Traditional Medicine

Tri Widyawati

New drug
(release process)

Traditional drug
(in widespread use)

Screening Mechanism Component efficacy

Utilisation Safety

System effectiveness
Component efficacy Mechanism

System effectiveness
Safety

 Herbal medicines are natural

medicines which made from plant or plants part

Most of traditional medicines are

herbal, although some of it are animal-origin The knowledge of traditional medicines are handed down from generation to generation over centuries in different communities

Herbal Medicine: therapeutic agents

Good examples: vincristine and vinblastine for

cancer, morphin for pain, digitalis for heart failure, colchicine for acute attacks of gout, and artemisinin for drug-resistant malaria.

Good prospects: finding some herbal formulations

for life-threatening diseases such as cancer and HIV.

Digitalis, the heart stimulant, is found in the leaves of the European foxgloves (Digitalis purpurea)

Why people use traditional medicine ?

Health care Esthetic Alternatif Economi Easy to obtained, prescription (-)

Pegagan

Indonesian Schemes of Herbal Medicines

1.Jamu (Empirical based herbal medicine)

seluruh bahan tanaman

5-10 plants

Empiric. Handed down from generation to generation : safety and efficacy

2.Obat Herbal Terstandar (Scientific based herbal medicine)

extract formulation complex tools, skills pre klinik

Ex.
Extract
Arvensis Curcuma (temulawak) (Curcuma xanthorrhiza) Arvensis Turmeric (kunyit) (Curcuma domestica) Arvensis Green Tea (teh) (Camellia sinensis) Arvensis Retropiper (cabe jawa) (Piper retrofractum) Arvensis Orthosiphon (kumis kucing) (Orthosiphon stamineus) Arvensis ginger (jahe) (Zingiber purpureum Roxb.) Arvensis galanga (kencur) (Kaempferia galanga)

Conc.
> 17.50% Curcumin > 30% Curcumin

Indication
Hepatoprotector Appetice Enhancer Antioxidant Anti Dyspepsia Immunomodulator Anti-inflamatory Anti Oxidant Aphrodisiac Tonicum Diuretic Anti Hypertension Analgesic Cardiotonic Anti Dyspepsia Appetite Stimulant

> 70% Polyphenols > 40% Piperin > 0.20% Sinensetin > 0.05% Essential Oil > 5.60% Essential Oil

3. Phytopharmaca (Clinical based herbal medicine)

= modern medicine
Standard Clinical study

Jamu to Phytopharmaca
Plant Part of plant Extract Curcuma Xanthorriza Roxb Curcuma Rhizoma Extracum Curcuma

Campuran Senyawa Bioaktif

Kurkuminoid Minyak Atsiri

Kelompok Senyawa Bioaktif Senyawa Murni

Kurkuminoid Kurkumin

Minyak Atsiri

Allo-Aromandenren Ar-Curcumen Xanthorizol

Latin
Radix Rhizome Bulbus Tubera Flos Fructus Semen Lignum

Bagian Tanaman Akar Rimpang Umbi lapis Ubi Bunga Buah Biji Kayu

Cortex
Caulis Folia Herba Amyllum Thallus

Kulit kayu
Batang Daun Seluruh tanaman Pati Bagian dari tanaman rendah

How do herbs work ?

For most herbs, the specific ingredient that cause a therapeutic effect is not known Whole herbs contain many ingredients
(alkaloids, terpenoid, saponin, flavonoids, phenols, volatile oils, etc)

that work together to produce the desired medicinal effect

Table 1. Comparism of modern pharmacology and herbalism

Modern pharmacology
Isolated One active ingredients

Herbalism
Holistic Whole plants

One effect that measurable & repeatable Synergistic effect of its components

Pharmacology characteristics of medicinal plants

Have a broad therapeutics range

Onset of action occurred after a latent period (weeks or months)

The action have usually been observed empirically in human patient treated with the herbs

Pharmacology characteristic

(continued)

Accurate pharmacokinetic data for extracts that have a complex composition is difficult

to obtain

Subjective assessments by the patients or physician used to evaluate efficacy

Phytomedicines that have undergone pharmacology testing

Herb extract Ginkgo biloba Leaf extracts Pharmacological action Anti ischemic Anti hemorrheologic anti PAF hypolipidemic Antithrombotic fibrinolytic Hypotensive positive inotropic anti arrythmic coronary vasodilatation uses Cerebral insufficiency Peripheral vascular disease Dyslipidemia CV-disorders

Garlic cloves (Allum sativum)

Hawthorn extract (Cratageus monogyna)

mild heart failure (St. II NYHA)

between Herbal and Conventional Drugs Herb

echinacea > 8 week

Potential Interaction
Conventional drugs
anabolic steroids, methotrexate, amiodarone, ketoconazole immunosuppresants

problem
hepatotoxicity

antagonist effect altered bleeding time

garlic, ginger, ginkgo warfarin ginseng

warfarin altered bleeding estrogens, corticosteroids time additive effects barbiturates additive effects (exessive sedation)

valerian

Many things must take into account when prescribing herbs, i.e :
Variety of plant The plants habitat How it was stored & processed Whether or not there are contaminants

Traditional Medicine Development

Benefit Risk Ratio : Tapak dara (Catharanthus roseus) antidiabetic & antileukemia

Market ??? Malaria and filariasis not profitable

Active constituents : Stabil

The Rasionalitation
Morphology ?
- Curcuma zedoaria ( kunyit putih, kunir putih) Vs Curcuma mangga ( temu mangga)

Dosage?

- Kunyit (Curcuma domestica) :

low dose : maag, high dose induce maag

- Mentimun (Cucumis sativus) BP

The Rasionalitation
When ? - Jamu Kunir asem abortivum - Jamu cabe puyeng uterus contraction

How? - Kecubung (Datura metel) oral: mabuk kecubung midriasis

Safety ?
- Daun tapak dara ( Catharanthus roseus) leukosit - Keji beling (Sericocalyx crispus) diuretik renal damage Biji kapas (Gossypium sp.) gossypol spermicide but libido

Avoid misuse: - Jamu masuk angin : asetosal bleeding

SOP in Formal health services

HISTORY EXAMINATION

DIAGNOSE

TREATMENT

without drugs

with drugs

EBM ?

Standard diagnostic

Standard treatment

Evaluating Web Sites

Accuracy Authority Bias Currency Coverage