Pharmacological aspect Pharmacological aspect ofof

Medicinal Medicinal PlantPlant

Santun Bhekti RahimahSantun Bhekti Rahimah

Herri S. SastramihardjaHerri S. Sastramihardja

Depart. of Pharmacology & TherapyDepart. of Pharmacology & Therapy

Medical School- Medical School-

Bandung Islamic UniversityBandung Islamic University

BackgroundBackground Plants had been used for medicinal Plants had been used for medicinal

purposes by all culture throughout historypurposes by all culture throughout history

People in different part of the globe People in different part of the globe tended to use similar plants for the same tended to use similar plants for the same purposespurposes

The herbal products today symbolise The herbal products today symbolise safety in contrast to the synthetics that arsafety in contrast to the synthetics that ar regarded as unsafe to human and regarded as unsafe to human and environment. environment.

BackgroundBackground Over three-quarters of the world population relies Over three-quarters of the world population relies

mainly on plants and plant extractsmainly on plants and plant extracts for health care. for health care. plant drugsplant drugs constitute as much as constitute as much as 8080% of the total % of the total

drugsdrugs in in fast developing countries such as Chinafast developing countries such as China and Indiaand India..

Of the 2,50,000 higher plant species on earth, Of the 2,50,000 higher plant species on earth, more than 80,000 are medicinal. more than 80,000 are medicinal.

Many drugs commonly used to day are or herbal Many drugs commonly used to day are or herbal origin, for examples origin, for examples aspirinaspirin (from willow bark), (from willow bark), digokxindigokxin ( from ( from digitalisdigitalis), ), quininequinine (from cinchonar (from cinchonar bark) & bark) & morphinmorphin (from opium poppy (from opium poppy))

How do herbs How do herbs work ?work ? For For most herbsmost herbs, the specific , the specific

ingredient that cause a therapeutic ingredient that cause a therapeutic effect is not knowneffect is not known

Whole herbsWhole herbs contain many contain many ingredients (alkaloids, terpenoid, ingredients (alkaloids, terpenoid, saponin, flavonoids, phenols, volatile saponin, flavonoids, phenols, volatile oils, etc) that oils, etc) that work togetherwork together to to produce the desired medicinal effectproduce the desired medicinal effect

Many things must take into Many things must take into account when prescribing account when prescribing herbs, i.e :herbs, i.e :

Variety of plantVariety of plant The plant’s habitatThe plant’s habitat How it was stored & processedHow it was stored & processed Whether or not there are Whether or not there are

contaminantscontaminants

Modern Modern pharmacologypharmacology

HerbalismHerbalism

• IsolatedIsolated

• One active ingredientsOne active ingredients

• One effect that One effect that measurable & measurable & repeatablerepeatable

• HolisticHolistic

• Whole plantsWhole plants

• Synergistic effect Synergistic effect of its componentsof its components

Table 1. Comparism of modern phamacology and herbalism

Pharmacology Pharmacology characteristics of medicinal characteristics of medicinal plantsplants Have a broad Have a broad therapeutics rangetherapeutics range

Onset of actionOnset of action occurred occurred after a after a latent periodlatent period (weeks or months) (weeks or months)

The action have usually been The action have usually been observed observed empiricallyempirically in human in human patient treated with the herbspatient treated with the herbs

Pharmacology characteristicPharmacology characteristic (continued…)(continued…)

Accurate Accurate pharmacokinetic datapharmacokinetic data for for extracts that have a complex composition extracts that have a complex composition is is difficult to obtaindifficult to obtain

Subjective assessmentsSubjective assessments by the patients by the patients or physician used to evaluate or physician used to evaluate efficacyefficacy

Do not indicateDo not indicate to use in emergency or to use in emergency or acute situationsacute situations

Demand & advantages of Demand & advantages of herbal remediesherbal remedies DemandDemand is rooted partly in the is rooted partly in the

emotional perceptionemotional perception that natural that natural products are gentler & less products are gentler & less hazardous than chemical productshazardous than chemical products

Greater trustGreater trust on the part of the on the part of the patients that herbal remedies are patients that herbal remedies are safe & tolerablesafe & tolerable

Table Table 22. P. Phytomedicines that have hytomedicines that have undergone undergone pharmacology testing pharmacology testing

Herb extractHerb extract PharmacologicPharmacological actional action

usesuses

• Ginkgo biloba Ginkgo biloba

Leaf extractsLeaf extracts

• Anti ischemic Anti ischemic • Anti Anti hemorrheologichemorrheologic• anti PAFanti PAF

• Cerebral Cerebral

insufficiencyinsufficiency• Peripheral Peripheral vascular vascular

disensedisense• Garlic clovesGarlic cloves

(Allum satium)(Allum satium)

• hypolipidemichypolipidemic• AntithromboticAntithrombotic• fibrinolyticfibrinolytic• HypotensiveHypotensive

• DyslipidemiaDyslipidemia• CV-disordersCV-disorders

• Hawthorn extractHawthorn extract

(Cratageus (Cratageus monogyna)monogyna)

• positive inotropic positive inotropic • anti arrythmicanti arrythmic• coronary coronary vasodilatationvasodilatation

• mild heart failure mild heart failure

(St. II – (St. II – NYHANYHA))

Table Table 3. The3. The nine priority of nine priority of Indonesian Indonesian medicinal plant medicinal plant ( = ( =IMP IMP ))Herb extractHerb extract PharmacologiPharmacologi

cal actioncal actionusesuses

• Curcuma Curcuma xanthorizaexanthorizae

(= temu lawak)(= temu lawak)

• hypolipidemichypolipidemic• antiinflammatoryantiinflammatory• antioxidantantioxidant• apetite stimulantapetite stimulant• galactogogue galactogogue

• dyslipidemiadyslipidemia • GI disorderGI disorder• hepatic disorderhepatic disorder• anorexiaanorexia• flow of milkflow of milk• PPPP uterine uterine resolutionresolution

• Curcuma domestica Curcuma domestica

( = kunyit)( = kunyit)

• hypolipidemichypolipidemic• antiinflammatory antiinflammatory • antispasmodicantispasmodic• stomachicstomachic• carminativecarminative• thrombolyticthrombolytic

• dyslipidemiadyslipidemia • rheumatic rheumatic diseasedisease• diare / dyspepsiediare / dyspepsie• hepatic disorderhepatic disorder• gingivitisgingivitis

Table Table 4.4. The nine priority ofThe nine priority of IMPIMP (cont(continued..)inued..)

Herb extractHerb extract PharmacologiPharmacological actioncal action

usesuses

• Andrographis Andrographis paniculata paniculata

(=sambiloto)(=sambiloto)

• antipyreticantipyretic• AntiinflammatoryAntiinflammatory• ImmunostimulantImmunostimulant• AntispasmodicAntispasmodic• AntisecretoryAntisecretory• mucosal protectivlemucosal protectivle• antithromboticantithrombotic• HypoglycemicHypoglycemic• antibcterialantibcterial

• Rheumatic diseaseRheumatic disease• common coldcommon cold• chronic leukemiachronic leukemia• Peptic ulcerPeptic ulcer• atheroselerotic atheroselerotic

diseasedisease• DMDM• otitisotitis

• Guazuma ulmifoliaGuazuma ulmifolia

(= jati belanda)(= jati belanda)

• astringentastringent• DiaphroreticDiaphroretic• Lipase Lipase stimulationstimulation• hypolipidemichypolipidemic

• dyslipidemiadyslipidemia• diarhe / dyspepsiediarhe / dyspepsie• LeucorrhoeLeucorrhoe

Table 5. The nine priorityTable 5. The nine priority ofof IMPIMP (continued..)(continued..)

Herb extractHerb extract PharmacologiPharmacological actioncal action

usesuses

• Zingiber officinale Zingiber officinale

(= jahe merah)(= jahe merah)

• antiemeticantiemetic• carminativecarminative• antispasmodicantispasmodic• antiinflammatoryantiinflammatory• alkylatingalkylating

• motion sicknessmotion sickness• emesisemesis• intestinal colicintestinal colic• diarrhe / dyspepsiediarrhe / dyspepsie• chronic leukemiachronic leukemia

• Morinda citrifolia Morinda citrifolia

( = mengkudu )( = mengkudu )

• antioxidantantioxidant• hyportensivehyportensive• hypoglikemichypoglikemic

• hepatic disorderhepatic disorder• hypertensionhypertension• DMDM

• Piper retropraktum Piper retropraktum

( = cabe jawa)( = cabe jawa)

• antispasmodicantispasmodic• carminativecarminative• antiinflamatoryantiinflamatory• apphrodisiacapphrodisiac• counter irritantcounter irritant

• dyspepsiedyspepsie• PVDPVD• neuralgicneuralgic• rheumatic pain rheumatic pain (local)(local)• aroma therapyaroma therapy• sexsual dysfunctionsexsual dysfunction

Table 6.The nine priority ofTable 6.The nine priority of IMP IMP

(continued..)(continued..)

Herb Herb extractextract

PharmacologiPharmacological actioncal action

usesuses

• Eugenia Eugenia polyanthapolyantha

( = daun ( = daun salam)salam)

• astringentastringent• carminativecarminative• hypoglycemichypoglycemic• hypotensivehypotensive

• diarrhe / dyspepsiediarrhe / dyspepsie• gastritisgastritis• DMDM• Hypertension Hypertension

• Psidium Psidium guajavaguajava

(daun jambu biji)(daun jambu biji)

• imunomodulationimunomodulation• antiviralantiviral• thrrombosiythrrombosiy

• DHFDHF

Table 7.Table 7. P Potential interaction between otential interaction between herbal herbal and conventional drugs and conventional drugs

HerbHerb Conventional Conventional drugsdrugs

problemproblem

• echinacea > 8 echinacea > 8 weekweek

• anabolic steroids, anabolic steroids, methotrexate, methotrexate, amiodarone, amiodarone, ketoconazoleketoconazole• immunosuppresantsimmunosuppresants

• hepatotoxicityhepatotoxicity

• antagonist effectantagonist effect

• garlic, ginger, garlic, ginger, ginkgo ginkgo

• warfarinwarfarin • altered bleeding altered bleeding

timetime• ginsengginseng • warfarinwarfarin

• estrogens, estrogens, corticosteroidscorticosteroids

• altered bleeding altered bleeding

timetime• additive effectsadditive effects

• valerianvalerian • barbituratesbarbiturates • additive effects additive effects (exessive sedation)(exessive sedation)

SOP SOP in Formal health servicesin Formal health servicesHISTORYHISTORY

TREATMENTTREATMENT

EXAMINATIONEXAMINATION

with with drugsdrugs

without without drugsdrugs

Standard diagnosticStandard diagnostic Standard treatmentStandard treatment

EBM ?EBM ?

DIAGNOSEDIAGNOSE

I.I. From a systematic From a systematic review of all relevant RCTreview of all relevant RCT

II.II. From at least From at least one properly designed RCTone properly designed RCT

III.III. 1. From 1. From well-designed pseudo-RCTwell-designed pseudo-RCT (Alternate allocation or some other method)(Alternate allocation or some other method)

2. From 2. From comparative studies with concurent controlscomparative studies with concurent controls & &

nonrandomized allocation (cohort studies), case-nonrandomized allocation (cohort studies), case-control control

studies or interrupted time series with a control studies or interrupted time series with a control group.group.

3. From 3. From comparative studies with historical controlcomparative studies with historical control or or interupted time series without a pararel control interupted time series without a pararel control

group.group.

IV. From case seriesIV. From case series

Levels of Evidence-RatingsLevels of Evidence-Ratings

Herbal drug Herbal drug DevelopmentDevelopment

Medical plants play a vital role for the Medical plants play a vital role for the development of new drugsdevelopment of new drugs

The important aspect are:The important aspect are: justify the correct part of the plantjustify the correct part of the plant active active

chemical contituent essential for the chemical contituent essential for the pharmacology activitypharmacology activity

Preliminary phytochemical screeningPreliminary phytochemical screening The selection of solventThe selection of solvent Extraction processExtraction process Other methodologyOther methodology

The use of medical The use of medical plantsplants

Faced with many constraint:Faced with many constraint: Not fully identified, inventoried and Not fully identified, inventoried and

characterizedcharacterized Information and knowledge not being Information and knowledge not being

adequatelyadequately Alarming commercial , over exploitasiAlarming commercial , over exploitasi Consequent genetic erosion of medical Consequent genetic erosion of medical

plantsplantsMedical plant conversation, utilization and documentation

Conclusion Conclusion

The results from appropriate The results from appropriate pharmacological testing and pharmacological testing and clinical study base on clinical study base on GCPGCP is the is the good good EBM to established EBM to established the the medicinal plant usage in formal medicinal plant usage in formal health serviceshealth services

RefferenceRefference Joy PP, Thomas J., Mathew S., skaria BP, Medicinal Joy PP, Thomas J., Mathew S., skaria BP, Medicinal

Plants, Kerala Agricultural university, Plants, Kerala Agricultural university, Aromatic and Aromatic and Medicinal Plants Research StationMedicinal Plants Research Station, 1998., 1998.

Verma S., Singh SP, Current and Future status of Verma S., Singh SP, Current and Future status of Herbal medicine, vet.world vol.1 No II, 2008.Herbal medicine, vet.world vol.1 No II, 2008.

Tamya A., herbal Drug Developmant and Tamya A., herbal Drug Developmant and Pharmacological potensial of Some Herbs, Pharmacological potensial of Some Herbs, http://www.pharmatutor.org/, diunduh tagl 1 , diunduh tagl 1 November 2011.November 2011.

Batugal PA., Kanmid J, et all. Medicinal Plants Batugal PA., Kanmid J, et all. Medicinal Plants Research in Asia Vol. I: The Framework and Research in Asia Vol. I: The Framework and Projeck Workplans.Projeck Workplans.

Thank you

CURRICULUM VITAECURRICULUM VITAE NamaNama : : Santun Bhekti Rahimah, Santun Bhekti Rahimah,

dr.M.Kesdr.M.Kes TTL TTL : : BandungBandung,,23 Juni23 Juni 19 197676 AgamaAgama : Islam: Islam PangkatPangkat : : Assisten AhliAssisten Ahli / / IIIaIIIa Jabatan Jabatan : : Staff Staff Bag. Farmakologi Bag. Farmakologi

FK FK UNISBA UNISBA

CURRICULUM VITAE

Nama : Prof. DR.dr.Herri S. Sastramihardja, SpFK.TTL : Cianjur,8 April 1944Agama : IslamPangkat : Guru Besar / IV-eJabatan : Kepala Bag. Farmakologi FK UNPAD /

Farmakologi Klinik RSHS Dekan FK UNISBA

Dokter (1971). Dokter (1971). Kursus Farmakologi Klinik Nasional (1979). Kursus Farmakologi Klinik Nasional (1979). AKTA V (1984). AKTA V (1984). Internasional Course on Drugs Internasional Course on Drugs

Epidemiology (1988). Epidemiology (1988). Traning Monitoring Efek Samping Obat Traning Monitoring Efek Samping Obat

(1992). (1992). Spesialis Farmakologi Klinik (1994).Spesialis Farmakologi Klinik (1994). Doktor (1995). Doktor (1995). National Workshop on Teaching of Rational National Workshop on Teaching of Rational

Drug Use (1996).Drug Use (1996).

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