Traditional systems of herbal medicine

Oriental systems there is a resurgence of interest in the older oriental systems due to: A dissatisfaction with conventional treatments The recent interest in all things natural, environmentally friendly and biodegradable

These older types of medicine are philosophically based, and are holistic in that they treat the patient as a whole rather than as the ‘owner’ of a disease or malfunctioning organ Holistic medicine: An approach to medical care that emphasizes the study of all aspects of a person’s health, including physical, psychological, social, and economic influences on health status

It is necessary for pharmacist to know about the basic principles of the older medical systems for two main reasons: to be in a position to advise patients who may wish to consult an alternative practitioner because traditional use is a common starting point in the ongoing search for new drugs Two types of traditional medicine have been chosen as an illustration: Traditional Chinese Medicine (TCM) Ayurveda

Minor or self-limiting disorders The diseases in traditional systems can be classified as minor or self-limiting disorders, or chronic or serious disorders Minor or self-limiting disorders such ailments include aches and pains, diarrhea, wounds or injuries, and facilitating childbirth, for which a common remedy will be usually offered The remedy would usually be an indigenous plant or herb or a remedy obtainable from a local market, and would be well known within the community

Chronic or serious disorders these may be fatal, life-threatening or debilitating conditions, or those that cannot be diagnosed by indigenous healers; they are often considered to have a “supernatural” component e.g. forms of cancer and genetic or metabolic disorders

The dose In traditional medicine, this usually means a lack of specific dose e.g. calabash, seashell, tumbler Traditional medicine is more concerned with how to take remedy rather than how much  this aspect of traditional medicine is very important indeed because it means that highly potent plants are rarely part of a traditional pharmacopoeia and some plants which we now find useful were considered dangerous e.g. foxglove (Digitalis purpurea L.)

Correlation of traditional use with scientific evidence There may be a correlation between traditional usage and pharmacological action, such as the isolation of antipyretic principles from a ‘fever’ remedy, but, even so, it may turn out different to our expectations. For example: the periwinkle Vinca (Catharanthus) rosa was traditionally used for treating diabetes, but on further investigation yielded the powerful anticancer alkaloids vincristine and vinblastine

Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM) The study of TCM is a mixture of myth and fact, stretching back well over 5000 years Chinese medicine is philosophically based, and as an holistic therapy the concept of balance and harmony is supremely important

Concepts in TCM Qi, the essential life force Qi (or chi) permeates everything. It is transferable. For example: Digestion extracts qi from food and drink and transfers it to the body; and breathing extracts qi from the air and transfers it to the lungs. These two forms of qi meet in the blood and form ‘human qi’, which circulates through the body.

Qi, the essential life force It is the quality, quantity and balance of qi that determine your state of health Food and air affect health, so diet and breathing exercises are very important It is considered that the original vital energy, qi, is gradually dissipated throughout life, so it is important to conserve it using diet, kung fu, breathing exercise and herbal medicine

Yin and Yang The theory of yin and yang still permeates all aspects of Chinese thought. Attributes of both are: Yin: negative/passive/dark/female/water Yang: positive/active/bright/male/fire

Yin and Yang Yin is considered to be the stronger: fire is extinguished by water, and water is ‘indestructible’. So yin is always mentioned before yang Yin and yang are always in balance

The five elements Heart: fire Kidneys: water Liver: wood Lungs: metal The earth is divided into wood, fire, earth, metal and water. They dominate everything on earth, and each is associated with a vital organ of the body: Heart: fire Kidneys: water Liver: wood Lungs: metal Spleen: earth

The vital organs These do not correspond to our organs exactly Exact anatomy was not considered important since it was the relationship between the organs, the five elements, qi and yin and yang that mattered. For example: if a person with a red complexion (fire color) and who laughs a lot (fire sound) may have an over-fired heart; in this case, herbs to sedate the heart will be given

The vital organs The organs are considered to be yin or yang and are paired. Coupled organs are connected by meridians, or energy channels, through which qi flows. Meridians are not associated with the nervous system and cannot be seen physically. Meridians are stimulated with herbs and by acupuncture and will have a direct effect on a particular organ as well as a toning effect on the system.

Causes of disease Bacteria, viruses and chemicals are not considered to be causes. If an organ is weak, it may be attacked, and therefore the weakness is the cause and must be rectified. The disease may be the result of external forces and internal emotional factors.

Causes of disease The external forces are called the six excesses: Wind Cold Summer heat Dampness Dryness Fire Most people, if healthy, are not affected by the six excesses but, if the body is deficient in qi or weather conditions are abnormal, then this may cause problems.

The seven emotions These are considered to be the major internal causes of disease. Excessive emotional activity causes: A severe yin/yang imbalance Blockage of qi in the meridians Impairment of vital organ function Excessive emotional activity will lead to damage of the organs and allow disease to enter from outside, or a minor weakness from inside to develop.

The seven emotions The seven emotions are: Joy Anger Anxiety Concentration Grief Fear (A feeling of agitation and anxiety caused by the presence or imminence of danger) Fright (Sudden intense fear)

The seven emotions Once physical damage has occurred, by whatever cause, it will need more than emotional factors to cure it and herbs will be used. There are a few other causes, which are not emotional or external excesses. These are the exception of the rule, and include: Epidemics Insect and animal bites Worm infestation Hereditary diseases

Diagnosis Various methods are used: Examination of the tongue Pulse diagnosis Palpation of internal organs (to determine consistency and tone) Massage (to detect temperature and knotted muscles and nerves) Interviewing (vital, questions are asked about sleep patterns, tastes in food and drink, stool and urine quality, fever, perspiration and sexual activity)

Treatment the purpose is to rectify harmony, restore qi and the yin/yang balance. For example: ‘cold’ diseases, such as cold in the lungs, coughs, vomiting and nausea are considered to be a deficiency of yang and treatment would be with a warming herb such as a ginger. Once the prescription has been chosen and written out, the patient takes it to a Chinese herbalist who prepares the remedy.

Type of disease Example of disease Nature of disease Nature of remedy Example of remedy Desired effect Cold Nausea, vomiting Yin Yang Ginger Warming Hot Malaria, fever Sweet wormwood Cooling

Ayurveda

Ayurveda is considered to be the most ancient of all medical disciplines. Ayurveda is a system of sacred Hindu medicine, originating in India. In Ayurvedic medicine, the patient is viewed as unique, and ‘normality’ as what is appropriate for that particular person and this is in contrast to Western medicine, where populations are generalized and ‘normal’ means what is applicable to the majority.

Ayurvedic medicine is worthy of study because: It is the most ancient system of medicine still in use today. It has influenced so many other types. Philosophically, Ayurveda has similarities with traditional Chinese medicine (TCM): In TCM, there are two (yin and yang), and in Ayurveda there are three (the tridosha). There are five elements in both, but they are slightly different. Many remedies are common to both systems although the philosophical rationale for their application may be a little different

Concepts in Ayurveda

Prana, the life energy Prana is the vital energy, activating both body and mind. Nutrient prana from the air gives energy to the vital prana in the brain, via respiration, and is thus the equivalent of qi in TCM. In the body it is seated in the head, and governs emotions, memory and other functions of the mind. Prana (1) kindles the bodily fire [agni] and (2) governs the functioning of the heart, entering the bloodstream from where it controls the vital organs [dhatus].

Bhutas, the five elements The basic elements of cosmic energy are: the ether (space), air, fire, water and earth. The five elements are related to the five senses: hearing, touch, vision, taste & smell. For example: Ether is related to hearing, since sound is transmitted through it, and from there to the ear, the associated sense organ, leading to speech, from the organs of action which are the tongue and vocal cords.

Tridosha: vata, pitta & kapha (the three humors) The five elements are manifest in the human body as three basic principles or humors known as the ‘tridosha’. The three humors (vata, pitta, kapha) govern all biological, psychological and physiopathological functions of the body and mind. The primary requirement to diagnosis and treatment of disease is to understand the relationship between the humors.

The tridosha affects the creation, maintenance and destruction of bodily tissues and the elimination of toxins (ama) from the body. The tridosha is responsible for psychological phenomena, including basic human emotions such as fear, anger and greed, and more complicated sentiments such as understanding, compassion and love, and as such is the foundation of the psychosomatic nature of man.

the tridosha has recently been redefined as an equilibrium, balance and coordination between the three vital body systems: the central nervous system (CNS)  vata the endocrine system  pitta the immune axis  kapha The tridosha can be considered to govern all metabolic activities: catabolism  vata metabolism  pitta anabolism  kapha

For example: When vata is out of balance, the metabolism will be disturbed, resulting in excess catabolism, which is the breakdown or deterioration process in the body; excess would therefore induce emaciation. When anabolism is greater than catabolism (excess kapha), there is an increased rate of growth and repair of organs and tissues.

The tridosha can be described further: Vata, affiliates to air or ether (space), is a principle of movement. It can be characterized as the energy controlling biological movement and is thus associated with the CNS, and governs functions such as breathing, blinking, heartbeat and nervous impulses. Pitta, is affiliated to fire and water, and governs bodily heat and energy. It is involved in metabolism, digestion, excretion, manufacture of blood and endocrine secretions and is also involved with intelligence and understanding.

Kapha, is associated with water and earth. It is responsible for: Physical structure Biological strength Regulatory functions Immunity Production of mucus and synovial fluid Wound healing Vigor and memory retention

Prakruti, the human constitution Humans can be divided into personality types, and the constitution of an individual is determined by the state of the parental tridosha at conception. Most people are not completely one type, but can be described as vata-pitta or pitta-kapha. As well as the vata, pitta and kapha type of personalities, there are three basic attributes (satva, rajas & tamas) provide the basis for distinctions in human temperament, individual differences and psychological and moral dispositions.

Satva expresses essence, understanding, purity, clarity, compassion and love. Rajas describes movement, aggressiveness and extroversion. Tamas manifests in ignorance, inertia, heaviness and dullness.

Agni, the digestive fire Agni governs metabolism and is essentially pitta in nature. An imbalance in the tridosha will impair agni and therefore affect metabolism. Agni plays a vital role in the creation and maintenance of dhatus (body tissues). Agni contains heat which helps in the digestion of external elements that enter our body. The food which enters our digestive tract is converted into life sap with the help of agni. Agni also helps in destroying ama (toxins). These are produced if there is an imbalance of doshas.

Malas, the three waste products These are as may be expected the feces, urine and sweat, and production and elimination of these are vital. Their appearance and properties can give many indications of the state of the tridosha and therefore health.

Dhatus, the seven tissues The human body consists of seven basic tissues or organs (constructing elements) or dhatus. When there is a disorder in the balance of the tridosha, the dhatus are directly affected. The dhatus do not correspond to our definition of anatomy, but are more a tissue type than an individual organ.

Diagnosis Taking the case history involves astrological considerations as well as a thorough examination, where the appearance of the tongue, properties of the urine, sweat and sputum will also be examined.

Treatment Treatment may involve: Diets Bloodletting Fasting Skin applications enemas Yogic breathing Herbal treatments minerals

Some important herbs of Ayurveda and their uses Botanical name Ayurvedic name Effect on dosha Medical use Nigella sativa Kalonji Pacifies vata & kapha Digestive, antiseptic Piper nigrum Kalmirch Pacifies vata & pitta Digestive, respiratory disorders Terminalia chebula Haritaki Balances tridosha Digestive, blood tonic, antiasthmatic