Herbal Medicines: Prospects and Constraints
Summary
Herbs and herbal preparations have been used to treat ailments throughout the
history of humanity. A World Health Organization (WHO) survey has reported
that about 70–80% of the world’s population rely chiefly on traditional medicines,
mainly of herbal sources, in their primary health care. Towards the end of the
twentieth century herbal medicine became more mainstream throughout the
world, partly as a result of the recognition of the value of traditional medicinal sys-
tems, particularly of Asian origin. We have also seen an increase in the popularity
and use of natural remedies in developed countries, including herbs, herbal medi-
cines, over-the-counter health foods, neutraceuticals, harbal medicinal products.
The use of herbal medicines is especially prevalent in primary health care and for
many chronic diseases. Overall, the world market for herbal medicine and prod-
ucts is increasing rapidly, especially for Chinese, German, and Indian herbal med-
icines.
Major problems associated with herbal medicine are the lack of standardization,
consistency, toxicity, safety, quality, and, in some countries, regulations. The cor-
rect identification of herbal materials and pharmacologically active constituents,
standardization, pharmacological basis of efficacy, toxicity, clinical and nonclinical
trials, adopting Good Agricultural Practices (GAP), Good Sourcing Practices
(GSP), Good Manufacturing Practices (GMP), and strict implementation of regu-
lation are needed to improve the acceptability, quality, and possible integration of
herbal medicines with modern medicine for the effective management of health
problems. These issues are discussed in this chapter.
Introduction
Herbs and herbal preparations have been used to treat ailments since prehistoric
times, and the treatment of various diseases with plant-based medicines has re-
59
mained an integral part of many cultures across the globe. The World Health Or-
ganization (WHO) estimates that 80% of the people living in developing countries
almost exclusively use traditional medicine. Such medicines, derived directly or in-
directly from plants, constitute 25% of the pharmaceutical arsenal. Herbal medi-
cine has now become mainstream worldwide since the latter part of twentieth cen-
tury. This is primarily due to the recognition of the value of traditional and indige-
nous pharmacopeias, the need to make health care affordable for all, and the per-
ception that natural remedies are somehow safer and more efficacious than reme-
dies that are pharmaceutically derived [1].
Over the past two decades we have witnessed two apparently unrelated trends in
the biomedical and biotechnological development of medicinal products. There
has been rapid development of recombinant DNA technology and related proce-
dures to provide biomedical proteins and related therapeutic drugs, prophylactic
vaccines, and diagnostic agents [2]. At the same time the growth in popularity of
over-the-counter (OTC) health foods (nutraceuticals) and herbal products has tak-
en a very large share of the health care market [3].
The WHO defines complementary and alternative medicine (CAM) as all forms
of health care provision that usually lie outside the official health sector. There are
over 100 different therapies available as CAM treatments, but the five discrete clin-
ical disciplines (acupuncture, chiropractic, herbal medicine, homeopathy, and os-
teopathy) are distinguished by having established foundations of training and pro-
fessional standards [4]. CAM treatments are recommended for chronic pain affect-
ing the spine, joints, and muscles, for the control of nausea, eczema, and other
skin complaints, asthma, cancer, and migraine, etc. [5].
Herbal medicine occupies an important position, with the lowest level (7.6%) of
reported adverse effects compared with other CAMs [6]. All over the world, there
are numerous therapeutic approaches based on medicines of plant origin. The
Chinese and Indian systems of traditional medicine and German phytomedicine
are of international importance. Other common traditional therapeutic approach-
es of regional significance include Indusyunic medicine (Pakistan), Islamic medi-
cine (Middle East), kampo (Japan), Korean medicine (Korea), aromatherapy, her-
balism, and homeopathy (European), and botanicals (USA).
WHO guidelines define herbal medicines as finished labeled medicinal prod-
ucts containing an active ingredient that is obtained from the aerial or under-
ground parts of botanicals or other plant materials or their combination [7]. Plant
materials include juices, gums, fatty oils, essential oils, and any other substances
of this nature. Medicines containing plant material combined with chemically de-
fined isolated constituents of plants are not considered to be herbal medicines. Ex-
ceptionally, in some countries herbal medicines may also contain, by tradition, nat-
ural organic or inorganic active ingredients that are not of plant origin.
60 3 Herbal Medicines: Prospects and Constraints
3.1.1
Traditional Systems of Medicine
3.1.1.1 Asian Medicinal System
The most established herbal therapeutic systems are Ayurveda, Unani and Siddha
of Indian origin, WU-Hsing (China) and kampo (Japan). Most of the herbal reme-
dies are mixtures of plants, sometimes also containing animal parts and minerals.
The basis of preparation is synergistic or additive therapeutic value of the prepara-
tion. Under ideal conditions, care is taken by traditionally trained practitioners to
identify the ingredients carefully, to harvest the plants at very specific times to en-
sure appropriate levels of bioactivity, to prepare the remedies under strict rules,
and to prescribe them to achieve an appropriate clinical response [
Summary
Herbs and herbal preparations have been used to treat ailments throughout the
history of humanity. A World Health Organization (WHO) survey has reported
that about 70–80% of the world’s population rely chiefly on traditional medicines,
mainly of herbal sources, in their primary health care. Towards the end of the
twentieth century herbal medicine became more mainstream throughout the
world, partly as a result of the recognition of the value of traditional medicinal sys-
tems, particularly of Asian origin. We have also seen an increase in the popularity
and use of natural remedies in developed countries, including herbs, herbal medi-
cines, over-the-counter health foods, neutraceuticals, harbal medicinal products.
The use of herbal medicines is especially prevalent in primary health care and for
many chronic diseases. Overall, the world market for herbal medicine and prod-
ucts is increasing rapidly, especially for Chinese, German, and Indian herbal med-
icines.
Major problems associated with herbal medicine are the lack of standardization,
consistency, toxicity, safety, quality, and, in some countries, regulations. The cor-
rect identification of herbal materials and pharmacologically active constituents,
standardization, pharmacological basis of efficacy, toxicity, clinical and nonclinical
trials, adopting Good Agricultural Practices (GAP), Good Sourcing Practices
(GSP), Good Manufacturing Practices (GMP), and strict implementation of regu-
lation are needed to improve the acceptability, quality, and possible integration of
herbal medicines with modern medicine for the effective management of health
problems. These issues are discussed in this chapter.
Introduction
Herbs and herbal preparations have been used to treat ailments since prehistoric
times, and the treatment of various diseases with plant-based medicines has re-
59
mained an integral part of many cultures across the globe. The World Health Or-
ganization (WHO) estimates that 80% of the people living in developing countries
almost exclusively use traditional medicine. Such medicines, derived directly or in-
directly from plants, constitute 25% of the pharmaceutical arsenal. Herbal medi-
cine has now become mainstream worldwide since the latter part of twentieth cen-
tury. This is primarily due to the recognition of the value of traditional and indige-
nous pharmacopeias, the need to make health care affordable for all, and the per-
ception that natural remedies are somehow safer and more efficacious than reme-
dies that are pharmaceutically derived [1].
Over the past two decades we have witnessed two apparently unrelated trends in
the biomedical and biotechnological development of medicinal products. There
has been rapid development of recombinant DNA technology and related proce-
dures to provide biomedical proteins and related therapeutic drugs, prophylactic
vaccines, and diagnostic agents [2]. At the same time the growth in popularity of
over-the-counter (OTC) health foods (nutraceuticals) and herbal products has tak-
en a very large share of the health care market [3].
The WHO defines complementary and alternative medicine (CAM) as all forms
of health care provision that usually lie outside the official health sector. There are
over 100 different therapies available as CAM treatments, but the five discrete clin-
ical disciplines (acupuncture, chiropractic, herbal medicine, homeopathy, and os-
teopathy) are distinguished by having established foundations of training and pro-
fessional standards [4]. CAM treatments are recommended for chronic pain affect-
ing the spine, joints, and muscles, for the control of nausea, eczema, and other
skin complaints, asthma, cancer, and migraine, etc. [5].
Herbal medicine occupies an important position, with the lowest level (7.6%) of
reported adverse effects compared with other CAMs [6]. All over the world, there
are numerous therapeutic approaches based on medicines of plant origin. The
Chinese and Indian systems of traditional medicine and German phytomedicine
are of international importance. Other common traditional therapeutic approach-
es of regional significance include Indusyunic medicine (Pakistan), Islamic medi-
cine (Middle East), kampo (Japan), Korean medicine (Korea), aromatherapy, her-
balism, and homeopathy (European), and botanicals (USA).
WHO guidelines define herbal medicines as finished labeled medicinal prod-
ucts containing an active ingredient that is obtained from the aerial or under-
ground parts of botanicals or other plant materials or their combination [7]. Plant
materials include juices, gums, fatty oils, essential oils, and any other substances
of this nature. Medicines containing plant material combined with chemically de-
fined isolated constituents of plants are not considered to be herbal medicines. Ex-
ceptionally, in some countries herbal medicines may also contain, by tradition, nat-
ural organic or inorganic active ingredients that are not of plant origin.
60 3 Herbal Medicines: Prospects and Constraints
3.1.1
Traditional Systems of Medicine
3.1.1.1 Asian Medicinal System
The most established herbal therapeutic systems are Ayurveda, Unani and Siddha
of Indian origin, WU-Hsing (China) and kampo (Japan). Most of the herbal reme-
dies are mixtures of plants, sometimes also containing animal parts and minerals.
The basis of preparation is synergistic or additive therapeutic value of the prepara-
tion. Under ideal conditions, care is taken by traditionally trained practitioners to
identify the ingredients carefully, to harvest the plants at very specific times to en-
sure appropriate levels of bioactivity, to prepare the remedies under strict rules,
and to prescribe them to achieve an appropriate clinical response [
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