herbal & modern medicine compare and contrast

8/6/2019 Herbal & Modern Medicine Compare and Contrast

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Dr. Manoj KumarB.A.M.S.;M.B.B.S.;D.P.M.&R.;D.N.B.

Specialist Physical Medicine & RehabilitationAyurvedic Practitioner

DHTC

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History of Herbal Medicine

y Since early civilization

y Nobody knows exactly when it startedy Been there as part of folk medicine with all

civilizations.

y Egyptian Medicine, Greek Medicine, Indian Medicine,

Chinese Medicine

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Modern Medicine: Roots in Herbal

Medicine

y 25% of prescription drugs used in USA contain at least

one active ingredient derived from plantsyAspirin-Salicylic acid- White willow bark

y Quinine- Cinchona bark

yVincristine-Periwinkle

y Morphine & Codeine- Opium poppy seed

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Egyptian Mediciney Edwin Smith Papyrus:Ancient Egyptian text book

( surgical) dates back to 3000 BC

y Earliest known surgery in Egypt was performed in BC2750

y Ebers papyrus: (c. 1550 BC) is applications meant toturn away disease-causing demons, and other

superstition.y Kahun Gynaecological Papyrus: (c.1800 BC)treats

women's complaints, including problems withconception.

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IMHOTEP

Considered asfounder ofEgyptian medicine

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Babylonian Medicine

y Early phase of second Millennium BC

y Diagnostic Handbookwritten by the physicianEsagil-kin-apli of Borsippa is one of the earliest book

yAs in Egyptian medicine, Introduced concept ofdiagnosis, prognosis, physical examination and

prescriptiony Hebrew Medicine: 1st Millennium BC from Torah ; 5

books of Moses

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Indian Medicine ( Ayurveda)y Early writings fromAtharva veda- sacred book of Hindus

( Early Iron age 1200- 272 BC)

y 1st Millennium BC:Ayurveda worlds first scientific systemof medicine emerged

y Two schools of thought available as compendium of texts:Surgical Susrutha; Medical Charaka

y SusruthaCompendium:Various surgeries and surgical

equipments are described. Technique for rhinoplasty ( evenmentioned in modern text books), ear lobe surgeries,cataract , CS and perineal surgeries

y Susrutha : Father ofSurgery/Father ofAestheticSurgery

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Susrutha

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Susrutha Rhinoplasty

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Surgical instruments Susrutha

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Susrutha Compendium

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Caraka

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Caraka Compendium

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Ayurveday Susruthasamhitahas 184 chapters, 1120 conditions

described, 125 surgical instruments and 300 surgeries

mentioned in 8 sectionsy Carakasamhita: More of internal medicine,120

chapters under 8 sections.

yAyurvedic 8 branches of Medicine:

1. Internal Medicine2. Surgery including Anatomy

3. ENT and Eye disorders

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Ayurveda

4. Paediatrics5. Toxicology

6. Spirit Medicine/ Psychiatry

7. Rejuvenation Medicine/ Medicine for longevity

8. Aphrodisiac Medicine

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Chinese MedicineBasic Text is Yellow emperors Inner Canon; which is

composed of two books Suwen and Lingshu

The texts attributed to Yellow emperor 27th

Century BC (some date them 5th Century- 221 BC)

Consists of Chinese herbal medicine, Acupuncture, Tuina massage.

They try to balance Ying & Yang

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Greek Mediciney Healing in temples dedicated toAesclepius- the

healer God

yFirst Greek medical school opened in Cnidus in 700BC

y Hippocratic Corpus; collection of 70 medical works byHippocrates and his students

y Hippocrates ( 460-370 BC) considered as father ofmodern medicine

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Hippocratesy Categorized illness into acute chronic, epidemic

endemic, terms like exacerbations, relapse, paroxysms,

convalescencey Major contribution to Thoracic Empyema: symptoms,

physical findings, surgical treatment andconvalescence.

y

Described Clubbingy First documented Chest surgeon

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Hippocrates

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Hippocratic face

y [If the patient's facial] appearance may be described

thus: the nose sharp, the eyes sunken, the templesfallen in, the ears cold and drawn in and their lobesdistorted, the skin of the face hard, stretched and dry,and the colour of the face pale or dusky. and if there

is no improvement within[a prescribed period oftime], it must be realized that this sign portends

death."

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Galeny Great Surgeon who performed brain & eye surgeries

y In 1530sAndreas Vesaliustranslated many of Galens

works from Greek to Latiny AndreasVesaliuswas one of the first doctors to

openly criticise Galen. He corrected many of themistakes that Galen had made on human anatomy

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Islamic Mediciney Influenced by Greek, Roman and Indian Medical

practices; helped in further development of these

mediciney Hunayn ibn Ishaq and his assistants translated 129

works of Greek physician Galen to Arabic

y Muslim physicians set up the earliest dedicated

hospitalwhich later spread to Europe during theCrusade

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Islamic mediciney Abual-Qasim (Abulcasis)wrote Kitab al-Tasrifa 30

volume medical encyclopaedia and some considers

him as Father of Modern Surgeryy Ibnal-Nafis ( 1242)was the first to

describe pulmonary and coronary circulation

y Mansur ibn Ilyas (c. 1390)wrote The Tashrih al-

badan (Anatomy of the body)

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Modern Mediciney AndreasVesaliuswas born in Brussels in 1514

officially the world's first modern anatomist

y

First doctor to openly criticise Galeny William Harveywas born in 1578. Harvey's greatest

discovery was on the circulation of the blood.

y Ambroise Pare born in France in 1510 treated war

wounds and found out ligature

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Modern Mediciney John Snow a London doctor researched an outbreak

of cholera in the Broad Street area of London, First

epidemiologist.y EdwardJenner a British doctor discovered and

introduced first vaccine against Small pox ( end of 18th

century)

y

Louis Pasteur first came up with the germ theoryy Robert Kochwas the doctor ( born in Prussia 1843)

who related Pasteur's germ theory to human illness

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Modern Mediciney JosephLister (born in England 1827) invented the use

of carbolic acid as an anti-septic to kill germs in

operationsy Considered as Father of Modern Surgery

y In 1901 blood groups were discovered.

y Alexander Fleming 1928 in Britain discovered that

penicilliny Leonardo daVinci (1452 - 1519) was unofficially the

world's first anatomist

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History of Pharmacologyy Organic chemistry started in 1828 when FriedrichWohler synthesized urea from inorganic substances.

y

Oswald Schmiedeberg (18381921) is generallyrecognized as the founder of modern pharmacology.

y In 1878, he published a classic text, Outline ofPharmacology

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Oswald Schmiedeberg

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Folk Medicine UAE

y Four types of practitioners in traditional UAE society;

1. Al Mutabbib: Traditional healer ( like GP)2. AlAshshab : the herbalist ( like pharmacist)

3. Al Daya : the midwife ( like gynaec)

4. Al Mutawwa: religious leader ( Psychiatrist)

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Folk Mediciney Al Hijama( Blood letting) &Al fasd ( blood letting

with out suction) widely practiced in UAE for back

ache, tooth ache and cataract.y Performed by village barber

y Al tajbir ( bone setting) traditional orthopaedists.They used splints of wood instead of Plaster

y Al wasm ( curing by fire) using hot iron rod to thebody parts for healing

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Importance of Herbal Medicinesy Natural Medicine

y Many modern pharmaceutical preparations are

extractions from Herbsy Many more to come

y Less side effects, if any

y Gentle to the system

yActive ingredients vary from part to part

y Extraction and concentration right approach?

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Bottoms up approachy Modern Medicines come from lab to population

y Herbs come from population to lab

y Many are used as Folk medicines, traditionalpreparations for centuries

y Most of the uses and side effects ( if any ) are alreadyknown to mankind

y But when it is concentrated are they becoming toostrong to produce side- effects?

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yWild plants in their natural habitat has more potencythan when cultivated

y

Heavy metal poisoning depends upon where they aregrown

y Plant has many alkaloids for synergistic action toimprove its efficacy or antagonistic to reduce the

unwanted effectsy But when we extract and concentrate one ingredient, it

produces side effects

y Then we chemically replicate its structure

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Adverse Effectsy Intrinsic: Due to phytochemicals in the product- Dose

related toxicity and interactions and idiosyncraticreactions

y Extrinsic: Due to mis identification of plant, lack ofstandardization, impurities thru contamination,adulteration or substitution, inappropriate labeling,incorrect dosage

y Some studies show that about 24% of over 2600traditional Chinese medicines samples contained anadulterant, 50% contain two or more adulterant likeanti inflammatory, analgesic and diuretic

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Organ systems affectedy Most common general reaction involve the Skin, liver

and GIT

y Hepatotoxicity and liver enzyme elevation are seen insome herbs like Germander, Chaparrel, Borage,Skullcap etc.

y GIT: Nausea and vomiting with Echinacea andEphedra

y Some herbs antagonize Warfariny Sauropus androgynus and Aristolochia are known to

produce Hepatitis, renal failure and bronchiolitisobliterans

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Some herbs and its possible side

effectsEchinacea:y Immune system stimulant

yAllergic reaction usually mild like asthma, atopy andrhinitis but can be serious like anaphylaxis

y Flavanoids may inhibit Cyt P450

y May lead to immunosuppression if taken prolonged (

> 8 wks)

y Not recommended in patients on immunosuppressivetherapy

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Feverfewy Used for migraines

y Suppresses PG and TX production

y Gastric upsets, oral ulcersy Cautious in patients getting anticoagulants

Garlic:y

HT and Hyper cholesterolemiayAllicin is the effective alkaloid

yAnticoagulant patients cautious

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Ginkgo bilobay Improve circulation and cognition

y Produce dizziness, nausea, head ache, sensitive skin

y Platelet inhibitor

y Caution in patients with anti coagulant medications

St. Johns Worty Used for depression, viral infections

y

Adverse effects Photosensitivity, allergic reactions,head ache, dizziness, nausea, vomiting

y Potential inhibitor of MAO

y Can interact with Warfarin

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Herbal Medicine Regulationsy No uniform standards

y Most reputed companies follow GMP standards

y Comes under three categories ( in UK)

y Unlicensed herbal remedies

Doesnt have nay specific standards or safety

y Registered Traditional Herbal Medicines

Required to meet some specified standards and quality with

some indication. More with Traditional preparationsy Licensed Herbal Medicines

Just like any other medicines, Needed to demonstrate safety,quality and efficacy

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Benefits and Flaws of Regulationy More standardization

y Some sort of reliability

y

Less adulterationy Becomes more expensive

y Only leading players with more money can enter intothe field

y

Many are combinations and they have multipleindications

y Standardization difficult

y Era of tissue culture and potency issues

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Modern PharmaceuticalsyAble to determine concentration potency and dosage

y Make it available universally

yVarious formulations like time release, injectablesy More studies in labs for best dosage and potency

y Studies about drug - drug interactions

y Herb drug interactions now growing science

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Pharmacogenomicsy New theory?

y No

y Concept of personalized medicines were there inTraditional medicines

yAyurveda stresses the need of having personalizedmedications

y Concept of Prakruthi: Biophysiological profile

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Era of PharmaceuticalsyWe are in the era of Pill for every illness

y This is a reductionist approach

y No question that Modern Medicine has tremendousadvances in Emergency medicine Surgery anddiagnostic tools

yWhen it comes to chronic diseases it doesnt have

much answersyWhy this system creates 3rd leading cause of deaths in

developed nations?

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Some Facts are scarier than Fiction!

y The Journal of The American Medical Associationstated that prescription drugs kill over 100,000people per year in U. S. hospitals.

y One in seven hospital beds is taken up by patients

suffering from adverse drug reactionsy The General Accounting Office stated that 51.5%

of all drugs introduced between 1976 and 1985 hadto be relabelled because of serious adversereactions found after the marketing of these drugs

yWhy more lives are saved when hospitals go onstrike?

Doctors'strike in Israel may be good for healthJudy Siegel-Itzkovich

BMJ 2000;320:1561 doi:10.1136/bmj.320.7249.1561 (Published 10 June 2000)8/12/2011 47Dr. Manoj


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Thank You

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herbal & modern medicine compare and contrast

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