Fundamentals of Herbal Medicine: History, Phytopharmacology and Phytotherapeutics Vol 1

By Kofi Busia

This book consists of cutting-edge materials drawn from diverse, authoritative sources, which are sequentially arranged into a multipurpose, one-stop-shop, user-friendly text. It is divided into four parts as follows:
Part 1: Historical overview of some indigenous medical systems; an outline of the basic concepts of pharmacognosy, ethnopharmacology; common analytical methods for isolating and characterising phytochemicals; and the different methods for evaluating the quality, purity, biological and pharmacological activities of plant extracts.
Part 2: Phytochemistry and mode of action of major plant metabolites.
Part 3: Systems-based phytotherapeutics; discusses how dysfunctioning of the main systems of the human body can be treated with herbal remedies.
Part 4: Provides 153 monographs of some medicinal plants commonly used around the world, including 63 on African medicinal plants.

This book therefore demonstrates the scrupulous intellectual nature of herbalism, depicting it as a scientific discipline in its own right.

• Language: English
• Publisher: Xlibris UK
• Release date: Aug 27, 2016
• ISBN: 9781514447352

Kofi Busia

Kofi Busia holds a BSc (Hons.) degree in chemistry and a PhD in biological organic chemistry from Birkbeck, University of London. He also studied basic medical science at the St Bartholomew’s and the Royal London School of Medicine and Dentistry Queen Mary, University of London. Kofi also holds a BSc (Hons.) degree in herbal medicine and a postgraduate certificate in higher education from Middlesex University, UK, where he served as a much-valued senior lecturer in pharmacognosy, herbal pharmacology, herbal pharmacy, and transferrable skills for nine years. He has rare expertise in natural product research, phytochemistry, and phytopharmacology, which he increasingly combines with herbal practice. Between 2004 to 2006, he was the external examiner on the herbal medicine degree programme of University of Lincoln, UK. From August 2005 to January 2007, he was a senior lecturer in the Department of Chemistry at the University of Ghana. Kofi is a member of the Royal Society of Chemistry, founder of the Ghana Association of Medical Herbalists, and a past member of the accreditation panel of the European Herbal Practitioners’ Association. Kofi is currently the programme officer of traditional medicine at the West African Health Organisation. He currently serves on the editorial boards of the Journal of Herbal Medicine, Integrative Medical Case Reports, African Journal of Traditional, Complementary and Alternative Medicines, and the Journal of Zheijiang University Science.

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Copyright © 2016 by Kofi Busia.

Library of Congress Control Number:   2016906309

ISBN:      Hardcover      978-1-5144-4737-6

      Softcover      978-1-5144-4736-9

      eBook         978-1-5144-4735-2

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Rev. date: 08/26/2016

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Contents

Foreword

Acknowledgements

Introduction

Part 1 Historical Use of Traditional Medicines

Traditional Medicine Worldwide

Brief History of Some Indigenous Medical Systems

African Traditional Medicine

Indian Traditional Medicine (Ayurvedic Medicine)

Middle Eastern Traditional Medicine

Traditional Chinese Medicine

Australian and Southeast Asian Traditional Medicine

North, Central, and South American Traditional Medicine

European Medicine

Modern Medicine

Development of Pharmacology

Herbal Medicine Today

The Challenges of Standardisation and Regulation

Ethnopharmacology and Plant-Derived Medicines

Ethnobotany

The Ethnopharmacological Approach

Aspirin: An Example of Ethnopharmacological Discovery

The Story of Hoodia

Importance of Ethnomedically Derived Natural Products in Modern Medicine

Part 2 Phytochemistry and Phytopharmacology of Archetypal Plant Metabolites

Types of Plant Metabolites

Examples of Simple Phenols and Phenolic Glycosides

Arachidonic Acid Metabolism

Coumarins

Glucosinolates

Cyanogenic Glycosides

Cardiac Glycosides

Saponins (Latin Sapo Means Soap)

Anthraquinones

Phytooestrogens

Flavonoids

Anthocyanins (Greek: antho-, flower; kyanos, blue)

Tannins

Alkaloids

Gums and Mucilage

Acrid Principles

Bitter Principles

Part 3 Phytotherapeutics of Systems Dysfunction

The Herbal Therapeutic Approach

The Cardiovascular System

The Respiratory System

The Endocrine and Metabolic System

The Immune System

The Lymphatic System

The Nervous System

The Musculoskeletal System

The Gastrointestinal System

The Skin

What Is the Genitourinary System?

Male Reproductive System

Urinary System

Genotourinary and Skin Cancers

Herbal Treatment for Cancer Patients

What Are Infectious Diseases?

African Trypanosomiasis (‘Sleeping Sickness’)

Cholera

Dengue Fever

Japanese Encephalitis

Hepatitis

Human Immunodeficiency Virus

Leishmaniasis

Malaria

Measles

Meningitis

Onchocerciasis

Schistosomiasis

Tuberculosis

Yellow Fever

Foreword

Hippocrates’s comment on the struggles involved in acquiring competence and skill in medical practice ‘The Life so short, the Art so long to learn’ applies also to the herbal practitioner. The ability to find sense within complexity is hard won, whatever the form of medicine.

The complexity of the patient, of the illness, of the therapeutic response—this is what student practitioners, including student herbalists, have to wrestle with on a daily basis. And they are fortunate if they have reference books at hand as comprehensive as Fundamentals of Herbal Medicine that will aid them in unravelling and making sense of this complexity.

If I was starting out again as a student of herbal medicine, I would be delighted to have this book in my hands. I suspect it will prove to be a good friend to many student herbalists not just in Africa but far and wide. Scientifically accurate and up-to-date, this book covers an extraordinary range of subject areas directly relevant to the study of herbal medicine. Not all of it will be relevant to every reader, but every reader will find something of relevance to them.

Andrew Chevallier FNIMH MCPP

Herbal Practitioner

Past President, National Institute of Medical Herbalists (UK)

Former Senior Lecturer in Herbal Medicine, Middlesex University, London, UK

_____________________________________

Clinical practitioners of herbal medicine face a continuing struggle for recognition and training worldwide, despite the substantial role of herbal medicine in the service of the larger part of the world population. Thus, while plants are widely used without question and out of necessity for health purposes, they are readily denigrated, dismissed, and even excluded from modern medical practice. Yet there is undeniable evidence for the effects of many plant constituents, and much of this evidence help to explain the thousands of years of empirical administration of plants for health maintenance and treating illness. The roots of herbal medicine (forgive the pun) stretch back to antiquity and have considerable cultural weight, reflected in the major traditions and embodied in the texts and lifestyle practices of many peoples. More recently, claims of the benefits of herbal and traditional medicine have extended in the globalisation of herbal medicine markets, particularly as the traditions of Chinese and Ayurvedic medicine have been taken up in Western contexts. In the service of pharmaceutical discovery, there have been waves of ethnopharmacological studies based on historical archives and oral sources. Some single and combination plant extracts have reached clinical trials aimed at commercial exploitation as drugs, but systematic research in herbal medicine is poorly resourced. We lack reliable texts that draw together knowledge of modern medicine with pharmacological understanding of plants to provide a sound clinical basis for the use of herbal medicines. This book is of key importance in clearly establishing such a basis, and providing links between theory and practice.

This book will have widespread application on every continent for those interested in the practice of herbal medicine. A comprehensive overview of herbal history is provided and, alongside the more familiar European background and plants, there is an introduction to African herbal medicine with detailed monographs for key plants from Aloe to Yohimbe. The book fully addresses the chemistry of plants, identifying constituents with physiological actions. Drawing on the most up-to-date research evidence available, all of the plant monographs include safety and dosage advice. However, this book provides much more than an extensive overview of plants as drugs. This is only one aspect of herbal medicine since, as readers will discover, there is an underlying integrated approach which seeks to establish a therapeutic programme to promote and sustain health. This approach is addressed by bringing together a clear exposition of principles underpinning a clinical practice framework; from the medical consultation and diagnosis to preparations in the pharmacy. The detail is extensive, and even the sustainability of plant supplies is considered with the inclusion of details of wild harvesting standards. This book will support the development of training to a professional standard in the use of herbal medicines, enabling safe and effective clinical practice. It is a reference work setting a high standard, providing a bedrock text that will give guidance to all manner of clinical herbal practitioners for many years to come.

Anne Stobart, PhD

Previously Divisional Manager for Complementary Health Sciences at Middlesex University, London

Honorary Research Fellow, University of Exeter, UK

Acknowledgements

First and foremost, I would like to express my heartfelt gratitude to two former tutors of Birkbeck, University of London, Dr Howard Carless (my PhD supervisor) and Dr Barry Smith (mentor), for nurturing me with their patience, knowledge, and excellent teaching skills. It was Einstein who said, ‘I never teach my pupils; I only attempt to provide the conditions in which they can learn.’ In Howard and Barry, I found beauty in the pursuit and propagation of knowledge, humility, kindness, tolerance, friendship, guidance, discipline, and love!

In writing this book, I have been most greatly inspired by the friendship and mentorship of some amazing colleagues I was fortunate enough to meet at Middlesex University, UK: Andrew Chevallier, without doubt one of the finest medical herbalists and writers of our time; Dr Anne Stobbart; Peter Jarrett; and Dr Barbara Pendry. A prolific writer of international repute, Andrew granted me permission to use his precious lecture notes on herbal therapeutics and gave me the courage to make major changes to the content, organisation, and tone of the book. Quite remarkably, Peter, an expert gardener, generously and willingly offered me many of the plant photos in his library while Anne, leveraging on her rich teaching experience, provided valuable insights that ultimately shaped the structure of this book. Barbara’s constant encouragement kept me going whenever there was stagnation. I am indeed honoured and grateful to consider Andrew, Peter, Anne and Barbara not only as colleagues but more importantly as friends.

This book did not only benefit from the support of colleagues, but it was also directly inspired by the writings, teachings, and research of some unsung heroes and heroines: Simon Mills, Kerry Bone, David Hoffmann, Richard Adams, Adrian McDermott, Hananja Brice-Ystma, Michael McIntyre, Peter Conway-Grim, Dr Lily Holman, late Dr Ellis Snitcher, Dr Celia Bell, Colin Nichols, Emeritus Prof Peter Houghton, Prof Joanne Barnes, Prof Michael Heinrich, Prof Elizabeth Williamson, Jim Clark, Dr Merlin Willcox, Dr Gerard Bodeker, and Prof Ameenah Gurib-Fakim, the current president of Mauritius. To these distinguished practitioners, teachers, and plant medicine research scientists, I owe a debt of gratitude, which neither words nor material rewards can adequately pay. If you find this book interesting, informative, or educative, you would be advised to ‘go to the source’ and read their books and publications or experience their teaching as well.

Several people also contributed many hours of their time, attention, and valuable expertise towards improving this book. Some of them are friends or blood family whom I solicited directly, but most are just good people whose only aim was to help! I would like to thank Prof Kofi Annan, Prof Charles Ansah, and Dr Isaac Kingsley Amponsah; all of the Faculty of Pharmacy of the Kwame Nkrumah University of Science and Technology (KNUST) in Ghana; the medical herbalists Yaso Shan and Martin Logue; Dr Augustine Donkor of the University of Ghana; Charlesetta Ben of the University of Liberia; as well as Hadijatou Janneh and Akpene Dzikum of the West African Health Organisation.

Copyright permission was granted by Jim Clark of ChemGuide (Infrared, nuclear magnetic resonance, and mass spectroscopy); Peter Jarrett of Middlesex University (plant photos); Dr Deepak Bhanot (schematic diagram of gas chromatograph); Prof Kofi Annan (thin layer chromatography diagrams, chemical structures, and plant photos); Dr Cynthia Amaning Danquah (photos of analytical instruments); Waters (schematic diagram of a basic gel permeation chromatograph); Dr Jacquie Richardson of the University of Colorado at Boulder (fractional distillation setup); Dr Shula Levin (schematic diagram of a high performance liquid chromatography system), and my daughter Amma Busia (anatomical drawings).

Above all, I would like to thank my immediate family (the Busias), for supporting and encouraging me in spite of all the time it took me away from them. This journey, which began over a decade ago, could not have been completed without their understanding, spiritual and moral support, patience, and tolerance.

Introduction

The WHO estimates that out of a global population of about 6.3 billion, about 4 billion (80%) mainly in developing countries, depend on traditional medicine, particularly herbal medicines, for their health care needs. Medicinal plants are cheaper, more accessible, and culturally acceptable to most of the developing world’s rural population. The use of traditional and herbal medicines continues to expand rapidly even in developed countries, where modern medicine is readily available.

With the growing realisation of the immense potential of herbal medicine for the treatment of some of the killer diseases of the modern age, and the increasing demand for safe, effective, and affordable medicines, the last three decades have seen an upsurge of interest in the field in several parts of the world. This has led to intense herbal medicine research and development activities, usually aimed at validating the folkloric uses of some plants and also to uncover new leads for the production of life-saving medicines.

Herbal medicines have become more widely available commercially, especially in developed countries, where plant-derived remedies are sometimes marketed for uses that were never contemplated in the traditional healing systems from which they emerged. A notable example is the use of Ephedra (ma huang) for weight loss or enhancement of athletic performance rather than its traditional use as an antiasthmatic agent. In some cases, the active principles of the plants have been isolated and characterised and their mechanisms of action elucidated. However, for many, including virtually all the most common herbal products on the market, such information is either incomplete or unavailable. In many cases, the complexity of herbal preparations has been cited as the reason for this paucity of information while others have ascribed it to the reluctance of herbal practitioners to subject their remedies to the same scientific scrutiny as drugs due to the traditionally held belief that the synergistic combination of several active principles in herbs contributes significantly to their beneficial effects.

Nevertheless, there is now a plethora of literature publications on herbal medicines unsurpassed by any period in the interesting history of this healing art. Several monographs on selected herbs are currently available from many sources including the World Health Organization (WHO, 1999), European Scientific Cooperative on Phytotherapy (ESCOP, 1999), and the German Commission E (Blumenthal et al., 1998). Other resources that provide detailed information about herbal products in current use include the Natural Medicines Comprehensive Database (Jellin, 2002) and NAtural PRoducts ALERT (NAPRALERT) (2001).

Importantly, as in countries such as China and India, where traditional and complementary medicine have been part of the national health systems for many years, huge efforts are being made in Africa to do likewise. Regional institutions such as the World Health Organization for Africa and the West African Health Organisation, a specialised health institution of the Economic Community of West African States, are driving the process with huge technical and financial resources aimed at supporting their member states to institutionalise traditional medicine in their health systems. Among other things, the member states are being urged to establish training programmes in herbal medicine in particular for both practitioners of traditional medicine and conventional medicine and to promote dialogue between the two sectors through collaborative activities. Some member states have responded by establishing such training and ethnomedical research programmes, but their efforts are being hampered by a paucity of relevant literature.

This timely and comprehensive book aims to contribute to the efforts being made to address this need and also serve as a useful addition to the growing body of knowledge in this field. It encapsulates years of experience in teaching, research, and practice in herbal medicine both in the United Kingdom and Africa (Ghana and Burkina Faso). The book therefore takes a multipurpose approach that draws material from diverse authoritative sources to blend together the different domains that constitute modern herbal medicine so that it can be of benefit to students and practitioners of herbal medicine and other complementary therapies, traditional medicine practitioners, researchers in phytochemistry/herbal pharmacology, as well as teachers of phytochemistry and materia medica and therapeutics. This book will also be of interest to a variety of orthodox health care professionals, including doctors, pharmacists, nurses, midwives, community health care workers, as well as medical anthropologists and academic readers desirous of continuous professional education in this field. For this group of health workers, this book surely presents a sound academic understanding of herbal medicine and evidence of its multidisciplinary nature. It is anticipated that this diverse target audience will find in this book a genuine appreciation of the huge potential of herbs for the treatment of some problematic pathologies such as skin and respiratory disorders that respond poorly to conventional medicines. More specifically, this book can be used in pharmacognosy, herbal pharmacology, phytochemistry, herbal pharmaceutics, materia medica and therapeutics, clinical sciences, herbal medicine/natural product research as well as by regulatory bodies for the quality assessment of herbal medicines.

The Fundamentals of Herbal Medicine is a two-volume science-based guide for understanding the use of herbal medicines for the prevention and treatment of disease. The two volumes provide a comprehensive overview of the historical development of traditional medicine, phytochemistry and phytopharmacology, phytotherapeutics, and materia medica. Also covered is a summary of the essential analytical techniques for identifying the active constituents as well as the quality, purity, and biochemical actions of medicinal plants. Above all, the book provides previously unpublished monographs on scientifically evaluated African herbal medicines and importantly sets African and European traditional medicines in context so they can be compared and evaluated.

Divided into three parts, volume 1 begins with a historical overview of some indigenous medical systems, focusing in particular on African traditional medicine and European medicine. This is followed by a brief outline of the basic concepts of ethnopharmacology with some examples of medicinal plants, which have yielded or have the potential to yield essential medicines. From the plethora of peer-reviewed scientific publications currently available, it is becoming increasingly evident that plants are reservoirs of a multiplicity of fascinating chemical constituents with actual and potential effects on the human body. Part 2 of volume 1 therefore discusses the phytochemistry and mode of action of the major plant metabolites based on currently available scientific knowledge. It begins with a brief classification of plant metabolites together with an outline of the biosynthesis of secondary metabolites and a description and classification of the major plant phenolics. Examples of the biosynthesis of simple phenolic glycosides are then provided, focusing in particular on arbutin and the salicylates. This section continues with an overview of the arachidonic acid metabolism to illustrate the association among phenolic compounds, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, and the key mediators of inflammation. The next section in this part then provides an outline of the phytochemistry and phytopharmacology of the major plant metabolites including the coumarins, cardiac glycosides, saponins, adaptogens, glucosinolates, cyanogenic glycosides, anthraquinones, phytooestrogens, flavonoids and anthocyanins, tannins, alkaloids, volatile oils as well as gums and mucilage, acrid principles, and bitter principles. Each of these constituents is described with examples of herbs from different herbal traditions and where possible with their structure-activity relationships, pharmacodynamics, and pharmacokinetics.

Although this book is not intended to be a clinical textbook, part 3 of volume 1 focuses on basic clinical science and the phytotherapeutics of a range of disease conditions commonly presented to herbalists such as diabetes, hypertension, cancer, allergic rhinitis, asthma, sinusitis, digestive disorders, menstrual problems, and neurodegenerative disorders, among others. This part therefore presents material that can be otherwise readily accessed from many authoritative sources to show the extent to which modern herbalism is grounded on sound medical science and the rationale that underpins the therapeutic use of medicinal plants. Importantly, this part is primarily aimed at students preparing for final-year clinical examinations in herbal medicine and other complementary therapies, who would want a text that serves as a ‘one-stop shop’ source of revision. As a result, this partakes a systems-based approach and presents outlines of the pathophysiology and clinical manifestations of some of the most common disease conditions that affect the major systems of the body, followed by brief reviews of the herbal approaches for managing them. Where possible, some sample herbal prescriptions are provided to contextualise the phytotherapeutics of a particular disease. These herbal prescriptions are more schematic than actual; they are about providing guidelines for combining herbs and recommendations on potentially viable treatment plans. For the purpose of this book, although herbalists are not allowed to treat cancer, some information/advice about strategies that can be used to support a patient undergoing cancer chemotherapy is provided. As a novelty, a reasonably comprehensive coverage is also given to some infectious diseases that afflict large populations of the developing world, particularly Africa. The infectious diseases covered in the book include malaria, HIV/AIDS, tuberculosis, African trypanosomiasis, hepatitis, cholera, onchocerciasis, schistosomiasis, leishmaniasis, yellow fever, Japanese encephalitis, dengue fever, typhoid fever, meningitis, and measles. Since the phytotherapeutics of these diseases are generally not well developed, the treatment approach focuses on prevention and the use of some time-tested home remedies. The aim is to stimulate research interest in this area for the benefit of the vast majority of the impoverished populations affected by these diseases.

The global popularity of herbal medicine and its promise for treating chronic diseases, in particular, have led to a growing quest for rigorous scientific evaluation of their pharmacological and biological activities. Volume 2 of the book, which also has three main parts, therefore covers the main characteristics of some major plant families, the analytical techniques used in plant medicine research, and monographs of some common medicinal plants. It begins with an outline of the system used to name plants scientifically (binomial nomenclature), with specific reference to families and species. Here, a list of some descriptive specific epithets and general rules used to ascertain the gender of a plant is provided to enable the reader appreciate the meanings of these botanical terms. This section is then followed by summaries of the characteristic features of some major plant families, together with examples of important medicinal plants found in each family. As much as possible, the geographic origin of each plant is indicated to show their distribution worldwide. The next section in this part focuses on the common modes of preparation, cultivation, and wild harvesting of medicinal plants. In order to provide the reader with an understanding of the common analytical methods used to isolate and characterise phytochemicals, the next section outlines the basic principles of soxhlet extraction, supercritical fluid extraction, steam distillation, fractional distillation, enfleurage, and cold pressing. Also included in this section is the common chromatographic methods used in herbal medicine research such as adsorption chromatography, thin-layer chromatography, thin-layer chromatography bioautography, column chromatography, flash chromatography, gas liquid chromatography, partition chromatography, paper chromatography, high-performance liquid chromatography, gel permeation chromatography, and ion exchange chromatography. Following on from this is an overview of different methods for evaluating the quality, purity, and biological and pharmacological activities of plant extracts, such as methods for biological screening for pharmacological activity, preclinical studies, assays commonly used in the pharmacological evaluation of medicinal plants, as well as toxicity and clinical studies. The section ends with an outline of the basic principles of some spectroscopic methods used to elucidate the structure of phytochemicals. These include nuclear magnetic resonance spectroscopy, mass spectroscopy, and infrared spectroscopy.

The last part of volume 2, which constitutes the largest proportion of this book, is devoted to monographs of some of the most common plants used to treat some diseases commonly presented to herbalists or phytotherapists and that of some plant-derived anticancer agents. It contains comprehensive details of the current scientific rationale for the traditional uses of 153 common plants found in Europe and other parts of the world and includes 63 previously unpublished monographs on African medicinal plants. All these monographs are presented with information that are of particular relevance to the practitioner, such as parts used, chemical constituents, dosages, actions and indications, and safety/toxicity. The monographs also contain a substantial volume of information on herbs that will be of interest to the general reader seeking knowledge of the rational use of herbal medicines or patients who increasingly use medicinal plants for their health care needs but are ignorant of the potential dangers associated with some of them. However, since most of the studies on plants are carried out on extracts in vitro or in vivo rather than by the gold-standard placebo-controlled, double-blind clinical trials, this information cannot be taken wholly as a positive affirmation of clinical effect, although evidence for the efficacy of some of these time-tested remedies cannot be disputed.

More importantly for this book, in addition to the usual monographs on plants from Asia, Europe, and the US, monographs of several medicinal plants of African origin, particularly for cardiovascular disorders and common infectious diseases, are also presented. The purpose here is to set African materia medica and that of the Western world in context so they can be compared and evaluated. Since herbs tend to have more than one indication, a monograph is first placed under the system for which the herb is commonly used and reference made to it when any other condition or system for which it is reputedly indicated is subsequently discussed.

Finally, in order to help readers identify and relocate the sources from which materials have been drawn, and to corroborate the assertions and claims made in the text, each part of the book is thoroughly referenced.

In summary, this book will appeal to those who are literally learning to drive in a safe, structured traditional medicine environment as well as those who have passed their test and need to confront the realities of driving in this interesting field.

Part 1

Historical Use of Traditional Medicines

Since the dawn of time, man has searched for suitable plant and animal products for maintenance of health and well-being. Available records and evidence uncovered in 1960 in a burial site of a Neanderthal man show that humans have used traditional medicines for at least some 60,000 years (Stockwell, 1988; Thomson, 1978). The clay tablets of Mesopotamia of about 2600 BC contained records of substances used in prehistoric times and had among its list such remedies as the oils of Cedrus species (cedar) and Cupressus sempervirens (cypress), Glycyrrhiza glabra (liquorice), Commiphora species (myrrh), and Papaver somniferum (poppy juice), all of which are still useful therapeutic agents today (Gurib-Fakim, 2006). Also, the Egyptian Ebers Papyri, written over 4000 years ago, describe a complex fully developed pharmacology, with details of prescriptions for herbal remedies, their methods of preparation, and their actions and indications (Sumner, 2000).

In the course of time, human societies across the globe developed rich sets of experiences and explanations relating to their environments and a broad natural pharmacopoeia consisting of wild plant and animal species to combat disease.

However, owing to ancient man’s concept of the supernatural world, the medicine of antiquity was often mixed with magico-spiritual beliefs, although as would be shown later, there was considerable rational thought in Greek medicine, for example. In many societies around the world, medicine men maintained the health of their communities by providing plant, animal, or mineral-based remedies, medical advice, together with supernatural treatments, which could be in the form of charms, incantations, and amulets to drive away evil spirits.

Many of these societies believed that there was divine control of the universe and that it was possible to contact this divinity to find explanations and information on past, present, and future events. Knowledge therefore became stagnant, treatment more experiential and shrouded in charms and superstitions. Even Egyptian medicine, which is the best known of the prescientific systems, was largely magical and included many antique practices (Evans-Anfom, 1990). The healers were also priests and practised strictly according to the rules of their sacred books written by some earlier priests. They did not dare to depart from these writings lest they became liable to punishment by death should a patient die.

The seers and oracles of ancient Egypt and Babylon were regularly consulted by the public on a wide range of problems. Besides the ability to assign the reason for a particular illness, some of these diviners were also able to suggest a remedy. Although these healers lacked understanding of what is known today as medical science, through practice in treating illness, attending childbirths, and making use of locally grown herbs, they were able to develop a high level of practical medical knowledge. Indeed, some knew so much about animals and plants with medicinal properties that they could claim to have been the first doctors.

In some cases, medicine men (witch doctors or shamans) also performed minor surgical procedures such as circumcisions, incisions, and scarification. For example, in India, surgery attained a high standard as scissors, saws, needles, and forceps were used in amputations, removal of cataract, skin grafting, and plastic surgery for repairing or reshaping of the nose (rhinoplasty) (Evans-Anfom, 1990). However, among ancient societies, the man who cured illnesses was looked upon more as a magician than a doctor (Evans-Anfom, 1990).

These early healers claimed that some of the knowledge of the medicinal properties of herbs or animal parts came to them through visions and dreams. Whatever the source of their knowledge, in the course of time, ancient man was able to learn through trial and error to distinguish among useful plants with health benefits and harmful or inactive ones, as well as combinations or methods of preparation that could yield consistent and optimal results. Interestingly, many of the remedies recorded in ancient texts are still used today to treat ailments such as coughs, colds, parasitic infections, and inflammation or have served as sources of potent chemotherapeutic agents. For instance, morphine originated from the herb opium poppy while Echinacea was the common herbal treatment for respiratory infections prior to the development of antibiotics. Also, the herb bishop’s weed (Ammi majus), which the Egyptians used to treat vitiligo, has yielded the drug β-methoxypsoralen for treating psoriasis and other skin disorders, as well as T-cell lymphoma (Gurib-Fakim, 2006).

As mentioned earlier, using products derived from animals for the treatment of disease (zootherapy) (Salomonsen et al., 2011; Alves et al., 2008; Costa-Neto, 2005) has also served as an important alternative among many other known therapies practised worldwide. Wild and domestic animals and their by-products such as hooves, skins, bones, feathers, and tusks are important ingredients in the preparation of many curative, protective, and preventive medicines (Adeola, 1992; Anageletti et al., 1992). Indeed, many traditional medical systems including African traditional medicine, traditional Chinese medicine, Ayurveda, unani, jamu, kampo, and Iranian medicine use both plants and animal products for treatment. For example, in traditional Chinese medicine, besides the use of plants, more than 1,500 animal species have been recorded to be of some medicinal value (CNCTHMMM, 1995). In India, nearly 15–20% of the Ayurvedic medical system is based on animal-derived products (Unnikrishnan, 1998); and in Bahia State, in the northeast of Brazil, over 180 medicinal animals have been recorded (Costa-Neto, 2004).

Plant and animal products have thus been part of the repertoire of medicinal agents used in various cultures around the globe for many centuries (Lev, 2003; Adeola, 1992; Anageletti et al., 1992), although plant usage seems to receive more attention and continue to play a key role in health care (Chang and But, 1986; Kapoor, 1990).

It is clear from the foregoing account that naturally derived substances of plant, animal, and mineral origins have provided a continuing source of medicines, and ingredients obtained from some of these sources are increasingly valued as raw materials in the preparation of modern medicines (Kang and Phipps, 2003; Lev, 2003; Nakashima et al., 2000; David and Anderson, 1969). As a result, even today, despite the huge advances in medical science, the vast majority of people on this planet still rely on traditional medicines, particularly herbal medicines, for their health care needs often due to lack of other forms of health care or as an alternative to mainstream medicine (Heinrich et al., 2004).

Traditional Medicine Worldwide

Brief History of Some Indigenous Medical Systems

Various societies around the world have over the years observed and experimented with the plants and animals around them and developed a knowledge base of useful remedies, which has been handed down orally through a community, family, and individuals, from generation to generation. Notable examples of these indigenous medical systems include traditional Chinese medicine; African traditional medicine; Indian traditional medicine (Ayurvedic medicine); Middle Eastern traditional medicine; Australian and Southeast Asian traditional medicine; North, Central, and South American traditional medicine; and European medicine. This section outlines aspects of these indigenous medical systems, but for the purpose of this book, greater attention is given to the history of African traditional medicine and European medicine.

African Traditional Medicine

Of all the ancient systems of medicine, African traditional medicine is probably the most diverse and yet the least documented. African traditional medicine is holistic and considers the body and spirit as an integral unit. Disease, good health, success, and failure are believed to be the products of the actions of individuals and ancestral spirits according to the balance or imbalance between the individual and the social environment (Helwig, 2010). In African traditional medicine, sickness may be attributed to displeasure of the gods or God, or as a result of a person, family, or village breaching a universal moral code (Onwuanibe, 1979).

Traditional medicine practitioners seek to bring about a link of the person with the society and the ancestors (Busia, 2005), and attempts are usually made to reconnect the social and emotional equilibrium of patients based on community rules and relationships (Hillenbrand, 2006; Fabrega, 1975). Based on the type of imbalance the individual may have, an appropriate treatment, valued for its therapeutic effect as well as its symbolic and spiritual significance, will then be given (Helwig, 2010). In treating diseases, the practitioners use a range of approaches including ‘magic’ and biomedical methods such as fasting, dieting, bathing, massaging, administration of herbs, and the use of certain surgical procedures (Conserve Africa Foundation, 2010). This approach to medical care has its roots in Egyptian medicine, which credited many vegetables and fruits with healing properties and used tree resins, including myrrh, frankincense, and manna (Porter, 1997).

The history of the healing arts in Africa can be traced back to the reign of Menes, the first Pharaoh of ancient Egypt in about 3200 BC. In ancient Egypt, documentation of medical knowledge took the form of wall paintings in tombs and on papyrus. The most notable of these was the Ebers Papyrus, which dates back to around 1500 BC. The Ebers Papyrus, named after Prof Ebers Georges in 1872, is considered the oldest-surviving medical document. With a size of over 20 metres long, it covers a range of illnesses, with information on diagnosis and methods of treatment, including spells and incantations. The Ebers Papyrus contained plant medicines such as aloe, cannabis, cassia, castor oil, frankincense, fennel, henna, juniper, linseed, myrrh, opium, senna, and thyme. Cloves of garlic have been discovered in ancient burial sites in Egypt, including the tomb of Tutankhamen and in the sacred underground temple of the bulls at Saqqara (Patrick et al., 2009). Egyptians consumed large amounts of garlic and onions as they believed that they had the ability to promote survival. Imhotep, who lived about 2980 BC during the reign of Pharaoh Zosar of the Third Dynasty, became a figure akin to the Greek god Asclepius and is credited with the title of first African physician in a scientific sense (Mungwini, 2009; Porter, 1997). Like Asclepius, Imhotep became associated with healing shrines and temple sleep (incubation cures). He treated his patients by making them sleep overnight in the inner precincts of the temples so they would be cured through dream experiences during which they would be visited by a god or an emissary like a snake (Porter, 1997).

Egyptian medical theory held that humans were born healthy but were susceptible to disorders caused by both demons and intestinal putrefaction (Porter, 1997). According to the Egyptians, both earthly and supernatural forces, particularly evil spirits, could enter the body through the orifices to consume vital substances of the victim. While health was linked with proper living as well as having peaceful relationships with the gods, spirits, and the dead, illness was a matter of imbalance, which could be restored to equilibrium by supplication, spells, and rituals (Porter, 1997). Indeed, not all of Egyptian medicine was based on superstition and magic; much was the result of experimentation and observation. Ancient Egyptians practised massage and manipulation and made extensive use of medicinal plants and foods (Aboelsoud, 2010; Zucconi, 2007). In fact, surgery was well advanced although it was limited to repairing injuries and bone fractures. Sutures and cautery were employed in these procedures, and a honey and grease or resin preparation was used as wound dressing. Various accounts indicate that there was a high degree of specialisation among physicians in Egypt (Halioua et al., 2005; Aboelsoud, 2010). The Egyptians were advanced medical practitioners and masters of human anatomy mostly due to their skills in mummification, which involved removing most of the internal organs including the brain, lungs, pancreas, liver, spleen, heart, and intestine (Aboelsoud, 2010; Millet et al., 1980). Their great knowledge of anatomy, as well as the interaction with the Greeks and other cultures, equipped them with extensive knowledge of the functioning of the organs and many other medical practices. Herodotus and Pliny were among Greek scholars who benefitted from this interaction with the Egyptians and further contributed to the ancient and modern medical records handed down by Ancient Egypt (Aboelsoud, 2010; Sanders, 1963). As mummification suggests, the Egyptians did not share the taboos that forbade tampering with corpses, and embalmers formed a separate guild and were of low caste. In terms of the workings of the human body, the Egyptians believed that life lay in breath and a speculative vascular network that was likened to the Nile and its canals, as carrying blood, urine, air, semen, tears, and solid wastes to all bodily parts. For good health, this vascular network needed to be free of obstruction, especially rotting food and faeces. Such blockage needed cleansing with laxatives. The Egyptians were reputed to set aside three days each month for evacuating the body with emetics and enemas (Porter, 1997). Plant extracts, notably senna, colocynth, and castor oil, were used as purgatives.

Ancient Egyptians were as skilled in pharmacy as they were in medicine. Available records show that in administering medications, the doctors and pharmacists of ancient Egypt recited certain incantations. They prepared remedies from herbs such as aloe, caraway, castor, cumin, glue, fennel, linseed oil, pomegranates, and safflower. Mineral substances such as copper salts, plain salt, and lead as well as eggs, liver, hairs, milk, animal horns and fat, honey, and wax were also used to make remedies (Aboelsoud, 2010; Rosen, 1979). Breast milk was sometimes given as an antiviral against the common cold while fresh meat was placed on open wounds and sprains. It is worthy of note that ancient Egyptian chemists invented some household drugs (pesticides) against domestic pests. A preparation consisting of nitron water and charcoal, mixed with ground ‘pipit’ plant was used to spray houses while goose fat was used as a protective agent against fly bites and fresh oil against mosquito bites. Other interesting practices included placing a dried fish or a piece of nitron at the entrance of a serpent’s hole to prevent it from coming out and spreading a piece of cat fat around the house to ward off rats (Aboelsoud, 2010; Sauneron, 1958).

Egyptian physicians were much sought after in the ancient world. Ramses II sent physicians to the king of Hatti, and many rulers including the Persian Achaemenids had Egyptian doctors in attendance. Their treatments were based on examination, followed by diagnosis (Aboelsoud, 2010; Breasted, 1930). Although the reliance on magic and faith may have retarded the development of more rational ideas about the causes and treatments of diseases, in the light of current understanding of the placebo effect, it may well be that the strong belief patients had in the divine origins of these treatments may have contributed to their effectiveness (Aboelsoud, 2010; Zucconi, 2007). Egyptian medical theories and practices influenced the Greeks, who formed the greater part of the physicians of the Roman empire and through them influenced Arab and European medical thinking for many centuries (Aboelsoud, 2010; Sanders, 1963).

In sub-Saharan Africa, the ancient kingdoms and empires of Asante, Benin, Borno, Ethiopia, Jukun, Monomotapa and Mali, Nubia, Nri, Nupe, Oyo, and Songhai had remarkably codified healing recipes (Mungwini, 2009). The discovery of physostigmine from the Calabar bean and the life-saving vincristine from the Madagascar periwinkle are just but a few examples of the wealth of sub-Saharan African traditional medicine. Sub-Saharan African traditional medicine practitioners—variously addressed as Babalawo, Adahunse, Abia ibok, Boka, Sangoma or Nyanga, Marabu, and Adunsefo among others (Cook, 2009)—often act, in part, as intermediaries between the visible and invisible worlds and between the living and the dead. They are highly respected in their communities and are therefore widely consulted for the treatment of diverse conditions including asthma, cancers, diabetes, eczema, epilepsy, fever, gout, high blood pressure, malaria, prostate enlargement, psychiatric disorders, urinary tract infections, venereal diseases, burns, and wounds (Helwig, 2010).

Before prescribing medicines to treat an illness, these practitioners often make their diagnosis through incantations, which are believed to help establish mystical and cosmic connections. However, in cases where the illness cannot be identified, the patient may be advised to consult a diviner who can make the diagnosis by establishing contact with the spirit world through a process whereby objects are thrown and the patterns in which they fall are given metaphysical interpretations. The process of divination often requires not only medication but also sacrifices (Onwuanibe, 1979). Diagnosis may also involve confessions with the aim of extracting vital information, as it is done in some religions (Heinrich et al., 2004). Treatment will be prescribed according to the seriousness of the condition and often involves a combination of herbal therapy, incantations, rituals and sacrifices (Heinrich et al., 2004). As part of the treatment regimen, healers will typically address possible psychological causes such as effects of broken relationships with friends and family or neighbours or work colleagues, the guilt of immorality, as well as violation of religious codes and cultural taboos. In some cases, the method of ‘bleed cupping’ was used to treat conditions such as migraines, coughs, abscesses, and pleurisy, followed by application of a herbal ointment and oral intake of herbal medicines. In some cultures, headaches are treated by rubbing hot herbal ointment across a patient’s eyelids while malaria is treated with both oral intake of herbal mixtures and steam inhalations, and vomiting is induced with herbal emetics. In the Bight of Benin, gout and rheumatism are treated with the fat of a boa constrictor (Onwuanibe, 1979).

Interestingly, contrary to the widespread belief that African traditional medicine is shrouded in mysticism, superstition, and witchcraft and therefore not scientific, some of the treatment regimens seemed to suggest that practitioners of this indigenous medical system were probably aware that illness could also be due to natural causes (Bello, 2006; Erinosho, 1998, 2005, 2006; Jegede, 1996; Oke, 1995). For example, a critical look at some of the plants used to treat diseases seems to suggest that many of them were chosen not only for their spiritual and symbolic significance but also for their perceived ‘pharmacological’ effects. Examples of these plants include Acacia senega (gum Arabic), Agathosma betulina (buchu), Aloe ferox (cape aloes), Aloe vera (North African aloes), Artemisia afra (African wormwood), Aspalanthus linearis (Rooibos tea), Boswellia sacra (frankincense), Catha edulis (khat), Commiphora myrrha (myrrh), Harpagophytum procumbens (devil’s claw), Hibiscus sabdariffa (hibiscus, roselle), Hypoxis hemerocallidea (African potato), Prunus africana (African cherry); Strophanthus species (strophanthus), and Catharanthus roseus (rosy periwinkle) (Hostettmann et al., 2000; Sofowora, 1993). The folkloric claims of a number of these plants have been scientifically validated and as a result are being commercialised either in their whole state or as sources of new medicines. Monographs of some of these plants are presented in part 3 of volume 2.

As in conventional medicine, herbal medications may be given orally, nasally, rectally, or topically; but in some cases, such medications may be worn as amulets, necklaces, or as talismans around the waist or ankles. Some medications may also be hung on doors and windows or placed under a mat or pillow or some obscure place in the house. These methods of using remedies are primarily aimed at warding off the spirits that may be suspected to be the cause of the disease (Heinrich et al., 2004). Thus, in administering medications, African traditional medicine practitioners give as much regard to the context in which the disease is being treated as the method of preparation, the mode of administration, as well as the chemical compounds contained therein.

Africans were also known to practise variolation, a traditional form of inoculation against diseases such as yaws and smallpox, centuries before Jenner (father of immunology). The method involved passing the disease ‘from arm to arm’ by using a thorn to scratch material from the pustule of a patient affected with smallpox and rubbing into the skin of uninfected persons. In many cases, no adverse reaction was produced, but in some cases, a mild nonfatal form of the disease would be produced and thereby confer permanent immunity. In fact, this practice became a problem for colonial medical campaigns as it was reported to spread the disease rather than provide protection (Schneider, 2009; Herbert, 1975).

Thus, prior to the introduction of what is often termed Western medicine, the only source of health care for the vast majority of Africans was traditional medicine (Romero-Daza, 2002). Unfortunately, the healing practices and materia medica of the time were not documented. During this period, traditional medicine practitioners wielded a great deal of influence in their communities. They were bound by unwritten codes of ethics, which were strictly complied with to avoid the wrath of the gods and ancestors. During this period, the association between traditional medicine practitioners and the society was both ritual and spiritual, mediated by ancestral experience. Traditional medicine practitioners and traditional leaders (called kings or chiefs) with whom they were allied had a huge influence over the social welfare and health status of communities under their jurisdiction. There was a continuous dialectical interchange from which a bijective (one to one), permissive, therapeutic relationship resulted, with the effective participation of these key actors in the treatment exercise (Harley, 2008; WHO, 1978).

However, the influence of European colonial rule on the African continent in the 19th century marked a significant turning point in the history of this age-long tradition and culture. For example, The Witchcraft Suppression Ordinance of 1896 enacted in Great Britain, which branded the ‘witch doctor’ as a criminal and drove traditional medicine practice underground, was also enacted in the British colonies with similar consequences. In some extreme cases, traditional medicine was outright banned because of the belief that African concept of disease and illness was embedded in ‘witchcraft’, ‘backwardness’, and ‘superstition’. This unfortunate development resulted in traditional medicine practitioners losing much of their authority over communal affairs, but their knowledge survived through informal transmission to trusted members of the family.

Besides using the law to suppress African traditional medicine, the influence of ‘Western’ culture, which had conventional medicine as a key component, also led to its gradual erosion. The imported ‘medical system’ was instituted as an integral part of government administration in many parts of the colonies, with a specific budget allocation. The authorities sought to expand ‘modern’ health services by establishing medical and nursing schools for the training of health professionals. As a result, the populations gradually moved away from their indigenous medicine to embrace this ‘refined’ system of health care. The gradual demise of African traditional medicine was also due in part to the introduction of Christianity, which sought to purge Africans of belief systems that were considered demonic. The teachings of Christianity undermined the ideologies of African religions by emphasising individual accountability to God. Some missionaries constantly denigrated and castigated African cultural and religious beliefs as pagan, demonic, and evil. Ironically, some reverend fathers and pastors practised traditional medicine in some countries in Africa (Sofowora, 2008).The problem was further compounded by the emergence of a new African elite, which adopted European cultural practices to the neglect of their own (Ebrahimnejad, 2008; Guthrie, 1951; Mungwini, 2009; Okere, 1983).

The suppression of traditional medicine in many African countries continued even after independence, resulting in protests and agitations for official recognition in some countries (Erinosho, 1998, 2006). However, towards the latter part of the 20th century, attitudes began to change when it was realised that African traditional medicine was an integral part of African culture and therefore deserving of proper attention. Concerted efforts were then made to recognise its potential to contribute meaningfully to health care delivery in many countries (WHO, 2001). This assumed a new dimension after the Alma Ata Declaration (1978) that called on WHO member states to incorporate traditional medicine in their national health systems. From this period, some African governments took the initiative to systematically integrate traditional medicine into their national health systems, and patients began to develop a degree of freedom in accessing it.

Nevertheless, the lingering mistrust between practitioners of conventional and traditional medicine in Africa has continuously hampered and thwarted the process of integration and efforts to promote collaboration between the two sectors (Nevin, 2001; Ebomoyi, 2009).

Despite the negative attitude shown towards traditional medicine in Africa that has contributed largely to its neglect (Bello, 2006; Feierman, 2002), it still enjoys a high degree of patronage. Indeed, in certain African countries, up to 90% of the population still relies exclusively on plants for their health care needs (Okigbo and Mmeka, 2006). For example, in Ghana, Mali, Nigeria, and Zambia, herbal medicines are routinely used as the first line of treatment for 60% of children with malaria-induced high fever (Busia and Kasilo, 2010; Kasilo et al., 2010; WHO, 2002b). In Burkina Faso, there is an increasing demand for traditional medicine for the treatment of rheumatic and neurological complaints (Carpentier et al., 1995); and in Ghana, about 70% of the population depends primarily on traditional medicine (Roberts, 2001). In rural Tanzania, traditional medicine is used to treat convulsion, which is locally referred to as degedege (Makundi et al., 2006). There are also reports that the vast majority of South Africans use traditional medicine to treat a variety of ailments (Lekotjolo, 2009; Mander et al., 2007). In some instances, patients use traditional medicine simultaneously with modern medicine especially in the management of chronic disorders, such as hypertension (Amira and Okubadejo, 2007).

The practice of African traditional medicine was confined not only to the African subcontinent. In fact, one of the results of the trans-Atlantic slave trade was the spread of African traditional medicine to the Caribbean islands and among African Americans in the US. Over the 350-year period of the trans-Atlantic slave trade, African plants were regularly transported to the Americas and the Caribbean aboard slave ships as food and medicines and were grown by the slaves on plantations, dooryard gardens, and subsistence plots (Laguerre, 1987; Carney, 2003; Brussell, 1997). These included African rice (Oryza glaberrima), yams (Dioscorea cayensis, D. rotundata), cow (black-eye) peas (Vigna unguiculata), pigeon (Congo) peas (Cajanu cajan), melegueta peppers (Aframomum melegueta), palm oil (Elaeis guineensis), sorrel/roselle (Hibiscus sabdariffa), okra (Abelmosclus esculentus), sorghum (Sorghum bicolor), millet (Pennisetum glaucum, Eleusine coracana), the Bambara groundnut (Vigna subterranean), mangoes (Mangifera indica), African cucumber (Momordica charantia), leaf of life (Kalanchoe integra), carry-me-seed (Phyllanthus amarus), leonotis (Leonotis nepetifolia), kola nut (Cola acuminata), broomweed (Corchorus spp) and Abrus precatorius, watermelon, akee apple (Blighia sapida), wild spinach or pigweed (Amaranthus hybridus, Amaranthus spp.), bitter leaf (Vernonia spp.), Brassica spp, and baobab (Adansonia digitata) (Laguerre, 1987; Carney, 2003; Brussell, 1997). Common species such as lemon, which was used in Africa for its medicinal effects, was cultivated and used as medicines in Brazil by 1549 (Laguerre, 1987; Carney, 2003; Brussell, 1997).

As a result, although Africa and the New World are separated by a vast expanse of ocean, the two regions share certain fundamental characteristic features in their healing traditions. Slaves arriving in the Caribbean would have recognised many of the medicinal plants they encountered and continued to use them in the same manner as they had done in Africa. For instance, Rauwolfia spp., which acts as a tranquiliser, was commonly used in Africa and by Caribbean diasporans while Euphorbia spp.—which is used as a remedy for colds, indigestion, and pain—feature prominently in the traditional pharmacopoeias of both regions. Carried aboard slave ships, African plants contributed significantly to the survival and socioeconomic well-being of Caribbeans (Laguerre, 1987; Carney, 2003; Brussell, 1997).

A survey of the West Indies conducted in the mid-20th century found that 20% of the region’s plant species were alien and that the majority had arrived from the Old World during the period of colonisation (Laguerre, 1987). The descendant maroon population (enslaved Africans who fought the British for autonomy and retained much of their African culture) in Jamaica and other societies all over the Caribbean and the Americas still practise African traditional medicine (Carney, 2003; Laguerre, 1987).

Towards the end of the slave trade, African slaves arriving in Venezuela introduced healing rituals with tobacco that were uniquely African. Similarly, the Portuguese transported the South American peanut to Africa and incorporated it into the African ethnomedical system. This was then carried to the Caribbean as food and medicine for captive labourers (Laguerre, 1987; Carney, 2003; Brussell, 1997). Thus, overall, Africa and South America share about one hundred and eighty-six plant families and almost 700 genera (Laguerre, 1987; Carney, 2003; Brussell, 1997).

Exchange of plant between India and Africa by sea and land routes had also been ongoing for thousands of years before the advent of the slave trade in the 15th century. Examples of Asian crops that spread to Africa during this period include taro (Coloasia esculenta), lime (Citrus aurantifolia), luffa sponge (Luffa spp.), edible green (Celosia argentea), and banana and plantain (Musa spp.) (Carney, 2003; Laguerre, 1987). In the same way, tropical plants from Africa found their way to Asia (notably, with India and China) about 3,000 years ago and included tamarind (Tamarindus indica), castor bean (Ricinus communis), and okra (Abelmoshus esculentus). Other African domesticated plants such as sorghum (Sorghum bicolor) and millets (Pennisetum glaucum, Eleusine coracana) were intensely bred for thousands of years in India before returning again to Africa as new varieties (Carney, 2003; Laguerre, 1987). Plants such as mustard green and kale, introduced from the Mediterranean, were long established in Africa prior to their dissemination across the Atlantic by slave ships. Another of such Old World plants is sesame, which was originally from Asia but so long used in Africa that it bears the name ‘benne’, by which it is still called in southern US to this day (Carney, 2003; Laguerre, 1987).

It can therefore be argued that if the conditions of slavery prevented certain African cultural practices, in the case of disease treatment, slaves were allowed or even encouraged to rely on their own healing devices (Carney, 2003; Laguerre, 1987). Interestingly, the African approach for using plants differed significantly from those favoured by Europeans. The Africans preferred fresh herbs to dried herbal preparations. Moreover, the Africans preferred using herbal medicines for treatment as opposed to the invasive treatment approaches of venesection, cupping, blistering, purging, and leeching practised by Europeans during the plantation slavery era (Carney, 2003; Laguerre, 1987). While such techniques have largely disappeared, the use of African herbal remedies to treat a variety of diseases endures to this day both in Africa and the Caribbean.

Indian Traditional Medicine (Ayurvedic Medicine)

Ayurveda is derived from the Indian words ayar (life) and veda (knowledge or science) and hence means the science of life. It is a practical and holistic set of guidelines for maintaining balance and harmony in the human body. Proponents of this traditional medical system believe that adherence to the Ayurvedic principles would help ensure longevity for the pursuit of righteousness (dharma), wealth (artha), and happiness (sukha).

Considered to be the origin of systemised medicine, Ayurveda is believed to be the most ancient of all documented medical traditions, being probably older than traditional Chinese medicine. In fact, whereas Greek and Middle Eastern medical texts refer to ideas and drugs of Indian origin, ancient Hindu writings on medicine contain no references to foreign medicines. Dioscorides, who lived in the AD 1st century and influenced Hippocrates, is thought to have taken many of his ideas from India.

The transmission of knowledge and wisdom from one generation to the next in India occurred through songs and poems, which scholars and physicians had to learn by heart and recite. The earliest of the ancient Indian text, the Veda—written in four parts (Rig Veda, Sama Veda, Yajur Veda, and Atharva Veda)—dates back to 2000 years BC. The Rig Veda consists of many poetic hymns on the principles of Ayurvedic medicine and the uses of medicinal plants (Gurib-Fakim, 2006). In 500 BC, the first Ayurvedic medical school was established at the University of Banaras, and the great Samhita (Encyclopaedia of Medicine) was written at about the same time. This was followed 700 years later, with the writing of another great encyclopaedia. These two texts together form the basis of Ayurveda.

Like galenical medicine, Ayurveda is also based on bodily humours (dosas) and the inner life force (prana) thought to maintain digestion and mental activity. In this system of medicine, the living and the nonliving environment is composed of the elements earth (prithvi), water (jada), fire (tejac), air (vaju) and space (akasa) (Gurib-Fakim, 2006); and illness is believed to be the result of imbalance among the various elements. The goal of ayuverdic treatment therefore is to restore balance.

Notable Ayurvedic herbal medicines include Azadirachta indica (neem), Centella asiatica (gotu kola), Cinnamomum camphora (camphor), Elettaria cardamomum (ela or cardamom), Rauwolfia serpentina (Indian snake root), Santalum album (sandalwood), Terminalia species (myrobolan), and Withania somnifera (ashwagandha) (Gurib-Fakim, 2006).

Middle Eastern Traditional Medicine

The oldest written records on the use of medicinal plants in the Arabic traditions were uncovered from the works of the Sumerians and Akkadians of Mesopotamia (Heinrich et al., 2004). Archaeological excavations of the grave of the Neanderthal man from Shanidar in Iraq uncovered pollen of several species of plants including Centaurea solstitialis (Asteraceae), Ephedra altissima (Ephedraceae) and Althea sp. (Malvaceae), which may have been used as far back as 60,000 BCE. Interestingly, these plants or closely related species from the same genus are still used today in Iraqi phytotherapy and other cultural traditions. The cuneiform writings of the Babylonians, Assyrians, and Sumerians, including particularly the Code of Hammurabi (about 1700 BC), list several medicinal plants, some of which are still in use today.

The Arabs are credited with the preservation of much of the Greco-Roman medical expertise and were the first to set up private pharmacies in the eighth century. Avicenna—the Persian pharmacists, physician, philosopher, and poet and one of the notable citizens of the region of that era—contributed greatly to the Canon Medicinae, thought to be the ‘final codification of all Graeco-Roman medicine’. This document forms the basis of the Islamic healing system called unani-tibb and also contains information on other healing traditions (Gurib-Fakim, 2006).

The Middle East, including Egypt, is noted for important medicinal plants such as ajowan (Trachyspermum ammi), almond (Prunus dulcis), asafoetida (Ferula assafoetida), caraway (Carum carvi), castor oil plant (Ricinus communis), damask rose (Rosa x damascena), fenugreek (Trigonella foenum-graecum), grape (Vitis vinifera), henna (Lawsonia inermis), onion (Allium cepa), opium poppy (Papaver somniferum), pomegranate (Punica granatum), safflower (Carthamus tinctorius), senna (Senna alexandrina), sesame (Sesamum indicum), Syrian rue (Peganum harmala), toothbrush tree (Salvadora persica), and tragacanth (Astracantha gummifera) (Gurib-Fakim, 2006).

Traditional Chinese Medicine

Traditional Chinese medicine (TCM) has been in existence for thousands of years. Although the first recorded history of TCM dates back over 2,000 years, it is believed that the system goes back more than 5,000 years. Legend has it that the origin of traditional Chinese medicine is traced back to the three mythical emperors: Fu Xi, Shen Nong, and Huang Di. Shen Nong, who lived about 5000 years ago, is hailed as the ‘divine cultivator’/’divine farmer’ by the Chinese people because he is believed to be the founder of herbal medicine and taught people how to farm. In order to determine the nature of different herbal medicines, Shen Nong sampled various kinds of plants, ingesting them himself to test and analyse their individual effects. According to ancient texts, Shen Nong tasted a hundred herbs including seventy toxic substances in a single day in order to get rid of people’s pain from illness. As there were no written records, it is said that the discoveries of Shen Nong was passed down verbally from generation to generation.

The first written documentation on TCM is the Hung-Di Nei-Jing (Yellow Emperor’s Canon of Internal Medicine), which is also believed to be the world’s oldest medical textbook, with different opinions dating it back to between 800 BCE and 200 BCE. The Yellow Emperor’s Canon of Internal Medicine outlines the theories of Chinese medicine and includes extensive summaries of previous experience of treatment and various theories of medicine, such as the meridian theory, acupuncture, and moxibustion.

Traditional Chinese medicine is based on the theories of yin and yang and the five elements (wu xing). Yin and yang represent complementary opposites that interact within a greater whole, being essential qualities of all of the universe’s physical matter. However, yin-yang is much more than just a pair of opposites, as each is dependent on the other and continuously transforms from one into the other. No yang can exist without the concept of yin, and vice versa. For example, just as night (yin) becomes day (yang) and day becomes night, so does birth (yang) becomes death (yin) and vice versa. In the same way, without