a complementary therapy is using
aromatherapy to relieve patient's discomfort following surgery.

4. Integrative Medicine
Special diet instead of treatment
Acupuncture with cancer treatment
Described by health professionals
Standard Medical Care + C A M

5. Complementary and Alternative Medicine
CAM
Herbal Medicine

6. Herbal Medicine
Phytomedicine or herbalism is a type of complementary and
alternative medicine (CAM) that uses plants or their crude
products for the treatment of diseases. It may include also animal,
fungi or bacteria products (≠ conventional medicine, which uses
pure chemicals regardless of their origin, natural or synthetic).

7. Phytotherapy
Complementary and Alternative Medicine
CAM
Herbal Medicine

8. Phytotherapy
The branch of herbal medicine that describes the potentials and
limitations of herbal drugs in the treatment of human diseases and
should be practiced by physicians trained in herbalism.
 Herbal Drugs: (Phyto-pharmaceuticals =
Herbal medicines)
They are products containing exclusively plant
material (comminuted or powdered vegetable
drugs) or vegetable drug preparations
(extracts, tinctures, fatty or essential oils,
expressed plant juices, etc….) used for
treatment of disease (usually chronic) or to
maintain a condition of improved health.
 They don’t include defined isolated
constituents or their mixtures

9.  Examples of Complementary and Alternative
Medicine (CAM)
1- Acupuncture
2- Cupping
3- Hydrotherapy
4- Aromatherapy
5- Ayurveda

10. Involves the insertion of very thin needles through your skin at strategic
points on your body. It is being used for overall wellness, including stress
management. Traditional Chinese medicine explains acupuncture as a
technique for balancing the flow of energy or life force
 Examples of Complementary and Alternative Medicine
(CAM) Cont.
1- Acupuncture

11. Cupping therapy is done with animal horns, glass, bamboo, porcelain,
silicone or plastic cups. People get it for many purposes, including to
help with pain, inflammation, blood flow, relaxation and well-being,
and as a type of deep-tissue massage.
 Examples of Complementary and Alternative Medicine
(CAM) Cont.
2- Vacuum cups (Cupping)

12. The use of water in the treatment of different conditions, including
arthritis and related rheumatic complaints. It involves special
exercises that you do in a warm-water pool. The water temperature
is usually 33–36°C.
 Examples of Complementary and Alternative Medicine
(CAM) Cont.
3- Hydrotherapy
4- Aromatherapy
It is a branch of complementary and alternative medicine that depends
on treatment through stimulation of the sense of smell. It uses of
essential oils from plants in the form of:
- Aroma bath
- Aroma candle
- Body massage

13. The term “Ayurveda” combines the words ayur (life) and veda (science
or knowledge).
System of medicine with historical roots in Indian subcontinent.
Its concepts about health and disease promote the use of herbal
compounds, special diets, and other unique health practices.
 Examples of Complementary and Alternative Medicine
(CAM) Cont.
5- Ayurveda

14. 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).
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.

15. Rare as they are generally safe except minor allergic reactions They can
arise from:
1- Mislabeling
Proper identification of the plant and labeling with common name and
Latin name prevent this
2- Intensive addition of unnatural synthetic 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
Side effects &/or toxic reactions to herbal medicines

16. 3- 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.
4- Natural toxic ingredients
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 of
essential hypertension were found to promote breast cancer from
previously initiated cells.
 Side effects &/or toxic reactions to herbal medicines (cont.)

17. A 52-year-old female presented to her general practitioner with a one-
week history of nausea, pruritus, and painless jaundice with associated
pale stools and dark urine. She rarely consumed alcohol, was a
nonsmoker, and had no prior history of liver disease and had normal
liver function tests three months before (bilirubin of 162 𝜇mol/L). she
was referred to the emergency department, at which point her bilirubin
peaked at 536 𝜇mol/L (progressive jaundice over the subsequent days)
Approximately one month prior to presentation she had commenced
one tablet per day of Ancient Wisdom Modern Medicine_ High
Potency Turmeric (375mg curcuminoids and 4mg black pepper per
tablet), along with a flaxseed oil supplement and occasional diclofenac
use for arthritic pain. There was no recent history of paracetamol use.
Upon admission, all oral medications and supplements were ceased.
Abdominal ultrasonography showed
 Case Study of Turmeric Toxicity

18. She was discharged day 12 of admission (bilirubin 260𝜇mol/L, ALT
1232U/L) with the presumptive diagnosis of diclofenac induced liver
injury (according to Abdominal ultrasonography& a liver biopsy). By
two months bilirubin level had normalized (21𝜇mol/L) and she was
discharged from the clinic. At this point she recommenced the
turmeric supplement (1125mg curcuminoids per day) as sole therapy
for her arthritis. Three weeks later her nausea recurred and repeat liver
function tests showed an acute hepatitis (ALT 2093U/L, AST
1030U/L, and bilirubin 60𝜇mol/L). Repeat viral serology was
unremarkable. She was advised to cease the turmeric supplement, and
two months later her liver function tests had again normalized.

19.  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 do herbs work?

20. 1- Oral dosage forms
1.1- Liquids
1.2- Tablets
1.3- Capsules
1.4- Powders
1.5- Medicinal tea
1.6- Infusions and Decoctions
1.7- Effervescent granules
2- Inhalations form
3- Topical forms
4- Herbal baths
 Herbal Dosage forms

21. Fluid extracts Tinctures
1- Concentrated liquid preparation,
containing a definite proportion of the
active principles of a medicinal
substance
1- More diluted than the fluid
extracts
2- May or may not contain alcohol 2- Mostly hydro-alcoholic extracts
1- Oral dosage forms
1.1- Liquids

22. Advantages:
1. Easily prepared (minimal processing)
2. Truly reflect the chemical characteristics of a herb in a compact
convenient formula
3. Offer dosage flexibility (suitable for children)
4. Readily absorbed and convenient to take
Disadvantages:
1. Taste problems (in case of bitters it is part of the therapy overcome
by adding flavors & sweetners)
2. Alcohol may cause allergy and is refused by muslims
1- Oral dosage forms (cont.)
1.1- Liquids (cont.)

23. May contain powders or solid extracts (to↓ tablet size, solvent removed
under vacuum)
Advantages:
1. Convenient dosage form
2. No problem of taste or alcohol
Disadvantages:
1. Processing required for preparation
2. In case of using solid extracts, heat sensitive or volatile compounds
can be damaged
1- Oral dosage forms (cont.)
1.2- Tablets

24. Capsules are filled with concentrated
extracts instead of powders.
Advantages:
1- Conceals the unpleasant taste of the
powder
Disadvantages:
1- Many capsules need to be taken to
achieve adequate doses (max. 600
mg/capsule)
1- Oral dosage forms (cont.)
1.3- Capsules

25. Suitable for herbs containing:-
- Mucilage (Powders are mixed with water just before use & taken
without delay as it swells forming a gel).
- Tannin for treatment of colon problems (tannins are slowly
dissolved from the herb matrix and still being in active form when
reaching the colon).
Advantage:
1- Total constituents of the herb are presented to the patient’s digestive
tract
1- Oral dosage forms (cont.)
1.4- Powders

26. Single or combination drug formula
- Combination preparations preferred as
they give additive Synergistic effects and
lead to reduction of undesirable effects of
individual components
Label should specify:
 Method of preparation (infusion or
decoction)
 Time of steeping the tea in water
 Dosage and duration of treatment
1- Oral dosage forms (cont.)
1.5- Medicinal teas

27. Infusion Decoction
Hot water is poured over the dried herb
and left for some time in closed
container with herbs with components
that are more volatile or dissolve readily
in water
Herb is boiled with water More potent in its
strength and therapeutic properties
- For water-soluble active constituents e.g. polysaccharides, some
glycosides, mucilage and tannins.
- For diaphoretics (must be given hot to maximize their effects)
Disadvantages:
1. unpleasant taste (add sweetener)
2. water is not a good solvent for all active constituents
1- Oral dosage forms (cont.)
1.6- Infusions and Decoctions

28. - Contain an acid (usually citric and tartaric acids) and an alkali
(sodium bicarbonate) in addition to the main ingredient and
releases CO2 in contact with water.
Advantages:
1. Faster onset of action.
2. More efficient delivery of active ingredients.
1- Oral dosage forms (cont.)
1.7- Effervescent granules

29. Infusion and inhaling the vapor of the contained volatile oil
- For treatment of cold , cough and sinus problems (volatile oil
containing herbs act expectorants and possess decongestive and
antibacterial effects)
2- Inhalations dosage form
3- Topical dosage form
 Mashed or crushed fresh herb used as paste or poultice.
 Absorbent cloth or cotton pad moistened with the infusion or decoction
and used as plaster or poultice.
 Rubs or liniments containing volatile oils applied to throat and chest for
treatment of cold or as rubefacient for rheumatic pains (menthol)
 Plasters, creams, liniments or ointments containing rubefacients
(capsaicin)

30. 1- Astringent baths: for genital areas skin disorders e.g.
Bilberry tea or extract
2- Aromatic baths: for stimulation and improvement of skin
complexion e.g. Chamomile baths (tea or drops of volatile oil
mixed with hot bath water)
4- Herbal baths

31. - Respiratory tract disorders.
- Skin conditions & Hair care.
- Urinary tract disorders.
- The muscular system disorders.
- Cardiovascular system & metabolic diseases.
- Gastro-Intestinal Tract Disorders.
 Practical Case Study includes:-