PHYTOTHERAPY

MOELYONO MW
FACULTY OF PHARMACY
UNIVERSITAS PADJADJARAN
PHYTOTHERAPY

PREVENTION AND
TREATMENT OF HUMAN
DISEASES USING PLANTS,
PARTS OF PLANTS, OR
HERBAL PREPARATIONS
 THERAPEUTIC
HERBAL SYSTEM
DEVELOPMENT OF THE CONCEPT :

• THE BEGINNING
• GRAECO ROMAN MEDICINE
• ISLAMIC MEDICINE
• CHINESE HERBAL MEDICINE
• AYURVEDIC HERBAL MEDICINE
 THERAPEUTIC
HERBAL SYSTEM
THE BEGINNING

• ANIMALS USING HERBS OR

PLANTS
FOR TREATMENT OF THEIR
HEALTHY PROBLEMS
 THERAPEUTIC HERBAL SYSTEM
• GRAECO ROMANS
MEDICINE

HIPOCRATIC CONCEPT :

VIS MEDICATRIX NATURAE

(Natural Treatment)
• HIPOCRATIC TRADITION IS
GENERALLY ASSOCIATED
WITH THE CONCEPT OF
THE NATURAL HEALING
POWER OF LIFE
 THERAPEUTIC HERBAL SYSTEM
• GRAECO ROMANS MEDICINE

GALENUS CONCEPT
• THE DRUG MUST BE A
GOOD UNADULTERATED
QUALITY

• THE ILLNESS MUST BE

SIMPLE, NOT COMPLEX

• THE ILLNESS MUST BE

APPROPRIATE TO THE
ACTION OF THE DRUG

• THE DRUG MUST BE

POWERFULL THAN THE ILLNESS
 THERAPEUTIC HERBAL SYSTEM
• GRAECO ROMANS MEDICINE

GALENUS CONCEPT
(Continued)
• ONE MUST ENSURE THAT THE
EFFECT OF THE DRUG IS SAME
FOR EVERYBODY AT EVERYTIME

• ONE MUST SEE THAT THE EFFECT

OF THE DRUG IS SPESIFIC FOR
HUMAN BEING

• ONE MUST DISTINGUISH THE

EFFECT OF THE DRUG FROM FOODS
 THERAPEUTIC HERBAL SYSTEM
•
ISLAMIC MEDICINE

PHYSICIANS WERE EXPECTED TO UNDERSTAND :

• THE NATURE OF EACH REMEDY

• THE NATURAL HABITAT
• THE SPESIFIC ENERGY PATTERN
• ACTION
• INDICATION
• SPESIFIC RELATIONSHIP TO ORGANS
• DURATION OF ACTION
• TOXICITY
• CONTRA INDICATIONS
• TYPES OF PREPARATIONS
• DOSAGE
• ADMINISTRATION
• ANTIDOTES
 THERAPEUTIC HERBAL SYSTEM

• CHINESE HERBAL
MEDICINE

THE MAIN PROPERTIES OF

HERBAL MEDICINE ARE TO
ADJUST THE IMBALANCE OF YIN
AND YANG
 THERAPEUTIC HERBAL SYSTEM
• CHINESE HERBAL
MEDICINE
(Continued)

THE CAUSE OF ILLNESS IS FELT TO

BE DUE TO ABNORMAL CHANGES IN
YIN AND YANG EQUILIBRIUM. IF THE
PATIENTS SUFFER FROM YANG -
FEVER, WE SHOULD PRESCRIBE A
YIN - COOL DRUG AND VICE VERSA
 THERAPEUTIC HERBAL SYSTEM

• CHINESE HERBAL
MEDICINE
(Continued)

EXCESS OR LACK OF TAKING

CERTAIN FOOD, THE BALANCE OF
YIN-YANG IN VISCERA CAN BE
BROKEN, AND THE IMBALANCE
WILL CAUSE DISEASE, SO DRUGS
SHOULD BE TAKEN TO ADJUST
THE IMBALANCE
 THERAPEUTIC HERBAL SYSTEM
• AYURVEDIC
HERBAL MEDICINE

MEDICINE WERE CLASSIFIED BY

THEIR TASTE ,THERAPEUTIC
CATEGORIES, AND THEIR EFFECTS
ON ILLNESS :

• DOSHA
• KAPHA
• PITTA
• VATA
 THERAPEUTIC HERBAL SYSTEM

• AYURVEDIC
HERBAL MEDICINE
(continued)

• DOSHA

ESSENTIALLY A FAULT IN THE

HEALTHY STATE OF THE BODY
CAUSING OF THE DISFUNCTION OF
ONE OR MORE ORGANS
 THERAPEUTIC HERBAL SYSTEM
• AYURVEDIC
HERBAL MEDICINE
(continued)

KAPHA
A CONDENSATION OF WATER AND
EARTH, ILLNESS OF KAPHA ARE
MARKED BY SYMPTOM OF COLD,
OEDEMA, AND ABDOMINAL
CONGESTION. ILLNESS OF KAPHA ARE
RELIEVED BY WARMING, DRYING, AND
STIMULATING REMEDIES.
 THERAPEUTIC HERBAL SYSTEM
• AYURVEDIC
HERBAL MEDICINE
(continued)
• PITTA
COLLECTION OF FIRE AND WATER
ELEMENTS INTO THE PRODUCTION OF BILE
AND ITS ASSOCIATED WITH DIGESTIVE
JUICE. ILLNESS OF PITTA ARE MARKED BY
BILLIARY DISTURBANCES AND MAY
INCLUDE FEVER, INFLAMATION, INFECTION,
BLEEDING.
ILLNESS OF PITTA ARE RELIEVED BY
COOLING REMEDIES
 THERAPEUTIC HERBAL SYSTEM

• AYURVEDIC
HERBAL MEDICINE
(continued)

• VATA
ARISES FROM CONDENSATION
OF AIR AND SPACE, LINKED TO THE
FUNCTIONS OF RESPIRATORY SYSTEM.
ILLNESS OF VATA MARKED BY COLD,
DRYNESS, AND NERVOUS ACTIVITY.
ILLNESS OF VATA ARE RELIEVED BY
PUNGUENT HERBS IN SHORT TIME
ONLY OR MODERATE WARMING HERBS.
 BAHAN ALAM DALAM FARMASI

 PENGGUNAAN/ PEMANFAATAN BAHAN ALAM

DALAM FARMASI

 HERBAL MEDIK
 FOOD HERBAL
 COSMETICAL HERBAL
BAHAN ALAM HERBAL UNTUK FITOTERAPI

HERBAL MEDIK

UNTUK MANUSIA
UNTUK HEWAN

TRADISIONAL
FARMASETIKAL
BAHAN ALAM HERBAL UNTUK
KOSMETIKA

COSMETICAL HERBAL

 TRADISIONAL
 FARMASETIKAL
BAHAN ALAM HERBAL UNTUK FOOD

FOOD HERBAL

 SUPPLEMENT HERBAL
 ADDITIF

 PEWARNA
 EMULSIFYER
 DLL
PERHATIAN UNTUK PENGGUNAAN BAHAN
ALAM SEBAGAI OBAT

TOKSISITAS

TIDAK TOKSIK
TOKSISITAS RENDAH
TOKSIK
SANGAT TOKSIK
BAHAN ALAM HERBAL UNTUK FOOD

FOOD HERBAL

 SUPPLEMENT HERBAL

 ADDITIF

 PEWARNA
 EMULSIFYER
 DLL
SYARAT UNTUK PENGGUNAAN
BAHAN ALAM SEBAGAI OBAT

 BENAR
 BERSIH
 AMAN
 BERKHASIAT
 SYARAT TUMBUHAN UNTUK DIGUNAKAN
SEBAGAI FITOTERAPI

• BUKAN TUMBUHAN LIAR

• DAPAT DIBUDIDAYAKAN : GAP JELAS
• ADA DATA EMPIRIS
• TIDAK TOKSIK
• TIDAK MENGANDUNG LOGAM BERAT
• TIDAK MENGANDUNG BAKTERI PATOGEN
• TIDAK MENGANDUNG AFLATOKSIN
QUALITY ASSURANCE
FARMASETIKA HERBAL

JAMINAN MUTU DARI PRODUSEN BAHWA

SEDIAAN FARMASETIKA PRODUKSINYA DIBUAT
DALAM KUALITAS TERSTANDAR
QUALITY ASSURANCE
FARMASETIKA HERBAL

KUALITAS TERSTANDAR ARTINYA KUALITAS

SEDIAAN FARMASETIKA HERBAL SESUAI
DENGAN PERSYARATAN KUALITAS DALAM
FARMAKOPE ATAU BUKU-BUKU RESMI
LAINNYA
QUALITY ASSURANCE
FARMASETIKA HERBAL

KUALITAS TERSTANDAR ARTINYA KUALITAS

SEDIAAN FARMASETIKA HERBAL SESUAI
DENGAN PERSYARATAN KUALITAS DALAM
FARMAKOPE ATAU BUKU-BUKU RESMI
LAINNYA
KUALITAS SEDIAAN FARMASETIKA HERBAL
DINILAI PENGGUNA MELALUI AKTIVITAS
FARMAKOLOGI

AKTIVITAS FARMAKOLOGI
TERGANTUNG PADA KUALITAS
BAHAN BAKU SEDIAAN
 SYARAT STANDAR BAHAN BAKU
FARMASETIKA HERBAL

BENAR
BERSIH
AMAN
BERKHASIAT
BENAR

MEMENUHI PERSYARATAN DALAM

PARAMETER FARMAKOGNOSI DAN FITOKIMIA
BERSIH

MEMENUHI PERSYARATAN DALAM

PARAMETER FARMAKOGNOSI, FITOKIMIA,
DAN MIKROBIOLOGI
AMAN

MEMENUHI PERSYARATAN DALAM

PARAMETER TOKSISITAS
BERKHASIAT

MEMENUHI PERSYARATAN DALAM

PARAMETER FARMAKOLOGI / PRA KLINIK
BAHAN BAKU FARMASETIKA
HERBAL

SIMPLISIA

EKSTRAK
VARIABEL PEUBAH KUALITAS BAHAN BAKU
FARMASETIKA HERBAL
SIMPLISIA
•SUMBER
•CARA PANEN
•TEMPAT TUMBUH
•PROSES PENDAHULUAN
•PENYIMPANAN
»
VARIABEL PEUBAH KUALITAS BAHAN BAKU
FARMASETIKA HERBAL
EKSTRAK
•SIMPLISIA
•TEKNOLOGI PROSES
•PENYIMPANAN
»
PARAMETER KUALITAS FARMASETIKA
HERBAL

PARAMETER FARMAKOGNOSTIK
PARAMETER FITOKIMIA
PARAMETER MIKROBIOLOGI
PARAMETER PRA KLINIK
PARAMETER KLINIK
PERBANDINGAN QA
OBAT FARMASETIKA SINTETIS
DAN FARMASETIKA HERBAL

OBAT FARMASETIKA FORMAL

OBAT FARMASETIKA HERBAL

GMP
GAP
GMP
DOSAGE AND DOSAGE FORMS
IN PHYTOTHERAPY
 DOSAGE AND DOSAGE FORMS IN
PHYTOTHERAPY
THE PHYLOSOPHIES ABOUT THERAPEUTIC ACTION OF
MEDICINAL PLANTS

• THE THERAPEUTIC EFFECT RELIES ON A SPESIFIC

DOSE OF THE ACTIVE CHEMICALS CONTAINED IN
EACH PARTICULAR PLANT

• A HERBAL MEDICINE BEING DERIVED FROM LIVING

ORGANISM, CARRIES CERTAIN ENERGY OR VITAL
FORCE. THE QUALITY OF ENERGY CONFERS THE
THERAPEUTIC EFFECT
 DOSAGE APPROACH OF CHINESE
HERBAL MEDICINE

• THE DAILY DOSE FOR INDIVIDUAL NON TOXIC

HERBS : 3 – 9 GRAMS TAKEN THREE TIME
DAILY GIVEN AS A DECOCTION, PILLS, OR
POWDERED FORMS
• DOSE ALSO VARIES ACCORDING TO THE
WEIGHT AND AGE OF PATIENTS AND
ACUTNESS OF THEIR CONDITION.
 DOSAGE APPROACH OF CHINESE
HERBAL MEDICINE
(continued)

• IF FORMULAS GAVE IN A GRANULATED

FORM, THE GRANULES WERE PREPARED BY
DRYING OR FREEZE DRYING THE DECOCT.
• THE DAILY DOSE OF GRANULES : 2 GRAMS
CORESPONDING TO ABOUT 6-10 GRAMS OF
ORIGINAL DRIED HERBS TAKEN THREE TIME
DAILY
 DOSAGE APPROACH OF
AYURVEDIC

• THE DAILY DOSE FOR INDIVIDUAL NON TOXIC HERBS

: 1-6 GRAMS AS POWDER OR TINCTURES
• HIGHER DOSE OFTEN RECOMMENDED FOR
DECOCTION
• MORE DOSAGE DIVERSITY THAN CHINESE HERBAL
MEDICINE

• AYURVEDIC HERBAL MEDICINE OFTEN INVOLVES

COMPLEX FORMULATIONS WHICH ARE PREPARED
OVER SEVERAL DAYS AND CAN CONTAIN MANY
HERBAL AND MINERAL COMPONENTS
 DOSAGE APPROACH OF
BRITISH HERBAL PHARMACOPOEIA

• THE DOSE GIVEN BY BRITISH HERBAL

PHARMACOPOEIA CONTAIN SOME
INCONSISTENCY

• DOSE FOR TINCTURES OFTEN DO NOT

CORRELATE TO CORESPONDING DOSE FOR
LIQUID EXTRACT
 DOSAGE APPROACH OF
BRITISH HERBAL PHARMACOPOEIA

(continued)

• THE BHP DOSE WERE IN PART DERIVES FROM

SURVEY OF HERBAL PRACTITIONER. IT IS
PROBABLE THAT THERE WERE DIFFERENT
DOSAGE PHYLOSOPHY

• THE DIFFERENT TECHNIQUE OF

MANUFACTURING IS AN IMPORTANT ASPECT
WHICH CAN CAUSE INCONSISTENCY IN THE
DOSE
 DOSAGE APPROACH OF
COMMISION E MONOGRAPH

DOSE FOR INFUSIONS OR DECOCTIONS

ARE REFLECTS THE COMMON USE IN
THE GERMAN MARKET PLACE

• THE DAILY DOSES ARE USUALLY IN

RANGE OF 2 – 10 GRAMS
 DOSAGE APPROACH OF
COMMISION E MONOGRAPH

(continued)

• TINCTURES AND EXTRACTS DOSE ARE

GIVEN BY THE COMMISION E THERE IS
NOT ALWAYS A GOOD CORRELATION
CAUSE OF THE SAME REASON WITH
BRITISH HERBAL PHARMACOPOEIA.
 RATIONAL SYSTEM FOR
MODERN PHYTOTHERAPY

• A RATIONAL APPROACH
ESTABLISHED BY
CLINICAL TRIALS CAN
BE USED AS A
PROBLEM SOLVING OF
DOSE INCONSISTENCY
 THE CONCEPT OF
HERBAL PHARMACOLOGY

THE BASIC IS A QUESTION :

• WHY PLANT SECONDARY METABOLITES HAVE
BIOLOGICAL ACTIVITIES IN HUMAN BODY ?
THE ANSWER ARE :
• PLANTS AND HUMAN BODY HAVE SEVERAL
ENZYMES AS CATALYST FOR MANY BIOCHEMICAL
REACTION
• BOTH OF THE ENZYME SYSTEM CAN REACT WITH
AN IDENTIC SUBSTRATS
(SECONDARY METABOLITES ACT AS A SUBSTRAT FOR
ENZYMATIC REACTIONS IN PLANTS AND HUMAN
BODY)
49
 THE CONCEPT OF
HERBAL PHARMACOLOGY

PLANT METABOLITES :
PRIMARY METABOLITES :
PROTEINS, CARBOHYDRATES, LIPIDS,
CHLOROPHYL
NECESSARY TO SUSTAIN THE LIFE

SECONDARY METABOLITES
DO NOT APPEAR TO BE NECESSARY TO
SUSTAIN THE LIFE
INCREASING SURVIVAL IN ITS NATURAL
ENVIRONMENT
50
 THE CONCEPT OF
HERBAL PHARMACOLOGY

MODEL OF HERBAL PHARMACODYNAMIC

• TANNINS
• HYDROLYZABLE TANNIN
» GALLOTANNIN
» ELLAGITANNIN

• CONDENSED TANNIN
» CATECHIN
» EPICATECHIN
» OPC (OLIGOMERIC PROCYANIDIN)
51
 THE CONCEPT OF
HERBAL PHARMACOLOGY
MODEL OF HERBAL PHARMACODYNAMIC
(Continued)
• TANNINS
• ADSTRINGENT
• ANTI ULCER
• ANTI OXIDANT
• NEUTRALIZE INFLAMATION PROTEIN

• TANNINS CAN COMPLEXING METAL ION AND INHIBIT

THEIR ABSORPTION
• TANNIN CAN ALSO REACT WITH THIAMINE AND
DECREASE ITS ABSORPTION

52
 THE CONCEPT OF
HERBAL PHARMACOLOGY
MODEL OF HERBAL PHARMACODYNAMIC
(Continued)
• PHENOLIC
• BACTERIOSTATIC – BACTERICIDE
• ANTI OXIDANT
• ANTI THYROID

• CYANOGENIC GLYCOSIDE
• ANTI CANCER
CANCER TISSUES CONTAIN GLUCOSIDASE THAT WAS
CONYUGATED TO TUMOR ASSOCIATED ANTIBODY

53
 THE CONCEPT OF
HERBAL PHARMACOLOGY
MODEL OF HERBAL PHARMACODYNAMIC
(Continued)
• MUCILAGE
• ANTI GI TRACT INFLAMATION
• ANTI OBESITY
• LAXATIVES

• FLAVONOIDS
• ANTI OXIDANT
• ANTI INFLAMATION
• IMUNNOMODULATOR

• VOLATILE OILS
• ANTIBACTERIAL
• CARMINATIVES
• EXPECTORANT
• SPASMOLYTIC
• SEDATIVES

54
ORAL DOSAGE FORMS
IN HERBAL MEDICINE

 POWDERS
 LIQUIDS
 TABLETS
 CAPSULES
 STANDARDIZED
EXTRACT
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
POWDERS
 PARTICULARLY APPLIES TO MUCILAGE CONTAINING HERBS. WHEN
THESE HERBS ARE MIXED WITH WATER, THE MUCILAGE REACT WITH
WATER TO FORM , AND THE WET HERBS SWELL TO MANY ITS ORIGINAL
VOLUME

 APPLIES TO TANNIN CONTAINING HERBS FOR TREAMENT OF COLON

PROBLEMS. THIS BECAUSE THE TANNINS ARE ONLY SLOWLY DISSOLVED
IN HERB MATRIX AND ARE THEREFORE STILL BEING RELEASE IN AN
ACTIVE FORM WHEN THE HERB REACHES THE COLON

 WHERE THE FAT SOLUBLE COMPONENTS ARE IMPORTANT PART OF THE

ACTIVITY OF THE HERBS, THE POWDER SHOULD BE FOLLOWED BY A
DOSE OF VEGETABLE OILS OR LECITHIN TO ASSIST ABSORPTION
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
LIQUIDS

THE ADVANTAGE OF LIQUIDS DOSAGE FORM :

 EASY PREPARATION OF FORMULATIONS FOR EACH

INDIVIDUAL PATIENT
 INVOLVE MINIMAL PROCESSING
 DOSAGE FLEXIBILITY
 READILY ABSORBED
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
LIQUIDS
(continued)

THE DISADVANTAGE OF LIQUIDS DOSAGE FORM :

 UNPLEASANT TASTE CAN NOT BE ELIMINATED

 THE ALCOHOL CONTENT
 IN CASE OF WATER AS SOLVENT, STABILITY OF
LIQUIDS FORM BE A PROBLEMS, ESPECIALLY IN CASE
OF BACTERIA AND FUNGI GROWTH
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
LIQUIDS
(continued)

 INFUSION and DECOCTION

INFUSION AND DECOCTION ARE MAINLY USED WERE THE
ACTIVE COMPONENTS OF THE HERBS ARE WATER SOLUBLE

MAJOR DISADVANTAGE OF THOSE FORMS IS THAT WATER IS

NOT GOOD SOLVENT FOR MANY OF THE ACTIVE
COMPONENTS IN HERBS

 TINCTURES
 EXTRACTS
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
THE PREPARATION OF THE HERBAL LIQUIDS
THE FACTORS INVOLVED IN THE PREPARATION OF HERBAL LIQUID :
 THE STRENGTH OF RATIO
THE STRENGTH OF LIQUIDS PREPARATIONS IS USUALLY EXPRESSED AS
RATIO, FOR EXAMPLE 1 : 5 MEANS THAT 5 mL OF THE FINAL
PREPARATIONS IS EQUIVALENT TO 1 GRAM OF DRIED HERB FROM WHICH
THE PREPARATION WAS MADE

LIQUID PREPARATION WHICH HAVE RATIO 1 : 1 OR 1 : 2 ARE CALLED

EXTRACT WHEREAS WEAKER THAN 1 : 2 ARE CALLED TINCTURES

INCTURES ARE USUALLY MADE BAY MACERATION, WHEREAS EXTRACT

ARE BEST MADE USING PERCOLATION WITH ETHANOL AS THE SOLVENT.

HIGHER ETHANOL PERCENTAGE DO NOT ALWAYS CONFER HIGHER ACTIVITY

 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
THE PREPARATION OF THE HERBAL LIQUIDS
(CONTINUED)

THE FACTORS INVOLVED IN THE PREPARATION OF HERBAL LIQUID

 DER (DRUG TO EXTRACT RATIO)
DER IS THE RATIO OF THE MASS OF HERBAL DRUG (STARTING
MATERIAL) TO THE MASS OF RESULTING NATIVE HERBAL
PREPARATION (NATIVE EXTRACT)
HIGH VALUE OF DER ALWAYS STAND FOR LOW QUANTITY OF
EXTRACTABLE MATTER AND VICE VERSA.
DER 20 : 1 MEANS THAT THE EXTRACT CONTAIN OF 5 % EXTRACTABLE MATTER
DER 2 : 1 MEANS THAT THE EXTRACT CONTAIN OF 50 % EXTRACTABLE
MATERIAL
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
THE PREPARATION OF THE HERBAL LIQUIDS
(CONTINUED)
CALCULATION OF THE DER :

HERBAL DRUG (Kg)

DER = -------------------------------
NATIVE EXTRACT (Kg)

100 Kg OF NATIVE HERBAL DRUG PREPARATION (NATIVE

EXTRACT) ARE OBTAINED FROM 400 Kg OF HERBAL DRUG

400 (Kg) . 1
X = ------------------ = 4 -------- DER = 4 : 1
100 (Kg)
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
THE PREPARATION OF THE HERBAL LIQUIDS
(CONTINUED)
CALCULATION OF THE DER AT THE STAGE OF SOFT EXTRACT

HERBAL DRUG (Kg). 1. 100%

DER = ---------------------------------------- ---  DS = DRY SUBSTANCE
SPISSUM EXTRACT (Kg). DS (%)

200 Kg OF SOFT EXTRACT CONTAINING 50% DRY SUBSTANCE ARE

OBTAINED FROM 400 Kg HERBAL DRUG

400 (Kg) . 1. 100 (%)

X = ------------------------------ = 4 ------  DER = 4 : 1
200 (Kg) . 50 (%)
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
THE PREPARATION OF THE HERBAL LIQUIDS
(CONTINUED)

CALCULATION OF THE DAILY DOSE OF NATIVE EXTRACT

DD HERBAL DRUG (g)

DD = ----------------------------------------
DER

FOR VALERIAN EXTRACT, THE DOSE TO BE ADMINISTERED SHOULD BE 9 GRAMS OF

HERBAL DRUG DIVIDED INTO THREE TIMES PER DAY. THE DER IS 3 : 1

DD VALERIAN ROOTS (GRAMS) 9

DD = ------------------------------------------ = ------------- = 3
DER 3

THE DAILY DOSE OF THE EXTRACT IS 3 GRAMS DIVIDED INTO THREE TIMES EACH
OF 1 GRAM
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE
TABLETS
NO PROBLEMS WITH TASTE AND ALCOHOL CONTENT

 MAJOR PROBLEM IS THE DEGREE OF PROCESSING REQUIRED

 TABLETS ARE USUALLY MADE FROM EXTRACTS WHICH ARE MORE

CONCENTRATED THAN THE ORIGINAL HERBS
 THE HERBS ARE FIRST EXTRACTION WITH A SOLVENT
 THE RESULTANT LIQUID IS THEN DRIED TO EITHER SOFT EXTRACT
OR POWDERED CONCENTRATE USING PROCESS
 HEAT SENSITIVE OR VOLATILE COMPONENTS CAN BE DAMAGE OR
LOST BY THE PROCESS
 ORAL DOSAGE FORMS
IN HERBAL MEDICINE

 THE HERBALIST SAID THAT HERBS ACTION IS AN

EXPRESSION OF THE SUM TOTAL OF KNOWN AND
UNKNOWN CHEMICAL CONSTITUENT

THERE IS STRONG BELIEVE THAT THE

RELATIONSHIP AMONG THE CONSTITUENTS MAY BE
AS IMPORTANT AS ACTUAL CONSTITUENT
THEMSELVES
 THE CONCEPT OF
HERBAL TREATMENT

• CLEANSING
Detoxification and Elimination

• HEATING
Moving circulation

• COOLING
Stimulating digestion

• TONIFICATION
Supporting Nourishment and
Repair
 THE CONCEPT OF
HERBAL TREATMENT
CLEANSING
Detoxification and elimination

 DISEASES ARE CAUSED BY TOXIN

 TOXIN ELIMINATED BY NATURAL MECHANISM :

 VOMITING
 URINE
 COUGH
 SWEAT
 THE CONCEPT OF
HERBAL TREATMENT
CLEANSING
Detoxification and elimination
(continued)

 THE FAILURE OF NATURAL MECHANISM WILL CAUSE

TOXIFICATION

 DETOXIFICATION AND ELIMINATION CAN BE DONE BY

MECHANISM OF :
 LAXATIVES
 DIURESIS
 CHOLERETIC
 MUCOLYTIC
 EXPECTORANT
 THE CONCEPT OF
HERBAL TREATMENT

TIPICALLY IN HERBAL
THERAPEUTICS, ELIMINATORY
MEASURES WERE THE FIRST
STAGE OF TREATMENT
 THE CONCEPT OF
HERBAL TREATMENT
HEATING
Moving the Circulation

 IT WAS APPARENT TO ALL HUMANS THAT

HEAT EQUATED TO VITALITY

 IN MODERN TERM HEATING REMEDIES USED IN

FEVER MANAGEMENT ARE CALLED
DIAPHORETICS AS THEIR MAIN EFFECT IS TO
INCREASE PERSPIRATION
 THE CONCEPT OF
HERBAL TREATMENT
HEATING
Moving the Circulation
(continued)

 SWEAT WAS UNDERSTOOD NOT ONLY AS A

COOLING AGENT, BUT ALSO AS THE PRIME
ELIMINATORY ROUTE IN FEBRILE DISEASE

 HEAT IN MODERN TERM EQUATED ALSO TO

CIRCULATION.
 THE CONCEPT OF
HERBAL TREATMENT
COOLING
STIMULATING DIGESTION

 COOLING WAS QUALIFY THE HEAT OF

STOMACH AND CAUSE DIGESTION
 THE CONCEPT OF
HERBAL TREATMENT
TONIFICATION
SUPPORTING NOURISHMENT AND REPAIR

 TONICS WERE TAKEN TO REFER TO REMEDIES WITH

SUBSTANTIALLY SUPPORTIVE REPUTATIONS

 SUPPORT SOME ASPECT OF BODY FUNCTION

 TONIFICATION WAS OFTEN THE FINAL STAGE OF HERBAL

TREATMENT
THE CONCEPT OF HERBAL
MEDICINE USAGE
HERBAL MEDICINE IS A COMPLEX

FORMULATION, WHILST A DRUG IS A SINGLE
AGENT

 LIFE IS INDEED CHEMICALLY COMPLEX, IT

DOES SEEM LOGICAL THAT, JUST AS OUR
FOODS ARE CHEMICALLY COMPLEX, SO
SHOULD OUR MEDICINE BE

 THE IMPORTANT CONCEPT IN HERBAL

PHARMACOLOGY IS SYNERGICITY
THE CONCEPT OF HERBAL
MEDICINE USAGE
SYNERGICITY

 CHEMICAL COMPOUNDS IN PLANTS WHICH HAVEN’T

PHARMACOLOGICAL ACTIVITY, PLAY A ROLE AS AN
AGENT TO INCREASING STABILITY, SOLUBILITY,
BIOAVIABILITY, OR HALF TIME OF THE ACTIVE
COMPOUND

 ASCORBIC ACID IN CITRUS EXTRACT WAS MORE

AVAILABLE THAN ASCORBIC ACID ALONE
(American Journal Of Clinical Nutrition , 1988, 48, 601-4)
 ARE HERBAL MEDICINES GENERALLY
SAFE?

 it is best to use herbal medicine under the

guidance of a medical professional

 The active ingredients in many herbs and

herbal supplements are not known

 Some herbal supplements have been

found to be contaminated with metals,
unlabeled prescription drugs,
microorganisms, or other substances.
http://www.nlm.nih.gov/medlineplus/herbalmedi
 Proven Effective Herbal Medicine: GARLIC
USES BASED ON SCIENTIFIC EVIDENCE Grade
High cholesterol
small reductions in total blood cholesterol and low-density lipoproteins ("bad
cholesterol") over short periods of time (4 to 12 weeks). Effects on high- B
density lipoproteins ("good cholesterol") are not clear. Well-designed and
longer studies are needed in this area.
Anti-fungal (applied to the skin)
Several studies describe the application of garlic to the skin to treat fungal C
infections, including yeast infections.
Anti-platelet effects (blood thinning)
The effects of garlic on platelet aggregation have been assessed in several
C
human trials. Because garlic has been associated with several cases of
bleeding, therapy should be applied with caution.
Atherosclerosis ("hardening" of the arteries)
Preliminary research in humans suggests that deposits of cholesterol in blood C
vessels may not grow as quickly in people who take garlic.
A: Strong scientific evidence for this use; B: Good scientific evidence for
 Proven Effective Herbal Medicine:
GARLIC
 Side Effects and Warnings
 Bad breath, body odor, and allergic reactions; rash or skin
burns, both in people taking garlic therapy and in food
preparers handling garlic

 Other reported side effects include dizziness, increased

sweating, headache, itching, fever, chills, asthma flares,
and runny nose.

 Bleeding is a potentially serious side effect of garlic use,

including bleeding after surgery and spontaneous bleeding.

 Proven Effective Herbal Medicine:
GARLIC
 Interactions with Drugs

 garlic may increase the risk of bleeding when taken

with drugs that also increase the risk of bleeding.
Examples include aspirin, anticoagulants, anti-platelet
drugs and non-steroidal anti-inflammatory drugs

 Garlic may lower blood sugar levels. Caution is

advised when using medications that may also lower
blood sugar.
TIPE INTERAKSI

 HERBAL – HERBAL

 HERBAL – DRUGS

 HERBAL - FOODS
JENIS INTERAKSI

 INTERAKSI FISIKA

 INTERAKSI KIMIA

 INTERAKSI FARMAKOLOGI :
 INTERAKSI FARMAKODINAMIK
 INTERAKSI FARMAKOKINETIKA
INTERAKSI HERBAL-HERBAL

 TERJADI ANTARA KOMPONEN-KOMPONEN

DALAM HERBAL YANG BERLAINAN

 TIDAK TERJADI ANTAR KOMPONEN-

KOMPONEN DALAM HERBAL YANG SAMA
INTERAKSI HERBAL - DRUGS

PENURUNAN ATAU KENAIKAN JUMLAH

OBAT DALAM DARAH/BIOAVAIBILITAS
 INAKTIVASI ENZYM

 MENURUNKAN ATAU MEMPERTINGGI EFEK

OBAT TANPA PENINGKATAN JUMLAH OBAT
 INTERAKSI HERBAL -
DRUGS
 MENGUNTUNGKAN
 Efek sinergis

 MERUGIKAN
 Menimbulkan efek toksik
 Mengurangi efek
 INTERAKSI HERBAL -
DRUGS
 Minor Drug Interaction
 Tidak berpengaruh pada efek klinik
 Tidakmemerlukan perubahan regiment terapi
 Moderate Drug Interaction
 Membutuhkan penyesuaian dosis dan monitoring ketat
 Severe Drug Interaction
 Berpotensi memberikan toksisitas yang berbahaya
 INTERAKSI HERBAL -
DRUGS

 MENINGKATKAN EFEK SAMPING

 MENGURANGI EFEK TERAPI
 MENINGKATKAN EFEK TERAPI :
 DAPAT MENYEBABKAN OVERDOSIS
 MEMODIFIKASI KERJA:
 MENYEBABKAN KOMPLIKASI
 INTERAKSI HERBAL -
DRUGS

 INTERAKSI FARMAKOKINETIK

 INTERAKSI FARMAKODINAMIK :
 ANTAGONIS
 SINERGIS
 INTERAKSI HERBAL -
DRUGS
CONTOH

 GINKO BILOBA + ASPIRIN  PENDARAHAN

 ECHINACEA + INH  LIVER TROXICITY

 CAFFEIN + GINSENG  INSOMNIA

 GARLIC + WALFARIN  PENDARAHAN

 TANIN MENGURANGI ABSORPSI CODEIN, EPHEDRIN, THEOPHYLIN

 HERB-DRUG INTERACTION
Herbs may magnify, or oppose the
effects of many drugs
EXAMPLES :
 ARECA CATECHU INTERACT WITH FLUPHENAZINE, PREDNISON,
SALBUTAMOL : TREMOR, INADEQUATE CONTROL OF ASTHMA
 CHILI PEPPER (CAPSICUM SPP) INTERACT WITH ACE INHIBITOR
CAUSE COUGH. AND INCREASING ABSORPTION AND
BIOAVIABILITY OF THEOPHYLLINE

 SEE ANOTHER EXAMPLES

INTERAKSI HERBAL-FOODS

OBAT HERBAL DAN MAKANAN

DAPAT BERINTERAKSI
POSITIF ATAU NEGATIF
ADVERSE EFFECT
OF
HERBAL REMEDIES
ADVERSE EFFECT OF HERBAL REMEDIES

SOME OF THE ADVERSE EFFECTS AND DRUG

INTERACTIONS REPORTED FOR HERBAL
PRODUCTS COULD BE CAUSED BY
IMPURITIES (E.G., ALLERGENS, POLLEN AND
SPORES) OR
BATCH-TO-BATCH VARIABILITY