TRADITIONAL MEDICINE

AND DISEASES CONTROL

TRID 6132

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 CONTENTS

Introducing traditional medicine

- Definition
- Brief history
- Current role of traditional medicine in public healthcare
- Systems of traditional medical practices
- Drawbacks of traditional medicine
- Challenges of traditional medicine
- Integrating traditional & modern medicine

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Ethiopian Traditional medicine

- Brief history

- Characteristics of Ethiopian traditional medicine

- Types of medical practitioners
- Remedy types used in Ethiopian traditional medicine
- Policy and regulatory aspects (in brief)

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Role of medicinal plants in public health and drug discovery
– Role of medicinal plants in public health
– Medicinal plants & drug discovery
– Intellectual property rights and benefit-sharing mechanisms related to
medicinal plants (very brief)

Ethnobotany and drug discovery

– Definition
– Brief history
– Current scope and application
– Role of ethnobotany in drug discovery

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Ethnobotanical data collection and analytical tools
– Ethnobotanical data collection methods
– Analytical tools used in ethnobotanical data analyses

Procedures used in collection of medicinal plant specimens and their

identification and storage

Procedures used in collection of medicinal plant samples for bioassay

and phytochemical tests

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Preparation and extraction methods of medicinal plants

Major types of plant secondary metabolites

Qualitative and quantitative identification of secondary metabolites in

plants

Procedures used in evaluation of medicinal plants for pharmacological

activities

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 1. INTRODUCING TRADITIONAL MEDICINE

1.1. Definition of traditional medicine (TM)

•TM is a comprehensive term referring to culture-bound health practices, approaches,
knowledge and beliefs employed to:
- diagnose illnesses,
- treat illnesses,
- prevent illnesses, or
- maintain & promote well-being (physical, spiritual, social, mental & material)

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• TM applies a holistic approach (considering a person in his/her totality within an
ecological context; usually will not only look after the sick part of the body).

•Besides giving treatment, traditional practitioners usually provide advice on lifestyles &
healthy behavior.

•TM involves the use of (singly or in combination) of the following:

- plants, animals, fungi
- minerals
- spiritual therapies
- manual techniques & exercises
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•TM therapies can be categorized into two as follows:

• Medication therapies: involve use of herbal medicines, animal parts and/or minerals, or

• Non-medication therapies: carried out primarily without use of medication, e.g., -

- acupuncture & related techniques,
- manual therapies: chiropractic (musculo-skeletal system), osteopathy
(muscles and joints),
- thermal therapy
- mind-body therapy: yoga, hypnotherapy, spiritual healing

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• TM often passed verbally from generation to generation

• TM, in some cases, involves a sophisticated written theory & system (e.g. Asian system)

•Traditional medicine is dynamic; it can be both ancient & contemporary/new. New

knowledge is added up every time.

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•Traditional medicine may also be known as complementary/alternative medicine
when:

1.) When it refers to traditional medicine that does not play a major role in
national healthcare (industrialized countries), Western medicine/modern medicine
(allopathic Medicine) takes full responsibility in the healthcare, or

2.) When it refers to traditional medicine that is practiced in a country but not part
of the country’s own/indigenous tradition

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1.2. Brief history

•There is long history of practising traditional medicine; since time immemorial, people
have been practicing TM to treat & prevent diseases.

•TM precedes modern medicine: it existed in human societies before the application of
modern science to health.

•Its history perhaps goes back as early as the Neanderthal period (stone age) (120
MYA).

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* Physical evidences (fossil) discovered in Iraq revealed the use of
medicinal plants, traced back to some 60,000 years ago.

* Written evidences also indicated the long history of use of medicinal

plants

1) Pharmacopoeia of Chinese herbal, written by Shen Nung,

describe 366 remedies – 4,800 years ago

2) Curved stone tablets in the Babylon listed several medicinal

plants - 18th century BC

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3) Documents found in Egypt from 1600 BC: contained lists of
many medicinal plants, among others. including:

Myrrh (Commiphora myrrha),

Cannabis (Cannabis sativa),
Opium (Papaver somnifera),
Aloes (Aloe spp.),
Hemlock (Conium maculatum),
Cassava (Manihot esculenta)

4) Document written in the 1st Century AD by the Greek physician,

Dioscorides,: described 600 medicinal plants

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1.3. Current role of traditional medicine in public healthcare

•Before the advent of modern medicine, TM has made great contribution to human
healthcare.

•TM still playing important role in the primary healthcare of developing countries mainly
because it is:
- Easily accessible
- Economically affordable, &
- more familiar/popular to users
- Culturally and socially acceptable (preferable)
- Effective in treating some chronic disorders, e.g. mental illness
- employs holistic approach (overall well-being) & person-centered approach (not
disease centered)

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For example:
• In the rural world, 80% or more of the population use traditional medicine
• In Africa, up to 80% of people rely on traditional medicine
• In India, 70% of people use traditional medicine
• In Chile, 71% of people use traditional medicine
• In China, 40% of the population employ traditional medicine
• In Ethiopia, about 80% of people still use traditional medicine for its public and animal
healthcare

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•Traditional medicine is also becoming popular in developed countries.
•Recent studies indicate that close to 50% or more of populations in many industrialized
countries regularly use some form of traditional medicine.
 United States, 42%
 Australia, 48%
 France, 49%
 Canada, 70%
 In Belgium, almost 40% of the population have used CM at least once; 59% of
doctors prescribed complementary medicine

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•Traditional therapies have especially shown to be effective in:

- Disease prevention
- Treatment of non-communicable diseases
- Management of mental health, &
- Promotion of quality life for an aging population

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• The global and national market sales for herbal medicines has shown rapid growth.
According to the Secretariat of CBD report published in 2000:
The global medicines market in 2000 was estimated at US$ 60 000 million
In Japan, the herbal medicines market was worth US$1000 million in 1991, &
US$2400 million in 2000
In the United Kingdom, this market was worth US$92 million in 1994, & US$159
million in 2000
For the USA, the figures are US$I600 million in 1994, & US$5400 million in 2000.

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1.4. Systems of traditional medical practices

There are different systems of traditional medicine (TM) based on their main features or
characteristics. The main ones are Asian system & African system.

1.4.1. Asian systems of traditional medicine

•The Asian systems of TM are based on well-established and written philosophies &
theories.

• Asian systems, among others, include:

A) Chinese TM
B) Ayurveda &
C) Unani

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A) Chinese Traditional Medicine (CTM)

– It is one of the oldest medical systems in the world.

– According to system, concept of health is based on the balance of the body with
external environment

– Diagnosis & treatment are based on holistic understanding of the patient &
patient’s symptoms; & are expressed in terms of the balance of yin & yang.

• Yin : represents earth, cold & femininity

• Yang: represents sky, heat & masculinity

– The balance of the two influence interaction of five elements composing the
universe (which is the body):
metal, wood, water, fire & earth

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-CTM practitioners seek to control the level of yin & yang by manipulating 14 meridians
(channels) regarded as entrance points of vital energy to body.

Chinese medicine encompasses a range of practices including:

- acupuncture
- moxibustion
- herbal remedies
- manual therapies
- exercises
- breathing techniques, &
- diets

Acupuncture
-It involves the insertion of thin filiform needles into various parts of the
body to treat a variety of diseases, mainly along the 14 meridians.

-So far, 657 acupuncture points have been discovered along the 14 meridians (channels).

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- During treatment, needles are left in position for about 15-30 minutes &
are manipulated in twirling or push/pull movements. Needles may be
activated by electrical impulses.

- Acupuncture is practiced to tone up or disperse energy (by doing so stops

patients from feeling pain).

- Diseases treated with acupuncture include:

- common cold
- bronchial asthma
- cardiac diseases
- hypertension
- arthritis
- dysentery
- infectious hepatitis, &
- malaria

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Moxibustion
– In addition to the use of needles, moxa leaves (Artemisia vulgaris) are burned
either near or on the skin of diseased person.

Herbal remedies
– Chinese medicine also employs a wide variety of herbal remedies.

*in China, processing of herbal remedies gradually have developed into industrial scale.
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- Chinese traditional medicine is still commonly practiced in China.

- Nearly 50% of the population in China regularly uses traditional remedies

- About 5000 traditional remedies are available in China; they take up approximately
1/5th of the entire Chinese pharmaceutical market

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B) Ayurveda (way of life)

- Ayurveda originated in the 10th century BC from Asia.

- Well-known form of medicine, next to CTM.
- Is widely practiced in South-Eastern Asia, primarily in India.

- It defines positive health as the blending of human physical, mental, social, moral & spiritual
welfare.

- Based on Ayurveda theory, human body is well-balanced combination of

3 humours (body fluids), 7 basic tissues & 3 excretions.

- The three humours (vata, pitta & kapha) are derided from 5 basic physical elements:
earth, water, fire, air & sky (human is considered as miniature of universe).

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- Vita, pitta & kapha, can be compared to the neurotransmitters known in modern medicine:
acetylcholine, catecholamine & histamine, respectively in our body.

- According to Ayurveda, all bodily functions & structures are controlled by the three
humours

- If balance of the three humours is disturbed/upset, the individual falls sick.

- Treatment is therefore, given to keep the balance of the three body humours.

- Ayurveda treatment encompasses a range of practices including:

- yoga
- use of herbal remedies &
- surgical measures

- Ayurveda is widely practiced in India, Bangladesh, Nepal, Pakistan & Sri Lanka.

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C) Unani (Arab medicine)

- It has been practiced since about 1100 AD.

- The system presupposes presence of four humours (temperaments) in

the body:
- dam (blood) – is hot & moist
- balgham (phlegm) – cold & moist
- safra (yellow bile) – hot & dry
- sauda (black bile)- cold & dry

- If the 4 humours are in a state of equilibrium, the person is healthy. If not, he falls sick.

- Treatment is, therefore, given to restore balance among the four humours.

- Diagnosis is made by Hakim through examination of (mainly) pulses, urine & stool.

- Treatment mainly involve herbal remedies; ‘hot’ medicine would treat ‘cold’ disease

- Treatment also involves: venesection, cupping & massages.

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1.4.2. Traditional African medicine (TAM)

- TAM is mainly oral tradition & unlike the Asian medical systems, there are no well-written
records concerning its thoughts & theories.

- TAM is practiced differently in different parts of the continent, but there is common
characteristic feature, i.e. a belief that serious illness is caused by supernatural agency, e.g.
due to anger of ancestor spirits

- As a result, divination & incantation play major role in TAM.

* Divination is diagnostic mechanism used to discover a hidden sin due to

anger of ancestor spirits
Reason for anger: disregard to ancestors & disrespect to moral laws.

* Incantation is treatment process through rituals accompanied by the use of herbal

remedies.
It is collection of carefully selected words used to bring about healing effect of remedy.

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- TAM involves the widespread use of plants & animals as remedies.

- TAM tends to exclude poisonous plants; they are excluded over time through trial & error
methods.

- Plants used in TAM can be grouped into two broad categories:

a) Plants used for minor ailments (due to natural causes) such as aches & pains,
headache, fever & bruises. No divination & incantation is required. Here, medicinal plant
research may yield modern medicine.
b) Plants used for serious illness – where supernatural agencies are believed to be
the causes of illnesses.
- Here, divination & incantation are used for treatment.

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- In TAM, people recognized for practising traditional medicine are called traditional healers.
Four types of healers are frequently cited.

1. Faith healers: belong to a particular religious movement (e.g. priests)

- employ holy books, holy water & prayers to cure illnesses
- Practitioners are mostly men
2. Spiritualists: belong to a specific shrine (place associated to divinity)
- Are specialists in diagnosing illness (through divination)
3. Traditional birth attendants/midwives
- Mostly middle & old-aged women, with great exp. in pregnancy & child birth
4. Traditional herbalists
- They basically use herbs to treat illnesses.

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1.5. Drawbacks/weaknesses of traditional medicine

Some of the weaknesses of traditional medicine are:

1) Lack of scientific proof for efficacy claims

- Many of the claims have not yet been thoroughly investigated and verified.

2) Diagnosis often imprecise – diagnosis is crude

- Diagnosis of stomach trouble could mean microbial infection, indigestion, ulcer,
or cancer
- Practitioners tend to treat/stop symptom rather than the cause of the disease;

3) Lack of precise dosage

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4) Unhygienic medical practice
- Includes both the practitioner’s clinic & his mode of remedy preparations

5) The intangible aspect of the practice

- Sometimes, difficult to prove scientifically

6) Evil aspects of the practice

- Certain practices are designated to bring harm/damage to other people

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1.6. Challenges in relation to development traditional medicine
- Lack of official recognition of TM and TM providers
- Lack of TM integration into national health care systems
- Lack of regulatory and legal mechanisms
- lack of mechanisms for equitable distribution of benefits arising from use of TM
knowledge and products
- Inadequate allocation of resources for TM research and capacity building
- Lack of research methodology
- Inadequate evidence-base for TM therapies and products
- Lack of standards for ensuring safety, efficacy and quality control of therapies and
products
- Lack of registration of TM providers and products

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1.7. Integrating traditional medicine with and modern medicine
- WHO encourages & supports member states to integrate traditional medicines
into their official national healthcare system for better healthcare delivery.

- To that end, WHO has been helping member countries:

- By supporting research & training of national programs
- By supporting preparation of technical guidelines & internat. standards (e.g. to check
safety & standards)
- By facilitating information exchange b/n countries

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- Integration between the two can be applied in different ways:
- Conduct of joint research works
- Offering joint training &
- through complimentary treatment.

-WHO has defined three types of health systems to describe the degree to which traditional
medicines is an officially recognized element of healthcare. These are:
- integrative system
- inclusive system
- tolerant system

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- Integrative system: TM is officially recognised & incorporated into all
areas of main stream healthcare systems. This means:
- TM is included in national drug policy
- Service providers & products are registered & regulated at all levels
- TM therapies are available at hospitals & clinics
- There is health insurance coverage to the system
- There is support for research and education

- Countries who attained full integration include, China, NK, SK & Viet Nam

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- Inclusive system: TM is recognised but not fully integrated.
- TM service might not be available at all healthcare levels
- Health insurance might not cover treatment with TM
- Regulation of TM providers & products might be lacking or partial

Countries who reached such level of integration include Nigeria, Mali, Canada, UK

- Tolerant system: Official healthcare system is entirely based on allopathic/modern

medicine; But practices of TM are tolerated by law (e.g. Ethiopia)

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 2. ETHIOPIAN TRADITIONAL MEDICINE

2.1. Brief history

Although traditional medical practice in Ethiopia is thought to have a very long

History, the oldest traditional medical writings/pharmacopoeas only go back to the 15th
century.

e.g. - “Metshafe Fews” was written in Geez in the med 15th century.

More information on the history of TM in Ethiopia will be provided later

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2.2. Characteristics of Ethiopian traditional medicine
- As it is also true in many African regions, healing in Ethiopia is not only
concerned with curing diseases but also with protection & promotion of
physical, spiritual, social, mental & material wellbeing.

- Thus, Ethiopian TM involves both preventive and curative practices:

-Preventive practices: avoiding contact in time of epidemics, inoculating people with pus
taken from sick persons (e.g. small pox), covering floors with plants, use of kitabs
(amulets) to protect individual against evil eye and snake and scorpion bites, eye make-
up to protect evil eye, cultural rituals and scarification (inserting medicine under the skin)

-Curative practices: measures taken to cure a variety of illnesses (e.g.: gastrointestinal

disturbances, respiratory disorders, sexually transmitted infections, tuberculosis,
impotency, hemorrhoids, rabies, intestinal parasites, skin problems, liver diseases,
mental disorders, hypertension, diabetes, gynecological conditions, rheumatism,
malaria)

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- The knowledge & skill of traditional practitioners is passed ,largely ,orally largely from father
to favourite child, usually the son, and is transferred usually accompanied by
spiritual procedures
- The practice is often associated with religion & often involves prayers
- TM often also involves magic

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- Remedies are prepared in various dosage forms: including, liquids, ointments,
powders and pills.

- Some remedies are given in non-formulated (unprocessed) forms.

- Herbal preparations are administered using different routes, mainly applied orally, topically
or nasally (by inhalation).

- Additives (e.g., honey, sugar, alcohol) usually incorporated to increase their palatability

- Concoctions are frequently used to enhance activity/potemcy, but may also be used to
conceal the active plants.

- Antidotes are used when untoward effects become severe (e.g., milk, egg)

- Restrictions may be imposed on patients when certain types of drugs are taken.

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 TM is widely practiced by professional healers, with knowledge widely believed to be given to
them by God. Complicated diseases are handled by Professional healers

 There is also old tradition of self-care in home by lay people to cure minor ailments

 Traditional medical heritage is mainly indigenous although influenced to some extent by

historical developments, e.g.:

- Immigration of people from Southern Arabian Peninsula

- Introduction of Greek culture
- Introduction of Christianity & Islam

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2.3. Types of medical practitioners

There are different categories of trad. med. practitioners in Ethiopia including:

1) Herbalists
- Are the most popular practitioners
- Use different plants for treatment
- Herbalist further categorised into:
- herbal medicine gatherers (medhanit korach)
- herbal medicine preparers (medhanit atechi)
- amulet makers (kitab ketabi)

2) Surgical practitioners
- Are distinguished according the organ domain/specialization they are dealing with,
Example:
- bone and jimat (cord) setter - wegesha
- tooth extractor - yetirs awaki
- uvula and tonsil cutter - intil korach

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3) Spiritual & faith healers
- Practitioners whose powers are from privileged access to spirits of the
church or zar, examples are:

- debteras (Christians)
- tenquay (witch doctors)
- weqaby
- kalicha (Muslims)

4) Miscellaneous/others
- Include practitioners such as
- cuppers
- traditional birth attendants (yelimd awalaj)

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2.4. Remedy types used in Ethiopian traditional medicine

Different sources are used in the preparation of Ethiopian remedies. These

include:

a) Plant preparations
b) Animal products
c) Mineral substances (e.g. sulphur)
d) Holy water:
- tsebel for Christians
- zemezem for Muslims

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2.5. Policy and regulatory aspects of TM in Ethiopia

- The Importance of TM has been recognized by governments in the past & present

- As a result, governments tried to formulate and implement various proclamations & policies to
promote regulated use of TM

- The first formal sympathy/recognition to TM was reflected in Proclamation No.100/1948.

E.g.: Article 3(b) states that practitioners are allowed to practice TM as long as it
is non-dangerous to health.

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- The 1993 Health Policy of Ethiopia encourages the practice of traditional medicine:

- Article 2 states that due attention shall be given to the development of the beneficial
aspects of Traditional Medicine (including related research and its gradual integration
into modern medicine).

- Article 8 states that traditional medicine shall be appropriate attention by:

- identifying and encouraging utilization of its beneficial aspects

- Coordinating and encouraging research including its linkage with modern
medicine
- Developing appropriate regulation and registration for its practice

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- In 1979, the Coordinating Office for Traditional Medicine was established
under the MoH; which was upgraded to the Department of Traditional Medicine
under the Ethiopia Health and Nutrition Research Institute in 1988. Recently, it is
renamed as Drug Research Directorate.

- However, there are, so far. no existing regulatory mechanisms in place to ensure the
safety, efficacy and quality of traditional medicine.

- Thus,
- TM practitioners and their products are not legally registered.

- As a result, assurances for the safety, efficacy and standard of services and products
cannot be provided.

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THE END

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