Article 5 : PLANTS IN TRADITIONAL AND COMPLEMENTARY MEDICINE

ARTICLE 5:PLANTS IN TRADITIONAL &COMPLEMENTARY MEDICINE

Disclaimer : while various traditional systems of medicine are mentioned, no further details will be made available as this article does not intend to promote the practice nor advocate the application of alternative medicines in the cure of ailments and diseases without proper administration of certified physician or medical officer. Likewise, the list that contains plants used to treat various ailments in diseases is for documentation. Proper consultation with and medical practitioners/specialist is highly advised. 

 

1.0          INTRODUCTION

 

Traditional medicine is defined as the sum total of knowledge, skills and practices based on the theories, beliefs and experiences of indigenous people of different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illness ) [1].  When the traditional medicine has been adopted by other populations (outside its indigenous culture), then it is termed “alternative” or “complementary medicine. The Malaysian Ministry of Health has defined traditional and complementary medicine as “ T&CM practice together, is other than the practice of medicine or surgery, by registered medical practitioners as defined in Medical Act 1971”.

Traditional complementary medicine can offer several advantages over modern medicine (allopathic medicine). Among the reasons why traditional medicine is so popular worldwide  are:

  1. Traditional medicine system has been practiced in various countries from time immemorial and still persists in modern age, the people have both found it as well as believe that the system is efficacious in curing diseases. [2]
  2. A holistic way of treatment is the basis of all traditional medicinal systems throughout the world, as such, traditional medicine aims at curing the whole body instead of specific symptoms, which is often done in allopathic medicine. [2]
  3. Traditional medicine offers a cheaper alternative, since the traditional medicinal practitioner mostly uses decoctions of plants, animals or minerals, the medicine can be afforded by the poorer segments of the population, particularly of the undeveloped and developing countries. [2]
  4. Since traditional medicinal practitioners are usually found in rural areas, people have better access to them than modern medical practitioners, who tend to converge in bigger cities and towns, and so are inaccessible to the rural population lacking road and other communication facilities. [2]
  5. The close proximity of traditional practitioners with the rural population generates in the rural people, particularly women, to disclose their illnesses to the traditional practitioners, such rural women may feel hesitant to discuss their illnesses or symptoms with a city doctor, who to her is an alien being. [2]
  6. Allopathic medicine cannot provide any cure for common diseases like rheumatism or diabetes but merely treats and alleviates the symptoms, while traditional medicinal practitioners claim to have a complete cure of these diseases in many parts of the world. [2]
  7. Allopathic drugs are now increasingly associated with severe side-effects, and development of drug-resistant vectors. [2]

The use of traditional medicine is so popular that in some Asian and African countries, 80% of thepopulation depend on traditional medicine for primary health care. In many developed countries, 70% - 80% of the population has used some form of alternative or complementary medicine.  [1]

Herbal treatmentsare the most popular form of traditional medicine, and are highly lucrative in the marketplace. In Western Europe alone, annual revenues reached to US$5 billion in 2003-2004, while in China, sales of products totaled US14 billion in 2005. Herbal medicine revenue in Brazil was recorded at US160 million in 2007. [1]

The practice of traditional complementary medicine in Malaysia is composed of (i) Malay traditional medicine, (ii) Chinese traditional medicine, (iii) Indian traditional medicine, (iv) homeopathy, and (v) complementary medicine.

2.0       TRADITIONAL MEDICINE IN MALAYSIA

In terms of the use of alternative or traditional complementary medicine, Malaysia is no different. In fact, Malaysia has as well-developed traditional system of medicine, which has been in practice from time immemorial. The reliance to the traditional complementary medicine can be traced back to the local people living in or nearby tropical rainforests, which is said to abound in sources of natural cures to common ailments and diseases of people.

The principles of Malay traditional medicine are generally based on the Arabic Unani medicine and Galenic philosophy. [3] When Indians and Chinese traders arrived in Malaysia, they brought along various medical practices but did not replace the indigenous medical system in Malaysia. Later on, the introduction of Islam by Indians and Arabs, led to major changes in the traditional medical system, among them was treatment by recitation of verses from the Koran. [4]

Nowadays, the diversity in medical systems in Malaysia reflects the diverse population of Malay, Chinese, Indian and other indigenous heritage. In addition to allopathic medicine, the major systems of medicine practices in Malaysia include ayurveda, siddha, unani, traditional Chinese medicine, traditional systems of medicine, such as that provided by traditional medicine practitioners, spiritualists, bonesetters, traditional birth attendants, and others who use home remedies. Medical options also include homeopathy, naturopathy, reflexology, aromatherapy, and chiropractic. [4]


fig 1 piper betle
fig1 sirih
  Figure 1.Orthosiphonaristatus or Misai kucing (left) and Piper betle or daun sirih (right) are just some plants of known traditional medicinal values that are commonly planted in a typical Malaysian backyard.

In the study,  traditional Malay medical practices can be traced mainly to Indonesians.  These medical practices are especially popular among Malays in rural areas and rely on practical experience and observation handed down orally and in writing from generation to generation, especially the early Indonesian migrants. Medical treatment may include reciting incantations over water and giving it to the patient to drink, administering herbs internally or externally, giving amulets, and prescribing special baths, with lime flowers, holy water, for example. More than one of these options may be used and more than one traditional medicine practitioner may be called upon. [4]

Chinese traditional medicine is believed to have been introduced into Malaysia by Chinese migrants working in the tin mines. These migrants brought herbal medicines as well as other forms of treatment, including acupuncture. Chinese medical practitioners hold high status and are known as sinseh. Today, traditional Chinese medicine is also used in urban centres. [4]

Siddha, Ayurveda, and Unani– all traditional Indian medical systems– are practiced in Malaysia. the majority of medicines used in these systems are of vegetables, minerals, and animal origin. Herbal preparations and herbal products are imported from India as medical tablets, oils, ointments, metals, mineral concoctions, and herbal powders.[4]

The tables below summarized the types of traditional complementary medicine available in Malaysia both as medicinal practice and health problems, as well as maintaining health of an individual.

Table 1:Modalities of traditional complementary medicine practices in Malaysia.  [5]

Category Modality Category Modality
Mind-body medicine

Meditation

Hypnosis

Prayers for health reason

Exercise, dance and leisure (i.e. yoga,  chi qong)

Energy healing therapies (i.e. magnetic healing)

Manipulative and body based practices

Midwifery

Bekam/cupping

Massage

Bone therapy (i.e. rawatanpatahtulang)

Reflexology

Temperature based (i.e. demah)

Resdung treatment

Biologically based therapies

Herbs

Vitamin and supplement

Animal parts

Application/beauty/hygiene product

Diet based therapy (i.e. nutrition therapy)

Whole medical systems

Acupuncture

Ayurveda

Homeopathy

Traditional Chinese medicine

Table 2: Most common modalities of traditional complementary medicine used for health problems in Malaysia. [5]

Modality Health Problem Usage Modality Health Problem Usage

Herbs based application/beauty/herb based hygiene product

Herbs

Resdung treatment

Homeopathy

Temperature based (hot or cold water application)

 

23.60%

 

17.10%

 

10.00%

 

10.00%

 

10.00%

Acupuncture

Massage

Animal based therapy (i.e. bird’s nest)

Prayer for health reason

Midwifery

 

10.00%

 

4.90%

 

4.20%

 

2.30%

 

1.00%

Table 3: Most common modalities of traditional complementary medicine used for health maintenance in Malaysia. [5]

Modality Usage Modality Usage

Herbs based application/beauty/herb based hygiene product

Herbs

Exercise, dance and leisure for health reason

Vitamin and supplement

 

6.30%

 

 

29.6%

 

11.0%

 

7.40%

Animal based therapy (i.e. bird’s nest)

Midwifery

Diet based therapy

Prayer for health reason

Massage

Reflexology

3.80%

 

1.70%

 

1.70%

 

1.40%

 

1.10%

 

0.40%

 

3.0   COMMONLY USED PLANTS IN TRADITIONAL MEDICINAL PRACTICES IN MALAYSIA

It is known that local people have used plants and animals, including fungi (i.e. mushrooms) in their search of cure to ailments and diseases, however it is the plants in its various kinds that are commonly used by many, if not all indigenous and ethnic groups in Malaysia. However, the complete documentation of the plants traditionally used in Malaysia for traditional complementary medicine is lacking. The popularity of, and demand for medicinal plants as health supplements or for medicinal purposes have been increasing world-wide. The renewed interest of knowledgeable consumers could be associated with increasing information and availability of herbal supplements globally. [2] It has been reported that in 1999 alone, sales of herbal products world-wide had aggregated to US$80 billion. In the same year, the Malaysian market for natural or herbal products, medicinal plants and aromatic plants including aquatic animals was estimated at RM 4.6 billion with an annual growth projection of 15-20%. [2]

Traditional medicinal practitioners in Malaysia use a variety of medicinal plants for treatment of various ailments. [9] Herbal products is an important component in the Malaysian traditional medicinal system, and for the record, there are about 550 genera of tropical plants, containing over 1,300 species are said to possess medicinal values. [2] Of these, several are medicinal plants yielding clinically useful drugs and are summarized in Appendix 1. Some of the most popular medicinal plants that are currently undergoing extensive research are Eurycoma longifolia Jack (tongkat ali), Labisia pumila (kacip Fatimah), Andrographis paniculata (hempedu bumi), Orthosiphon aristatus (misai kuching), Centella asiatica (pegaga), Phyllanthus niruri (dukung anak), and Momordica charantia (peria), among others

In 1999, the Malaysian market for herbal products, medicinal and aromatic plants was estimated at a staggering RM4.6 billion with an annual projected growth rate of 15-20%. [9] The very popularly known plants used in traditional medicine in Malaysia are Aloe vera L. (lidah buaya), Morinda citrifolia L. (mengkudu), Pipers armentosum Roxb. (daun sirih; kaduk), Acorus calamus L. (jerangu), Andrographis paniculata (Burm.f) Wall. ex Nees (hempedu bumi), Orthosiphon aristatus (Blume) Miq. (misai kucing), Eurycoma longifolia Jack (tongkat ali), and Centella asiatica (L.) Urb. (pegaga). [9]

 

labisia pumila
 Figure 2 : Labisia pumila is one of the most commonly used plants in Malay traditional medical practices.

 

LIST OF PROHIBITED HERBAL PLANTS IN HERBAL PREPARATIONS

List of plants containing schedule poisons under Poisons Act 1952 (Revised 1989) [11]

Genus Species Common names Parts of plant Prohibited Constituent(s) of concern
Aconitum All species   Whole plant Aconite
Asidosperma quebracho White quebracho Whole plant Asidospemine, yohimbine
Atropa belladonna Deadly nightshade Whole plant Atropine, hyoscine (scopolamine), hyoscyamine
Berberis All species   Whole plant Berberine
Cabola albarrane Squill Whole plant Glycoside
Catharanthus roseus Periwinkle Madagascar, Old Maid, Vinca rosea, Myrtle Whole plant Vinca, Vincristine, Vinblastine
Chondodendon tomentosum Curare, Velvet leaf, Ice Vine Whole plant Tubocurarine
Claviceps pupurea Ergot Whole plant Ergometrine
Colchicum autumnale Autumn Crocus/ Meadow Saffron/ Naked Lady Whole plant Colchicine
Datura metel Devil’s Trumpet, Metel, J California Jimson Weed Whole plant Atropine, Scopolamine
stramonium Jimson Weed/ Gypsum Weed, Loco Weed Whole plant Atropine, Hyoscyamine, Scopolamine
Delphinium staphysagria Lice bane, Stavesacre Whole plant Delphinine
Digitalis purpurea Common Foxglove, Purple Foxglove, Kecubung Leaf Glycoside
Drimia maritima Squill Whole plant Glycoside
Ephedra All species Ma Huang Whole plant Ephedrine, Pseudoephedrine
Gelsemium sempevirens Yellow Jessamine, Evening Trumpet, Carolina Jessamine Whole plant Gelsemine
Hyoscyamus muticus Egyptian henbane Whole plant Hyoscyamine
niger Black henbane Whole plant Hyoscyamine – atropine
Lobelia inflata Lobelia, pokeweed, Indian tobacco, gagroot, asthma weed, vomitwort, bladderpod Whole plant Lobeline
nicotianifolia Wild Tobacco Whole plant Lobeline
Mitragyna speciosa Daun Ketum Whole plant Mitrogynine
Nicotiana tabacum Common tobacco Whole plant Nicotine
Papaver somniferum Opium poppy  Whole plant Morphine, codeine, hydrocodone, meperidine, methadone, papaverine
Pausinystalia yohimbe Yohimbe, Johimbe  N/A Yohimbine
Physostigma venenosum Calabar bean N/A  Physostigmine
Pilocarpus microphyllus Pilocarpus jaborandi, jaborandi N/A  Pilocarpine
Punica granatum Pomegranate Bark Iso – pellatrierine
Rauwolfia serpentina Indian snakeroot, Serpentine root N/A  Reserpine
vomitoria African serpentwood  N/A Reserpine
Schoenocaulon officinale Veratrum officinale  N/A Sabadilla, Veratrine
Scillae bulbus Sea onion, Squill N/A   
Solanum nigrum Black nightshade N/A  Solanine
Strychnos Nux-vomica Poison nut, Quaker button, strychinine tree, ma qian zi N/A  Strychnine
Valerian All species   All part except root  
Veratrum All species    N/A  
Vinca All species   N/A  Vinca, Vincristine, Vinblastine, Vinpocetin

Plants not allowed

  1. Dryobalanops aromatica and Borneolum syntheticum – contains camphor and borneol not allowed in oral preparations
  2. Larreatri dentata and Larrea mexicana – reported to cause liver damage
  3. Hydrastis canadensis – reported to cause nerve system disruptions
  4. Magnolia officinalis – reported to cause kidney damage
  5. Stephania tetrandra – reported to cause kidney damage
  6. Piper methysticum– reported to cause liver damage
  7. Plants that contain aristolochic acid – reported to cause kidney damage

4.0        HERBAL MEDICINE

The natural world once served as the source of all medicinal agents, and plants provided most of these therapeutic entities. Documentation found in archeological excavations roves that various medicines extracted from plants were used as long ago as 2500 BC. The start of systematic study of these plants in the 19th century has been one of the major factors in the development of drug research. [6] Traditional knowledge on the use of plants in T&CM has been the basis of many drugs used in allopathic medicine. Some of the most important drugs discovered in the last centuries are derived from plants such as morphine, thebanine, codeine, noscapine and papaverine from Papaversomniferum (Opium poppy); atropine from Solanum plants; cocaine from Erythroxylumcocao (coca plant); pilocarpine from Pilocarpous sp.; digoxin from Digitalis lanata (foxglove); reserpine from Rauwolfiavomitoria; and artemisinin from Artemisia annua, among others.

The World Health Organization (WHO) defined herbal medicine as “finished, labeled medicinal products that contain active ingredients aerial or underground parts of plants, or other plant material, or combinations thereof, whether in crude state or as plant preparations. Plant material includes juices, gums, fatty oils, essential oils, and other substances of this nature. Herbal medicines may contain excipients in addition to the active ingredients. Medicine containing plant material combined with chemically defined substances, including chemically defined, isolated constituents of plants, are not considered to be herbal medicines. Exceptionally, in some countries, herbal medicines may also contain, by tradition, natural organic or inorganic active ingredients which are not of plant origin. [10]

5.0        NATIONAL REGULATIONS OF TRADITIONAL COMPLEMENTARY MEDICINE

Traditional medicine has always maintained its popularity world-wide. Over the last decade, the use of complementary and alternative medicine in many developed and developing countries are continuously increasing. However, there are some issues and concerns that have to be considered, and these vary from one country to another. The issue on safety and efficacy of traditional medicine and complementary and alternative medicines, as well as quality control, have become important concerns for both health authorities and the public. [5] Various traditional medicine practices have been developed in different cultures in different regions, but without a parallel development of international standards and appropriate methods for evaluating traditional medicine. Therefore, sharing national experience and information and headed by one central authority is crucial, and at the same time, traditional knowledge are to make sure protected and not abused.

The use of plants in traditional medicine has been one of the sources of development of drugs used in allopathic medicine. It has been widely recognised that tropical rainforest harbour a wide array of chemicals that are of medicinal importance. The tropical rainforest plants are biologically and chemically diverse as they synthesize various chemicals as defense agents against pests, diseases and predators, hence, an excellent reservoir of medicines and chemicals that lead to research and eventually synthesis of new drugs. In fact, about 25% of the drugs used in modern medicine owe their origins to plants from tropical rainforest. The phytochemicals synthesized by plants can be used unmodified as drugs, as starting material for partial synthesis of drugs or as molecular models to synthesize new drugs. [1]The identification of plants with potential medicinal properties is generally based on the indigenous uses of plants by the local people. Ethnobotanical approach is one of several methods that are applied in selecting plants for biological screening in a drug discovery program. [1] Although this method simplifies the search for potential drugs, it also poses threats on many aspects: (i) threat to overexploitation/over harvesting of plants identified with potential medicinal properties, and (ii) threat to the people who might misuse the plant or danger that a different plant might be collected and used. 

In Malaysia, the earliest documented report on medicinal plant research was by H.R. Arthur in 1954 followed by Douglas and Kiang in 1957. [1] Since then, explorations and discoveries on the use of plants drug development started.

Despite the availability of drugs in convenient forms (i.e. pills, liquid, etc.), many are still using plants in traditional medicine, especially those who are in rural and remote areas.

In the past, the government has taken a neutral stand on the practice of traditional Chinese medicine. However, in recognition of the current potential contribution of traditional and complementary/alternative medicine to health care, the Government is now considering bringing traditional Chinese medicine in the official health care systemThe Ministry of Health has set up the Steering Committee on Complementary Medicine with a multisectoral membership to advise and assist in formulation policies and strategies for monitoring the practice of traditional Chinese medicine in the country. [5] Recognising this, the government has to make sure that proper regulatory measures are in place to protect both the people and the biodiversity in general. However, to date, the official health care system adopted and implemented in Malaysia is an allopathic one. Subsection 1 of Section 34 of the Medical Act of 1971 contains the following broad general exemption

“Subject to the provisions of subsection 2 and regulations made under this Act, nothing in this Act shall be deemed to affect the right of any person, not being a person taking or using any name, title, addition or description calculated to induce any person to believe that he is qualified to practice medicine or surgery according to modern scientific methods, to practice systems of therapeutics or surgery according to purely Malay, Chinese, Indian or other native methods, and to demand and recover reasonable charges in respect of such practice.”

To protect the patient, Subsection 2 limits the treatment of eye diseases to practitioners of allopathic medicine. Likewise, the Poisonous Ordinance of 1952 restricts the use of certain substances to practitioners of allopathic medicine. [4]

The Midwives (Registration) Regulations of 1971 (254) legalize the practice of eligible traditional birth attendants. Subsection 2 of Section 11 of the Regulations permit midwifery to be practiced by the following : “Any person untrained in the practice of midwifery, who within four years of the commencement of [the Midwives Act of 1966] satisfies the Registrar that such person has during a period of two years immediately preceding application for registration... attended to women during childbirth.”

There are no other laws affecting traditional medical practice in Malaysia. However, there are a number of laws that regulate the production and sale of traditional medicines. There are the Poisonous Act of 1952, Sale of Drug Act 1952, Advertisement and Sale Act of 1956, and the Control of Drugs and Cosmetics Regulations of 1984. [4]

The Drug Control Authority is responsible for product registration, including quality and safety. Every manufacturer of traditional medicine is required to comply with good manufacturing practices, and importers are required to comply with good storage practices. All homeopathic medicines have to be registered with the National Pharmaceutical and Drug Control Board. [4]

 

References:

  1. World Health Organization (WHO). 2008. WHO Congress on Traditional Medicinal. Geneva:WHO Press.
  2. Khatun M A, Harun-Or-Rashid M, & Rahmatullah M. (2011). Scientific Validation of Eight Medicinal Plants Used in Traditional Medicinal Systems of Malaysia: a Review. American-Eurasian Journal of Sustainable Agriculture,5(1), 67-75.
  3. Jamia A J. 2006. Malay traditional medicine: An overview of scientific and technological progress. Tech Monitor Nov-Dec 2006, 37-49.
  4. World Health Organizations (WHO). 2001. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review.
  5. Siti, Z.M., A. Tahir, A. Ida Farah, S.M. Ami Fazlin, S. Sondi, A.H. Azman, A.H. Maimunah, M.A. Haniza, M.D. SitiHaslinda, A.K. Zulkarnain, I. Zakiah, W.C. Wan Zaleha. 2009. Use of traditional and complementary medicine in Malaysia: a baseline study. Complementary Therapies in Medicine 17: 292-299.
  6. Ibrahim Jantan. 2004. Medicinal plant research in Malaysia: scientific interests and advances. JurnalSainsKesihatan Malaysia, 2(2): 27-46.
  7. World Health Organization (WHO). 2005. National policy on traditional medicine and regulation of herbal medicine. Report of a WHO global survey.  Geneva: WHO Press.
  8. Ying Wang. 2008. Needs for new plant-derived pharmaceuticals in the post-genome era: An industrial view in drug research and development.Phytochemistry Review 7:395-406.
  9. Mat-Salleh& A. Latiff. 2002. Tumbuhanubatan Malaysia. Ministry of Science, technology and Innovation and UniversitiKebangsaan Malaysia.
  10. World Health Organisations (WHO). 1996. WHO Specifications for Pharmaceutical Preparations. Annex 11 (Guidelines for the Assessment of Herbal Medicine). 34th Report : 863.
  11. Zhari Ismail 2010. Potential of Malaysian herbs as halal pharmaceuticals.Universiti Sains Malaysia. Third World Halal Research Summit, 23-25 June 2010, KLCC.