Herbal medicine is the use of plants or plant extracts for medicinal purposes (especially plants that are not part of the normal diet). Phytonutrient or nutraceutical or functional food Natural substances that aid the body to maintaining health and combating disease such as anthocyanidins, isoflavones and carotenoids. Natural product : is biosynthetic substances produced by living cells. Crude Drug: It’s a medically useful drug of plant or animal origin without any further processing or modification.

1. By
Dr. Mostafa Mahmoud Hegazy

2. What is herbal medicine?
Herbal medicine , phytomedicine or herbalism is a type of
alternative and complementary medicine (CAM) that uses plants
or their crude products for the treatment of diseases. It may
include also animal, fungi or bacteria products (≠ conventional
medicine, which uses pure chemicals regardless of their origin,
natural or synthetic).
Other types of CAM
•Physical therapy •Aromatherapy
• Vacuum cups (cupping) • Acupuncture
Phytopharmacology
A recently established field of drug research, dealing with the
study of the interactions that occur between a living organism and
natural drugs.

3. Herbal medicine is the use of plants or plant extracts for
medicinal purposes (especially plants that are not part of the
normal diet).
Phytonutrient or nutraceutical or functional food
Natural substances that aid the body to maintaining health
and combating disease such as anthocyanidins, isoflavones
and carotenoids.
Natural product : is biosynthetic substances produced by
living cells.
Crude Drug: It’s a medically useful drug of plant or animal
origin without any further processing or modification.

4. Phytopharmacuticals;Is the natural biologically active fraction
or standerdized extracts formulated in certain pharmaceutical
dosage form and legally approved for intended use and user
Phytochemistry The study of chemical constituents in the
plants.
Extracts
Extraction is the obtaining of a mixture of compounds from herbal
materials by using adequate solvents
Standardized extract: this is extract with relatively well-
established chemical, pharmacological and clinical profiles
Non - standardized extract: extract with little information about
quality, chemical composition and efficacy.

5. Differences between Herbal drugs, purified and single
compound medicinal agents (i.e. conventional drugs)
1) They are generally safer with moderate use (active compounds
are present in lower concentrations than in conventional drugs).
2) Many of them are used in the form of extract to concentrate
the active compound(s).
3) They contain a wide variety of different compounds (active and
inactive).
4) The concentration and composition of their active
compounds (mostly secondary metabolites) vary with many
factors (amount of sunlight, rainfall, temperature, soil and season).
5) They contain mixture of components that may have active,
synergistic or antagonistic compounds, which determines their
mode of use.
6) They could treat certain chronic and self-limiting
diseases that could be responsive to self-treatment such as
headache, constipation, diarrhea, cough, skin infections,….

6. 7(Certain herbs are used as remedies and foods at the same
time e.g. garlic, citrus, grapes, green and black tea.
8(They may support the general health and offer prophylaxis
against certain diseases e.g. antioxidants, antihepatotoxics
(protect against cancer and liver diseases), antihyperlipidemics
and antihypercholesterolemics (protect against atherosclerosis
and cardiovascular diseases(.
9(They are generally cheaper than conventional medicines.
10)due to complexity of the mixture of the herbal products it may
be exert multiplicity of mechanisms and fewer side effects.

7. Natural drugs
Gentle Intermediate Powerful
e.g. chamomile,
hawthorn.
Complex of natural
principles
e.g. chamomile extract,
hawthorn extract.
e.g. licorice, e.g. belladonna,
digitalis.
Isolated natural
principles e.g.
atropine,
digitoxin.

8. Gentle Intermediate Powerful
Heart diseases Hawthorn Lily-of-the-
valley
Digitalis
Gastrointestinal
diseases
Chamomile,
peppermint
Licorice Belladonna
(atropine
Nervous diseases Valerian Hypericum Opium
(morphine),
melissa.
Anti-inflammatory Azulene,
flavonoids
Cortisone
Antispasmodic Chamomile,
fennel,
peppermint.
Atropine,
papaverine
Analeptic Camphor Lobeline
Sedative Hops, Kavaine,
Valerian
Barbiturate.
Sympathomimetic Crataegus Adrenaline

9. Major therapeutic categories in which Herbal medicine
were prescribed
Cardiovascular system.
Nervous system.
Digestive system.
Immune system.
Urological system
Respiratory system.
Rheumatic conditions.
Skin diseases.
Wounds, and sprains.
Some metabolic and endocrinal conditions.
Gynecological conditions and diseases of the breast.
Cancer.

10. Examples of Conventional Drugs Derived from Plants
Drug Herb Common Name (Latin Name) Action/Approved Use
Colchicine Autumn crocus (Colchicum autumnale) Anti-inflammatory
Digoxin/Lanoxin Digitalis/foxglove (Digitalis spp.) Cardiotonic/Pdsitive
inotropic
Tubocurarine Curare (Chondrodendron tomentosum) Neuromuscular blocker
Ephedrine Ephedra (Ephedra sinica) Sympathomimetic
Etoposide Mayapple (Podophyllum peltatum) Antitumor
Physostigmine Calabar bean (Physostigma
venenosum)
Cholinesterase inhibitor
' (parasympathomimetic)
Reserpine Rauwolfia (Rauvolfia serpentina) Hypotensive
Scopolamine Jimson weed (Datura stramonium)
Duboisia (Duboisia spp.)
Antimuscarinic; antimotion
sickness
Taxol* Pacific yew (Taxus brevifolia) Antitumor
Vincristine Madagascar periwinkle (Catharanthus
roseus)
Acute lymphocytic
leukemia; non-Hodgkins
lymphoma, etc.

11. Herbs and Herbal Materials Approved as Over-the-Counter (OTC)
Drug Ingredients by the U.S. FDA*
Herb Common
Name
Latin Name Approved Use
Capsicum fruit
oleoresin
Capsicum spp. Topical analgesic
Ipecac root Cephaelis ipecacuanha Emetic
Psyllium seed husk Plantago spp. Bulk laxative
Senna leaf and fruit Senna alexandrina; Cassia
senna
Stimulant laxative
Slippery elm bark Ulmus rubra Demulcent
Witch hazel bark Hamamelis virginiana Astringent
* Herbs and herb materials refers to whole plants and/or plant parts, or their derived
chemically complex products (e.g., oleoresin capsicum), but not single chemical
entities (e.g., capsaicin, the primary active ingredient in capsicum oleoresin, approved
as both an Rx and OTC drug, but not considered "herbal" although it is plant-derived).
Further, pure compounds from herb-derived oils, although approved for OTC drug use,
are not considered "herbal;" these include eucalyptol from eucalyptus leaf, menthol
from peppermint leaf oil, and thymol from thyme leaf oil.

12. Quality control of herbal medicine

13. Aspects must be considered in herbal medicine
1- Identity
Macroscopical, microscopical, chemical investigation.
2- Purity
Detection of adulterants and pollutants
3- Efficacy
Cell, tissue and organ cultures, Animal and clinical studies.
4- Safety

14. 1- Identity
Investigation of herbal medicine drugs involves several
points, include the following:
a) Macroscopical examination:
N. B. For pharmaceutical preparations, suitable tests are
done (e.g. for tinctures, extracts: clarity, specific gravity, pH.)

15. b) Microscopical examination:
This is very useful, especially for herbal medicines present in
the powdered forms. Microscopical examinations aims at:
- Identifying, or confirming the identity of herbal ingredients
through presence of their diagnostic elements.
- Confirming purity, through absence of foreign elements
(presence of which indicates adulteration).
- Distinguishing between closely related species usually by
determining certain microscopical numerical values such as
stomatal index, palisade ratio, vein islet number and
veinlet termination number.
- Determination of percentage of some adulterants that contain
certain characteristic elements by the lycopodium method.

16. c) Histochemical tests

17. d) Qualitative chemical tests
According to the type of active coustitents present, general
tests should carried out:

18. e) Quantitative chemical analysis
This is carried out depending on the type of active
constituents present.
The amount of active constituents should be within the
official or required limits.
f) Chromatographic detection of active constituents in
different extracts.

19. 2- Purity
Detection of adulterants and pollutants
The following types of potential contaminants will be
considered:
A- Toxic botanicals
B- Micro-organisms and microbial toxins
C- Pesticides and fumigation agents
D- Radioactivity
E-Toxic metals
F- Synthetic and animal drug substances

20. Type of contaminant Examples
Botanicals Atropa belladonna, Digitalis, Colchicum, Rauwolfia
serpentina, pyrrolizidine-containing plants
Micro-organisms Staphylococcus aureus, Escherichia coli (certain strains).
Salmonella, Shigella, Pseudomonas aeruginosa
Microbial toxins Bacterial endotoxins, aflatoxins
Pesticides Chlorinated pesticides (e.g., DDT, DDE, HCH isomers,
HCB, aldrin, dieldrin, heptachlor), organic phosphates,
carbamate insecticides and herbicides, dithiocarbamate
fungicides, triazin herbicides
Fumigation agents Ethylene oxide, methyl bromide, phosphine
Radioactivity Cs-134, Cs-137, Ru-103, I-131, Sr-90
Metals Lead, cadmium, mercury, arsenic
Synthetic drugs Analgesic and anti-inflammatory agents (e.g.,
aminophenazone, phenylbutazone, indomethacin),
corticosteroids, hydrochlo-rothiazide, diazepam
Animal drugs Thyroid hormones

21. Micro-organisms and microbial toxins
-Infection by pathogenic micro-organisms, such as salmonella
-Microbial transformation of botanical constituents into more toxic compounds
-Production of microbial toxins, such as bacterial endotoxins and mycotoxins
3- Efficacy
a) Cell, tissue and organ cultures
-It is modern alternative to animal experimentation.
-It is used for in vitro preliminary screening in drug discovery programs.
-Its advantages are direct observation of the action of agent on target cells and with
reduced ethical difficulties.
-Its disadvantage, it is impossible to predict the balance of plant constituents that will
actually reach internal tissue (after digestion, absorption, and first pass hepatic effect.
b) Animal experiments
c) Clinical trials

22. 4- Safety
a) Investigation of acute and chronic toxicity.
b) Determination of the duration of administration.
c) Identification of therapeutic and toxic doses.
d) Studying the effects during lactation and pregnancy.
e) Postmarketing surveillance.
- adverse reaction reports.
- drug interaction reports.
- phototoxicity reports.
- hypersensitivity reports.

23. I- Liquids II- SolidII- Solid
Oral
Infusions and decoctions
Tincture
Syrup
Tablets
Capsules
Powder
TopicalTopical
Liniments
Lotions
Eardrops
Eyebaths
Gargles
Inhalants (or vapours)
Baths
CreamCream
OintmentOintment
Jellies (or gels)Jellies (or gels)
PlastersPlasters
PoulticesPoultices
Suppositories and pessariesSuppositories and pessaries
Dosage forms in herbal medicine

24. Herbal Medicine for the Treatment of
Cardiovascular Disease
 CONGESTIVE HEART FAILURE
 HYPERTENSION
 ANGINA PECTORIS
 ATHEROSCLEROSIS
 CEREBRAL AND PERIPHERAL VASCULAR DISEASE
 VENOUS INSUFFICIENCY
 ARRHYTHMIA

25. number of herbs contain potent cardioactive glycosides, which have
positive inotropic with negative chronotropic actions on the heart.
 The drugs digitoxin, derived from either D purpurea (foxglove), and
digoxin, derived from D lanata , have been used in the treatment of
congestive heart failure for many decades.
Cardiac glycosides have a low therapeutic index, and the dose must be
adjusted to the needs of each patient.
 CONGESTIVE HEART FAILURE

26. HYPERTENSION
Rauwolfia serpentina root: the natural source of the alkaloid reserpine,
 Reserpine was one of the first drugs used on a large scale to treat systemic
hypertension.
 It acts by irreversibly blocking the uptake of catecholamines
(norepinephrine, dopamine, and serotonin) in the storage vesicles of
central and peripheral adrenergic neurons, thus leaving the
catecholamines to be destroyed by the monoamine oxidase.
 The depletion of catecholamines accounts for reserpine's sympatholytic
and antihypertensive actions.

27. ANGINA PECTORIS
Crataegus hawthorn ,
a name for many Crataegus species which have acquired the
reputation in modern herbal literature as an important tonic for the
cardiovascular system that is particularly useful for angina.
• flowers, and fruits contain a number of biologically active substances, such as
procyanins, flavonoids, and catechins.
• Crataegus extract antagonizes the increases in cholesterol, triglyceride, and
phospholipid levels in low-density lipoprotein (LDL) and very low-density
lipoprotein , thus it may inhibit the progression of atherosclerosis

29. Panax ginseng (Asian ginseng), Panax notoginseng has
acquired the common name of pseudoginseng, especially since it
is often an adulterant of P ginseng preparations.
It is often used in the treatment of patients with angina and
coronary artery disease

30. ATHEROSCLEROSIS
Garlic, has demonstrated multiple beneficial cardiovascular effects. A number of
studies have demonstrated these effects that include lowering blood pressure, inhibiting
platelet aggregation, enhancing fibrinolytic activity, reducing serum cholesterol and
triglyceride levels, and protecting the elastic properties of the aorta.
garlic (Allium sativum) is one of the herbal medicines that has been examined more
closely by the scientific community. In recent decades, research has focused on garlic's
use in preventing atherosclerosis.
side effects from a garlic odor on the breath and body, moderate garlic consumption
causes few adverse effects. However, consumption in excess of 5 cloves daily may
result in heartburn, flatulence, and other gastrointestinal disturbances.

31.  CEREBRAL AND PERIPHERAL VASCULAR DISEASE
Ginkgo biloba
At least 2 groups of substances within G biloba extract
(GBE) demonstrate beneficial pharmacological actions.
1- The flavonoids reduce capillary permeability as well as
fragility and serve as free radical scavengers.
2- The terpenes (ie, ginkgolides) inhibit platelet-activating
factor, decrease vascular resistance, and improve
circulatory flow without affecting blood pressure
Continuing research appears to support the primary use of GBE for treating
cerebral insufficiency and its secondary effects on vertigo, memory, and mood;
also, GBE appears to be useful for treating peripheral vascular disease,
including diabetic retinopathy.

32.  VENOUS INSUFFICIENCY
Aesculus hippocastanum,
have long been used in Europe to treat venous disorders such as varicose veins. The
saponin glycoside aescin from horse chestnut extract (HCE) inhibits the activity of
lysosomal enzymes thought to contribute to varicose veins by weakening vessel walls
and increasing permeability, which result in dilated veins and edema