Ther 202: Pharmacotherapeutics
Medications
and Integrative
Lec 12:Herbal
Herbal Medications
and Integrative
Medicine Medicine
Ma. Stephanie Fay S. Cagayan, MD
Mind-Body
Interventions
TOPIC OUTLINE
I.
Definitions
A. Health and Wellness
B. Oriental/Traditional and Western Medicine
C. Complementary and Alternative Medicine
II. Why Should We Care About CAM?
III. Issues on the Use of CAM/Herbal Medicine
IV. What Can We Provide to Meet the Demand?
Biological
Based
Therapies
Manipulative
and BodyBased
Methods
Energy
Therapies
I. DEFINITIONS
A. HEALTH AND WELLNESS

Health (WHO): A state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity
Ther 202
1
August 28, 2014
cognitive-behavioral
approaches,
meditation,
hypnosis, dance, music, art therapy, prayer,
mental healing
Dietary supplements, herbs, orthomolecular
(varying concentrations of chemicals, such as,
magnesium, melatonin, and mega-doses of
vitamins), individual biological therapies (use of
laetrile, shark cartilage, bee pollen).
Chiropractic, osteopathic manipulation, massage
Qi
gong,
Reiki,
therapeutic
touch,
bioelectromagnetic-based therapies (pulsed fields,
magnetic fields, or alternating current or direct
current fields)
II. WHY SHOULD WE CARE?




60% of Filipinos still lack access to doctors
Majority of Filipinos are below poverty level and cannot afford cost of
health care
600 million visits a year to CAM providers – more than to primary
care providers
Why? What is mainstream medicine not offering to our patients?
A. HAVE WE MISSED THE BOAT?
Figure 1. Components of Wellness
B. ORIENTAL/TRADITIONAL MEDICINE AND WESTERN MEDICINE
Oriental/Traditional
Western












Dissatisfaction with health care providers and medical outcomes
Side effects of drugs and treatments
High health costs/No choice
Technology
Lack of control in their own health care practices
Time spent with practitioner
Looking for “cures”
Want to use “natural” products
Patient feels empowered
Focus on spirituality and emotional well-being
Health Care Provider provides the 3 T’s: touch, talk, time
No choice
B. WHAT ABOUT COMMUNICATION?
Figure 2. Comparison between Oriental/Traditional Medicine and Western
Medicine

B. COMPLEMENTARY AND ALTERNATIVE MEDICINE
•
•
Complementary and Alternative Medicine is a group of diverse
medical and health care systems, practices, and products that are
not presently considered part of conventional medicine (NCCAM)
o Complementary medicine: used together with conventional
medicine
o Alternative medicine: used in place of conventional medicine
Integrative medicine combines mainstream medical therapies and
CAM therapies for which there is some high-quality scientific
evidence of safety and effectiveness


C. HISTORICAL DEVELOPMENTS: GLOBAL



Table 1. Modalities under the 5 Domains of CAM (WILL BE ASKED!)
Ayurveda, Chinese, Native American, Aboriginal,
African, Middle Eastern, Tibetan, Central and
South
American
cultures,
Homeopathy,
Naturopathy
Jeff Geoff Marz
World Health Organization (WHO): 1978 Alma Ata Declaration on
Primary Health Care (PHC): Integration of Traditional Medicine in
PHC
1999: US Congress established the National Center for
Complementary and Alternative Medicine (NCCAM) in the National
Institutes of Health (NIH) Bethesda, Maryland.
Worldwide Perspective
o Complementary
o Alternative
o Traditional
o Primary medical care
o Treatment of minor ailments
o Health maintenance
D. GOALS OF USE/TREATMENT WITH CAM
Figure 3. 5 Domains of CAM
Alternative
Medical
Systems
Between 40 and 70% of CAM users do not disclose their use to their
physician
o 60% - “My doctor never asked.”
o 60% - “It wasn’t important for my doctor to know.”
o 20% - “My doctor wouldn’t understand.”
o 14% - “My doctor would disapprove.”
70% of patients see their Physician before or concurrent with their
visits to a CAM provider
Why would we not trust CAM?
o Quackery
o Doctors concerned because several cases reported of liver
failure with Kava Kava, a widely used natural remedy for anxiety
1.
2.
3.
4.
5.
Promotion and maintenance of health
Prevention of disease and injury
Relief of pain and suffering
Cure of curable diseases and illnesses
Care of people who are ill
Page 1 / 4
Herbal Medications and Integrative Medicine
6.
7.
Avoidance of premature death
Peaceful death

E. REGULATIONS





Varied from stringent to none
Canada
o Federal and provincial regulations
o 2004 National Health Products Regulations
European Union
o Directive to register and license products
Mexico
o Traditional birth attendants, homeopathic
chiropractors licensed
o Registry of traditional practitioners
China and India
o Integrated with allopathic medicine, regulated

Ther 202
o About 40% of medicinal plants used in indigenous communities
have not been documented
There are about 250,000 traditional medical practitioners in the
Philippines
See appendix for list of medicinal plants
III. ISSUES ON THE USE OF CAM/HERBAL MEDICINE
A. SAFETY OF HERBAL MEDICINE
practitioners,
F. PHILIPPINE EXPERIENCE IN INTEGRATIVE MEDICINE









Mid-70’s: Private physicians started training in acupuncture in China
Early 1980’s: DOH physicians trained acupuncture in China; herbal
medicine production started
1993-95: DOH established the Traditional Medicine Unit which
promoted the use of medicinal plants, acupuncture and therapeutic
massage
1995: De La Salle University inaugurated the Center for Indigenous
Medicine in Dasmarinas, Cavite -the 1st Philippine university to do
so.
1997: Republic Act 8423 (TAMA) established the Philippine Institute
for Traditional and Complementary Health Care (PITAHC) in as an
attached agency of the Department of Health (DOH).
Traditional and Alternative Medicine as defined by RA 8423
o The scope of alternative health care modalities as other forms of
non-allopathic, occasionally non-indigenous or imported healing
methods, though not necessarily practiced for centuries nor
handed down from one generation to another.
1999-2000: Filipino physicians have organized the Philippine
Association of Medical Acupuncturists Inc (PAMAI) and the
Philippine College for the Advancement of Medicine (PCAM) to
promote the practice of Integrative Medicine.
2001: The UP College of Medicine started an elective course on
Integrative Medicine in both graduate and undergraduate courses.
The UP-Philippine General Hospital inaugurated the Traditional and
Integrative Medicine Clinic.
2008 -The Philippine Institute of Traditional and Alternative Medicine
(PITAHC) started the accreditation of acupuncturists practicing in
the Philippines, both for medical and non-medical practitioners.
Figure 4. Reported Actions, Treatments, Adverse Reactions and Drug Interactions
of Herbal Alternative Medicines used in Neuropsychiatry (transers’ note: Ma’am
said she might ask about this, esp. on St. John’s Wort! Bigger copy found in
appendix)
B. EVIDENCE BASED MEDICINE



Difficulties With CAM Research
o Sham Acupuncture
o Non Standardized Herbal Formulations
o Difficult to Blind Patients and Practitioners
o Treatments Very Individualized – Difficult to Formulate Protocols
Mainstream Medicine
o Large Double Blind Placebo Controlled Trials
o Many Exclusions Such As Multiple Medicines, Other Illnesses,
Female, Pregnant, Children, Race
o “Placebo Effect” Discounted
o Apply These Narrow Results to The Individual
Integrative Medicine
o Very Individualized
o “Placebo Effect” Not Discounted
G. WORLD VIEW OF HEALTH IN FILIPINO TRADITIONAL MEDICINE
C. CHALLENGES TO THE FILIPINO COMMUNITY





Theory of macrocosm and microcosm (“kalawakan”
“sangkatauhan”)
The balance, synergy and harmony:
o Between Humankind and the Universe
o Between Humankind and Nature
o Between and Amongst people
o Within his body, mind and spirit
Theory of nature elements
o fire (kalikasan ng apoy)
o earth (kalikasan ng lupa)
o water (kalikasan ng tubig)
o air (kalikasan ng hangin)
Theory of body humours
o Init (hot) and lamig (cold)
o Wet (basa) at Dry (tuyo)
Belief in nature spirits/guardians of nature and spirit ancestors
at
1.
2.
3.

H. FOLK OR TRADITIONAL MEDICINE




80% of Third World countries utilize folkloric medicine
Formal training vs apprenticeships vs observation, imitation, practice
o Skill may be inherited
Range of remedies
o prayer, touch, charms, rituals, teas, tinctures, poultice, etc
All cultures
I. HERBAL MEDICINE IN THE PHILIPPINES


4.
5.
6.
7.
8.
Majority of Philippine medicinal plants remain undocumented and
untapped.
Scientific studies supporting Philippine traditional medicine
practices is still in the early phase and full potential has not been
explored
Lack of collaboration among research institutions, private sector
and academe
NIRPROMP (National Integrated Research Program on Medicinal
Plants
o
A multidisciplinary research team established in 1976 under the
Department of Science and Technology
o
Tasked to validate scientifically certain folkloric uses of medicinal
plants and to propagate the use of herbal medicines rationally by
the majority of the people (for example, sambong has a folkloric
use for cough but upon scientific validation, it is now used as a
diuretic)
Lack of investments in research and development, raw material
production, post harvest processing and herbal manufacturing.
Low level of scientific technology in herbal medicine research and
manufacture among small and medium enterprises.
Low support for traditional medicine research in the academic
community.
Need for market and government incentives like the ones given to
rice, corn, coconut, sugar, bananas, pineapples and mangoes.
Need for standardized procedures/ accreditation/recognition in
Filipino traditional medicine/herbal medicine practices.
8,000 to 12,000 flowering plants
1,500 species actively utilized by traditional healers
Jeff Geoff Marz
Page 2 / 4
Herbal Medications and Integrative Medicine
Ther 202
D. ANSWERS TO CHALLENGES








A wareness raising
N etworking among groups
T echnical capacity building
I nformation exchange/monitoring
D eepening of understanding
O rganizing concerned people
T ransformative action
E mpowerment of people


Awareness, understanding and appreciation of resources
Capability for a relevant and self-reliant research and development
program
Recognition and respect of community rights and indigenous
knowledge
Strong national policies and laws to protect indigenous resources
Active defense against immediate threats to biodiversity (mining,
deforestation)
Preventive
action
against
potentially
destructive
technologies/activities (developmental aggression)
Confronting structural causes of unsustainable use (political system)





IV. WHAT CAN WE PROVIDE TO MEET THE DEMAND?

Patients are choosing integrative and alternative medicine, but
what about us, physicians?
A. THE FUTURE OF INTEGRATIVE MEDICINE







The Future Is Sometimes Curing, But Always Caring
Integrative medicine requires a paradigm shift from:
o The disease-centered approach of conventional medicine to
o To an approach in which patient values and participation of
patients are central
Definition of Integrative Medicine from the CAHCIM
o Integrative medicine is the practice of medicine that reaffirms the
importance of the relationship between practitioner and patient,
focuses on the whole person, is informed by evidence, and
makes use of all appropriate therapeutic approaches to achieve
optimal health and healing.
The term “Integrative Medicine will die
o Our patients will demand integrative medicine from all of us
o Training will be demanded by medical students
o Training will be demanded by residents
Integrative medicine will be a skill set added on just like:
o Electronic health records
o New medications
o New procedure
How do we add on these skills?
o Build your database
o Build a referral team
o Ask your patients whom they see
o Look for summaries of available data
o Have an open dialogue with your patients
What cannot be added on is empathy, open-mindedness and
respect for other people’s beliefs
SUMMARY









Know what integrative medicine is
Dialogue with your patients
Build your database
Build your referral base
Develop patient care teams
Consider all available options
Be open-minded
Be an agent of change in your community
Above all: be caring, concerned and compassionate
END OF TRANSCRIPTION
Jeff:
Geoff:
Marz: Hello, block 5-star (physician)! Kain tayo please. Or roadtrip haha.
Hello sa dating(?) transmates ko, Micah and Kit! Hi MSSR 2017, closing
party na bukas for AMSEP PH for Taiwan, punta kayo please haha :D
#domore #bemore Hello swim team babawi ako sa October!
Jeff Geoff Marz
Page 3 / 4
Herbal Medications and Integrative Medicine
Medicinal Plant
Lagundi
(Vitex negundo)
Sambong
(Blumea balsamifera)
Akapulko
(Cassia alata)
Yerba Buena
(Mentha arvensis)
Tsaang Gubat
(Carmona retusa)
Pansit-pansitan
(Peperomia pellucida)
Ampalaya
(Momordica charantia)
Niog-niogan
(Quisqualis indica)
Ipil-Ipil
(Leucaena leucocephala)
Bawang
(Allium sativum)
Sibuyas
(Allium cepa)
Bayabas
(Psidium guajava)
Roselle
(Hibiscus sabdariffa)
Sili
(Capsicum frutescens)
Luya
(Zingiber officinale)
Turmeric
(Curcuma longa)
Malunggay
(Moringa oleiferanale)
Balanoy
(Ocimum basilicum)
Sinta
(Andrographis
paniculata)
Banaba
(Lagerstroemia speciosa)
Jeff Geoff Marz
Ther 202
Uses
Bronchodilator, Anti-cough, Anti-inflammatory, Analgesic, Anti-gout, Antioxidant, Antihistamine, Anti-spasmodic,
Hypoglycemic
Anti-urolithiasis, Diuretic, Anti-hypertensive, Anti-hyperuricemia, Anti-oxidant, Antibacterial, Anti-cough
Antifungal, Antibacterial, Anti-scabies, Laxative, Antioxidant, Anticancer, Anthelmintic (in dogs)
Analgesic, Anti-inflammatory, Antioxidant, Vasorelaxant, Antimicrobial, Antiviral, Anti-mite (avian) , Choleretic, Antispasmodic, Anti-flatulence, Anti-ulcer, Antifertility (male)
Anti-spasmodic, Anti-diarrheal, Antimicrobial, Anti-dental caries, Analgesic
Anti-hyperuricemia, Anti-inflammatory, Analgesic, Antibacterial, Wound healing, Diuretic
Antidiabetic, hypolipidemic, Antioxidant, Antiviral, anti-HIV, Antimutagenic, Antifertility, Antiprotozoa, Anti-tumour
(skin papilloma)
Antihelminthic (fruits) , Antirheumatism (roots), To relieve boils and ulcers (leaves)
Antihelminthic, Antiviral (yellow fever, dengue), Antibacterial, Cell proliferation inhibitor (potential anticancer)
Antibacterial, antifungal, Anti-cholesterol, hypolipidemic, Anti-hypertensive, Anti-platelet, anti-coagulant, fibrinolytic,
Anti-inflammatory, Hypoglycemic , Anti-spasmodic
Anti-cholesterol, hypolipidemic, Anti-platelet, anti-coagulant, Hypoglycemic, anti-diabetic, Anti-bacterial, antifungal,
Anti-inflammatory, anti-keloid , Anti-allergy, Anti-spasmodic
Antibacterial, Anti-scorbutic, antioxidant, Anti-diarrheal, Anti-diabetic, Anti-mutagenic
Antioxidant, Antihypertensive, diuretic, Antidiabetic, hypolipidemic, Anti-inflammatory, Antiplatelet, Cardioprotective,
neuroprotective, Liver protective, Anticancer
Analgesic, anti-arthritis, Antioxidant, Cardioprotective, Antihypertensive, Antimicrobial, Antidiabetic, Hypolipidemic
Anti-inflammatory, anti-arthritis, Carminative, antispasmodic, Antimicrobial, antiviral, Anti-motion sickness, antiemetic, Anti-angiogenesis, anticancer, Antidiabetic, antilipidemic
Anti-dyspepsia, anti-ulcer, choleretic, Anti-inflammatory, anti-arthritis, Anti-oxidant, anticancer, anti-angiogenesis,
Prevents liver and kidney damage, Antidiabetic, anti-obesity, Vasorelaxant, Promotes wound healing
Antioxidant, Antibacterial, antifungal, Anti-inflammatory, Antidiabetic , Anti-hypertensive, hypolipidemic,
Hepatoprotective, Antitumour, Water purifier
Antioxidant, cardioprotective, Antimicrobial, preservative, Antiplatelet, hypolipidemic, Antidiabetic, antihypertensive,
Antimutagenic, Anticancer, Anti-ulcer, anti-stress, Anti-inflammatory, immunomodulator, Insecticidal, larvicidal
Treatment of upper respiratory infections, Antibacterial, antiviral (HIV), Immunomodulatory, Anti-inflammatory,
antipyretic, Antidiarrheal, Antimalaria, Hepatoprotective, Antivenom (cobra)
Antidiabetic, Diuretic, To relieve dysuria, Antihypertensive, Anti-obesity
Page 4 / 4