REPORT OF AN INTERCOUNTRY MEETING ON THE USE OF …applications.emro.who.int/docs/who_em_pharm_107_en.pdf · REPORT OF AN INTERCOUNTRY MEETING ON THE USE OF MEDICINAL PLANTS AT THE

WHO-EN/PHARM/ 107

August 1985

REPORT OF AN INTERCOUNTRY MEETING ON THE USE OF MEDICINAL PLANTS AT THE PRIMARY HEALTH CARE LEVEL

Kuwait, 20-25 April 1985

(Meeting Reference: EM/INc.swG.~WG.UMP.PHC/~)

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN

1985

EDITORIAL NOTE

The issue of this document does not constitute formal publication.

The manuscript has only been modified to the extent necessary for proper comprehension. The views expressed, however, do not necessarily reflect the official policy of the World Health Organization.

The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Organization concerning the 1egal.status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

TABLE OF CONTENTS

page

. I OPmmG CEREMONY ............+...................-.... . 1

.................................... I1 ELECTION OF OFFICIALS 2

COUNTRY REPORTS

................................................... AFGHANISTAN 4 EGYPT ......................................................... 4 KT-IIJATT ....................................................... 5 PAKISTAN .................................................... 5 SAUDI ARABIA .................................................. 6 SOMALIA ....................................................... 7 SUDAN ........................................................ 8

IV WHO'S PROGRfQME I N TRADITIONAL MEDICINE .................. 8

V ISLAMIC MEDICINE CENTRE. KUWAIT .......................... 9

V I MEDICTNAL PLANTS I N THERAPY .............................. 'CTI RESEARCH NEEDS I N THE USE OF MEDICINAL PLANTS FOR THE

DELIVERY OF HEALTH CARE .................................. 10

....... V I I I SELECTION OF MEDICINAL PLANTS FOR USE AT PHC 'LEVEL 11

I X BROAD PLAN FOR DEVELOPMENT OF A REGIONAL P R O G W ON THE USE OF MEDICINAL PLANTS AT PHC LEVEL ................. 12

X RECOMMENDATIONS .......................................... 12

ANNEX I CATEGORIES OF THE MOST COMMON DISEASES AND DISTURBANCES ENCOUNTERED AT PHC LEVEL FOR WHICH HERBAL REMEDIES COULD BE IDENTIFIED ................. 15 .

ANF\"EX I1 A COW . LIST OF bLEDICINAL FZANTS FOR USE AT PHC LEVEL 1 6

M E X I11 HERBAL REPZDIES FOR COMMOX DISEASES AND SWTOMS SEEN 19

Ah'NKX I V HKUAD PLAN FOR T)EVELOPl.ENT OF A REGIONAL PROGRk"I?fE ON THE USE OF MEDICINAL P M T S AT THE PRIMARY HEALTH PRIMARY HEALTH CARE LEVEL presented by D r EL SAFI 2 4

................................ ANNEX V LIST OF PARTICIPANTS 29

.............................................. ANTEX V 1 AGENDA 33

........................................... ANNEX V f T P R O C R A W 34

An In te rcoun t ry S c i e n t i f i c Working Group Meeting on "Use of Medicinal Plant s ar the Primary Health Care Level" was held a t t h e Holiday Inn Hotel , Kuwait, i n c o l l a b o r a t i o n with t h e Government of Kuwait, from 20-25 Apr i l 1985

L OPENING CEREMONY

The meeting was conducted by H.E. D r A . R . A 1 Awadi. Minis ter of P u b l i c Health and Minister of PlannjnE, Government of Kuwait, who, i n h i s inaugural address , r e f e r r e d t o t h e r i c h h e r i t a g e i n t h e use of medicinal p l a n t s and he rba l remedies descr ibed i n I s l amic Medicine by Arab and o t h e r Muslim physic ians and s c i e n t i s t s , We f e l t t h a t t h i s s torehouse of knowledge should be used today f o r t h e t rea tment o i t h e d i seases seen i n t h e coun t r i e s i n t h e Region. There was no need, he f e l t , t o u s e s y n t h e t i c drugs when simple he rba l remedies were a v a i l a b l e and had been used f o r c e n t u r i e s t o cure common condit: ions. He f elk, however, t h a t 1 1 4 ~ nf s l i rh mndi cinal plants should be introduced c a r e f u l l y and i n a s c i e n t i f i c manner, avoiding, on t h e one hand, p ressure f o r r a p i d in t roduc t ion without study and, on t h e o t h e r , i r r a t i o n a l b i a s a g a i n s t such remedies. He s t a t e d t h a t the welcome i n i t i a t i v e taken by t h e World Heal th Organization i n holding t h i s in te rcoun t ry meeting should go a long way towards reso lv ing s e v e r a l of t h e i s s u e s assoc ia ted with t h e use of t h e s e h e r b a l r e m e d i e s . ~ r A1 Awadi welcomed t h e p a r t i c i p a n t s and observers t o Kuwait, was happy that the meeting was being held in Kuwait and wished it a l l success .

The message from D r Hussein A . Gezairy, Regional D i r e c t o r , Eas tern Mediterranean Reg-ional Off ice . was read a t t h e inaugurat ion. D r Gezairy thanked t h e Government of Kuwait f o r hos t ing the meeting. H e s t a t e d t h a t severa l coun t r i e s of t h e Region have been and a r e s t i l l using medicinal plailLs F U L delivery of health. It was important and timely, hc felt, to review t h i s f i e l d a t t h i s junc tu re when t h e s t r a t e g i e s f o r d e l i v e r y of h e a l t h a t the primary h e a l t h c a r e l e v e l were being formulated and implemented i n t h e coun t r i e s . It was important t o see t h a t t h i s h e r i t a g e should be employed t o t h e f u l l and u t i l i z e d most e f f e c t i v e l y f o r t h e a l l e v i a t i o n of sickness and s u f f e r i n g .

The Regiu r l a l DirecLur i n d i c a t e d that this meeting had limited specific objec t ives . These were: (a) t o i d e n t i f y a core l i s t of medicinal p l a n t s t o be used a t t h e primary h e a l t h c a r e l e v e l i n coun t r i e s i n the Region, and ( b ) t o prepare a broad, e f f e c t i v e , imaninative and comprehensive plan f o r r eg iona l a c t i v i t y i n t h i s chal lenging and ye t d i f f i c u l t f i e l d . D r Gezairy welcomed the p a r t i c i p a n t s and observers t o t h e meeting and wished i t a l l

t success.

The meeting was attended by representatives from Afghanistan, Egypt, Kuwait, yakisran, Saudi Arabia, Somalia and S u d a ~ ~ . A list uf participants, temporary advisers and observers who attended the meeting is attached (see Annex V).

The provisional agenda (see Annex VI) was adopted. The programme of the meeting is given in Annex VII.

11 ELECTION OF OFFICIALS

The following persons were se lec ted as Chairman, vice-chairman and Rapporteurs for the meeting:

Chairman: Vice-Chairman: Rapporteurs:

Dr Abdel Rahman A1 Awadi Dr Mohamed Ikram Dr M. El Safi Dr S. Hilal

111 INTRODUCTION

In his introductory remarks, Dr Ranjit Roy Chaudhury, Regional Adviser, Pharmaceutical, Diagnostic and Therapeutic Substances, provided the background which had led to the convening of the meeting. He expressed the hope that this would be only thc first of n seriec of such working group meetings. In the original suggestion received from the Government of Kuwait, among the topics mentioned were standardization of herbal preparations, development of regulatory procedures for the use of herbal preparations, and economic exploitation of the availability of raw materials available in the Region for preparation of herbal remedies, These issues and others could be discussed at subsequent meetings.

Dr Chaudhury then stressed the importance of identifying a common limited list of herbal remedies which could be used for most of the illnesses and symptoms seen at the primary health care level. The identification of such a limited list from the large number of plants reportedly being used for a similarly large number of conditions would be the first step in rationally developing a broad plan for the use of herbal preparations at the primary healch care level. It should be clearly u r l d e r s ~ u u d that tile core list would only be a model and guide for the countries and that countries themselves would need to prepare their own national lists. Once a list for the country had been agreed upon. then only could efforts be made for procurement, cultiva- tion, collecrion, storage, preparation, standardization and use of these herbal preparations. He expressed the hope that the group would be able to produce such a core list of herbal remedies.

D r Chaudhury then d i scussed the o t h e r two expected outcomes of t h e meeting, v i z : (i) d e l i n e a t i o n of what r e s e a r c h needs t o be c a r r i e d out i n t h e f i e l d of h e r b a l remedies and ( i i ) t h e development of a broad p l an f o r development o t t h i s field of work i n t h e Kegion. He hoped t h a t t h e p l an drawn up and t h e recommendations made i n both t h e s e a r e a s would be r e a l i s t i c and f e a s i b l e f o r implementat ion w i t h i n t h e nea r f u t u r e w i t h i n t h e count ry r e sources a v a i l a b l e f n r surh 2 r t i v i t i ~ q . Tn f a c t , such a p l a n should enab le t h e programme i n t h e Region t o be i n i t i a t e d immediately.

D r A 1 Awadi t hen addressed t h e group and asked them t o approach t h e i r t a s k w i t h o b j e c t i v i t y and c a u t i o n and t o put forward r a t i o n a l and s c i e n t i f i c o b j e c t i v e s f o r t h e f u r t h e r development of t r a d i t i o n a l medic ine . This h e r i t a g e has been w i t h u s , he s a i d , f o r thousands of y e a r s and t h e in fo rma t ion a v a i l a b l e today from t h e a c t u a l use of h e r b a l remedies, and from t h e a n c i e n t t e x t s of I s l amic Medicine, a s a l s o t h e knowledge e x i s t i n g i n o t h e r c o u n t r i e s , should be u t i l i z e d f o r t h e b e n e f i t of t h e people. It was, however, e s s e n t i a l t h a t u t i l i z a t i o n of t h e h e r b a l remedies be p laced w i t h i n a s c i e n t i f i c frame- work s o t h a t t h e c o u n t r i e s and t h e i r popu la t ions would t a k e s e r i o u s l y and wi th enthusiasm t o t h e widespread use of h e r b a l remedies. There were s e v e r a l obvious reasons f o r u s e of h e r b a l remedies i n t h e everyday c o n t e x t , i n c l u d i n g a v a i l a b i l i t y of t h e sourccs of t h c rcmcdics i n t h e c o u n t r i e s themselves, low c o s t and a c c e s s i b i l i t y t o such remedies only by l a r g e segments of t h e popu la t ion i n some c o u n t r i e s of t h e Region. It was impor t an t , however, t o approach t h i s whole i s s u e wi th cau t ion and o b j e c t i v i t y . There should be no unnecessary p r e s s u r e t o push t h e use of t r a d i t i o n a l medicines nor should t h e r e be b i a sed oppos i t i on t o such use . I n c r e a s i n g u s e of t r a d i t i o n a l medicines should be supported by o b j e c t i v e , r a t i o n a l and s c i e n t i f i c informa- t i o n ga the red i n t h e countries rega rd ing t h e e f f i c a c y as w e l l as t h e s ide - e f f e c t s of t h e s e r ened ie s and t h e f e z s i b i l i t y of o b t z i n i n g r e g u l z r s t anda rd ized p repa ra t ions f o r widespread use . D r A 1 Awadi hoped t h a t t h i s would be only t h e f i r s t of s e v e r a l meet ings and c o n s u l t a t i o n groups which would examine i s s u e s such a s s t a n d a r d i z a t i o n of h e r b a l remedies, r e g i s t r a t i o n and r egu la - t i o n s r ega rd in% s a l e of h e r b a l remedies and economic e x p l o i t a t i o n of r e sources f o r h e r b a l remedies a v a i l a b l e i n c o u n t r i e s of t h e Region.

COUNTRY REPORTS

Representa t ives of t h e d i f f e r e n t coun t r i e s presented shor t backgroqd papers desc r ib ing the s t a t u s of use of medicinal p l a n t s i n t h e i r coun t r i e s . These a r e summarized below.

Afghanistan i s a mountainous a rea and because of semi- t ropical and dry c l imate and a v a s t d i f f e r e n c e i n a l t i t u d e s t h e temperature v a r i e s from

0 a r e a t o a rea , reaching sub-zero i n winter whi le i n summer r i s i n g t o 45 C . Medicinal p l a n t s abound i n Afghanistan and grow n a t u r a l l y i n t h e p l a i n s and mountains .

The use of medicinal p l a n t s by t h e people of d i f f e r e n t ai lments has been i n vogue s ince very ancient t imes. They used r o o t s , f lowers , l eaves , seeds and o the r p a r t s of the herbs and p l a n t s sometimes a s decoct ions , o r powdered and taken wi th milk or water . Ointments a r e a l s o made, f o r s k i n d i s e a s e s , and t h e j u i c e of medicinal p l a n t s i s a l s o e x t r a c t e d . These remedies a r e used by t h e people on t h e b a s i s of experience handed down from generat ion t o genera t ion and a l s o by p r a c t i t i o n e r s of "Unani" Medicine.

EGYPT

The discovery of the hea l ing and c u r a t i v e p r o p e r t i e s of p l a n t s i s as o ld a s the human race . Egyptian papyri d a t i n g back a s f a r a s 2000 B . C . record f o r example, t h e use of mustard, l inseed and s q u i l l . I n the twent ie th century , wi th t h e advent of s y n t h e t i c drugs, t h e use of medicinal p l a n t s underwent a set-back. The use of medicinal p l a n t s i s mostly confined t o t h e poor l i v i n g i n r u r a l a reas urban f r i n g e , d e s e r t lands and oases. The use of herbs by t h e s e people i s based upon experience i n h e r i t e d from both ancient Egyptian and I s l amic c i v i l i z a t i o n .

During t h e l a s t few years u t i l i z a t i o n of medicinal herbs has been extended from poor and r u r a l a reas t o middle-class and r i c h people and t o b ig c i t i e s . This s h i f t has come about not only a s a sequel t o s ide - r eac t ions of s y n t h e t i c drugs but it i s a l s o an economic n e c e s s i t y i n developing coun t r i e s . Herbs a r e used e i t h e r i n the crude s t a t e o r a s mixtures. There a r e many forms: decoct ions , he rba l t e a s , powders, i n s t a n t t e a s , t a b l e t s , drops , ointments and l o t i o n s . A v a r i e t y of g a l e n i c a l s and pharmaceutical prepara t ions a r e a l s o made up from medicinal p l a n t s and a r e used extensively.

KUWAIT

Medic ina l p l a n t s have cont inued t o s e r v e through t h e ages a s a sou rce of medicament f o r t r e a tmen t of a number of d i s e a s e s i n t h e d i f f e r e n t systems of medic ine i n t h e world. Eminent Muslim s c h o l a r s such a s Al-Razi, Ibn S i n a , Ibn Al-Betar Al-Samarqandi and o t h e r s have t o t h e i r c r e d i t compi l a t i ons d e s c r i b i n g many p l a n t s w i t h morphologica l d e t a i l s , p a n s u sed , mer;hods of p r e p a r a t i o n and dosage , e t c . They c l a s s i f i e d p l a n t s a cco rd ing t o t h e d i s e a s e s and t h e d i s e a s e s acco rd ing t o t h e humoural t h e o r y .

The Arabian p e n i n s u l a , i n a d d i t i o n t o i t s importance due t o i t s geog raph ica l s i t u a t i o n , h a s t h e advantage of a wide r ange of c l i m a t i c v a r i a t i o n s w i t h t h e r e s u l t t h a t d i f f e r e n t t y p e s of med ic ina l p l a n t s abound c h e r e . These p l a n t s have f e w e r s i d e e f f e c t s Lhan s y n t h e t i c medicaments, and a r e cheaper and t h e r e f o r e more a v a i l a b l e t o t h e needy.

With t h e growing c o s t of h e a l t h c a r e and m a n i f e s t a t i o n s of s e r i o u s s i d e - e f f e c t s of s y n t h e t i c drugs t h e r e i s a growing tendency t o "go back t o na tu re " . The deve loping c o u n t r i e s a r e u s i n g med ic ina l p l a n t s a s t h e main sou rce of t r e a t m e n t f o r v a r i o u s d i s e a s e s . However, one should d i f - f e r e n t i a t e beKween r h e aims of i n r r o d u c i n g h e r b a l rreacmenr i n r h e developed and t h e deve loping c o u n t r i e s . One f a c e s d i f f i c u l t i e s i n t h e use of med ic ina l p l a n t s i n t r e a t m e n t , s t a r t i n g from i d e n t i f i c a t i o n of t h e p l a n t s and ending w i t h t h e r e g i s t r a t i o n of t h e pharmaceut ica l p r e p a r a t i o n s . The h e r b s used d i f f e r i n many r e s p e c t s from t h o s e u t i l i z e d i n t h e s y n t h e t i c v a r i e t y of medic ine .

PAKISTAN

Man has used p l a n t s f o r h i s su s t enence and a l s o f o r t h e r e l i e f of h i s a i l m e n t s f o r thousands of y e a r s . Indeed , t hey were t h e main form of t r e a t - ment till t h e t u r n of t h e c e n t u r y . They a r e s t i l l used by thousands of people i n deve loping c o u n t r i e s and a r e t h e f i r s t l i n e of t r e a tmen t i n t h e r u r a l areas of P a k i s t a n , where 75% of r h e c o u n r r y ' s popu la r ion l i v e s . Medic ina l p l a n t s a r e cheap and e a s i l y a v a i l a b l e . They a r e u s u a l l y r e p o r t e d t o have no o r low t o x i c i t y . Every v i l l a g e i n P a k i s t a n has a "hakim"; t h e r e a r e about 40 000 r e g i s t e r e d hakims and perhaps double. t h i s number who a r e u n r e g i s t e r e d . These p r a c t i t i o n e r s p r a c t i s e t h e a r t of h e a l i n g bo th i n r u r a l and urban p o p u l a t i o n s . Some of them a r e g r adua t e s from "Tibbi" Co l l eges . Others d e r i v e knowledge from f o l k l o r e o r s e c r e t s passed on t o tl1e111 by e l d e r s . T h e hakim i s looked upon wi th r e s p e c r and r eve rence a s he forms a p a r t of t h e l o c a l c u l t u r e .

The d i v e r s i t y i n c l i m a t i c c o n d i t i o n s , topography and o t h e r geographica l v a r i a t i o n s have g iven P a k i s t a n a r i c h med ic ina l f l o r a . One med ic ina l p l a n t may be g iven f o r s e v e r a l a i l m e n t s . A sma l l f r a c t i o n of t h e thousands of med ic ina l p l a n t s have been i n v e s t i g a t e d f o r a l k a l o i d s e c c . The pharma- cok inez i c s and t h e e x a c t mode of a c t i o n of most of t h e s e p l a n t s o r t h e i r

a c t i v e ingred ien t s have y e t t o be determined. Some e f f o r t s i n t h i s d i rec - t i o n a r e i n progress . However, i n Pak i s t an , many pharmaceu~ica l I i r~us s p e c i a l i z e i n the manufacture of compound formulat ions made f r o m severa l s i n g l e drugs men~ioned i n t h e c l a s s i c a l t e x t s of Ibn Sina , Al-Razi e t c .

SAUDI ARABIA - In t h e p a s t t h e people of Saudi Arabia depended exc lus ive ly on m e d i c i r l a l

p l a n t s t o cure d i seases and t h i s p r a c t i c e continues a longside modern medicine. The use of medic inal p l a n t s has been passed down through family t r a d i t i o n s , d r u g recipcs and t r a d i t i o n a l h e r b a l i s t s . S a u d i Atahia has d i v e r s e c l i m a t i c condi t ions and i s r i c h i n p lan t resources ; more than a thousand p l a n t s have been mentioned i n i t s f l o r a .

Rea l i s ing t h e s e f a c t s , the Government of Saudi A r a b i a - represented by t h e Minis t ry of Hea l th , Saudi Arabian Nat ional Center f o r Science and Technology (SAVCST) and King Saud Univers i ty , have promoted app l i ed s c i e n t i f i c ~ e s e a r c h into n a t i o n a l rcsourceE. Two projec ts c o n c e r n i n g m ~ d i r i n a l p l a n t s and drugs used i n f o l k medicine a r e now i n progress i n which phytochemical, pharmacological, pharmacognostical, haernatological and a n t i m i c r o b i a l s t u d i e s have been undertaken.

The survey of d i f f e r e n t regions of Saudi Arabia f o r t h e prevalence of d i seases and t h e i r t rea tment wi th l o c a l h e r b a l drugs has shown t h a t l o c a l resources are sufficient t o mcct thc rcquircmentc of common ai l m ~ n t c .

There i s a g r e a t p o t e n t i a l i n medicinal p l a n t s , y e t t h e i r a p p l i c a t i o n nationwide f o r PHC should be c a r r i e d out cau t ious ly . A p i l o t study should be undertaken, choosing a few v i l lages and s e l e c t i n g appropr ia te medicinal p l a n t s whicS have proved t o be e f f e c t i v e and s a f e .

It i s worth mentioning t h a t , from t h e ana lys i s of t h e l i s t of e s s e n t i a l d r u g s cumpiled by W D , it has been a s c e r t n i n c d t h a t there a re a t l e a s t f i f ~ ~ ~ n s u c h drugs which can be s u b s t i t u t e d by medicinal p l a n t s found i n Saud i Arabia.

SOMALIA

Most of t h e Somali popula t ion l i v e i n r u r a l a reas where he rba l medicine i s the only source of medical ca re . The t r a d i t i o n a l hea le r s tend t o be s e c r e r i v e . Tliey llavr. been drafted to w o r k in the THC programme; howcvcr, t h i s experiment has not been very s a t i s f a c t o r y , H e r b a l i s t s a r e a l s o working a t rhe Centre f o r Medicinal Plants. I n 1974, t h e Minis t ry of Health i ssued c e r t i f i c a t e s t o t r a d i t i o n a l h e a l e r s who had been been success fu l ly examined f o r t h e i r knowledge. These h e a l e r s run small shops where they s e l l d i f - f e r e n t remedies of p l a n t and animal o r i g i n ,

The Somali N a ~ i o r ~ a l Uuivers i ty has i n c l u d e d traditional medicine as an o f f i c i a l sub jec t i n the Medical Facul ty . I n t h i s teaching, about one-third of t h e hours (100 hours t o t a l ) are earmarked f o r medicinal p l a n t s . The s tuden t s acqu i re knowledge about t h e l o c a l names of a l l known p l a n t s used i n t h e country and t h e d i s e a s e s they cure , inc luding c o l l e c t i o n , processing and l abora to ry - tes t ing them. The po l i cy of both t h e Minis t ry of Health and t h e Somali National Univers i ty i s t o promote s c i e n t i f i c research on medicinal p l a n t s wirh a view t o i n ~ e g r a ~ i n g u s e f u l plarlLs i u ~ u Like l ~ e a l t l ~ ca re of t h e country.

A t present t h e r e a r e two c e n t r e s f o r t h e study of medicinal p l a n t s , with t h e following a c t i v i t i e s :

1. Preparing pharmaceutically t h e most commonly used p l a n t s i n ~ r a d i t i o n a l medicine f o r f u r t h e r t e s t i n g .

2. L i t e r a t u r e survey and b o t a n i c a l i d e n t i f i c a t i o n . 3 . Experimental s t u d i e s . h . C l i n i c a l verificat inn of e f f i r a c y . 5. I s o l a t i o n and determinat ion of s t r u c t u r e of pharmacologically

a c t i v e compounds.

It i s now proposed t o combine t h e two cen t res so as t o form t h e " I n s t i t u t e f o r Research on Natura l Products". The Univers i ty Programme f o r Medicinal P l a n t s i s expected t o a c c e l e r a t e t h e screening of p l a n t s regarding their an t imic rob ia l , a n t i - i n f l a m a t o r y and analgestic a c t i v i t i e s . Toxicolo- g i c a l i n v e s t i g a t i o n of p l a n t s showing s i g n i f i c a n t pharmacological a c t i v i t y i s proposed so t h a t c l i n i c a l s t u d i e s may be c a r r i e d o u t ,

~ r a d i t i o n a l l y a ve ry h igh percentage of people i n Sudan depend on h e r b a l remedies. This has been a r e s u l t of v a r i o u s c u l t u r a l i n f l u e n c e s over a pe r iod of t ime. Most med ic ina l p l a n t s grow wild and i n abundance i n many p a r t s of Sudan, There i s ample scope f o r sys t ema t i c c u l t i v a t i o n of p l a n t s i n l a r g e a r e a s which a r e l y i n g was te .

T h e Medicinal and Aromatic P l a n t s Research I n s t i t u t e under t h e Nat ional Council f o r Research was e s t a b l i s h e d i n 1972 t o s tudy v a r i o u s a spec t s o f p l a n t s indigenous t o Sudan - t h e i r phytochemistry, agronomy, pharmacology and pharrnacognosy. The I n s t i t u t e i s compiling m a t e r i a l f o r t h e p u b l i c a t i o n of an a t l a s of medic ina l p l a n t s used i n Sudanese f o l k medicine. I n t h i s I n s t i t u t e p l a n t s on which t h e r e i s a l r e a d y some e thnobo tan ica l o r an thro- p o l o g i c a l informat ion are studied ~ I I p r e I r ~ r n c t : tu p l a n t s for w h i c h these is as y e t no such background informat ion .

The c u r r e n t r e s e a r c h p r o j e c t s i n t h e I n s t i t u t e i nc lude :

- M o l l u s c i c i d a l a c t i v i t y of c e r t a i n p l a n t s . - Ant i -he lmint ic a c t i v i t y . - Ant i -mic rob ia l agen t s of p l a n t o r i g i n . - Ant i -d i abe t i c a c t i v i t y of p l a n t s used i n Sudanese f o l k medicine. - Oxytocic, c o n t r a c e p t i v e and a b o r t i v e a c t i v i t y . - A n t i - c a n r ~ r aeent s - T r a d i t i o n a l management of g a s t r o - i n t e s t i n a l d i s tu rbances and

d i s e a s e s of e a r l y chi ldhood.

T h i s I n s t i t u t e en joys a c t i v e c o l l a b o r a t i o n wi th t h e T r a d i t i o n a l Medicine Research I n s t i t u t e , Khartoum.

Sudan has a-rich spontanenus f l o r a l d i s t r i h i ~ t l ' n n and thcrc is variation i n t h e use of medic ina l p l a n t s a t t h e PHC l e v e l .

I V IHO' s PROGMHME I N TRADITIONAL MEDICINE

Dr R.R. Chaudhury p re sen ted , on behalf of WHO Headquar ters , a paper on WHO'S overal lprogramme i n the f i e l d of t r a d i t i o n a l medicine. WHO had a l l o c a t e d p r i o r i t y t o t h r e e a r e a s f o r c o l l a b o r a t i o n wi th Member S t a t e s . These were i n t h e f i e l d s of Eva lua t ion , I n t e g r a t i o n and Tra in ing . I n t h e f i r s t a r e a , WHO was a t t empt ing t o have t r a d i t i o n a l medicine examined and evalua ted c a r e f u l l y , w i th an open mind, s o t h a t i t could be accepted and supported by a l l s e c t i o n s f o r use i n t h e d e l i v e r y of primary h e a l t h ca re . The second area, t h a t of i n t e g r a t i o n . involved an - e f f o r t t o col- l a b o r a t e w i t h national govcrnmcnts to integrate the use and practice of t r a d i t i o n a l medicine i n t o n a t i o n a l h e a l t h systems. With r ega rd t o t h e t h i r d a r e a , t r a i n i n g , a l l h e a l t h s t a f f - but p a r t i c u l a r l y medical and nu r s ing s t u d e n t s - need t o be made aware of t h e p l a c e of t r a d i t i o n a l medic ine , wh i l e t r a d i t i o n a l p r a c t i t i o n e r s need t o be approached wi th unders tanding and r e c o g n i t i o n of t h e i r s k i l l s s o a s t o encourage them t o sha re t h e i r knowledge

and play t h e i r p a r t i n t h e n a t i o n a l h e a l t h se rv ices . The es tabl ishment of WHO Col laborat ing Centres i n 'Lradi t ional Medicine, t h e ho ld i i lg ul: c u u s u l t a - t i o n group meetings and t h e organizat ion of courses i n s p e c i f i c s u b j e c t s were some of the mechanisms being used by WHO i n t h i s f i e l d ,

I S LAM1 C MEDICINE CENTRE, KUWAIT

D r Ahmed R. El-Gindy, then descr ibed t h e a c t i v i t i e s of rhe I s l amic Medicine Centre, Kuwait. He ind ica ted t h a t t h e r e were t h r e e main ongoing a c t i v i t i e s a t t h e Centre. S tud ies were being ccnducted on:

(a) Her i tage of t h e Muslim scho la r s (b) Rela t ion between Islam and Medicine (c) Herbal Medicine.

In t h e f i e l d of Herbal Medicine, t h e main theme of the a c t i v i t i e s were c a r r i e d on i n two departments as described below.

V-1. C l i n i c a l Department

Treatment of e i g h t d i s e a s e s has been introduced. The d i seases s e l e c t e d a re : (a) a l l e r g i c r h i n i t i s ; (b) bronchia l asrhma; ( c ) chronic s i n u s i t i s ; (d) d i a b e t e s ; ( e ) migraine; ( f ) rheumatism; (g) u r ina ry t r a c t i n f e c t i o n and (h) v i t i l i g o .

D r El-Gindy a l s o descr ibed r e l a t i o n s between t h e Centre and o t h e r h o s p i t a l s i n Kuwait and how they check on t h e i r p a t i e n t s .

V - 2 . Department of Research on Herbal Treatment

The Department comprises t h e following u n i t s :

(a) ~ h a r m a c o l o g i c a l u n i t (b) Phyto- and pharmacognostical u n i t Cc) Pharmaceutical and Development Unit ( d ) Quali ty Control Unit (e) Bacteriology ( f ) Ins t rumenta l a n a l y s i s .

Dr El-Gindy a l s o i d e n t i f i e d the aims, ob jec t ives and d u t i e s of each u n i t and gave examples of how t h e he rba l combination i s suggested and how the C e n t r e proceeds t o develop it i n t o a pharmaceutical formulat ion.

During the course of t h e meeting, the p a r t i c i p a n t s v i s i t e d t h e I s l amic Medicine Centre, t h e Cancer Centre and Adam Hospi ta l and saw t h e a c t i v i t i e s a t t h e s e cenr res . The group a l so visired the K u w a i t Oil Company a t Ahmadi.

WHO-EMIFHARM/ 107 page 10

VI MELllCLNAL PLANTS IN THERAPY

Dr Fsrnqwnrth then presented a background paper on Medicinal P l a n t s i n Therapy, He s t a t e d t h a t p l a n t s a r e u s e f u l sources of drugs , e i t h e r i n t h e form of e x t r a c t s or a s pure substances der ived from them. There a r e approximately 119 substances of known s t r u c t u r e t h a t a r e used g loba l ly a s drugs and which a r e e x t r a c t e d from p l a n t s . Abour 75Z of t h e s e drugs a r e used f o r t h e same purpose(s) a s t h e p l a n t s from which they a r e der ived. This meant t h a t , i n most c a s e s , t h e progeni tor p l a n t s could s t i l l be u s e f u l a s drugs i n t r a d i t i o n a l medicine. These 119 drugs were obrained from about 90 spec ies of p l a n t s , many of which can be c u l t i v a t e d i n developing coun t r i e s . These 119 plant -der ived d rugsof known s t r u c t u r e and/or t h e 90 spec ies of p l a n t s from which they were discovered, a r e u s e f u l f o r t h e t rea tment of 62 d i f f e r e n t d i s e a s e cond i t ions ( t h e r a p e u t i c c a t e g o r i e s ) .

Because of a s h o r t supply of q u a l i f i e d pharmacologists i n developing countries and since chemists/biochernists are usually not i n s h o r t supp ly , i t i s suggested t h a t i n the e a r l y s t a g e s of drug development programmes, i n t a c t animal s t u d i e s be s u b s t i t u t e d by so-cal led "pre-screens" ( i n -- v i t r o b i o a s s a y ~ ) t o i d e n t i f y u s e f u l drug e f f e c t s of p l a n t e x t r a c t s . These assays can b e c a r r i e d out by chemists/biochemists .

VII RESEARCII NEEDS IN TTE USE O F MEDICINAL PLANTS FOR TME DELIVERY OF HEALTH CARE

D r Mohammed lkram then presented a background paper on resea rch needs i n t h e u s e of medicinal p l a n t s f o r t h e d e l i v e r y o f - h e a l t h care. After discuss ion of t h e paper i t was f e l t t h a t t h e fo l lowing a c t i v i t i e s s h a l l be undertaken: . (a) Se lec t ion of he rba l p repara t ions f o r t h e most common d i seases i n each

country. (b) Pharmacological sc reen ing of the above p repara t ions should be undertaken

i n o rde r t o s e l e c t e f f e c t i v e medicinal p l a n t s . It w i l l be b e t t e r and more e f f e c t i v e i f c e n t r e s of excel lence i n s p e c i a l f i e l d s a r e developed i n each country , t h e s e could c o l l a b o r a t e i n pharmacological screening.

( c ) Pharmacological t e s t i n g ~ r i ~ r r i a have tu be u ~ u r l i f i r d f u r those herbal prepara t ions which have been i n use f o r a long time i n each country. The experience of China and Japan i n p a r t i c u l a r could be h e l p f u l i n t h i s r e s p e c t .

( d ) Standards have t o be p resc r ibed f o r q u a l i t y c o n t r o l of herbs . Poss ib le parameters could be: microscopic examination, l o s s on drying, ash con ten t , ac id inso lub le ash , water-soluble and a lcohol-soluble s o l i d s , q u a l i t a t i v e t e s t s , TLC and HPLC* Experience of China, Japan and I n d i a could be h e l p f u l .

WHO-EM/PHARp.1/107 page 11

The d i f f e r e n t approaches t o a ssess ing t h e e f f e c t i v e n e s s of medicinal p l a n t s were discussed by t h e p a r t i c i p a n t s . The advan~ages and d i s a d v a ~ l ~ a g e s * of both t h e t r a d i t i o n a l approach, whereby t h e p lan t substance i s t e s t e d f o r t o x i c i t y and f o r i t s pharmacological p r o p e r t i e s before being c l i n i c a l l y evaluated for efficacy, and t h e a l t ~ r n n t i v e approach whereby p l a n t s i n c m o n use could be d i r e c t l y assessed f o r e f f i c a c y i n p a t i e n t s a f t e r l imi ted animal toxicology s t u d i e s , were d iscussed a t l eng th . It was agreed t h a t each country would need t o i d e n t i f y which approach s u i t e d t h e country and fol low t h a t approach.

VIII SELECTION OF MEDICTIGAT.. PT.ANTS FOR USE AT PHC LEVEL

D r H i l a1 then presented a paper on t h e s e l e c t i o n of medicinal p l a n t s f o r use a t PKC l e v e l . This was discussed a t length i n r e l a t i o n t o t h e l i s t of p l a n t s suggested f o r use by t h e coun t r i e s a t Ehe PHC l eve l . A core l i s ~ of p lan t s f o r use i n t h e Region was then prepared. D r H i l l a l ind ica ted t h a t promotion and support of t h e incorporat ion of u s e f u l elements of t r a d i t i o n a l medicine i n t o n a t i o n a l health systems, viz. a t PHC l e v e l , has been a b a s i c approach i n WHO'S Global Medium-Term Programme of Trad i r iona l Medicine.

I n t h i s Region, t h e information which has been s y s ~ e m a c i c a l l y c o l l e c t e d from Member Countries showed t h a t t h e r e i s a wide range of t r a d i t i o n a l medicine wi th a v a r i e t y of backgrounds of b e l i e f s , p a t t e r n s of p r a c t i c e and p o t e n t i a l resources. A n increasing i n t e r e s t i n t h e promotion of t r a d i t i o n a l medicine, p a r t i c u l a r l y i n t h e f i e l d of medicinal p l a n t s and he rba l remedies, has been expressed by s e v e r a l coun t r i e s of t h e Region.

Regional progrulme a c t i v i t i e s have been p r imar i ly d i r e c t e d towards promoting and supporting n a t i o n a l e f f o r t s t o incorporate u s e f u l t r a d i t i o n a l p r a c t i c e s of proven e f f i c a c y wi th a view t o s t rengthening and extending the de l ive ry of h e a i t h care along w i t h the g loba l z t ra tegy of HFA/2000.

The f i r s t In te rcoun t ry Meeting on T r a d i t i o n a l Medicine was organized i n Khartoum i n March 1983. During the meeting, t h e Regional Medium-Term Programme f o r t h e per iod 1984-1989 was presented and discussed. Encouraging t h e development of l i s t s of Gssen t i a l medicinal and he rba l remedies which could be u s e f u l l y u t i l i z e d i n PHC was urged i n t h e recommendations.

Each country has , t h e r e f o r e , t h e d i r e c t r e s p o n s i b l i t y f o r prepar ing t h e appropr ia te l i s t according t o i t s own resources , d i s e a s e p a t t e r n s , a c c e p t a b i l i t y t o t h e people, h e a l t h p o l i c y and va r ious o the r environmental and soc io -cu l tu ra l f a c t o r s .

W H O - E M / P ~ ' I / ~ O ~ page 12

I X BROAD PLAN FOR DEVELOPMENT OF A REGIONAL PROGRAMME ON THE USE OF EIEDICINAL PLANTS AT PHC LEVEL

D r E l Saf i presented a paper e n t i t l e d "A Broad Plan f o r development of a r eg iona l programme on t h e u s e of medicinal p l a n t s a t PHC l e v e l " ( f o r complete t e x t , s e e Annex f V ) .

This was discussed a t l eng th and even tua l ly a p lan of a c t i o n was agreed upon for activities in the areas of (a) policies; (b) rcscarch; (c) manpower development and (d ) development of formulat ions ,

Agreement was a l s o reached concerning t h e inpu t s r equ i red from WHO f o r f u r t h e r development of t h i s programme.

X-1. A National Task Force o r Advisory Group should be s e t up i n every country t o i n i t i a t e , coordinate , monitor and implement programmes of t r a d i t i o n a l medicine.

X-2. It i s recommended t h a t information and knowledge about t h e use of herbal remedies be provided on a regular basis t o medical, paramedical and pharmacy graduates and s tuden t s .

X-3 . Systematic r e sea rch i n va r ious aspec t s of he rba l medicine should be i n i t i a t e d , organized and f u r t h e r s t rengthened. Centres of c l i n i c a l pharmacology should be s e t up t o he lp i n c l i n i c a l eva lua t ion of h e r b a l remedies f o r e f f i c a c y and s a f e t y .

4 A consu l t a t ion should be held t o develop s p e c i f i c r e g u l a t i o n s f o r r e g i s t r a t i o n o f h e r b a l p repara t ions i n coun t r i e s of t h e Region.

X - 5 . A c o n s u l t a t i o n should be held i n t h e Region f o r s t andard iza t ion of he rba l p repara t ions f o r , t h e r a p e u r i c purposes.

X-6. A meeting should be held i n L l i e Regiuri fur d e v r l u p i r l g a plan f u r economic e x p l o i t a t i o n of raw m a t e r i a l a v a i l a b l e i n t h e coun t r i e s of t h e Region and f o r s e t t i n g up r e g u l a t i o n s f o r i t s import and expor t .

X-7. It i s recommended t h a t pe r iod ic meetings be held t o monitor progress i n t h e implementation of t h e programme f o r t h e use of medicinal p l a n t s a t PHC l e v e l .

X-8. It i s f u r t h e r recommended t h a t WHO i n i t i a t e a c t i v i t i e s i n t h e following a reas :

(a) Drug information shee t s which should be prepared f o r a l l medic inal p l a n t s i d e n t i f i e d i n t h e Core L i s t f o r t h e most appropr ia te use of these a t PHC l e v e l .

WHO-EM/F'HARM/ 10 7 page 13

(b) Training to be provided in quality control, standardization, experimenral pllarmacology and c l i n i c a l pharmacology, all related to herbal medicine.

( c ) Data on medicinal plants identified in the core list can be supplied through the WHO Collaborating centre for Traditional Medicine in Chicago, USA, and the NAPRALERT data base.

X-9. A R e g i o n a l Advisory Panel f o r traditional medicine should be set up to accelerate development of this programme.

X-10. It is recommended that WHO should identify centres for eventual designation as WHO collaborative centres in rhis Lield.

WHO-EM/PHARM/ 107 page 15

ANNEX I

CATEC,OR.TES OF THE MOST COMMON DISEASES AND DISTURBANCES ENCOUNTERED AT

PHC LEVEL FOR WHICH HERBALREMEDIES COULD BE IDENTIFIED

G a s t r o i n t e s t i n a l t r a c t d i seases

Respiratory diseases

Skin d i seases

Helminthic i n f e s t a t i o n

Fever

f a i n and inflammation

A 1 l ergy

Urinary t r a c t d i seases

A r t h r i t i c condi t ions

Eye d i seases

Burns, s c a l d s , wounds, abscesses and swel l ings

Snake b i t e s , scorpion s t i n g s and i n s e c t s t i n g s

WHO-EM/PHARY/ 107 page 16

ANNEX I1

A CORE LIST OF MEDICINAL PLANTS FOR USE AT PHC LEVEL

C r i t e r i a for s e l e c t i n n of a core list

Tlie c o r e l i s t of h e r b a l remedies was s e l e c t e d , keep ing i n view t h e

following criteria:

a ) a c t u a l u s e of t h e m e d i c i n a l p l a n t s i n t h e c o u n t r i e s i n the Region;

b ) s c i e n t i f i c l i t e r a t u r e i n d i c a t i n g e f f i c a c y of the p l a n t s i n c e r t a i n d i s e a s e s and common a p p l i c a t i o n s ;

c ) ment ion in e a r l y t e s t s of I s l a m i c s c h o l a r s a s h a v i n g t n e r e p e u t i c e f f e c t , and

d ) u s e of t h e m e d i c i n a l p l a n t s f o r t h e r a p e u t i c purposes i n c o u n t r i e s o u t s i d e t h e Region.

Acacia a r a b i c a ( n i l 0 t i ca ) L.

Adhatoda v a s i c a Nees

A l b i z i a a n t h e l m i n t i c a Brongn.

~ ' i l l i u m cepa L.

OE! s p p . ( v e r a L . , f e r o x ?filler, barbadense)

X L t h e a o f f i c i n a l i s L .

A m i m a j u s L .

<Ismi v i snaga L.

Apium g r a v e o l e n s L .

~ l r t e m e s i a s p p . L. ( c i n a ) (Berg) h'illkom!

: \ zad i rac ta i n d i c a A. ( , ~ u s s )

B ~ r b e r i s a r i s t a t a L.

WHO-EM/PWJW/ 107 page 17

Capsicum minimum Roxb. (annum) L.

1 Cassia spp. (acutifolia Delile, angustifolia Vahl, fistula L.)

Chichorium intybus L. t

Cinnamomum Zeylanicum Nees (C. cassia Blume )

Commiphora makul mgl. (C. molmol Engier)

Cydonia oblonga Mill

Cympopogon proximus (Hochs t) S tapf

Datura spp. L.

Elettaria cardamamurn Maton

Fagonia arabica I,.

Ficus carica L.

Glycyrrhiza glabra L ,

Hibiscus sabdarrifa L.

Eyoscyamus spp. L.

Lactuca sativa L.

Lawsonia alba La Mark

Linum usitatissimum L.

Lupinus termis (albus) L.

Matricaria chamomile L.

Mentha spp. L.

Morus alba L.


Ocimum sanctum L.

Origanum spp. L.

Peganurn harmala L.

Plantago spp. (ovata Forsk, psyllium L. )

Prunus dornestica L.

Portulacca oleracia L.

fsidium guajava L.

Punica granatum

Raphanus sativum L.

Rheum officinalisa Baillon

Ricinus communis L.

Rosa dornestica L.

Sanralum album L.

Solenestemma argel Del., Hayne

Umbelliferous fruits: (anise L., fennel L., caraway L., cumin L., coriander L., dill L.. . . . . . . .)

Urginea maritima (Squill) L.

Withania somnifera L.

Zingiber officinale Roscoe


ANNEX T T J

HERBAL REMEDIES FOR COMMON DISEASES AND SYMPTOMS SEEN

Guidel ines f o r Development of Herbal Remedies .

Each p l a n t should be a u t h e n t i c a t e d b o t a n i c a l l y and the method of i t s c u l ~ i v a t i u ~ i , c o i l e c r i o n , s t o r a g c , processing and m a n u f a c t u r e should be e s t a b l i s h e d . The p a r t (s) of t h e p l a n t used and t h e t r a d i t i o n a l methods o f p repa ra r ion , dosage, mode of a d m i n i s t r a t i o n and usage should always be sought . This may n e c e s s i t a t e c o l l a b o r a t i o n between t h e c o u n t r i e s of t h e Region, The compiled t e x t should be r e g u l a r l y reviewed and updated i n t h e l i g h t of more informat ion , t o meer t he needs of h e a l t h c a r e .

The followirlg i s a list of rcmcdies used f o r common diseaqes and d i s tu rbances enountered a t PHC l e v e l . This list i s only a model of some h e r b a l medic ina l p l a n t s which a r e i n use i n most c o u n t r i e s of the Region, and should be modified by each r n r l n t r y t o meer i t s own requi rements . The p a r t of t h e p l a n t used, method of pre- p a r a t i o n of the remedy, dose t o be adminis te red , mode of a d m i n i s t r a r l o n of t h e p l a n ~ subs t ance and o t h e r such d e t a i l s w i l l be desc r ibed i n a s e p a r a t e subsequent pub l i ca t ion . This w i l l i n c o r p o r a t e Inf orrnation Shee t s f o r each of t h e p l a n t s inc luded i n t h l s l ist .

1. G a s t r o i n t e s t i n a l T r a c t Remedies

b. Laxatives .

c . Carminatives

d. Spasmolyt ics

e . S tamachics

f. Anti-Emetics

a. An t i -d i a r rhoea l s

Acacia a r a b i c a

Acacia ca techu '

Bexberis a r i s t a t a

Commifora molmol, C. mukul

Punica granatum


b. Laxatives

Aloe fe rox , A. barbadense, A. Vera

Cassia a c a t i f o l i a , C. angus t i f o l i a

Chicorium intybus

Glycyrrhien globra

Plantago ovata , P. p sy l l i um

Rharnnus f rangu la

Ricinus communis ( f ixed o i l )

Carminatives

Cinnamomum zeylanicum

E l e t t a r i a cardamomurn

Mat r i ca r i a chamomile

Menrha s p p .

Ocirnum sanctum

Origanuni spp . Thymus vu lga re

Umbelliferons F r u i t s , A n i s e , Caraway, Coriander, Cumin, D i l l , Fennel

Zingiber o f f i c i n a l e

. d. Spasmoly t i c s

Arropa belladonna

Datura spp .

Hyoscyamus s p p . Solcncstemnm n r g e l

e. Stomachics

Rheum o f f i c i n a l i s

f . Anti-Erne t i c s

Atropa belladonna

Hyoscyamus s p p .

Plentha s p p .

Z ing ibe r of f i c i n a l i s

WHO-EM/PHAIth/ 107 page 21

Remedies f o r Upper Kespiratory Ulseases

Adhatoda vas ica

Allium cepa

Althea o f f i c i n a l i s

Amni viannga

Cassia £ i s t u l a

Cinnamomum zeylanicum

Ficus c a r i c a

Glycyrrhiza g labra

Hibiscus s u b d a r r i f a

Linum usi ta t i ss imum

Mentha s p p .

Nigel la sativum

Ocimum sanctum

f runus domes tica

Psidium gua jara

T i l i a tomentosa, T. u l m i f o l i a

Urginea maritima

Zingiber o f f i c i n a l i s

3 - Remedies f n r Skin Diseases

Aloe Vera, A. barbadense, A. ferox

Armni majus

Azadiracta i n d i c a

F i cus c a r i c a

Fumaria o f f i c i n a l i s , F. p a r v i f l o r a

Lawsonia a lba

L u p i n u s t e n n i s , L. a lbus

Mat r i ca r i a chamomillae

N~mphaea alba

Santalum albam

WHO-EM/PHARM/~~~ page 22

4 . Anthclminthico

A l b i z i a a n t h e l m i n t i c a

A r t e m i s i a cina

5. A n t i p y r e t i c s

Allium cepa, A . sa t ivum

Fagonia a r a b i c a

6. Analges ics and Anti-Inflammatory Agents

Lac tuca s a t i v a

M a t r i c a r i a chamomile

f eganum harmala

7 . Anti-allerglcs

Cydonia oblonga

Zuzyphus v u l g a r i s

8, Remedies for Urinary In fec t ions

Ammi v i s n a g a

Enlnnitcs acgyp tioca

Cucumis sa t ivum, C. melo

Cympopogon proximus

Nymphaea a l b a

Raphanus s a tivum

9. Remedies f o r A r t h r i t i c Cond i t i ons

Capsicum minimum, C. annuum

Commif o r a mukul

WI tlnanla somnifera

WHO-EE.I/PHARM/ 107 page 23

10. Remedics for Eye Diseases

Berbe r i s a r i s t a t a

Rosa domascena

11. Treatment for burns , s c a l d s , wounds, abscesses and swellin~s

Aloe Vera, A. barbadense, A. f e r o x

Lawsonia a l b a

Linurn us i t a t i s s imum

Punica granatum

12.

Aloe s p p .

Azadi rac ta i n d i c a

Heliotropeum s t r ingosum

- .

N.R. Medicinal p l a n t s can a l s o be used a t Primary Heal th Care l e v e l f o r p reven t ive measures, e.g. i n s e c t r e p e l l e n t s : C i t r o n e l l ; Mul lusc i c ides ; B a l a n i t e s aegyp t i a c a e .

WHO-EM/PHARM/~~~ page 24

ANNEX IV

RROAn PLAN FnR T)F.VET.IIPMF.NT OF A REGIONAL PROGRAMME ON THE USE OF MEDICINAL PLANTS AT THE PRIMARY HEALTH CARE LEIEL

presented by

Plants and herba l remedies a r e I I G P ~ in C P V P T R ~ r n u n t r i e s in t h e E a s t e r n Mediterranean Region of T H O fo r the rapeu t i c purposes. P a r t i c u l a r l y i n t h e r u r a l a r e a s , people have b e l i e f and f a i t h i n he rba l medicine and look on t h e h e r b a l i s t and t h e t r a d i t i o n a l h e a l e r , t o a l a r g e e x t e n t , as t h e f i r s t l e v e l of h e a l t h c a r e t o which they have ready access .

It i s important t o use t h i s h e r i t a g e of .knowledge and information f o r treatment of p a t i e n t s a t t h e primary h e a l t h ca re (PHC) l e v e l where, i n f a c t , i t i s a l ready being used on a wide s c a l e .

There a r e , however, severa l d i f f i c u l t i e s , problems and c o n s t r a i n t s which a r e inherent i n t h e use of medicinal p l a n t s f o r t h e r a p e u t i c purposes. There a r e a l a r g e number of p l a n t s reputed t o be e f f e c t i v e f o r t h e t rea tment of a v a r i e t y of symptoms and s p e c i f i c d i seases and s e l e c t i o n needs t o be made as to which plants could be used for cach d i s c a s c . Practitionerc of the a l l o p a t h i c system of medicine may not r e a d i l y accept the claims regarding t h e e f f i c a c y of t h e s e he rba l remedies and need t o be convinced t h a t they a r e e f f e c t i v e and s a f e . Other i s s u e s , such a s t h e a v a i l a b i l i t y of t h e p lan t m a t e r i a l i n adequate q u a n t i t i e s , c u l t i v a t i o n of such p l a n t s or importat ion thereof i f necessary , s t andard iza t ion of the d i f f e r e n t p repara t ions , s to rage and d i s t r i b u t i o n may a l s o pose problems.

Primary Health Care (PHC) i s defined a s e s s e n t i a l ca re based on p r a c t i c a l , s c i e n t i f i c a l l y sound, s o c i a l l y acceptable methods and technology made un ive rsa l ly a c c e s s i b l e t o ind iv idua l s and f a m i l i e s i n t h e cornunity through t h e i r f u l l p a r t i c i p a t i o n and a cos t t h e community and country can a f fo rd . Two of t h e main elements of PWC a r e the provis ion of appropr ia te treatment of common d i seases and i n j u r i e s and provis ion of e s s e n t i a l drugs .

A r i c h mater ia medica, employing c h i e f l y cheap and indigenously a v a i l a b l e non-toxic drugs, deep knowledge of d i e t e t i c s i n h e a l t h and d i sease and a wide range of t h e r a p e u t i c measures a r e the c h a r a c t e r i s t i c s of t r a d i t i o n a l medicine. In view of the foregoing i t i s necessary t h a t a well-conceived po l i cy be adopted f o r t h e development and u t i l i z a t i o n of medicinal p l a n t s f o r use i n medical ca re .

WHO-EM/PHARM/107 page 25

Medicinal plants fnrm t h e main r e sources f o r t h e p r e p a r a t i o n of t h e r a p e u t i c r e c i p e s used i n t r a d i t i o n a l medicine. Each coun t ry , sub-region or l o c a i l i t y has i t s own p e c u l i a r f l o r a r e s u l t i n g from i t s own geophys ica l and c l i m a t i c cond i t ions .

These med ic ina l p l a n t s a r e e i t h e r c u l t i v a t e d s y s t e m a t i c a l l y o r grow w i l d l y . They may be indigenous t o t h e coun t ry o r imported i n a v a r i e t y of forms. Each coun t ry , through usage , has i d e n t i f i e d t h e most commonly used p l a n t s .

The group agreed on t h e fo l lowing broad p l a n of a c t i o n .

1. POLICIES

1.1. A t country l e v e l t h e r e i s a need f a r fo rmula t ion and d e c l a r a t i o n of n a t i o n a l p o l i c i e s f o r t h e development and use of t r a d i t i o n a l medicine systems i n c l u d i n g t h e u s e of med ic ina l p l a n t s This should be coupled w i t h a d m i n i s t r a t i v e , o r g a n i z a t i o n a l and budgeiary cumtl i tments t o meet t h i s g o a l .

1.2. Supportive legislation at all levels should be promulgated when necessa ry and r e s t r i c t i v e laws and c l a u s e s i d e n t i f i e d and r epea led i f p o s s i b l e .

1 .3 . I n many c o u n t r i e s r e s e a r c h on med ic ina l p l a n r s i s i n p r o g r e s s . Some c o u n t r i e s have compiled and pub l i shed i n v e n t o r i e s , f o r m u l a r i e s and pharmacopoeias of medic ina l p l a n t s . The c e n t r e s involved i n medicinal plant s research should be identified and a f o c a l c e n t r e des igna ted i n each count ry t o enhance i n t r a - and in t e r - coun t ry l i a i s o n and be r e s p o n s i b l e f o r follow-up of t h e implementat ion of t h e n a t i o n a l programme of u s e of med ic ina l p l a n t s a t PHC l e v e l .

1 .4 . A n a t i o n a l t a s k f o r c e o r working advisory group should be e s t a b l i s h e d . The composit ion of t h i s group should be m u l t i d i s c i p l i n a r y and widely representative including all concerned parties .

The t a s k f o r c e should have t h e fo l lowing t e r n s of r e f e r e n c e :

1.4.1. To s e n s i t i z e pol icy-makers and p l anne r s t o c u r r e n t i s s u e s r e l a t i n g t o medic ina l p l a n t s used a t PBC l e v e l and t o e n s u r e t h e c o l l a b o r a t i o n and h e l p u f policy-makers and planners in charge of the PHC programme i n each count ry .

1 . 4 . 2 , To i d e n t i f y , i n c o l l a b o r a t i o n w i t h t h e concerned h e a l t h a u t h o r i t i e s , t h e most commonly encountered d i s e a s e s a t PHC l e v e l .


1 .4 .3 . To i d e n t i f y and compile a l i s t of t h e medicinal herbs most commonly used f o r t h e treatment of these d i seases and d i so rders .

1.4.4. To formulate and implement a n a t i o n a l plan of a c t i o n f o r t h e s a f e and e f f e c t i v e in t roduc t ion of t h e s e medicinal p l a n t s f o r medical ca re a t PHC l e v e l .

1 . 4 . 5 . Tu e n s u r e luechanisms f o r regular procurement and distribution of medicinal p l a n t s t o h e a l t h de l ive ry teams a t PHC l e v e l . Such mechanisms should provide f o r s a f e s to rage and, i f necessary , c u l t i v a t i o n and/or importat ion of medicinal p l a n t s .

1 .4 .6 . To sponsor necessary resea rch conducive t o t h e e f f i c a c i o u s and s a f e use of medicinal p l a n t s and ensure t h a t i t i s c a r r i e d o u t . T h i s should be consonant wi th Lhe sLandards a i d r e g u l a t i v ~ ~ s 01 tile

country i n quest ion.

1- 6 . 7 . Tn devise mechanisms for on-going eva lua t ion and pe r iod ic review of progress of t h e in t roduc t ion of medicinal herbs f o r use a t PHC l e v e l .

2. RESEARCH

Research shcluld address q i i ~ s t i nns nf e f f i r.acy and s a f e t y and should s a t i s f y n a t i o n a l r e g u l a t i o n s and s tandards . The n a t i o n a l t a s k f o r c e may address t h e following:

2 . 1 . Formulate p lans f o r muldisciplinary/muLticentre appl ied research programmes i n each country. In tercountry programmes among Member coun t r i e s of t h e Region i n t h e s p i r i t of t echn ica l cooperation among developing countries (TCDC) is encouraged.

2.2. The o b j e c t i v e s of r e sea rch must be very c l e a r and d i r e c t e d toward p r a c t i c a l needs.

2 . 3 . A l l f a c i l i t i e s f o r research and exper t manpower, wi th in each country and i n t h e ~ e g i o n , should be u t i l i z e d maximally.

2 , 4 . L i t e r a t u r e f low and experience exchange should be encouraged between coun t r i e s of t h e Region. I n t e r n a t i o n a l da ta bases on medicinal p l a n t s , t h e i r delays and/or o the r l o c a l l i t e r a t u r e se rv ices should be e f f e c t i v e l y u t i l i z e d .


3 . MANPOIJER DEVELOPMENT

Active s t eps should be taken i n t o considera t ion with WHO t o promote manpower development i n t h e d i f f e r e n t d i s c i p l i n e s and a reas r e l a t e d t o the development and in t roduc t ion of medicinal herbs f o r use a t PHC l e v e l . Tile i u l l u w i n g areas should be considcred:

3.1. Devise appropr ia te t r a i n i n g programmes f o r t r a i n i n g of t r a i n e r s of Community Health Workers (CHWs), Trad i t iona l Medical P r a c t i t i o n e r s (TMF's) e t c . Tra ining of t r a i n e r s should be a cenr ra l a c t i v i t y f o r which i n s t r u c t o r s must be c a r e f u l l y chosen and coached.

3 . 2 . Compilation of s i m p l e training manuals on m~dirinal p l a n t s i n use a t PHC l e v e l i s e s s e n t i a l a s t r a i n i n g mate r i a l f o r Community Health Workers a s we l l as f o r o the r h e a l t h personnel.

3 .3 . Research f ind ings and re levan t in£ ormat ion on medicinal p l a n t s should be c i r c u l a t e d widely t o a l l personnel and t o t h e l ay pub l i c through a l l ava i l ab le and re levant media and through teaching, t r a i n i n g and orient-at i n n programmes.

3 . 4 . Revise manuals f o r Community Health Workers and Trad i t iona l B i r th Attendants with a view t o including i n them t h e re levan t information on rhe se lec ted m e d i c i r l a l plant s t o be u s e d at P l I C l eve l .

3 . 5 . It would be d e s i r a b l e f o r the therapy regimen t o be given t o PHC workers t o enable them t o t r e a t t h e i r p a t i e n t s appropr ia te ly . The regimen should expla in t h e s igns and symptoms of t h e d i s e a s e , i t s course, t h e drug of choice, the po in t s t o be observed during the course of t rea tment , and an ind ica t ion a s t o when and where t o r e f e r the patient at t h e r i g h t t i m e .

4. DEVELOPMENT OF FORWLATIONS OF MEDICINAL PLANTS FOR USE AT PHC LEVEL

4.1. There i s need t o make a v a i l a b l e t o medical and paramedical personnel, t r a d i t i o n a l medical p r a c t i t i o n e r s and community hea l th workers, e t c . s tandardized medicinal plant p r e p ~ r a t i nns i n appropr ia te formulation. Member S t a t e s w i l l need t o consider c a r e f u l l y t h e appropr ia te methods of manufacturing formulations presented f o r use a t PHC l e v e l , according t o each country ' s p a r t i c u l a r needs and ava i l ab le resources .

4 .2 . Counrrl es are encouraged t o produce a t l e a s t some herbal pharmaceuticals l o c a l l y . I n order t o do t h i s , funds should be ava i l ab le f o r f e a s i b i l i t y s t u d i e s t o e s t a b l i s h q u a l i t y con t ro l and a small-scale 'production f a c i l i t y .

WHO-EM/PHW/ 107 page 28

4 . 3 . There i s need t o improve and promote methods of c u l t i v a t i o n , c o l l e c t i o n and s t o r a g e of s e l e c t e d med ic ina l p l a n t s . The c u l t i v a t i o n , c o l l e c t i o n and product ion of medic ina l p l a n t s w i t h i n a count ry should be c a r e f u l l y s t u d i e d .

4 .4 . Where necessa ry and a p p r o p r i a t e , s imple mul t ipu rpose k i t s con ta in ing a s e l e c t e d assor tment of med ic ina l p l a n t s (among o t h e r a c c e s s o r i e s ) f o r Community Hea l th Workers (CHWs) should be dev i sed .

5 . WHO INPUTS

A Regional Advisory Pane l f o r T r a d i t i o n a l Medicine should be s e t up t o g i v e impetus r o t h e whole programme of t r a d i t i o n a l medic ine i n t h e Region.

5.1. Through i t s network of Co l l abora t ing Cent res f o r T r a d i t i o n a l Medicine and o t h e r r e l a t e d d i s c i p l i n e s , both w i t h i n and o u t s i d e t h e Region, WHO should maximally u t i l i z e a r e a s of competence of each c e n t r e , i n thc interests of healthy collaboration and exchange of p x p e r i p n ~ e , e x p e r t i s e and knowledge.

5 . 2 . A s e r i e s of workshops a t n a t i o n a l l e v e l should be sponsored by IJHO t o addres s problems r e l a t e d t o t h e u s e of med ic ina l p l a n t s at PHC l e v e l .

5.3. In-count ry training courses and scholarships should be f a c i l i t a t p d and sponsored by WHO i n t h e f i e l d of med ic ina l p l a n t r e s e a r c h .

5 .4 . Funds t o f i n a n c e n a t i o n a l programmes of use of med ic ina l p l a n t s a t PRC l e v e l should be a l l o c a t e d by TkEIO.

WHO-EM/PHARM/ I07 page 29

ANNEX V

AFGHANISTAN

EGYPT

KUWAIT

PAKISTAN

LIST OF PARTICIPANTS

M r A. Rahman Pazhoohesh Pharmacist Min i s t ry of Pub l i c Heal th Kabul

DL Mullanled Gala1 Gllurab H e ad Department of Research and Drug Contro l Memphasis Pharmaceutical Company, Zei ton Cairo

* D r Shehab Ahmed Shehab Medical O f f i c e r Cent re of I s l amic Medicine Kuwait -.

* D r (Mrs) Kadriah A 1 Awadi Min i s t ry of Heal th Kuwa i t

D r Adel A1 Sharad Min i s t ry of Health Kuwa i r

D r Abdullah Al-Khars Department of Pharmacology/Toxicology Facu l ty o i Medicine Kuwait Un ive r s i ty Kuwait

* D r Sameeha Al-Fla i j Min i s t ry of Heal th Kuwait

D r Mazharul Haaue Associa te Phys i c i an and A s s i s t a n t P ro fes so r Department of Medicine J innah Pos tgraduate Medical Cent re Karachi

* Did no t a t t e n d .

WHO-EM/PHAKM/ 107 page 30

SAUDI ARABIA

SOMALIA

OBSERVERS

KUWAIT

Pharm. Saud Al-Eshaiwy Riyadh Cen t r a l H o s p i t a l Rivadh

D r Abdullahi Mohamed Ahmed Lec tu re r of ~ r a d i t i o n a l Medicine Faculty of Mcdicine, S.N.U. Mogadishu

D r Ahmed Khider Bashi r Senior Researcher Medical Research I n s t i t u t e and Acting D i r e c t o r , Medical Research Council Na t iona l Council fo r Research Khart o m

Dr Mohamed Z u l ~ u u r A 1 Hassar~ Mini s t ry of Heal th Kuwait -. . D r Ahmed Abul Fad1 Min i s t ry of Heal th Kuwait

Pharmacist Mokhtar A1 Bish r Min i s t ry of Heal th Kuwait -- D r Ryad A 1 Alami Min i s t ry of Hea l th Kuwait

WHO-EM/PHARM/107 page 31

OBSERVERS (cont 'd)

KUWAIT

SAW1 ARABIA

D r Saleh Garbawi Minis t r y of Heal th Kuwait --

Dr (Mrs) M a r i e m A1 Jaccim Minis t ry of Heal th Kuwait -- D r Fahim h e r Minis t ry of Health Kuwait -- D r Ahmed Shawky Ibrahim Minis t ry of Heal th Kuwait

D r Mohamed Saber Minis t ry of Heal th Kuwa i t

D r Hamel A 1 Shabouri Minis t ry of Heal th Kuwait

D r Unaizy Al-Unaizy M i r l i s t r y uf Health Kuwait

M r Tala1 Fouad Hamdi D i r e c t o r , Kiraa Hosp i t a l Mecca - M r Saleh Al-Senouna D i r e c t o r , Medical Supply S t o r e s Eas te rn Province Min i s t ry of Health Dammam

M r Ibrahim Motawea King Fahd Hosp i t a l Pharmacy Department Med ina

D r Mohammed Abdul A z i z Al-Yahya College of Pharmacy King Saud Univers i ty Riyadh


RESOURCE EXPERTS -

Prof . N . Farnsworth

Dr Ekram Sezik

Professor of Pharmacognosy Univers i ty of I l l i n o i s , Chicago USA

Hacettepe Univers i ty Faculcy of Pharmacy Head, Pharmacognosy Department and Consultant of Minis t ry of Health nn Herhal Medicine

Ankara TURICEY

WHO SECRETARIAT

D r R.R. Chaudhury Regional Adviser, World Health Organization Pharmaceutical , Diagnostic

and Therapeut ic Substances (Secretary)

D r Ahmed E l Saf i Temporary Adviser

D r Mohamed Ikram Temporary Adviser

D r A .R . E l Gindy Temporary Adviser

DL S a y e d Hilal T e r r ~ p u ~ a r y A d v i s e r

Hakim H.A. Razzack Temporary Adviser

Miss Aysha Heta ta Conference Off i c e r

Mrs M.T. Panayo t t i Secre tary

D i r e c t o r , v

T r a d i t i o n a l Medicine Research Institute

and WHO Col laborat ing Centre

f o r T r a d i t i o n a l Medicine Khartoum, SvDAX

D i r e c t o r , Pak i s t an Council of Scientific and I n d u s t r i a l Research, Pesbawar , PAKISTAN

Is lamic Medical Centre , Kuwait

D e a r i , Faculty of Medicine, Cairo Univers i ty Cairo, EGYPT -- Direc to r , Centra l Council f o r Research i n Unani Medicine. New Delhi, I N D I A

World Health Organization

World Health Organization

WHO-EM/PHARY/ 107 page 33

ANNEX VI

AGENDA

1. Opening o i meetlng.

2. P r e s e n t a t i o n and d i s c u s s i o n of exper ience i n t h e use of medic ina l p l a n t s for p r i m a r y h e a l t h care in c-ountries i n the Region.

3 . P r e s e n t a t i o n and d i s c u s s i o n of t h e exper ience i n t h e use of med ic ina l p l a n t s f o r primary h e a l t h c a r e i n o t h e r c o u n t r i e s o u t s i d e t h e Region.

4 . I d e n t i f i c a t i o n of a c o r e l i s t of med ic ina l p l a n t s t o be used f o r d e l i v e r y of primary h e a l t h c a r e i n c o u n t r i e s i n t h e Region.

5. Discuss ion of t h e r e s e a r c h needs f o r f u r t h e r u s e of med ic ina l p l a n t s a t the primary h e a l t h c a r e l e v e l .

6 . Discuss ion and development of a broad Regional programme t o s u p p o r t t h e use of medic ina l p l a n t s f o r primary h e a l t h c a r e i n c o u n t r i e s i n t h e Region.

7. Closing session.

WHO-EM/PHARM/ 3.07 page 34

ANNEX VLL

PROGRAMME

Saturday , 20 A p r i l 1985

09.30 - 10.00 - R e g i s t r a t i o n

Sunday, 21 A p r i l 1985

U8.3U - 1U.UU

10.30 - 11.00

11.00 - 11.30

- Opening Sess ion , P lenary Inaugura l Address by H.E. D r Abdul Rahman A 1 Awadi, M i n i s t e r of P u b l i c Heal th and M i n i s t e r of P lanning

- Message from D r Hussein A. Gezai ry , D i r e c t o r , WllO Eastern fledi terranean Region

- Recess

- E l e c t i o n of O f f i c e r s (Chairman, Vice Chairman, Rapporteur)

- Adoption of t h e Anenda

- I n t r o d u c t o r y Remarks - Regional Adviser on Pharmaceut ica ls , D r R. R. Chaudhury

- P r e s e n ~ a ~ i o n of background pape r s on p l a n ~ s be ing used a t t he primary h e a l t h c a r e l e v e l i n t h e c o u n t r i e s of t h e Region

- Yresen ta t lon of background papers by p a r t i c i p a n t s

- Recess

- Presentation by D r E l Gindy on " I s l amic Medical Cen t r e i n Kuwait"

- "An overview of t h e use of med ic ina l p l a n t s for d e l i v e r y of primary h e a l t h ca re" prepared by D r 0. Akere le , Programme Manager TRM, Geneva, p r e sen ted by Dr K.R. Chaudhury

- P r e s e n t a t i o n of background paper " S e l e c t i o n of med ic ina l p l a n t s f o r use a t the primary h e a l t h c a r e l e v e l "

- General Discuss ion

WHO-EM/PHAKM/107 page 35

Monday, 22 A p r i l 1985

08.30 - 15.00

Tuesday, 23 A p r i l 1985

08.30 - 09.30

Wednesday, 24 A p r i l 1985

08.30 - 09.30

- V i s i t t o I s l amic Medicine Cent re

- V i s i t t o Cancer Cent re

- V i s i t t o Al-Eidan Hosp i t a l

- V i s i t t o KOC a t Ahmadi

- Workshop d i s c u s s i o n s on p r e p a r a t i o n of a c o r e l i s t of medic ina l p l a n t s f o r u se i n c o u n t r i e s <TI the Region

- Discuss ion on p r e p a r a t i o n of a co re l i s t (cont inued)

- "Herbal M e d i c i n e today". L e c t u r e p r e s e n t e d by P ro fes so r N. Farnsworth, P r o f e s s o r of Pharma- cognosy, Un ive r s i ty of I l l i n o i s , Chicago, USA.

- P r e s e n t a t i o n of a c o r e l is t of med ic ina l p l a n t s t o be used a t t h e primary h e a l t h c a r e l e v e l

- Recess

- Discuss ion and f i n a l i z a t i o n of c o r e l i s t

- P r e s e n t a t i o n of background paper on "A broad p l a n f o r development of u se of med ic ina l p l a n t s f o r primary h e a l t h c a r e i n t h e c o u n t r i e s i n t h e Region"

- Recess

- Research needs i n t h e use of medic ina l p l a n t s f o r d e l i v e r y of h e a l t h c a r e

- Discuss ion on development of a broad p l a n f o r u s e of med ic ina l p l a n t s f o r primary h e a l t h c a r e i n the countries i n t h e Region

Thursday, 25 A p r i l 1985

08.30 - 09.10

WHO-EM/PHARY/ 10 7 page 36

- Problems and c o n t r o v e r s i e s i n c l i n i c a l e v a l u a t i o n of m e d i c i n a l p l a n t s

- Recommendations r e g a r d i n g f u r t h e r use of m e d i c i n a l plants f o r d e l i v e r y of p r imary h e a l t h c a r e

- Recess

- Adoption of Repo r t

- Clos ing S e s s i o n .

Documents

REPORT OF AN INTERCOUNTRY MEETING ON THE USE OF …applications.emro.who.int/docs/who_em_pharm_107_en.pdf · REPORT OF AN INTERCOUNTRY MEETING ON THE USE OF MEDICINAL PLANTS AT THE