First Aid using

Medicinal Plants
and herbal medicines
at iba pa

Cecilia C. Maramba-Lazarte, MD,

MScID, MScCT
Director, Institute of Herbal Medicine
NIH, UP Manila
Professor 8, Dept of Pharmacology
and Toxicology
Clinical Professor, INTROP,Dept of

Summary
Phil FDA definitions of
different herbal based
products
Similarities and differences
between synthetic and
herbal medicines
Synergy in herbal
preparations
Myths about herbal
medicines
Research approach/Drug
development

First Aid using

medicinal plants
and herbal
medicines
1. Burns
2.

Philippine FDA Definitions

Traditionally used Herbal
Products/- preparations from plant
materials whose claimed application
is/are based only on experience
of long usage which should be at
least 5 or more decades as
documented in medical, historical
and ethnological literature

Traditionally used
Herbal
Products

Minimal evidence for safety and efficacyPhilFDA 2004 Guidelines

Documentation of prolonged and permanent
uneventful use of herbal product
Absence of unsuspected potential for
systematic toxicity, carcinogenicity and
teratogenicty
Evidence for claimed application shall be
based on medical/ pharmaceutical literature

Herbal/Food Supplement

No explicit Phil FDA Definition

Only evidence for safety is required
Not a drug or medicine
Cannot make specific therapeutic
claims
Only a supplement

MAHALAGANG
PAALALA: ANG
(name of
product) AY
HINDI GAMOT AT
HINDI DAPAT
GAMITING
PANGGAMOT SA
ANUMANG URI
NG SAKIT.

Philippines FDA Definitions

Herbal medicines -finished labeled medicinal
products that contain active ingredient/s aerial or
underground part(s) of plants or any other plant
material or combination thereof, whether in the
crude state or as plant preparations. Herbal
medicines may contain excipients in addition to
the active ingredient
- Shall have specific therapeutic claim(s) and shall
be intended for use in the diagnosis, alleviation,
cure or treatment of disease, promotion of health
or intended to affect or modify the structure or any
function of the body of humans or animals

Herbal medicines
Evidence of safety and efficacy- PhilFDA AO 172
2004
1. Pre clinical- Acute LD50
Pharmacological effects both in vivo and in vitro
Bioassay
Non-mutagenicity- Ames test and micronucleus
test
sub-chronic and chronic toxicity
2. Clinical- for galenicals- Phase 1 trials
For dosage forms- Phase 1,2 and 3 trials

Examples of modern medicine derived from plant sources

Medicine

Common
name of
plant

Aspirin

Bark of the Salix alba

white
willow

Oseltamivir Star anise

Scientific
name of
plant
source

Illicium
verum

Atropine

Belladonna Atropa
belladona

Tiotropium
bromide

Belladonna Atropa
belladona

Indication

Mechanism of action

Treatment of fever, pain

inflammatory conditions
and Kawasaki
disease;prevention of
thromboembolism

decreases production of
prostaglandins and TXA2
due to its irreversible
inactivation of the
cyclooxygenase enzyme

Treatment and
prevention of Influenza A
and B
Antidote for overdose of
cholinergic drugs and
organophosphate
pesticides; treatment of
bradycardia

Inhibits neuraminidase

Inhibits the muscarinic

actions of acetylcholine
on structures innervated
by postganglionic
cholinergic nerves

Maintenance treatment of Inhibits the muscarinic

bronchospasm
actions of acetylcholine
associated with COPD

Medicine

Common
name of
plant

Scientific
name of
plant
source
Galega
officinalis

Metformin

French
lilac

Artemether

Qinghausu Artemisia
annua

Sodium
Khellin/
chromoglyc Khella
ate

Ammi
visnaga

Quinine

Cinchona
officinalis

Cinchona
bark

Indication

Mechanism of action

Treatment of type 2
diabetes
mellitus

reduction of hepatic
glucose
production and renal
gluconeogenesis

Treatment of
chloroquine-resistant
plasmodium falciparum
infections
Treatment of asthma,
allergic conjunctivitis and
allergic rhinitis

Inhibition of a
parasite Ca+
dependent ATPase
Leukotriene receptor
antagonits; mast cell
stabilizer

Treatment of plasmodium Inhibits hemozoin

nfections
biocrystallization

in Heme
Detoxification
pathway,
which facilitates the
aggregation of
cytotoxic heme

Similarities
Similarities between synthetic and
herbal medicines
Must be evaluated for:
- efficacy
- safety
- adverse effects/toxicity
Undergo pre-clinical and clinical trials
Both will have herb-drug interactions

Single compounds vs. Plant

extracts
-routine practice for scientists to
investigate medicinal plants to find a single
chemical substance responsible for the
therapeutic effect and later synthesized
Plant extracts- multiple compounds
Synergy
Multi-targeted approach

Synergy
An effect seen by a combination of
substances being greater than would
have been expected from a
consideration of individual
contributions
Increased therapeutic effect
Reduced profile of side effects

Synergy
Possible Mechanisms
Facilitation of transport across
membranes
Inhibition of metabolism of active
compound
- phase 1 and 2 enzymes
Inhibition of multidrug resistance

Examples of synergy
Artemisia annua- leaf tea used for thousands
of years in China to treat malaria
- isolated the active principle ARTEMISININE
- a total dose of 3000mg orally over 4 days
for cure of malaria equal to a 4 day course of
leaf tea corresponding to a total dose of 50 mg
artemisinine
- artemisinine activity is enhanced by
flavonoids artemetin and casticin which in itself
have no antimalarial activity

Examples of Synergy
Salix alba RCT for osteoarthritis of the hip and knee
in elderly patients; GI side effects of aspirin were not
observed
Salicin is a salicylalcohol derivative which exhibits
antiinflammatory and analgesic effects after
transformation into salycylic acid in the liver
salicin dose of 240 mg produced therapeutic effects
- flavanoids and tannins may contribute to the
synergistic effect
- salicin did not affect COX1 but only COX2 in
therapeutic doses

Multi-targeted Approach
Diseases have multifactorial etiology
or mechanisms
ex. Diabetes mellitus
hypertension
asthma- LAGUNDI

Lagundi
Botanical name: Vitex negundo L
Filipino name: Lagundi, Dabtan, Tugas
English name: five-leaf chaste tree
Indication: for relief of cough due to common cold, flu
and mild to moderate acute bronchitis
For relief of reversible mild to moderate bronchospasm
in >2 years old with obstructive airway disease such
as asthma, and chronic bronchitis
Formulation: 300mg/tablet, 600mg/tablet
300mg/5mL syrup, 600mg/5mL syrup

Clinical trials of lagundi

Several clinical trials involving adult and
pediatrics patients with mild to mod cough
of non-bacterial origin
Decreased frequency of cough by the third
day compared to placebo wherein
frequency of cough deceased by the 6 th day
Increased airflow/bronchodilation
Improved ease of expectoration and
disappearance of phlegm

Phytochemical studies on Lagundi Leaves

Compound Assay results
Chrysopleno Relaxes cat tracheal muscle; inhibits
release of histamine from rat peritoneal
lD
Luteolin
Isoorientin

mast cells (IC50 =100M), inhibits 5lipoxygenase

inhibits the release of histamine from
rat peritoneal mast cells (IC50=85M)

inhibits the release of histamine from

rat peritoneal mast cells (IC50=4.4M);
inhibits 5 lipoxygenase

Negligible activity
Casticin
Luteolin -7- (?)
0- glucoside

Plot of Histamine Release vs. Concentration of Pure

flavonoids

yrit F. Phytochemicaal Studies on the Leaves of Vitex negundo. Lagundi(Vitex neg

nograph.1989 PCHRD Technical report series no.6

Identification of four iridoids in the

pharmacologically-active fraction of
Vitex negundo
Three of the iridoids contain glucosyl and
parahydroxybenzoic acid moities.
Among the properties attributed to
iridoids include analgesic and antiinflammatory activities.
The 4 iridoids isolated and identified are
2'-p-hydroxybenzoyl mussaenosidic acid,
6'-p-hydroxybenxoyl mussaenosidic acid,
agnuside and lagundinin

Anti-leukotriene activity

evaluated the anti-inflammatory properties of

Vitex negundo leaves in a cellular model of
inflammation (Griess Assay) and an enzyme
kinetic assay (Lipoxygenase Assay)
crude extracts of leaves from Vitex negundo
inhibited the biosynthesis of NO production
with IC50 value of 25.20 g/ml and inhibited
the activity of lipoxygenase enzyme with IC 50
value of 60.60 g/ml.
phytochemical work-up has led to the
isolation of two different glycosides (flavonoid
CHEMICAL
BIOLOGICAL
ACTIVITIES OF VITEX NEGUNDO
glycosideAND
and
iridoid glycoside)

J.Fadzureena1,2, M.A.Rasadah1, S. Khozirah2,4, D.A.Israf2,3, N.H.Lajis2,4

1
Medicinal Plants Programme, Biotechnology Division, Forest Research
Institute Malaysia, 2Institute of Bioscience, 3 Dept of Biomedical Science
and 4 Dept of Chemistry, University Putra Malaysia, 2003

blocks the action of leukotriene cascade by blocking the action of

arachidonate 5-lipoxygenase, This reduces the bronchoconstriction
otherwise caused by the leukotriene and results in less inflammation.

Choose
Agricultur
al
Researche
s
Cultivation

Propagation
Harvesting
Postharvest
handling

Survey of Traditional
Healers on herbal
medicines and folkloric
used/ Literature review
herbal medicines for a specific indication
and
Pharmaceutical
screen for
Preparation
pharmacologic action
Researches
Preclinical researches
Plant material
Ex. -Acute toxicity
processing
-sub chronic/chronic
Crude drug
toxicity
preparation
Safety pharmacology
(Galenicals) and
Mutagenicity, clastogenicty
Heavy metal content
Quality control
In vitro and in vivo
Drug formulation
bioassays
and manufacturing
Isolation of active
research
compound
Quality control of
Human Trials
Pharmaceutical
Phase 1
product
Phase 2
Phase 3

Intellectual Property
Rights/Herbal medicine
registration with Phil FDA

Differences between conventional

drugs and herbal products
Long term use of herbs suggests, but
does not assure a favorable riskbenefit ratio
Pharmacokinetics is not absolutely
required- may be possible if
biologically active compounds or
other biomarkers are identified
Dosing regimens can be extrapolated
from traditional use and from
pharmacologically active

BURNS

Burns
First aid care of burns is
meant to prevent shock ,
prevent infection and to
control pain.
Superficial burn- redness,
swelling and pain, without
blisters
Place affected area
immediately in cold water
or apply cold compress to
relieve the pain. Do not
apply pomade , cooking oil
or coconut oil.

Medicinal Plants for Superficial Burns

Plant material

Preparation

Direction for use

Gumamela flower
buds
(Hibiscus
rosasinensis)
Oregano leaves
(Coleus amboinicus
Lour)

Use only 1 of the

plants listed
Express the juice
from fresh material

Apply the juice on

the affected parts
2x/day; maintain
cleanliness

Sabila leaves
(Aloe barbadensis
Mill)

Use fresh sabila

leaves; Collect
enough juice to
cover the burn

Apply the juice to

the burn. Wash of
the sabila juice
after 15 min
2x/day; maintain
cleanliness

Burns
Burns with blister
formation do not drain blister.
If the blister bursts, take
off adjoining skin and
clean with soap and
water. A suggested
medicinal plant may then
be applied.
It would be better to
leave the burned area
exposed to the air.
If the wound cannot be
kept clean, cover the
burned area with a clean
pad or cloth with

Burns
Deep or extensive
burns
If the burn is severe with
gaping flesh or bones, or
a big body surface is
burned, call a physician
immediately or bring to
the nearest hospital or
clinic.
While waiting - follow
the tips listed above.
Wrap the burned area
with a clean cloth or
towel
Comfort and reassure
the patient because

Diarrhea
Bowel movements
>2x/day and change
to soft or watery
Etiologies- infectious
spoiled food,
indigestion, milk
intolerance; allergy
to food; antibiotics;
poisoning; worms;
emotional stress

Most important
problem; Dehydration
- use Oresol
- Coconut water
1L clean water + 2
tbsp sugar or honey+
1/4tsp baking soda +
tsp salt+
Use a recommended
medicinal plant

Diarrhea
Plant
mater
ial

Amount of
chopped leaves
needed

Abuka
do
(Perse
a
amerik
ana
Mill)

Bayab
as
(Psidiu
m
guajav
a L)
Adult

Dried

Fresh

Adult

8 tbsp

10 tbsp

7-12
yrs

4 tbsp

5 tbsp

2-6 yrs

2 tbsp

2 tbsp

Dried

Fresh

8 tbsp

10 tbsp