ETHNOPHARMACY

Outline

• Historical Review of Traditional Medicine (TM)/Complementary and Alternative Medicine (CAM)
• TM Practices (an overview)
• Transformation of Herbal Medicine (HM) Practice in Ghana

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ETHNOPHARMACY

Definition

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• Ethnopharmacy is defined as the interdisciplinary science that investigates the perception and use of traditional pharmaceuticals in a given human society.

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Scope

• It involves studies of;
• the identification and classification (ethnotaxonomy) of the natural material from which the natural remedy will be produced
• Traditional preparations of the pharmaceutical forms (ethnopharmaceutics)
• Biological evaluation of the pharmacological action of the preparations (ethnopharmacology)
• Clinical efficacy of such preparations (Clinical ethnopharmacy)

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Objectives

• Trace the history of the use of traditional medicine (TM)
• Define terms commonly associated with TM
• Know how and when to collect plants for medicinal use and their preparations
• Explore some social consequences of the use of medicinal plants
• Some common plants that are used as medicines

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Historical Review

• Traditional medicine is the oldest form of healthcare known to mankind.
• The use of plants play an integral role in this form of medical system
• Ez 47:12
• And for the most part, the knowledge of the use of plants as medicine was passed from generation to generation by word of mouth.
• Science has isolated, analysed and synthesized the medicinal properties of a large number of botanicals that are now used as medicines.�

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Examples

examples

• Vincristine, used to treat certain types of cancer, comes from periwinkle.
• The opium poppy yields morphine, codeine, and paregoric.
• Currently morphine, the most important alkaloid of the opium poppy-remains the standard against which new synthetic analgesics are measured

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• Until the beginning of the early 19^th century all forms of medicine in use was traditional.
• From diagnostic methods to materials used in the treatment of these diseases.
• One of the earliest records of the use of herbal medicine is that of Chaulmoogra oil form spp of Hydnocarpus, which was known to be effective in the treatment of leprosy.

• Recorded in the pharmacopoeia of the Emperor Shen Nung of China between 2730 B.C. and 3000B.C.

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• Seeds of the opium poppy (Papaver somniferum) and seeds of Ricinus communis were excavated from some tombs in Egypt which indicated their use in Africa to as far back as 1500B.C.

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• And they may have been used for the same medical reasons they are used today.
• Hippocrates (father of medicine) born in 460 B.C described a number of herbal recipes in his materia medica.
• Some of the medicinal plants he described included opium, sage, mint, rosemary and verbena.( find the botanical sources and medicinal uses of these plants)

• Theophrastus of Athens (370 B.C.) was another Greek biologist –botanist who produced the famous manuscript Historia Plantarium.
• This became the standard botanical text book in his time and also after his death.
• Dioscorides (A.D. 60) wrote De Materia Medica and served as reference manuscript in Europe during the medieval period.
• It contained the description of some 600 medicinal plants.

• The use of many medicinal plants in Europe in the 14th century was based on the doctrine of Signature or Similars developed by Paracelsus (1490-1541), a Swiss alchemist and physician.
• According to this doctrine, healing herbs have features made by God that identifies them with specific diseases or part of the body.
• Eg, Asplenium trichomanes for the treatment of the spleen

• Asplenium trichomanes

• Spleen

Doctrine of signatures/similars

WHO’s definition

• WHO defines traditional medicine as “the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness whether explicable or not which is passed on from generation to generation”
• Traditional medicine covers a wide variety of therapies and practices which vary from country to country and region to region. In some countries, it is referred to as "alternative" or "complementary" medicine (CAM).

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Categories of Practitioners

• TM Practitioners may be characterized on the basis of the mode or tools of practice and include:
• Herbalists,
• Psychic healers/Spiritualists,
• Shrine devotees and Cult adherents,
• Traditional Birth Attendants/Traditional midwives
• Bone Setters and
• Circumcisers.

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Who uses TM/CAM?

• In some Asian and African countries, 80% of the population depend on TM for primary health care.
• In many developed countries, 70% to 80% of the population have used some form of alternative or complementary medicine (e.g. acupuncture)
• In China, traditional medicines account for 30 – 50% of total medicinal consumption.
• Within China, the traditional systems of health care (TCM) are incorporated into the formal component of national health care.

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Statistics in Ghana

• In Ghana, about 70% of the population depend exclusively on traditional medicine for their health care
• There is approximately one traditional medicine practitioner for every 400 people, compared to one allopathic doctor for every 12 000 people
• With over 100 000 traditional medicine practitioners uniformly distributed nationally, they are not only more accessible to the public, but also the backbone of the health care delivery system

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TM has developed in the midst of expanding global use of natural therapies , improvement in educational levels of practitioners, improvement in the quality, safety and efficacy of the herbal products and the demand of clients for evidence based modern practice environment

The case for TM/CAM

• Cheaper than orthodox medicine
• More accessible to the population in developing countries
• Enjoys more acceptability
• Potential source of new drugs
• “Safer” to use than orthodox medicine
• Any others?...

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Challenges to acceptance of TM/CAM

• Lack of scientific proof of efficacy
• Imprecise diagnosis given by practitioners
• Lack of precise dosing regimen
• Sometimes unhygienic
• Intangible aspects or occult practices cannot be verified scientifically
• Evil aspects associated with TM discredit the use of this form of medicine
• Any others?...

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Traditional Medicine has however undergone several modifications, incorporating several aspects of orthodox medicine to make it more acceptable.

Some Traditional Medical Systems

• Acupuncture
• Ayurveda
• Homeopathy
• Naturopathy
• Hydropathy
• Chiropractice

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Acupuncture

• Among the oldest healing practices in the world.
• Aims to restore and maintain health through the stimulation of specific points on the body
• The term “acupuncture” describes a family of procedures involving the stimulation of anatomical points on the body using a variety of techniques.
• The technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.
• In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: Yin (cold, slow or passive principles) and Yang (hot, excited or active principles).

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Principle behind Acupuncture

• In Acupuncture, health is achieved by maintaining the body in a “balanced state”. Disease is due to an internal imbalance of Yin and Yang.
• This imbalance leads to blockage in the flow of Qi (vital energy) along pathways known as meridians. Qi can be unblocked, by using acupuncture at certain points on the body that connect with these meridians.
• Each meridian is associated with a physiological system and internal organ.
• Acupuncture needles are metallic, solid, and hair-thin and cause no pain on entry into a meridian. However, improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.

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An illustration

• For example, in the case of someone suffering from bronchitis during the cold weather,  a Chinese diagnosis would classify it as having cold in the lung. The cause is an excess of Yin (which represents cold) and a lack of Yang (representing warmth).  To treat the illness, all the specific points related to the lung meridian could be touched to disperse the cold concentration to other parts of the body where it won't cause harm. 
• An alternative treatment consists of stimulating the fire point within the lung meridian that will heat the body up and add Yang (again, warmth) so that the body's natural immune system can be strengthened

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What does Acupuncture treat?

• Based on clinical experience, it's known that acupuncture can treat a variety of respiratory, eye and mouth, gastro-intestinal, neurological and muscular disorders. It's especially effective on headaches, migraine and back pain
• Acupuncture is also used to help people stop smoking, lose weight, lower blood pressure, relive constipation, anxiety, insomnia, allergies, asthma and alleviate skin disorders.

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Ayurveda

• Literally translates from Sanskrit as ayus meaning ‘life’ and veda meaning ‘science or knowledge’.
• Defined as the science and knowledge of life that promotes longevity and prevention of ill health.
• It is said to be a holistic system of medicine
• The Ayurvedic medical system is believed to have been in practice for over 5000 years mainly in India.
• Involves among other things the use of herbs for the diagnosis and treatment of diseases.

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Principle behind Ayurveda

• According to Ayurveda, the body consists of five main elements collectively known as Bhutas i.e. air, fire, water, earth and ethereal parts of the sky.
• In addition, life is said to depend on the mind, soul and the presence of normally functioning sense organs.
• Therefore, a healthy man is one who possesses a perfectly balanced body of humours, proper functioning of all body elements and one with a pleasant disposition.

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Principle behind Ayurveda

• According to Ayurveda all bodily functions and structures are controlled by three Ayurvedic humours- data, pitha and kapha and when the balance is upset the individual falls sick
• 1. Vata- A person with constitution usually has a thin body and unstable temperament. He is often restless, usually talkative, quickly grasps but also readily forgets facts. He has thick rough hair and usually develops illnesses such as excessive nervousness, insomnia, stress disorders such as peptic ulcer

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• Pitha- A person in this category has a moderately well built, muscular body and is courageous and strong. He has scanty soft hair and when provoked he devolps circulatory problems. He is likely to develop hypertension and coronary thrombosis even when young.
• Kapha- A person with this constitution has a bulky and heavy body with smooth rounded face and limbs. He is generally slow in action and speech. He is usually susceptible to allergic manifestations. He is not excitable.

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Treatment in Ayurveda

• Curative treatment in ayurveda consists of

1. Administration of medicine internally

2. Application of external preparations

3. Surgical measures and

4. Treament by psychosomatic measures

• Herbs represent the most effective way of treating ailments in ayurvedic medicine. They are used in the form of concoctions, teas, powders, infusions, etc

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Herbs used in Ayurveda

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Advantages of Ayurveda

• Complete cure and not only control of signs and symptoms
• Free from side effects, rather side benefits are there
• It is a holistic system of medicine and does not have segregated approach, as it cures the patient as a whole and not the disease only.

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Homeopathy

• Based on the principle of "like cures like“
• This differs from the theory of Signatures proposed by Paracelsus.
• In Homeopathy, a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people
• Remedies are prepared by repeatedly diluting a chosen substance in alcohol or distilled water
• Dilutions are necessary, since large doses of drugs that caused similar symptoms would only aggravate illness

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Hydropathy

• Also known as hydrotherapy, hydropathy relies on the use of water for pain relief and treatment
• The physical properties of water, such as temperature and pressure are employed for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases
• The "active agents in the treatment are heat and cold", and water as the vehicle
• Partly responsible for the popularity of spas in modern day lifestyles

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Herbal Medicine

• Herbalists use medicinal plants to treat and prevent diseases and promote optimum health.
• The principle for the practice is that the whole plant treats the whole person facilitating deep and lasting health improvements in a manner that is safe, gentle and effective (holistic).
• It is the oldest form of medicine and from a global perspective, it is still the most commonly used type of medicine in the world today.
• Synonyms: Botanical medicine, Herbalism, Phytotherapy, Phytomedicine, and Plant medicine.

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Categories of Herbal Medicine

• Medicinal plant: any plant which in whole or in part contains substances that can be used for therapeutic purposes or which are precursors for the synthesis of useful drugs.
• Herbs: crude plant material which includes leaves, barks, roots, etc,
• Herbal Materials: includes not only the herbs but fresh juices, dry powders including semi processed materials made by steeping with honey, alcoholic beverages [ bitters].
• Herbal Preparations: produced by extraction, fractionation purification which are the basis of the ultimate in herbal medicines
• Finished Herbal Products: which are at the apex of the assortment of preparations/products and are the most advanced or highest value-added forms of herbal medications

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Origins of Herbal Medicine

• No accepted theories as to the origins of herbalism but it seems reasonable to assume it is same as proposed for traditional medicine. Several folk tales from different regions and cultures of the world point to anecdotes on origins such as:

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• Accidental discovery or Serendipity.
• Trial and error,
• Extra sensory perception including divine revelations,
• Lessons from nature especially from animal observations,
• Experimental – modern arts

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History of Herbal Medicine in Ghana

• The history of herbal medicine is coincident with traditional medicine and is significant in the context of the introduction of allopathic medicine and passage of laws to suppress indigenous customs-e.g. in 1878, the Native Customs Regulation Ordinance prohibited many customary practices which “offended European sensibilities”.
• Various indigenous groups such as the Aborigine Rights Protection Society (1930) and Ga Medical Association (1950) resisted the laws of suppression of traditional practices.

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History continued…

• Before colonialism, traditional medicine was solely practiced in an unorganized manner
• After independence (1957) Dr. Kwame Nkrumah began Africanisation process including modernization of traditional medicine
• Establishment of the Ghana Psychic and Traditional Healing Association in 1961 encouraged some members to set up the Complex Hospital at Nsawam

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History continued…

• The Danfa Comprehensive Rural Health and Family Planning Project (began in 1964) is a notable one for the training of TBAs.
• In 1978, significant boost given TM in healthcare delivery in Ghana in particular due to the Alma Ata declaration of ‘Health for All’ which recognized the role of TM in primary healthcare
• Other healthcare training initiatives to upgrade traditional healthcare practice were also undertaken such as the Primary Health Training for Indigenous Healers Project (PRHETIH) by the MOH and the Catholic Holy Family Hospital in 1979.

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History continued…

• 1964 Dr. Nkrumah set up CSIR with special charge to Dr. Irvine and later Dr. Ducose to identify and document medicinal plants of Ghana
•  In the early 1960s, Dr. Nkrumah sent Dr. Oku Ampofo and others to China to benefit from the Chinese experience in herbal medicine
• 1975 Dr. Oku Ampofo out of his own interest and with government, donor and other interest groups’ support, set up CSRPM at Mampong-Akuapem
• CSRPM has a total of 750 acre arboretum located at three different vegetational zones in the Eastern Region of Ghana

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History continued…

• 1991 The Traditional and Alternative Medicine Unit was set-up by the MOH, headed by a Deputy Director
• 1992 The Ghana Herbal Pharmacopoeia was launched
• 1997 The Federation of the 6 major Traditional Health Practitioner Associations was formed facilitated by government-GHAFTRAM
• 2000 Ethno-botanical and floristic studies in Ghana were reviewed with emphasis on TM
• 2001 The B.Sc. Herbal Medicine program began at the KNUST

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History continued…

• 1992 Food and Drugs Board Law passed but became operational in 1997
• 2003 Traditional and Alternative Medicines Directorate was elevated to a full Directorate headed by a Director.
• 2007 2^nd edition of the Ghana Herbal Pharmacopoeia
• The Government of Ghana has set aside the third week of March every year as Traditional Medicine Week, starting from the year 2000

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Transformation of HM in Ghana

• Growth of ‘neo-herbalism’ in the midst of expanding global renaissance in natural therapies use in healthcare
• Growth in business in herbal medicinal products
• Increase in herbal clinics following concepts of orthodox medical set-ups in mainly urban/city areas
• Directly advertised to customer practices and products
• Commercial production of varied dosage forms, possibly including new combination products
• Modern packaging of products with presumed longer shelf-life

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Transformation…

• The quality of a product is defined in terms of identity, purity and active content (potency) or as “the status of a drug, which is determined either by identity, purity, content and other chemical physical or biological properties or by the manufacturing process”
• The FDB became operational in 1997 and started regulation of herbal medicine quality in 1998
• Other policy initiatives and legislation such as the Ghana National Drugs Policy (Ministry of Health, August, 1999 revised 2004) aims at promoting R&D and rational use of medicines.

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Transformation…

• Various governmental bodies and non-governmental ones have contributed to the development of herbal medicine. These include:
• TAMD, TMPC, GNDP, FDA, CSRPM, the Faculty of Pharmacy and Pharmaceutical Sciences, KNUST, Department of Chemistry and the NMIMR University of Ghana Legon, and the Ghana Federation of Traditional Medicine Practitioners Association (GHAFTRAM)

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Transformation…

• The initiatives by stakeholders not only created an awareness towards evidence-based herbal medicine practice but also afforded the opportunity to initiate training schemes to benefit both practitioners and clients on two fronts: improved practices and product quality, safety and efficacy.
• Currently (since 2010), FDA requires for registration, the provision of safety data: acute, sub-acute, chronic and sub-chronic toxicity for some categories of medicines.

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Transformation…

• Other NGOs provided support to improve practice e.g. GHAFTRAM etc by instilling professionalism in patient care and dispensing in a wholesome environment

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• These provided the basis for the introduction of the BSc. Herbal Medicine program in the KNUST, Kumasi in 2001

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Backed by Legislation

• ACT 575, Traditional Medicine Practice Act, 2000
• The Act defines traditional medicine as "practice based on beliefs and ideas recognized by the community to provide health care by using herbs and other naturally occurring substances"
• An ACT to establish a Council to regulate the practice of traditional medicine
• To register practitioners and license practices
• To regulate the preparation and sale of herbal, medicines
• To provide for related matters

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1. Establishment of the Council

(I) There is established by this Act a body corporate to be known as the Traditional Medicine Practice Council.

(2) The Council shall have perpetual succession, a common seal and may sue and be sued in its own name.

(3) The Council may for the performance of its functions acquire and hold movable and immovable property and may enter into a contract or any other transaction.

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2. Object and functions of the Council

(1)The object of the Council is to promote, control and regulate traditional medicine practice.

(2) For the purposes of subsection (I) the Council shall

(a) set standards for the practice of traditional medicine;

(b) issue a certificate of registration to a qualified practitioner and license premises for a practice;

(c) determine and enforce a code of ethics for traditional medicine practice in conjunction with an association of traditional medicine practitioners recognized by the Minister responsible for Health

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d) promote and support training in traditional medicine;

e) approve in consultation with the educational and research institutions determined by the Board the curriculum for training in traditional medicine in the institutions;

f) collaborate with the Ministry to establish centres for provision of traditional medical care within the national health care delivery system;

g) advise the Minister on matters relating to and affecting the practice of traditional medicine;

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h) collaborate with the appropriate agencies for large scale cultivation of medicinal plants and for the preservation of bio-diversity;

i) advise the Food and Drugs Board in writing on rules for the registration, advertisement, manufacture, packaging, preparation, labeling, sale, supply, exportation and importation of herbal medicine;

j) monitor fees payable by clients for services provided by practitioners; and perform any other functions that are ancillary to the objectives of the Council.

k) perform any other functions that are ancillary to the objectives of the Council.

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FDB Regulation

• GUIDELINES FOR THE REGISTRATION OF HERBAL AND HOMEOPATHIC DRUGS IN GHANA
• REQUIREMENTS
• Registration
• SPECIFIC REQUIREMENTS
• Includes: acute, sub-acute, chronic and sub-chronic test reports shall be required
• LOCALLY MANUFACTURED DRUGS
• Pharmacotoxicological test reports shall be submitted from but not limited to any of the under listed institutions:
• i. Centre for Scientific Research into Plant Medicine, Mampong
• ii. Noguchi Memorial Institute for Medical Research, University of Ghana, Legon
• iii. Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science an and Technology (KNUST), Kumasi
• iv. Pharmacology Department, University of Ghana Medical School, Korle Bu.

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Herbal Products registered by FDB

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Herbal Practitioners in Ghana

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Would TM become extinct?

• Three factors legitimize the role of the healer
• their own beliefs
• the success of their actions
• the beliefs of the community
• When the claims of indigenous medicine become rejected by a culture, generally three types of adherents still use it
• those born and socialized in it who become permanent believers
• temporary believers who turn to it in crisis times
• those who only believe in specific aspects, not in all of it

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