Herri S.

Sastramihardja

Department of Pharmacology & Therapy Faculty of medicine Padjadjaran University

Background
Plants had been used for medicinal purposes by all culture throughout history
People in different part of the globe tended

to use similar plants for the same purposes

Many drugs commonly used to day are or herbal origin, for examples aspirin (from

willow bark), digokxin ( from foxglove), quinine (from cinchonar bark) & morphin (from opium poppy)

How do herbs work ?

For most herbs, the specific ingredient that

cause a therapeutic effect is not known

Whole herbs contain many ingredients (alkaloids,

terpenoid, saponin, flavonoids, phenols, volatile oils, etc) that work together to produce the desired medicinal effect

Many things must take into account when prescribing herbs, i.e :
Variety of plant The plants habitat How it was stored & processed Whether or not there are contaminants

Table 1. Comparism of modern phamacology and herbalism

Modern pharmacology

Herbalism

Isolated
One active ingredients One effect that measurable & repeatable

Holistic
Whole plants Synergistic effect of its components

Pharmacology characteristics of medicinal plants

Have a broad therapeutics range Onset of action occurred after a latent period

(weeks or months)

The action have usually been observed empirically

in human patient treated with the herbs

Pharmacology characteristic

(continued)

Accurate pharmacokinetic data for extracts that have a complex composition is difficult to obtain Subjective assessments by the patients or physician used to evaluate efficacy
Do not indicate to use in emergency or acute situations

Demand & advantages of herbal remedies

Demand is rooted partly in the emotional

perception that natural products are gentler & less hazardous than chemical products herbal remedies are safe & tolerable

Greater trust on the part of the patients that

Table 2. Phytomedicines that have undergone

pharmacology testing
Herb extract

Pharmacological action

uses

Ginkgo biloba Leaf extracts

Anti ischemic Anti hemorrheologic anti PAF hypolipidemic Antithrombotic fibrinolytic Hypotensive positive inotropic anti arrythmic coronary vasodilatation

Cerebral insufficiency Peripheral vascular disense Dyslipidemia CV-disorders

Garlic cloves (Allum satium)

Hawthorn extract (Cratageus monogyna)

mild heart failure (St. II NYHA)

Table 3. The nine priority of Indonesian

medicinal plant ( =IMP )
Pharmacological action
hypolipidemic antiinflammatory antioxidant apetite stimulant galactogogue

Herb extract

uses
dyslipidemia GI disorder hepatic disorder anorexia flow of milk PP uterine resolution dyslipidemia rheumatic disease diare / dyspepsie hepatic disorder gingivitis

Curcuma xanthorizae (= temu lawak)

Curcuma domestica ( = kunyit)

hypolipidemic antiinflammatory antispasmodic stomachic carminative thrombolytic

Table 4. The nine priority of IMP (continued..)

Herb extract

Pharmacological action

uses
Rheumatic disease common cold chronic leukemia Peptic ulcer atheroselerotic disease DM otitis

Andrographis paniculata (=sambiloto)

antipyretic Antiinflammatory Immunostimulant Antispasmodic Antisecretory mucosal protectivle antithrombotic Hypoglycemic antibcterial

Guazuma ulmifolia (= jati belanda)

astringent Diaphroretic Lipase stimulation hypolipidemic

dyslipidemia diarhe / dyspepsie Leucorrhoe

Table 5. The nine priority of IMP

Herb extract

(continued..)

Pharmacological action

uses

Zingiber officinale (= jahe merah)

antiemetic carminative antispasmodic antiinflammatory alkylating antioxidant hyportensive hypoglikemic antispasmodic carminative antiinflamatory apphrodisiac counter irritant

motion sickness emesis intestinal colic diarrhe / dyspepsie chronic leukemia hepatic disorder hypertension DM dyspepsie PVD neuralgic rheumatic pain (local) aroma therapy sexsual dysfunction

Morinda citrifolia ( = mengkudu ) Piper retropraktum ( = cabe jawa)

Table 6.The nine priority of IMP (continued..)

Herb extract

Pharmacological action
astringent carminative hypoglycemic hypotensive

uses

Eugenia polyantha ( = daun salam)

diarrhe / dyspepsie gastritis DM Hypertension

Psidium guajava (daun jambu biji)

imunomodulation antiviral thrrombosiy

DHF

Table 7. Potential interaction between herbal

and conventional drugs Herb

Conventional drugs
anabolic steroids, methotrexate, amiodarone, ketoconazole immunosuppresants

problem
hepatotoxicity

echinacea > 8 week

antagonist effect
altered bleeding time

garlic, ginger, ginkgo ginseng

warfarin

warfarin estrogens, corticosteroids

altered bleeding time additive effects

valerian

barbiturates

additive effects (exessive sedation)

Arah Pengembangan OTI Jamu : warisan budaya bangsa

Herbal terstandar :

telah digunakan secara empirik Sudah diuji farmakologi Bahan bakunya standar Bentuk sediaan modern s.d.a Sudah diuji klinik // OM
(Sampurno,2002)

Fitofarmaka:

TO Unggulan Nasional
Sambiloto Kunyit Daun Salam

Jati Belanda
Temu Lawak

Daun Jambu Biji Jahe Merah Mengkudu Cabe Jawa

Kriteria Dasar Unggulan

Tumbuh dengan baik di Indonesia
Telah dikenal khasiat & keamanannya Berpotensi ekonomis yang prospektif

Pandangan & Temuan Dokter/Klinisi dalam Pemanfaatan TO

Dukungan EBM belum mamadai & kurang dikomunikasikan
Iklan promosi OT seringkali berlebihan & tidak etis Tidak dijamin oleh ASKES

SOP in Formal health services

HISTORY EXAMINATION

DIAGNOSE

TREATMENT

without drugs

with drugs

EBM ?

Standard diagnostic

Standard treatment

Levels of Evidence-Ratings
I.

From a systematic review of all relevant RCT

II.

From at least one properly designed RCT

(Alternate allocation or some other method)

III. 1. From well-designed pseudo-RCT

2. From comparative studies with concurent controls & nonrandomized allocation (cohort studies), case-control studies or interrupted time series with a control group. 3. From comparative studies with historical control or interupted time series without a pararel control group. IV. From case series

Conclusion
The results from appropriate pharmacological testing and clinical study base on GCP is the good EBM to established the medicinal plant usage in formal health services