Professional Documents
Culture Documents
Research Briefings
April 2011
Natural Resources Division, Pakistan Agricultural Research Council, Islamabad,
Pakistan
Research Briefings
1. Introduction
Herbal medicine -- also called botanical medicine or phytomedicine -- refers to using a plant's
seeds, berries, roots, leaves, bark, or flowers for medicinal purposes. Herbalism has a long
tradition of use outside of conventional medicine. It is becoming more main stream as
improvements in analysis and quality control along with advances in clinical research show
the value of herbal medicine in treating and preventing disease.
1.1. Background information
Plants had been used for medicinal purposes long before recorded history. Ancient Chinese
and Egyptian papyrus writings describe medicinal uses for plants.
In the early 19th century, when chemical analysis first became available, scientists began to
extract and modify the active ingredients from plants. Later, chemists began making their
own version of plant compounds, and over time, the use of herbal medicines declined in favor
of drugs. The word drug comes from the old Dutch word drogge meaning 'to dry', as
pharmacists, physicians and ancient healers often dried plants to use as medicines. Today
approximately 25 per cent of all prescription drugs are still derived from trees, shrubs, or
herbs. Some are made from plant extracts; others are synthesized to mimic a natural plant
compound. The World Health Organization notes that of 119 plant-derived pharmaceutical
medicines, about 74 percent are used in modern medicine in ways that correlated directly
with their traditional uses as plant medicines by native cultures.
According to WHO 2002, about 80% of world population is still dependent on herbal
remedies to treat illness. In Germany, about 600 - 700 plant-based medicines are available
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and are prescribed by some 70% of German physicians. In the last 20 years in the United
States, public dissatisfaction with the cost of prescription medications, combined with an
interest in returning to natural or organic remedies, has led to an increase in herbal medicine
use.
Over the world there are wide utilization trends of herbs for primary health care, both through
traditional means and through industrially prepared pharmaceutical products. It is a common
concept especially in developing countries that herbal-based industrialization is not profitable
but now literature shows that there are increasing opportunities for agro-based
industrialization and especially of herbal-based industrialization as there is an increasing
demand of herbs in developed countries for pharmaceutical and cosmetics industries.
Himalayan region areas of Pakistan are enriching in natural herbal resources, but they are not
properly utilized and commercialize, even they have strong potential for these purposes.
Herbal utilization not only contributes to socio-economic development but also contribute to
environmental development For the proper utilization of herbs the requirement is, have only
to determine and elaborating their uses and markets through industrialization and
institutionalization.
Herbs have been used in all cultures throughout history. Extensive scientific documentation
now exists concerning their use for health conditions, including premenstrual syndrome,
indigestion, insomnia, heart disease, cancer and HIV.
Yet, for the most part, modern medicine has veered from the use of pure herbs in its treatment
of disease and other health disorders. One of the reasons for this is economic. Herbs, by their
very nature, cannot be patented. Since herbs cannot be patented and drug companies cannot
hold the exclusive right to sell a particular herb, they are not motivated to invest any money
in that herb's testing or promotion. The collection and preparation of herbal medicine cannot
be as easily controlled as the manufacture of synthetic drugs, making its profits less
dependable. Yet, the current viewpoint seems to be changing. "The revival of interest in
herbal medicine is a worldwide phenomenon," says Mark Blumenthal, Executive Director of
the American Botanical Council.
1.2:There are numerous medicinal herbs which are used in drugs; some important medicinal
herbs are mentioned in (Annexture-1)
1.3. Industrial use of medicinal plants
Green plants synthesize and preserve a variety of biochemical products, many of which are
extractable and used as chemical feed stocks or as raw material for various scientific
investigations. Many secondary metabolites of plant are commercially important and find use
in a number of pharmaceutical compounds. However, a sustained supply of the source
material often becomes difficult due to the factors like environmental changes,
cultural practices, diverse geographical distribution, labors cost, selection of the superior
plant stock and over exploitation by pharmaceutical industry. In some cases, the crude extract
of medicinal plants may be used as medicaments. On the other hand, the isolation and
identification of the active principles and elucidation of the mechanism of action of a drug is
of paramount importance. Hence, works in both mixture of traditional medicine and single
active compounds are very important. Where the active molecule cannot be synthesised
economically, the product must be obtained from the cultivation of plant material.
Herbs as a medicine are used in many forms or ways. In market it is available in the form of
teas, syrups, oils, liquid extract, tinctures, and dry extract (pills or capsules) often prepared by
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Hakims locally or by well known companies. Teas can be made from dried herbs left to soak
for a few minutes in hot water, or by boiling herbs in water and then straining the liquid.
Syrups, made from concentrated extracts and added to sweet-tasting preparations, are often
used for sore throats and coughs. Oils are extracted from plants and often used as rubs for
massage, either by themselves or as part of an ointment or cream. Tinctures and liquid
extracts are made of active herbal ingredients dissolved in a liquid (usually water, alcohol, or
glycerol). Tinctures are typically a 1:5 or 1:10 concentration, meaning that one part of the
herb is prepared with five to ten parts (by weight) of the liquid. Liquid extracts are more
concentrated than tinctures and are typically a 1:1 concentration..A dry extract form is the
most concentrated form of an herbal product (typically 2:1 - 8:1) and is sold as a tablet,
capsule, or lozenge.
Disadvantages:
Herbs are not without some disadvantages. For sudden, serious illnesses, mainstream
medicine still reigns supreme. An herbalist would not be able to treat serious trauma, such as
a broken leg, nor would he be able to heal appendicitis or a heart attack as effectively as a
conventional doctor using modern diagnostic tests, surgery, and drugs. Modern medicine
treats sudden illness and accidents much more effectively than herbal or alternative
treatments.
Another disadvantage of herbal medicine is that herbal treatments can interact with
medications. Because some herbs may have some side effects. Nearly all herbs come with
some warning, and many, like the herbs used for anxiety such as Valerian and St. John's
Wort, can interact with prescription medication such as antidepressants. It's important that
herbs are medicines, and like taking medications, herbs have some advantages and
disadvantages. Visiting a physician for the correct diagnosis, consulting an herbalist for the
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proper herb and dosage, and embracing modern medicine when it makes the most practical
sense may be the best of all possible worlds for those who wish to use alternative and
complimentary therapies.
3.0 Some of leading herbal companies and their products are discussed in (Annexure-2)
4.0 Herbal products of common Diseases:
There are yet numerous medicinal herbs whose medicinal characteristics are unknown,
because the herb of a particular ecology is known by the local inhabitants of that area, and is
unknown to others. One herb may have different common names in other parts of the world.
So the traditional healers (hakims/Tabibs) of a particular area make their own formulations
for different diseases. Here, some formulations of some common diseases are given as an
example.
4.1 Blood Pressure:
Hypertension, or high blood pressure, is a serious condition that affects 50 million
Americansone in four adults. Blood pressure is the force of blood against the walls
of arteries. High blood pressure is dangerous because it makes the heart work harder
to pump blood to the body and it contributes to hardening of the arteries or
atherosclerosis.
A normal blood pressure is less than 130/85.
High blood pressure is 140/90 or higher.
If your blood pressure is between 120/80 and 140/90, then you have
prehypertension.
High blood pressure increases your chance (or risk) for getting heart disease and/or
kidney disease, and for having a stroke. Hypertension is often called the silent killer. It is
especially dangerous because it often has no warning signs or symptoms.
4.2 Diabetes
ZAYABETUS(Diabetes)
Diabetes is a metabolic disorder that prevents the body from utilizing glucose
completely or partially. There are basically two types of diabetes.
1. Type 1 diabetes: The type 1 diabetic patients have to take insulin as a routine.
The body doesnt produce enough insulin to keep blood sugar at normal levels
whereas in type 2 diabetes the cells do not properly respond to the insulin. The
normal fasting blood sugar is 80-120 mg/dL; this can go up to a level of 160
mg/dL two hours after meals. Type 1 diabetes usually occurs in childhood or
adolescence but can develop at any age. These patients need insulin everyday.
2. Type 2 diabetes: This is common among adults, especially those who are
overweight and over age 40. These people are able to control their blood sugar
levels through weight control, regular exercise and a well-balanced diet. Due to
the life style, weight and age.
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4.3 Cholesterol:
Heart diseases are caused by impasse of the coronary arteries. This blockage is
nothing however the cholesterol. When this cholesterol blocks the arteries, the
quantity of blood passing to the guts is lowered because of the less passage that is
available. As the guts do not receive enough quantity of blood, its to pump
exhausting, that causes several heart connected diseases.
There are two types of cholesterol bad cholesterol, LDL, and good cholesterol, HDL.
Good cholesterol is the type our body makes, and the bad cholesterol is the type we
add to the good when we eat things we shouldn't. LDL cholesterol clogs arteries and
is better at the lowest levels. HDL is naturally made in our bodies and is better at
higher levels. There is prescription medication that a doctor can prescribe if we have
too much of the bad cholesterol, and it is not recommended to replace that
medication with home remedies. However, there are good and inexpensive things we
can do at home to keep the cholesterol under control. These home remedies can be
used with the prescribed medications to help keep good cholesterol under control
and keep bad cholesterol away.
First Category:
Cholesterol:
Herbal medicines
Take a glass of milk and a piece of garlic and
boil them together. Drink this for a few days to
reduce the heart pains and to cut back
cholesterol.
Second Category:
High Blood Pressure
Herbal medicines
In half of the cup of lukewarm water add one
teaspoon of cayenne pepper. Drink it when
needed. This is also one of the effective home
remedies for high blood
pressure
Third Category:
Patients having high cholesterol problems normally have high blood pressure. Therefore
prescription has to be developed for this category of patients.
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Herbal medicines
There is a great deal of scientific interest in
turmeric. The main ingredient in turmeric is
curcumin, a powerful antioxidant and antiinflammatory substance, and it was found that this
can lessen insulin resistance and help prevent type
2 diabetes. Turmeric combines well with piperine,
from black pepper, and can increase its absorption
by up to 2000%.
Dosage: Mix 2parts of turmeric+1part of black pipper, take
half teaspoon with a glass of water before the breakfast in the
morning.
Fourth Category:
Patients having complex issues of diabetics, high blood pressure and high cholesterol are now
common in old age. The prescription for the three diseases separately might have some side
effects or complication because of risks associated with different herbs. Therefore, a
comprehensive prescription of herbal medicines is suggested.
Herbal medicines
The benefits of a diabetic from taking garlic
consist not only in lowering high blood sugar
level, but also can provide you with a healthy
blood circulation. Eat garlic regularly as it
regulates sugar level.
Part of food supplements for all categories:
Try to feature additional of fibrous food, fish oil,
soy and garlic in your daily diet.
Mix the coriander paste in water and consume it
every day for concerning one month. This will be
known to reduce the cholesterol levels.
Consume dry fruits like almonds and walnuts
daily.
Avoid eating ice creams, chocolates, red meats
and every one other junk food. They contain high
quantity of calories
Baked potatoes are best for lowering the blood
pressure.
Last however not the smallest amount you would
like to adapt a habit of drinking more of water. Water will push out the toxics
present in your body that got build up from the arteries.
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Quality Concerns: Quality control directly impacts the safety and efficacy of
herbal medicinal products. WHO has developed a series of technical guidelines
relating to the quality control of herbal medicines. The guidelines provide a
detailed description of the techniques and measures required for the appropriate
cultivation and collection of medicinal plants and for the recording and
documentation of necessary data and information during their processing. Despite
such guidelines, there is still considerable disparity between knowledge and
implementation. While pharmaceutical and other companies are striving to meet
the requirements for the quality control of herbal medicines, they cannot force
farmers, producers, handlers and processors to follow good agricultural and
collection practices for medicinal plants. The training of farmers and other
relevant persons is therefore one of many important measures to be taken to
ensure that good agricultural and collection practices are adopted in order that
medicinal plant materials of high quality are obtained. Good agricultural and
collection practices for medicinal plants is only the first step in quality assurance,
on which the safety and efficacy of herbal medicinal products directly depend
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upon, and will also play an important role in the protection of natural resources of
medicinal plants for sustainable use. Until now, only the European Union and a
few countries, such as China and Japan have developed regional and national
guidelines for good agricultural and collection practices for medicinal plants.
o lack of standardization
The quality and standardization of medicinal herbal product depends on all the factors
(environment, collection methods, cultivation, harvest, post- harvest) processing,
transport and storage practice). In verdant contamination by microbial or chemical
agents during any of the production stages can also lead to deterioration in safety,
quality and standardization.
Another factor which counts in drug standardization is that herbal medicines are in the
form of crude extracts which are a mixture of several ingredients and when isolated
individually fails to give that desired result In the absence of pharmacopoeia data on
the various plant extracts, it is not possible to isolate or standardize the active contents
having the desired effects. An integrated approach for the cultivation, conservation
and preservation of important plant species through plant molecular biology, plant
tissue culture; research on the rationale and methodology of Ayurvedic medical
practice; isolation of active constituents and their development into new therapeutics;
standardization and validation of known herbal medicines and other related aspects
need to be focused upon (Sharma, 1997).
o lack of listing formulae constituents resource-rich lot normally prefer allopathic
medicines educated and well informed lot is now very much keen to use natural
medicines and food supplements but they hesitate because they are not sure about
the constituents and quality of ingredients used in these medicines. There is a general
feeling among the well informed and educated lot that the herbal and unani Hakeems
are using steroids which will affect their health. Therefore listing of constituents and
quality control mechanisms are required.
Private sector participation isolated
In herbal pharmacy most of the work is from private sector. There is no co-operation
among private sector and with government also. There is small scale business
concept. Most of companies and Hakims are working in isolation. Similarly corporate
sector is also missing. All Hakims are working individually
Policy and Regulatory gaps
In Pakistan, a national policy on Traditional medicines is being developed. Laws and
regulations were developed in 1965 and amended in 1970 and 2002. A national
programme was issued in 1965 and the national office was established in the same
year; the office is part of the Ministry of Health. An expert committee on TM/CAM
was established in 2001. The Drugs Control and Traditional Medicines Division of
the National Institute of Health serve as the national institute on traditional medicine
and was established in 1991.
The Drugs Act of 1962 controls the regulation of herbal medicines as regards
advertising and prevention of misuse. Herbal medicines are regulated as over the
counter medicines and dietary supplements. No claims may legally be made about
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herbal medicines. The national pharmacopoeia is the Tibbi pharmacopoeia (1967); the
information is not legally binding. The Monographs of unani medicines (Vol. 1) has
been prepared and published.
The Tibb e Unani, Ayurvedic, Homoeopathic, Herbal and Any Other Non Allopathic
Medicine Act has been prepared to regulate the manufacture, sale, storage, import and
export of medicines from these systems. The Act has been approved by the Federal
Cabinet and Prime Minister of Pakistan; however, there are currently no regulatory
requirements for either manufacture or safety assessment of herbal medicines. There
is no registration system. Herbal medicines are not included on an essential drug list.
A post marketing surveillance system is being developed. In Pakistan, herbal
medicines are sold in pharmacies as over the counter drugs, by licensed practitioners,
and in special outlets without any restrictions.
Inadequate Knowledge and actions to make herbal medicine as a
commercial/business enterprise
A major factor depriving the development of the herbal medicine as a commercial
enterprise in Pakistan has been lack of information on the social and economic
benefits that could be derived from the industrial utilization of medicinal plants.
People just utilize the herbs using their indigenous knowledge for their health needs.
Due to lack of information about proper marketing of herbal medicines and trading
possibilities the real potential of these herbs for socio-economic development could
not exploited. In Pakistan People have limited their minds only up to their personal
benefits, and thus most of the population from all remote areas of Pakistan centered in
big cities, because crop production at their villages couldn't overcome their needs, and
they are unaware of socio-economic importance of herbs at national and international
level
5.2 Constraints
In terms of political economy, the allopathic system of cure is a British colonial
legacy that retained influence on the entire health care system of the country. With
this elite-backed system, the attitude of looking down on the indigenous systems
has been coupled with an established antagonism between the practitioners of the
two systems (Zaidi.S.A.,1988). Current evidence, although limited, suggests that
physicians may reasonably accept some herbal medicinal therapies as adjuncts to
conventional care.
The relationship between the conventional allopathic physician and the herbal
medicine provider is of rivalry , just as happens in any other part of the world
(Fink S.2002) Orthodox medicine has never been in favor of traditional medicine;
therefore, these practices are denounced vigorously by restricting their access,
labeling them as antiscientific and imposing penalties on their practice.Some
understandable factors for this rejection include lack of education, training,
regulation and the evidence base for herbal medicine practitioners.
Lack of Public Policy for herbal medicines
Inadequate and inappropriate professional education for herbal medicines,
Unani medicines and homeopathy as the country priority is allopathic medicines
due to the involvement of muti-national companies having strong hold in the
public policy
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6. Way Forward
To develop a balanced health policy to provide efficient and acceptable health services, we
need to understand the diversity of health-seeking behavior of the population in both
(allelopathy and traditional medicine) health care system of Pakistan. People have been
consulting traditional healers for ages and they will keep on doing so for various reasons. The
solution lies only in bringing these herbal medicinal healers into the mainstream by providing
them with proper training, facilities and back-up for referral.
The state regulatory authorities have a crucial role to play in this scenario, in terms of
recognition of herbal medicines, financing and appreciating training and research in this field.
The inclusion of some introductory modules of herbal medicinal knowledge into the medical
curriculum of allopathic medical schools may be considered.
A positive interaction between all cadres of health providers, academicians, policy makers
and researchers has to be harnessed to work for a common goal to improve the health of the
people. It is important to note that as the global use of healing practices outside conventional
medicine is on the increase, ignorance about these practices by physicians and scientists risks
broadening the communication gap between the public and the profession that serves them.
This necessitates the integration of the two systems at least in terms of evidence-based
information sharing.
Today, in the West, there is an overwhelming effort towards integration of alternative
medicine with the mainstream allopathic therapeutics. However, before this can be done,
research into herbal medicine itself needs to be recognized as a mainstay to design any public
health interventions. Guidelines for policy formulation, regulation, promotion and
development of traditional medicine need to be developed. introducing herbal and Unani
medicines as a part of the curriculum of allopathic medicines so that MBBS students on one
side have the knowledge of natural medicines and food supplements and on the other side
systematic education for Herbal pharmacy can be initiated.
7. References
1. Babar T.Sheikh and Juanita Hatcher. Complementary and Alternative Medicine in
Pakistan: Prospects and Limitations. Advance Access Publication 2005; 2(2)139-142
2. Cultivation, collection Conservation and propagation of medicinal herbs: Prospects and
Precautions. Dr.Muhammad Aslam. 2006.
3. Fink S. International efforts spotlight traditional, complementary, and alternative medicine.
Am J Publ Health 2002; 92:17349.
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7. Zaidi SA. Issues in the health sector in Pakistan. In: The Political Economy of Health Care
in Pakistan. Lahore: Vanguard Books (Pvt) Ltd,1988.
Links:
http://www.hamdard.com.pk
http://www.herbion.com
http://www.hashmisurma.com
http://www.qarshi.com
http://tayyebi.com.pk
http://www.marhaba.com.pk
Annexure 1:
1.3. Important Medicinal Herbs (Take it to Annex)
Shinwari, 1996 reported that there are about 6000 plant species exist in Pakistan and out of
which only 1010 species (16.8%) are identified as having medicinal value.. The major
manufacturers produce 300-400 products plants raw material. Natural medicines are in great
demand in the developed world for primary health care because of their efficacy, safety and
lesser side effects. They also offer therapeutics for age-related disorders like memory loss,
osteoporosis and immune disorders for which no modern medicine is available that can be as
effective as natural drugs.
The most commonly used herbal supplements in the U.S. include echinacea (Echinacea
purpurea and related species), St. John's wort (Hypericum perforatum), ginkgo (Ginkgo
biloba), garlic (Allium sativum), saw palmetto (Serenoa repens), ginseng (Panax ginseng, or
Asian ginseng; and Panax quinquefolius, or American ginseng), goldenseal (Hydrastis
canadensis), valerian (Valeriana officinalis), chamomile (Matricaria recutita), feverfew
(Tanacetum parthenium), ginger (Zingiber officinale), evening primrose (Oenothera biennis),
and milk thistle (Silybum marianum).
Mdicinal herbs are classified in various ways depending upon their scientific name, local
name, uses and active ingredients present in plant organs, particularly roots, leaves,flowers,
seeds or other parts of the plant. There is a long list of important medicinal plants of Pakistan.
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Annexure 2:
3.0 Herbal pharmaceuticals companies and their products (Annexure)
In Pakistan there is a long list of national and multinational pharmaceutical companies.
Traditional healers (Hakims/Tabibs) are also manufacturing their own medicines. Traditional
healers (Hakims/Tabibs) are Registered by the Govt. under an Act of the Parliament but there
is no regulatory control on the manufacture, sale, and distribution etc. of traditional
medicines. There are around 46,000 Registered "Hakims" and about 74,000 Registered
Homeopaths14 as against some 102516 Registered Physicians. The number of recognized
Tibbia Colleges and Dispensaries is 28 and 315 respectively. It is important to mention that
there are about 86 registered manufacturers of herbal medicine.
The most famous manufacture companies are as following:
Hamdard Laboratories
It produces Six hundred (600) Herbal Products. The products are produced in three
different forms i.e. liquids, solids, and semi solids. The products range fulfills the
health requirements from all age groups i.e. from infants to aged persons. Hamdard
has a full range of medicines for the cure of various diseases such as: Blood Pressure,
diabeties, stomach, liver infections etc.
Hashmi
The company Mohammad Hashim Tajir Surma was established by Hakim
Mohammad Hashim in 1794 at Bareilly, India. It was started with the introduction of
Surma.Now this company is also establishing its name in other herbal products
Qarshi Industries Pvt. Ltd
Qarshi Industries (Pvt.) Ltd. is also one of the largest herbal pharmaceutical company
in Pakistan. From a humble Dawakhana, Qarshi Industries (Pvt.) Ltd. has emerged as
modern, successful and progressive company manufacturing & marketing leading
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brands like Jam-e-Shirin, Johar Joshanda and Springley (Natural Mineral Water) apart
from more than 200 herbal products.
Tayyebi Dawakana
Tayyebi prepares over 350 different medicinal and healthcare products.
Tayyebi covering a span of 193 years and is actively involved in new product
development. There are over 25 patented products ranging from a general health tonic
to cough syrup to blood purifier.
Marhaba Laboratories
Marhaba Laboratories is also one of the leaders in the revival of Herbal Medicines. It
was established on Ist. July 1975 in lahore. Marhaba is involved in preparation of
single drugs, vegetable oils, distillates, syrups, compound drugs, patent drugs, health
food products and herbal cosmetics.
Medics Laboratories
Medics Laboratories is a young privately owned enterprise. Medics is a pioneer in
ethical marketing of phytopharmaceuticals in Pakistan through health care
professionals. Their products are produced as per drug manufacturing standards, by a
team of qualified pharmacists, chemists and herbalists. Their facilities are equipped to
manufacture a wide range of dosage forms such as lotions, creams, tablets, granules,
liquids and suspensions etc