marketing trends & future prospects of herbal medicine in the

www.wjpr.net Vol 4, Issue 09, 2015.

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Manish et al. World Journal of Pharmaceutical Research

MARKETING TRENDS & FUTURE PROSPECTS OF HERBAL

MEDICINE IN THE TREATMENT OF VARIOUS DISEASE

1*Manish Gunjan, Thein Win Naing

1, Rahul Singh Saini

2, Dr. Amaluddin bin Ahmad

3,

Dr. Jegathambigai Rameshwar Naidu4, Ishab Kumar

5

1Asia Metropolitan University, Faculty of Medicine, Johor Bahru, Malaysia.

2Brahmanand Group of Institutions, Bulandshahr, UP, India.

3AMU,Faculty of Medicine,JB,Malaysia.

4AMU,Faculty of Medicine,JB,Malaysia.

5College of Pharmacy,BGI,Bulandshahr,UP.India.

ABSTRACT

Traditional medicine also known as indigenous or folk medicine

comprises medical knowledge systems that developed over generations

within various societies before the era of modern medicine. I have

gone through literature review published in online journals and related

websites, then after study of all the literatures I found that global

pharmaceutical market was worth US $550 billion in 2004 and is

expected to exceed US $1100 billion or more by the year 2015. The

herbal industry shares about US $100 billion with good growth

potential. The World Bank report trade in medicinal plants, botanical

drugs products and raw materials is growing at annual growth rate of

about 15% (WHO). Within the European community botanical medicine represents an import

share of the pharmaceutical market. Natural products compounds discovered from medicinal

plants (and their analogues thereof) have provided numerous clinically useful drugs in the

treatment of chronic and or acute disease and still remain as an essential component in the

search for new medicines. So, these traditionally used plants can be explored effectively in

order to find New Chemical Entity for the treatment of chronic and acute disease. Hence the

small but having greater future perspectives review was performed systematically.

KEYWORDS: Folk medicines, chronic disease, indigenous medicines.

World Journal of Pharmaceutical Research SJIF Impact Factor 5.990

Volume 4, Issue 9, 132-155. Review Article ISSN 2277– 7105

Article Received on

28 June 2015,

Revised on 18 July 2015,

Accepted on 12 Aug 2015

*Correspondence for

Author

Manish Gunjan

Asia Metropolitan

University, Faculty of

Medicine, Johor Bahru,

Malaysia.

http://en.wikipedia.org/wiki/Medicine


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INTRODUCTION

1.1 History of Herbal Medicine

Plants had been used for medicinal purposes long before recorded history. Ancient Chinese

and Egyptian papyrus writings describe medicinal uses for plants as early as 3,000 BC.

Indigenous cultures (such as African and Native American) used herbs in their healing rituals,

while others developed traditional medical systems (such as Siddha, Ayurveda, Unani and

TCM) in which herbal therapies were used.[1]

The consumption of plant-based medicines and

other botanicals in the West has increased manifold in recent years. About two centuries ago,

our medicinal practices were largely dominated by plant-based medicines. However, the

medicinal useof herbs went into a rapid decline in the West when more predictable synthetic

drugs were made commonly available. In contrast, many developing nations continued to

benefit from the rich knowledge of medical herbalism. For example, Siddha & Ayurveda

medicines in India, Kampo Medicine in Japan, traditional Chinese medicine (TCM), and

Unani medicine in the Middle East and South Asia are still used by a large majority of

people.[2]

1.2 What is traditional medicine?

Traditional medicine refers to health practices, approaches, knowledge and beliefs

incorporating plant, animal and mineral based medicines, spiritual therapies, manual

techniques and exercises, applied singularly or in combination to treat, diagnose and prevent

illnesses or maintain well-being.In industrialized countries, adaptations of traditional

medicine are termed “Complementary” or “Alternative” (CAM).

Recently there has been a shift in universal trend from synthetic to herbal medicine, which we

can say „Return to Nature‟. Medicinal plants have been known for millennia and are highly

esteemed all over the world as a rich source of therapeutic agents for the prevention of

diseases and ailments. Nature has bestowed our country with an enormous wealth of

medicinal plants; Therefore India has often been referred to as the Medicinal Garden of the

world. Countries with ancient civilizations such as China, India, South America, Egypt, etc.

are still using several plant remedies for various conditions. In this regard India has a unique

position in the world, where a number of recognized indigenous systems of medicine viz.,

Ayurveda, Siddha, Unani, Homeopathy, Yoga and Naturopathy are being utilized for the

health care of people. No doubts that the herbal drugs are popular among rural and urban

community of India. The one reason for the popularity and acceptability is belief that all


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natural products are safe. The demand for plant based medicines, health products,

pharmaceuticals, food supplement, cosmetics etc are increasing in both developing and

developed countries, due to the growing recognition that the natural products are non-toxic,

have less side effects and easily available at affordable prices.[3]

Herbal medicine is still the mainstay of about 75 - 80%of the world population, mainly in the

developing countries, for primary health care.[4]

This is primarily because of the general

belief that herbal drugs are without any side effects besides being cheap and locally

available.[5]

According to the World Health Organization (WHO), the use of herbal remedies

throughout the world exceeds that of the conventional drugs by two to three times.[6]

The use

of plants for healing purposes predates human history and forms the origin of much modern

medicine. Many conventional drugs originated from plant sources: a century ago, most of the

few effective drugs were plant based. Examples include aspirin (willow bark), dioxin (from

foxglove), quinine (from cinchona bark), and morphine (from the opium poppy).[7]

Herbal medicine was also an effective healing method, but was viewed less

enthusiastically.[8]

Herbal products were discarded from conventional medical use in the mid

20th century, not necessarily because they were ineffective but because they were not as

economically profitable as the newer synthetic drugs,[9]

In the early 19th century, scientific

methods become more advanced and preferred, and the practice of botanical healing was

dismissed as quackery. In the 1960s, with concerns over the iatrogenic effects of

conventional medicine and desire for more self-reliance, interest in “natural health” and the

use of herbal products increased. Recognition of the rising use of herbal medicines and other

non-traditional remedies led to the establishment of the office of Alternative Medicine by the

National Institute of Health USA, in 1992. Worldwide, herbal medicine received a boost

when the WHO encouraged developing countries to use traditional plant medicine to fulfill

needs unmet by modern systems.[10]

1.3 Why People Use Herbal Medicine

The earliest evidence of human‟s use of plant for healing dates back to the Neanderthal

period.[10]

Herbal medicinal is now being used by an increasing number of patients who

typically do not report to their clinicians concomitant use,[11]

There are multiple reasons for

patients turning to herbal therapies. Often cited is a “sense of control, a mental comfort from

taking action, “which helps explain why many people taking herbs have diseases that are

chronic or incurable viz. diabetes, cancer, arthritis or AIDS. In such situations, they often


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believe that conventional medicine has failed them. When patient use home remedies for

acute, often self-limiting conditions, such as cold, sore throat, or bee sting, it is often because

professional care is not immediately available, too inconvenient, costly or time-

consuming.[10]

In rural areas, there are additional cultural factors that encourage the use of botanicals, such

as the environment and culture, a “man earth relationship.” People believe that where an area

gives rise to a particular disease, it will also support plants that can be used to cure it.[10]

In

India vast sections of the rural population have no access to modern medicine,[12]

Hundred of

primary health centers which are intended to serve rural areas, lack staffs, diagnostic

facilities, and adequate supplies of drugs. The rural population is heavily dependent on

traditional medical systems,[12]

Natural plant products are perceived to be healthier than

manufactured medicine,[13]

Additional, report of adverse effect of conventional medications

are found in the lay press at a much higher rate than reports of herbal toxicities, in part

because mechanisms to track adverse effect exist for conventional medicines whereas such

data for self-treatment is harder to ascertain. Even physicians often dismiss herb as harmless

placebos.[10]

1.4 Increasing use and popularity

TM has maintained its popularity in all regions of the developing world and its use is rapidly

spreading in industrialized countries. In China, traditional herbal preparations account for 30-

50 per cent of the total medicinal consumption. In Ghana, Mali, Nigeria and Zambia, the first

line of treatment for 60 per cent of children with high fever resulting from malaria is the use

of herbal medicines at home. WHO estimates that in several African countries traditional

birth attendants assist in the majority of births? In Europe, North America and other

industrialized regions, over 50 per cent of the population have used complementary or

alternative medicine at least once. In San Francisco, London and South Africa, 75 per cent of

people living with HIV/AIDS use TM/CAM. 70 per cent of the population in Canada has

used complementary medicine at least once. In Germany, 90 per cent of the population has

used a natural remedy at some point in their life. Between the years 1995 and 2000, the

number of doctors who had undergone special training in natural remedy medicine had

almost doubled to 10,800. In the USA, 158 million of the adult population use

complementary medicines, and according to the USA Commission for Alternative and


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Complementary medicines, US$ 17 billion was spent on traditional remedies in 2000. In the

United Kingdom, annual expenditure on alternative medicine is US$ 230 million.

The global market for herbal medicines currently stands at over US$ 60 billion annually and

it is growing steadily.

3. Difference of Herbal and Conventional Drugs & Trends in herbal medicine use

Although superficially similar, herbal medicine and conventional pharmacotherapy have

three important differences:

Use of whole plants

Herbalists generally use unpurified plant extracts containing several different constituents. It

is claimed that these can work together synergistically so that the effect of the whole herb is

greater than the summed effects of its components. It is also claimed that toxicity is reduced

when whole herbs are used instead of isolated active ingredients (“buffering”). Although two

samples of particular herbal drug may contain constituent compounds in different

proportions, practitioners claim that this does not generally cause clinical problems. There is

some experimental evidence for synergy and buffering in certain whole plant preparations,

but how far this is applicable to all herbal products is not known.[14]

Herb combining

Often several different herbs are used together. Practitioners say that the principles of synergy

and buffering apply to combinations of plants and claim that combining herbs improves

efficacy and reduces adverse effect. This contrasts with conventional practice, where poly

pharmacy is generally avoided whenever possible.[14]

Diagnosis

Herbal practitioners use different diagnostic principles from conventional practitioners. For

example, when treating arthritis, they might observe, “under functioning of a patient‟s

symptoms of elimination” and decide that the arthritis results from “an accumulation of

metabolic waste products”. A diuretic, cholerectic or laxative combination of herbs might

then be prescribed alongside herbs with anti-inflammatory properties.[14]

3.1 Trends in herbal medicine use

Worldwide it is estimated that 80% of the population uses herbs; in the developing world

rates could be as high as 95%.[15]

The U.S. continues to see an increase in the use of herbs.[16]


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The most recent national survey conducted in 2007 by the National Center for

Complementary and Alternative Medicine (NCCAM).[17]

showed that 17.7 % of adults have

used natural products (primarily herbs) in a one year period. Complementary and alternative

medicine (CAM) was used most commonly by whites (43.1%) followed by Hispanics

(23.7%). In the El Paso region studies, use of herbs by Hispanics, including older adults was

much higher (between 59-70%).[18,19]

It is possible that certain methodologies may

underestimate rates of use. In most studies, disclosure rates of herb use to providers are very

low (a major concern). We found two main reasons for such low rates: providers did not ask

about herb use or they showed displeasure with use of herbs. Our experience indicates that in

some countries, herbs more commonly used vary depending on which products are marketed

and on regional practices. Another recent trend in Western countries involves adding herbs to

energy drinks and weight loss and nutritional products.

4. Marketing Of Herbal Remedies

4.1 Market value of herbal medicines

The market for ayurvedic medicines is estimated to be expanding at 20% annually. Sales of

medicinal plants have grown by nearly 25% in India in past ten years (1987-96), the highest

rate of growth in the world. But the precipitant expenditure in India on medicines per annum

is amongst the lowest in the world. In other developing countries too, plants are the main

source of medicine. Two of the largest users of medicinal plants are China and India.

Traditional Chinese Medicine uses over 5000plant species; India uses about 7000. According

to Export Import Bank, the international market for medicinal plant related trade having a

growth rate of7% per annum. China‟s share in world herbal market is US$ 6 billion while

India‟s share is only US$1 billion.

The annual export of medicinal plants from India is valued at Rs. 1200 million. All the major

herbal-based pharmaceutical companies are showing a constant growth of about 15 per cent.

Traditional medicine has served as a source of alternative medicine, new pharmaceuticals,

and healthcare products. Medicinal plants are important for pharmacological research and

drug development, not only when plant constituents are used directly as therapeutic agents,

but also as starting materials for the synthesis of drugs or as models for pharmacologically

active compounds. A significant number of modern pharmaceutical drugs are derived from

medicinal plants. The derivatives of medicinal plants are non-narcotic with little or no side

effects.


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4.2. Indian Herbal Trade In World Scenario

The utilization of herbal drugs is on the flow and the market is growing step by step,[20]

The

annual turnover of the Indian herbal medicinal industry is about Rs. 2,300 crore as against the

pharmaceutical industry‟s turnover of Rs. 14,500 crores with a growth rate of 15 percent.[21]

The export of medicinal plants and herbs from India has been quite substantial in the last few

years. India is the second largest producer of castor seeds in the world, producing about

1,25,000 tones per annum. The major pharmaceuticals exported from India in the recent years

are isabgol, opium alkaloids, senna derivatives, vinca extract, cinchona alkaloids, ipecac root

alkaloids, solasodine,Diosgenine/16DPA, Menthol, gudmar herb, Mehdi leaves, papian,

rauwolfia guar gum, Jasmine oil, agar wood oil, sandal wood oil, etc.[22]

The turnover of

herbal medicines in India as over-the-counter products, ethical and classical formulations and

home remedies of traditional systems of medicine is about $ one billion and export of herbal

crude extract is about $ 80 million,[23]

The herbal drug market in India is about $1 billion.

Some of the medicinal plants, whose market potential is very high have been identified and

summarized.[24]

In India, It is estimated that there are about 25,000 licensed pharmacy of Indian system of

medicine. Presently about 1000 single drugs and about 3000 compound formulations are

registered. Herbal industry in India uses about 8000 medicinal plants.

From about 8000 drug manufactures in India, there are however not more than 25

manufactures that can be classified as large scale manufactures. The annual turnover of

Indian herbal industry was estimated around US $ 300 million in Ayurvedic and Unani

medicine was about US $ 27.7 million. In 1998-1999 again went up to US $ 31.7 million and

in 1999-2000 of the total turnover was US $ 48.9 million of Ayurvedic and herbal products.

Export of herbal drugs in India is around $ 80 million.[26]

4.3 Global herbal market

It is extremely difficult to calculate sales data regarding the use of herbs worldwide; these

calculations are likely underestimated. This is due in part to the varied ways in which herbs

are used (e.g. food products, energy drinks, multivitamins, raw form). The World Health

Organization (WHO) estimates that the global market is approximately US $83 billion

annually.[28]

In some countries, marketing and sales of some herbs is driven primarily by

profits. However, in other countries, herbs can serve as a major way of treating certain


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conditions or diseases more cost effectively, especially if the herb can be grown locally or

regionally.

4.4 World Wide Herbal Trade

The global market for herbal medicines currently stands at over $60 billion annually. The sale

of herbal medicines is expected to get higher at 6.4% an average annual growth rate.[29]

Due

to the contribution of numerous significant factors, the market of herbal medicines has grown

at an expressive rate worldwide. Some of them are: preference of consumers for natural

therapies; concern regarding undesirable side effects of modern medicines and the belief that

herbal drugs are free from side effects, since millions of people all over the world have been

using herbal medicines for thousands of years; great interest in alternative medicines;

preference of populations for preventive medicine due to increasing population age; the belief

that herbal medicines might be of effective benefit in the treatment of certain diseases where

conventional therapies and medicines have proven to be inadequate; tendency towards self-

medication; improvement in quality, proof of efficacy and safety of herbal medicines and

high cost of synthetic medicines. According to World Health Organization, herbal medicines

are lucrative globally and they represent a market value of about US$ 43 billion a year.

According to an estimate in 1991, the herbal medicine market in the European countries was

about $ 6 billion, with Germany accounting for $ 3 billion, France $ 1.6 billion and Italy $ 0.6

billion while in other countries was 0.8 billion. In 1996, the herbal medicine market in the

European countries was about $ 10 billion, in USA about $ 4 million, in India about $ 1.0

billion and in other countries was $ 5.0 billion. In 1997, the European market alone reached

about $ 7.0 billion. The German market corresponds to about 50% of the European market,

about $ 3.5 billion. This market is followed by France, $ 1.8 billion; Italy, $ 700 million; the

United Kingdom, $ 400 million; Spain, $300 million; the Netherlands, about $ 100 million.

4.5 Market potential of phytomedicine

The estimation of total phytomedicine sale reported in country wise European Union was

about US$ 6 billion in 1991 and $ 4 billion in 1996, of which almost half were sold in

Germany $ 3 billion, in France $ 1.6 billion, in Italy $ 0.6 billion and in Japan $ 1.5 billion.

The present global market is said to be US 250 billion.[30]

In India the sale of total herbal

products is estimated at $ 1 billion and the export of herbal crude extract is about $ 80

million, of which 50% is contributed by Ayurvedic classical preparations. Plant derived drugs

are important in Germany and Russia. Particularly, herbal drugs are imported by several


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countries for their usage of traditional medicinal preparation from various parts of the

country. Some of the important Indian medicinal plants exported to various countries.

5. Development In Herbal Medicine Industry With Reference To Trade

There is great demand for herbal medicine in the developed as well as developing countries

like India, because of their wide biological activities, higher safety of margin than the

synthetic drugs and lesser costs.[31]

Medicinal plants play a great role in food supplements for

care as well as in personal care of the mankind alongside the therapeutically active

substances, thus medicinal plant based industry is a promising sector and enormous economic

growth potential. Nutraceuticals (Health Food) are in great demand in the developed world

particularly USA and Japan. Nutraceutical market in USA alone is about $ 80-250 billion,

with a similar market size in Europe and Japanese sales worth $ 1.5 billion,[32]

Such huge

markets have arisen because of the Dietary Supplement Health Education Act passed by USA

in 1994, which permits unprecedented claims to be made about food or the dietary

supplements ability about health benefits including prevention and treatment of diseases. This

act has motivated pharma to include not only compounds isolated from fauna and flora but

also herbal medicines as Nutraceuticals, which is unfortunate. The Indian herbal pharma

companies also see this as a good opportunity and are marketing such products.[33]

However,

the importance of medicinal plants in the national economy and their potential for the rapid

growth of herbal products, perfumery and allied industry in India has been emphasized from

time to time.[34]

New trends are emerging in the standardization of herbal raw materials

whereby it is carried out to reflect the total content of phytoconstituents like polyphenols,

which can be correlated with biological activity. The major traditional sector pharmas,

namely Himalaya, Zandu, Dabur, Hamdard, Maharishi, etc, are Standardizing their herbal

Formulations by Chromatography techniques like TLC/ HPTLC finger printing, etc.

6. Herbal Medicine In The Treatment Of Chronic Diseage

Herbal medicines have been widely utilized as effective remedies for the prevention and

treatment of multiple health conditions for centuries by almost every known culture. The first

documented records of herbal medicine use date back 5,000 years,[35]

in China. Similarly,

India‟s Ayurvedic medicine tradition is thought to be more than 5,000 years old and herbal

medicines remain an essential component of its practice.[36]

Today, the populations of certain

countries still depend on herbal medicines to address their healthcare needs. In the U.S. the


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use of herbal medicines continues to grow since Eisenberg et al. conducted the first national

study of complementary and alternative medicine use.

Additionally, as a general rule, older adult populations are more likely to use both

conventional drug therapy and herbal medicines. This population is also more likely to have a

higher incidence of chronic disease, which more often than not requires the use of

increasingly complex conventional drug therapy. As such, the potential for herb-disease and

herb-drug interactions increases with older adult populations. At present, there is a dearth of

research evaluating the use of herbal medicines, especially clinical trials. This, together with

the ongoing development of new conventional drug therapies, further compounds the number

of unknown outcomes when using elements of these two treatment approaches together. In

many countries, including the U.S., herbal medicines are not regulated as extensively as

conventional drug therapy. Also, globalization has greatly increased accessibility of herbal

medicines from all parts of the world to any single consumer. Clearly there is a great need for

coordinated efforts to conduct the necessary clinical trials to study the efficacy and safety of

herbal medicines, both alone and in conjunction with conventional drug therapies.

6.1 Present Status of Herbal Medicine

The wide spread use of herbal medicine is not restricted to developing countries, as it has

been estimated that 70% of all medical doctors in France and German regularly prescribe

herbal medicine.[37]

The number of patients seeking herbal approaches for therapy is also

growing exponentially.[38]

With the US Food & Drug Administration (FDA) relaxing

guidelines for the sale of herbal supplement.[39]

The market is booming with herbal

products.[40]

As per the available records, the herbal medicine market in 1991 in the countries

of the European Union was about $ 6 billion (may be over $20 billion now), with Germany

account for $3 billion, France $ 1.6 billion and Italy $ 0.6 billion. In 1996, the US herbal

medicine market was about $ 4 billion, which have doubled by now. The Indian herbal drug

market is about $ one billion and the export of herbal crude extract is about $80 million.[41]

In

the last few decades, a curious thing has happened to botanical medicine. Instead of being

killed off by medical science and pharmaceutical chemistry, it has made come back. Herbal

medicine has benefited from the objective analysis of the medical science, while fanciful and

emotional claims for herbal cures have been thrown out, herbal treatments and plant medicine

that works have been acknowledge. And herbal medicine has been found to have some

impressive credentials. Developed empirically by trial and error, many herbal treatments


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were nevertheless remarkably effective.[42]

In a recent survey,[43]

estimated that 39% of all

520 new approved drugs in 1983-1994 were natural products or derived from natural

products and 60-80% of antibacterial and anticancer drugs were derived from natural

products.[44]

The penicillin that replaced mercury in the treatment of syphilis and put an end

to so many of the deadly epidemics comes from plant mold. Belladona still provides the

chemical used in ophthalmological preparations and in antiseptics used to treat

gastrointestinal disorders. Rauvolfiaserpentina(The Indian snake root) which has active

ingredient, reserpine, was the basic constituent of a variety of tranquilizer first used in the

1950‟s to treat certain types of emotional and mental problems. Though reserpine is seldom

used today for this purpose, its discovery was a breakthrough in the treatment of mental

illness. It is also the principal ingredient in a number of modern pharmaceutical preparations

for treating hypertension.

6.2 Status of Herbal Medicine in India

India has a rich tradition of herbal medicine as evident from Ayurveda, which could not have

flourished for two thousand years without any scientific basis. Ayurveda which literally

means knowledge (Veda) of life (Ayur) had its beginning in Atharvaveda. CharakSamhita

and Sushruta Samhita are the two most famous treatises of Ayurveda several other were

compiled over the centuries such as Bela Samhita, Kashyap Samhita, Agnivesh Tantra,

Vagbhata‟s Ashtanghridaya (600), MadhavaNidan(700 AD).[46]

Vegetable products

dominated Indian Meteria Medica which made extensive use of bark, leaves, flower, fruit,

root, tubers and juices. The theory of rasa,vipaka, viryaand prabhava formed the basis of

Ayurveda pharmacology, which made no clear distinction between diet and drug, as both

were vital component of treatment. Charak, Sushruta and Vagbhata described 700 herbal

drugs with their properties and clinical effects.Based on clinical effects 50 categories of drug

have been described – such as appetizers, digestive stimulant, laxatives, anti-diarrhea, anti-

hemorrhoid, anti-emetic, anti-pyretic,anti-inflammatory, anti-pruritic, anti-asthmatic,

antiepileptic, anti-helminthes, haemoptietic, haemostatic, analgesics, sedative, promoter of

life (Rasyana), promoter of strength, complexion, voice, semen and sperm, breast milk

secretion, fracture and wound healing, destroyer of kidney stones etc.[45]

Use of the herbal

medicine in jaundice, presumably viral hepatitis, has been known in India science the Vedic

times. About 170 phyto-constituents isolated from 110 plants belonging to 55 families have

been reported so far to possess liver protective activities. It is estimated that about

6000commercial herbal formulations are sold world over as hepato proctective drugs. Of


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them about 40 patent polyherbal formulations representing a variety of combinations of 93

Indian herbs from 44 families are available in the Indian market.[46]

However, the following

four herbal medicines have been found to be most promising in the treatment of viral

hepatitis, (i.) Silymarin obtained from the seeds of Silibummarianum, (ii.) Extracts of

Picrorrhizakurroa, popularly known „Kutaki‟ (iii.) Extract of many plant of the genus,

Phyllanthus, have been used as hepatoprotective, of them, the most widely used ones have

been Phyllanthusniruriand Phyllanthusamarus, (iv.)Glycyrrhizin preparations have been used

in the past for peptic ulcer as well as liver diseases with mixed results. However, a new

Japanese preparation from glycyrrhizin, strongerneomenophagen C (SNMC), appears to be

very promising in the treatment of virus related chronic liver diseases. Liv 52, an extract of

several plants prepared for Ayurvedic medicine was reported to improve serum biochemistry

values in rats with toxic liver damage, and uncontrolled observations in patients with liver

disease seemingly gave similar result.[47]

Double-blinded and well-designed clinical trials

have also been conducted with Argyowardhani in viral hepatitis, Mucunapruriensin

Parkinson‟s disease, Phyllanthusamarusin hepatitis and Tinosporacordifoliain obstructive

jaundice,[47]

Most popular herbal brands are mentioned in figure no.1.

6.3 Explanatory Models of Illness and Chronic Disease Management

Socio cultural factors influence the explanatory models that patients use to understand and

respond to illness. An explanatory model (EM) is a culturally-specific understanding of a

particular disease or health condition and includes beliefs about the etiology, prevention and

treatment of illness,[48]

Explanatory models may refer to a biomedically-recognized disease

such as asthma, or they may describe folk illnesses such as empacho, a highland Mexican

folk illness characterized by diarrhea and caused, according to this model, by an obstruction

in the digestive system,[49]

Traditional cultural and biomedical health beliefs may also be

combined in an explanatory model, especially among immigrant groups.[50]

For example, in

cultures with humeral (hot/cold) theories of disease, asthma often is seen as a „„cold‟‟ type of

illness.[51]

with treatments involving the application of „„hot‟‟ elements to counteract the

„„cold‟‟ and restore balance. Ethnographic and other studies with immigrant groups have

shown that these health beliefs and practices evolve over time as populations encounter new

information, experiences, and changes in the social context,[52]

Many societies have

explanatory models for acute illness conditions that include an array of specific responses and

treatments, yet lack an understanding of the idea of chronic disease.[53]

As a consequence of

this lack, the Hmong, for example, „„in general are not as willing to treat asymptomatic


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chronic diseases such as hypertension, diabetes, or hyperlipidemia as they are to treat acute,

symptomatic illness. Some argue that the concept of chronic disease is a product of ongoing

contact with biomedical systems of health care.[54]

Even in the U.S „„remission of symptoms

may be considered to be a cure by people in some ethnic groups.‟‟ mixed method (qualitative

and quantitative) study, Latinos with chronic illnesses in California perceived „„each

exacerbation of symptoms as a separate illness that was unrelated to previous episodes.

Diagnosis and treatment was seen as a discrete entity with each illness event, particularly for

illnesses that had a variety of symptoms.‟‟ The authors attribute this to a lack of information

about the nature and meaning of chronic disease. In such cases, physicians seeking to educate

their patients about hypertension, for example, must be sure that the patient first understands

the ideas of chronicity and asymptomatic illness.


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Table no-1- List of plants used in the treatment of chronic & acute disease

S. No. Common name Botanical name Part used Family Uses

1 Tulsi Ocimum sanctum Leaves Labiatae Antipyretic; Antitussive

2 Neem Azadirachtaindica Leaves Meliaceae Antipyretic

3 Brahmi Centellaasiatica Whole plant Umbellifera Antipyretic; Blood purifier

4 Amla Emblicaofficinalis Fruits Euphorbiaceae Antipyretic

5 Dhaniya Coriandrumsativum Leaves, seeds Umbelliferae Antipyretic; Carminative

6 Satavari Asparagus adscendens Tuberous Roots Liliaceae Antipyretic; Demulscent; Nutritive Tonic

7 Bahera Terminaliabelerica Fruits Combretaceae Antipyretic; Expectorant

8 Cinchona Cinchona officinalis Bark seed Rubiaceae Antipyretic;

9 Bhindi Abelmoschusesculentus Fruits Malvaceae Antipyretic, Diuretic

10 Imli Tamarindusindica Wood, volatile oil Caesalpiniaceae Antipyretic; Carminative

11 Swetchandan Santalum album Fruits Santalaceae Antipyretics; Sedative

12 Palwal Santalum album Roots; Flower; Fruits; Bark Cucurbitaceae Antipyretic; Laxative

13 Nirgandi Vitexnegundo Dried roots Verbenaceae Antipyretic; Astringent

14 Bish Aconitum ferox Leaves; Bark; Milky Juice Ranunculaceae Antipyretic

15 Datyuni Alstoniascholaris Stem; Leaves; Root Apocynaceae Antipyretic; Stimulant

16 Gulancha Cocculuscordifolia Stem Menispermaceae Antipyretic;Aphrodisiac

17 Jharhaldi Coscinumfenestratum Leaves, roots Menispermaceae Antipyretic; Stomachic

18 Phalakantak Daemiaextensa Dried roots Ascepidaceae Antipyretic; Expectorant

19 Kali mirch Piper nigrum Roots Piperaceae Antipyretic; Carminative

20 Chitravalli Rubiacordifolia Roots Rubiaceae Antipyretic; Astringent

21 Jwaranthakah Swertiachirata Whole Herb Gentianaceae Antipyretic; Antidot

22 Gurach Tinosporacardifolia Stem; Root Menispermaceae Antipyretic; Antidote

23 Jangalilahusan Allium sativum Bulb, oil Liliaceae Antipyretic; Antiseptic

24 Kasondi Cassia occidentalis Leaves;Seeds; Root Caesalpiniaceae Antipyretic; Purgative

25 Bhringraj Ecliptaerecta Roots, leaves Compositae Antipyretic; Emetic

26 Akasbel Cuscutareflexa Seeds; Stem; Fruits Convolvulaceae Antipyretic; Carminative

27 Aghata Achyranthesaspera Leaves, seed ,roots Amarantaceae Antipyretic;Astringent

28 Cashew Anacardiumoccidentale Fruit, seed, bark, oil Anacardiaceae Antipyretic;Irritant;

29 Ganja Cannibis sativa Leaves; Cannabaceae Antipyretic; Analgesic


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DriedFlourerscence

30 Wild mint Lantana involucrate Whole herb Verbenaceae Antipyretic

31 Biiter gourd Momordicacharantia Fruit; Leaves; Seeds Cucurbitaceae Antipyretic; Stimulant

32 Bamboo Bambusa vulgaris Shoot; Seeds; Roots;

Leaves Graminae Antipytretic; Diuretic

33 Australian fever tree Eucalyptus globules Dried leaves,gum, oil Myrtaceae Antipyretic; Carminative

34 Pan Piper betel Leaves Piperaceae Antipyretic; Carminative

35 Yellow kedar Tecomastans Wood oil Bognoniaceae Antipyretic; Sedative

36 Tulsi Ocimum sanctum All parts Labiatae Antiulcer,Antibacterial

37 Tippani Allophylusserratus Leaves Sapindaceae Antiulcer, elephantiasis

38 Shaparni Desmodiumgangeticum Root extract Leguminosae Typhoid, piles, inflammation,

asthma,Antiulcer

39 Neem Azadirachtaindica Dry bark extract Meliaceae Gastrointestinal dieses, leprosy, respiratory

Disorders

40 Indian

Sarsaparilla

Hemidesmusindicus Extract Asclepiadaceae Antidiarrhoeal, mucoprotective,Antiulcer

41 Satavari Asparagus racemosus Extract of fresh root Liliaceae Anti-diarrhoeal, Antibacterial, Antiulcer

42 Triphala Terminaliapallida Plant extract Combretaceae Antiulcer,

43 Amla Emblicaofficinalis Fruit extract Euphorbiacae Antiulcer,

44 Gotu kola Centellaasiatica Fresh Juice Apiaceae Antiulcer,

45 Brahmi Bacopamonniera Fresh Juice Scrophulariaceae Antiulcer,

46 Apple bananas Musa sapientum Fruit Scitaminaceae Antiulcer,

47 Papeeta Carica papaya Seed Caricaceae Anti-helmintic,antiamebic, Antiulcer

48 Pausanto Kielmeyeracoriacea Stem Guttiferae Anxiolytic, Antiulcer

49 Brindleberry Garciniacambogia Fruit extract Clusiaceae Antiulcer

50 Winter melon Benincasahispida Fruit Cucurbitaceae Antiulcer, epilepsy

51 Wild peepal Ficusarnottiana Fruit Moraceae Antiulcer, demulcent

52 Indian devil tree AlstoniaScholaris Whole plant Apocynaceae Antiulcer,

53 Indian mulberry Morindacitrifolia Fruit Rubiaceae Antiulcer, Antidiabetic

54 Indian borage Plectranthusamboinicus Whole plant Lamiaceae Diuretic, Antiulcer


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Fig-1- Popular herbal Brands for the treatment of chronic & acute disease

7.1. Herbal medicine research

There are limited clinical trials to determine efficacy and safety of traditional herbal

medicines. This lack of research does not impede most from using them, given that these

remedies are often grounded in long standing cultural traditions. When trials are conducted,

the Western-defined disease classification may not be appropriate to measure efficacy and

safety in relation to the use of herbs in other countries. Tylburt and Kaptchuk recently

published an ethical analysis of global herbal medicine research. They pose multiple

scientific questions that shed light on the difficulties of conducting research with herbal

medicines worldwide. Finding appropriate ways to conduct this type of research is an

ongoing challenge.

7.2 Role of World Health Organization (WHO) in phytomedicine

In 1991 WHO developed guidelines for the assessment of herbal medicine, and the

6thInternational Conference of Drug Regulatory Authorities held at Ottawa in the same year

ratified the same. The salient features of WHO guidelines are:

1). Quality assessment

Crude plant materials or extract plant preparation and finished product.


148


2). Stability

Shelf life.

3). Safety assessment

Documentation of safety based on experience and toxicological studies.

4). Assessment of efficacy

Documented evidence of traditional use and activity determination (Animals and human).

7.3 The Challenges in Herbal Medicines

A key challenge is to objectively assess conflicting toxicological, epidemiological, and other

data and the verification of herbal materials used. The following key issues remain.

Management within ranges of risk

Communication of uncertainty

Pharmacological, toxicological, and clinicaldocumentation

Pharmacovigilance

Understanding why addition of harmful additives works

evaluating “drug” interactions

Constraints with clinical trials and people available

Standardization

Safety, and efficacy assessment

7.4 The evaluation of new herbal products consists of six steps,

Characteristics of new substances,

History and pattern of use,

Any adverse reaction,

Biological action,

Toxicity and carcinogenicity, and

Clinical trial data.

7.5 WHO efforts in promoting safe, effective and affordable traditional medicine

The World Health Organization launched its first ever comprehensive traditional medicine

strategy in 2002. The strategy is designed to assist countries:

Develop national policies on the evaluation and regulation of TM/CAM practices;

Create a stronger evidence based on the safety, efficacy and quality of the TM/CAM

products and practices;

Ensure availability and affordability of TM/CAM, including essential herbal medicines;


149


Promote therapeutically sound use of TM/CAM by providers and consumers; and

Document traditional medicines and remedies.

At present, WHO is supporting clinical studies on anti malarial in three African countries; the

studies are revealing good potential for herbal anti malarial. Other collaboration is taking

place with Burkina Faso, the Democratic Republic of the Congo, Ghana, Mali, Nigeria,

Kenya, Uganda, and Zimbabwe in the research and evaluation of herbal treatments for HIV/

AIDS, malaria, sickle cell anemia and Diabetes Mellitus. In Tanzania, WHO, in collaboration

with China, is providing technical support to the government for the production of anti

malarial derived from the Chinese herb Artemisia annua. Local production of the medicine

will bring the price of one dose down from US$ 6 or 7 to a more affordable $ 2.

7.6 Potential negative outcomes

While many benefits can be derived from the use of herbs, potential negative outcomes

cannot be ignored. Saper et al reported that 20% of Ayurvedic medicines purchased via the

Internet contained detectable levels of lead, mercury, and arsenic. Many herbal product

adulterations have been detected primarily containing drugs like sildenafil (Viagra®),

lovastatin (Mevacor®, and others), estrogen, alprazolam (Xanax®, and others), indomethacin

(Indocin®, and others), and warfarin (Coumadin®, and others). There is an apparent trend of

adding drugs or analogues to herbs to make them more effective, especially for weight loss

and enhanced sexual function. Herbs that have caused major adverse events include creosote

bush (hepatotoxicity), ephedra or Mau Huang (cardiovascular complications and

hepatotoxicity), and kava (hepatotoxicity). Using the proper parts of the plant and the

appropriate processes for obtaining the ingredients could prevent toxicity, as seen in kava-

induced toxicity. Herbs that may alter bleeding are also of importance especially in patient

populations with coagulopathies, on antiplatelet or anticoagulant drugs, or in surgical

patients. We reported a case of a surgical patient with a prolonged unexplained bleeding after

taking large quantities of an herbal tea that contained Mexican arnica. Keep in mind that

many medications used today may cause similar adverse events if not monitored or used

correctly.

8. Future prospects of herbal medicine market

It is estimated that nearly three fourths of the herbal drugs used worldwide were discovered

following leads from local medicine. According to WHO about 25% of modern medicines are

descended from plants first used traditionally. Many others are synthetic analogues built on


150


prototype compounds isolated from plants. Almost, 70% modern medicines in India are

derived from natural products. The basic uses of plants in medicine will continue in the

future, as a source of therapeutic agents, and as raw material base for the extraction of semi-

synthetic chemical compounds such as cosmetics, perfumes and food industries. Popularity of

healthcare plant-derived products has been traced to their increasing acceptance and use in

the cosmetic industry as well as to increasing public costs in the daily maintenance of

personal health and well being. In the dual role as a source of healthcare and income,

medicinal plants make an important contribution to the larger development process. Though

the efficacy of herbal requires development of quality consciousness in respect of the

evaluation related evidences, supplying the demand for botanicals and herbals is a booming

business. Recently even developed countries, are using medicinal systems that involve the

use of herbal drugs and remedies. Undoubtedly the demand for plant derived products has

increased worldwide. The demand is estimated to grow in the years to come fuelled by the

growth of sales of herbal supplements and remedies. This means that scientists, doctors and

pharmaceutical companies will be looking at countries like China, India, etc. for their

requirements, as they have the most number of medicinal plant species and are the top

exporters of medicinal plants.

8.1 Future investigation of tribal medicines

Tribal healers in most of the countries, where ethno medical treatment is frequently used to

treat cut wounds, skin infection, swelling, aging, mental illness, cancer, asthma, diabetes,

jaundice, scabies, eczema, venereal diseases, snakebite and gastric ulcer, provide instructions

to local people as how to prepare medicine from herbal. They keep no records and the

information is mainly passed on verbally from generation to gene. World Health

Organization (WHO) has shown great interest in documenting the use of medicinal plants

used by tribal from different parts of the world. Many developing countries have intensified

their efforts in documenting the ethno medical data on medicinal plants. Research to find out

scientific evidence for claims by tribal healers on Indian herbs has been intensified. Once

these local ethno medical preparations are scientifically evaluated and disseminated properly,

people will be better informed regarding efficacious drug treatment and improved health

status.

CONCLUSION

Herbal medicine is still the mainstay of about 75 - 80%of the world population, mainly in the

developing countries, for primary health care. This is primarily because of the general belief


151


that herbal drugs are without any side effects besides being cheap and locally available.

According to the World Health Organization (WHO), the use of herbal remedies throughout

the world exceeds that of the conventional drugs by two to three times. The use of plants for

healing purposes predates human history and forms the origin of much modern medicine.

Many conventional drugs originated from plant sources: a century ago, most of the few

effective drugs were plant based. Examples include aspirin (willow bark), dioxin (from

foxglove), quinine (from cinchona bark), and morphine (from the opium poppy). Medical

history from the beginning of time is filled with descriptions of persons who used herbs to

heal the sick of the society. However, parallel to the onset of the industrial revolution we

witnessed the rise of allopathic medicine. Herbal medicine was also an effective healing

method, but was viewed less enthusiastically.

Herbal products were discarded from conventional medical use in the mid 20th century, not

necessarily because they were ineffective but because they were not as economically

profitable as the newer synthetic drugs. In the dual role as a source of healthcare and income,

medicinal plants make an important contribution to the larger development process. Though

the efficacy of herbal requires development of quality consciousness in respect of the

evaluation related evidences, supplying the demand for botanicals and herbals is a booming

business.

Recently even developed countries, are using medicinal systems that involve the use of herbal

drugs and remedies. Undoubtedly the demand for plant derived products has increased

worldwide. The demand is estimated to grow in the years to come fuelled by the growth of

sales of herbal supplements and remedies. This means that scientists, doctors and

pharmaceutical companies will be looking at countries like China, India, etc. for their

requirements, as they have the most number of medicinal plant species and are the top

exporters of medicinal plants.

Hence by keeping the facts in mind I have tried to highlight the role & future of herbal

remedies so that researcher might get an idea to explore the search of new herbal based

chemical entity, as the “HERBAL AGE IS ABOUT TO COME”.

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Documents

marketing trends & future prospects of herbal medicine in the