Traditional medicine: Back to basics — Part One …shifting to herbal therapies

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DESPITE the wide use of Western medicine, traditional medicine has remained the most affordable and easily accessible source of treatment in the primary healthcare system of resource-poor communities in Zimbabwe. 

Here, the local indigenous people have a long history of traditional plant usage for medicinal purposes.

A total of 93 medicinal plant species representing 41 families and 77 genera are used in south-central Zimbabwe. 

These plant species are used to treat 18 diseases and disorder categories, with the highest number of species used for gastro-intestinal disorders, followed by sexually transmitted infections, cold, cough and sore throat as well as gynaecological problems. 

Shrubs and trees (38 percent each) were the primary sources of medicinal plants, followed by herbs (21 percent) and climbers (three percent). 

The therapeutic claims made on medicinal plants documented in south-central Zimbabwe are well supported by literature, with 82,8 percent of the plant species having similar applications in other regions of Zimbabwe as well as other parts of the world while 89,2 percent have documented biological and pharmacological properties.

The recent announcement by the Ministry of Health and Child Care to bring traditional medicine practitioners in line with other countries, such as Canada, was welcome.

In Canada, new regulations, the Natural Health Products Regulations, came into force in January 2004.  

Products that fall within the new regulations include herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics, amino acids and essential fatty acids.

In Zimbabwe, COVID-19 brought about a renewed interest in traditional herbal remedies resulting in a frenzied rush for garlic, lemon and zumbani/lippia java – notwithstanding any scientific proof of their efficacy, but purely on hearsay and gossip.

Worldwide, there has been an increased interest in traditional herbal treatments.  

In Zimbabwe, due to the non-availability and the high cost of conventional Western medicines, an estimated 80 percent of the population rely on traditional herbal medicine.  

Herbal medicines are also referred to as herbal remedies, herbal products, herbal medicinal products, phytomedicines or phytopharmaceuticals.

Across the developed world, a reported “…general disillusionment with conventional medicines, coupled with the desire for a ‘natural’ lifestyle has resulted in an increasing utilisation of complementary and alternative medicine.”  

Complementary and alternative medicine (CAM) studies of long-term trends in the use of complementary and alternative medicine therapies in the US reported a steady increase since the 1950s.  

However, since then, there have been reports that the US market has levelled off and, in some cases, even declined.  More recently, studies confirmed the prevalence of complementary and alternative medicine has remained stable with about a third of adults in the US reporting the use of such therapies.

In many Western countries, the use of CAM therapies increased, particularly in the 1970s and again in the 1990s, regardless of gender, ethnicity or level of education, but more commonly in younger people. 

The continuing use of CAM therapies has also been reported in South Australia where, in 2004, CAMs were reportedly used by over 50 percent of the population.  

Several other studies have documented the growing use of alternative medicine in the UK, where estimates are reported to “…range from 10,6 percent, for use of a limited list of CAM therapies, to 46,6 percent for use of CAM therapies or over-the-counter (OTC) CAM products.”   

The report concluded that the continuing demand for CAM therapies will affect delivery of healthcare for the foreseeable future.

In a report on CAM therapies, the House of Lords Select Committee on Science and Technology’s sub-Committee on Complementary and Alternative Medicine highlighted the lack of comprehensive information on the use of herbal medicines in the UK.   

Estimates of herbal medicine use are available, but it is difficult to gauge usage accurately as many products are

considered to be food supplements. 

Studies in the UK, Australia and the US show that pharmacists are frequently involved in the supply of herbal medicines.  

Against the background of increasing usage of herbal medicines by the public, a number of major public health issues have raised concerns about these products and have highlighted the need for healthcare professionals to have up-to-date scientific information on the quality, safety and efficacy of these products.

Pharmacists need to be able to advise the consumer on the rational and safe use of all medicines. 

In order to fulfil this role, pharmacists need to be knowledgeable about herbal medicines and should have access to reliable information in order to advise patients and the public on the safe, effective and appropriate use of herbal preparations.   

Many other healthcare professionals are becoming increasingly aware of their patients’ use of herbal medicines and should to be informed of the suitability of these products for use as medicines.

The increased awareness of the harmful effects associated with the consumption of excessive tea and coffee has also prompted many individuals to switch to herbal teas.  While some herbal teas may offer pleasant alternatives to tea and coffee, some contain pharmacologically active herbal ingredients which may have unpredictable effects on a consumer, depending on the quantity of tea consumed and strength of the brew.  

Some herbal teas contain laxative herbal ingredients.

In the belief that natural remedies may be safer than conventional medicines, some parents may, at times, be influenced to choose herbal medicines for their children.  While herbal medicines may offer a milder alternative to some conventional medicines, the suitability of a herbal remedy needs to be carefully considered with respect to its quality, safety and efficacy.  

Herbal medicines should be used with caution in children and medical advice should be sought at all times, especially if in doubt.

The administration of herbal teas to children is generally not recommended unless used according to professional advice.  

Several surveys indicate that herbal use in children is increasing and it has been estimated that 28-40 percent of children may be exposed to herbal preparations for the management of asthma, anxiety attention deficit, hyperactivity disorders, insomnia and respiratory infections.

The WHO’s Uppsala Monitoring Centre (WHO-UMC; Collaborating Centre for International Drug Monitoring) receives summary reports of spontaneous reports of suspected adverse drug reactions from national pharmacovigilance centres of over 70 countries worldwide.   

For example, at the end of 2005, the WHO-UMC’s Vigi search database contained a total of 10 reports, describing a total of 22 adverse reactions; giving as an example for products reported to contain phybridus only as the active ingredient.

However, findings show that many of the reports of adverse effects are associated with products of poor quality where the adverse effect is caused by adulteration with heavy metals or conventional pharmaceutical drugs.

According to the authors, use of herbal medicines in an evidence or science-based approach for the treatment and prevention of disease is known as (rational) phytotherapy. This approach to the use of herbal medicines contrasts with traditional medical herbalism which uses herbal medicines in a holistic manner and mainly on the basis of their empirical and traditional uses.  Although these two approaches (traditional/holistic and rational/evidence-based) are entirely different, in some instances they use the same terminology. 

For example, traditional herbalism is also described as ‘phytotherapy’ and refers to preparations of plant material as ‘herbal medicines’.

Today, a continuum between these approaches exists and many herbalists also use scientific evidence to support their traditional use of herbal medicines. 

Plants have been used medicinally for thousands of years by cultures all over the world.  

According to WHO, 80 percent of the world’s population uses plant-based remedies as their primary form of healthcare; in some countries, especially in Africa, including Zimbabwe, herbal medicines are still a central part of the medical system.

However, the need to be reliably informed of the quality, safety and efficacy of herbal medicines is essential for the herbalist, pharmacist, doctor and consumer, especially in Zimbabwe where regulations do not exist. 

Dr Tony Monda is Zimbabwean socio-economic analyst-consultant. He is currently conducting veterinary epidemiology, agro-economic and food security research in Zimbabwe and Southern Africa.

For views and comments, email tonym.MONDA@gmail.com

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