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

Specialist Physical Medicine & Rehabilitation Ayurvedic Practitioner DHTC

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History of Herbal Medicine

y Since early civilization y Nobody knows exactly when it started y 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 y y y y

one active ingredient derived from plants Aspirin-Salicylic acid- White willow bark Quinine- Cinchona bark Vincristine-Periwinkle Morphine & Codeine- Opium poppy seed

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Egyptian Medicine
y Edwin Smith Papyrus: Ancient Egyptian text book

( surgical) dates back to 3000 BC y Earliest known surgery in Egypt was performed in BC 2750 y Ebers papyrus: (c. 1550 BC) is applications meant to turn away disease-causing demons, and other superstition. y Kahun Gynaecological Papyrus: (c.1800 BC)treats women's complaints, including problems with conception.
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IMHOTEP Considered as founder of Egyptian medicine

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Babylonian Medicine
y Early phase of second Millennium BC y Diagnostic Handbook written by the physician

Esagil-kin-apli of Borsippa is one of the earliest book y As in Egyptian medicine, Introduced concept of diagnosis, prognosis, physical examination and prescription y Hebrew Medicine: 1st Millennium BC from Torah ; 5 books of Moses
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Indian Medicine ( Ayurveda)

y Early writings from Atharva veda- sacred book of Hindus ( Early Iron age 1200- 272 BC) y 1st Millennium BC: Ayurveda world s first scientific system of medicine emerged y Two schools of thought available as compendium of texts: Surgical Susrutha; Medical Charaka y Susrutha Compendium: Various surgeries and surgical equipments are described. Technique for rhinoplasty ( even mentioned in modern text books), ear lobe surgeries, cataract , CS and perineal surgeries y Susrutha : Father of Surgery/Father of Aesthetic Surgery
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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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Ayurveda
y Susrutha samhita has 184 chapters, 1120 conditions

described, 125 surgical instruments and 300 surgeries mentioned in 8 sections y Caraka samhita: More of internal medicine,120 chapters under 8 sections. y Ayurvedic 8 branches of Medicine: 1. Internal Medicine 2. Surgery including Anatomy 3. ENT and Eye disorders
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Ayurveda
4. Paediatrics 5. Toxicology 6. Spirit Medicine/ Psychiatry 7. Rejuvenation Medicine/ Medicine for longevity 8. Aphrodisiac Medicine

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Chinese Medicine
Basic Text is Yellow emperor s 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, Tui na massage. They try to balance Ying & Yang

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Greek Medicine
y Healing in temples dedicated to Aesclepius- the

healer God y First Greek medical school opened in Cnidus in 700 BC y Hippocratic Corpus; collection of 70 medical works by Hippocrates and his students y Hippocrates ( 460-370 BC) considered as father of modern medicine

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Hippocrates
y Categorized illness into acute chronic, epidemic

endemic, terms like exacerbations, relapse, paroxysms, convalescence y Major contribution to Thoracic Empyema: symptoms, physical findings, surgical treatment and convalescence. y Described Clubbing y 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 temples fallen in, the ears cold and drawn in and their lobes distorted, 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 of time], it must be realized that this sign portends death."

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Galen
y Great Surgeon who performed brain & eye surgeries y In 1530s Andreas Vesalius translated many of Galen s

works from Greek to Latin y Andreas Vesalius was one of the first doctors to openly criticise Galen. He corrected many of the mistakes that Galen had made on human anatomy

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Islamic Medicine
y Influenced by Greek, Roman and Indian Medical

practices; helped in further development of these medicine y Hunayn ibn Ishaq and his assistants translated 129 works of Greek physician Galen to Arabic y Muslim physicians set up the earliest dedicated hospital which later spread to Europe during the Crusade

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Islamic medicine
y Abu al-Qasim (Abulcasis) wrote Kitab al-Tasrif a 30

volume medical encyclopaedia and some considers him as Father of Modern Surgery y Ibn al-Nafis ( 1242) was the first to describe pulmonary and coronary circulation y Mansur ibn Ilyas (c. 1390) wrote The Tashrih albadan (Anatomy of the body)

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Modern Medicine
y Andreas Vesalius was born in Brussels in 1514

officially the world's first modern anatomist y First doctor to openly criticise Galen y William Harvey was 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 Medicine
y John Snow a London doctor researched an outbreak

of cholera in the Broad Street area of London, First epidemiologist. y Edward Jenner a British doctor discovered and introduced first vaccine against Small pox ( end of 18th century) y Louis Pasteur first came up with the germ theory y Robert Koch was the doctor ( born in Prussia 1843) who related Pasteur's germ theory to human illness
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Modern Medicine
y Joseph Lister (born in England 1827) invented the use y y y y

of carbolic acid as an anti-septic to kill germs in operations Considered as Father of Modern Surgery In 1901 blood groups were discovered. Alexander Fleming 1928 in Britain discovered that penicillin Leonardo da Vinci (1452 - 1519) was unofficially the world's first anatomist
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History of Pharmacology
y Organic chemistry started in 1828 when Friedrich

Wohler synthesized urea from inorganic substances. y Oswald Schmiedeberg (1838 1921) is generally recognized as the founder of modern pharmacology. y In 1878, he published a classic text, Outline of Pharmacology

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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. Al Ashshab : the herbalist ( like pharmacist) 3. Al Daya : the midwife ( like gynaec) 4. Al Mutawwa: religious leader ( Psychiatrist)

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Folk Medicine
y 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 the body parts for healing

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Modern Medicine
y First Hospital opened Sharjah 1952 Sara Hospital y Al waha ( oasis hospital) in Al Ain 1960 - Drs. Pat and

y y y y

Marian Kennedy first arrived in November of 1960, at the invitation of Sheikh Zayed bin Sultan Al Nahyan Al Maktoum Hospital Completed by 1973 ( first phase started in 1951) Rashid Hospital opened in 1972 Dubai Hospital 1983 Al Wasl Hospital 1986
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Importance of Herbal Medicines

y Natural Medicine y Many modern pharmaceutical preparations are y y y y y

extractions from Herbs Many more to come Less side effects, if any Gentle to the system Active ingredients vary from part to part Extraction and concentration right approach?

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Bottoms up approach
y Modern Medicines come from lab to population y Herbs come from population to lab y Many are used as Folk medicines, traditional

preparations for centuries y Most of the uses and side effects ( if any ) are already known to mankind y But when it is concentrated are they becoming too strong to produce side- effects?

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y Wild plants in their natural habitat has more potency y y

y y

than when cultivated Heavy metal poisoning depends upon where they are grown Plant has many alkaloids for synergistic action to improve its efficacy or antagonistic to reduce the unwanted effects But when we extract and concentrate one ingredient, it produces side effects Then we chemically replicate its structure
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Adverse Effects
y Intrinsic: Due to phytochemicals in the product- Dose

related toxicity and interactions and idiosyncratic reactions y Extrinsic: Due to mis identification of plant, lack of standardization, impurities thru contamination, adulteration or substitution, inappropriate labeling, incorrect dosage y Some studies show that about 24% of over 2600 traditional Chinese medicines samples contained an adulterant, 50% contain two or more adulterant like anti inflammatory, analgesic and diuretic
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Organ systems affected

y Most common general reaction involve the Skin, liver y

y y y

and GIT Hepatotoxicity and liver enzyme elevation are seen in some herbs like Germander, Chaparrel, Borage, Skullcap etc. GIT: Nausea and vomiting with Echinacea and Ephedra Some herbs antagonize Warfarin Sauropus androgynus and Aristolochia are known to produce Hepatitis, renal failure and bronchiolitis obliterans
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Some herbs and its possible side effects

Echinacea:
y Immune system stimulant y Allergic reaction usually mild like asthma, atopy and

rhinitis 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 immunosuppressive therapy
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Feverfew
y Used for migraines y Suppresses PG and TX production y Gastric upsets, oral ulcers y Cautious in patients getting anticoagulants

Garlic:
y HT and Hyper cholesterolemia y Allicin is the effective alkaloid y Anticoagulant patients cautious
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Ginkgo biloba
y y y y

Improve circulation and cognition Produce dizziness, nausea, head ache, sensitive skin Platelet inhibitor Caution in patients with anti coagulant medications

St. John s Wort

y 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 Regulations

y No uniform standards y Most reputed companies follow GMP standards y Comes under three categories ( in UK) y Unlicensed herbal remedies Doesn t 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 preparations y Licensed Herbal Medicines Just like any other medicines, Needed to demonstrate safety, quality and efficacy
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Benefits and Flaws of Regulation

More standardization Some sort of reliability Less adulteration Becomes more expensive Only leading players with more money can enter into the field y Many are combinations and they have multiple indications y Standardization difficult y Era of tissue culture and potency issues
y y y y y
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Regulating and assessing Practitioners

y More than 80% of world population use some sort of y y y y y y

Herbal Medicine Needs to have separate parameters Too much complicated Different systems, different regions, regional needs Different formulations Medical Doctors needs training in Alternative Medicine Alternative Medicine Practitioners need exposure to Modern Pharmacology, Emergency medicine
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Modern Pharmaceuticals
y Able to determine concentration potency and dosage y Make it available universally y Various formulations like time release, injectables y 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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Pharmacogenomics
y New theory? y No y Concept of personalized medicines were there in

Traditional medicines y Ayurveda stresses the need of having personalized medications y Concept of Prakruthi: Biophysiological profile

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Era of Pharmaceuticals
y We are in the era of Pill for every illness y This is a reductionist approach y No question that Modern Medicine has tremendous

advances in Emergency medicine Surgery and diagnostic tools y When it comes to chronic diseases it doesn t have much answers y Why 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 Association

stated that prescription drugs kill over 100,000 people per year in U. S. hospitals. y One in seven hospital beds is taken up by patients suffering from adverse drug reactions y The General Accounting Office stated that 51.5% of all drugs introduced between 1976 and 1985 had to be relabelled because of serious adverse reactions found after the marketing of these drugs y Why more lives are saved when hospitals go on strike?
Doctors' strike in Israel may be good for health Judy Siegel-Itzkovich BMJ 8/12/2011 2000;320:1561 doi:10.1136/bmj.320.7249.1561 (Published 10 June 2000) Dr. Manoj
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Thank You

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