Edward S. Ayensu
EDWARD S. AYENSU, of Ghana, is Director of the Office of Biological Conservation, Smithsonian Institution, Washington, D.C. This article is a shortened version of "A worldwide role for the healing power of plants" which originally appeared in the Smithsonian Magazine, published by the Smithsonian Institution.
Medicinal plants native to developing countries are often exported to developed countries where they are screened, analysed and used in drug preparations, only to be returned as high-priced medicines.
The therapeutic value and healing powers of plants were demonstrated to me when I was a boy of about ten. I had developed an acute, persistent abdominal pain which did not respond readily to hospital medication. My mother had taken me to the city's central hospital on several occasions where different drugs were administered. In total desperation, she took me to Egya Mensa, a well-known herbalist in my home town in the Western Province of Ghana. This man was no stranger to the medical doctors at the hospital. He had earned the reputation of offering excellent help when they were confronted with difficult cases where Western medicine had failed to effect a cure.
After a brief interview, not very different from those that occur daily in the consulting offices of many general medical practitioners, he left us waiting in his consulting room while he went out to the field. He returned with several leaves and the bark of a tree, and one of his attendants immediately prepared a decoction. I was given a glass of this preparation; it tasted extremely bitter, but within an hour or so I felt some relief. The rest of the decoction was put in two large bottles so that I could take doses periodically. Within about three days the frequent abdominal pains stopped and I regained a good appetite. I have appreciated the healing powers of medicinal plants ever since.
My experience may sound unusual to those who come from urban areas of the developed world, but for those in the less affluent nations such experiences are a common occurrence. In fact, demographic studies by various national governments and intergovernmental organizations such as the World Health Organization (WHO) indicate that for 75 to 90 percent of he rural populations of the world, the herbalist is the only person who handles their medical problems.
In African culture, traditional medical practitioners are always considered to be influential spiritual leaders as well, using magic and religion along with medicines. Illness is handled with man's hidden spiritual powers and with the application of plants that have been found especially to contain healing powers.
Chief Joseph Olusola Lambo of Nigeria, in a recent interview for the Voice of America, described his own introduction to herbal medicine at the age of 15, some 40 years ago. Currently president of the Nigerian Association of Medical Herbalists, Chief Lambo became interested in traditional medicine as a result of a severe headache he had while very young. A relative escorted him to a village where a traditional medical practitioner washed young Lambo's head in a pool with a locally made soap containing native medicine. Soon after this treatment, his headache vanished. He was so impressed that he began his own research into herbalism. To him, this was "science in action".
Chief Lambo's youngest brother, Dr Thomas Lambo, is the Deputy Director-General of the World Health Organization and an internationally recognized psychiatrist. They are both very much concerned about the relationship between traditional medical practice and modern medicine. Chief Lambo explains: "In the olden days the relationship was very strained because the modern doctors did not believe in traditional medicine. They did not want even to see traditional healers. But lately they have found out that there is a lot to be gained from traditional medicine." The situation has improved so much that at the Drug Research Center at the University of Ife, in Nigeria, a herbalist is employed as a full-time consultant to Dr Abayomi Sofowora's plant chemistry programme. Dr Sofowora and his colleagues, while well-versed in modern scientific research, recognize the importance of herbal medicine and believe there is much to learn from reputable herbalists.
During a recent trip to New Delhi, I visited several "drugstores" filled with only locally manufactured medicinal plant products. One of the storekeepers handed me a tin of medicine labelled Baidyanath Chyawanprash Avaleha. "Take this and use it. It builds up vitality and memory. It can also cure bronchial and respiratory diseases. You can use six to 12 grams with milk or honey twice a day. It will be good for you," he said.
flowers of African tulip tree - Spathodea campanulata heal skin ulcers
peppers = base for many herbal remedies
African vine Strophanthus hispidus both an arrow poison and a cardiotonic
I picked up some well-packaged bark and roots of Rauwolfia serpentina, a plant that was very well-known in ancient Asiatic medicine and contains the alkaloid reserpine. Before I could ask any questions about it, the storekeeper said, "This is a very important plant. It contains a lot of very powerful chemicals. Do you know that this plant has the power to lower your blood pressure and your pulse? Do you know of anyone who has hypertension? This is the best medicine for it. Well, we also use it to calm down mad people, because alkaloids in the plant have specific influence on the mind." The storekeeper, I later learned, had a medical degree from an Indian university but chose to administer herbal medicine because he felt his people were better off with local medicines than with the expensive, imported synthetic drugs that had no traditional, social or psychological meaning.
He proceeded to lecture me on the fact that India was one of the countries that had pioneered the development and practice of subsequently well-documented indigenous systems of medicine, the two most notable being the Ayurveda (Hindu) and Unani (Greek and Islamic). He stressed that the materia medica of these two systems encompasses a rich heritage of indigenous herbal practices that have helped to sustain the health of the peoples of India for centuries. "I am very much pleased and satisfied that after training as a modern medical doctor I have returned to our kind of medicine, which is most suitable for us," he told me.
In the neighbouring Himalayan Kingdom of Nepal, at the Royal Drug Research Laboratory, where an impressive programme of medicinal plant research is being conducted, I met the Director-General. Dr S.S. Malla, who also expressed tremendous satisfaction in the increased attention to herbal medicine in his country and abroad. He proceeded to remind me that medicinal plants have played an important role in Hindu culture, as shown in the Rig-Veda, which is said to have been written between 4500 and 1600 BC. Then he added, "It is unlikely that the Hindu culture will abandon such a rich heritage, especially in the face of escalating prices of Western drugs."
While on a tour of the research facilities, I was prompted to ask several questions concerning the acceptability of herbal medicine, especially among the Western-educated Nepalese. "Deep down they all trust the local medicines. Some of the crude drugs, species of Rauwolfia, Ephedra, Aconitum and Nardostachys, are still very popular for the cure of hypertension and many heart diseases," reported one of the staff members.
In recent years, medicinal plants have been recognized widely as "chemical factories". The Eurasian aroid Acorus calamus, for example, used currently in 51 different drug preparations because the rhizomes contain an essential oil with insecticidal and sedative properties, is under heavy collecting pressure.
Around the world, the bulk of the raw materials used in preparing drugs are mostly collected from the wild. In fact, heavy collecting of certain plants for local as well as foreign pharmaceutical markets has become a major problem. A striking example is the depletion of a much sought-after species of yam (Dioscorea), whose chemical compound diosgenin is used as the foundation material in the manufacture of birth-control pills.
Vincristine, the chemical derived from the Madagascar periwinkle (Catharanthus roseus) sells for more than US$ 100000 per 0.5 kg (1 lb). It has led to a remarkable decrease in mortality among young leukaemia patients. In China, at present, literally all available soil suitable for the growth of this plant is under cultivation. Because of the low yield of vincristine from Catharanthus roseus, it is necessary for the Chinese to process at least 100000 kg in order to recover a reasonable yield of the alkaloid. The leaves represent about ten percent of the total dry weight of the plant. Therefore the Chinese usually process about 900000 kg of dried plants at a time.
China is perhaps the leading country in systematically amalgamating herbal medicine into natural health-care systems. In several visits to China, I have had the opportunity to observe the practice of herbal pharmacology on a mass scale.
On the outskirts of Beijing, for example, there is an experimental plantation for the institute of Materia Medical This establishment, covering about 26 ha (64 acres), contains some 1500 species of well-tended medicinal plants. "Here about 10000 barefoot doctors are trained every year to gain experience in the cultivation of medicinal plants," an Institute official explained. "Our population is big' therefore we need more such doctors to work with the people in the cities as well as the remote areas." The plantation is also recognized as a reliable supply house where pharmaceutical research laboratories obtain sufficient authenticated plant material for biological evaluations or chemical studies.
In travelling through the developing world. I am pleasantly surprised to find mounting interest among even the best-educated people in traditional medicine. This observation is particularly true of people in the Indian subcontinent. The educated public in Africa and Latin America still have some way to go in reeducating themselves. I am particularly disturbed by Third World Western-trained doctors who show total disregard and disdain for the importance that herbal medicine plays in the world's health situation. Some of these doctors are even ashamed to admit that their parents relied on these ancient folk remedies to treat and save their lives during childhood. Many of the Western-trained doctors seem to have been brainwashed into believing that only drugs originating in the developed countries have healing powers.
Some of these same doctors seem unaware that the major pharmaceutical houses are constantly searching for new active compounds from the medicinal plants of developing countries. Confronted with mounting prices for drugs, particularly the synthetic drugs derived from petrochemicals, chemists are turning their attention back to herbs in their search for new drug substances that have to this day eluded them. Furthermore, many developing countries are aware that their native medicinal plants are imported into the developed countries where they are screened, analysed and used in drug preparations, only to be returned to them at exorbitant prices. This situation has been described by Dr Halfdan Mahler, Director-General of WHO, as "drug colonization".
For health, social and economic reasons it seems clear that developing countries should begin an extensive programme aimed at an examination of the most important medicinal plants. At the moment, information on such plants in most countries is dispersed and unorganized. Much of it is in the heads of aging herbalists who represent a dying breed.
A WELL-STOCK ED STALL AT AN OPEN MARKET - West Africa's typical "drugstore"
A MODERN HERBAL PHARMACY IN INDIA - a new wave of traditional medicine practices
CHINESE MEDICINE CHEST - a cornucopia of medicinal herbs
MODERN PACKAGING - a new image for traditional medicines
However, there is a general feeling among specialists that gradually the magic, superstition and dogma that surround medicinal plants are giving way to an understanding of the real basis of their curative powers. The proliferation of information on "natural foods" has influenced the recent great interest in herbal remedies.
More and more people realize that a substantial number of the prescriptions bought from drugstores contain different crude plant products. In 1973, the last year in which good data were available on prescriptions in the United States, it was shown that of the 1532 thousand million prescriptions sold in pharmacies throughout the United States, 41.2 percent contained natural products and of these, 25.2 percent were products from flowering plants. If prescriptions offered by state and federal hospitals in the United States alone are considered, it is estimated that prescriptions containing flowering plants or their products amount to US$4 thousand million a year.
For those in the affluent world, it may seem inconceivable that about 85 percent of the world's population in the poor nations, when they are ill, do not consult medical doctors and many never enter a hospital from the time they are born until they die. Such statistics have prompted the World Health Organization, after many years of benign neglect, to initiate a programme to promote and develop traditional medicine to be carried out throughout the developing world.
Traditional medicine "needs to be evaluated, given due recognition and developed so as to improve its efficacy, safety, availability and wider application at low cost," according to WHO reports. "It is already the people's own health-care system and is well accepted by them. It has certain advantages over imported systems of medicine in any setting because as an integral part of the people's culture, it is particularly effective in solving certain cultural health problems. It can and does freely contribute to scientific and universal medicine. Its recognition, promotion and development will secure due respect for a people's culture and heritage."
Dr R.H. Bannerman, until recently the Programme Manager for Traditional Medicine at WHO, summed up the current feeling on traditional medicine as follows: 'There are those who lake a hostile attitude toward traditional medicine, and those who, without reservation, accept all things handed down by tradition. Both of these attitudes are indeed wrong. The more realistic tendency which is emerging is discriminating and discarding the crude and harmful practices while retaining the refined and useful methods for further development and application."
All countries belonging to WHO have pledged to provide primary health-care for all their people by the year 2000. Obviously, we cannot continue to rely exclusively on the administration of Western medicine. This is particularly self-evident when we realize that, for example, there are more medical doctors currently within the metropolitan Washington, D.C. area in the United States than there are in the whole of Black Africa. As traditional medicine gains the respect of our modern societies, there is the likelihood that a new breed of practitioners will emerge. I can foresee a transformation: the development of well-educated herbalists who can write down their diagnoses, follow up their clinical observations, and record the efficacy and safety of the herbs administered. Finally, one hopes the traditional healer will retain the trappings of his medical practice and maintain his psychological position in the community.
