Complementary & Alternative Medicine

1. Chapter - 1 Introduction to Complementary and Alternative Medicine By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 1

2. Introduction • Worldwide, healing traditions adapted and defined by their cultures, beliefs and environment, w/c satisfied their health communities over centuries. • This healing tradition is deep-rooted in a specific socio-cultural context and reflects different philosophical cultural origin. people developed unique care needs of backgrounds and By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 2

3. • TM varies from country to country. • Each country approach to health and diseases. • Thus, there are many TMP as there are many communities. • TM implies the ancient and cultural bound medical practices w/c existed before the application of science to health matters. has its own particular By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 3

4. • How the primitive people do developed traditional healing practices? – Trial and error – Doctrine of signature – Divine power – Serendipity • The WHO launched its first ever comprehensive TM strategy in 2002. – According to the WHO, TM has a central role to play in the 21stcentury. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 4

5. • The strategy is designed to assist countries to: − Develop national policies on the evaluation and regulation of TM/CAM practices − Create a stronger evidence based on the safety, efficacy and quality of the TM/CAM products and practices − Ensure the availability and affordability of TM/CAM including essential herbal medicines − Promote therapeutically sound of use of TM/CAM by providers and consumers − Document traditional medicine and remedies By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 5

6. Definition of Terms – CAM - it is any healing practice that doesn't fall with in the scope of conventional medicine. – CAM- is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 6

7. – Conventional Medicine - modern medicine as practiced by medical doctors, nurses, pharmacists… – Are complementary medicine different from each other? –Yes, they are different! and alternative By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 7

8. • Complementary Medicine - practiced along with conventional medicine – Include supportive treat symptoms and enhance well-being. – Aromatherapy in w/c the scent of essential oils from flowers, herbs & trees is inhaled to promote health and well- being to help discomfort following surgery. – Acupuncture approaches that lessen a patient’s By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 8

9. • Alternative Medicine - Use of CAM in place of conventional medicine. – E.g. using special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by conventional doctor. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 9

10. Traditional Medicine – WHO approaches, incorporating plants, animals and mineral based medicines, spiritual therapies, manual technique and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses and maintain well being. defines TM as health practices, beliefs knowledge and By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 10

11. Traditional healer/indigenous healer/ traditional medical practitioner (TMP) – A person who is recognized by the community in which he/she lives as competent to provide health care service using natural substances animal, mineral) methods. (vegetable, certain and other By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 11

12. – These methods are based on social, cultural, and religious backgrounds as well as on the knowledge, attitudes, and beliefs that are prevalent in the community regarding physical, mental, and social well-being and the causes of disease and disability. – TMPs include; o Herbalist - uses herbs to treat diseases o Bone setter - manipulate bones and fractures o Spiritual healer - heals using supernatural powers o Traditional birth attendants o Surgeons By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 12

13. Herbalist: – This term describes a traditional healer whose specialization lies in the use of herbs to treat various ailments. – He is expected to be highly knowledgeable in the efficacy, toxicity, dosage, & compounding of herbs. Herbs: – Crude plant material such as leaves, flowers, fruit, seed, stems, wood, bark, roots, rhizomes or other plant parts, which may be entire, fragmented or powdered. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 13

14. Bone setter: – A bone setter is a specialist in one aspect of traditional healing, being skilled in the ability to treat fractures. – He/she do healing practice by tying pieces of wood or straight stems (as splits) with a fibrous plant (as rope) around the bone and applying traditional medicaments to the broken point as appropriate. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 14

15. Faith healing/medical belief/spiritual healing: – A form of TM w/c involves the use of religious folk objects or items and prayers to cure illness. Folk medicine: – The knowledge or mode of treatment or traditional beliefs w/c is common to a group of rural people. – A simple form of TM used by any particular group of people. E.g. A special type of palm oil rubbed on the hand to ward off an evil spirit. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 15

16. Ethnomedicine: – The study of TM among different ethnic groups. Ritual rites: – Forms of procedures necessary to appease the gods in a particular form of treatment or situation. E.g. sacrificing a goat or performing certain dances and eating only certain foods or parts of foods. and/or sacrifice By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 16

17. – In some African countries, ritual dances are very common and feature as part of the treatment of mentally disturbed patients. – Sacrifices are placed at various points around the village supposedly. • To keep the evil spirits from entering the village or • To drive them a way and • Prevent them from returning – Ritual rites can therefore be for preventive or curative purposes. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 17

18. Incantation: – A form of play in words (smiles) written or delivered orally in poetic form to conjure up forces (efficacies) in to a medicine. Divination: – The practice of attempting to acquire hidden knowledge and insight into events- past, present and future-through the direct or indirect contact of human intelligence with supernatural. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 18

19. Charm: – Any formula, act or object supposed to have magical power to ward off danger or to bring good luck. Amulet: – Any object worn as a charm. Doctrine of signature: – The principle that the plant or animal part bear some physical resemblances to the condition to be treated. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 19

20. Native Medicine: – Is a derogatory version of what should be termed traditional medicine. – The ‘native’ meaning anything not foreign. – The ‘natives’ a local use for a medicinal plant. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 20

21. Juju: – Juju is a terms applied to that kind of traditional medicine supernatural or magical implication. – Refer to any form of medicine that casts an evil spell on someone or is used to prevent an evil spell. E.g if someone arrives at work to find spider tied with black cloth & stained with blood on his chair, he exclaim: ‘someone has put juju on my seat’. w/c includes some By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 21

22. Medicinal Plant: – Is any plant w/c, in one or more of its organs, contains substances that can be used for therapeutic purposes or w/c are precursors for the synthesis of useful drugs. – A definition of medicinal plants should include the following. a) Plants or plant parts used medicinally in galenical preparations infusions, etc). (eg. Decortion, By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 22

23. b. Plants used for extraction of pure substances either for direct medicinal use or for the semi-synthesis of medicinal cpds (e.g. Semi-synthesis of sex hormones from diosgenin). c. Food, spice, and perfumery plants used medicinally. d. Microscopic plants, e.g. Fungi, actinomycetes, used for isolation for drugs especially antibiotics. e. Fibre plants, e.g. Cotton, flax, jute, use for the preparation of surgical dressings. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 23

24. Vegetable Drug – The term ‘vegetable drug’ be applied to part of a medicinal plant (leaf, bark, etc) used for therapeutic purposes. – Such material, w/c structure, is referred to in pharmacy as an ‘organized drug’. – While medicinal agents such as gums, balsams, etc w/c have no cellular structure, are called ’unorganized drugs’ or ‘acellular drugs’. possesses a cellular By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 24

25. TM vs MM – Both traditional medicine and modern medicine have the same objective but they differ in; o Their concept of cause of diseases o Their approach to healing & healing methods – The basic concept of modern medicine centers a round the results of experiment and the diseases is regarded as caused by pathophysiological agents. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 25

26. Advantages and Limitations of TM – TM is very important for primary health care delivery and its use is widespread in developing countries; oIn Africa up to 80% of the population use TM By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 26

27. • The advantages of TM include; o Affordability o Accessibility o Acceptability due to its firm embedment within the belief systems of the people o Potential sources of new drugs o More tolerated by the body o Some diseases are better treated using TM By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 27

28. Limitations of TM – Lack of scientific proof of its efficacy – The intangible aspects of TM cannot be verified scientifically – Imprecise diagnosis • Stomach trouble could mean –Indigestion –Ulcer –Cancer By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 28

29. • Lack of precise dose • Many practitioners are not hygienic in their methods • Some traditional medical practices are harmful – Blood letting – Tooth extraction – Incision of the eye lid • Some practitioners fail to recognize their limit of competence • They tend to handle every problem By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 29

30. Limitation of MM – Failure to cure disease such as HIV/AIDS, cancer, hemorrhoids, etc – Failure to identify patient problems – Adverse drug reactions – Development of drug resistance By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 30

31. Historical Review of TM − One of the earliest records of the use of herbal medicine is that of chaulmoogra oil from species of Hydrocarpus Gaertn, w/c was known to be effective in the treatment of leprosy. − Such a use was recorded in the pharmacopoeioa of the Emperor Shen Nug of China b/n 2730 and 3000 B.C. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 31

32. − Similarly, the seeds of the opium poppy (Papaver somniferum) and castor oil seed (Ricinus communis L.) were excavated from some ancient Egyptian tombs, w/c indicated their use in that part of Africa as far back as 1500 BC. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 32

33. Hippocrates (460 B.C.) o Hewas the first Greek to regard medicine as a science and −He is now referred to as the father of medicine oHe was a distinguished physician who travelled regularly into foreign countries practicing & researching into medicine By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 33

34. His Material Medica consisted; oEssentially of herbal recipes, oSome 400 simple remedies having been compiled and deserved by him oSome of the medicinal plants described by him include opium, mint, sage, rosemary and verbena. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 34

35.  Theophrastus (370 B.C.) Greek; oHe was a biologist-botanist and produced a number of manuscripts including the famous Historia plantanium. oW/c became the standard botanical text book in his time and for years after his death. The medical school in Alexandria (the first of its kind in Africa) was founded in 332 B.C. That medical school was eventually destroyed by Christian extremists in A.D 391. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 35

36. The great work of Diosconides (A.D. 60) – “De materia medica” o Was regarded as the standard reference work in Europe during the medieval period (late 5thto late 15thcentury or from down fall of Western Renascence and age of discovery). o Because it contained the description of some 600 medicinal plants. o This Greek writer was served as the physician and surgeon. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) Roman Empire to 36

37. In the middle ages the writing of Galen (A.D.131) became popular oAlthough many of his 500 books and manuscripts were destroyed in a fire, some 80 of these were retrieved. oHe is considered today to be the most distinguished physician of antiquity after Hippocrates. oHe treated disease essentially by the use of herbs. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 37

38. Pliny the elder (A.D. 23) was one of the first Roman naturalists o He wrote some 37 books and devoted two volumes to medical botany but superstition crept into some of his writings at that time (believe supernatural influences for good and bad lack. E.g. Disease is a bad lack and health as a good lack). After the fall of the Roman empire o The progress w/c had been made in western medicine was seriously affected and the use of herbal preparations and remedies soon became obscured in myth and superstition. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 38

39. The continued research into medicine: o By translating the original works of the Greeks into Arabic, o Adding their own observations and bringing new drugs into general use Avicenna (A.D. 980) was a well-known Arab physician who was later given the little of ‘the prince of physicians’. Arabian physicians, however, By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 39

40. The first organized medical school in Europe was that at salerno (Italy). Apparently, it was originally a health resort for the Romans and thrived from A.D. 1090 to 1275, in the time of the crusader. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 40

41. The use of many medicinal plants in Europe was based on the Doctrine of signatures or similar developed by Paracelsus (1490-1541), a Swiss alchemist and physician According to this doctrine healing herbs have features made by God identifying the plant with a specific disease or part of the body By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 41

42. E.g. oPlants with heart-shaped leaves were good for treating heart disease, oThose with liver-shaped prescribed for bilious diseases, and oPlants exuding a believed to increase lactation in women oThe use of eyebright ( Euphrasia officinalis L.) for the treatment of dim sight The corolla of this plant has a dark purple spot resembling an eye part were milky juice were By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 42

43. In the 17th century the herbalist Culpeper believed that all disease and illness were governed by the planets as were the hundreds of herbs he prescribed. After a short apprenticeship he established a medical practice in 1640 and devoted his time to the study of astrology and medicine. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 43

44. The South American countries have provided the world with some useful drugs for when Mexico and Peru were conquered by Spain between 1531 and 1536 the settlers found medicinal plant gardens containing plants such as coca and tobacco. The book chronica del Peru written by Pedro de cieza de Lean and published in Seville in 1553, lists plants such as the potato and coca. By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 44

45. Theories on the origin of herbal medicine – Although it is not known exactly when the first man practiced Herbalism in Africa. – A number of theories have been advanced by scholars and traditional medical practitioners. 1. Deliberate selection of specific plant for treatment of diseases 2. Medicinal plants gained by accident 3. Religious thoughts and magic rituals 4. By observing effects exerted by plants on domestic animals 5. From wizards and witches 6. Hunters 7. By sprit of ancestors who practiced herbalism By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 45

46. TYPES OF CAM 1. Natural Products/Biologically Based Practices – Herbs – Special Diets – Vitamins – Minerals By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 46

47. 2. Mind-Body Medicine • Interaction between Mind, Body & Behavior • Uses a variety of techniques to enhance the mind’s capacity to affect bodily function and symptoms. – Some MBM techniques attention or maintaining a specific posture to suspend the steam of thoughts and relax the body and mind. are focusing By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 47

48. Acupuncture (thin needles are inserted in to the body − Meditation (focusing the mind on a particular object, thought or activity to train attention and awareness, to a achieve a mentally clear and emotionally calm and stable state) − Hypnosis (changed state relaxation that allows for improved focus and concentration) − Guided Imagery (helping the patient to evoke or generate mental images that simulate or recreate the sensory perception of sights, sounds, tastes, smells, etc.,) − Dance Therapy − Music Therapy − Art Therapy − Prayer and Mental Healing By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) of awareness & increased 48

49. 3. Manipulative & Body Based – Focuses on structures & systems of body. – Are based on manipulation and/or movement of one or more parts of the body such as bones, joints… – E.g. Massage therapy Chiropractic medicine exercise, diet, etc.) Osteopathic medicine/manipulation (treating the entire person rather than just the symptoms i.e. help develop attitudes and life styles that doesn’t just fight illness but help prevent it too!) By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) (spinal manipulation, 49

50. 4. Whole Medical Systems – Are built upon complete system of theory and practice. – Evolved overtime in different cultures • E.g. Ayurveda, Traditional Chinese medicine, Homeopathic medicine, medicine. 5. Energy Medicine – Involve the use of energy fields. Naturalopathic By Shewaneh Ayele (B.Pharm, MSc in Pharmacognosy) 50