Jamu (Ginger and Kaempferia) PDF

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Review
Jamu: Indonesian traditional herbal medicine

towards rational phytopharmacological use
Elfahmi a , Herman J. Woerdenbag b , Oliver Kayser c,
a
School of Pharmacy, Institut Teknologi Bandung (ITB), Jl Ganesha 10, Bandung 40116, Indonesia and Department
of Pharmaceutical Biology, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
b Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1,
9713 AV Groningen, The Netherlands
c Technische Biochemie, Technische Universitt Dortmund, Emil-Figge-Strasse 66, 44227 Dortmund, Germany
a r t i c l e
i n f o
a b s t r a c t
Article history:
Jamu is the Indonesian traditional herbal medicine that has been practised for many cen-
Received 2 June 2012
turies in the Indonesian community to maintain good health and to treat diseases. Although
Received in revised form
modern (conventional) medicine is becoming increasingly important in Indonesia, jamu is
9 October 2013
still very popular in rural as well as in urban areas. Based on its traditional use jamu is
Accepted 7 January 2014
being developed into a rational form of therapy, by herbal practitioners and in the form of
Available online 26 January 2014
phytopharmaceuticals. Jamu has acquired a potential benet, both economically and clinically. We surveyed the most frequently used plants in jamu that have also been investigated
Keywords:
regarding their constituents and pharmacological effects. The Indonesian government has
Jamu
divided the preparation of medicinal plants into three categories, i.e. jamu, standardized
Indonesian medicinal plants
herbal medicines and tofarmaka (phytomedicines). As the biological activity ascribed to
Phytomedicine
jamu is largely based on empirical data, more research is needed to scientically prove
Pharmacological activity
efcacy and to assure safety. In the further development of jamu, ethical issues such as
intellectual property rights, benet sharing, biodiversity and conservation need to be considered. This paper aims to review the current status of jamu and to give comprehensive
views that can be used in its future development for the further improvement of its utility
in curing illnesses and maintaining good health.
2014 Elsevier GmbH. All rights reserved.
Contents
1.
2.
3.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Indonesian medicinal plants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.1. Biodiversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2. Recent research development and research communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.3. Economical prospective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Corresponding author at: Technische Biochemie, Emil-Figge-Strasse 66, 44227 Dortmund, Germany. Tel.: +49 231 7557 487;
fax: +49 231 7557 489.
E-mail address: oliver.kayser@bci.tu-dortmund.de (O. Kayser).
2210-8033/$ see front matter 2014 Elsevier GmbH. All rights reserved.
http://dx.doi.org/10.1016/j.hermed.2014.01.002
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4.
5.
6.
7.
1.
3.4. Ethical considerations in the development of medicinal plants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Jamu as a way of traditional healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1. Rational phytotherapy with jamu and phytomedicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2. Preparation of jamu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3. Legislative aspects of jamu and phytomedicines in Indonesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Biological activity of the most common plants in jamu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1. Anticancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2. Antiviral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3. Antimalarial and antiparasitic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.4. Anti-inammatory, antirheumatic, antipyretic and analgesic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.5. Hepatoprotective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.6. Antidiabetic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.7. Antimicrobial and antifungal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.8. Gastroprotective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.9. Cardioprotective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.10. Antihypertensive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.11. Anti-asthma, antitussive and anti-allergic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.12. Immunostimulating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.13. Central nervous system (CNS) activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.14. Others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Known risks and side effects of medicinal plants used in jamu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction
Next to the Amazon rain forests, Indonesia has the second

biggest biodiversity in the world expressed by a high number
of indigenous medicinal plants. Based on this rich source of
medicinal plants, most of the Indonesian people especially in
rural areas use traditional herbal medicines known as jamu to
treat disease. Jamu is a word in Javanese tribal language, meaning the traditional medicine from plants. Minerals, animals
and parts thereof have also been used but are not the subject of this review. Today, jamu has been adopted into Bahasa
Indonesia with the similar meaning (Riswan and Roemantyo,
2002). Jamu gendong is a kind of traditional jamu sold without a
label and freshly prepared (not preserved) from plant material
in warung, the ubiquitous stalls along the streets in Indonesia
(Limyati and Juniar, 1998; Suharmiati, 2003). Jamu gendong is
instantly served to whom orders this jamu requested preparation. The sellers bring the jamu from door to door. The word
gendong itself means to carry something on the back of a body.
The fresh jamu is put inside the bottles and stored in bamboo or rattan baskets and they use a long wide shawl called
selendang for carrying the baskets on their back (Riswan and
Roemantyo, 2002). Nowadays the production of jamu is also
being developed on an industrial scale. The Indonesian government, industry and academia all recognize that to further
the development of jamu, extensive research is required to
establish the safety and efcacy of the many traditional jamu
preparations.
This paper reviews the use of Indonesian medicinal plants
used in jamu medicine including its history, current status,
economic potential and scientic development plus possible
future developments.
2.
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Methodology
Both online and ofine literature searches were carried out

to compile this review. PubMed (Medline), Highwire and ISI
Web of Science were used to retrieve any online publications using the following search terms: Indonesia, medicinal
plants, ethnopharmacology, jamu, phytomedicine, specic
plant species, herbal medicines, natural product medicines,
phytochemistry, pharmacognosy. Local library searches looking at the Medicinal Herbs Index in Indonesia (Anonymous, 1995)
were also carried out by Indonesian researchers able to read
old Java language in the cities of Bandung (the capital of WestJava province) and Yogyakarta (an old cultural city in central
Java). About 5000 species of medicinal plants were retrieved
from the Medicinal Herbs Index in Indonesia and the plants that
are most frequently used as constituents of jamu are discussed
in this paper.
3.
Indonesian medicinal plants
3.1.
Biodiversity
Biodiversity is dened as the variety of all life forms on earth,

along with the interactions between them and their physical environment. As an archipelagic state with thousands of
islands, Indonesia is endowed with a rich and unique biodiversity. The area of Indonesian tropical forests covers about
143 million hectares and is home to about 80% of the worlds
medicinal plants. It is estimated that the Indonesian tropical
forests contain 28,000 plant species. There are various reports
concerning the inventory of higher plants in Indonesia. The
Indonesian Country Study on Biodiversity (ICSBD 1993) estimates the number of owering plants species in Indonesia to
be between 25,000 and 30,000. Some 40 million Indonesians
have historically used the herbal medicines for protection
and the treatment of diseases and the Indonesian community
makes use of around 6000 plant species. Data of the number
of medicinal plants also vary. PT Eisei (1995) published the Dictionary of Indonesian Medicinal Herbs containing more than 2500
plant species which principally can be developed for medicinal purposes, while Zuhud et al. (2001) identied 1845 species
with medicinal potential in the forests of Indonesia. These
numbers are potentially to be updated due to the continuing inventory and investigation of yet unidentied species.
According to the National Agency of Drug and Food Control
(NADFC/BPOM), 283 plant species have been ofcially registered for their medicinal use; the larger remainder is used
traditionally.
To facilitate the activities on the conservation and sustainable use of biodiversity of Indonesian medicinal plants
as medicines and functional foods, the Indonesian Government, through the National Development Planning Agency
(BAPPENAS), has launched the Indonesian Biodiversity Strategy and Action Plan 20032020 (IBSAP). IBSAP is based on
the evaluation of the previous action plan from 1993 called
BAPI (Biodiversity Action Plan for Indonesia), formulated in
collaboration between the Indonesian Government (BAPPENAS), the Ministry of Environment, research institutes and
non-governmental stakeholders with the support of the international development institutions.
3.2.
Recent research development and research
communities
Evaluation of jamu as a rational phytotherapy has to cover
different areas of research including social, cultural, economic, and ethical viewpoints. Preclinical pharmacological
studies have been carried out with extracts and isolated
compounds, and even a few clinical studies are available.
However, jamu is still largely not evidence-based from a
clinical perspective. The results from in vitro and in vivo preclinical studies support the traditional use of many jamu
products.
Many institutions in Indonesia, especially governmental institutions such as the Ministry of Health, Ministry
of Forestry, Ministry of Environment, Ministry of Agriculture, the National Development Planning Agency (BAPPENAS),
the National Agency of Drug and Food Control (NADFC or
BPOM) are engaged in research directed at the development of medicinal plants. The universities are also actively
involved in plant research through their related faculties
or departments from a variety of different areas such as
medicine, pharmacy, chemistry, biology, agriculture, forestry,
marine, environment and engineering. National research
institutions such as the Indonesian Institute of Science
and the Herbarium Bogoriense, are involved in the development of jamu as well as non-governmental institutions
such as KEHATI (Indonesian Biodiversity Foundation), WALHI,
SKEPHI, and various industrial companies (Bermawie et al.,
2005).
3.3.
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Economical prospective
Since the 1980s small jamu producers have grown sufciently

to introduce larger scale and modern production methods
(Beers, 2001). The jamu producing industry now has an annual
growth of 2530%, according to BPOM. According to Pramono
(2002) there are about 810 companies active in the production
of Indonesian traditional medicine of which 87 are classied
as IOT (Industri Obat Tradisional, Traditional Medicine Industry)
and 723 as IKOT (Industri Kecil Obat Tradisional, Small Industry
of Traditional Medicine). In 2005, 872 companies in this eld
were registered at NADFL. In addition, 462 companies from
foreign countries also play a role in the production of Indonesian traditional medicine. About 20 national companies are
the major players. Examples of jamu products from these companies are shown in Table 1. The industry revenue from jamu
in 2000 was estimated to be 150 million USD. This amount of
revenue can potentially be increased (Pramono, 2002). In the
period between January and June 2005, the export of medicinal
plants from Indonesia such as Amomum cardamomum, Burmani,
Piper species and many others used to make jamu reached an
amount of 126.8 million USD (Ministry of Industry, Republic of
Indonesia, 2005).
3.4.
Ethical considerations in the development of
medicinal plants
Intellectual property rights (IPR), indigenous knowledge, benet sharing, efcacy and safety are issues that must be
considered in the further development of Indonesian medicinal plants. Jamu has been handed down from generation to
generation based on the traditional knowledge and experience of the community. When new plant-derived therapeutics
based on indigenous knowledge are being explored, it is
important that the companies return benets to the native
population and the local governments from which the
research material was obtained (King et al., 1996). When
individuals or institutions from biotechnologically developed
countries wish to obtain indigenous raw material from a
biotechnologically less developed country, an agreement for
the procurement of such material may be negotiated. In article 19.2 of the Rio Convention (1992) there is an agreement
in regard to the handling of biotechnology and distribution
of its benets. It is mentioned that each contracting party
shall take all practicable measures to promote and advance
priority access on a fair and equitable basis by contracting parties, especially developing countries, to the results
and benets arising from biotechnologies based upon genetic
resources provided by those contracting parties. Such access
shall be on mutually agreed terms. Goodwill to maintain
such a ow may be achieved through appropriate scientic
and monetary compensation, both in real time and in longterm sharing of the benets of discovery (Soedjarto, 1996).
Over-harvesting may render medicinal plants into endangered species. Individuals or institutions exploring medicinal
plant material also have responsibilities for their conservation. Most of the current knowledge that jamu can maintain
health and/or cure certain diseases comes from the native
people who have experienced success in curing illness by taking jamu It remains to be proven that jamu fulls the generally
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Table 1 Examples of jamu products (and composition) from the major Indonesian jamu companies.
Industry name
Jamu name
Ingredients
Post Partum Herbs
Calami rhizoma, Zingiberis purpurei rhizoma, Ligusticae acutilobumae

radix, Baeckeae folium, Curcumae domesticae rhizoma, Parkiae
semen, Isorae fructus, Sappan lignum, Curcumae rhizoma,
Andrographidis herba, Caryophylli os
PT. Phapros
Menstralax
PT. Sido Muncul
Sakit kencing
Ligustici rhizoma, Paeomiae alba radix, Polygalae tenuifolia radix,

Rehmanniae preparata radix, Carthami tinctorius os, Leonuri
heterophyclus herba, Angelicae sinensis radix, Concha ostrea gigas,
Albizziae julibrissin cortex, Moutan radicis cortex
Orthosiphonis folium, Ligustrinae lignum, Blumeae folium, Curcumae
rhizoma, Imperatae rhizome
Tamarindi pulpa extract, Zingiberis rhizoma extract, Cinnamomi cortex,
Kaempferiae rhizoma extract, Oryza sativa
Beras kencur Sido Muncul
PT. Kimia Farma
Kuku Bima
Ginseng radix extract, Eurycomae radix extract, Kaempferiae rhizoma

extract, Zingiberis rhizoma extract, Zingiberis aromaticae rhizoma
extract, Phyllanthi herba extract
Fitogas
Hypericum extract, Centellae folium extract, Curcumae domesticae

rhizoma pulveratum, Curcumae xanthorrhizae rhizoma extract
Trigonella foenum graecum, Tribulus terrestris, Yohimbe extract,
Talinum paniculatum, Plantago major extract
Sauropus folium extract
New Padibu
Fitolac
PT. Deltomed Laboratories
PT. Jamu Iboe Jaya
Srongpas Ginseng
Retofracti fructus, Zingiberis zerumbeti rhizoma, Elephantopi radix,

Eurycoma radix, Panax ginseng radix extract
Antangin JRG
Zingiberis rhizoma, Panax ginseng extract, Blumeae folia, Menthae

folia, Alstoniae cortex, Myristicae semen
Hiperten
Orthosiphonis folium, Phyllanthi herba, Plantaginis folium, Blumeae

folium, Centellae herba, Morindae fructus, Alstoniae cortex,
Andrographidis herba, Apii herba
Tinosporae caulis, Andrographidis herba, Curcumae rhizoma, Syzigii
semen
Zingiberis aromaticae rhizoma, Zingiberis rhizoma, Panax ginseng
radix, Retrofracti fructus, Theae folium, Colae semen, Gynurae folium
Diabetin
PT. Mustika Ratu
Tonic tea plus daun dewa dan ginseng
Relieves abdominal pain after giving

birth, eases excrements and vaginal
inammations. Stimulates blood
circulation and improves appetite and
digestion as well as strengthening and
promoting health generally
Regulates endocrine gland secretion and
menstruation, promotes ovulation,
reduces menstrual clots
Treats disorders of the urinary tract
Reduces fatigue, refreshes the body,
prevents haemorrhoids and the common
cold, raises stamina and immunity to
disease
Raises mens stamina and libido, and
makes them appear more youthful. Helps
blood circulation, discharging faeces
more easily and reduces the possibility of
atherosclerosis and diabetes
Relieves digestive disorder symptoms
Treats liver and kidney disturbance
Increases and accelerates breast milk
production
Increases vitality, relieves backache, sore
muscles, fatigue, and general debility,
improves appetite, and nourishes the
kidneys
Effectively combats a cold and alleviates
its symptoms such as fever, nausea,
bloating, cold sweat, dizziness, and
fatigue
Treats mild hypertension
Treats diabetes mellitus

Is effective for general health
maintenance of men and women, good
for improvement of stamina vitality and
body immunity to make the body fresh, t
and energetic
Sariayu Martha Tilaar
Indications/use
Jamu godog bugar ayu
Jamu Jago
Usneae thalus, Zingiberis purpurei rhizoma, Retrofracti fructus, Santali

lignum, Sappan lignum, Illicium verum, Kaempferiae rhizoma,
Curcumae rhizoma, Foenigraeci semen, Andrographidis herba,
Centellae herba, Curcumae domesticae rhizome
Orthosiphonis folia, Zingiberis zerumbeti rhizoma, Zingiberis rhizome
Boesenbergiae rhizoma, Curcumae domestica rhizoma, Curcumae
rhizoma, Orthosiphonis folia, Serycocalycis folia
Slows the ageing process, improving the

blood circulation producing more energy
and strength
Pegal linu
Curcumae rhizoma, Eucalipty fructus, Retrofracti fructus, Zingiberis

zerumbeti rhizoma, Zingiberis rhizome
Esha
Eurycomae longifoliae radix, Retrofracti fructus, Piperis nigri fructus,

Phyllanthi herba, Zingiberis rhizome
Piperis folium, Centellae herba, Curcumae domesticae rhizoma,
Languatis rhizoma
Euphorbiae thymifoliae herba, Kaempferiae rhizoma, Caricae folium,
Blumeae folium
Coriandri fructus, Parameriae cortex, Baeckeae folium, Foeniculi
fructus, Curcumae rhizome
Foeniculi fructus, Paederiae folium, Menthae arvensis, Zingiberis
rhizoma
Zingiberis purpurei rhizoma, Zingiberis rhizoma, Piperis nigri fructus,
Saccharum album, Zingiberis aromaticae rhizoma, Languatis rhizoma,
Peppermint powder, Foeniculi fructus, Glycyrrhizae radix, Curcumae
domesticae rhizoma, Curcumae rhizoma, Coptici fructus, Alyxiae
cortex, Boesenbergiae rhizome
Sauropi folium, Zingiberis zerumbeti rhizoma, Curcumae rhizoma,
Elephantopi folium
Alleviates muscle pains, improves

stamina and avoids lethargy and
insomnia
Immunostimulating properties
Encok
Sirnakarang
Allus
Nyonya Meneer
Jamu sakit Maag

Jamu Akas Jantung
Singkir angin
PT. Air Mancur
Jaket pegal linu
PT. Martha Tilaar
Jamu postnatal Innoshape
PT. Soho Farmasi
Diapet NR
PT. Bintang Toedjoe
Encok
Irex Max
Diami
PT. Konimex
PT. Tenaga Tani farma
PT. Puspo Internusa
Sentia
Pil Binari
Pacekap diabest
Perusahaan jamu Sido Jodo
Diamanis
Useful for various coronary problems

Treats the common cold
Eliminates fatigue, relieves painful
stiffness of the muscles and joints after
hard work and improves stamina
Slims down and rms up the body,

reducing cellulite, whilst rejuvenating
generally
Anti-diarrhoea properties
For treatment of muscle pains
Improves vitality and sexual power
Anti-diarrhoea properties
Treats stomach pain and diarrhoea
Inner care for womans health
55
Curcumae domesticae rhizoma, Granati pericarpium extract, Psidii

folium extract, Coicis semen, Chebulae fructus extract
Siler radix, Zingiberis rhizoma, Anemarrhenae rhizoma, Notopterigii
rhizoma, Pterospermi lignum
Yohimbe bark extract, peppermint oil, Retrofracti fructus, Eurycoma
longifolia extract, Ginseng extract
Sausurea radix, Curcumae domesticae rhizoma, Kaempferiae rhizoma,
Agastachis herba, Amomi fructus, Atractylodes rhizome
Coptidis rhizhoma, Curcuma domesticate rhizoma
Catechu, Gallae, Jatrophae curcas folium
Morindae fructus extract, Orthosiphonis folium extract, Syzygii
polyanthi extract, Andrographidis herba extract, Centellae herba
extract, Curcumae rhizoma extract
Plantaginis folium, Swieteniae macrothyllae semen, Syzygii jambolani
cortex, Momordicae fructus, Murrayae folium, Ocimi bacillici folium,
Curcumae rhizoma, Kaempferiae rhizoma, Melaleucae fructus,
Blumeae folium, Caryophylli os, Catharanthi radix, Alii cepae bulbus,
Alstoniae cortex, Andrographidis herba
Treats peptic ulcer
PT. Jamu Borobudur
Alleviates rheumatism
Dissolves kidney stones
56
accepted criteria of safety and efcacy for the protection of

patients.
4.
Jamu as a way of traditional healing
4.1.
Rational phytotherapy with jamu and
phytomedicine
Jamu, as traditional medicine arising from experiences of the
past and embedded in the culture of society, cannot stand
still but constantly changes and develops. Along with conventional medicine it shares issues in appropriate and rational
use. This includes qualication and licensing of the provider,
proper use of good quality products, good communication
between traditional medicine providers and patients and provision of scientic information and guidance to the public
(WHO, 2002). The WHO encourages the use and development
of traditional medicine as an accessible and affordable means
to provide healthcare for all people (WHO, 2005). Although
the pharmacological effects of some jamu constituents have
been recorded, there is an apparent lack of records or written
data reporting the effectiveness of jamu medicine, especially
jamu gendong. To assure the correct use of such products,
the Indonesian government (NADFC) has divided the medicinal plants into three categories based on the way they are
prepared and based on a judgement of proof of their efcacy; i.e. jamu, standardized herbal medicines, and tofarmaka
(phytomedicines; regulation nr. HK.00.05.4.2411, 2004). All
preparations have to meet basic safety criteria. The therapeutic effects of jamu have to be supported by empirical data. The
efcacy of standardized herbal medicines has to be proved
in preclinical trials and standardization on active ingredients is required, while for the efcacy of tofarmaka, clinical
trials have to be carried out. The Indonesian government
has launched the Centre for Development and Implementation of Traditional Treatment (Sentra P3T) in 1995. The
Centres activities include research on herbal medicines, education and training of human resources as well as service of
herbal medicines based treatment. Other programmes include
selecting, testing, certifying, registration/licensing, inventory,
screening, clinical testing, utilization and evaluation of traditional medicine, and compilation of laws applicable to
traditional treatment.
4.2.
Preparation of jamu
Original jamu (jamu gendong) is prepared in the form of a decoction and is sold by ladies carrying jamu on their back. Jamu
gendong is produced by cottage industries using traditional
methods. Traditional jamu makers are aware of issues relating
to hygiene, sanitation and chemical contaminations from biological or non-biological sources (such as bacterial and fungal
toxins, heavy metals).
They try to protect raw plant materials and products from
contamination, although this is unlikely to comply with international industrial standards. The methods of preparation
are often different from producer to producer, and production steps like selection of raw materials, sorting, grating,
scraping, crushing, mixing and cooking, followed by boiling

of the plant material in a hygienic way can differ signicantly.
To ensure public safety it was considered that professional
training was necessary to ensure certain standards like identication of the raw materials used in jamu according to the
Materia Medika Indonesia (MMI), while for the proof of efcacy
of tofarmaka clinical trials have to be carried out. Jamu makers have to be trained in hygienic production methods and the
use of semi-modern techniques such as the small scale extraction methods. The most important aspect of the education by
academic institutions is the introduction of scientic aspects
of jamu. From cottage industries jamu has been developed
and is now produced by the industries called IKOT (Industry
Kecil Obat Tradisional) and IOT (Industri Obat Tradisional). To prepare jamu, IKOT and IOT use modern technologies and their
activities are based on a scientic approach: not traditional
but evidence-based, supported with research data. They have
to follow the directions for good manufacturing production
(GMP). Today industrially produced jamu is no longer only prepared in the form of a decoction but also in the form of a
tablet, pill, powder, pastille, capsule, extract, cream or ointment.
4.3.
Legislative aspects of jamu and phytomedicines in
Indonesia
The Indonesian government, through the Ministry of Health
and NADFC, is regulating jamu and phytomedicines (tofarmaka). The regulations are aimed at developing safe
herbal medicinal products and to monitor the quality of the
products including efcacy and efciency by pharmacovigilance reports. For the production of traditional medicine
in Indonesia, the jamu gendong and small-scale industries
have to refer to good manufacturing practice guidelines for
traditional medicine, called CPOTB (Cara Pembuatan Obat Tradisional yang Baik). CPOTB is regulated by the Ministry of
Health (regulation nr. 659/MENKES/SK/X/1991). This regulation was renewed by BPOM in 2005 with regulation nr.
HK.00.05.4.1380. CPOTB and includes all aspects of production such as raw material, production process, quality
control, factory building, workers, management, instrumentation, and sanitation. CPOTB is also to be applied to
manufacturers producing standardized herbal medicines and
phytomedicine.
The traditional medicine manufacturers (IOT and IKOT)
as well as the jamu products have to be registered
in the BPOM (246/MENKES/Per/V/90 and HK.00.05.41.1384,
2005). Using this regulation, the production and distribution of traditional medicine can be controlled to full
the requirements according CPOTB. Traditional medicines
are produced in a range of formulations including powders, pills, capsules, crude extracts, tablets and liquids.
These medicinal products have to be produced according to the description published in regulation number
661/MENKES/SK/VII/1994. To develop the traditional jamu
medicines, the Indonesian government has established
the Centre for Development of Traditional Medicine (Sentra P3T). The Centre is supported by regulation number
0584/MENKES/SK/VI/1995.
Table 2 Review of published literature relating to selected medicinal plants used in jamu.
Plant name
Curcuma domestica
Plant part
Rhizomes
Zingiber ofcinale
Ethanol
Rhizomes
Zingiber aromatica
Kaemferia pandurata
Alpinia galanga
Ethanol
Rhizomes
Rhizomes
Major compound(s)
or group of
compounds
Curcumin
Xanthorrhizol
Test system (and

concentration/dose)
Results
Clinical (180 mg per day)
Inhibition of DNA polymerase II and

induction of apoptosis (Sharma et al.,
2005)
Clinical (120 mg per day)
Improvement of the morning stiffness

and joint swelling in arthritis patients
(Chattopadhyay et al., 2004a,b)
Inhibition of HIV-I integrase (De
Clercq, 2000)
Induction apoptosis (Ismail et al.,
2005)
Induction of apoptosis (Kirana et al.,
2003)
In vitro IC50 = 40 M
In vitro and in vivo
EC50 = 6.16 g/ml
In vitro, in vivo,
IC50 = 40.6 g/ml
Ethanol
Gingerol, paradol
Ethanol
Zerumbone
Hexane
Pinostrobin
Chloroform
Hydroxypanduratin A
In vitro, topical, IC50 = 84

and 12 g/ear
Panduratin A
In vitro IC50 = 5.6 M and

18.7 M
In vitro MIC = 24 g/ml
Ethyl- and ethyl

4-methoxy-transcinnamate
l -Acetoxychavicol and
1S-1 -Acetoxyeugenol
acetate
In vitro 20 mg per 2 days
Oil
Aqueous
acetone
In vitro, in vivo,
IC50 = 20.2 g/ml
In vitro 10100 g/ml
Induction of apoptosis (Kirana et al.,

2003)
Inhibition of DNA topoisomerase I in
human tumour cell (Sukardiman
et al., 2000)
Inhibition of TPA induced ear oedema
formation on rats (Tuchinda et al.,
2002)
Inhibition of HIV-1 protease activity
(Cheenpracha et al., 2005)
Antibacterial activity against Prevotella
intermedia, P. loescheii, Streptococcus
matans (Park et al., 2005)
Induction of glutatione S-transferase
(GST) (Zheng et al., 1993)
In vivo 2 mg/kg BW
Induction of apoptosis (Ichikawa et al.,

2005)
In vitro IC50 = 15 and

19 M
Increase of the glutathione (GSH)

levels of gastric mucosa in rats
(Matsuda et al., 2003a,b)
Traditional use of plant
Appendicitis, metritis, tonsillitis,

asthma, chancre, rheumatism,
anaemia, diarrhoea, hypertension,
scabies, dysentry, haemorrhoids
Anorexia, malaria, gastritis,

anthelmenthic
Headache, rheumatism, anorexia,
cholera, antiemeti, anorexia,
inuenza, anaemia, malaria,
anthelmentic, cough, vertigo
Dry cough, fungal infection

diphtheria, gonorrhoea and as a
spice in cooking
Curcuma xanthorrhiza
Type of extract
Stomachic, anorexia, dermatosis,

malaria, gastritis
57
58
Table 2 (Continued)
Plant name
Rheum palmatum
Cymbopogon citrates
Plant part
Root
Leaves
Type of extract
Methanol
Oil
Major compound(s)
or group of
compounds
In vitro IC50 = 1.5 g/ml

2.5 g/ml
In vitro IC50 = 280 g/ml
and 600 g/ml
In vitro 20 mg per 2 days
Geranial, neral,
myrcene, -pinene
In vivo 500 mg/kg BW
Plumeria bicolour
Bark
Methanol
Plumieride
In vitro, IC50 = 49.5 g/ml
Alstonia scholaris
Stem bark
Ethanol
Echitamine
In vivo 180 mg/kg body

weight
In vitro, ED50 = 2.5 g/ml
Cuminum cyminum
Andrographis paniculata
Seeds
Aqueous,
ethanol
Ethanol
Fruits
Aerial part
Ethanol
Alkaloid
Essential oil
In vivo, 160 mg/g diet
In vivo ED50 = 0.12 ml/kg
14In vitro ED 50 = 2.8 g/ml

Deoxyandrographolide
1.5 g/ml
14-Deoxy-11,12didehydroandrographolide
Andrographolide
Clinical 5 mg/kg
bodyweight (BW)
In vivo 1.5 mg/kg BW
In vitro IC50 = 4 g/ml
Results
Inhibition of -hexosaminidase, as a
marker of antigen-IgE-mediated
degranulation (Matsuda et al., 2003a,b)
Inhibition of the growth HeLa
epithelioid and BT-20 human breast
carcinoma cells (Kubo et al., 1992)
Inhibition of -glucosidase activity
(Kubo et al., 1991)
Induction of glutatione S-transferase
(GST) (Zheng et al., 1993)
Growth inhibition of Plasmodium
berghei 86.6% (Tchoumbougnang et al.,
2005)
Inhibition of the growth RIF tumour
cell lines (Dobhal et al., 2004)
Increase of the killing effect of
berberine against tumour on Ehrlich
ascites carcinoma (EAC)-bearing mice
(Jagetia and Baliga, 2004)
Cytotoxic effect in HeLa cell (Jagetia
and Baliga, 2005)
Stimulation of non specic immune
response (Iwo et al., 2000)
Increase of GST activity, inhibit
hepatocarcinogenesis (Aruna and
Sivaramakrishnan, 1998)
Exhibition of anticonvulsant activity
in both PTZ- and MES-induced
seizures (Sayyah et al., 2002)
Exhibition of the cytotoxic activity
against human T-47D cell line (Tan
et al., 2005)
Inhibition of HIV induced cell cycle

disregulation (Calabrese et al., 2000)
Reduction of the plasma glucose level
in streptozotocin-induced diabetic
rats (Yu et al., 2003)
Skin softening, stomach-ache, tonic
Dysuria, diaphoretic, oedema,

common cold, rheumatism,
gastritis, enteritis
Dysuria, malaria, syphilis, purgative,

fever,oedema
Fever, dermatosis, anorexia,
nephritis, malaria, lowering of blood
pressure
Stimulant, stomachic, gastric ulcer
Tonsillitis, chancre, antidote for

many poisonings. Typhus, fever,
diabetes, tonic, dysentery, ear
diseases, eczema, appendicitis,
common cold, diphtheria,
depurative, epilepsy, gonorrhoea,
syphilis, dandruff
Pulmatin and
chrysophanein
physcionin
4 -O-methylpiceid and
rhapontin
d-Limonene and
geraniol
Test system (and

concentration/dose)
Roots
Chloroform
Xanthone
Ethanol
Antiplasmodial activity against

Plasmodium falciparum (Dua et al., 2004)
Andrograpanin
In vivo 30 mg/kg
In vitro 3 M
Arcangelisia ava
Whole part
Berberine
In vitro, 25 M
Ardisia compressa
Leaves
Aqueous
Phenolic compounds
In vivo, IC50 = 47 g/ml
Phyllanthus species
Whole plants
Aqueous
Alkaloids, avonoids,
lignans and terpenoids,
tannins
Clinical 1.5 g per day
Elargic acid, lignans,

quercetin, lupeol
In vitro and in vivo

IC50 = 1.3 g/ml

IC50 = 6.5 g/ml
In vivo 25 mg/kg BW
Piper sarmentosum
Berries
Methanol
Piper caba
Aqueous
acetone
Sarmentine, 1-piperetyl
pyrrolidine
Piperine, piperanine,
pipernonaline
Piper longum
Ethanol
Piperine
In vitro IC50 = 7.0 M
Isobutyleicosatrienamide,
trachyone,
pergumidiene
In vitro MIC = 70, 60,

58 M
Isoliquiritigenin
In vitro 1 g/ml
Liquiritin apioside,
liquritin and
liquiritigenin
In vivo 30 mg/kg BW
Piper nigrum
Glycyrrhiza glabra
Roots
Ethanol
Enhancement of chemokine stromal

cell-derived factor-1 alpha (SDF-1
alpha) induced chemotaxis (Ji et al.,
2005)
Inhibition of the growth of human
HepG2 cells (Chi et al., 1994)
Inhibition of hepatocarcinogenesis
(De Mejia and Ramirez, 2004)
Antihepatitis B through prevention of
ALT ares, progression to cirrhosis
and/or liver cancer, and ultimately
prolong survival (Liu et al., 2001)
Anti-HIV activity blocked the
interaction of HIV-1 gp120 with its
primary cellular receptor CD4 at 50%
inhibitory (Notka et al., 2004)
Antiplasmodial activity against P.
falciparum (Tona et al., 2004)
Antiplasmodial activity against P.
falciparum (Rukachaisirikul et al., 2004)
Inhibition of ethanol- and
indomethacin-induced gastric lesions
(Morikawa et al., 2004)
Inhibition of monoamine oxidase and
antidepressant like activity (Lee et al.,
2005)
Inhibition of the growth of B. subtilis,
B. sphaericus, S. aureus Klebsiella
aerogenes and Chromobacterium
violaceum (Reddy et al., 2004)
Inhibition of reductase activity and
platelet aggregation (Tawata et al.,
1992)
Antitussive (Kamei et al., 2005)
Jaundice, stomachic, anthelmentic

Fever, diarrhoea, cough
Wound healing, asthma, epilepsy,
malaria, constipation, lowering
blood pressure, menstrual disorders,
tetanus, diarrhoea, convulsant
Cough, asthma
Diaphoretic, oedema lowering blood
pressure diaphoretic, dyspnoea
Leaves
Rheumatic
59
60
Table 2 (Continued)
Plant name
Plant part
Type of extract
Eurycoma lancifolia
Roots
Methanol
Anacardium occidentale
Stem barks
Aqueous
Test system (and

concentration/dose)
IC50 = 2.1 g/ml
Antiplasmodial activity (Kardono

et al., 1991)
Fever, depurative, dysentery, aphtha,

tonic, anorexia
Purgative, aphtha, dermatosis
Stigmast-4-en-3-ol and
stigmast-4-en-3-one
In vivo 1.5 mg/kg BW
Anacardic acid
In vitro MIC = 6.25 g/ml
Inhibition of the fresh egg

albumin-induced acute inammation
(Ojewole, 2004)
Hypoglycaemic activity in normal,
healthy dogs (Alexander-Lindo et al.,
2004)
Inhibition of -lactamase (Bouttier
et al., 2002)
rats (Liu et al., 2005)
rats (Rajasekaran et al., 2004)
Enhancement of gastric ulcer healing
(Cheng et al., 2004)
Aerial parts
Buthanol
Myricetin
In vivo EC50 = 0.1 M
Aloe vera
Leaves
Ethanol
Centella asiatica
Aerial parts
Aqueous
Asiaticoside
In vivo 10 mg/kg BW
Polysaccharide
In vitro 100 g/ml
Pimarane-type
diterpenes,
neoorthosiphols A and B
Methylripariochromene
A
In vitro IC50 15.2 and

60.1 nmol/ml
Terpenoids
In vitro MIC 0.87 mg/ml
Coriandrum sativum
Leaves
Fruits
Aqueous
Essential oil
Eurycomanone
7-methoxy--carboline1-propionic
acid
Abelmoschus moschatus
Orthoshipon aristatus
Results
In vivo IC50 = 23.8 g/ml
Enhancement of the proliferation of T

and B lymphocytes (Wang et al., 2005)
Inhibition of the contractile response
in rat thoracic aorta smooth muscle
(Ohashi et al., 2000a,b)
Decrease of systolic blood pressure in
conscious stroke-prone
spontaneously hypertensive rats
(Ohashi et al., 2000a,b)
Inhibition of the growth of
Escherichia coli, Bacillus megaterium,
Pseudomonas, Erwinia, Xanthomonas,
Agrobacterium (Lo Cantore et al., 2004)
Convulsant, stomachic, aphrodisiac,

itch
Haemorrhoid, anthelmen-tic,
diabetes, cough, gonorrhoea,
tuberculosis
Stomachic, anorexia, wound
healing, chancre, bronchitis,
dysentery, cough
Laxative, haemorrhoid, dysentery,

diarrhoea, colitis, menstrual
disorder, stomachic,cholecystopathy
Stomach ache, vertigo, emetic,

stomachic, aphtha, menstrual
disorders
Hexane
Major compound(s)
or group of
compounds
5.
Biological activity of the most common
plants in jamu
The biological activities of the most common plants used in
jamu as reported in the literature are summarized in Table 2.
These are discussed in more detail in the following sections.
5.1.
Anticancer
Plants from the family Zingiberaceae are the most frequently

used ingredient of jamu. Eleven Curcuma species (Curcuma
aeruginosa, C. aurantiaca, C. colorata, C. domestica (synonym:
C. longa), C. euchroma, C. mangga, C. petiolata, C. purpurascens,
C. soloensis, C. xanthorrhizae, and C. zedoria) have been used
traditionally as a spice and to treat several illnesses such
as appendicitis, asthma, itch, rheumatism, abdominalgia,
anaemia, hypertension, diarrhoea, and dysentery (Hatcher
et al., 2008). Curcumin is the main phenolic constituent of
the genus especially in the rhizoma of tumeric (C. domestica).
Although C. domestica also known as C. longa, has not traditionally been used for anti-carcinogenic purposes, recent
investigations show that this plant has promising effects in
this area, mainly to be ascribed to curcumin (Gupta et al., 2012).
The anticarcinogenic mechanism of action of curcumin has
been partly elucidated. Inducing apoptosis plays an important role. Furthermore, it reduces the cell cycle progression
thereby preventing cancerous cell growth (Chattopadhyay
et al., 2004a,b; Karunagaran et al., 2005). In vitro (in cancer cells)
and in vivo (in animal models), it suppressed carcinogenesis
of the liver, kidney, colon, and breast (Okazaki et al., 2005;
Kirana et al., 2003). Preclinical and clinical studies with curcumin in relation to its anticarcinogenic potential have been
reviewed. Human clinical trials indicated no dose-limiting
toxicity up to 10 g/day taken orally. The studies reviewed
suggest that curcumin has potential in the prevention and
therapy of cancer (Agarwal et al., 2003; Sharma et al., 2005). C.
xanthorrhiza used traditionally as an antibacterial, anticarcinogenic and anti-inammatory agent has been shown to exhibit
antiproliferative and anticarcinogenic activities. These activities are largely attributed to the sesquiterpene compound
xanthorrhizol isolated from this plant which was observed
to signicantly increase apoptosis in HeLa cells (Ismail et al.,
2005).
Ginger (Zingiber ofcinale Rose) which contains the phenolic
ketones gingerol and paradol has been launched in Indonesia
as tofarmaka (HMP or phytomedicine) for malignancies (antineoplasma). It has been licensed as a standardized herbal
medicine in Indonesia for this indication and has proven
the activity. Anti-carcinogenic activity of the ginger ethanolic
extract has been reported in vitro (to human colon cancer
and breast cell cancer cell lines) and in vivo (in rats). The
strongest anticancer carcinogenic activity has been shown
for another Zingiberaceae species, Zingiber aromaticum (Kirana
et al., 2003; Manju and Nalini, 2005). It has been suggested
that Z. aromaticum containing the sesquiterpene zerumbone
also has the potential to be developed as HMP with anticarciogenic properties because of apoptosis induction. Panduratin,
a chalcone derivative isolated from Kaemferia pandurata, also
a member of the Zingiberaceae family rhizoma has been
61
reported to suppress carcinogenesis in human colon cancer

cell lines (Kirana et al., 2003; Yun et al., 2005). Pinostrobin,
a avonoid from this plant showed cytotoxic activity against
human mammary carcinoma cells (Sukardiman et al., 2000).
Ethyl trans-cinnamate and ethyl 4-methoxy-trans-cinnamate
from galanga root oil (Alpinia galanga) induced the activity
of the detoxifying enzyme, glutathione S-transferase (GST),
a major mechanism for chemical carcinogen detoxication
(Zheng et al., 1993). Another isolated compound from this
plant, 1 -acetoxychavicol acetate has been found to suppress
chemical- and virus-induced tumour initiation and promotion. Although the mechanism is not fully understood, this
compound inhibits activation of NF-B and NF-B-regulated
gene expression. This may explain its ability to enhance apoptosis and to inhibit tissue invasion (Ichikawa et al., 2005).
Isolated compounds from plants used in jamu, including
Zingiberaceae species, showed anti-oxidative activity in vitro
using H4IIE rat hepatoma cells. Kaempferol and luteolin
protected these cells against oxidative stress. The ability
of kaempferol and luteolin to inhibit oxidative DNA strand
breaks supports their suggested role as protective agents
against diseases such as cancer (Steffan et al., 2005). Three
anthraquinone glycosides (pulmatin, chrysophanein and
physcionin) isolated from Rheum palmatum roots exhibited
moderate cytotoxic activity against HeLa epitheloid cells and
inhibited the growth of BT-20 human breast carcinoma cells
(Kubo et al., 1992). The in vitro cytotoxicity of the plumieride,
an iridoid compound which was isolated from methanol
extract of the bark of Plumeria bicolor and several analogues
was determined in radiation-induced brosarcoma (RIF)
tumour cells. The analogues gave stronger activity than
plumieride itself (Dobhal et al., 2004). An ethanolic extract
of the bark of Alstonia scholaris enhanced the anticancer
activity of berberine in Ehrlich ascites carcinoma-bearing
mice. This extract also showed cytotoxic activity to HeLa
cells. Compared to the active principle echitamine, present in
A. scholaris, the bark extract was more effective against HeLa
cells (Jagetia and Baliga, 2004, 2005). The cytotoxic activity of
the extract was shown to depend on the season of collection
of the plant bark. The extract of bark collected in the summer
season has the highest activity (Jagetia and Baliga, 2004, 2005).
Usually plants to be used in jamu are collected during the dry
season (also considered as the summer season). Andrographis
paniculata also called sambiloto by native Indonesians has
been intensively investigated for its anticarcinogenic activity.
The diterpenoid compounds 14-deoxyandrographolide and
14-deoxy-11,12-didehydroandrographolide isolated from the
aerial parts of this plant showed marked activity against
a human breast carcinoma cell lines (T-47D, Hs-578T) (Tan
et al., 2005). The consumption of Ardisia compressa tea
(aqueous extract) resulted in complete inhibition of the
chemically induced hepatocarcinogenesis in Wistar rats
(De Mejia and Ramirez, 2004). Catharanthus roseus that has
been used to treat cancer (e.g. leukaemia, lymphoma, breast
cancer, long cancer, Hodgkins disease) (Cragg and Newman,
2005) contains the clinically used anticancer compounds
vincristine, vinblastin and other vinca alkaloids (Cragg and
Newman, 2005). A water extract of Centella asiatica signicantly
reduced the multiplicity of neoplasms in the small intestine
of male F344 rats suggesting that C. asiatica may have a
62
O
HO
H3CO
OCH3
HO
HO
OH
3
HO
HO
HO
2
1
R3O
OR1
HO
OR2
4. R1 = R2 = R3 = H
5. R1 = R2 = H, R3 = CH3
OH
HOH2C
BzO
BzO
R2O
O
OH
OAc
R1O
N
HHO
8. R1 = OH, R2 = Ac
9. R1 = Ac, R2 = OH
CO2CH3
+
N CH3
10
CO2CH3
O
O
HO
HO
COOR4
CO2CH3 O
HO
OH
OH
HO
HOH2C
O
OCH3
OH
OH
O
HO
OH
O
O
O
H3CO
OH
HO
O
O
O
HO
OR1
COOR3
OR2
HO
OH
OH
11. R1 = R2 = CH3, R3 = R4 = X
12. R1 = H, R2 = CH3, R3 = R4 = X
13. R1 = R2 = R3 = CH3, R4 = X
14. R1 = R2 = CH3, R3 = X, R4 = CH3
15. R1 = H, R2 = CH3, R3 = R4 = X
OH
16. R1 = CH3, R2 = H, R3 = X, R4 = CH3
X=
OH
CO2CH3 OH
Fig. 1 Chemical structure of several active compounds from plants used in jamu; andrographolide (1),
14-deoxyandrographolide (2) (Andrographiis paniculata), curcumin (3) (Curcuma domestica), hydroxypanduratin A (4),
panduratin A (5) (Kaempferia pandurata), asiaticoside (6) (Centela asiatica), methylripariochromene A (7), orthosiphol A and B
(8 and 9) (Orthoshipon aristatus), echitamine (10) (Alstonia scholaris), helicterins AF (1116) (Helicteres isora).
chemopreventive effect on colon tumorigenesis (Bunpo et al.,

2004). 2 -Hydroxycinnamaldehyde isolated from Cinnamomum
cassia bark, strongly inhibited the in vitro growth of a broad
panel human cancer cells and the in vivo growth of the SW-620
human tumour xenograft (Lee et al., 1999). Coriandrum sativum
was shown to act protectively against the deleterious effects
of disturbance of the lipid metabolism in experimental colon
cancer in rats (Chithra and Leelamma, 2000) (Fig. 1).
Ganopoly, an aqueous polysaccharide fraction extracted
from the fruiting bodies of Ganoderma lucidum has antitumor activity ascribed to immunomodulating activity (Takara
et al., 2005) and is a recent addition to the jamu materia
medica. A similar effect has occurred with other traditionally
used jamu plants. Ganopoly signicantly reduced the tumour
weight in a dose-dependent manner in mice, with inhibition
rates of 32.3, 48.2, and 84.9% at doses of 20, 50, and 100 mg/kg,
respectively. It may represent a novel promising immunotherapeutic agent or a lead for cancer treatment (Gao et al., 2005).
Immunomodulating effects that may be useful in the treatment of cancer have been reported for ethanolic extracts of
aerial parts of Phyllanthus niruri (Maat, 2002). The combination
of anticancer drugs such as paclitaxel with herbal extracts e.g.
from Glycyrrhizae radix, Rhei rhizoma, Scutellariae radix, Zizyphi
fructus and Zingiberis rhizoma enhanced the paclitaxel sensitivity in HeLa cells via the inhibition of multidrug resistance
by inhibiting cellular mechanisms that underlie multidrug
resistance (e.g. P-glycoprotein (P-gp)). These extracts, in a concentration dependent way, suppressed the growth of HeLa
cells (human ovarium carcinoma cell line). The results concluded that the combination of anticancer drugs with some
herbal extracts contributes to the improvement of clinical outcomes in cancer chemotherapy (Takara et al., 2005). Alkaloids
and quassinoids from Eurycoma longifolia, iridoids and lignans
from Plumeria rubra showed cytotoxic activity to human breast,
colon, brosarcoma, lung, melanoma, KB, KB-V1 cancer cell
lines and in murine lymphocytic leukaemia (Kardono et al.,
1990, 1991). The cytotoxic and antitumor activities of plants
used in jamu as reported in the literature, are further summarized in Table 1.
5.2.
Antiviral
Many of the medicinal plants used in jamu have been tested

for antiviral activity in vitro and in vivo, there is however a
paucity of rigorous clinical trials. The methanolic extracts of
plants used in jamu e.g. A. paniculata, Swietinia mahagoni and C.
aeruginosa showed anti-HIV activity using HIV-I-infected MT4 cells. With the dose range of 4.2175 g/mL they inhibited
the HIV-protease (Otake et al., 1995). Methanolic extracts
of Melaleuca leucadendron fruit and Annona muricata stembark collected in Indonesia have been reported to be active
against herpes simplex virus-1 in vitro (Padma et al., 1998).
M. leucadendron signicantly prolonged the development of
herpes-related skin lesions in a mouse HSV-1 infection assay
and reduced their mortality (Padma et al., 1998; Nawawi et al.,
1999). Aqueous extracts, tannins, lignans and other isolated
compounds from Melaleuca and Annona species have been
tested for their anti-HIV activity in vitro and in vivo. They
inhibited the HIV-key enzymes e.g. integrase, reverse transcriptase and protease (Calixto et al., 1998; Notka et al., 2004).
63
The genus Phyllanthus has been intensively studied clinically

for its antiviral effects. A systematic review of 22 randomized
clinical trials showed that Phyllanthus species have positive
effects on antiviral activity and exhibit positive effects on
liver biochemistry in chronic hepatitis B virus infection (Liu
et al., 2001; Calixto et al., 1998). A. paniculata was also clinically tested for its antiviral activity. A phase I clinical trial
of andrographolide isolated from A. paniculata was conducted
in 13 HIV positive patients and ve HIV uninfected, healthy
volunteers. This trial concluded that andrographolide may
inhibit HIV induced cell cycle deregulation, leading to a rise
in CD4 (+) lymphocyte levels in HIV-1 infected individuals
(Calabrese et al., 2000). Helicterins AF, dimeric (7.5 ,8.2 )neolignans with a bicyclo[2.2.2]octene C-framework isolated
from Helicteres isora showed a mild inhibitory activity against
reverse transcriptase from avian myeloblastosis virus (Tezuka
et al., 2000).
5.3.
Antimalarial and antiparasitic
Most of the plants mentioned here have been traditionally

used as antimalarial agents in Indonesia. Methanolic extracts
prepared from the stems and bark of A. scholaris, Alstonia
macrophylla and Alstonia glaucescense have been assessed for
antiplasmodial activity against multidrug-resistant K1 strain
of Plasmodium falciparum cultured in human erythrocytes. The
active bisindole alkaloids, e.g. villalstonine, macrocarpamine,
from these extracts, in contrast to chloroquine (antimalarial medicine), had a signicantly higher afnity to the K1
strain than to the T9-96 strain (Keawpradub et al., 1999).
1,2-Dihydroxy-6,8-dimethoxy-xanthone, isolated from A. paniculata possessed in vitro activity against P. falciparum. In vivo
it showed antiplasmodial activity and gave a reduction (62%)
in parasitemia after treating the Swiss Albino mice infected
with Plasmodium berghei (Dua et al., 2004). The petroleum ether
extracts of the rind of Carica papaya and Citrus sinensis also
showed antimalarial activity against strain P. falciparum FCK
2 in vitro (Bhat and Surolia, 2001). Screening of plant extracts
that are traditionally used for the treatment of malaria in Java
showed strong antimalarial and antibabesial activitiy. They
include Achillea millefolium, Baeckea frutenscens, Brucea javanica, C. xanthorrhiza, Strychnos lucida, Swietenia macrophylla and
P. niruri (Trimurningsih et al., 2005; Subeki et al., 2005a,b).
Antibabesial activity was also found for protoberberine alkaloids and 20-hydroxyecdysone from Arcangelisia ava against
Babesia gibsoni (Subeki et al., 2005a,b). In principle B. gibsoni infects canines (dogs), but it may have relevance for
other zoonosis as well. An in vitro study on traditionally
used malaria remedies in the Kenyah of the Apo Kayan,
East Kalimantan (a remote forested plateau in Indonesian
Borneo) concluded that plants such as Lansium domesticum
and C. papaya are more likely to be effective antimalarials. These herbal remedies were found to have activity
against chloroquine-resistant P. falciparum (Leaman et al.,
1995). Eurycomanone and 7-methoxy--carboline-1-propionic
acid from E. longifolia, triterpenoid lansioides from L. domesticum, and leaf extract of Azadirachta indica collected from
Kalimantan demonstrated signicant antimalarial activity
(Kardono et al., 1991; Omar et al., 2003).
64
5.4.
Anti-inammatory, antirheumatic, antipyretic
and analgesic
osteoarthritis (Altman and Marcussen, 2001; Ahmed et al.,

2005).
The anti-inammatory effects of the methanol extract from

Morinda ofcinalis (noni or mengkudu) in vitro and in vivo
have been shown by inhibition of the production of nitric
oxide, prostaglandin E-2 and tumour necrosis factor-alpha in
lipopolysaccharide-stimulated RAW 264.7 macrophages (Kim
et al., 2005a,b). Anti-inammatory effects were determined
in rats using the carrageenan oedema model. Antinociceptive
activity was determined in mice using the acetic acid-induced
abdominal constriction test and the hot plate test. The inhibition of the prostaglandin E2 production in CaCo2 cells has
been also shown by Aloe vera gel. Another effect of A. vera was
the inhibition on reactive oxygen metabolites in the human
colorectal mucosa biopsies. This nding may have a therapeutic relevance in inammatory bowel disease (Langmead et al.,
2004). An aqueous extract of tempe (fermented soya-beans)
which is a popular food in Indonesia has been reported to have
anti-inammatory, antioxidant and antithrombotic activity in
an experimental photochemical thrombogenesis model using
rat femoral artery (Rilantono et al., 2000). Cinnamomum cortex
that was collected in Indonesia inhibited the rise in vascular
permeability and oedema induced by acetic acid, carrageenin,
serotonin and arachidonic acid in mice. The effect was also
shown on secondary lesions in the development of adjuvantinduced arthritis (Kubo et al., 1996). Hydroxypanduratin A
and panduratin A isolated from K. pandurata rhizoma showed
signicant topical anti-inammatory activity in the assay of
TPA-induced ear oedema in rats. The presence of these compounds may very well be related to the uses of this plant
in traditional medicine, to treat colic disorder, fungal infections, dry cough, rheumatism and muscular pains (Tuchinda
et al., 2002). The lignans niranthin, phyltetralin and nirtetralin isolated from aerial parts of Phyllanthus amarus exhibited
marked anti-inammatory properties in vitro suggesting that
these lignans may be the main active principles responsible for
the traditional application of this plant for anti-inammatory
properties (Kassuya et al., 2005). The screening of 75 medicinal plants collected in Indonesia showed that many of
them had inhibitory effects on nitric oxide (NO) production
in lipopolysaccharide-stimulated RAW264.7 macrophages as
well as antioxidant activity through the evaluation of free radical scavenging effect and reducing power (Choi and Hwang,
2005). NO is widely recognized as an important messenger
and effective molecule in a variety of biological systems. The
NO production is inhibited by nitric oxidase inhibitors that
can be used as therapeutic agents for inammatory diseases
(Tinker and Wallace, 2006). Chrubasik et al. (2005) comprehensively reviewed the effects of an ethanolic extract of
ginger (Z. ofcinale rhizoma) and its efcacy proles in vitro,
in vivo (in laboratory animals) and in clinical studies. Ginger
extracts (50 g ginger daily) for musculoskeletal pain resulted
in some pain relieving effects. His review, however, suggested
that further studies were needed to establish efcacy and
to nd an optimum dosage of ginger preparations for the
treatment of osteoarthritic pain. The ethanolic extract of
ginger (Z. ofcinale) together with A. galanga, C. longa, Camellia sinensis and Uncaria tomentosa also showed a statistically
signicant effect on reducing knee pain in patients with
5.5.
Hepatoprotective
Herbal preparations containing Andrographis panuculata and P.

amarus for various liver disorders have been shown to have
antihepatotoxic activity (Ram, 2001). The ethanolic extract and
isolated diterpenes andrographolide and neoandrographolide
from the aerial parts of A. paniculata showed signicant
antihepatotoxic action in P. berghei K173-induced hepatic damage in Mastomys natalensis (multimammate rats) (Chander
et al., 1995). A hepatoprotective effect of ethanolic extracts
of turmeric together with sesquiterpene and curcuminoidcontaining fractions has been shown to be related to the
suppression of alanin and aspartate aminotransferase and
lactate dehydrogenase level on d-galactosamin induced liver
injury in rats (Miyakoshi et al., 2004). The levels of certain
enzymes in the blood are a measure for the liver function.
Changes in these levels may indicate liver function disorder.
The hepatoprotective effect of A. scholaris bark on liver injuries
induced by the carbon tetrachloride (CCl4 ), -d-galactosamine,
acetaminophen and ethanol were investigated by means
of serum-biochemical and histopathological examinations.
Ethanolic extracts of A. scholaris bark signicantly lowered
-d-galactosamine induced serum transaminases elevation
in the serum biochemical analysis in rats (Lin et al., 1996).
CCl4 -induced hepatotoxicity in the liver of rats, as judged by
the raised serum enzymes, glutamate oxaloacetate transaminase and glutamate pyruvate transaminase, was prevented by
pretreatment with the extracts of P. niruri, demonstrating its
hepatoprotective action (Harish and Shivanandappa, 2006).
5.6.
Antidiabetic
Diabetes mellitus is recognized by chronic elevation of the glucose level in the blood and often accompanied by symptoms
of severe thirst, polyuria, weight loss, and stupor. Medicinal plants that are used clinically to treat diabetes have
shown their antidiabetic activity in vitro, in vivo (in animal
models) and in clinical studies. The methanolic and aqueous extracts derived from A. galanga caused highly signicant
reduction in the blood glucose levels of normal rabbits (Akhtar
et al., 2002). The glucosidic compounds 4 -O-methylpiceid
and rhapontin, isolated from kelembak (R. palmatum) roots
that were collected from the market in Indonesia exhibited
moderate -glucosidase inhibitory activity in vitro. The inhibition of -glucosidase activity may be effective in controlling
abnormal levels of blood glucose in metabolic diseases such
as diabetes (Kubo et al., 1991). Hypolipidemic effects have
been shown for aqueous extracts of cumin seeds (Cuminum
cyminum) on alloxan-induced diabetic, triton and cholesterol
fed hyperlipemic rats. Hyperlipidemia is an associated complication of diabetes mellitus. In this study, administering
a cumin extract to diabetic rats signicantly reduced their
blood glucose levels. The mechanism may be a potentiation
of the insulin effect or by increasing the pancreatic secretion
of insulin from the cells (Dhandapani et al., 2002). Guazuma
ulmifolia leaves and Trigonella fonum graceum seeds that are
used clinically against diabetes mellitus have been studied
for their antihyperglycemic effect. Aqueous extract of these

plants reduced blood glucose levels in the rabbits, pointing
at a hypoglycemic activity of the extract (Alarcon-Aguilara
et al., 1998). G. lucidum, the water and ethanol extracts of Piper
betle and dianex, a polyherbal formulation consisting of the
aqueous extracts of Gymnema sylvestre leaves, Eugenia jambolana seeds, Momordica charantia fruits, A. indica leaves, Cassia
auriculata owers, Aegle marmelose fruits, Withania somnifera
roots, and C. longa rhizoma had hypoglycemic activity in normal and streptozotocin-induced diabetic mice and rats (Yang
et al., 2004; Mutalik et al., 2005; Arambewela et al., 2005). Most
of those plants are used in jamu. Preclinical evaluation consisting of animal studies, acute and subacute toxicity testing
and evaluation of the antidiabetic effect of E. jambolana seed
powder in streptozotocin-diabetic rats was adequate for the
approval to start phase 2 clinical trials to evaluate this seed
powder as a complementary therapy in patients with type
2 and type 1 diabetes. The study showed that E. jambolana
possibly acts as a hypoglycemic agent by increasing insulin
levels, but it remains unclear whether type 1 or type 2 diabetes
are indicated. Toxicity studies in rats showed no evidence of
mortality or abnormality (Sridhar et al., 2005). The total triterpenoid fraction isolated from the aerial parts of C. asiatica, has
been studied in diabetic patients with microangiopathy. It was
shown that this fraction is useful in diabetic microangiopathy by improving microcirculation and decreasing capillary
permeability and protected against the deterioration of microcirculation due to diabetic microangiopathy (Cesarone et al.,
2001).
5.7.
Antimicrobial and antifungal
Antibacterial and antifungal activities have been shown by

aqueous extracts plus andrographolide and arabinogalactan
proteins isolated from A. paniculata which were comparable
(in terms of growth inhibition of Bacillus subtilis, Escherichia coli,
Pseudomonas aeruginosa and Candida albicans) to some known
antibiotics, streptomycin, gentamycin and the antifungal
nystatin (Singha et al., 2003). Extracts of A. scholaris, Anacardium occidentale (hexane), and C. papaya seeds (methanol and
butanol) have been reported to possess a broad spectrum of
antibacterial activity (Bouttier et al., 2002; Khan et al., 2003;
Dawkins et al., 2003). Remarkably, plants or plant extracts displaying toxicity to bacteria or fungi frequently show toxicity
in other in vitro systems. Apparently there is an underlying
general mechanism of toxicity responsible for this. This is
illustrated by an ethanolic extract of C. papaya seeds that
caused elevation of rat serum levels of acid phosphatase (ACP),
alkaline phosphatase (ALP), and aspartate amino transferase
(AST). Also mild to severe metaplasia of hepatocytes was
revealed in a dose-related manner as well as proliferation of
Kupfer cells and hepatic cells cirrhosis. These biochemical and
pathological changes indicated liver cell damage and malfunction (Udoh and Udoh, 2005).
The growth-inhibiting activity of cinnamaldehyde isolated
from C. cassia towards human intestinal bacteria (Clostridium
perfringens, Bacteroides fragilis and Bidobacterium bidum)
was shown using an impregnated paper disc method and
compared with that of tetracycline and chloramphenicol (Lee
and Ahn, 1998). The essential oils of C. sativum and Foeniculum
65
vulgare were reported to possess antibacterial activity to E.

coli and Bacillus megaterium in vitro. The essential oil from C.
cyminum and the isolated compounds, p-mentha-1,4-dien7-al, cumin aldehyde, -terpinene, and -pinene, showed
antibacterial activity against the genera Clavibacter, Curtobacterium, Rhodococcus, Erwinia, Xanthomonas, Ralstonia, and
Agrobacterium (Lacobellis et al., 2005). The essential oils from
Cymbopogon citratus, C. nardus, and Cymbopogon schoenanthus
showed a fungistatic effect against supercial mycosis (Koba
et al., 2003). The essential oil of Cinnamomum burmanni (bark
and leaves) and Tagetes erecta (leaves) that were collected
in Indonesia have been reported to exhibit antimicrobial
activity against B. subtilis and Salmonella typhimurium and
antifungal activity against C. albicans in vitro (Sukandar et al.,
1999; Hartati et al., 1999). An ethyl acetate extract of C. longa
has been reported to have antibacterial activity and the
potential to restore the effectiveness of -lactams against
methicillin-resistant Staphylococcus aureus (MRSA), and inhibit
the MRSA invasion of human mucosal broblasts (Kim et al.,
2005a,b). A study of Indonesian plants with ethnomedical uses
showed that the methylene chloride and methanolic extracts
of Terminalia catappa, S. mahagoni, Phyllanthus acuminatus,
Ipomoea spp., Tylophora asthmatica and Hyptis brevipes have
antibacterial activities against E. coli, S. aureus, Xanthomonas
campestris and B. subtilis and antifungal activities against C.
albicans, Pythium ultimum, Rhizoctonia solani and Sclerotium
rolfsii (Goun et al., 2003). The ethanolic extracts from several
plant species belonging to the Zingiberaceae family used in
Kenyah (Indonesian Borneo), especially A. galanga, Curcuma
zedoaria and Zingiberis purpureum, were found to have pronounced inhibitory activities against a wide variety of human
pathogenic fungi, including strains resistant to the common
antifungals amphotericin B and ketoconazole. As members of
the Zingiberaceae are generally regarded as safe for human consumption, these species are excellent candidates for further
development as medicinal plant products (Ficker et al., 2003).
5.8.
Gastroprotective
Isolated compounds, 1S-1 -acetoxychavicol acetate and 1S-1 acetoxyeugenol acetate, from A. galanga markedly inhibited
the ethanol-induced gastric mucosal lesions in rats. The
action of 1S-1 -acetoxychavicol was attenuated by pretreatment with indomethacin and N-ethylmalcimide and
signicantly increased the glutathione (GSH) levels of gastric
mucosa in rats. GSH acts as an antioxidant and is important for
maintaining the mucosal integrity in the stomach (Matsuda
et al., 2003a,b). A different mechanism of hepatoprotective
activity was shown by asiaticoside, an active triterpenoid
constituent of leaves of C. asiatica. They were found to promote angiogenesis and stimulate blood vessel formation and
mucosal cell regeneration during the gastric ulcer healing
stage that are important aspects of the wound healing process. Angiogenesis in granulation tissues improves circulation
to the wound site thus providing oxygen and nutrients essential for the healing process (Cheng et al., 2004). The effect
of an ethanolic extract of A. vera on acute gastric mucosal
lesions induced by 0.6 M HCl and acid output was studied in
pylorus ligated and lumen perfused rats, respectively showing
that A. vera has gastric acid anti-secretory activity and thus
66
could potentially protect the gastric mucosa at low concentrations against injurious agents (Yusuf et al., 2004). Morinda
citrifolia (noni) inhibits gastric emptying in male rats via a
mechanism involving stimulation of cholecystokinin and its
receptor activation. Cholecystokinin is a peptide hormone of
the gastrointestinal system responsible for stimulating the
digestion of fat and protein. It delays gastric emptying and
inhibits gastric acid and plasma gastrin responses (Konturek
et al., 1994; Pu et al., 2004). Ethanol extract and water extract of
Abrus cantoniensis, Saussurea lappa, Eugenia caryophyllata, Magnolia ofcinalis and Ligusticum species strongly inhibited the
growth of Helicobacter pylori which is an important etiologic
impetus leading usually to chronic active gastritis and gastric
ulcer (Li et al., 2005).
5.9.
Cardioprotective
A study on the edible plants common in Asian diets such

as Ipomoea batatas, P. betle, A. occidentale, Gynandropsis gynandra, C. papaya, and Mentha arvensis extracts showed that they
exhibited more than 50% relaxing effect on aortic ring preparations. P. betle and C. citratus showed comparable vasorelaxation
on isolated perfuse mesenteric artery preparation (Runnie
et al., 2004). 14-Deoxy-11,12-didehydroandrographolide from
A. paniculata was shown to have bradycardia-inducing and
-adrenoceptor antagonistic properties in vivo using anesthetized Sprague-Dawley rats (Zhang et al., 1998). These
effects are brought in relation to potential health benets.
A cardioprotective effect of C. asiatica on the antioxidant
tissue defence system during doxorubicin induced cardiac
damage in rats has been reported. Doxorubicin is a clinically
used cytostatic agent that displays cardiotoxicity as a major
side effect. The aqueous extracts of this plant produced a
signicant reduction in the levels of lactate dehydrogenase,
creatine phosphokinase, glutamate oxaloacetate transaminase and glutamate pyruvate transaminase. Increased activity
in serum of these enzymes is a well-known diagnostic marker
of myocardial function. The triterpenes (asiatic acid and asiaticoside) may be responsible for the cardioprotective effect
of C. asiatica extracts, because of their antooxidative effect
(Gnanapragasam et al., 2004). The cardioprotection provided
by ligustrazine (tetramethylpyrazine) is related to a reduction
of TNF-alpha content by inhibition of free radical production
in isolated rats hearts. It was known that TNF-alpha can contribute to myocardial damage during ischaemia-reperfusion
(Zhou et al., 2004). The studies of the antioxidative and
cytoprotective effects using H9c2 cardiac myoblasts showed
that Phyllanthus urinaria have a protective activity against
doxorubicin cardiotoxicity. This protection was mediated
through multiple pathways such as enhancement of survival factor through elevation of glutathione, activation of
catalase/superoxide dismutase activity and inhibition of lipid
peroxidation. This plant may serve as an alternative source
of antioxidants for prevention of doxorubicin cardiotoxicity
(Chularojmontri et al., 2005).
5.10.
Antihypertensive
Ethanolic extracts of fresh matured fruits of C. papaya

markedly depressed the blood pressure and heart rate in rats
with hypertension when compared with the normotensive

controls. The extracts (20 mg/kg i.v.) decreased the blood pressure by about 20.1%, 50.7% and 54.5% in normotensive, renal
and DOCA-salt hypertensive rats, respectively. The extract
appeared to be more potent then hydralazine (200 g/kg
i.v.), a well known antihypertensive (vasodilator) agent that
decreased the blood pressure by about 10.7%, 22.8% and 26.4%
in the three applied models of hypertension (Eno et al., 2000).
The total triterpenoid fraction of C. asiatica, a venoactive drug
acting on the microcirculation and on capillary permeability,
has been tested in three groups of patients with venous hypertension. The improvement of signs and symptoms observed
in venous hypertensive patients taking the extracts correlated well with the improvement of the variation of capillary
ltration rate (assessed by venous occlusion plethysmography) and ankle oedema (swelling sensation, restless lower
extremity, pain and cramps, tiredness (De Sanctis et al., 2001).
The vasodilatory effect of plants from the Curcuma species
have been studied. C. longa, for example, induced endotheliumindependent vasodilatation. It was concluded that Curcuma
herbs have hypotensive and protective effects on the endothelium in spontaneously hypertensive rats, and its mechanism
is thought to be related to a radical scavenging effect and
improvement of hemorheology (Goto et al., 2005). A major
constituent in the water decoction of Orthosiphon aristatus
leaves, methylripariochromene A (a benzochromene), exhibited a continuous decrease in systolic blood pressure after
subcutaneous administration in conscious stroke-prone spontaneously hypertensive rats. The leaves of this plant known as
kumis kucing in Indonesia is commonly used by the Javanese
people in their jamu, mainly for treatment of hypertension
(Ohashi et al., 2000a,b).
5.11.
Anti-asthma, antitussive and anti-allergic
A study of selected medicinal plants that are traditionally

used for asthma treatment in Indonesia indicated that alcoholic extracts from the leaves of Plantago major, the leaves
and fruits of Eucalyptus globulus, Cinnamomum massoiae cortex and the leaves of Vitex trifolia plus two hexane extracts of
E. globulus leaves inhibited IgE-dependent histamine release
from RBL-2H3 cells suggesteding that these extracts contain active compounds which inhibit mast-cell degranulation,
and thus may be used in the development of new drugs
for treating asthma and/or allergic disease (Ikawati et al.,
2001). An ethanolic extract of A. scholaris leaves induced
pronounced bronchodilatory activity in anaesthetized rats
mediated presumably by prostaglandins (Channa et al., 2005).
Clinical studies with A. paniculata extract showed effectivity at the early treatment of uncomplicated acute upper
respiratory tract infection. In clinical studies, an ethanolic
extract of A. paniculata alone or in combination with the
ethanolic extract of A. senticocus appeared to be more effective than placebo in the treatment of an uncomplicated
acute upper respiratory tract infection (Poolsup et al., 2004).
The active constituents of A. paniculata, andrographolide
and neoandrographolide, have been reported to have an
antiallergic effect in a rat model. This effect is due to its
mast cell stabilizing activity, comparable to the antiallergic drug, disodium cromoglycate. Neoandrographolide was
more potent than andrographolide in this study (Gupta et al.,

1998). An antitussive effect of liquiritin apioside, liquritin
and liquiritigenin, isolated from G. radix (licorice) has been
reported. The effect of liquiritin apioside may depend on
both peripheral (modulation of ATP-sensitive K+ channels)
and a central mechanism (modulation of serotonergic system) (Kamei et al., 2005). An aqueous extract of A. galanga
rhizoma was found to inhibit the release of -hexosaminidase,
a marker of antigen-IgE-mediated degranulation in RBL-2H3
cells. The compounds, 1 S-1 -acetoxychavicol acetate and 1 S1 -acetoxyeugenol acetate isolated from A. galanga inhibited
-hexosaminidase and a passive coetaneous anaphylaxis
reaction in mice and the antigen-IgE-mediated TNF-alpha and
IL-4 production, both of which participate in the late phase of
type I allergic reactions (Matsuda et al., 2003a,b).
5.12.
Immunostimulating
An immunostimulating effect has been reported from pule (A.

scholaris) that is used in South-East Asia mainly as an antimalarial and antidysentery agent. In BALB/c mice an aqueous
extract of A scholaris bark stimulated a non specic immune
response, restored the reduction of phagocytic action induced
by prednisolone and protected the animals from the opportunistic infection caused by E. coli (Iwo et al., 2000). This
effect in BALB/c mice was also shown by curcumin isolated
from C. longa in (Antony et al., 1999). A polysaccharide extract
from the rhizome of A. galanga rhizoma showed a marked
stimulating effect on the reticulo-endothelial system (RES)
and increased the number of peritoneal exudate cells, and
spleen cells of mice, which may relate to immunomodulating
effects (Bendjeddou et al., 2003). Immunomodulating effects
were also shown by a methanolic extract from A. paniculata
and isolates andrographolide, 14-deoxyandrographolide and
14-deoxy-11,12-didehydroandrographolide that enhanced the
proliferation and interleukin-2 (IL-2) induction in human
peripheral blood lymphocytes (Kumar et al., 2004). Hexane
and aqueous extract of C. papaya seeds and its bioactive fractions signicantly enhanced the phytohemagglutinin
responsiveness of lymphocytes and inhibited the classical
complement-mediated hemolytic pathway, indicating a possible immunostimulating effect (Mojica-Henshaw et al., 2003).
5.13.
Central nervous system (CNS) activity
The essential oil from the fruits of C. cyminum, traditionally used as a stimulant exhibited anticonvulsant activity
in both pentylenetrazole- and maximal electroshock-induced
seizures in male NMRI mice (Sayyah et al., 2002). Antidepressant effects have also been recently reported for curcumin.
It is suggested that this effect may be mediated by actions
in the central monoaminergic neurotransmitter systems (Xu
et al., 2005). G. radix, together with other medicinal plants
such as Bulpleuri radix, Paeoniae radix and Angelicae sinensis radix, have been tested in patients who were exhibiting
tremor, a possible symptom of antipsychotic-induced Parkinsonism. The results concluded that the combination of the
medicinal plants mentioned was effective against tremor from
Parkinsonism (Ishikawa et al., 2000). Methanol leaf extract of
A. macrophylla has been reported to have a CNS depressant
67
activity. It caused a signicant reduction in spontaneous activity, a decrease in exploratory behavioural pattern, a reduction
in muscle relaxant activity and also signicantly potentiated phenobarbital sodium-induced sleeping time in mice
(Chattopadhyay et al., 2004a,b).
5.14.
Others
Various other activities have been reported from the medicinal

plants which are used in jamu. Grosvenor et al. (1995) surveyed
the medicinal plants in Riau Province, Indonesia. Out of one
hundred and fourteen species of owering plants belonging
to 51 families and claiming to have medicinal uses, 50% were
recorded to be used to combat fever, 33% for diarrhoea and 31%
for other gastrointestinal problems. Unny et al. (2003) reviewed
about 161 medicinal plants which are a potential source of
new contraceptive principles. The review contains the isolated
compounds and the mechanism of actions. Some of them are
used in jamu, e.g. F. vulgare, Abrus precatorius, Muraya paniculata,
Punica granatum, C. longa, and C. zedoria. They inhibited implantation and increased foetal loss in mice and reduced secretory
activity and weight of accessory sex glands. Aqueous extracts
of C. papaya and Ananas comosus have been reported to possess
diuretic activity. Both plant extracts gave similar proles of
urinary electrolyte excretion to that of hydrochlorothiazide
(thiazide diuretic). The analyses of the urinary osmolality and
electrolyte excretion per unit time, together with the plant salt
contents, may help to differentiate the mechanism by which
these plants act as diuretics The results indicated that the
diuretic activity of A. comosus was intrinsic and not a result
of the salt loading effect, whereas C. papaya extracts may have
resulted from the high salt content of the extract. This activity
correlated well with the maximum volume, the highest osmolality, and the amount of electrolytes excreted during urine
collection (Sripanidkulchai et al., 2001). A methanolic extracts
of Areca catechu, Brucea sumatrana, Allamanda cathartica, collected in Sumateran rainforests showed strong antinematodal
activity against Bursaphelenchus xylophilus (Alen et al., 2000).
6.
Known risks and side effects of
medicinal plants used in jamu
It is generally assumed by the public, and also even by
some medical practitioners, that plant drugs are harmless
and therefore are preferable to orthodox medicines. Although
on the whole plant medicines used at the correct dosage
elicit fewer side effects than their orthodox counterparts
their safety and efcacy cannot automatically be assured.
Numerous examples on herb-induced side effects have been
documented (Aronson, 2009).
Data from clinical trials suggest that the most commonly
experienced adverse effects of Panax ginseng for example
are headache, sleep and gastrointestinal disorder. Kavakava (Piper methysticum), currently banned in many European
countries and in the USA may cause tiredness, low energy,
headache, hepatoxicity, skin reactions and gastrointestinal
symptoms. A 52-year-old woman for example, was seen with
papules and plaques on the face and later on her dorsal and
ventral thorax and arms after taking a kava product (type
68
of extract unspecied) for 3 weeks (Stevinson et al., 2002).

Although ginger (Zingiberis ofcinalle) shows a very broad range
of pharmacological effects it may cause heartburn and act as
a gastric irritant in doses exceeding 6 g dried ginger. Inhalation of dust from ginger may produce IGE-mediated allergy
(Chrubasik et al., 2005).
The risk of herbal medicines producing an adverse reaction depends not only on the medicine and its dosage but
also on consumer-related parameters, such as age, genetics, concomitant diseases and co-medication (herbherb and
herbdrug interactions). Reports about herbal medicinal products affected by contamination, adulteration or substitution
of botanical material have repeatedly caused concern. Asian
herbal medicinal products including jamu are most often
implicated (Ernst and Pittler, 2002). A report by Limyati and
Juniar (1998) mentions the microbial contamination of raw
material and end product of jamu gendong. Agranulocytosis
and citrobacterial infection have been found after using jamu
containing deliberately admixed phenylbutazone (to enhance
the analgetic and anti-inammatory effect) (Paul et al., 2005).
A study of 23 commercial jamu products showed the presence
of natural aatoxins that exhibit carcinogenic, teratogenic and
mutagenic properties (Ali et al., 2005). A case report describes
a 45-year-old patient who had highly elevated transaminases and elevated lactate dehydrogenase after having used
M. citrifolia. This gave rise to the suspicion of herbal toxicity, which was conrmed by taking a liver biopsy from the
patient (Millonig et al., 2005). Finally, there is always the risk
of herbdrug interactions, which may inuence the effectiveness of conventional drugs (Na et al., 2011; Izzo and Ernst, 2009;
Kennedy and Seely, 2010; Tarirai et al., 2010) Users, prescribers
and producers of jamu should be aware of this. Denitely, more
and continuous control is needed on traditional medicines
such as jamu to guarantee safety for the user. This should
preferably be regulated on a national level and implemented in
the manufacturing process as well as later, when the product
is on the market (Woerdenbag et al., 2012).
7.
Conclusion
Jamu is and will remain an integral part of the Indonesian healthcare system. The in vitro, in vivo and clinical
studies on medicinal plants that are used in jamu have
in part scientically proved their claimed biological activities. Species belonging to the family Zingiberaceae such as
Curcuma, Zingiber, Kaempferia, are the most frequently used
plants in jamu. These species have also been studied intensively for their secondary metabolites and biological activity.
Curcumin and panduratin are typical examples of bioactive
secondary metabolites from these plant species. As members of the Zingiberaceae are generally regarded as safe for
human consumption, these species are excellent candidates
for development as novel standardized jamu products. BPOM
has carried out systematic and comprehensive research on
nine priority plants used in jamu in Indonesia, i.e. ginger
(Z. ofcinale) and king of bitter (A. paniculata) as antineoplasmatics; turmeric (C. domestica), Java turmeric (C. xanthorrhiza)
and bastard cedar G. ulmifolia as antihyperlipidemcs; Java
noni (M. citrifolia), Indonesian bay-leaf Syzygium polyanthum
as antidiabetics; guava Psidium guajava as anti viral; and

Javanese long pepper Piper retrofractum as androgenic. Other
medicinal plants have been launched as herbal medicinal
products such as P. niruri as immunostimulant, C. xanthorrhiza
as antirheumatic, P. guajava and C. domestica as antidiarrhea
(Bermawie et al., 2005). Based on the literature search, we conclude that there are many more medicinal plants that have the
potential to be developed as herbal medicinal products or as
sources of new therapeutic agents. Although the commonly
used plants in jamu have been investigated scientically for
their biological activities, the jamu makers or the industries
still have to standardize the formulae of jamu in order to assure
the efcacy and safety.
For the near future, it is a challenge to develop the traditional jamu into standardized extracts and tofarmaka. This
will need investments from the Indonesian government, the
pharmaceutical industry and academia and a multidisciplinary approach. As a result, qualitatively better, safer and
more effective products should become available to the market and contribute to the quality of healthcare in Indonesia.
In addition, further research should be performed to evidence
the traditional use of jamu scientically.
Due to the vast biodiversity of Indonesias indigenous
medicinal plants, jamu has the potential for economic development. Exploration of medicinal plants which are known to
the Indonesian community should also cover ethical issues,
such as efcacy, safety, IPR, benet sharing and biodiversity
conservation.
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j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 5173

Available online at www.sciencedirect.com

Jamu: Indonesian traditional herbal medicine

Received 2 June 2012

Received in revised form

modern (conventional) medicine is becoming increasingly important in Indonesia, jamu is

Accepted 7 January 2014

Available online 26 January 2014

Indonesian medicinal plants

herbal medicines and tofarmaka (phytomedicines). As the biological activity ascribed to

3.4. Ethical considerations in the development of medicinal plants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Next to the Amazon rain forests, Indonesia has the second

Both online and ofine literature searches were carried out

Indonesian medicinal plants

Biodiversity is dened as the variety of all life forms on earth,

Since the 1980s small jamu producers have grown sufciently

Post Partum Herbs

Calami rhizoma, Zingiberis purpurei rhizoma, Ligusticae acutilobumae

PT. Sido Muncul

Ligustici rhizoma, Paeomiae alba radix, Polygalae tenuifolia radix,

Beras kencur Sido Muncul

PT. Kimia Farma

Ginseng radix extract, Eurycomae radix extract, Kaempferiae rhizoma

Hypericum extract, Centellae folium extract, Curcumae domesticae

PT. Jamu Iboe Jaya

Retofracti fructus, Zingiberis zerumbeti rhizoma, Elephantopi radix,

Zingiberis rhizoma, Panax ginseng extract, Blumeae folia, Menthae

Orthosiphonis folium, Phyllanthi herba, Plantaginis folium, Blumeae

Tonic tea plus daun dewa dan ginseng

Relieves abdominal pain after giving

Treats diabetes mellitus

Sariayu Martha Tilaar

Jamu godog bugar ayu

Usneae thalus, Zingiberis purpurei rhizoma, Retrofracti fructus, Santali

Slows the ageing process, improving the

Curcumae rhizoma, Eucalipty fructus, Retrofracti fructus, Zingiberis

Eurycomae longifoliae radix, Retrofracti fructus, Piperis nigri fructus,

Alleviates muscle pains, improves

Jamu sakit Maag

PT. Air Mancur

Jaket pegal linu

PT. Martha Tilaar

Jamu postnatal Innoshape

PT. Soho Farmasi

PT. Bintang Toedjoe

Perusahaan jamu Sido Jodo

Useful for various coronary problems

Slims down and rms up the body,

Treats diabetes mellitus

Curcumae domesticae rhizoma, Granati pericarpium extract, Psidii

Treats peptic ulcer

PT. Jamu Borobudur

accepted criteria of safety and efcacy for the protection of

Jamu as a way of traditional healing

scraping, crushing, mixing and cooking, followed by boiling

Test system (and

Clinical (180 mg per day)

Inhibition of DNA polymerase II and

Clinical (120 mg per day)

Improvement of the morning stiffness

In vitro, topical, IC50 = 84

In vitro IC50 = 5.6 M and

Ethyl- and ethyl