Are Herbal Medicines Safe?

Evangeline C. Amor
Associate Professor
Institute of Chemistry, University of the Philippines
Diliman, Quezon City 1101
ecamor@up.edu.ph

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History of Medicine
• 8000 BC (Prehistoric medicine)

Trepanning: an ancient human skull viewed from above.

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 History of Medicine
• 2000 BC (Egyptian medicine)

Egyptian heiroglyphs,
like this one, show medical procedures.
Medical papyrus.

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History of Medicine
• 450 BC – 300 AD (Greeks and Romans)
Blood gave a person a lively
personality and lots of energy. They
would enjoy life and the arts.
Phlegm made a person feel lethargic or
have a dull personality.
Black bile caused depression and
sadness.
Yellow bile influenced a person's
temperament. It caused anger and a
fiery temper.

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Imagine that you are a Greek doctor. For each
of these people, decide which of the
humours are not in balance.

a. Suffering from depression

b. Really tired and slow all the time
c. Disruptive and always getting into fights

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History of Medicine
• 450 BC – 300 AD (Greeks and Romans)

Galen. One of the first physicians

to use dissections to understand
how the body works.

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 History of Medicine
• 500 – 1400 AD (The Middle Ages)

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History of Medicine
• 700 – 1500 AD (Arabic Medicines)

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 History of Medicine
• 1400 – 1700 AD (The Renaissance)

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History of Medicine
• 1700 – 1900 AD (18th and 19th century)

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 History of Medicine
• 1900 – 2000 AD (The 20th century)

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R
A
P
I
S
T


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 History of Medicine
• 2000 – 2100 AD (21st century medicine)

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Cause of Death (1900)

1– Pneumonia (all forms) and Influenza 2 – Tuberculosis (all forms)

3– Diarrhea, enteritis & ulcer of the int. 4 – Diseases of the Heart
5– Intracranial lesions of vascular origin 6 – Nephritis
7– All Accidents 8 – Cancer and tumors
9– Senility 10 - Diphtheria
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 Cause of Death (1992)

1– Diseases of the heart 2 – Cancer and other malignant tumors

3– Stroke 4 – Chronic obstructive lung diseases
5– All accidents 6 – Pneumonia (all forms)
7– Diabetes Mellitus 8 – HIV infections including AIDS
9– Suicide 10 – Homicide (and legal intervention)
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Some questions….
• Are all medicines drugs and vice versa?
– Medicines are agents that is used to treat
disease or injury
– Drugs are substances used in the treatment or
prevention of disease or as a component of
medication
• How is the safety of a medicine/drug
determined?

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 Clinical trials
• "The drug must be free from any extraneous accidental quality."
• "It must be used on a simple, not a composite, disease."
• "The drug must be tested with two contrary types of diseases,
because sometimes a drug cures one disease by its essential qualities
and another by its accidental ones."
• "The quality of the drug must correspond to the strength of the
disease. For example, there are some drugs whose heat is less than
the coldness of certain diseases, so that they would have no effect
on them."
• "The time of action must be observed, so that essence and accident
are not confused."
• "The effect of the drug must be seen to occur constantly or in many
cases, for if this did not happen, it was an accidental effect."
• "The experimentation must be done with the human body, for
testing a drug on a lion or a horse might not prove anything about its
effect on man."

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Folk Medicine = Alternative Medicine

• Every approach to healing that does not fall
within the realm of conventional medicine
• Unconventional, unorthodox, unproven,

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 5 Domains from NCCAM
Alternative Ayurveda, Chinese, Native American, Aboriginal, African,
Medical Middle Eastern, Tibetan, Central and South American cultures,
Systems Homeopathy, Naturopathy

Mind-Body cognitive-behavioral approaches, meditation, hypnosis, dance,

Interventions music, art therapy, prayer, mental healing
Biological dietary supplements, herbs, orthomolecular (varying
Based concentrations of chemicals, such as, magnesium, melatonin, and
Therapies mega-doses of vitamins), individual biological therapies (use of
laetrile, shark cartilage, bee pollen).
Manipulative chiropractic, osteopathic, manipulation, massage
And Body-
Based Methods
Energy Therapies Qi gong, Reiki, therapeutic touch, bioelectromagnetic-based
therapies (pulsed fields, magnetic fields, or alternating current
or direct current fields)

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Types of CAM

Acupuncture Imagery
Aromatherapy Magnets
Biofeedback Massage
Chiropractic Prayer
Diets Reflexology
Exercise Relaxation
Folk remedies Self-help/support groups
Herbal/botanical therapy Spiritual healing (by others)
Homeopathy Vitamins
Hypnosis Yoga

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 Who uses CAM?

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Why are people using CAM?

(Stephen Strauss)

• PUSH
– Dissatisfaction with health care providers and
medical outcomes
– Side effects of drugs and treatments
– High health costs
– Technology
– Lack of control in their own health care practices
– Time spent with practitioner

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 PULL Factors

• Looking for “cures”

• Want to use “natural” products
• Patient feels empowered
• Focus on spirituality and emotional well-
being
• Health Care Provider provides the 3 T’s
(Dr. Strauss): touch, talk, time

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The Case For Herbal Medicine

• Tradition: used throughout history
• Natural: perceived as gentler and safer
• Cost: often less expensive than prescription
medicine
• Access: patient maintains control & no
prescription necessary
• Synergism: a view that multiple ingredients
working together yield better results

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 The Case Against Herbal Medicine

• Lack of Regulation and Oversight

– Lack of Dosage Standardization
– Potential for adulteration
• Potential for toxicity and drug interactions:
natural is not always safer
• More effective therapy may be delayed
• Many herbs are not superior to prescription
medicines

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Regulatory Issues
• Dietary Supplement Health Education Act
(DSHEA) of 1994
– Herbal products are legally food supplements
– Manufacturer may state usage and safety, but not make
curative claims
– Manufacturer alone is responsible for product safety
– FDA must prove product unsafe to remove it from the
market
• Europe: Herbs regulated as pharmaceuticals

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 Herbal medicine in the Philippines
• Traditional and Alternative Medicine Act
(TAMA) of 1997
• Philippine Institute of Traditional and
Alternative Health Care (PITAHC) under
the DOH
• National Integrated Research Program on
Medicinal Plants (NIRPROMP) funded by
DOST
• Bureau of Food and Drug (BFAD)
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Agriculture Pharmacy Pharmacology

(raw material) (formulation) (bioassay,
toxicity,
mutagenicity)

Clinical Trials

Technology Transfer
(Herbal Drug)

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• 1996: Herbal products lagundi (AscofTM)
and sambong (Re-leafTM) were introduced
to the market by Pascual Laboratories.

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 Medicinal Chemistry Research
 Plant, Marine,
Microbial Origin
 Extraction
 Fractionation
 Isolation
 Bioassays
 Structure Elucidation
 Further Studies

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What plant to study?

Ethnobotanical
Phytochemical
Taxonomic
Random

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 Where and what to sample?
Accessibility and availability
Plant part – root, flower, leaves, stem, bark,
fruit

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Where and what to sample?

Choose healthy
samples – microbial
and other infections
may change the
metabolites
produced by the
specimen.

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 Where and what to sample?
Variations in collection site (altitude, plant
age, climate soil type) – may change the
concentration levels of secondary
metabolites and even the kinds of
compounds synthesized.

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Where and what to sample?

EO 247 (18 May 1995) : Proper
compensation of indigenous people
Prior informed consent
Research agreement with the Philippine
government (Academic or Commercial)

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Identification and Authentication of the sample

Deposit voucher specimen to a herbarium

(place, altitude, environment, characteristics, etc.)

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Validation
(Bioassay)

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 Acetic Acid Induced Writhing Test
ICR strain, 14 – 18 g
% reduction in squirms
no. of squirms for (acetic acid + solvent control) -
no. of squirms for (acetic acid + test sample)
X 100
no. of squirms for (acetic acid + solvent control)

after 30 min after 5 min

count squirms for
15 min

Oral gavage of sample i.p administration of

0.7% acetic acid
Guevara B.Q. and B.V. Recto. 1985. Phytochemical, Microbiological, and Pharmacological Screening of Medicinal Plants. UST, Manila.

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Herbal Remedies for Pain

• Cayenne
(Capsicum annuum)
• Active component is
capsaicin, which when
applied to the skin acts as
a local analgesic because
it desensitizes nerve
endings
• Believed to stimulate
production of Substance
P http://www.herbalremediesinfo.com

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Herbal Remedies for Pain
• Echinacea
(angustifolia/purpurea)
• Caffeic acid derivatives,
polyacetylenes,
alkylamides
polysaccharides essential
oils, flavonoids, and
glycoproteins.
• Stimulate immune
response and reduce
http://www.herbalremediesinfo.com
inflammation

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Herbal Remedies for Pain

• Kava
(Piper methysticum)
• Analgesic, sedative
and euphoriant
• Long term use
associated with liver
and skin damage

http://www.herbalremediesinfo.com http://www.kava.co.uk

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Herbal Remedies for Pain
• Turmeric
(Curcuma longa)
• High in antioxidants,
has anticancer and
anti-inflammatory
properties
• Long term use cause
stomach distress
http://www.herbalremediesinfo.com

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Herbal Remedies for Pain

• Kataka-taka leaves
(Kalanchoe pinnata
(Lam.) Pers.)
• Used for toothache
http://www.livinginthephilippines.com/
herbalmedicine/herbal_remedies.html

http://www.filipinoherbshealingwonders.filipinovegetarianrecipe.com/
herbs_pics/katakataka.jpg

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 Herbal Remedies for Pain
• Yerba buena leaves
(Mentha cordifolia)
• Used for headache,
tootache and arthritic
pains
• Tablet, capsule, tea-
form
http://www.pcarrd.dost.gov.ph/prosea/proseaherbal/yerba_buena_doc.htm

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Hypoglycemic Assay
(post-prandial)

Measure BGL Feed

(tail venipuncture method) 40% glucose

Test Groups:
Measure BGL
- Glucose control group
(after 15 min)
- Positive control group (euglocon)
Feed sample
- Negative control group (solvent)
- Plant extracts (methanol) Measure BGL
(15-min interval)

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 Infant Mortality: Ten (10) Leading Causes
Number & Rate/1000 Livebirths & Percentage Distribution
Philippines, 2003 Diarrhea statistics
Number Rate Percent
Cause

1. Other perinatal conditions 9,695 5.8 42.4

2. Pneumonia 2,314 1.4 10.1

3. Bacterial sepsis of newborn 1,439 0.9 6.3

4. Congenital malformation of the

1,127 0.7 4.9
heart
5. Diarrhea and gastroenteritis of
984 0.6 4.3
presumed infectious origin

6. Congenital Pneumonia 783 0.5 3.4

Image courtesy of www.sandylevel.org/.../ img_photos_sept_02/
7. Other congenital malformation 550 0.3 2.0

8. Respiratory distress of newborn 462 0.3 2.0

9. Neonatal aspiration syndromes 440 0.3 1.9

Source: The 2003 Philippine Health Statistics
10. Disorders related to short * percent share from total infant deaths, all causes, Philippines
433 0.3 1.9
gestation and low birth weight
Last Update: January 11, 2007 www.doh.gov.ph

MORBIDITY Source: 2003 FHSIS Annual Report **rate/100,000 of sex-specific pop.

TEN LEADING CAUSES OF MORBIDITY * Total population of regions with reports only
No. & Rate/100,000 Population
PHILIPPINES, 2003 Last Update: January 11, 2007 (www.doh.gov.ph)

MALE FEMALE BOTH SEXES

CAUSE
Rate** Rate** Number Rate*

1. Acute Lower RTI and Pneumonia 770.9 748.2 674,386 861.2

2. Diarrheas 695.0 655.0 615,692 786.2

3. Bronchitis/Bronchiolitis 639.6 677.0 604,107 771.4

4. Influenza 455.4 503.1 431,216 550.6

5. Hypertension 325.4 420.7 325,390 415.5

6. TB Respiratory 126.4 84.0 92,079 117.9

7. Heart Diseases 28.8 29.2 30,398 38.8

8. Malaria 41.1 30.4 28,549 36.5

9. Chickenpox 30.3 30.4 26,137 33.4

10. Measles 30.2 30.4 25,535 32.6

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 Herbal Remedies for Diarrhea
• Cymbopogon nardus
• Anti-inflammatory,
analgesic.
• Used for treatment of
headache, stomach ache,
diarrhea, rheumatism.
irregular menses, post
partum edema.
• Main source of citronella http://www.rimbundahan.org

oil.

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Herbal Remedies for Diarrhea

• Cinnamomum verum
(cinnamon)
• Roots treat rheumatism
and fever. Tree bark
used in many medicinal
powders and tinctures,
tonics for diarrhea and
colic.
http://www.rimbundahan.org

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 Herbal Remedies for Diarrhea
• Piper betel
• Leaves are eaten with
gambir for treating
diarrhea. Mild
stimulant, applied in
poultices for stomach
pains, coughs and
asthma. Leaf sap
applied to soothe oral
sores and ulcers.
http://www.rimbundahan.org

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Herbal Remedies for Diarrhea

• Curcuma longa
(Turmeric)
• One of the oldest spice
plants known, dried
rhizomes ground for
curries, dyes, used to
relieve flatulence and
diarrhea
• High in antioxidants, has
anticancer and anti-
inflammatory properties
Long term use cause
http://www.rimbundahan.org stomach distress
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 Herbal Remedies for Diarrhea
• Geranium maculatum
• Common astringent,
sore throat and canker
sores, Anti-
inflammatory, used for
diarrhea, hemorrhoids,
ulcers, douche,
excessive
menstruation. http://www.herbies-herbs.com

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Herbal Remedies for Diarrhea

• Drimys piperita
(sapal)
• Used for
symptomatic relief of
diarrhea
• 15-Nonacosanol and
bis(tridecyl)phthalate as
active constituents
www.cls.zju.edu.cn L.P Pladio and I.M. Villaseñor. PJS 133 (1), 2004.

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 Charcoal Tracing Method
ICR strain, 17 – 20 g

after 1 hr after 20 min

Oral gavage Oral gavage of

of sample charcoal meal

Measure distance
traveled by charcoal meal
from pylorus to caecum

Noel, M. and Villaseñor, I. Bioassay and Phytochemical Techniques. NRCP, 1996

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Are Herbal Medicines Safe?

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