CHAPTER I

INTRODUCTION

Modern medicine, with its arsenal of manufactured drugs and advanced technological
devices, presents a big disparity from the folk traditional healing with the use of medicinal plants
through comparison of their practices and principles. Suffused in the concept of modernity is
the idea of efficiency in treatment, reproducibility of medications and predictability of results; as
such, modern practitioners have criticized traditional medicine as inferior. However, high cost
of modern medicine, especially those manufactured abroad, and their unavailability in remote
areas led to the continued dependence of rural folks on medicinal plants as their primary
therapeutic means and has resulted in the need to re-evaluate the potential of these medicinal
plants as an alternative treatment resource.

The Philippines is endowed with rich and varied flora, which are known to have
medicinal properties since ancient times. The native herb doctor or “albularyo” of olden times
were skilled in the use of local plants to cure varied illnesses. They utilized the different parts of
the plant to form decoctions and concoctions and passed this knowledge on folk medicine from
one generation to another. To date, “albularyos” and their use of medicinal plants are still widely
practiced in rural areas of the country.

In a survey conducted by UPLB in 766 barangays or villages in 12 regions of the

country, 1687 plants were found being used “arbularyos”; of such, 120 medicinal plants have
been scientifically validated for safety and efficacy and 10 are being endorsed by the DOH as
effective therapeutic alternatives to pharmaceutical preparations, the “Sampung Halamang
Gamot”. But it is highly possible that there are more plant species that can be classified
medicinal given the Philippines' rich and diverse flora. The engenderment of discipline of
ethnopharmacology arises from such thought, and the need for the development of such field.
Ethnopharmacology is the interdisciplinary scientific exploration correlating ethnic groups, their
health and how it relates to their physical habits and methodology in creating and using
medicines.

Despite the need; however, there is yet to be a systematic research strategy towards the
identification, characterization and evaluation of such medicinal plants and steps towards

1
resolving this is still primitive. As an initial step; therefore, there is a need to develop a database
on medicinal plant utilization and documentation.

SIGNIFICANCE OF THE STUDY

Despite advancements in technologies and coming of the modern era, poverty is still one
of the most debilitating problems among third world countries. A lot of people still do not have
access to basic necessities, such as food, shelter and education; and in such state of economic
deprivation, it has been difficult for the low income group to prioritize one of the necessities in
life, health care. This compelled the Department of Health of the Philippines to reappraise
traditional medicinal therapy, and endorse the use of the ten herbal medicines clinically proven
to have therapeutic value in the relief and treatment of various aliments in place of expensive
pharmaceutical preparations, known as the “Sampung Halamang Gamot program.” Moreover,
medicinal plants address not only the need for access to medicine as a component of health
services but also to the need for increased income for farmers and as a significant contribution
to the national economy.

Such advantageous effects, however, are a long way from reality. Currently, the
distribution and diversity of medicinal plants is not well documented that productive research
and development in the field cannot be instigated. Therefore, the results of this research is vital
for the current characterization and evaluation of our biodiversity, as well as for the future
researches that will need the database collected as baseline prevalence for their study on local
medicinal plants. The results can also be used by DOH to identify and gauge the health
practices of Pulilan, Bulacan. And lastly, documentation of the collection of local medicinal
plants is the first step in information exchange that is important in the conservation and usage of
such flora.

The nature of the topic is also important, because shedding light on herbal medicinal
therapy will increase awareness and attention on the medicinal plants; ultimately leading to a
more reliable information on the traditional use of medicinal plants, more focused and cheaper
product based drug discovery, and serve as a bridge between traditional and modern medicine.

Lastly, this research will give the group an opportunity to perform a community-based
qualitative and quantitative study. It will provide knowledge, experience and know-how to
explore the field of ethnopharmacology in the Philippines.

2
GENERAL OBJECTIVE:

To document the different medicinal plants prescribed by folk herbalist and its
relationships to the Sampung Halamang Gamot endorsed by the Department of Health.

SPECIFIC OBJECTIVES

1. To determine the most common medicinal plants being prescribed for common disease
indications.

2. To determine the parts, formulations and prepartions of medicinal plants being prescribed for
common disease inidcations.

3. To identify the plants used by folk herbalists for common disease indications.

4. To determine which medicinal plants being used by the folk herbalists belong to the
“Sampung Halamang Gamot.”

5. To determine the conformity of the folk herbalist for the use of the “Sampung Halamang
Gamot” to its endorsed indications.

SCOPES AND LIMITATIONS

3
DEFINITION OF TERMS

Medicinal Plants- natural herbs from plants for the treatment or prevention of diseases,
disorders and the promotion of good health. These plants can be finished, labeled, medicinal
products that contain as active ingredient/s aerial or underground part/s of plant or other
materials or combination thereof, whether in the crude state or as plant preparations. Plant
material includes juices, gums, fatty oils, essential oils, and other substances of this nature.
Medicines containing plant material(s) combined with chemically defined active substances,
including chemically defined, isolated constituents of plants, are not considered to be herbal
medicines.

A list of medicinal plants for common disease indications will be made based on the interview.
Data will be gathered with the use of Section B of the data collection tool.

Folk Herbalist - person especially in rural areas who used medicinal plants and other
alternative materials and procedures to heal. They are general practitioners and dispensers of
primary health care. As with the other healers, there is usually a history of a healer in the family-
line and their healing considered a "calling," a power or ability bestowed by a supernatural
being, often, attributed to the Holy Spirit. Often lacking in formal education, his skills are based
on and honed from hand-me-down practices and lore, with a long period of understudy or
apprenticeship with a local healer.

This study will refer to a folk herbalist as any kind of alternative medical practitioner referred by
health care worker who is a resident of Puilan ,Bulacan and knowledgeable about medicinal
plants and prescribes and/or makes use of plants or plant parts in his treatment regimen. They
will be regarded as respondents in the course of the study. The term is translated as 'albularyo'
in Filipino.

Sampung Halamang Gamot (SHG)- The ten medicinal plants endorsed by the Department of
Health through its "Traditional Health Program". All ten (10) herbs have been thoroughly tested
and have been clinically proven to have medicinal value in the relief and treatment of various
aliments. It includes the following plants:

Akapulko (Cassia alata)

Ampalaya (Momordica charantia)
Bawang (Allium sativum)
Bayabas (Psidium guajava)
Lagundi (Vitex negundo)
Niyog-niyogan (Quisqualis indica L)

4
Sambong (Blumea balsamifera L.)
Tsaang Gubat or Wild Tea (Ehretia microphylla Lam.)
Pansit-pansitan Ulasimang Bato (Peperomia pellucida)
Yerba Buena (Mentha spicata)

COMMON DISEASE INDICATIONS -refers to the all the indications which the SHG is endorsed
for, this includes the following: fever, cough, bronchitis, ringworm, diabetes, gout, kidney stone,
diarrhea, sore throat, diuretic, irregular menstruation, toothache, abdominal pain, arthritis, skin
disease, wounds and burns.

CHAPTER II

5
 REVIEW OF RELATED LITERATURE

Traditional medicine provides essential healthcare to the people and long before modern
medicines were introduced, herbal medicines has been widely used in the Philippines. Today,
the use of traditional medicine has expanded and gained tremendously with wide global
acceptance and popularity. The traditional medical consultancy including the consumption of the
medicinal plants has a much lower cost than modern medical attention. Considering the
expensive western medical treatment, which most Filipinos could not afford, the practice of
traditional medicine achieved great importance. The folk herbalists are the one who tested the
curative effects of the herbal medicines on their patient with try-and-error basis. This knowledge
and skill has been handed from several generations. The folk herbalists received in return the
moral support and the psychological comfort from their patients. In the olden days, they are of
high social status and well respected.
The availability of the modern drug is starting to increase at much cheaper prices, thus,
the popularity of herbal medicines has begun to decline but mostly in urban areas. Despite of
the campaigns to make available medical services in rural areas, the services are still far from
adequate today. The people who belong to the economically challenge class who live far from
the district towns and are in need of health care the most are still unable to come to the
hospitals. These people who are the majority of the population of the Philippines divert their
healthcare needs to the folk herbalists and be medicated with herbal plants.

In 1992, the Department of Health (DOH), through former Health Secretary and former
Senator Juan M. Flavier, first came out with the Traditional Medicine Program by virtue of
Administrative Order No. 12. This special program was tasked to promote and advocate
traditional medicine nationwide. In order to institutionalize the program, the drafting of a
traditional medicine law started in 1994. Then in 1997, President Fidel V. Ramos, appreciate the
importance of traditional medicine in the country.1

Philippine Institute of Traditional and Alternative Health Care

1
Philippine Institute of Traditional and Alternative Healthcare. [www2.doh.gov.ph/pitahc/] Accessed last 30 July
2007

6
 The timely approval of Republic Act 8423 (R.A. 8423) otherwise known as the Traditional
and Alternative Medicine Act (TAMA) of 1997 gave rise to the creation of the Philippine Institute
of Traditional and Alternative Health Care (PITAHC), a government owned and controlled
corporation (GOCC) attached to the DOH to answer the present needs of the people on health
care through the provision and delivery of traditional and alternative health care (TAHC)
products, services and technologies that have been proven safe, effective and affordable.2

PITAHC has the vision of “Traditional and alternative health care in the hands of the
people”. According to Republic Act 8423 Traditional and Alternative Medicine Act of 1997,
alternative healthcare is the sum of total knowledge, skills, and practices on health care, other
than those embodied in biomedicine, used in the prevention, diagnosis and elimination of
physical or mental disorder. On the other hand, traditional medicine is the sum of total
knowledge, skills and practices on health care, not necessarily explicable in the context of
modern, scientific philosophical framework but recognized by the people to help maintain and
improve their health towards the wholeness of their being, the community and society, and their
interrelations based on culture, history, heritage and consciousness. The world health
organization states that traditional medicine is based on indigenous theories, beliefs and
experiences that are handed down form generation to generation.3

A better understanding of PITAHC could be obtained from reading the following objectives:

 To encourage scientific research on and develop traditional and alternative health care
systems that have direct impact on public health care;
 To promote and advocate the use of traditional, alternative, preventive and curative
health care modalities that have been proven safe, effective, cost-effective and
consistent with government standards on medical practice;

 To develop and coordinate skills training courses for various forms of traditional and
alternative health care modalities;

 To formulate standards, guidelines and codes of ethical practice appropriate for the
practice of traditional and alternative health care as well as in the manufacture, quality
2
Philippine Institute of Traditional and Alternative Healthcare. [www2.doh.gov.ph/pitahc/] Accessed last 30 July
2007

3
http://herbal-medicine.philsite.net/doh_herbs.html

7
 control and marketing of different traditional and alternative health care materials,
natural and organic products, for approval and adoption by the appropriate government
agencies;

 To formulate policies for the protection of indigenous and natural health resources and
technology from unwarranted exploitation, for approval and adoption by the appropriate
government agencies;

 To formulate policies to strengthen the role of traditional and alternative health care
delivery system; and

 To promote traditional and alternative health care in international and national

conventions, seminars and meetings in coordination with the Department of Tourism,
Duty Free Philippines, Incorporated, Philippine Convention and Visitors Corporation and
other tourism-related agencies as well as non-government and local government units. 4

According to the Department of Health, the health sector in the Philippines falls short in
meeting several problems due to several reasons [1] inappropriate health delivery system such
as, poor hospital facilities, fragmented primary health system, ineffective delivery mechanism
for public health program, and misdistribution of health human resources, [2] inadequate health
regulatory mechanisms such as gaps in regulatory mandates, lengthy and laborious regulatory
systems and processes and inadequate human resources and facilities resulting in poor quality
of health care, high cost of privately provided health services and high cost of drugs, [3] poor
health care financing such as inadequate funding, inefficient sourcing, and ineffective allocation.
To be able to transform the health system into that would ensure the delivery of cost effective
services, universal access to essential services and adequate and efficient financing, major
reforms must be undertaken. Pursuing the needed improvement, the entire health sector sets a
mission of “to ensure accessibility and quality of health care to improve the quality of life of all
Filipinos, especially the poor.” The DOH as the lead agency on health sets the vision for the
nation’s health, “Health for All Filipinos.”5

4
Ibid.

5
Complementary and Alternative Medicine: A prescription for Medical Tourism.
[pmtcongress.rxpinoy.com/downloads/Galindez-Prescription-CAM.pdf ] Accessed Last 30 July 2007

8
 In accordance to the mission of the DOH, the department endorsed a “Traditional Health
Program” in which ten (10) herbs have been thoroughly tested and have been clinically proven
to have medicinal values. The following is the list of the top ten medicinal plants in the
Philippines.

1. Akapulko (Cassia alata) - also known as "bayabas-bayabasan" and "ringworm bush" in

English, this herbal medicine is used to treat ringworms and skin fungal infections. It can also
be used as expectorant for bronchitis and dyspnea, mouthwash in stomatitis, alleviation of
asthma symptoms, used as diuretic and purgative, for cough & fever, as a laxative to expel
intestinal parasites and other stomach problems.6

2. Ampalaya (Momordica charantia) - known as "bitter gourd" or "bitter melon" in English, it

most known as a treatment of diabetes (diabetes mellitus), for the non-insulin dependent
patients. Other indications are for rheumatism, gout, anti-hypertension, anti-pyretic,
disinfectant, anti-diarrhea, enhances immunes system, and remedy for cough.7

3. Bawang (Allium sativum) - popularly known as "garlic", it mainly reduces cholesterol in the
blood and hence, helps control blood pressure. It is also good remedy in cough and cold. It
relieves sore throat and toothache.8

4. Bayabas (Psidium guajava) - "guava" in English. It is primarily used as an antiseptic, to

disinfect wounds. Also, it can be used as a mouth wash to treat tooth decay and gum infection.
It also helps in reducing fever and in alleviation of rheumatism.9

5. Lagundi (Vitex negundo) - known in English as the "5-leaved chaste tree". It's main use is
for the relief of coughs and asthma. It is also great remedy for cough, colds, fever, flu, and in
removal of worms and boils.10

6. Niyog-niyogan (Quisqualis indica L.) - is a vine known as "Chinese honey suckle". It is

effective in the elimination of intestinal worms, particularly the Ascaris and Trichina. Only the
dried matured seeds are medicinal -crack and ingest the dried seeds two hours after eating (5

6
Philippine Herbal Medicine [ http://herbal-medicine.philsite.net/akapulko.htm] Accessed Last 08 September 2007
7
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/ampalaya.htm] Accessed Last 08 September 2007

8
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/garlic.htm] Accessed Last 08 September 2007
9
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/guava.htm] Accessed Last 08 September 2007
10
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/lagundi.htm] Accessed Last 08 September 2007

9
 to 7 seeds for children & 8 to 10 seeds for adults). If one dose does not eliminate the worms,
wait a week before repeating the dose. It is also well known in relieving fever and toothache.11

7. Sambong (Blumea balsamifera)- English name: Blumea camphora. A diuretic that helps in
the excretion of urinary stones. It can also be used as an edema. It also treats dysentery, sore
throat, remove worms and boils, and as ant-pyretic.12

8. Tsaang Gubat (Ehretia microphylla Lam.) - Prepared like tea, this herbal medicine is
effective in treating intestinal motility and also used as a mouth wash since the leaves of this
shrub has high fluoride content.13

9. Ulasimang Bato (Peperomia pellucida) - also known as "pansit-pansitan" it is effective in

fighting arthritis and gout. The leaves can be eaten fresh (about a cupful) as salad or like tea.
For the decoction, boil a cup of clean chopped leaves in 2 cups of water. Boil for 15 to 20
minutes. Strain, let cool and drink a cup after meals (3 times day). It can also be used as
treatment for skin boils, abscesses, pimples, headache, abdominal pains, and kidney
problems.14

10. Yerba Buena (Clinopodium douglasii) - commonly known as Peppermint, this vine is used
as an analgesic to relive body aches and pain. It can be taken internally as a decoction or
externally by pounding the leaves and applied directly on the afflicted area. It also relieves
intestinal gas and indigestion.15

Some of the ten herbal medicines in the Philippines that were approved by the DOH
were already sold to the market as tablet forms. One is Lagundi, which is a therapy for
bronchospasm in bronchial asthma, chronic bronchitis and other bronchopulmonary disorders.
Another is sambong, which can be used to treat kidney stones, urinary tract pain and burn
sensations, it also increases urinary output in certain conditions characterized by edema or fluid

11
Philippine Herbal Medicine [http://www.pcarrd.dost.gov.ph/prosea/proseaherbal/niyog-niyogan_doc.htm]
Accessed Last 08 September 2007

12
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/sambong.htm] Accessed Last 08 September 2007

13
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/tsaang gubat.htm] Accessed Last 08 September
2007
14
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/pansit-pansitan.htm] Accessed Last 08 September
2007
15
Philippine Herbal Medicine [http://herbal-medicine.philsite.net/yerba buena.htm] Accessed Last 08 September
2007

10
retention. Tsaang Gubat can be used to provide relief for abdominal colic. These herbal plants
were already included in the PNDF Vol.1, 5th Edition, 2000.

ETHNOPHARMACOLOGY

Ethnopharmacology is the scientific study that correlates ethnic groups, their health
practices, and how it relates to their physical habits and methodology in creating and using
medicines. It incorporates the social science of ethnology and the medical science of
pharmacology. It is related to botany in that many pharmaceuticals are delivered through
plants.16 Combining the approaches of medical anthropology, phytotherapy, and pharmaceutical
science, this discipline explores medicinal plants in indigenous cultures, which includes the
bioactive compounds, and the sustainable development and production of nature-derived
therapeutics.17 Hence, ethnopharmacology studies the pharmacological aspects of a culture's
medical treatment as well as its social appeal. This includes taste, symbology, and religious
context. Through this, a culture's exposure to pharmacological substances can be determined.18

It is also often associated with ethnopharmacy, but while the aim of ethnopharmacology
is the bio-evaluation of the effectiveness of traditional medicines, the former deals instead with
much broader trans-disciplinary aspects related to the study of the perception, usage, and
management of pharmaceuticals but not necessarily traditional medicines within a given human
society.

When investigating a natural product used by a certain culture as a medicine, it is

important that the methods of collection, extraction, preparation are the same or similar to those
used by the ethnic group, as it is these processes which have allowed safe usage of the
substance and give it its safety record.19

In recent years the preservation of local knowledge, the promotion of indigenous medical
systems in primary health care, and the conservation of biodiversity have become even more of
a concern to all scientists working at the interface of social and natural sciences but especially
to ethnopharmacologists. They are particularly concerned with local people’s rights to further
16
(1996) "Ethnopharmacology: The Conjunction of Medical Ethnography and the Biology of Therapeutic Action",
Medical Anthropology: Contemporary Theory and Method. Praeger Publishers, 132-133, 151.
17
http://www.ethnopharmacology.org/
18
http://medicinus.info/research/areas/ethnopharmacology/
19
Heinrich, Michael. UUBook Review Editor, JEP

11
use and develop their autochthonous resources. Accordingly, today’s ethnopharmacological
research embraces the multidisciplinary effort in the:

• Documentation of indigenous medical knowledge

• Scientific study of indigenous medicines in order to contribute in the long-run to

improved health care in the regions of study

• Search for pharmacologically unique principles from existing indigenous remedies.

Consequently ethnopharmacology will contribute to the development of new

pharmaceutical products for the markets. Also, truly anthropologically-oriented research on
medicinal plants requires not only a detailed understanding of these medicines, but also the
scientific support to autochthonous developments in order to make better use of these products.

Ethnobotanical studies are often significant in revealing locally important plant species
especially for the discovery of crude drugs. Right from its beginning, the documentation of
traditional knowledge, especially on the medicinal uses of plants, has provided many important
drugs of modern day.20

The knowledge that some herbs and plants possess medicinal compounds has been
applied since time immemorial. Ethnopharmacology investigations classically involved folk
herbalists, botanist, anthropologist, chemist and pharmacologists (Raza). 21 The practice of
which was passed on from one generation to the next. It was the early people who understood
that therapeutic plants have the capacity to be very effective, yet with no or minimal toxicity.
Historical data shows that discovery of several important drugs of herbal origin owe to the
medical knowledge and clinical expertise of physicians (Raza). 22 The transformation of digitalis
from a folk medicine, foxglove, to a modern drug, digoxin, illustrates principles of modern

20
Tilahun T., Mirutse G. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern
Ethiopia. (March 2007).Journal of Ethnobiology and Ethnomedicine 2007, 3:12 doi:10.1186/1746-4269-3-12

21
Raza M. A role for physicians in ethnopharmacology and drug discovery (2006 April 6).
[http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=ShowDetailView&TermToSearch=16459039&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pu
bmed.Pubmed_ResultsPanel.Pubmed_RVDocSum] Accessed last 30 July 2007.
22
Raza M. A role for physicians in ethnopharmacology and drug discovery (2006 April 6).
[http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=ShowDetailView&TermToSearch=16459039&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pu
bmed.Pubmed_ResultsPanel.Pubmed_RVDocSum] Accessed last 30 July 2007.

12
pharmacology that have helped make drugs safer and more effective (Goldman P.). 23 Indeed
today many pharmacological classes of drugs include a natural product prototype. Aspirin,
atropine, ephedrine, digoxin, morphine, quinine, reserpine and tubocurarine are a few examples
of drugs, which were originally discovered through the study of traditional cures and folk
knowledge of indigenous people. Although the therapeutic and medicinal properties of such
resources have been apparent, it has only been recently that focus on ethnopharmacology
became a concern. 24

According to Raza, rising cost of modern drug development is attributed to the lack of
classical ethnopharmacological approach. Physicians can play multiple roles in the
ethnopharmacological studies to facilitate drug discovery as well as to rescue authentic
traditional knowledge of use of medicinal plants. These include: (1) Ethnopharmacological field
work which involves interviewing healers, interpreting traditional terminologies into their modern
counterparts, examining patients consuming herbal remedies and identifying the disease for
which an herbal remedy is used. (2) Interpretation of signs and symptoms mentioned in ancient
texts and suggesting proper use of old traditional remedies in the light of modern medicine. (3)
Clinical studies on herbs and their interaction with modern medicines. (4) Advising
pharmacologists to carryout laboratory studies on herbs observed during field studies. (5) Work
25
in collaboration with local healers to strengthen traditional system of medicine in a community.

Physician's involvement in ethnopharmacological studies will lead to more reliable

information on traditional use of medicinal plants both from field and ancient texts, more focused
and cheaper natural product based drug discovery, as well as bridge that gap between
traditional and modern medicine (Raza).26 In the study of Aburjai et al, in which collection of
information from local population concerning the use regional medicinal plants; identify the most
23
Goldman P. Herbal Medicine Today and the Roots of Modern Pharmacology
[www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15216922&dopt=Abstract]
Accessed Last 30 July 2007.
24
International Society for Ethnopharmacology. 2007. Journal of Ethnopharmacology.
[http://www.ethnopharmacology.org/] Accessed last 30 July 2007.
Ibid.
25
Raza M. A role for physicians in ethnopharmacology and drug discovery (2006 April 6).
[http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=ShowDetailView&TermToSearch=16459039&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pu
bmed.Pubmed_ResultsPanel.Pubmed_RVDocSum] Accessed last 30 July 2007.
26
Raza M. A role for physicians in ethnopharmacology and drug discovery (2006 April 6).
[http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=ShowDetailView&TermToSearch=16459039&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pu
bmed.Pubmed_ResultsPanel.Pubmed_RVDocSum] Accessed last 30 July 2007.

13
important species used; determine the relative importance of the species surveyed and
calculate the informant consensus factor (ICF) in relation to medicinal plant use. Data collection
relied predominantly on qualitative tools to record the interviewee's personal information and
topics related to the medicinal use of specific plants. In the rural people of India, traditional
herbal medicine is predominantly practiced especially the remote areas such as the Uttara
Kannada District in Western Ghats of Karnataka.27 Local folk herbalists play an important role in
the management of health problems of the native population due to socio-economical and
geographical factors.

The first formal study was published in 1979 as the pioneer article in the Journal of
Ethnopharmacology.28 Consequently, this has prompted the opening of a new area for research.
An advocacy runs, to allow the local people in further using and developing the autochthonous
resources that are abundant. Also, research in this field has permitted the following: a)
documentation of indigenous medical knowledge; b) health care improvement through the
scientific study of indigenous medicines; and c) the search for pharmacologically unique
principles from existing indigenous remedies.29

In the present study, 92 folk herbalists from various regions of Uttara Kannada district
were interviewed to collect information on the use of herbal treatments. Information was also
collected on the method of preparation, dose and duration along with the botanical names,
family and local names of the medicinal plants. The plants were then collected and identified
(Hegde et al).30 An ethnobotanical and medical study was carried out in the Navarre Pyrenees,
an area known both for its high biological diversity and its cultural significance. As well as the
compilation of an ethnopharmacological catalogue, a quantitative ethnobotanical comparison
has been carried out in relation to the outcomes from other studies about the Pyrenees.
Information was collected using semi-structured ethnobotanical interviews and the data was

27
Aburjai T. et al. Ethnopharmacological Survey of medicinal herbs in Jordan , the Aljoun Heights Region.
[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=15216922&dopt=AbstractPlus]
Accessed Last 30 July 2007.

28
International Society for Ethnopharmacology. 2007. Journal of Ethnopharmacology.
[http://www.ethnopharmacology.org/] Accessed last 30 July 2007.
29
Ibid.
30
Hedge HV et al. Herbal care for reproductive health: ethno medicobotany from Uttara Kannada district in
Karnataka, India.

[http://www.ncbi.nlm.nih.gov/sites/entrez?
cmd=Retrieve&db=PubMed&list_uids=15216922&dopt=AbstractPlus] Accessed Last 30 July 2007.

14
analyzed using quantitave indexes: Ethnobotonicity Index, Shannon-Wiener's Diversity,
Equitability and The Informant Consensus Factor. The official review has been performed using
the official monographs published by the WHO, ESCOP and the E Commission of the German
Department of Health (Akerreta et al).31 Since the Journal of Ethnopharmacolgy was published
numerous studies in the Journal dealing with medicinal and other useful plants as well as their
bioactive compounds have used a multitude of concepts and methodologies. In many cases
these were interdisciplinary or multidisciplinary studies combining such diverse fields as
anthropology, pharmacology, pharma-cognosy, pharmaceutical biology, natural product
chemistry, toxicology, clinical research, plant physiology and others (Soejarto, D.D., 2001,
Journal of Ethnopharmacology 74). September of 2000, the board of the Journal of
Ethnopharmacology took the initiative and proposed a revised statement to the editors and the
publisher. With the new statement by boards of the Journal of Ethnopharmacology drawing the
attention to the importance of nature-derived products (plant extracts and pure compounds) in
the healthcare of the original keepers of such ethnopharmacological knowledge. This needs to
be a primary goal of truly interdisciplinary ethnopharmacological research.32

In the study of Gazzaneo et al, the collection of data was done in a year with the help of
rural dwellers of the community being studied. The researchers had door-to-door visits in order
to identify the local folk herbalists with specialized knowledge on the use of the medicinal plants.
Non-random sampling was purposely used under the assumption that the local folk herbalists
would provide a better quality of information about the use of the medicinal plants. By using the
snowball method, the names of other interviewees were obtained. Six local folk herbalists who
had been living in the community for at least 30 years were interviewed. In the data analysis,
calculating for the informant consensus factor (ICF) was the first step employed. A low ICF value
that is near zero, if the plants are chosen randomly, or if there is no exchange of information
about the use of the medicinal plants. A high ICF value of near one, if there is a well-defined
selection criterion in the community or if there is an exchange of information between
informants. The ICF is calculated as the number of use citations in each category minus the
number of species used, divided by the number of use citations in each category minus one. All
citations were placed into one of the 14 categories of different indications. The use of value
which is a quantitative method that demonstrates the relative importance of species known
31
Akerreta S. et al. First comprehensive contribution to medical ethnobotany of of Western Pyrenees.
[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=15216922&dopt=AbstractPlus]
Accessed Last 30 July 2007.
32
International Society for Ethnopharmacology. 2007. Journal of Ethnopharmacology.
[http://www.ethnopharmacology.org/] Accessed last 30 July 2007.

15
locally was also calculated as summation of the number of citations per species divided by the
number of informants. The materials collected was processed, identified with the aid of
specialists, and subsequently deposited in the Biology Department of the Federal Rural
University of Pernambuco. The local informants help in the collection of 125 plants, distributed
among 61 botanical families, with little participation of native plants. This study demonstrated
that the local people agree with each other as regards to the use of plants in treating blood-
related problems, but with a more diverse group of plants to treat respiratory and digestive
systems problems. 33

The department of plant biology (botany) and the department of pharmacy and
pharmaceutical technology (pharmacogeny) of the university of navarra, spain organized an
interdisciplinary research team to conduct an ethnobotanical and medical study in the Navarre
Pyrenees. This area is known both for its high biological diversity and its cultural significance.
The study began in 2003 and was intended to attain a more thorough understanding on the
plants used in Navarre’s traditional medicine, the principles behind their use, their composition,
and therapeutic use. the Pyrenees are a mountain range of 435 in length from east to west,
dividing the Iberian Peninsula from the other parts of Europe. The area presents with a great
variety of climates and soils, responsible for its rich ecology and flora of 3500 taxa in total. The
area has a mild oceanic climate in its northern part which becomes a submediterranean climate
type as one reaches the southern areas of Navarre. The objectives of the study included
compiling an ethnobotanical and medical catalogue of the Navarre Pyrenean Region, to conduct
a quantitative analysis of the results and compare it with other ethnobotanical studies of the
Pyrenees region, and to do a review of the drugs within the community through studying the
monographs published by WHO, ESCOP and the E Commission of the German Department of
Health, institutions responsible for the safety and efficacy of medicinal plants, with the purpose
of assessing the official validity of the pharmacology of the Navarre Pyrenees. Field work was
done for two years, from November 2004 to December 2006. Ethnobotanical interviews were
conducted on people who have a knowledge on traditional medicine. Data gathering was done
through individual interviews, as well as group interviews in nursing homes. Open and semi-
structured questions were asked which encouraged the spontaneous participation of the
interviewees. The conversations were recorded with prior consent of the participants, and more
than one interview session took place to confirm the identification of some plants. 88 local

33
Gazzaneo L, Lucena R., Albuquerque U. Knowledge and use of medicinal plants by local specialists in an region
of Atlantic Forest in the state of Pernambuco (Northeastern Brazil), (01 November 2005) Journal of Ethnobiology
and Ethnomedicine. Available at http://www.ethnobiomed.com/content/1/19 Accessed Last 08 September 2007.

16
people in 40 villages were interviewed. Collection of the species were done with the interview in
situ, and were identified in the laboratory using keys for botanical determination. They were
labeled and included in the PAMP Herbarium at the School of Sciences. Data analysis was done
using quantitative indexes: Ethnobotonicity Index, Shannon-Wiener's Diversity, Equitability and
The Informant Consensus Factor. The results of the study showed that the ethnobotanical and
medical catalogue of the Navarre Pyrenees Area comprised of 92 species. 39 of which were
mentioned by at least three interviewees. The quantitative ethnobotany results revealed lower
values as compared to those found in other studies done about the Pyrenees. Moreover, 57.6%
of the Pyrenees medical ethnobotany described were not included in the documents published
by the aforementioned institutions.34

According to WHO, traditional medicine is still being used by 80% of the world
population as part of their health care, especially those in developing countries. Many African
countries including Tanzania, depend on traditional healers who provide primary health care by
taking care of people living with emerging diseases such as HIV/AIDS. The people who are
infected with HIV/AIDS are susceptible to fungal and bacterial opportunistic infections
secondary to immunosuppression. Treatment of such infections is therefore a primary
consideration for managing HIV/AIDS cases. However, factors such as poverty, high cost of life-
enhancing drugs, resistance to conventional medicine and the serious side effects associated
with antiretroviral drugs hindered the utilization of conventional therapies. It was noted that
greater than 60% of the people in Tanzania resort to traditional medicines in managing various
diseases including HIV/AIDS. Because of the scarcity of available drugs, the people with
HIV/AIDS depend on traditional health services in controlling the disease. The researchers used
an open-ended semi-structured questionnaire to gather field information. Analysis of the
ethnobotanical data collected was done using descriptive statistics. They used the factor of
informant consensus (Fic) to analyze the ethnobotanical importance of the plants. In the study
conducted, 75 plant species belonging to 66 genera and 41 families were discovered to be used
in treating one or HIV/AIDS related infections in the district. The most common manifestations of
HIV/AIDS opportunistic infections affecting most of the population in the area were revealed as
TB and oral candidiasis. The study unveiled the first detailed account of ethnomedical

34
Akerreta, S., Cavero, R., and Calvo, M., First Comprehensive Contribution to Medical Ethnobotany of Western
Pyrenees, (06 June 2007) Journal of Ethnobiology and Ethnomedicine 2007, Available at
http://www.ethnobiomed.com/content/3/1/26, Accessed last 08 September, 2007

17
documentation of plants which focused on the management of HIV/AIDS related infections in
the district.35

For the determination of the folk herbalists, in most of the studies conducted, there is a
constant assistance from one of the local representatives of the study area to help the
researchers in identifying the reliable folk herbalists. In the study of Gazzaneo et al, the rural
dwellers of the “Tres Ladeiras” community helped in collecting the information on the use of the
medicinal plants and also mediated in identifying the local folk herbalists to be interviewed in
connection to the confirmation of the native inhabitants. The interviewees identified were all
living in the community for at least 30 years. 36 In the study of Teklehaymanot et al, wherein a
representative form the Local Farmer’s Association facilitated in the identification of the reliable
interviewees.37 In the study of Akerreta et al, the local people of the villages and towns helped in
locating the folk herbalists. The interviewees are all born or had been living in the region for
most of their lives. All of the chosen local people have no scientific knowledge concerning to the
medicinal plants that they prescribed.38 505 interviewees were gathered and the information was
collected using semi-constructed ethnobotanical interviews. The selected local people having
lived most of their lives or born in the region studied. The age ranges from 22 to 100 year, the
age group from 71-80 years represented the mean (Akerreta et al).39

The largest number of remedies of medicinal plants was used to treat gastrointestinal disorder
and parasites (22.8%) followed by external injuries and parasites (22.1%), rabies and internal
diseases (17.9%). The proportion of remedies used for treatment of gastrointestinal related

35
Kisangau, D. P., Lyaruu1, H. , Hosea, K. M. and Joseph, C. C., Use of traditional medicines in the management of
HIV/AIDS opportunistic infections in Tanzania: a case in the Bukoba rural district, (10 July 2007) Journal of
Ethnobiology and Ethnomedicine 2007, available at http://www.ethnobiomed.com/content/3/1/29, accessed last 08
September 2007.
36
Gazzaneo L, Lucena R., Albuquerque U. Knowledge and use of medicinal plants by local specialists in an region
of Atlantic Forest in the state of Pernambuco (Northeastern Brazil), (01 November 2005) Journal of Ethnobiology
and Ethnomedicine. Available at http://www.ethnobiomed.com/content/1/19 Accessed Last 08 September 2007.
37
Tilahun T., Mirutse G. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern
Ethiopia. (March 2007).Journal of Ethnobiology and Ethnomedicine 2007, 3:12 doi:10.1186/1746-4269-3-12

38
Akerreta S., Cavero R., Calvo M. First comprehensive contribution to medical ethnobotany of Western Pyrenees (6
June 2007).Journal of Ethnobiology and Ethnomedicine 2007. Available at
http://www.ethnobiomed.com/content/3/1/26 Accessed Last 08 September 2007.

39
Akerreta S., Cavero R., Calvo M.,Lopez V. Analyzing Factors that influence the folk use and phytonomy of 18
medicinal plants in Navarre (13 April 2007).Journal of Ethnobiology and Ethnomedicine 2007. Available at
http://www.ethnobiomed.com/content/3/1/16 Accessed Last 08 September 2007.

18
disease are also high in most studies conducted in Ethiopia, accounting for 35% compared to
other type of remedies that were compiled as being used against human aliments. The rest
were used to treat swelling and cancer (8.3%), evil eye and devil sickness (6.2%), sensorial
disease (6.2%), venereal disease and impotence (4.8%), 'mich' and febrile diseases (4.1%),
respiratory and throat infection (4.1%), and snake bite (3.4%). Multiple plants treatments with
different combinations of medicinal plants were used to treat seven external and internal
illnesses. Seventy eight percent of the multiple plants treatments were roots and were prepared
by mixing the ingredients with different proportions. Three were used to treat evil eye and one of
the polyherbal remedy had nine medicinal plants. 40

Ethnopharmacology will also contribute to the development of new pharmaceutical

products for the markets. Also, truly anthropologically-oriented research on medicinal plants
requires not only a detailed understanding of these medicines, but also the scientific support to
autochthonous developments in order to make better use of these products. 41

The Journal of Ethnopharmacology is dedicated to the exchange of information and

understandings about people’s use of plants, fungi, animals, microorganisms and minerals and
their biological and pharmacological effects based on the principles established through
international conventions. Early people confronted with illness and disease, discovered a wealth
of useful therapeutic agents in the plant and animal kingdoms. The empirical knowledge of
these medicinal substances and their toxic potential was passed on by oral tradition and
sometimes recorded in herbals and other texts on materia medica. Many valuable drugs of
today (e.g., atropine, ephedrine, tubocurarine, digoxin, reserpine) came into use through the
study of indigenous remedies. Chemists continue to use plant-derived drugs (e.g., morphine,
taxol, physostigmine, quinidine, emetine) as prototypes in their attempts to develop more
effective and less toxic medicinals.42 The use of plants, plant extracts or plant-derived pure
chemicals to treat disease is a therapeutic modality, which has stood the test of time. There is a
revival of interest in herbal products (botanicals) at a global level and the conventional medicine
40
Tilahun T., Mirutse G. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern
Ethiopia. (March 2007).Journal of Ethnobiology and Ethnomedicine 2007, 3:12 doi:10.1186/1746-4269-3-12
41
International Society for Ethnopharmacology. 2007. Journal of Ethnopharmacology.
[http://www.ethnopharmacology.org/] Accessed last 30 July 2007.
42
International Society for Ethnopharmacology. 2007. Journal of Ethnopharmacology.
[http://www.ethnopharmacology.org/] Accessed last 30 July 2007.

19
is now beginning to accept the use of botanicals once they are scientifically validated (Gilani et
al).43 Some examples of ethnomedicine are gaining the popularity amongst modern physicians
due to the high cost involved in the development of patentable chemical drugs (Gilana et al).44

OTHER RELEVANT INFORMATION

International organizations and policy-makers consider the presence of primary health

care, including Western primary health-care services (PHCs) to be the solution to health
problems in remote and impoverished areas. Health-care institutions in developing countries
consist of governmental health services, nongovernmental organizations (NGOs), traditional
healers, and private practice. In such areas, not only does Western health care coexist with
traditional medicine (TM) which includes both self-care with medicinal plants and consultation
with specialized traditional healers, but conflicts with such health practice in those areas. the
residents of local communities are having difficulty integrating Western medicine as part of
improving their health due to reasons such as the cost of consultation, high travel distance,
perception of illness by patients as non-serious, and impersonal treatment of patients by the
medical staff. Moreover, some local health beliefs serve as obstacles to the use of
pharmaceuticals. For example, the Vietnamese believe that antibiotics should be minimally used
for those with a “hot” body (i.e. suffers from fever) because these medications are also
considered “hot,” therefore, producing no cooling effect on the body. In other areas of the world,
such as the women in periurban Brazil, preferred medicinal plants over pharmaceuticals
because of the low cost and that medicinal plants do not produce the side effects of
pharmaceuticals. Hence, in local communities the use of medicinal plants as primary health-
care is more culturally acceptable than Western medicine.

It was presumed that the earliest form of herbal medicine was marshmallow root, a
common grass said to be chewed by our closest evolutionary cousins, chimpanzees and
bonobos, to relieve an upset stomach. Likewise, hyacinth (a diuretic) causes the tissues to
expel excess water, is rich in tannins and alkaloids, and has a bitter, or pungent taste.

43
Gilani AH et al. Trends in Ethnopharmacology. [http://www.ncbi.nlm.nih.gov/sites/entrez?
cmd=Retrieve&db=PubMed&list_uids=15216922&dopt=AbstractPlus] Accessed Last July 30 2007
44
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=15216922&dopt=AbstractPlus

20
 As tribal human societies grew, a small body of knowledge grew regarding which plants
were beneficial for a certain ailment, until the role of a tribal herb lore specialist became known.

As human societies shifted to an agronomical view of the world, the cultivation of plants
for medicine provided an important role; eventually, herbal lore and herbal remedies became
codified, first with the Egyptians, then with the Greeks in the Western tradition, and the
knowledge base was slowly accumulated upon by the Romans. It's from the Greeks in particular
that the foundation of modern medicine – of not just prescribing a treatment, but recording what
the treatment was, and what its impact was, got started.

In India, the herbalist tradition was Ayurvedic, focusing on the use of metals, herbs and
parts of animals generally considered inedible, prepared in solution. These herbs and other
compounds are used in varying proportions to remedy specific ills, and may be applied internally
as pills or infusions, topically as ointments, inhaled as smoke, or pressed to the body as
powders.

In the Americas, without a written tradition to work from, most herbalism is carried by oral
traditions from various tribes; this has proven invaluable when looking for herbal remedies in the
rain forests and Andean uplands. Much of the American herbal tradition is tied to shamanism
and spiritualism.

In China, herbalism and herbal remedies were used as an adjunct to acupuncture, and
the medical morphology in use is of balancing qui or chi, the life force energies, which have yin
and yang elements; in Chinese herbalism, the aim is to bring the systems of the body, treating it
as an electrical system, back into balance, which is a tactic commonly expressed in modern, or
syncretic herbalism.45

The continued reliance of many African people on traditional medicines is partly due to
economic circumstances, which place modern health facilities, services and pharmaceuticals
out of the reach of the majority of the population. However, in many cases, it is also attributable
to the widespread belief in the effectiveness of many traditional therapies. Even where western
biomedical care is available, many people still prefer traditional treatments for treating many
aliments. 46

45
http://www.herbalremediesinfo.com/history-of-herbal-medicine.html, Copyright 2007 Marc Neveux Herbal
Remedies Info

21
 The number of ethnomedicinally important plant species documented in Zegie Peninsula
was 67. These species belong to 64 genera and 44 families. The genera Asteraceae,
Euphorbiaceae, Fabaceae and Solanaceae were families with four species each followed by
Malvaceae with three species and, Apocynaceae, Asclepiadaceae, Cucurbitaceae,
Dracaenaceae, Moraceae, Rhamnaceae and Rutaceae, each contributing two species.47

The Department of Health has been promoting products of medicinal plants as

alternative medicines. According to the DOH secretary, their low costs and effectiveness will be
an advantage for the health needs of many Filipino families as they have been a subject of
extensive research by Filipino scientists. The Department of Science and Technology
announced that 102 plants have been “scientifically validated for safety and efficacy.” Ten of
these plants are under different stages of development, and that studies have been completed
on sambong, lagundi, and akapulko. DOST said that from sambong and lagundi alone, a local
marker of herbal drugs is earning millions of pesos. However, recent reviews of the scientific
literature on herbal medicinal products warned that medicinal plants are not free of risk. One
such review was conducted by scientists from the Department of Complementary Medicine,
Universities of Exeter and Plymouth, United Kingdom. Their study, published in the journal
Pharmacoepidemiology and Drug Safety in 2004, focused on the toxicity, interactions, and
quality of herbal products. Toxicity data indicate that some herbal drugs "have the potential to
cause serious adverse events and fatalities." They "affect pharmacokinetic and
pharmacodynamic factors and thus cause herb-drug interactions." Contamination, adulteration,
or substitution of botanical material has repeatedly put patients in danger, and that most often
implicated are herbal drugs from Asia.48

Although it is widely perceived that "natural" products are safe, the evidence suggests
that its use is not without risk. Of 90 patients with rheumatoid arthritis, 82% had tried more than
one form of alternative medicine or therapy, including dietary modification, and 31% of these
patients had experienced at least one adverse effect. Of 1701 consecutive patients admitted to
46
Tilahun T., Mirutse G. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern
Ethiopia. (March 2007).Journal of Ethnobiology and Ethnomedicine 2007, 3:12 doi:10.1186/1746-4269-3-12

47
Tilahun T., Mirutse G. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern
Ethiopia. (March 2007).Journal of Ethnobiology and Ethnomedicine 2007, 3:12 doi:10.1186/1746-4269-3-12

48
Flor Lacanilao, PhD, Research on medicinal plants, http://www.bahaykuboresearch.net/index.php?
module=article&view=47

22
the Prince of Wales Hospital, Hong Kong, three (0.2%) had had adverse effects attributed to
traditional Chinese medicines and 75 (4.4%) to "Western" medications. A review of 5563
enquiries received by the National Poisons Unit, London, showed that 77.7% involved vitamin
preparations and 19.3%, herbal extracts, royal jelly, hormonal products and other natural
products. Exposure was linked to adverse effects in 49 (0.9%) of these cases. Adverse effects
of herbal medications may be intrinsic or extrinsic. The patient's age, genetic constitution,
nutritional state, concomitant diseases and concurrent medication may affect the risk and
severity of adverse events, as can consumption of large amounts or a wide variety of herbal
preparations, or long-term use.

Intrinsic effects are those of the herb itself and are characterised, as for
pharmaceuticals, as type A (predictable, dose-dependent) and type B (unpredictable,
idiosyncratic) reactions. Yohimbine, an alkaloid found in Pausinystalia yohimbe bark that has 2

-adrenoceptor antagonist activity, is taken for male impotence, and can cause hypertension and
anxiety in a predictable, dose-related manner (type A reaction); it has also been associated with
the serious idiosyncratic reactions of bronchospasm and increased mucus production when
taken in normal doses by a patient with severe allergic dermatitis (type B). Type A reactions with
herbal preparations also include effects with deliberate overdose or accidental poisoning and
interactions with pharmaceuticals.

Extrinsic effects refer to problems related to commercial manufacture or

extemporaneous compounding. Potential failures to adhere to a code of Good Manufacturing
Practice, while not specific to herbal medicine, can occur, particularly in developing countries
where such a code is not in place. This makes it more difficult for medical practitioners and other
health professionals to assess the adverse effects of herbal preparations compared with
pharmaceuticals.

Misidentification: It is essential that plants are referred to by their binomial Latin names for
genus and species; misidentification can occur when other names are used. For example, the
scientific name of the Chinese herb that is variously transliterated as "dong quai", "dong guai",
"danggui" and "tang kuei" is Angelica polymorpha (formerly sinensis). The common English
name "angelica" and the latinised name "Radix Angelica" could refer either to this species,
which is used in Australia, or to the European species Angelica archangelica, depending on the
country of origin.

23
Misidentification can result in erroneous associations being made, with potential clinical
implications. Plant material can be misidentified at the time of the manufacturer's bulk purchase
or when wild plants are picked.

Lack of standardization: The therapeutic/toxic components of plants vary depending on the

part of the plant used, stage of ripeness, geographic area where the plant is grown, and storage
conditions. Therefore, batch-to-batch reproducibility of plant material should be assessed in the
production of marketed products, but, in practice, product variation in herbal medicines can be
significant. The content of ginsenoside, the glycosylated steroid to which most of the biological
activity of ginseng (Panax ginseng) has been ascribed, was examined in 50 commercial brands
of ginseng sold in 11 countries. In 44 of these products, the concentration of ginsenoside ranged
from 1.9% to 9% w/w; six products contained no ginsenoside, and one of these six contained
large amounts of ephedrine (for which a Swedish athlete was accused of doping).

Contamination: During growth and storage, crude plant material can become contaminated by
pesticide residues, microorganisms, aflatoxins, radioactive substances and heavy metals; lead,
cadmium, mercury, arsenic and thallium have been reported as contaminants of some overseas
herbal preparations. In a case series of five patients in the United Kingdom with lead poisoning
from Asian traditional remedies, the preparations implicated contained 6%-60% w/w lead by
weight. The Australian Code of Good Manufacturing Practice specifies detection of
microorganisms and leaves estimation of other contaminants (not specified in internationally
recognised pharmacopoeial standards) to the discretion of manufacturers.

Substitution: A report of nine cases of rapidly progressive interstitial nephritis in young women
taking a Belgian slimming treatment led to the discovery that Aristolochia fangchi, containing the
nephrotoxic component aristolochic acid, had been introduced in place of Stephania tetrandra.
Eighty cases have now been identified and more than half of these patients developed terminal
renal failure.

Adulteration: The intentional use of pharmaceutical adulterants has been reported. Cases of
acute interstitial nephritis, reversible renal failure, loss of blood pressure control and peptic
ulceration have been reported with a product called "Tung Shueh" pills, taken for arthritic
complaints. The product contained mefenamic acid and diazepam, neither of which was
included on the label. Adulterants can also be added by unethical herbalists compounding
preparations for individual patients. In a recent Victorian court case, a Chinese herbalist was

24
prosecuted for adding a steroid cream to a herbal preparation, which produced severe facial
erythema in a patient.

Incorrect preparation/dosage: The processing of crude plant material carried out by a

manufacturer, CAM practitioner or the patient is a major determinant of the pharmacological
activity of the finished product. A Western Australian patient had a heart attack when he failed to
follow a herbalist's instructions to boil aconite (a restricted plant in Australia) in three pints of
water for one hour and take the decanted liquid; the patient increased the dose and shortened
the boiling time. Boiling changes the alkaloid composition, rapidly reducing the plant's toxicity,
and can substantially reduce microorganism contamination.

Another point to consider is that the activity of crude plant material may differ from that of the
purified constituents, as some constituents may modify the toxicity of others.

Inappropriate labelling/advertising: In early 1996, a direct-mailing campaign to individuals

who had purchased exercise bicycles included information on seaweed (Fucus vesiculosus)
patches for weight loss. Seaweed, or kelp, contains iodine, and it was claimed that the patches
would reverse hypothyroidism by releasing iodine into the body, speeding up the body's
metabolism, resulting in weight loss. This claim was unproven. Hyperthyroidism has been
reported in people who take kelp products orally, and if iodine were to be absorbed
transdermally it could lead to hyperthyroidism in susceptible individuals. The TGA became
aware of the product promptly and secured promise that no further supplies would be imported,
but keeping abreast of potentially unsafe products is a mammoth task. 49

CHAPTER III

49
Anna K Drew and Stephen P Myers, Safety issues in herbal medicine: implications for the health professions, The
Medical Journal of Australia, http://www.mja.com.au/public/issues/may19/drew/drew.html, 1997

25
 METHODOLOGY

This is a cross sectional study that documents the different plants prescribed by Folk
Herbalists in Pulilan, Bulcan and its relationships to ten medicinal plants endorsed by the
Department of Health.

The information in this research will be gathered through personal interviews of the
traditional medical practitioners, particularly folk herbalists, in Pulilan, Bulacan. Prior to the
interview, a standard questionnaire [see Appendix B] will be formulated by the researchers
regarding the beliefs and practices of these folk herbalists.

Comparison between the data collected and the 10 Medicinal Plants endorsed by the
DOH will be done. This would validate that the medicinal plants utilized by the folk herbalists
correspond to the approved indication.

Description of the Respondents

The folk herbalists residing in Pulilan, Bulacan will be the respondents for this study for
they are the ones most knowledgeable of medicinal plants. They are members of the society
who prescribe these plants for certain indications. They are the ones who can provide most
reliable data which this study would need.

Description of the Study Area

Pulilan is a small town in Bulacan composed of nineteen (19) barangays. Although

considered as industrially-competitive, Pulilan has no public hospital of its own. People tend to
consult the nearest medical clinic, private tertiary hospital or popular folk herbalists. Many
Pulilenios believe on the cost effectiveness of herbal medicine because of its availability and
efficiency for their ailments. The rich soil in Bulacan contributed not only to the livelihood of the
community but also to the growth of certain plants that can be useful in the relief of their
undesirable condition. The use of herbal medicine was strengthened by the recommendations
of some relatives and most importantly, by some folk herbalists.

Some seek folk herbalists due to financial factors and the unavailability of a public
hospital that would respond to their need for health assistance. Barangay Health Center are

26
available however, they have very limited supply of drugs and worse, the less fortunate people
could not afford even the half-priced generic drugs available in the Botika ng Barangay resulting
to poor compliance. These people would depend on the folk herbalists who give health service
in kind.

Pulilan, Bulacan is forty-seven(47) kilometers away from Manila and will take only a 30
to 45 minute-drive which makes it very accessible for the group to perform the study. Also, the
proximity and the small land area of Pulilan allow the researchers to abide by the scope and
time frame of the study through easy monitoring and follow-up. Moreover, the participation of
reliable health workers and officials in the community and the nearby place to stay during the
course of the study will assure the safety and security of the group.

Demographic Data

Pulilan is one of the 24 towns of Bulacan province, located in about its center—from
north to South—with an area of about 3,000 hectares. It is bounded on the North by Apalit in
Pampanga; on the East by Baliuag; on the South by Plaridel; and on the West by Calumpit. The
Angat River cutting its way through the Eastern edge of Baliuag, and the Southern fringes of
Pulilan down to the tributary of Manila Bay Southwest of Calumpit, serves as the boundary with
Plaridel. Its feature is flat and the soil is suited to farming.

The first time Pulilan was settled was unknown but if existing records of the towns of
Calumpit and Baliuag, between which the town lies, be made a basis, it could be deduced that
in the early part of the 17th century it could have had a sprinkling of settlers. (Calumpit was
declared s town in 1575, and Baliuag recently celebrated her 300th anniversary). It is presumed
that the settlers spread themselves in far-apart groups along the riverbanks for two reasons:
first, water facility secondly, the profound attraction of water to them. The word "Tagalog" in a
contraction of "taga-ilog" a name ascribed to this ethnic group of Malays who had the reputation
for cleanliness through their profuse use of water. (Bulacan.com.ph)

DATA COLLECTION

Data will be gathered by administering a face to face interview guided by a structured

interview schedule. All interviews will be recorded using an audio recording device. This is to
facilitate follow-up in case on the spot transcriptions become inappropriate.

27
 It is important to note that there is no official listing of folk herbalists in the municipality
of Pulilan, Bulacan. With this, in order to identify and locate the respondents, referrals will be the
main means.

Referrals and Endorsements

The Health Center is the establishment that provides healthcare to residents, it is

composed of doctors, dentists, nurses, midwives, medical technologists, laboratory aides and
barangay health workers. Barangay health worker (BHW) refers to a person who has undergone
training programs under any accredited government and non-government organization and who
voluntarily renders primarily health care services in the community after having been accredited
to function as such by the local health board in accordance with the guidelines promulgated by
the Department of Health (DOH). They are the ones responsible for monitoring the health
situation at the level of barangay. This makes BHWs, barangay health officials and municipal
health officials to be most knowledgeable of available alternative healthcare within a barangay
and municipality. And so, their referrals and endorsements they will be the main tool to identify
the folk herbalist in the community.

In order to validate these referrals and endorsements the triangulation method will be
imposed.

Triangulation

Triangulation will be used as a cross-checking tool to assess the credibility of the

respondents. Three criteria will be used to comply with the requirements of triangulation:

i. Endorsement from the Barangay Health Care Office;

A referral of the traditional medical practitioners, particularly the folk
herbalists, was obtained from the Barangay Health Care Office. The researchers will
be guided by the Health Care Officer (HCO) and a number of BHWs to verify that the
people to be interviewed are authentic traditional medical practitioners. Aside from
verbal endorsement, the HCO and BHWs will also be asked to quantitatively grade
the recommended folk herbalist using a rubric sheet [see Appendix B], which will be
facilitated by the researchers.

28
 ii. Confirmation by the folk herbalists that they practice the use of medicinal
plants;
The use of a rubric sheet will also allow the folk herbalists to self-assess.
This will be done in the same manner as to how the HCO and BHWs will accomplish
the rubric sheet.

iii. An interview will be conducted by the researchers.

The group of researchers will be divided into 5 subgroups. Each subgroup will be
assigned to interview two to three (2-3) folk herbalist. Using a standard
questionnaire, the folk herbalists will be asked regarding the different medicinal
plants used in their practice. This would include the following: a) indications, b) part
of the plant used, c) preparation and d) route of administration. A separate rubric
sheet will be answered by the researchers, the grade of which will be based from the
consistency of the folk herbalist’s answers.

The score of each folk herbalist will be equal to the average of the three corresponding rubric
sheets; that from the HCO, the folk herbalist and the researcher. A score of < 75 would indicate
unreliability, whereas a score of > 75 indicates reliability and gives credibility to the folk herbalist.

DATA COLLECTION TOOL

The group developed a standardized interview schedule with Filipino translations. This is
to facilitate the interview to be done among folk herbalists. Its format and structure was
patterned from a questionnaire from an ethnomedicinal research by Dr. Vendivil. The questions
were edited according to the level of understanding of the target population and according to the
particular information needed for the study.

Generally, the tool is composed of four parts namely namely letter of consent, part A,
part B and part C. The letter of consent is geared towards informing the respondent of the
interview that will be done. With this, the respondent will be asked to sign a consent form stating
that he/she is voluntarily cooperating. Part A includes respondent information, interview
information, referral details and preliminary questions to filter the eligibility of the respondent.
The respondent information includes details such as age, sex, address, occupation, contact
number. These details will be used merely as reference in case follow-up will be made. In data
analysis, respondents will be regarded as respondent numbers not by their names, in order to
facilitate confidentiality. Part B involves a table comprising of cells for the following information:

29
Plant, part used, preparation, dosage, source and notes. This part will be arranged according to
indication. Part C is basically the same as part , but this will be specific for the Sampung
Halamang Gamot endorsed by the DOH.

Validation and approval of the tool will be sought from certified statisticians. Also the
interview schedule will be pre-tested among 3 folk herbalists in manila. This is to foresee
probable difficulties which may be encountered during actual data collection. The tool will be
adjusted accordingly to the foreseen difficulties from the pre-test and recommendations from
authorities.

Appropriate orientation, training and familiarization will be done among all data
collectors. This is to standardize the approach in an interview and thus minimize bias.

PLANT IDENTIFICATION

After administering an interview, plant samples of all the mentioned specimen will be
collected. Proper protocol for plant handling and collection will be implemented. Also to facilitate
identification and documentation, digital photographs will be used as tool as well.

DATA ANALYSIS

The information on the plants and their uses will be utilized to establish pharmacological
knowledge in Pulila, Bulacan. Quantitative analysis of the data collected will be used to obtain
the following: most cited plants species, plants to which most uses were attributed, different
uses, parts of plants used, method of preparation, details of administration and dosage.

The indications for the use of the plants will be categorized into 10-20 groups based on
the data that will be collected. From this, the Informant Consensus Factor (ICF) will be
calculated for each cateorgy of ailments. This will be used to identify agreements of the
informants on the reported cures for the groups ailments50,51,3,4. The formula for ICF is as follows:
50
Teklehaymanot, T. & Giday, M. Ethnobotanical study of medicinal plants used by people in Zegie
Peninsula, Northwestern Ethiopia. Journal of Ethnobiology and Ethnomedicine 2007,3:12.
51
Akerreta, S., Cavero, R.Y., Calvo, M.I.. First comprehensive contribution to medical ethnobotany of
Western Pyrenees. Journal of Ethnobiology and Ethnomedicine 2007,3:26.
3
Gazzaneo, L.R.S., de Lucena, R.F.P., De Albuquerque, U.P. Knowledge and use of medicinal plants
by local specialists in a region of Atlantic Forest in the state of Pernambuco (Northeastern Brazil.)
Journal of Ethnobiology and Ethnomedicine 200,1:9.

30
 ICF = (nur – nt) / (nur – 1)

where nur = number of use citations in each category

nt = number of species used

The fidelity level (FL) will also be determined as a tool for quantitative analysis. It is the
percentage of informants claiming the use of a certain plant for the same major purpose 1. The
formula for FL is as follows:

FL(%) = (Np / N) x 100

where Np = number of informants that claim a use of a plant species to

treat a particular disease

N = number of informants that use the plants as a medicine to

treat any given disease

In addition, a qualitative comparison will be done to determine the differences or

similarities in the indication of plants being used by folk herbalists with those included in the “10
Halamang Gamot” endorsed by the Department of Health.

4
Kisangau, D.P. Lyaruu, H.V.M. Hosea, K.M., Joseph, C.C. Use of traditional medicines in the
management of HIV/AIDS opportunistic infections in Tanzania: a case in the Bukoba rural district.
Journal of Ethnobiology and Ethnomedicine 2007,3:29.

31