Herbal Medicine in Andrology

By Ashok Agarwal

Herbal Medicine in Andrology: An Evidence-Based Update provides a comprehensive overview of ethnomedical approaches in andrology, including ethnopharmacology of plant extracts and relevant bioactive compounds. It highlights information on the availability of medicinal plants and the legal and procedural processes involved in developing a marketable product. This reference helps clinicians and scientists develop an understanding on how herbal medicine can be used to treat andrological patients in practice. Only a limited number of journal articles are available on this topic, making this reference a valuable source of information for a large audience, including urologists, andrologists, gynecologists, reproductive endocrinologists and basic scientists.

• Provides essential evidence-based information about herbal medicine
• Offers an ethnopharmacological background on bioactive compounds in certain plant extracts
• Educates the basic scientist and clinician on the use of herbal medicines in andrology
• Provides an update to recent advances on herbal medicine in andrology from world experts

• Language: English
• Publisher: Academic Press
• Release date: Nov 13, 2020
• ISBN: 9780128155660

Book preview

health.

Preface

Ralf Henkel

Ashok Agarwal

Infertility is a global health concern affecting over 190 million couples in reproductive age of which half is due to a male factor, which contributes about 50% to infertility in general. Modern western medicines including reproductive medicine, and andrological medicine in specific, are expensive and put a strain not only on the health systems but also on couples desiring their own child, specifically in emerging economies or poor countries. About 80% of the global population relies on traditional remedies for their primary health care for traditional beliefs and because they are more affordable than western medicines. In addition, even in First World countries, many people are concerned about pharmaceutical drugs due to their known and unknown side effects and high cost. As a result, the market for herbal products is booming. On the other hand, only very few plant products such as yohimbin from the African Yohimbe tree are used in western medicine to treat andrological problems. Since herbal medicine is an under-investigated field, more light needs to be shed on the treatment options that plant products provide to treat male infertility and other kinds of andrological problems. Therefore, there is an urgent need not only to explore the opportunities that herbal medicine provides to treat andrological problems, but also to inform clinicians and scientists about the effects of herbal extracts on male reproductive functions.

This book provides a detailed description of the currently known, traditionally used herbal remedies from all over the world to treat andrological problems. Renowned experts from 10 countries have generously contributed 20 state-of-the-art chapters for this book. Our book provides detailed information on plants from different continents that can be used to treat a multitude of andrological conditions. The book also includes a brief history of herbal medicine as well as herbal pharmacognosy and aspects of quality control and legal regulations.

The combination of basic herbal science and clinical information makes our book well suited for fertility practitioners, andrologists, urologists, medical doctors, reproductive professional, and research students.

We are grateful to our contributors, who are distinguished leaders in the field with extensive experience from around the world.

This book would not have been possible without the excellent support of Elsevier. We are thankful to Tari Broderick, senior acquisition editor, and Sam Young, editorial project manager for an excellent management of this project. The editors are grateful to their families for their love and support.

We genuinely hope that this volume will support and enrich your clinical practice in clinical andrology.

Introduction

Damayanthi Durairajanayagama; Ashok Agarwalb; Ralf Henkelb,c,d, a Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia, b American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, United States, c Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom, d Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa

Traditional medicine is practiced around the globe either as a basis for health care or as a counterpart to it, whereby it is termed as complementary medicine [1]. Both traditional and complementary medicines are a mainstay in most countries worldwide. The increasing demand for its services supports the importance of traditional and complementary medicines as part of health care. Herbal medicine is a widespread and important form of traditional and complementary medicines that has been used since ancient times. The World Health Organization (WHO) defines herbal medicines as those that include herbs, herbal materials, herbal preparations, and finished herbal products that contain, as active ingredients, parts of plants, other plant materials, or combinations thereof [2]. The use of herbal medicines and interest in this branch of traditional medicine continue to grow in both developing and developed countries. Herbal medicines and remedies serve as either treatment or complementary/alternative therapy for a variety of acute and chronic conditions, including infertility and other reproductive disorders.

The book Herbal Medicine in Andrology: An Evidence-Based Update is a unique collection of articles that highlight the current knowledge and significant aspects regarding the use of herbal medicines in dealing with issues of the male reproductive tract. This first edition of the book provides a comprehensive overview of herbal-based approaches in andrology, which are well described within 20 chapters. The contributing authors of these chapters are clinicians, pharmacists, and scientists from 20 different institutions located in 10 countries across the globe who were carefully selected based on their expertise in the field. This book is divided into three main sections: the first section defines herbal medicine and describes its development as a therapeutic modality; the second section takes a closer look at some of the commonly used herbal medicines from various regions around the world; and the third section deals with issues regarding the regulatory and procedural processes involved in developing medicinal plants into a product of standardized quality for mass consumption.

In Chapter 1 of the first section, readers are introduced to the historical background of herbal medicine use [3]. In Chapter 2, Dada and colleagues delve into the utility of herbal medicines as a treatment option as either primary or supplementary therapy [4]. They emphasize the need for conventionally trained physicians to also familiarize themselves with common herbal remedies to bolster a more open and forthcoming doctor-patient relationship. Physicians may find it informative to read scientific articles on these common herbs and secondary plant metabolites to broaden their understanding of herbal medicines and how they work. Chapter 3 explores the increased scientific focus on herbal pharmacognosy in the search for novel therapeutic molecules that have the potential to be developed into medicines for use in clinical practice [5]. Chapters 4 and 5 in the first section give an overview of clinical presentations and indications of male reproductive disorders and how these may potentially be managed using herbal medicines [6, 7].

The second section of the book probes deeper into the use of herbal medicines from various parts of the globe, such as Asia and the Indian subcontinent, China, Europe, America, Middle East, and Africa in the treatment of andrology-related issues. The 10 chapters in this section provide readers with evidence-based updates on the plant-based herbal remedies normally used to treat male reproductive disorders and offers insights into the possible mechanisms through which these herbs may be acting. Asia is a continent blessed with a cornucopia of herbs. Among the selected herbs from Asia and the Indian subcontinent that are discussed in this book are Eleutherococcus senticosus and Astragalus membranaceus[8], Withania somnifera, Panax ginseng, and Centella asiatica[9], Eurycoma longifolia jack [10], Zingiber officinale, and Epimedium grandiflorum[11], as well as Ginkgo biloba, Curcuma longa, and Camellia sinensis[12]. The practice of herbal therapy is deeply rooted in traditional Chinese medicine. With regards to this, Ma and Meredith have described several tonic herbs that are traditionally used in treating ailments of the reproductive tract, namely Herba Epimedii, Lycium barbarum, Herba Cistanches, Semen Cuscutae, Radix Morindae Officinalis, and Fructus Psoraleae[13]. Europe also shares a vibrant history with respect to the use of herbal medicines. For example, Pinus pinaster extracts serve as a source of procyanidins to combat oxidative stress, while a combination of Urtica dioica and Serenoa repens (an older synonym for the species is Sabal serrulata) are clinically used in managing benign prostatic hyperplasia-induced lower urinary tract symptoms in European practice [14]. The Americas too are immensely rich in native medicinal plants. Among the species of herbs from the geographical subregions of North America, Central America and the Caribbean, and South America that are discussed include Lepidium meyenii (Maca), Serenoa repens, and Cucurbita pepo[15]. The wide array of medicinal herbs traditionally used in treating andrological conditions in countries of the Middle East [16] and Africa [17] are also described.

The final section of the book deals with issues concerning the development of herbal medicines and medicinal plants that have long been utilized in traditional medicine practices into quality-controlled products for clinical use. This section highlights the multiple legal and procedural processes involved in product development before it can become a marketable product. Emphasis is placed on the need for appropriate regulatory measures to facilitate strict quality control of raw plant materials along with standardized extraction, formulation, and manufacturing procedures [18, 19]. Implementation of qualified reference standards, good manufacturing practices, and regulatory requirements contribute greatly in producing herbal medicines of standardized quality. The clinical implications of drug interactions due to coadministration of conventional and herbal medicines in andrology are also described [20]. Evidence from clinical trials performed using traditional herbs, namely E. longifolia, L. meyenii, W. somnifera, and Trigonella foenum-graecum are reviewed along with regulatory issues associated with the acceptance of herbal medicines in andrology [21]. The final chapter of this book illustrates the factors affecting the integration of traditional herbal medicine into contemporary clinical practice and propose several strategies for its improvement [22].

With limited publications available on the clinical use of herbal medicines in treating andrological patients, the chapters included in this book provide immense value to both clinicians and scientists working in the evolving field of male reproductive health. It serves as a comprehensive and valuable evidence-based resource for a wide readership that include urologists, gynecologists, reproductive endocrinologists, andrologists, and basic scientists. We hope that you, as our readers, will appreciate the tremendous value of this book and share our enthusiasm for integrating herbal medicines into evidence-based clinical management of male sexual and reproductive health disorders.

References

[1] World Health Organization. WHO traditional medicine strategy: 2014–2023. Geneva: World Health Organization; Dec 2013.978-92-4-150609-0. Cited 23 May 2020. Available from: http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf.

[2] World Health Organization. WHO global report on traditional and complementary medicine 2019. Geneva: World Health Organization; 2019.978-92-4-151543-6. Cited 23 May 2020. Available from: https://www.who.int/publications-detail/who-global-report-on-traditional-and-complementary-medicine-2019.

[3] Sharma A., Sabharwal P., Dada R. Herbal medicine—an introduction to its history. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 1].

[4] Dada R., Sabharwal P., Sharma A., Henkel R. Use of herbal medicine as primary or supplementary treatments. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 2].

[5] Leisegang K. Herbal pharmacognosy: an introduction. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 3].

[6] Tambi I. Overview on the clinical presentation and indications (Part A). In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 4].

[7] Erasmus L. Overview on the clinical presentation and indications (Part B). In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 5].

[8] Opuwari C.S. Herbal medicine use to treat andrological problems: Asia and Indian sub-continent—Eleutherococcus senticosus, Astragalus membranaceus. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 6].

[9] Sengupta P., Durairajanayagam D., Agarwal A. Herbal medicine use to treat andrological problems: Asia and Indian sub-continent: Withania somnifera, Panax ginseng, Centella asiatica. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 10].

[10] Tambi I. Herbal medicine use to treat andrological problems: Asia and Indian sub-continent: Tongkat Ali (Eurycoma longifolia jack). In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 11].

[11] Erasmus L. Herbal medicine use to treat andrological problems: Asia and Indian sub-continent: Zingiber officinale, Epimedium grandiflorum. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 12].

[12] Roychoudhury S., Chakraborty S., Das A., Guha P., Agarwal A., Henkel R. Herbal medicine use to treat andrological problems: Asia and Indian sub-continent: Ginkgo biloba, Curcuma longa, Camellia sinensis. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 13].

[13] Ma X., Meredith J. Herbal medicine for the treatment of andrological diseases: Traditional Chinese Medicine. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 14].

[14] Leisegang K. Herbal medicine use to treat andrological problems: Europe. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 15].

[15] Gonzales G.F., Gasco M., Vasquez-Velasquez C., Fano D., Alarcón-Yaquetto D.E. Herbal medicine use to treat andrological problems: Americas. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 7].

[16] Bahramsoltani R., Rahimi R. Herbal medicine use to treat andrological problems: Middle East. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 8].

[17] Opuwari C.S., Moundipa P.F. Herbal medicine use to treat andrological problems: Africa. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 9].

[18] Patnala S., Kafner I. Quality control, extraction methods and standardization: interface between traditional use and scientific investigation. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 16].

[19] Kafner I., Patnala S. Regulations for the use of herbal remedies. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 17].

[20] Moundipa P.F. Herbal medicines used for andrological problems and drug interactions. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 18].

[21] George A., Liske E. Acceptance of herbal medicines in andrology. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 19].

[22] Ayodele E.S., Oyebola E.E. The status of integration of herbal medicines into modern clinical practice and possible development of the market. In: Henkel R., Agarwal A., eds. Herbal medicine in andrology: An evidence-based update. 1st ed. Academic Press; 2020:978-0-1281-5565-3 [chapter 20].

Chapter 1: Herbal medicine—An introduction to its history

Akanksha Sharmaa; Pooja Sabharwala; Rima Dadab    a Department of Rachana Sharir, CBPACS, New Delhi, India

b Molecular Reproduction and Genetics, Department of Anatomy, AIIMS, New Delhi, India

Abstract

Medicine is a substance that has nutritive, curative, or preventive properties, while the term herbal refers to a botanical or plant-based preparation. Hence, the term herbal medicine is used for plant-based substances that consist of nutritive, curative, or preventive properties. Herbal medicine is an interdisciplinary branch between herbal medicine and Ayurveda as it covers all fields of herbal medicine related to botany, medicinal plant research, pharmacognosy, phytochemistry, phytotherapy, botanical medicines, Ayurveda, natural chemistry, agriculture science, Unani medicine, biotechnology, and biochemistry. A person who deals with herbs, especially medicinal herbs, is known as an herbalist. Herbal journals deal with the use of plants in the treatment of diseases.

Keywords

Botanical medicine; Pharmacognosy; Phytochemistry; Ayurveda; Agriculture science; Herbal medicine; Biotechnology

1: Introduction

Herbal medicine is a practice that includes herbs, herbal material, and preparations that contain parts of plants or combinations thereof as active ingredients. These herbs are derived from plant parts such as leaves, bark, flowers, roots, fruits, and seeds [1].

The World Health Organization (WHO) defined traditional medicine (including herbal drugs) as therapeutic practices that have been in existence for hundreds of years, before the development and expansion of modern medicine, but are still practiced presently. Herbal drugs constitute only those traditional medicines that primarily use medicinal plant preparations for therapy. The earliest recorded evidence of their use in Indian, Chinese, Egyptian, Greek, Roman, and Syrian texts dates back about 5000 years. The classical Indian texts include Rigveda, Atharvaveda, Charaka Samhita, and Sushruta Samhita[2].

Generally, it is estimated that about 80% of the global population relies on herbal remedies for their primary health care, a figure that varies in different countries [3]. Data from the WHO reveal that the population in developing countries such as India (65%–70%), Rwanda (~  75%), Tanzania (50%–60%), Uganda (55%–60%), Benin (80%), and Ethiopia (90%) widely utilize their traditional and alternative medications for healthcare services. Even in developed countries such as Australia (48%–50%), Belgium (30%), France (50%), the United States (45%), and Canada (65%–70%), a remarkable proportion of the population is utilizing traditional cures occasionally for human health services [4–6].

It is hard to obtain exact figures for the aggregate number of medicinal plants on earth; in one estimation, around 35,000–70,000 plant species are being used worldwide in human healthcare services, and Indian Pharmacopeia alone incorporates more than 3000 drugs of natural origin [7].

According to the WHO, 80% of the population in developing countries depends almost entirely on traditional medicine practices and herbal medicines for their primary healthcare needs [8]. Furthermore, at the beginning of the 21st century, the worldwide annual market for herbal medicinal products approached US$60 billion [9] and the long tradition of herbal medicine continues to the present day in China, Indian, and many countries in Africa and South America.

2: Historical perspective of herbal medicine

Worldwide, people have been using herbal medicine for the treatment, control, and management of a variety of ailments since prehistoric times. The earliest written account of herbal medicine came from China and dates back to 2800 BC, and archeological remains from early civilizations have revealed that plants were used in burials and other rituals. Physical evidence of the use of herbal remedies goes back 60,000 years to a Neanderthal man’s grave uncovered in Northern Iraq in 1960. An analysis of the soil revealed extraordinary quantities of plant pollen at the grave, which were medicinal plants still in use today [10].

2.1: Vedic and Medieval era

The foundation of traditional medical knowledge on the Indian subcontinent is known as the ancient Vedic era (c.1500–500 BC), during the settlements of the first Indo-Aryan tribes in Northwest India and the Ganges plain. This period corresponds to the Vedas (Rigveda, Yajurveda, Samaveda, and Atharvaveda). There is an intense relation between Indian traditional medicine and the Vedas[11]. The Vedic sages adopted passages from the Vedic scriptures relating to Ayurveda and compiled books dealing only in Ayurveda. One of these books, called the Aatreya Samhita, is among the oldest medical books in the world. Ayurveda is the appurtenance of Atharvaveda. Worldwide, people have been using herbal medicine for the treatment, control, and management of a variety of ailments since prehistoric times. In India, herbal medicine, the Rigveda, a collection of Hindu sacred verses, contains most aspects of Vedic science such as yoga, meditation, mantra, and Ayurveda, which are still widely practiced today.

In the later Vedic period, theistic philosophies like Sankhyam, Yogam, Nyayam, Vaisheshikam, Poorvamimaamsa, and Utharamimaamsa, and atheistic philosophies, namely, Jainadarsan, Buddhadarsan, and Charvaakadarsan, paved the way for Ayurvedic principles. Agnivesh Samhita, Bhela Samhita, Haritha Samhita, Samshrutha, and Kashyapa Samhita are the other books on Ayurveda written in this period.

The documents of 500 BC indicate that this medicinal system might have even earlier origins. Even though Ayurveda knowledge is 3500 years old, there has been a continuous evolution of subjects and texts dating back to three major time periods [12–14]. This highlights the nature of Ayurveda as a living tradition.

In ancient times (Prachin Kala), dating back from c.1500 BC to the 12th century AD, major compendia (Samhitās) were created and attributed to different authors like Charaka, Suśruta, and Kashyapa. For instance, the Charaka Samhita, which relates internal medicine teachings of Punarvasu Aatreya to his students, was originally written by one of the students, Agniveśa (1500 BC), revised by Charaka around 200 BC, and reconstructed six centuries later by Dridhabala.

Another important piece of work is the Suśruta Samhita, relating to surgery knowledge. Again, several authors contributed: Nagarjuna, eight centuries later related the original works of Suśruta (c.400 BCE), later reviewed by Chandrhata (c.1000 CE). Samhitas are the master texts on which all the current prevailing documents are based, and were periodically edited over the centuries [15]. The knowledge included in the Samhitas relates to the tremendous advances made by physicians (e.g., Charaka) and surgeons (e.g., Suśruta) to describe and study human beings functioning as a whole, that is, mind and body.

A second period (6th–12th centuries CE) was Sangraha Kaala, during which compilations such as Astānga Sangraha, Astānga Hrudaya (c.600 CE), and Harita Samhita, mostly attributed to Vagbhatta I and II, were developed, which were easier to read and recite, and thus were adopted widely. The medieval times (Madhya Kaala) marked the development of elaborate compendia on individual herbs, their properties, and classification. This era is most commonly referred to as Nighantu Kaala (7th–16th centuries CE), during which compilations such as Madhava Nidana, Śārngadhar Samhita (c.1300 CE), Bhavaprakasha, Chakradutta, and Yogatarangini were developed. This was followed by Ras Kaala (8th–16th centuries CE), during which exhaustive accounts of mineral and metallic preparations, with their purification and processing before internal use, were provided. These descriptions indicate the advancement in knowledge and understanding of the chemistry during this period. The most referred to text of this time was Rasa Ratna Samuchaya by Vaghbhatta in the 13th century.

During the modern period (Adhunika Kaala, 18th–20th centuries), many compilations were made available, mainly with commentaries on the original texts, developed in different parts of the country. These rather suggest a demand for the system to continuously evolve in the contemporary era. Currently, more than 2000 herbs, 150 minerals, and over 97,000 formulations are documented worldwide for hundreds of diseases [16, 17]. Importantly, the therapeutic mechanisms of action have also been described along with their use in diseases.

Back in the Vedic era, medicine was in such an advanced stage that eight medical specializations were developed: Kāyachikitsā (internal medicine), Kumārabhritya (pediatrics, gynecology, and obstetrics), Bhutavidyā (psychotherapy), Śālākya tantra (otorhinolaryngology, including ophthalmology), Śhalya chikitsā (surgery), Agada tantra (toxicology), Rasayana tantra (geriatrics, including regenerative and promotive medicine toward positive health), and Vājīkarana tantra (science of virility, including reproductive system health). Even the tools used for diagnosis and therapeutic modalities, including surgeries, were elaborate and advanced with some of them quite novel considering the present knowledge of medicine. Interestingly, it transpires from the textual references that Ayurveda as a medicine was highly regulated because only those who had obtained the required training and approval from a federal structure (Rajanugya) could initiate a practice [18]. It was also stated that lethargy (Rajapramada) in enforcement of this regulatory process could lead to the thriving of quacks (Rogabhisara) in the system. There was a continuing tradition of training and practice of Ayurveda through old gurukul systems and family tradition wherein the education was imparted through verbal and practical approaches (Vaidya Paramara). Some of the present-day pharmaceutical companies like Aryavaidyashala, Zandu, and Sandu have their origins from these lineages (traditional knowledge-based medicine).

Key dates of the brief history in the development of herbal medicines are [10]:

●2800 BC: First written record of herbal medicines, the Pen Ts’ao by Shen Nung.

●c.400 BC (400 years before common era or century): First Greek herbal written; Hippocrates develops principles of diet, exercise, and happiness as the cornerstones of health.

●c.100 BC: First illustrated herbal produced in Greece.

●c. AD 50: Roman Empire spreads herbal medicine and the commerce of plants around the Empire.

●c. AD 200: Herbal practitioner, Galen, creates a system for classifying illnesses and remedies.

●c. AD 500: Hippocrates’ principles followed in Britain by Myddfai practitioners throughout Saxon times.

●AD 1100s: Arab world now a major influence on medicine and healing practices.

Physician Avicenna writes the Canon of Medicine.

●AD 1200s: Black Death spreads across Europe; qualified apothecaries try bleeding, purging, mercury, and arsenic to stem the epidemic with no more success than traditional herbalists.

●AD 1500s: Henry VII promotes herbal medicine in the face of the growing number of untrained apothecaries and other medical practitioners flourishing in London. Various Acts of Parliament passed to introduce some regulation of medical practices, including protection for simple herbalists to practice without fear of prosecution.

●AD 1600s: Society sees the first two-tier health system emerge—herbs for the poor and exotics (plant, animal, or mineral extracts) or drugs for the rich. Nicholas Culpepper writes his famous herbal The English Physician, explaining in simple terms the practice of herbal medicine.

●AD 1700s: Preacher Charles Wesley advocates a sensible diet, good hygiene, and herbal medicine as the keys to a healthy life.

●AD 1800s: Herbal medicines begin to be eclipsed by mineral drug-based treatments with powerful drugs such as calomel (mercury) and laudanum (alcoholic tincture of opium) available over the counter. Serious side effects begin to be documented. The National Association of Medical Herbalists founded to defend the practice, later to become the National Institute of Medical Herbalists (NIMH).

●AD 1900s: Medicinal herbals used extensively during World War I as drugs are in short supply. The postwar period sees enormous expansion in the international pharmaceuticals industry and the discovery of penicillin. A handful of dedicated herbalists keep the tradition alive. A Modern Herbal by Hilda Leyel is published. The Pharmacy and Medicines Act of 1941 (Hansard) is an Act of the Parliament of the United Kingdom that withdraws herbal practitioner’s rights to supply patients with medicines. As a result, a public outcry ensures that the Act was never enforced. After much campaigning by the NIMH, the Medicines Act 1968 of the United Kingdom reinstates practitioners’ rights and the British Herbal Medicine Association (BHMA) was founded. The BHMA produce the British Herbal Pharmacopeia, of which a revised edition was published in 1990. Public concern starts to grow over the side effects of the wonder drugs of the 1950s and their impact on the environment.

●AD 2000 : EU legislation advocates that all herbal medicines should be subject to compulsory clinical testing comparable to that undertaken for conventional drugs. Thus all herbal medicines would be licensed. Currently, the UK government is considering the possible impact and public perception of this legislation.

2.2: Present status of herbal medicine

The WHO has launched its traditional medicine in Traditional Medicine Strategy 2014–23, which aims to support member states to develop policies and strengthen the role of traditional medicine in keeping populations healthy [19]. The widespread use of herbal medicine is not restricted to developing countries as it has been estimated that 70% of all medical doctors in France and German regularly prescribe herbal medicine [20] and the number of patients seeking herbal approaches for therapy is also growing exponentially [21]. With the US Food and Drug Administration relaxing guidelines for the sale of herbal supplements [22], the market is booming with herbal products [23]. As per the available records, the herbal medicine market in 1991 in the countries of the European Union was about $6 billion (may be over $20 billion now), with Germany accounting for $3 billion, France $1.6 billion, and Italy $0.6 billion. In 1996, the US herbal medicine market was about $4 billion, which has now doubled. The Indian herbal drug market is about $1 billion and the export of herbal crude extract is about $80 million [24].

In the last few decades, curious incidents have happened to botanical medicine and it has made a significant comeback. Despite being side-lined by medical science and the pharmaceutical chemistry, the use of plants for healing purposes predates recorded history and forms the origin of much of herbal medicine. Many conventional drugs originated from plant sources: a century ago, most of the few effective drugs were plant based. Examples include aspirin (from willow bark), digoxin (from foxglove), and quinine (from cinchona bark). Although the medicinal use of willow (Salix sp.) dates back 6000 years [25], it was only in 1897 that the first synthetic drug, aspirin, was created out of the salicylic acid extracted from willow barks.

Herbal medicine has benefited from the objective analysis of medical science, while fanciful and emotional claims for herbal cures have been thrown out, and effective herbal treatments and plant medicine that work have been acknowledged. Hence, herbal medicine has been found to have some impressive credentials. Developed empirically by trial and error, many herbal treatments were nevertheless remarkably effective [26]: penicillin that replaced mercury in the treatment of syphilis and put an end to so many deadly epidemics. Atropa belladonna (deadly nightshade; belladonna) still provides the chemical used in ophthalmological preparations and antiseptics used to treat gastrointestinal disorders. Rauwolfia serpentina (Indian snake root), which has the active ingredient reserpine, was the basic constituent of a variety of tranquilizers first used in the 1950s to treat certain types of emotional and mental problems. Though reserpine is seldom used today for this purpose, its discovery was a breakthrough in the treatment of mental illness. It is also the principal ingredient in a number of modern pharmaceutical preparations for treating hypertension. However, reserpine can have serious side effects, e.g., severe depression. On the other hand, tea made of R. serpentina has been used in India as a sedative for thousands of years