Traditional systems of herbal medicine

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Chapter 12 Traditional systems of herbal medicine

Introduction

All modern medicine is derived originally from ancient herbal traditions. These have evolved to produce the conventional medicine known in the West, which uses both synthetic drugs and isolated natural compounds. Plant extracts are now rarely used by physicians or in hospitals, although herbal remedies are popular with the public and improvements in their formulation have resulted in a new generation of phytomedicines that are more potent than before and also chemically standardized. There is, however, a resurgence of interest in the older Oriental systems; this is due partly to dissatisfaction with conventional treatments and partly to the constantly growing 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. They also have much in common with traditional medical herbalism as it was, and still is, practised in Europe and America. Whether or not pharmacists, doctors and other healthcare professionals accept the validity of these older medical systems, it is necessary for them to know about their basic principles for two main reasons. First, to be in a position to advise patients who may wish to consult an alternative practitioner and, second, because traditional use is a common starting point in the ongoing search for new drugs.

It is necessary to consider the cultural environment in which traditional remedies are being used to make our expectations more reasonable, put these treatments in the context of Western thinking and widen the criteria of selection of remedies for our own use within modern medicine.

Three types of traditional medicine have been chosen as an illustration:

Traditional medicine can be defined as: Medical practice that includes diagnosis, prevention and treatment, relying on practical experience and observations handed down from generation to generation, whether verbally or in writing.

• Traditional Chinese Medicine (TCM)

• Ayurveda

• Traditional African medicine (TAM) or traditional African medical systems (TAMS).

TAM is an example of a mainly oral tradition, which applies to many types of indigenous medicine. TCM and Ayurveda are popular and highly sophisticated and have evolved through the ages whilst keeping their philosophy intact. All three systems use herbs as well as other forms of treatment. Discussion here, however, will be restricted to herbs since they have pharmacological activities and are, therefore, within the remit of this book. Before doing so, it would be useful to identify some aspects of the general approach of traditional medical systems to health, disease and treatment that affect our perception of them.

In the context of the systems discussed in this chapter, diseases can be considered as minor or self-limiting disorders, or chronic or serious disorders.

Minor or self-limiting disorder

Such ailments include aches and pains, diarrhoea, wounds or injuries for which a common remedy will be usually offered; in addition the facilitation of childbirth will also be considered. The remedy would usually be an indigenous plant or herb, or something that is 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. Examples include forms of cancer, and some genetic or metabolic diseases where obvious lesions may not be seen. Plant remedies will certainly be used, but they may be used as part of a ritual, and treatment will often also involve practices such as divination to find out which gods or ancestors have been offended and what sacrifices may be necessary to appease the supernatural entity. Naturally, the rationale behind the first type of common usage is more logical to Western thought, and scientists would therefore look, for example, for antipyretic or analgesic compounds in a herb known as a cure for fever, or for haemostatic substances in a plant used to staunch bleeding. It may even be possible to speculate, with some knowledge of chemotaxonomy, on the types of compounds that are present (e.g. tannins in a haemostatic plant, salicylates or sesquiterpene lactones in an antipyretic plant). However, if ritual is more often involved in the use of a particular plant, it is almost impossible to surmise what compounds may be present; this approach is therefore much less useful. The plant may be a treasure trove of useful compounds, but the traditional use will not provide any information about it.

The dose

In traditional medicine, this usually means a lack of specific dose. Typically, a calabash, seashell or a tumbler of a decoction may be taken from time to time. Traditional medicine is more concerned with how to take the 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 – pure compounds, accurate balances and volume measurements are not part of such cultures – and some plants which we now find useful were considered dangerous. For example, the foxglove, a source of the cardiac glycoside digoxin, has no historical documentation as a herbal medicine, and it was not until the 1800s that Withering used it for cardiac dropsy (congestive heart failure). Due to the narrow therapeutic index of the drug, it was necessary to develop a standardized preparation, which was powdered leaf, assayed biologically, and compressed into a tablet, before the drug gained widespread acceptance.

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. A classic example is ‘fever bark’ (Cinchona), which was traditionally used in South America for fever, but in many tropical countries ‘fever’ really means ‘malaria’. Quinine is actually antipyretic to some extent, but it has a much more relevant property, which is to kill the malaria parasite Plasmodium. Therefore, extracts of plants based on traditional usage should not only be tested for the activity expected, but be put through a battery of tests, since some important modern drugs have been developed from plants used for a different purpose entirely. For example:

• in the Caribbean the periwinkle Catharanthus (Vinca) rosea was used traditionally for treating diabetes, but on further investigation it yielded the powerful anticancer alkaloids vincristine and vinblastine

• Fagara xanthoxyloides, which is used in Nigeria as a chewing stick for cleaning the teeth, has been found not only to be antimicrobial, but also to have antisickling activity, and this finding has sparked off further work into this painful and chronic genetic condition.

Despite the reservations mentioned, traditional medicines have yielded many useful modern drugs, although not as many as poisonous species. Although toxic plants are only occasionally used as medicines, they are well known to the healers and may also be used for nefarious purposes, witchcraft or as ‘ordeal’ poisons, as, for example, Calabar bean (Physostigma venenosum), which is the source of the anticholinesterase physostigmine (eserine).

Asian and oriental medicine

The more systematic forms of traditional medicine arose in the East, particularly in India and China, and from there spread to other parts of the world where they influenced Greek, Arab and other highly sophisticated cultures. Ayurveda originated in India, and TCM in China, but in both cases they have evolved as they were incorporated into local customs; for example, Jamu arose in Indonesia and Kampo in Japan. These medical systems were (and still are) complicated and structured, and had a philosophical and religious aspect far removed from the primitive magic, superstition, divination and sacrifice that are characteristic of African, South American, Pre-Islamic Arabian and other cultures where medical knowledge was an oral (rather than written) tradition. Tibb-I-Islam is Islamic medicine and, therefore, practised by Muslims throughout Asia and the rest of the world, but it is more of a cultural way of looking at health (as dictated by the Koran) than a type of medicine, although of equal impact.

Traditional chinese medicine

The study of TCM is a mixture of myth and fact, stretching back well over 5000 years. At the time, none of the knowledge was written down, apart from primitive inscriptions of prayers for the sick on pieces of tortoise carapace and animal bones, so a mixture of superstition, symbolism and fact was passed down by word of mouth for centuries. TCM still contains very many remedies, which were selected by their symbolic significance rather than proven effects; however, this does not necessarily mean that they are all ‘quack’ remedies! There may even be some value in medicines such as tiger bone, bear gall, turtle shell, dried centipede, bat dung and so on. The herbs, however, are well researched and are becoming increasingly popular as people become disillusioned with Western medicine. Again, Chinese medicine is philosophically based, and as an holistic therapy the concept of balance and harmony is supremely important. The relevant records and documents were discussed earlier (Chapter 2), but additional historical milestones will be included here to show the evolution of TCM into what it is today.

The development of TCM

Shen Nong, the legendary Chinese Emperor, is credited with the discovery of herbal medicine in around 2800 BCE, and he is also reputed to have defined the opposing yet complementary principles eventually known as yin and yang. Confucius (551–479 BC) is celebrated as China’s greatest sage. He established a code of rules and ethics based on the premise that there is an order and harmony of the Universe resulting from a delicate balance of yin and yang forces. Humans should cultivate the five virtues of benevolence, justice, propriety, wisdom and sincerity, in order to exert their own life force in this cycle. Lao Zi extended the Confucian doctrine and taught that man can only achieve personal harmony by bowing to the inevitable. His followers invented a spiritual destination to the mythical ‘Island of the Eastern Sea’ where a herb with the power to bestow immortality was thought to grow. The way (or path) within this natural order of things is called the Tao and the religion is now called Taoism. Along this path, the two basic expressions of yin (negative and passive) and yang (positive and active) are interlocked. This philosophy was refined and extended by Dong Zhongshu to include the inner reaches of man himself, i.e. man as the universe on a small scale, containing within himself the locked cycle of yin and yang. It, therefore, follows that Taoist principles apply to the well-being of man, and extend to diet and medicine as factors in ensuring a balance between physical and mental health.

Food and medicine became inter-related. Herbal medicine was initially the domain of shamans and mountain recluses, who believed that the mountain mists contained high concentrations of qi, the vital essence of life. They practised the ‘way of long life’, which involved a herbal diet and medicine combined with martial arts – a link that continues today. The principles of TCM became consolidated and a search for the ‘elixir of life’ began to obsess the Chinese aristocracy. In TCM, drugs to rejuvenate and increase longevity are still prized.

The Han dynasty (206 BC to 220 AD) saw remedies (including veterinary) recorded in handy booklets or Gansu, which were strips of bamboo or wood bound together. All herbal medicines were collected together in the Shen Nong Ben Cao Jing (the pharmacopoeia of Shen Nong) and classified into three categories:

• Upper: drugs that nurture life

• Middle: drugs that provide vitality

• Lower: ‘poisons’ used for serious disease.

The most noted physician of these times was Zhang Zhogjing, who divided diseases into six types: three ‘yin’ and three ‘yang’. His prescriptions aimed to correct any imbalances of these forces. He also contributed to acupuncture by drawing a map of meridians along which the body’s vital energy (qi) is said to flow. During this period, the theory of the circulation of the blood was described, and anaesthetics were used, based mainly on Datura. By the end of the Han dynasty all the elements we regard as vital to TCM were in place, and refinement went on throughout the Tang, Song and Ming dynasties.

During the Ming dynasty, Li Shizhen (1518–1593 AD) produced the classic herbal encyclopaedia Ben Cao Gang Mu. It took 27 years to compile and consists of 52 volumes containing 1892 medicines. It was translated into Japanese, Korean, English, French, German and others, and is said to mark the beginning of a cultural exchange between Chinese and Western medicine.

In the 20th century, TCM came under attack from Western influences. Missionary doctors translated Western medical journals into Chinese, and Chinese doctors who had studied abroad turned against traditional herbal medicine. However, after the 1949 communist revolution, the government of the new People’s Republic of China reinstated TCM and set up new medical colleges, intended to break China’s dependence on the West. The 3rd (or Cultural) Revolution of 1966–1976 brought culture to a standstill, and ‘barefoot doctors’ with no more than 6 months of training were sent to rural areas to replace the denounced ‘intellectual’ Westerners. Today, both systems coexist and even Western-style medical schools teach students TCM and acupuncture.

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. It is the quality, quantity and balance of qi that determines your state of health and lifespan. Obviously, therefore, food and air affect health, so diet and breathing exercises are very important. These aspects of treatment will be considered first, before herbs are introduced. It is considered that the original vital energy, yuan 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

These have already been mentioned as central to Taoism, and 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 is considered to be the stronger: fire is extinguished by water, and water is ‘indestructible’. So yin is always mentioned before yang; however, they are always in balance. Consider the well-known symbol (Fig. 12.1): where yin becomes weak, yang is strong and vice versa. Both contain the seed of each other: their opposites within themselves.

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Fig. 12.1 The yin-yang symbol.

The five elements

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

• Liver: wood

• Spleen: earth

• Lungs: metal

• Kidneys: water.

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. Also, until the 20th century, cutting up a human body (dead or alive) was considered a grave insult to the ancestors. An example of the relationship between them all and its treatment is that of a person with a red complexion (fire colour) 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 organs are also 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. They 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. It may be the result of external forces and internal emotional factors. The external ‘cosmological’ 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 (i.e. not what is expected), 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 and impairment of vital organ function. This leads to damage of the organs and allows disease to enter from outside, or a minor weakness from inside to develop. The seven emotions are:

• joy

• anger

• anxiety

• concentration

• grief

• fear

• fright.

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 not the rule, and include epidemics, insect and animal bites, worm infestation and hereditary diseases.

Diagnosis

Various methods are used:

• Examination of the tongue: a very important aspect

• Pulse diagnosis: more than one pulse will be taken, depending on the pressure exerted

• Palpation of internal organs: carried out to determine consistency and tone

• Massage: used to detect temperature and knotted muscles or 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 ginger (see examples in Table 12.1). A list of common herbs and their indications is given in Table 12.2. Once the prescription has been formulated, the patient may be given a crude herb mixture with written instructions on how to prepare it at home, perhaps as an infusion or tea. Pastes and pills are prepared by the herbalist and may take several days to complete. Slow-release preparations are made using beeswax pills; tonic wines, fermented dough (with herbs in) and external poultices are also common.

Table 12.1 Treatment of disease in traditional Chinese medicine according to the nature of disease and the remedy

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Table 12.2 Some important herbs in traditional Chinese medicine and their uses

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Ayurveda

Ayurveda is considered to be the most ancient of all medical disciplines. It is a system of sacred Hindu medicine, originating in India, and as well as being an oral tradition, is also fairly well documented. Over 5000 years ago, the great seers (or ‘rishis’) organized the ‘fundamentals of life’ into what became known as Ayurveda, and this has evolved and adapted over the years whilst still retaining the philosophical basis on which it was founded. It now accommodates modern science, especially in relation to the testing of medicines, and research and adaptation are actively encouraged. Like other forms of holistic medicine, Ayurveda considers the patient as an individual and ‘normality’ as what is appropriate for that particular person. The patient is viewed as unique, and is, therefore, subject to unique imbalances. This is in contrast to Western medicine, where populations are generalized and ‘normal’ means what is applicable to the majority. However, unlike the difficulties with homoeopathy, for example, it is perfectly possible to evaluate Ayurvedic medicines using conventional clinical trials, and this is increasingly being carried out. Another important difference is that Eastern thought greatly values subjectivity, and even considers it to be a vital addition to objectivity, which is the goal in Western medicine.

There are only a few Ayurvedic practitioners (‘vaid’) in the West at present, but popularity is growing rapidly and Ayurvedic medicines are now being exported from India to many other countries. It is worthy of study for this reason, not only because it is the most ancient system of medicine still in use today, but also because it has influenced so many other types. Many ethnic populations from India and Pakistan continue to use their own traditional remedies while living in Europe, Australia or the USA, and it is important that healthcare professionals should have some knowledge of the background and remedies that they are using.

Philosophically, Ayurveda has similarities with traditional Chinese medicine, in that the concept of humanity as a microcosm within the macrocosm of the universe is accepted. There is a life force, which can be nourished, protected, and of course dissipated, as well as opposing forces or ‘humors’ whose balance is vital to health. 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 and will be outlined in the appropriate section. 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 Chinese medicine. In the body it is seated in the head, and governs emotions, memory, thought and other functions of the mind. Prana kindles the bodily fire (agni) and governs the functioning of the heart, entering the bloodstream from where it controls the vital organs or dhatus.

Bhutas, the five elements

The ether (space), air, fire, water and earth are considered to be the basic elements, which are manifestations of cosmic energy. They are related to the five senses (hearing, touch, vision, taste and smell) and from them to resultant actions. As an 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. Likewise, fire is associated with the eyes as sense organs, leading to an action such as walking, by an organ of action, such as the feet.

Tridosha: vata, pitta and kapha – the three humors

Ether, air, fire, water and earth (the five basic elements) are manifest in the human body as three basic principles or humors known as the ‘tridosha’, which is unique to Ayurveda. The three humors, known as vata, pitta and kapha (individually called doshas), govern all biological, psychological and physiopathological functions of the body and mind. The primary requirement for the diagnosis and treatment of disease is to understand the relationship between these. Some similarities can be drawn with the ancient Greek system of medicine in which the humoral theory considers the body to consist of four fluids (phlegm, blood, yellow bile and black bile) and disease is thought to occur when these fluids are out of balance. Similarly, when the tridosha works in harmony and functions in a balanced manner, the result is health and a feeling of well-being in the individual. However, in cases of imbalance and disharmony, the result is illness or disease. The tridosha affects the creation, maintenance and destruction of bodily tissues and the elimination of toxins (ama) from the body. It is also 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 (vata, pitta and kapha) has recently been redefined as an equilibrium, balance and coordination between the three vital body systems: the central nervous system (CNS) corresponding to vata, the endocrine system to pitta and the immune axis to kapha, operating with both positive and negative feedback. To try and correlate this ancient philosophy with modern science is difficult, but some analogies can be drawn. The tridosha can be considered to govern all metabolic activities: catabolism (vata), metabolism (pitta) and anabolism (kapha). 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. Excess pitta disturbs metabolism generally. The tridosha can be described further:

• Vata, affiliated 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, all forms of movement, heartbeat and nervous impulses.

• Pitta is affiliated to fire and water, and governs bodily heat and energy. It, therefore, controls body temperature, is involved in metabolism, digestion, excretion and the 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, including that of immunity, the production of mucus, synovial fluid and joint lubrication and assists with wound healing, vigour and memory retention.

Prakruti, the human constitution

Humans can also be divided into personality types, and the constitution of an individual (prakruti) is determined by the state of the parental tridosha at conception (unlike astrology, which depends on time of birth). Most people are not completely one type or another, but can be described as vatapitta or pittakapha, for example. People of vata constitution are generally physically under-developed with cold, rough, dry and cracked skin. People with pitta constitution are of medium height with moderate muscle development. Kapha people have well-developed bodies. Table 12.3 can be used to indicate constitution in a superficial way, but it is not a tool for self-diagnosis!

Table 12.3 Determining the human constitution according to the tridosha

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As well as the vata, pitta and kapha type of personalities, three attributes provide the basis for distinctions in human temperament, individual differences, and psychological and moral dispositions. These basic attributes are satva, rajas and tamas. In brief, satva expresses essence, understanding, purity, clarity, compassion and love; rajas describes movement, aggressiveness and extroversion; and tamas manifests in ignorance, inertia, heaviness and dullness. In Ayurveda, a state of health exists when the digestive fire (agni) is in a balanced condition and the bodily humors (vata-pitta-kapha) are in equilibrium. The three waste products (mala), which are urine, faeces and sweat, should be produced at usual levels, the senses functioning normally, and the body, mind and consciousness working in harmony. When the balance of any of these systems is disturbed the disease process begins.

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. Food will not be digested or absorbed properly, and toxins will be produced in the intestines, and may find their way into the circulation. These toxins are known as ama and are the root cause of disease. Overactive ama is also detrimental in that over combustion of nutrients may occur, leading to vata disorders and emaciation.

Malas, the three waste products

These are, as may be expected, the faeces, urine and sweat, and production and elimination of these are vital to health. Their appearance and properties can give many indications of the state of the tridosha and, therefore, health. As an example, the colour of urine depends on the diet, and, if the patient has a fever or jaundice (pitta disorders), it may be darker. Substances such as coffee and tea, which stimulate urination, also aggravate pitta and render the urine dark yellow.

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. Health can be maintained by taking steps to keep vata-pitta-kapha in balance through a proper diet, exercise and rejuvenation programme. The dhatus do not correspond to our definition of anatomy, but are more a tissue type than an individual organ.

Gunas, the attributes

Ayurveda encompasses a subtle concept of attributes or qualities called gunas. Caraka, the great Ayurvedic physician, theorized that organic and inorganic substances, as well as thought and action, all have definite attributes. These attributes contain potential energy while their associated actions express kinetic energy. Vata, pitta and kapha each have their own attributes, and substances having similar attributes will tend to aggravate the related bodily humor. The concepts governing the pharmacology, therapeutics and food preparation in Ayurveda are based on the action and reaction of the attributes to and upon one another. Through understanding of these attributes, the balance of the tridosha may be maintained. The diseases and disorders ascribed to vata, pitta and kapha are treated with the aid of medicines, which are characteristic of, but possessing the opposite attribute, to try and correct the deficiency or excess. Vata disorders are corrected with the aid of sweet (madhur), sour (amla) or saline and warm (lavana) medicines. The excitement or ‘aggravation’ of pitta is controlled by sweet (madhur), bitter (katu) or astringent and cooling (kashaya) herbs. Kapha disorders are corrected with pungent (tikta), bitter (katu) or astringent and dry (kashaya) herbs. The use of herbs in correcting any imbalance is of extreme importance and is essential for proper functioning of the organism. There is often little distinction between foods and medicines, and controlling the diet is an integral part of Ayurvedic treatment. Foods are also described according to their properties, such as their taste (rasa) and physical and chemical properties (guna); these affect the tridosha (see Table 12.4).

Table 12.4 Effect of different foods on the tridosha

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Application of ayurveda

Diagnosis

Taking the case history involves astrological considerations, as well as a thorough medical examination where the appearance of the tongue, properties of the urine, sweat and sputum will also be examined. Karma, the good and bad effects across reincarnations, is also taken into account.

Treatment

This may involve diets, bloodletting, fasting, skin applications and enemas used to cleanse the system. There is a programme consisting of five types of detoxification, known as panchkarma. Drugs may then be given to bring the dhatus into balance again. These include herbal treatments as well as minerals, and there are thousands in use. In addition, yogic breathing and other techniques are used. All will have their properties described: rasa, guna and their karma, as well as which doshas they affect. Some of the most popular herbes of Ayurveda are shown in Table 12.5.

Table 12.5 Some important herbs of Ayurveda and their uses

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In modern Indian herbal medicine the Ayurvedic properties are described together with the conventional pharmacological and phytochemical data. Drugs are prepared as tinctures, pills, powders and some formulae unique to Ayurveda (see Table 12.6). Ayurveda is very metaphysical, too much so for many Westerners to grasp, and practitioners view it as a way of life as opposed to a career.

Table 12.6 Methods of preparing Ayurvedic medicines

Formulation Method of production
Juice (swaras) Cold-pressed plant juice
Powder (churna) Shade-dried, powdered plant material
Cold infusion (sita kasaya) Herb/water 1:6, macerated overnight and filtered
Hot infusion (phanta) Herb/water 1:4, steeped for a few minutes and filtered
Decoction (kathva) Herb/water 1:4 (or 1:8, 1:16 then reduced to 1:4), boiled
Poultice (kalka) Plant material pulped
Milk extract (ksira paka) Plant boiled in milk and filtered
Tinctures (arava, arista) Plant fermented, macerated or boiled in alcohol
Pills or tablets (vati, gutika) Soft or dry extracts made into pills or tablets
Sublimates (kupipakva rasayana) Medicine prepared by sublimation
Calcined preparations (bhasma) Plant or metal is converted into ash
Powdered gem (pisti) Gemstone triturated with plant juice
Scale preparations (parpati) Molten metal poured on leaf to form a scale
Medicated oils or ghee (sneha) Plant heated in oil or ghee
Medicated linctus/jam (avaleha) Plant extract in syrup

Rasayana

Rasayana are remedies considered to have diverse action and, therefore, affect many systems of the body, leading to a positive effect on health – panaceas in other words. The most important are Asparagus racemosa (shatavari), Emblica officinalos (amla), Piper longum (pimpli), Terminalia chebula (haritaki), Tinospora cordifolia (guduchi) and Withania somnifera (ashwagandha). They are included in many recipes and are used to strengthen the tissues of the body. In general, modern research has found them to have antioxidant, immunomodulating and various other activities.

Acceptance of Ayurveda in Europe and other regions of the world is growing, but often its main role is in uses associated with ‘wellness’ and spa treatments, resulting in a dilution of traditional Ayurvedic concepts.

Traditional african medical systems

Very little about plant use in Africa has been written down. It is an important tradition passed on orally and many of the features of traditional African medical systems (TAMS) are similar to those of cultures in other parts of the world, and, like them, many practitioners were illiterate. The term ‘medical system’ is used to describe the complexity of medical practices in a society. The cultural diversity in Africa has resulted in a variety of different TAMS, although these often share important elements. TAMS as a whole tends to be empirical rather than theoretical, but it does assume the existence of supernatural forces in the cause of disease to a greater extent than some other systems and has been described as ‘non-scientific’ as a result of this. These general observations apply to TAMS in several different African societies; similar principles are involved, although details and some of the plants will be different.

Concepts in traditional african medical systems

The causes of disease, as they are defined culturally, are essential for an understanding of TAMS. In African thought, all living things are connected to each other and to the gods and ancestral spirits. If harmony exists between all of these then good health is enjoyed, but, if not, misfortune or ill-health will result. Forces can be directed at humanity by displeased gods, ancestors and also by witches, resulting in disharmony, which must be resolved before good health can be restored. Treatment may also involve much more than medicine; practices such as divination and incantation may be carried out to help with diagnosis, and sacrifices may be needed to placate the supernatural entity. The traditional healer is likely also to be a religious leader, since health and spirituality are closely intertwined in TAMS.

Apart from physical examination, the diagnosis may also involve several other forms of diagnosis and treatment:

• Confessions may be extracted. These are thought to be both healing and prophylactic. In the case of a child, the mother may need to examine her previous behaviour, since the sins of the mother can be visited on the child (this compares with ideas in Christianity and other religions).

• Divination may be required, and may involve throwing objects and interpreting the pattern in which they fall. This is a consistent feature of many cultures and still persists in Europe in such forms as the ‘reading of tea leaves’.

Serious illness is considered to be due to supernatural causes much more than minor aches and pains are, and treatment will correspondingly be more concerned with ritual, incantation and sacrifice than it would for minor disorders. Herbal medicines will be part of the ritual and less likely to lead to expected or anticipated pharmacological or therapeutic activity. The treatment of disease is based on mind–body dualism and is, therefore, holistic; it is concerned with the whole lifestyle of the patient. This spiritual emphasis is important and can be rationalized with respect to modern life to some extent. If stress is caused by a breakdown in relationships with neighbours, family or work colleagues, or to immoral behaviour and the resulting guilt, or sins due to disobedience of religious laws, lowered immune resistance and ill-health may ensue. We now recognize the importance of psychosomatic factors and the placebo effect demonstrates this very well. Although we are at present looking at TAMS mainly as a source of new drugs, it may well be that the practices of making amends, sorting out your life and living according to a reasonable moral code has as many lessons for modern medicine as testing medicinal plants for pharmacological activity!

In TAMS, medicinal plants are used in two ways, only one of which corresponds to our perception of drug therapy. When we talk of research into traditional medicines, we are really talking about the scientific analysis of medicinal plants. Some of the most commonly used African ones are listed in Table 12.7. The traditional healer will, however, use medicinal plants not only for their pharmacological properties but their power to restore health as supernatural agents. This is based on two important assumptions:

• Plants are living and it is thought that all living things generate a vital force, which can be harnessed.

• The release of the force may need special rituals and preparations such as incantations to be effective. This belief is rather similar to the concept held by some people nowadays that uncooked vegetables, particularly things such as sprouting beans, somehow contain a ‘life-force’ which is beneficial to health.

Table 12.7 Examples of common and widely used African medicinal plants and the main conditions for which they are used

Species Indigenous use
Rauvolfia vomitoria (Apocynaceae) Holarrhena wulfsbergii (Apocynaceae) Mental illness (especially schizophrenia)
Xylopia aethiopica (Annonaceae)
Piper guineense (Piperaceae)		 Oedema
Pycnanthus kombo (Myristicaceae)
Aframomum latifolium (Zingiberaceae)
Harpagophytum procumbensa (Pedaliaceae)		 Pain, inflammation, lumbago
Plumbago zeylanica (Plumbaginaceae)
Cassia alata (Caesalpiniaceae)		 Skin diseases
Elaeophorbia drupifera (Euphorbiaceae)
Picralima umbellata (Apocynaceae)		 Worms
Ricinus communis (Euphorbiaceae)
Carica papaya (Caricaceae)		 Contraceptive
Diospyros mespiliformis (Ebenaceae)
Ficus elegans (Moraceae)		 Dysentery, diarrhoea
Prunus africanaa (Rosaceae) Male urinary problems

a Developed into phytomedicines used in Europe and North America.

The method of application is essential for understanding TAMS. In conventional medicine, some form of absorption of the drug must take place. It can be orally, rectally, parenterally, topically or by inhalation. In TAMS, this is not necessarily important (although it will happen in many instances) as ingredients can be encapsulated and worn as an amulet, necklace or around the wrist or ankle. They may not even come into contact with the patient at all; perhaps being placed above the door, or under a mat or pillow. These practices are to ward off the evil spirits, which may be causing the disease.

In some cases, the choice of a species has been made on a basis that has no bioscientific rationale; for example, a plant that bears many fruits may be used to treat infertility. This is rather like the ancient ‘Doctrine of Signatures’, where the plant was thought to display features indicating to the healer what it should be used for. It is a recurrent theme in the history of medicine. For example, walnuts were thought to be good for the brain because they resemble the cerebellum, and in Chinese medicine the use of animal parts is thought to endow the person consuming them with the properties of the animal. Tigers’ bones are taken to imbue strength and courage, and the horn of the rhinoceros to increase sexual vigour. These observations show that plants used in these ways may not necessarily lead us to new drugs, except as a random result.

Further reading

Govindarajan R., Vijayakumar M., Pushpangadan P. Antioxidant approach to disease management and the role of Rasayana herbs of Ayurveda. J. Ethnopharmacol.. 2005;99:165-178.

Lad V. Ayurveda the science of self-healing. Wisconsin: Lotus Press; 1990.

Mukherjee P.K., Mukherjee D., Venkatesh M., Rai S., Heinrich M. The sacred lotus (Nelumbo nucifera) – phytochemical and therapeutic profile. J. Pharm. Pharmacol.. 2009;61:407-422.

Neuwinger H.D. African traditional medicine. Stuttgart: Medpharm; 2000.

Okpako D.T. Traditional African medicine: theory and pharmacology explored. Trends Pharmacol. Sci.. 1999;20:482-485.

Sairam T.V. Home remedies. India: Penguin, 2000;vols. I–III.

Sofowara A., editor. African medicinal plants: Proceedings of a conference. Nigeria: University of Life Press, 1979.

Thomas O.O. Perspectives on ethno-phytotherapy of Yoruba medicinal herbs and preparations. Fitoterapia. 1989;60:49-60.

Williamson E.M., editor. Major herbs of Ayurveda. Edinburgh: Churchill Livingstone, 2002.

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