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At the dawn of civilisation, herbal remedies are considered as a precious gift from God. Before the evolving age of technology, this natural heritage was the core elements in the preparation of drugs at ancient times. Thus, it is not surprising that 25% of the global prescribed medicines are actually plant derivatives (Benzie and Wachtel-Galor 2011). Herbal remedies, also known as phytomedicine, involve the use of plants to treat and prevent diseases. The medicinal values of herbal remedies are not confined to certain parts of the medicinal plants only. Instead, modern technology is used to extract active ingredients such as fatty acids, sterol and alkanoid from the leaves, flowers, seeds and even the roots of botanical plants (Bent , 2008; Ghazi-moghadam et al., 2012). Since herbal remedies possess magnificent therapeutic values, the position of herbal remedies in modern day pharmacy can be evaluated in terms of prevalence of herbal remedies usage, economic value of herbal medicines, and applications in different diseases and worldwide responds towards herbal remedies usage. 155
Prevalence of herbal remedies usage
Herbal therapy is a common practice to many undeveloped countries. About 80% of the world population are depending on herbal remedies as their healthcare delivery (WHO 2008). Prevalence of herbal medicines usage is evident when dependence on herbal remedies is shown by 90% of Africa and 70% of India population. In China , the health care delivery is comprised of 40% of traditional medicines and specialised units for traditional medicine are even offered by more than 90% of general hospitals (Benzie and Wachtel-Galor 2011).Indirectly, the growing tendency towards herbal remedies application has displayed the public interest in the therapeutic value of these natural products. 99
Figure : Percentage usage of herbal remedies among CAM treatment in South Australia from the year 1993 to 2000 (MacLenna et al. 2006)
In Figure 1, it was reported that the percentage usage on herbal remedies had increased from the year 1999 to 2000 in which the females experienced a greater increase in herbal medicines dependence compared to males (MacLenna et al. 2006).Obviously, these growing figures have indicated the current position of herbal remedies by illustrating the public dependence on herbal therapy. In U.S, 118 out of top 150 prescribed drugs are derived from natural sources such as plants, fungi, bacteria and vertebrate in which plants devoted a large portion (74%) in drug preparation as shown in Figure 2 (esa 2000). 93
Figure : Compositions of natural sources in 118 out of top 150 prescribed drugs (esa 2000)
The importance of herbal remedies in clinical market is further highlighted when natural products have accounted 50% of total clinical drugs (Van Wyk and Wink 2004).Since the contribution of herbal medicines towards health care cannot be neglected, WHO has included them in their essential medicines list and plant-based medicines have contributed 11% of the list (Sahoo et al. 2010). The efficacy of herbal remedies is even acknowledged by most of the pharmacists and this can be seen in a conducted survey in which 73% of the pharmacists claimed to have herbal products in their pharmacy (Bouldin 1999).
The prevalence of plant-derived medicines in market has definitely affirmed their position in the pyramid of health care system as it reflects the belief of society in herbal remedies applications. 117
Applications in various diseases scope
Surprisingly, about 25% of the global prescribed drugs are actually originated from plants (Sahoo et al. 2010). For example, Zemaphyte is made up of 10 different herbs and is used to treat eczema (K.Chan 2003).Even the well-known drugs such as quinine, morphine, codeine and digoxin are also derived from plants (Van Wyk and Wink 2004). The herbal medicines express their therapeutic values through their antioxidant, anti-inflammatory, antiviral and antimicrobial properties. Presence of chemicals such as fatty acids, sterol, alkaloids and flavonoid in the herbal remedies will exert chemical effects on the target (Bent 2008). 81
Table 1: 5 of the 10 best-selling drugs in US with their active ingredients and uses (Van Wyk and Wink 2004).
Dried aboveground parts
Flavonoid ,ginkgolides and bilobaline
-To treat dementia and peripheral arterial occlusive disease
Bulb of A.sativum
Allicin, ajoens and alliin
-To decrease total cholesterol and to increase high density lipoprotein level.
-To manage fatigue and treat atherosclerosis, bleeding disorder and diabetes.
Juice of fruit
-To prevent UTI, renal calculi and scurvy
-To promote wound healing and treat asthma
Rhizomes and roots
Volatile oil,valepotriates and cyclopentane sesquiterpenoids
-Non-addictive transquilizer against restlessness, sleeplessness and symptoms of menopause.
(flower and green,efficacy of herbal)
Herbal remedies play an important role in both ancient and modern times when it comes to diseases treatment. It is capable of treating different diseases which ranges from minor ailments to critical illness. In China, traditional medicines are one of the strategies in fighting SARS while Africa flower is constantly used by African to treat HIV symptoms (Benzie and Wachtel-Galor 2011). 57
Ginseng is involved in the treatment of angina. It acts as calcium ion channel antagonist which helps to decrease blood pressure. P.notoginseng will inhibits atherogenesis by decreasing the multiplication of smooth muscle cells. Besides this, allicin in garlic also express antibacterial properties which contribute to cardiovascular health (Benzie and Wachtel-Galor 2011). 47
A wide range of herbal plants can be used in treating diabetes such as Ivy Gourd, aloe, prickly pear cactus and others. Active ingredients in Ivy gourd are similar to the insulin in which glucose production is suppressed and thus helps to fight glycosuria (Benzie and Wachtel-Galor 2011). 44
New anticancer drugs, Taxol and vincristine are also plant-based medicines(Van Wyk and Wink 2004).Out of 177 drugs approved for cancer treatment, more than 70% of them originate from plants. In the report, Saffron,the derivative from flower of Saffron crocus tends to inhibits the skin carcinogenesis by causes changes in activation of carcinogen and multiplication of tumor. It also inhibits formation of tumour by suppressing the cell growth in neoplastic cell (Benzie and Wachtel-Galor 2011).
Indeed, herbal remedies have their places in the modern day pharmacy due to their active roles in fighting diseases. 86
Economic value of herbal remedies
The position of herbal remedies in modern day pharmacy can be evaluated in term of economic contribution to the country. In Table 2,compared to the profit of more than US$50 billion brought by the total market of supplements, it was estimated that the international market for botanical medicines alone have occupied about 19% of the total market with a profit of US$18 billion (Van Wyk and Wink 2004). 63
Table 2: Consumer sales (million US$) of global nutritional supplements for the year 2000(Van Wyk and Wink 2004).
Sports, homoeopathy and specialist product
Herbs and botanicals
The annual sales of botanical products have craved a profit of US$5.1 billion to United States while Western Europe managed to make annual revenue of US$5 billion out of herbal industry from the year 2003 to 2004. Since herbal therapy is common in India, about 178 out of 960 plant species used in herbal industries have been produced at large scale and even exceed 100 metric tons per year. In 1995, the herbal medicines for manufacture have casted a value of 17.6 billion in Chinese yuan while in 2005 the products sales have reached US$14 billion. The trend then continued with the Brazil estimated revenue at US$160 million in 2007 (Benzie and Wachtel-Galor 2011; WHO 2008). With the increasing global demand of herbal medicines, the export of herbal products in Egypt has totaled up to 77,850,312kg and this export value managed to recoup a profit of USD $ 174,227,394 in 2008.Again,herbal remedies are able to reassure its pharmaceutical places by representing 33.6% of the total export value in Egypt (Nahla et al. 2010). According to the report presented by WHO (2005), a steady growth in herbal medicines market was spotted for the period of 1999 to 2001 by compiling the data from 9 countries. 193
Figure : Annual sales of herbal medicines in nine countries from the year 1999 to 2000
Thus, herbal remedies are given reputable places in modern day pharmacy due to its contribution to economic growth in the country. 21
Worldwide responds towards the herbal medicines usage
Due to therapeutic effect of herbal medicines, integration of herbal therapy to the health care system is therefore highly recommended. In United State, more than $34 billion is spent annually in CAM. However, in some of the countries, the expenditure on CAM is not included in national insurance policy. Thus, the reputation of herbal medicine is reflected in their willingness to pay (Frass et al. 2012). 62
Australia, Canada and United State have spent US$80 million, US$1 billion and US$2.3 billion respectively on annual herbal medicine expenditure (Benzie and Wachtel-Galor 2011). Indeed, the willingness to invest has reflected their confidence in the potential of herbal remedies at present pharmaceutical market. In Malaysia, compared to the expenditure of US$ 300 million on allopathic medicines, an investment of US$ 500million is allocated in traditional medicines annually (WHO 2002). 63
The importance of herbal remedies is vividly depicted in the growing number of construction of research centers. In fact, most of the developing countries like China, India, Madagascar and the Republic of Korea have established several national research centers to have a better understanding on herbal medicines. In USA, they even offer CAM research units in universities such as Harvard University in Massachusetts (WHO 2002). Thus, the conducts of these research-based studies are displaying the public interest in the medicinal values of herbal remedies. 82
Governmental and non-governmental policies
With the acknowledgement on the importance of herbal remedies, the Ministry of Health in Thailand has put in a lot of efforts to promote awareness on the uses of medicinal plants. WHO even suggested that traditional medicine should be incorporated into the national health care system (WHO 2002).Indirectly, the expression of concerns towards the development of herbal industries have deduced the place of herbal medicines at present day. 67
In the glory days of herbal remedies, its presence was inseparable from our normal life routine especially when it came to health care maintenance. The remarkable history of herbal medicines may seem to fade gradually with the evolving trend of technology. However, the values of herbal remedies in medicinal perspectives have enabled them to survive through the current of globalisation era and this can be seen in the prevalence of herbal medicines usage at present day. Since there are mounting evidences that promise the therapeutic values of herbal remedies in fighting diseases, herbal medicines should be incorporated into modern day pharmacy. Inarguably, the annual profit brought by herbal products market alone has reassured the position of botanical medicines in health care delivery. On top of that, many developing countries have shown immense interest in the potential of herbal medicines and even take steps to reinforce its place through educations and research funding. In a nutshell, herbal remedies do have influences and position in modern day pharmacy.166