Lead in traditional and complementary medicine: a systematic review

Lead in the environment remains a matter of grave concern for public health. Lead has been associated with some traditional medicines and has been linked to cases of lead poisoning. A comprehensive compilation of these reports has not previously been conducted. The objective of this review is to explore how common is lead exposure after traditional medicine use, and which countries, systems and/or products are of most concern when it comes to lead contamination. A systematic search was conducted on PubMed, Ovid and EMBASE for studies published between 2005 and 2020. A grey literature search was conducted. Search terms related to lead and traditional medicine were developed for each database, and there were no limitations on language. Studies were included if they examined elevated lead in humans resulting from the use of traditional medicines reported in case reports, case-series, or observational studies. Of the papers discussing lead exposure, 85 case reports were identified and synthesized for the current review. Several themes were identified in the included studies. Traditional medicine has been used in the many parts of the world, however use is more common in South and Southeast Asian countries. The level of detectable lead in products varied widely by region and product types. Consumers of traditional medicines sought products for a wide variety of symptoms and ailments. The symptoms of lead poisoning from traditional medicine use reflected the typical symptom profile of lead poisoning, highlighting the need for awareness of traditional medicine products as a source of lead exposure. Traditional medicine usage remains an important part of health care in many regions, however there is a risk of lead exposure from several products. Health care practitioners in all regions of the world should be aware of the risk and explore the potential for traditional medicine use for patients presenting with elevated blood lead levels. Countries with a strong traditional medicine culture should explore policies for reducing lead exposure from traditional medicine products. JG, LO and MNBD are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization.

Ayush [Indian System of Medicines] Prophylaxis Against COVID-19: A Living Systematic Review and Meta-Analysis (Second Update)

Background: Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) system of medicine has been extensively used in India for the prevention and management of coronavirus disease 2019 (COVID-19). The present report is the second update of a living systematic review and meta-analysis and has been intended to assess the preventive potential and safety of Ayush drugs against COVID-19. Methods: A search of databases such as PubMed, the Cochrane central register of controlled trials, the World Health Organization (WHO) COVID-19 database, the clinical trial registry-India, the AYUSH research portal, and preprint repositories was performed till March 1, 2023. Randomized controlled trials or analytical observational studies were included. Incidences of COVID-19 infections and mortality were taken as primary outcome measures; and symptomatic severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, incidences of hospital admissions, and adverse events were taken as secondary outcomes. The risk of bias was evaluated by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool. Data were synthesized through the RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Out of 2350 articles, 15 studies were included in the review. The pooled estimate of Guduchi [Tinospora cordifolia (Thunb.) Miers], Chyawanprasha, and Ayuraksha kit was obtained. Meta-analysis of the data suggested that Guduchi may reduce the incidences of COVID-19 infections (risk ratio [RR]: 0.67 [95% confidence interval, CI: 0.48-0.95]) and the symptom development among the infected (RR: 0.88 [95% CI: 0.73-1.08]), however, no change was observed in hospital admissions (RR: 0.96 [95% CI: 0.20-4.53]). It is uncertain that Chyawanprasha reduces the incidence of COVID-19 infection (RR: 0.28; [95% CI: 0.07-1.08]). Ayuraksha kit as chemoprophylaxis may reduce the incidences of COVID-19 infections (RR: 0.49; [95% CI: 0.32-0.77]). The certainty of the evidence was low to moderate mainly due to the serious risk of bias. Conclusion: Prophylactic use of Ayush medicines for populations at risk may help to prevent COVID-19 infection by reducing incidence and severity. However, considering the certainty and fewer studies, high-quality studies are still desired to confirm the efficacy and safety of Ayush chemoprophylaxis for COVID-19. Nevertheless, this update will serve as a torchbearer for policymakers, physicians, and other stakeholders for their decision-making through evidence-based medicine.

Evaluation of traditional uses, phytochemical constituents, therapeutic uses and future prospects of Pyracantha genus: a systematic review

The Pyracantha genus consists of evergreen shrubs distributed from Southeast Europe to South-East Asia. They are found in geographical regions of India, China, and South West Europe. They are used in traditional medicines against earache, menstrual cycles, constipation etc. The genus is pharmacologically significant because of its antioxidant and antimicrobial effects. The genus also acts as a biomonitor species for heavy metals and bio sorbent in wastewater treatment. The review aims to present an overview of four species of the Pyracantha genus -P. crenulata, P. fortuneana, and P. coccinea and P. angustifolia. The comparison of their geographical distribution, traditional uses, therapeutic uses, phytochemical components and future prospects has been described. In this study, 189 research and review articles were scanned to provide summarised research of phytochemical composition, pharmacological effects and future prospects of the species which can benefit the plant as a therapeutic drug or as a functional food.

On the traditional medicinal plants and plant-derived natural drugs used by indigenous people of Nagaland, India

An ethnobotanical documentation on the medicinal plants used by local people of Nagaland (North-east India) has been presented here. The study explored 33 plant species (with their local names, indigenous applications, sources/origins, parts of plants used, bioactive compounds present, process of preparing medicines from the plants) belonging to 28 families have been reviewed thoroughly. Some examples are, Catharanthus roseus (Tsuinrinaro, Periwinkle), Acacia pennata (Chakrangaing, Ballikhadira), Adhatoda vasica (Kicharangnaro, Malabar-nut), Ageratum conzyoides (Imchenriza, Billy-goat-weed,/Tropical-white-weed), Alstonia scholaris (Lazarongpang, Blackboard), Rauvolfia serpentina (Per-mozutong, Indian-snakeroot), etc. Plant based drugs are very popular and effective in Nagaland from ancient times but thorough-documentation with scientific-background of effectiveness, active chemical-compounds present, their action-mechanism, etc., are still scanty. Such review can be of useful for pharmacologist, phyto-chemists to a broad group of researchers and may lead to discovery of new sources of novel medicines through traditional therapeutic knowledge.

Suspected cutaneous adverse drug reactions reported with traditional medicines: analysis of data for United Nations Asia region from WHO VigiBase

Background: Data on traditional medicine-induced cutaneous adverse drug reactions (ADRs) is very scarce. The current secondary analysis based on the WHO database (VigiBase) of individual case safety reports (ICSRs) focuses on the suspected cutaneous ADRs linked to traditional medicines (TMs). Methods: All the ICSRs reported between 1st January 2016 and 30th June 2021 from the UN Asia region in VigiBase where at least one TM was suspected to cause cutaneous ADRs were included in the study. Data regarding demographic details, suspected drug, adverse reaction as per MedDRA term, the seriousness of the reaction, de-challenge, re-challenge, and clinical outcome for suspected cutaneous ADRs associated with TM were obtained from VigiBase and analyzed for frequency of reported events and suspected medicines. Findings: Total 3,523 ICSRs with 5,761 ADRs related to "skin and subcutaneous tissue disorders" were included in the analysis. Amongst these, 6.8% of ICSRs were reported as serious. Pruritus (29.6%), rash (20.3%), urticaria (18.9%), and hyperhidrosis (3.3%) were commonly reported ADRs. Artemisia argyi H.Lév. and Vaniot. (14.9%), Ginkgo biloba L. (5.1%), Vitis vinifera L. (4%), Vitex agnus-castus L. (3.8%), Silybum marianum (L.), Gaertn (3.5%), and Viscus album L. (2.7%) were some commonly suspected TMs for cutaneous ADRs. There were 46 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis reported with TMs during the study period. Death was reported in 5 ICSRs. Interpretation: TMs are linked with various cutaneous ADRS ranging from pruritus to toxic epidermal necrolysis which may have serious consequences. TMs listed as suspected offending agents in this analysis, should be kept in mind while dealing with suspected cutaneous ADRs. Clinicians should be more vigilant in detecting and reporting events associated with TMs.

Kampo herbal ointments for skin wound healing

The management of skin wound healing problems is a public health issue in which traditional herbal medicines could play a determining role. Kampo medicine, with three traditionally used ointments, provides interesting solutions for these dermatological issues. These ointments named Shiunkō, Chuōkō, and Shinsen taitsukō all have in common a lipophilic base of sesame oil and beeswax from which herbal crude drugs are extracted according to several possible manufacturing protocols. This review article brings together existing data on metabolites involved in the complex wound healing process. Among them are representatives of the botanical genera Angelica, Lithospermum, Curcuma, Phellodendron, Paeonia, Rheum, Rehmannia, Scrophularia, or Cinnamomum. Kampo provides numerous metabolites of interest, whose content in crude drugs is very sensitive to different biotic and abiotic factors and to the different extraction protocols used for these ointments. If Kampo medicine is known for its singular standardization, ointments are not well known, and research on these lipophilic formulas has not been developed due to the analytical difficulties encountered in biological and metabolomic analysis. Further research considering the complexities of these unique herbal ointments could contribute to a rationalization of Kampo's therapeutic uses for wound healing.

Optimization of Process and Formulation Variables for Semha-Pinas Extract Effervescent Tablets Using the Box-Behnken Design

Semha-Pinas (SHPN) is a Thai traditional herbal formula used as an expectorant. Its traditional dosage form is pills, which are dispersed in water before use. The development of this recipe to effervescent tablets could enhance patient convenience with shortened the time needed to disintegrate the active ingredients. This work aimed to develop SHPN extract effervescent tablets based on process and formulation optimization using the Box-Behnken design. Four levels of three independent variables, including a compressional force, a quantity of effervescent base, and a quantity of fumed silica, were screened using the one factor at a time method. Three levels of each independent variable were included in the Box-Behnken design, including 1000 - 2000 psi, 46 - 52%, and 1.67 - 3.33%, respectively. Four responses were monitored, including tablet thickness, hardness, disintegration time, and friability. In terms of design space, the results showed that the tablet hardness was not less than 5 kP, disintegration time was not more than 5 min, and friability was not more than 1% found when 2000 psi compressional force was used. The optimal parameters were a compressional force of 2000 psi, effervescent base of 50%, and fumed silica of 2.5%. This formulation had a tablet weight of 598.86 ± 0.05 mg, a diameter of 12.68 ± 0.01 mm, a thickness of 3.67 ± 0.01 mm, a hardness of 5.57 ± 0.22 kP, a disintegration time of 1.68 ± 0.04 min, and friability of 0.43 ± 0.02%. In conclusion, this work succeeded in developing SHPN extract effervescent tablets with desired properties that were easy to use. Furthermore, the time needed to disintegrate the active ingredients was decreased when compared with the traditional dosage form due to being easily dissolved in water.

A multicenter study on practices and related factors of traditional medicinal plant use during pregnancy among women receiving antenatal care in East Gojjam Zone, Northwest Ethiopia

Background

Little is known about the practice of traditional medicinal plant use, especially during pregnancy in Ethiopia. Moreover, there has been no previous studies conducted on practices and related factors of medicinal plant use among pregnant women in Gojjam, northwest Ethiopia.

Methods

A multicentered facility-based cross-sectional study was conducted from July 1 to 30 2021. A total of 423 pregnant mothers receiving antenatal care were included in this study. To recruit study participants, multistage sampling techniques were used. Data were collected using a semi-structured interviewer-administered questionnaire. SPSS version 20.0 statistical package was used for statistical analysis. Univariable and multivariable logistic regression analysis was performed to identify factors related to the medicinal plants' utilization status in pregnant mothers. The study results were presented in both descriptive statistics (percents, tables, graphs, mean, and dispersion measurements like standard deviation) and inferential statistics (odds ratio).

Results

The magnitude of traditional medicinal plants' utilization during pregnancy was 47.7% (95%CI: 42.8-52.8%). Pregnant mothers residing in rural areas [Adjusted Odds Ratio (AOR) = 3.13; 95% Confidence Interval (CI):1.53, 6.41], who are illiterate (AOR = 2.99; 95%CI:1.097, 8.17), have illiterate husbands (AOR = 3.08; 95%CI:1.29, 7.33), married farmers (AOR = 4.92; 95%CI:1.87, 12.94), married merchants (AOR = 0.27; 95%CI:0.09, 0.78), have a divorced and widowed marital status (AOR = 3.93; 95%CI:1.25, 12.395), have low antenatal care visits (AOR = 4.76; 95%CI:1.93, 11.74), substance use history (AOR = 7.21; 95%CI:3.49, 14.9), and used medicinal plants in previous pregnancy (AOR = 4.06; 95%CI:2.03, 8.13) had statistically significant association with medicinal plant use during current pregnancy.

Conclusions

The present study revealed that a relatively large number of mothers used medicinal plants of various types during their current pregnancy. Area of residence, maternal educational status, husband's education level, husband's occupation status, marital status, number of antenatal care visits, use of medicinal plants in previous pregnancies, and substance use history were among the factors which were significantly associated with the use of traditional medicinal plants during the current pregnancy. Overall, the current finding provides scientific evidence useful for health sector leaders and healthcare professionals on the utilization of unprescribed medicinal plants during pregnancy and the factors associated with the utilization of the plants. Hence, they may consider creating awareness and providing advice on the careful use of unprescribed medicinal plants among pregnant mothers, especially those residing in rural areas, who are illiterate, who have divorced and widowed marital status, and who have a previous history of herbal and substance use. This is because using traditional medicines without prior discussion with a healthcare expert may harm pregnant mothers and their unborn child, as the safety of the utilized plants in the current study area is not scientifically proven. Prospective studies which need to confirm the safety of the plants used are recommended mainly in the present study area.

Patient Care and Treatment Strategies for Skin Diseases in Sub-Saharan Africa: Role of Traditional and Western Medicines

The perspective of the people of Sub-Saharan Africa (SSA) toward both traditional and western healthcare systems varies. The goal of the current study is to examine the SSA's unique skin disease health care system. This study comprises numerous research that sought to examine how the general public feels about the SSA's current healthcare system. In this review, common skin conditions, such as atopic dermatitis, buruli ulcers, dermatophytosis, and scabies, are addressed. According to this report, government agencies must pay particular attention to skin illnesses in SSA and raise public awareness. Availability of medical care, socioeconomic factors, degree of education, and other factors influence patients' attitudes toward traditional and western health care differently in different geographic areas. Facts suggest that self-medication is the preference of the majority of patients before seeking dermatological care. The present study concludes that the magnitude of skin diseases is neglected or underestimated in many regions of SSA. Also, western healthcare facilities of many regions of SSA are not up to the mark. The present study recommends that proper access to the health care system and awareness about skin diseases through various government programs can be helpful in the regulation of skin disorders among people of SSA.

Biodiscoveries within the Australian plant genus Eremophila based on international and interdisciplinary collaboration: results and perspectives on outstanding ethical dilemmas

In a cross-continental research initiative, including researchers working in Australia and Denmark, and based on joint external funding by a 3-year grant from the Novo Nordisk Foundation, we have used DNA sequencing, extensive chemical profiling and molecular networking analyses across the entire Eremophila genus to provide new knowledge on the presence of natural products and their bioactivities using polypharmocological screens. Sesquiterpenoids, diterpenoids and dimers of branched-chain fatty acids with previously unknown chemical structures were identified. The collection of plant material from the Eremophila genus was carried out according to a 'bioprospecting agreement' with the Government of Western Australia. We recognize that several Eremophila species hold immense cultural significance to Australia's First Peoples. In spite of our best intentions to ensure that new knowledge gained about the genus Eremophila and any potential future benefits are shared in an equitable manner, in accordance with the Nagoya Protocol, we encounter serious dilemmas and potential conflicts in making benefit sharing with Australia's First Peoples a reality.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part I: risks identification]

Globally, the use of drugs from traditional pharmacopoeias is a major subject. The confidence of the populations in these drugs is linked to their presumption of safety and also to the fact that geographically and financially they are more accessible than synthetic drugs. In view of the high exposure of the world population to traditional medicines, they are subject to pharmacovigilance guaranteeing their safety in use. Thus, this review aims to take stock of the risks identified by the national pharmacovigilance systems. It is based on research referenced in PubMed, Embase, ScienceDirect and GoogleScholar. These studies indicate that the use of traditional drugs can involve risks including adverse effects, interactions with synthetic drugs, adulteration and contamination. The spontaneous notification system was the basis for their identification. Strengthening this system and making populations aware of these risks constitute the key levers for traditional medicines pharmacovigilance progress.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part II: risks assessment and prevention]

After the initial stage of the pharmacovigilance process for medicines from traditional pharmacopoeias - which concerns the identification of the risks associated with their use - the risk assessment should now be approached. The latter makes it possible to detect potential signals early and to take preventive measures. We sought to understand, from a review of the literature, the steps and methods of risk assessment relating to traditional medicines, as well as the prevention strategies applied to them. All of the work carried out on the subject has shown that the steps and methods for assessing and preventing drug risks are the same for both conventional and traditional medicines. Risk assessment includes analysis of the quality of individual notifications, assessment of causality, detection and evaluation of signals. The World Health Organization method is the most widely used for causality assessment internationally, while disproportionality measures are the most applied for signal detection. Regarding prevention, risk communication is the main strategy for the risks associated with traditional medicines. This review suggests the involvement of traditional medicine practitioners both in the notification system and in the communication strategy on the risks associated with their products.

Computational Analysis of Naturally Occurring Aristolochic Acid Analogues and Their Biological Sources

Aristolochic acids are known for nephrotoxicity, and implicated in multiple cancer types such as hepatocellular carcinomas demonstrated by recent studies. Natural products that are analogues to aristolochic acids have been constantly isolated from organisms; a larger chemical space of these compounds and a wider coverage of biological sources should be determined in consideration of the potential hazard of aristolochic acid analogues and the wide distribution of their biological sources in the nature. Therefore, we carried out an in silico research of naturally occurring aristolochic acid analogues and their biological sources, as a supplement to existing studies. The result shows a chemical space of 238 naturally occurring aristolochic acid analogues that are present in 175 species of biological sources including 44 traditional medicines. With the computational estimation for toxicity and the implication in hazard assessment of a biological source with the presence of aristolochic acid analogues, we propose that additional awareness should be raised to the public for avoidance of toxic species, especially those that are used as herbal medicines and easily accessible.

Traditional medicines for COVID-19: Perspectives from clinical pharmacologists

There has been high interest in the use of traditional medicines for COVID‐19 from early in the course of the pandemic. Significant advances in the science of ethnopharmacology have helped to introduce chemical entities identified from natural sources into modern medicine. However, the wider integration of natural products into the modern drug discovery process will require enhanced collaboration amongst the pharmaceutical industry, academic research units, regulatory bodies, ethics review committees and local, regional, continental and international organizations. Revisiting this topic holds promise of benefit for both the current and future pandemics.

The Botanical, Chemical and Ethnobotanical Diversity of Southern African Lamiaceae

The Lamiaceae is undoubtedly an important plant family, having a rich history of use that spans the globe with many species being used in folk medicine and modern industries alike. Their ability to produce aromatic volatile oils has made them valuable sources of materials in the cosmetic, culinary, and pharmaceutical industries. A thorough account of the taxonomic diversity, chemistry and ethnobotany is lacking for southern African Lamiaceae, which feature some of the region’s most notable medicinal and edible plant species. We provide a comprehensive insight into the Lamiaceae flora of southern Africa, comprising 297 species in 42 genera, 105 of which are endemic to the subcontinent. We further explore the medicinal and traditional uses, where all genera with documented uses are covered for the region. A broad review of the chemistry of southern African Lamiaceae is presented, noting that only 101 species (34%) have been investigated chemically (either their volatile oils or phytochemical characterization of secondary metabolites), thus presenting many and varied opportunities for further studies. The main aim of our study was therefore to present an up-to-date account of the botany, chemistry and traditional uses of the family in southern Africa, and to identify obvious knowledge gaps.

Health-Seeking Behavior of People in Indonesia: A Narrative Review

This review aims to locate existing studies on health-seeking behavior of people in Indonesia, identify gaps, and highlight important findings. Articles were retrieved from Medline, Scopus, Web of Science, Academic Search Complete (via Ebsco), and ProQuest with a number of key words and various combinations. Articles from Indonesian journals were also searched for with Google Scholar. A total of 56 articles from peer-reviewed journal databases and 19 articles from Indonesian journals were reviewed. Quantitative designs were applied more frequently than qualitative, and mixed methods designs were used in some studies. The majority gathered retrospective information about people's behaviors. Communicable diseases and maternity care were the most frequently studied conditions, in contrast to noncommunicable diseases. In terms of geographical distribution, most research was conducted on Java island, with very few in outside Java. Important findings are a model of Indonesian care-seeking pathways, an understanding of determinants of people's care choices, and the role of sociocultural beliefs. The findings from this narrative review provide insight to what and how Indonesians make decisions to manage their illness and why. This makes an important contribution to understanding the problem of underutilization of medical services despite the government's extensive efforts to improve accessibility.

Perspective Adjunctive Therapies for COVID-19: Beyond Antiviral Therapy

The coronavirus disease 2019 (COVID-19) pandemic is the largest health crisis ever faced worldwide. It has resulted in great health and economic costs because no effective treatment is currently available. Since infected persons vary in presentation from healthy asymptomatic mild symptoms to those who need intensive care support and eventually succumb to the disease, this illness is considered to depend primarily on individual immunity. Demographic distribution and disease severity in several regions of the world vary; therefore, it is believed that natural inherent immunity provided through dietary sources and traditional medicines could play an important role in infection prevention and disease progression. People can boost their immunity to prevent them from infection after COVID-19 exposure and can reduce their inflammatory reactions to protect their organ deterioration in case suffering from the disease. Some drugs with in-situ immunomodulatory and anti-inflammatory activity are also identified as adjunctive therapy in the COVID-19 era. This review discusses the importance of COVID-19 interactions with immune cells and inflammatory cells; and further emphasizes the possible pathways related with traditional herbs, medications and nutritional products. We believe that such pathophysiological pathway approach treatment is rational and important for future development of new therapeutic agents for prevention or cure of COVID-19 infection.

Application of Advanced Technologies in Natural Product Research: A Review with Special Emphasis on ADMET Profiling

The successful conversion of natural products (NPs) into lead compounds and novel pharmacophores has emboldened the researchers to harness the drug discovery process with a lot more enthusiasm. However, forfeit of bioactive NPs resulting from an overabundance of metabolites and their wide dynamic range have created the bottleneck in NP researches. Similarly, the existence of multidimensional challenges, including the evaluation of pharmacokinetics, pharmacodynamics, and safety parameters, has been a concerning issue. Advancement of technology has brought the evolution of traditional natural product researches into the computer-based assessment exhibiting pretentious remarks about their efficiency in drug discovery. The early attention to the quality of the NPs may reduce the attrition rate of drug candidates by parallel assessment of ADMET profiling. This article reviews the status, challenges, opportunities, and integration of advanced technologies in natural product research. Indeed, emphasis will be laid on the current and futuristic direction towards the application of newer technologies in early-stage ADMET profiling of bioactive moieties from the natural sources. It can be expected that combinatorial approaches in ADMET profiling will fortify the natural product-based drug discovery in the near future.

Natural Medicines and Their Underlying Mechanisms of Prevention and Recovery from Amyloid Β-Induced Axonal Degeneration in Alzheimer's Disease

In Alzheimer’s disease (AD), amyloid β (Aβ) induces axonal degeneration, neuronal network disruption, and memory impairment. Although many candidate drugs to reduce Aβ have been clinically investigated, they failed to recover the memory function in AD patients. Reportedly, Aβ deposition occurred before the onset of AD. Once neuronal networks were disrupted by Aβ, they could hardly be recovered. Therefore, we speculated that only removal of Aβ was not enough for AD therapy, and prevention and recovery from neuronal network disruption were also needed. This review describes the challenges related to the condition of axons for AD therapy. We established novel in vitro models of Aβ-induced axonal degeneration. Using these models, we found that several traditional medicines and their constituents prevented or helped recover from Aβ-induced axonal degeneration. These drugs also prevented or helped recover from memory impairment in in vivo models of AD. One of these drugs ameliorated memory decline in AD patients in a clinical study. These results indicate that prevention and recovery from axonal degeneration are possible strategies for AD therapy.

Carry forward advantages of traditional medicines in prevention and control of outbreak of COVID-19 pandemic

Members of the China-ASEAN Joint Laboratory for International Cooperation in Traditional Medicine Research used the video conference platform to exchange and discuss the advantages of traditional medicine through the form of score exchange and report, and research and develop the amount and issues of the therapeutic COVID-19 products of concern. This paper mainly reviews the achievements of the implementation of the epidemic prevention and control plan, advances of scientific basic studies on SARS-CoV-2, analysis and screening of potential targets and pathways of antiviral compounds based on network pharmacology and development of antiviral food dual-use products. The authors believe that the declaration of the (10 + 3) special meeting of national leaders on epidemic prevention and control should raise the medical and pharmaceutical issues of common concern. It is the responsibility of our joint laboratory members to accelerate the development of traditional medicine research and industry. Also the authors believe that this exchange will certainly promote the development of the cause of cooperation.

The DNA-Based Authentication of Commercial Herbal Products Reveals Their Globally Widespread Adulteration

The herbal products, sold worldwide as medicines or foods, are perceived as low risk because they are considered natural and thus safe. The quality of these products is ineffectively regulated and controlled. The growing evidence for their lack of authenticity is causing deep concern, but the scale of this phenomenon at the global, continental or national scale remains unknown. We analyzed data reporting the authenticity, as detected with DNA-based methods, of 5,957 commercial herbal products sold in 37 countries, distributed in all six inhabited continents. Our global survey shows that a substantial proportion (27%) of the herbal products commercialized in the global marketplace is adulterated when their content was tested against their labeled, claimed ingredient species. The adulterated herbal products are distributed across all continents and regions. The proportion of adulterated products varies significantly among continents, being highest in Australia (79%), South America (67%), lower in Europe (47%), North America (33%), Africa (27%) and the lowest in Asia (23%). The commercial HPs' authenticity among the 37 countries included in our global analysis ranges between 0 and 100% from the total number of product reported for each specific national marketplace. For 9 countries, more than 100 products were successfully DNA-based authenticated and reported. From these countries, the highest percentage of adulterated commercial HPs was reported for Brazil (68%), followed distantly by Taiwan (32%), India (31%), USA (29%), followed closely by Malaysia (24%), Japan (23%), South Korea (23%), Thailand (20%), and China (19%). Our results confirm the large-scale presence of adulterated herbal products throughout the global market. The adulterated herbal products contain undeclared contaminant, substitute, and filler species, or none of the labeled species, which all may be accidental or intentional, economically-motivated and fraudulent. Due to the ever-increasing analytical sensitivity of the high throughput DNA sequencing, increasingly used for the untargeted, simultaneous multi-taxa identification, the proportion of adulterated HPs detected on the global market is expected to increase. In the context of the increasing demand for HPs, the limited supply of raw materials derived from many plant species, some of which being already nationally or internationally protected and having various degrees of trade restrictions, adds up to the differences and discrepancies between national HPs' regulatory frameworks and further increases the risks of adulteration of many types of herbal products. The globally widespread adulteration is a serious threat to consumers' well-being and safety, in spite of herbal products' claimed or expected health benefits.

Pharmacokinetic studies of nanoparticles as a delivery system for conventional drugs and herb-derived compounds for cancer therapy: a systematic review

The poor pharmacokinetic characteristics of most anticancer drugs have limited their clinical effectiveness. The application of nanoparticles as a novel drug delivery system has provided opportunities to tackle the current challenges facing conventional drug delivery systems such as poor pharmacokinetics, lack of specificity to tumor cells, multidrug resistance, and toxicity. This systematic review aims to examine the application of pharmacokinetic studies of nanoparticles loaded in conventional drugs and herb-derived compounds for cancer therapy. The pharmacokinetic parameters of several herbal medicines and chemotherapeutic drugs loaded into nanoparticles were reported. This included area under the curve (AUC) of plasma concentration-time profile, maximum plasma concentration (C_max), time to maximum plasma concentration (T_max), volume of distribution (V_d or V_ss), elimination half-life (t_½), and clearance (CL). The systematic review was conducted using information available in the PubMed and Science Direct databases up to February 2019. The search terms employed were: pharmacokinetics, pharmacokinetic study, nanoparticles, anticancer, traditional medicine, herbal medicine, herb-derived compounds, natural products, and chemotherapy. Overall, nanoparticle carriers not only significantly improved pharmacokinetics but also further enhanced permeability, solubility, stability, specificity, and selectivity of the carried anticancer drugs/herb-derived compounds to target tumor cells. Additionally, they also limited hepatic first-pass metabolism and P-glycoprotein (P-gp) efflux of the carried anticancer drugs/herb-derived compounds. Based on this systematic review, polymeric nanoparticles were the most commonly used nanocarrier to improve the pharmacokinetic parameters. The use of nanoparticles as a novel drug delivery system has the potential to improve both pharmacokinetics and cytotoxicity activity of the loaded drugs/herb-derived compounds for cancer therapy.

Use of traditional medicines and traditional practitioners by children in Indonesia: findings from a national population survey in 2014-2015

Background: Little data are available about traditional and complementary medicine use in children in the general population in Southeast Asia, including Indonesia. The aim of this investigation was to assess the prevalence of the use of traditional medicines and traditional practitioners in children in a national population-based survey in Indonesia.

Methods: The cross-sectional sample included 15,739 children (0–14 years) (median age 7.0 years, inter quartile range =7.0) that took part in the Indonesia Family Life Survey in 2014–2015.

Results: The prevalence of use of traditional medicines as a treatment in the past four weeks was 6.2%, vitamins or supplements 19.9%, and over-the-counter modern medicine 61.1%. The prevalence of traditional practitioner use in the past 4 weeks was 3.4%, and the prevalence of the use of traditional medicines and/or traditional practitioner in the past 4 weeks was 8.8%. The purpose of consulting the traditional practitioner was mainly massage (86.8%) and treatment for illness (14.8%). In the adjusted logistic regression analysis, having a birth certificate (as a proxy for better economic status) and poor self-rated health were associated with traditional medicine use. Younger age and poor self-rated health were associated with traditional practitioners use.

Conclusion: A high prevalence of traditional medicine use in children in Indonesia was found, and several social factors and poor health status of its use were identified.

Unblocking High-Value Botanical Value Chains: Is There a Role for Blockchain Systems?

Blockchain systems are a fast emerging and a currently widely discussed novel strategy for a decentralized cryptographically enhanced digital ledger recording transactions among stakeholders. This perspective paper looks at its potential uses in the context of high value and mostly low volume botanical material traded globally and used as medicines, health foods, in cosmetics and other applications. We offer a perspective on key areas in the supply of such products globally and how blockchain systems may help in sustainable sourcing, quality assurance, and in tackling supply problems in cases of complex multiherbal preparations. Both open and closed blockchain systems are feasible, and it seems likely that, at least in the initial development, closed ones are the main ones to be utilized. While blockchain’s potential is not yet clear, the examples presented here highlight the opportunities of this new technology.

Potential inhibition of major human cytochrome P450 isoenzymes by selected tropical medicinal herbs-Implication for herb-drug interactions

BACKGROUND

Increasing use of medicinal herbs as nutritional supplements and traditional medicines for the treatment of diabetes, hypertension, hyperlipidemia, and malaria fever with conventional drugs poses possibilities of herb-drug interactions (HDIs). The potential of nine selected widely used tropical medicinal herbs in inhibiting human cytochrome P450 (CYP) isoenzymes was investigated.

MATERIALS AND METHODS

In vitro inhibition of eight major CYP isoenzymes by aqueous extracts of Allium sativum, Gongronema latifolium, Moringa oleifera, Musa sapientum, Mangifera indica, Tetracarpidium conophorum, Alstonia boonei, Bauhinia monandra, and Picralima nitida was estimated in human liver microsomes by monitoring twelve probe metabolites of nine probe substrates with UPLC/MS-MS using validated N-in-one assay method.

RESULTS

Mangifera indica moderately inhibited CYP2C8, CYP2B6, CYP2D6, CYP1A2, and CYP2C9 with IC 50 values of 37.93, 57.83, 67.39, 54.83, and 107.48 μg/ml, respectively, and Alstonia boonei inhibited CYP2D6 (IC 50 = 77.19 μg/ml). Picralima nitida inhibited CYP3A4 (IC 50 = 45.58 μg/ml) and CYP2C19 (IC 50 = 73.06 μg/ml) moderately but strongly inhibited CYP2D6 (IC 50 = 1.19 μg/ml). Other aqueous extracts of Gongronema latifolium, Bauhinia monandra, and Moringa oleifera showed weak inhibitory activities against CYP1A2. Musa sapientum, Allium sativum, and Tetracarpidium conophorum did not inhibit the CYP isoenzymes investigated.

CONCLUSION

Potential for clinically important CYP-metabolism-mediated HDIs is possible for Alstonia boonei, Mangifera indica, and Picralima nitida with drugs metabolized by CYP 2C8, 2B6, 2D6, 1A2, 2C9, 2C19, and 3A4. Inhibition of CYP2D6 by Picralima nitida is of particular concern and needs immediate in vivo investigations.

Adaptation of a microbead assay for the easy evaluation of traditional anti-sickling medicines: application to DREPANOSTAT and FACA

CONTEXT

Sickle cell disease is a common inherited blood disorder affecting millions of people worldwide. Due to lack of progress in drug discovery for a suitable treatment, sufferers often turn to traditional medicines that take advantage of the plant extracts activity used by traditional healers.

OBJECTIVE

This study optimizes an anti-sickling screening test to identify preparations capable of reverting sickle cells back to the morphology of normal red blood cells. We focused on the miniaturization and practicability of the assay, so that it can be adapted to the laboratory conditions commonly found in less developed countries.

MATERIALS AND METHODS

We tested two traditional anti-sickling herbal medicines, FACA^® and DREPANOSTAT^®, composed of Zanthoxylum zanthoxyloides (Lam.) Zepern. & Timler (Rutaceae) and Calotropis procera (Aiton) Dryand. (Apocynaceae) at screening concentrations of hydroethanol extracts from 0.2 to 1 mg/mL. Potential bioactive molecules present in the extracts were profiled using Ultra High Performance Liquid Chromatography coupled with High Resolution Mass Spectrometry (UHPLC-HRMS/MS) method, identified through HRMS, MS/MS spectra and in silico fragmentation tools.

RESULTS

Hydroethanol extracts of FACA^® and DREPANOSTAT^® showed low anti-sickling activity, inhibiting less than 10% of the sickling process. The UHPLC-HRMS/MS profiles identified 28 compounds (18 in FACA^® and 15 in DREPANOSTAT^®, including common compounds) among which l-phenylalanine is already described as potential anti-sickling agent. When used as positive control, 7 mg/mL phenylalanine reduced the sickled RBC to 52%.

DISCUSSION AND CONCLUSIONS

This assay has been optimized for the easy screening of plant extracts or extracted compounds from bioassay guided fractionation, valuable to laboratories from less developed countries.

Chemical Components and Biological Activities of the Genus Phyllanthus: A Review of the Recent Literature

Medicinal plants have served humans since prehistoric times to treat various ailments. Both developed and underdeveloped countries rely on traditional systems of medication using natural sources from plants. Phyllanthus is one of the largest genus in the family Phyllanthaceae, comprising over 700 well known species cosmopolitan in distribution mainly in the tropics and subtropics. Phyllanthus species are being in constant used in traditional medications to cure an array of human diseases (constipation, inhalation related, arthritis, loss of appetite, injuries, conjunctivitis, diarrhoea, running nose, common cold, malaria, blennorrhagia, colic, diabetes mellitus, dysentery, indigestion, fever, gout, gonorrheal diseases of males and females, skin itching, jaundice, hepatic disorders, leucorrhea, vaginitis, menstrual irregularities, obesity, stomach pains, and tumors), confectionaries, food industry, and in some pesticides. Phyllanthus species are rich in diversity of phytochemicals e.g., tannins, terpenes, alkaloids, glycosidic compounds, saponins, and flavones etc. More in depth studies are a direly needed to identify more compounds with specific cellular functions to treat various ailments.

Evaluation of potential anti-cancer activity of cationic liposomal nanoformulated Lycopodium clavatum in colon cancer cells

Research dealing with early diagnosis and efficient treatment in colon cancer to improve patient's survival is still under investigation. Chemotherapeutic agent result in high systemic toxicity due to their non-specific actions on DNA repair and/or cell replication. Traditional medicine such as Lycopodium clavatum (LC) has been claimed to have therapeutic potentials against cancer. The present study focuses on targeted drug delivery of cationic liposomal nanoformulated LC (CL-LC) in colon cancer cells (HCT15) and comparing the efficacy with an anti-colon cancer drug, 7-ethyl-10-hydroxy-camptothecin (SN38) along with its nanoformulated form (CL-SN38). The colloidal suspension of LC was made using thin film hydration method. The drugs were characterised using ultraviolet, dynamic light scattering, scanning electron microscopy, energy, dispersive X-ray spectroscopy. Invitro drug release showed kinetics of 49 and 89% of SN38 and LC, whereas CL-SN38 and CL-LC showed 73 and 74% of sustained drug release, respectively. Studies on morphological changes, cell viability, cytotoxicity, apoptosis, cancer-associated gene expression analysis of Bcl-2, Bax, p53 by real-time polymerase chain reaction and western blot analysis of Bad and p53 protein were performed. Nanoformulated LC significantly inhibited growth and increased the apoptosis of colon cancer cells indicating its potential anti-cancer activity against colon cancer cells.

A Review of Evidence for a Therapeutic Application of Traditional Japanese Kampo Medicine for Oral Diseases/Disorders

Kampo medicines prescribed by specialized medical practitioners and Japanese physicians have gradually reemerged in Japan as alternatives to Western medications. Kampo formulations are composed of several plant extracts and, as such, the broad variety of phytochemicals they contain likely act synergistically to provide their beneficial effects. Kampo medicines have traditionally been prescribed for a number of health conditions, including chronic hepatitis, bronchial asthma, anemia, etc. The aim of this article is to review the beneficial effects of Kampos with respect to oral health. Pertinent papers published between 1970 and 2017 were retrieved by searching in PubMed, ScienceDirect, Web of Science, and Scopus using key words followed by evaluation of the relevant articles. In vitro studies have identified a number of properties that give credence to the potential of Kampos for treating or preventing oral diseases/disorders. Given their anti-microbial and anti-inflammatory properties, they may be promising agents for controlling periodontal diseases, oral mucositis, xerostomia, and drug-induced gingival overgrowth. Since some oral diseases have a complex etiology that involves microbial pathogens and the host immune response, agents with dual functionality such as Kampo phytochemicals may offer a therapeutic advantage.

Dietary Supplements: Regulatory Challenges and Research Resources

Many of the scientific and regulatory challenges that exist in research on the safety, quality and efficacy of dietary supplements are common to all countries as the marketplace for them becomes increasingly global. This article summarizes some of the challenges in supplement science and provides a case study of research at the Office of Dietary Supplements at the National Institutes of Health, USA, along with some resources it has developed that are available to all scientists. It includes examples of some of the regulatory challenges faced and some resources for those who wish to learn more about them.

Glycoproteins and Polysaccharides are the Main Class of Active Constituents Required for Lymphocyte Stimulation and Antigen-Specific Immune Response Induction by Traditional Medicinal Herbal Plants

Traditional herbal remedies stimulate and modulate the immune system, and it is thought that their glycoproteins and polysaccharides are responsible for this activity. We prepared crude water, protein, and polysaccharide extracts from Atractylodes macrocephala Koidz, Helianthus annuus L., Scutellaria barbata D. Don, and Hedyotis diffusa Willd, respectively, and compared their immune-stimulating activities in vitro and in vivo. All protein and polysaccharide samples of the plants led to greater lymphocyte proliferation and TNF-α and IL-6 production in cultured splenocytes than did the crude water extracts at the same concentrations tested. In addition, the protein and polysaccharide samples did not contain lectin- or lipopolysaccharide-like molecules, so glycoproteins were deduced to be responsible for the lymphocyte stimulation. Oral administration with each of the samples enhanced the hen egg-white lysozyme (HEL)-specific humoral immune and lymphocyte proliferative responses in HEL low-responder C57BL/6 mice. Splenocytes from the mice fed the samples showed significantly greater increases in the level of IFN-γ, but not IL-4, after stimulation with HEL compared with that from the untreated control. However, higher increases in HEL-specific IgG1, IgG2b, and IgG3 rather than IgG2a were found in the mice fed the samples. These results indicate that the sample-mediated enhancement of anti-HEL-specific humoral immune responses was due to the stimulation of B lymphocytes rather than a selective priming of helper T cell populations. Collectively, we suggest that glycoproteins and/or polysaccharides of traditional herbal remedies enhance cellular and humoral immune response induction and thus could be useful for patients who need enhanced immune function.

How Can Synergism of Traditional Medicines Benefit from Network Pharmacology?

Many prescriptions of traditional medicines (TMs), whose efficacy has been tested in clinical practice, have great therapeutic value and represent an excellent resource for drug discovery. Research into single compounds of TMs, such as artemisinin from Artemisia annua L., has achieved great success; however, it has become evident that a TM prescription (which frequently contains various herbs or other components) has a synergistic effect in effecting a cure or reducing toxicity. Network pharmacology targets biological networks and analyzes the links among drugs, targets, and diseases in those networks. Comprehensive, systematic research into network pharmacology is consistent with the perspective of holisticity, which is a main characteristic of many TMs. By means of network pharmacology, research has demonstrated that many a TM show a synergistic effect by acting at different levels on multiple targets and pathways. This approach effectively bridges the gap between modern medicine and TM, and it greatly facilitates studies into the synergistic actions of TMs. There are different kinds of synergistic effects with TMs, such as synergy among herbs, effective parts, and pure compounds; however, for various reasons, new drug discovery should at present focus on synergy among pure compounds.

A Metallurgical Study of Nāga Bhasma

Background:

The metal Nāga (Lead) is being used by Indians since ancient times. Its external and internal uses have been described in Caraka, Suśruta and other Ayurvedic Saṃhitā. According to most of the Rasa texts, Nāga Bhasma and its formulations are used in many diseases such as Prameha, Jvara, Gulma, Śukrameha etc.

Objectives:

In the present study, Nāga Bhasma was prepared by the traditional Puṭa method (TPM) and by the electric muffle furnace Puṭa method (EMFPM) and standardized using Metallographic studies. Doing so helps in the study of the microstructure of Nāga Bhasma and also helps in the identification of the metal particles along with the nature of compound formed during the Māraṇa (Bhasmīkaraṇa) process.

Setting and Design:

Different samples from initial raw material to final product of Nāga Bhasma were collected during the pharmaceutical process (1^st, 30^th and 60^thPuṭa) from both methods i.e. TPM and EMFPM. Samples from both methods were studied using metallographic examination.

Materials and Methods:

The processing of the Nāga Bhasma (ṣaṣṭipuṭa) was done according to Ānanda Kanda[9] Samples from the raw material i.e. Aśodhita Nāga (raw Lead) and that processed after 1^st, 30^th and 60^th Puṭa from both methods i.e. traditional Puṭa method (using heat from burning of cow dung cakes) and electric muffle furnace Puṭa method were taken. They were mounted on self hardening acrylic base. After careful polishing to obtain scratch free surface of product, they were used for metallurgical study.

Conclusion:

This study shows that traditional Puṭa method may be better than electric muffle furnace Puṭa method because of more homogeneous distribution of Lead sulphide in the Nāga Bhasma which is prepared by traditional method.

TREATMENT OF DIARRHOEA USING TRADITIONAL MEDICINES: CONTEMPORARY RESEARCH IN SOUTH AFRICA AND ZIMBABWE

BACKGROUND

Gastrointestinal disorders, diarrhoea in particular remain a major concern in South Africa and Zimbabwe resulting in high mortality rates when left untreated. This investigation was aimed at documenting herbal medicines used in the treatment of diarrhoea in South Africa and Zimbabwe.

MATERIALS AND METHODS

A review of literature on plant species used as remedies for diarrhoea in South Africa and Zimbabwe was undertaken by the use of different electronic databases such as Google Scholar, ScienceDirect, Scopus as well as library searches at the University of Fort Hare, South Africa and the National Herbarium of Zimbabwe (SRGH) in Harare, Zimbabwe.

RESULTS

This study reported ten plant species most widely used to treat diarrhoea in South Africa and Zimbabwe. Of the lot, Sclerocarya birrea (A. Rich.) Hochst. was the most popular medicinal plant used as antidiarrhoeal remedy (11 literature citations) in South Africa and Zimbabwe, followed by Elephantorrhiza elephantina (Burch.) Skeels and Schotia brachypetala Sond. with eight literature citations each. The roots (47.4%) are the most frequently used plant parts, followed by bark (26.3%), leaves (21.1%) and rhizomes (5.3%).

CONCLUSION

The documented antidiarrhoeal activities of this repository of selected plant species against diarrhoea causing agents such as rotavirus, Escherichia coli, Shigella, Campylobacter, Giardia, Entamoeba histolytica, Salmonella, Yersinia and Vibrio cholerae calls for further investigation aimed at isolating phytochemical compounds responsible for antidiarrhoeal activities, their mode of action, and also establish their safety and efficacy. This cross-cultural acceptance of antidiarrhoeal herbal medicines and the use of the same plant species in different geographical zones serve as an indication of the importance of herbal medicines in primary healthcare of local communities.

Delivery and postpartum practices among new mothers in Laputta, Myanmar: intersecting traditional and modern practices and beliefs

Myanmar is witnessing increased access to modern maternity care, along with shifting norms and practices. Past research has documented low rates of facility-based deliveries in the country, along with adverse maternal and child health outcomes. Research has also documented diverse traditional practices in the postpartum period, related to maternity care and maternal food intake. Through 34 qualitative interviews with women who recently gave birth and their mothers-in-law in one township in Myanmar (Laputta), we explore factors influencing decision-making around postpartum care and the practices that women engage in. We find that women use both modern and traditional providers because different types of providers play particular roles in the delivery and postpartum period. Despite knowledge of about healthy foods to eat postpartum, many women restrict the intake of certain foods, and mothers-in-laws' beliefs in these practices are particularly strong. Findings suggest that women and their families are balancing two different sets of practices and beliefs, which at times come in conflict. Educational campaigns and programmes should address both modern and traditional beliefs and practices to help women be better able to access safe care and improve their own and their children's health.

Herbal medicines: challenges in the modern world. Part 2. European Union and Russia

INTRODUCTION

Herbal medicines (HMs) have been well known to people of the European Union (EU) and Russia for centuries. Currently, Western HMs can be classified into two categories, plant-derived conventional medicines and dietary supplements. Interest to HMs has grown rapidly in all countries during the past two decades.

AREAS COVERED

The main goal of this review article is to present the history of HMs in the EU and Russia, forms of modern HMs, including Oriental Medicines that are popular among consumers of both countries. Additional discussion points comprise safety and adulteration issues associated with HMs, including regulatory changes and new legislative measures undertaken by the authorities. Materials available from legislative and governmental websites, PubMed and news media were used. Expert commentary: Due to cultural diversities in the EU and Russia, traditional HMs of other regions, particularly Chinese Traditional and Ayurvedic medicines, are also popular. Recently, dietary supplements containing multiple herbal and other natural products have flooded the EU and Russian markets. Pharmacovigilance in these markets is challenging in terms of establishing quality and safety of ingredients, determining efficacy, and defining risks of herb-herb and herb-drug interactions. Both the EU and Russia have introduced new legislation aimed to overcome these deficiencies.

Innovative development path of ethnomedicines: an overview of ethnomedicines in China

In the long history of disease prevention and treatment, ancestral populations worldwide have gained knowledge and experiences in traditional medicines. For instance, ethnomedicines of Chinese ethnic minorities constitute an important part of traditional medicines. In our study, we firstly clarified the concept of ethnomedicines and the connotations of ethnopharmacology. The particularity of ethnomedicine research were then summed up, and the development profiles of the ethnomedicines of Chinese ethnic minorities were discussed by investigating the current status and existing problems. On this basis, we abstracted the innovative development path of ethnomedicines for the first time, which was found to follows:resource study → standardized development research → industrialization of the achievements and efforts for internationalization. We found that platform establishment and team training are keys to achieving innovative development. Hence, this study provided a basis for ethnomedicine development.

The Traditional Medicine and Modern Medicine from Natural Products

Natural products and traditional medicines are of great importance. Such forms of medicine as traditional Chinese medicine, Ayurveda, Kampo, traditional Korean medicine, and Unani have been practiced in some areas of the world and have blossomed into orderly-regulated systems of medicine. This study aims to review the literature on the relationship among natural products, traditional medicines, and modern medicine, and to explore the possible concepts and methodologies from natural products and traditional medicines to further develop drug discovery. The unique characteristics of theory, application, current role or status, and modern research of eight kinds of traditional medicine systems are summarized in this study. Although only a tiny fraction of the existing plant species have been scientifically researched for bioactivities since 1805, when the first pharmacologically-active compound morphine was isolated from opium, natural products and traditional medicines have already made fruitful contributions for modern medicine. When used to develop new drugs, natural products and traditional medicines have their incomparable advantages, such as abundant clinical experiences, and their unique diversity of chemical structures and biological activities.

Herbal medicines: challenges in the modern world. Part 1. Australia and New Zealand

As in many developed countries, herbal medicines (HMs) are widely used in Australia and New Zealand (NZ). The popularity of HM continues to rise. Western, Asian and indigenous HMs are used, reflecting the cultural diversity of people in this region. HMs in Australia are regulated on a risk-based system with many HMs identified as being low risk. The legislation was reviewed in 2015 and proposals for change are under consideration. In NZ, it is recognised that current regulations for HMs and other natural health products (NHPs) do not adequately protect public health. NZ is entering a phase of regulatory change for this sector, and proposals for a 'light-touch' regulatory framework for NHPs are planned to be introduced into legislation during 2016.

Views and experiences of healthcare professionals towards the use of African traditional, complementary and alternative medicines among patients with HIV infection: the case of eThekwini health district, South Africa

BACKGROUND

Many patients with human immunodeficiency virus infection use traditional, complementary, and alternative medicines and other practices to combat the disease, with some also using prescribed antiretroviral therapy provided by the public health sector. This study aimed to establish the awareness of public sector biomedical health care providers on the use of traditional, complementary and alternative medicines by HIV-infected patients who also used highly active antiretroviral therapy, and to determine whether this was based on patients seen or cases being reported to them. Potential risks of interactions between the prescribed antiretroviral and non-prescribed medication therapies may pose safety and effectiveness issues in patients using both types of treatment.

METHODS

A descriptive cross-sectional study, using a researcher administered semi-structured questionnaire, was conducted from June to August 2013 at ten public sector antiretroviral clinics in five regional, three specialised and two district hospitals in eThekwini Health District, South Africa. Questionnaires were administered through face-to face interview to 120 eligible participants consisting of doctors, nurses, pharmacists and post-basic pharmacist assistants in HIV clinical practice. The results are presented as percent or proportion with standard error (SE), or as frequency.

RESULTS

Ninety-four respondents completed the questionnaire, yielding a response rate of 78.3 %. Almost half (48/94) were aware of patients using African traditional herbal medicines, over-the-counter supplements, unnamed complementary Ayurveda medicines and acupuncture. Twenty-three of the 94 respondents (24.4 %) said they had consulted patients who were using both antiretroviral therapy and certain types of non-prescribed medication in the previous three months.

CONCLUSIONS

Awareness among healthcare providers on patient use of traditional, complementary and alternative medicines was relatively high. Few respondents had seen patients who used mostly African traditional medicines, over-the counter supplements, and negligible complementary Ayurveda medicines and acupuncture, with caution being advised in the interpretation of the former. Further research is needed to investigate communication between healthcare providers and patients in this regard, and levels of acceptance of traditional, complementary and alternative medicines by biomedical health care workers in HIV public sector practice.

Barriers to biomedical care and use of traditional medicines for treatment of cervical cancer: an exploratory qualitative study in northern Uganda

Use of traditional medicines for treatment of cancers has increased worldwide. We used a qualitative approach to explore barriers to biomedical care and reasons for use of traditional medicines for the treatment of cervical cancer in Gulu, northern Uganda. We carried out 24 focus group discussions involving men and women aged 18-59 years. We employed content analyses technique in data analysis. Traditional medicines were used mainly due to barriers to biomedical care for cervical cancer. The barriers included health system factors, for example long distances to health facilities and unavailability of medicines; health workers' factors, for example negative attitudes towards patients and demands for bribes; individual patient's factors, for example inability to pay for medical care; and socio-cultural beliefs about superiority of traditional medicines and perceived greater privacy in accessing traditional healers. Barriers to biomedical care and community beliefs in the effectiveness of traditional medicines encourage use of traditional medicines for treatment of cervical cancer but might hinder help-seeking at biomedical facilities. There is need for targeted culturally sensitive awareness campaign to promote effectiveness of modern medicine and to encourage cautious use of traditional medicines in the treatment of cervical cancer.

Ethnomedicine use in the war affected region of northwest Pakistan

BACKGROUND

North-West of Pakistan is bestowed with medicinal plant resources due to diverse geographical and habitat conditions. The traditional use of plants for curing various diseases forms an important part of the region's cultural heritage. The study was carried out to document medicinal plants used in Frontier Region (FR) Bannu, an area affected by the "War on Terror".

METHODS

Fieldwork was carried out in four different seasons (spring, autumn, summer and winter) from March 2012 to February 2013. Data on medicinal plants was collected using structured and semi-structured questionnaires from 250 respondents. The voucher specimens were collected, processed and identified following standard methods.

RESULTS

Of the 107 species of ethnomedicinal plants reported, fifty percent species are herbaceous. The majority of the reported species were wild (55%) but a substantial proportion are cultivated (29%). For most of the plant species (34%), leaves are the most commonly used part in the preparation of ethnomedicines. The most common use of species is for carminative purposes (14 species), with the next most common use being for blood purification (11 species). The main methods used in the preparation of ethnomedicinal recipes involves grinding and boiling, and nearly all the remedies are taken orally along with ingredients such as water, milk or honey for ease of ingestion. Traditional healers prepare plant remedies using one or more plants. There was a significant correlation (r2 = 0.95) between the age of local people and the number of plants known to them, which indicates that in the coming 20 years, an approximate decrease of 75% in the indigenous knowledge may be expected.

CONCLUSION

Traditional medicines are important to the livelihoods of rural communities in the region affected by the Global war on Terrorism. The medicinal recipes are indigenous; however, there is a threat to their future use on account of rapid modernization and terrorist activities. Documentation of medicinal plants and recipes may help in the conservation of the regional indigenous medicinal knowledge for future generations and to provide a baseline for further studies.

Traditional medicines and globalization: current and future perspectives in ethnopharmacology

The ethnopharmacological approach toward the understanding and appraisal of traditional and herbal medicines is characterized by the inclusions of the social as well as the natural sciences. Anthropological field-observations describing the local use of nature-derived medicines are the basis for ethnopharmacological enquiries. The multidisciplinary scientific validation of indigenous drugs is of relevance to modern societies at large and helps to sustain local health care practices. Especially with respect to therapies related to aging related, chronic and infectious diseases traditional medicines offer promising alternatives to biomedicine. Bioassays applied in ethnopharmacology represent the molecular characteristics and complexities of the disease or symptoms for which an indigenous drug is used in “traditional” medicine to variable depth and extent. One-dimensional in vitro approaches rarely cope with the complexity of human diseases and ignore the concept of polypharmacological synergies. The recent focus on holistic approaches and systems biology in medicinal plant research represents the trend toward the description and the understanding of complex multi-parameter systems. Ethnopharmacopoeias are non-static cultural constructs shaped by belief and knowledge systems. Intensified globalization and economic liberalism currently accelerates the interchange between local and global pharmacopoeias via international trade, television, the World Wide Web and print media. The increased infiltration of newly generated biomedical knowledge and introduction of “foreign” medicines into local pharmacopoeias leads to syncretic developments and generates a feedback loop. While modern and post-modern cultures and knowledge systems adapt and transform the global impact, they become more relevant for ethnopharmacology. Moreover, what is traditional, alternative or complementary medicine depends on the adopted historic-cultural perspective.

Detection of carbonaceous material in naga bhasma

Traditional medicines have maintained their popularity in all regions of the developing world and are being adopted increasingly by people worldwide. Indian traditional system of medicine Ayurveda make use of unique metallic-herbal preparations (called Bhasma) which involves different processing steps including repeated steps of calcination of metal in the presence of natural precursor (herbal juices, decoctions, and powders, etc). It has been recently established that Bhasma contains nano/sub-micron size particles and different nutrient elements. However, the role and the end product of the raw materials, especially the herbal parts, used during the synthesis of the drug (Bhasma) is one of the important but unanswered problems in such medicinal preparations. Present work on Naga Bhasma is an attempt to understand the role of natural precursors in detail. Our results on infrared, Raman and X-ray photoelectron spectroscopy along with thermal measurements identify the presence of carbonaceous material (hydrogenated amorphous carbon) in the drug along with other compounds. In addition, this work also suggests the science and mechanism behind such complex preparations which could help in standardization of such medicines.

Legal regulations of complementary and alternative medicines in different countries

Traditional medicines that formed the basis of health care throughout the world since the earliest days of mankind are still widely used and have considerable importance in international trade. Recognition of their clinical, pharmaceutical, and economic value is still growing, although this varies widely between countries and therefore regulation of exploitation and exportation is essential, together with international cooperation and coordination for their conservation so as to ensure their availability for the future. World Health Organization and European Union issued the guidelines defined the basic criteria for the evaluation of quality, safety, and efficacy of herbal medicines with the goal of assisting national regulatory authorities, scientific organizations, and manufacturers in assessing documentation, submissions, and dossiers in respect of such products. Legislative controls in respect of medicinal plants have not evolved around a structured control model. There are different ways in which countries define medicinal plants or herbs or products derived from them. The present review highlights the status of different countries adopted various approaches to licensing, dispensing, manufacturing, and trading to ensure their safety, quality, and efficacy.

Nutritional content and a phase-I safety clinical trial of a herbal-nutritional supplement (IMUNITI) with putative immune-modulating properties

The relationship between HIV and AIDS and poor nutrition has been well established. Poor nutrition hastens the progression of HIV infection to AIDS. The rising pandemic of HIV and AIDS and high toxicity associated with anti-retroviral use are major factors that have compelled research to explore traditional herbal medicines as potential alternatives or supplements to anti-retroviral agents. A Phase I clinical trial was conducted on IMUNITI Wellness Pack, a herbal product with putative immune-modulating properties. The product is a combination of 7 herbal preparations, minerals, vitamins, and a specially formulated soya-maize meal porridge and a bottle of water purifier. The aim was to evaluate the safety and tolerability of IMUNITI, with a purpose of developing it for use in HIV-infected patients. The phase I study was conducted at the MRC clinic in Botha's hill and the study lasted 5 weeks from date of participant dosing. The study was a randomised blinded placebo-controlled phase I clinical trial conducted on 48 healthy males. The participants were randomly divided into 4 groups of 12. The 3 groups received different escalating doses of IMUNITI while the forth group received placebo tablets. Participants consumed IMUNITI daily for a period of 5 weeks. Assessments were done at baseline, week 1 and week 5 to determine the safety parameters in all participants. In this study, IMUNITI did not show any safety concerns. In all study participants, there were no significant changes above the upper limit of the reference ranges of the laboratory tests for full blood count, INR, renal and biochemical safety parameters. IMUNITI was well tolerated. Furthermore, the nutritional content analysis of IMUNITI showed that it is a high kilojoule, high protein content product which contains a mixture of sugars, vitamins, traces of calcium, phosphorus and minerals.