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The practice of herbal medicine dates back to the very Earliest human history . There is evidence of herbs having been used in the treatment of diseases and for revitalizing body systems in almost all ancient civilizations like Indian ,Egyptian , Chinese and even Greek and Roman civilization . In India , there are references to the curative properties of some herbs in Rig Veda , which is believed to have been written between 3500 and 1800 BC . Information about herbs is recorded in Charaka Samhitha and Shusrutha Samhitha - the two important works in Ayurvedic system of medicine . The ancient Chinese document Pen T' sao Ching describing the various plant medicament and instructions on their use , dates back to 2800 B.C (Bakru H.K. , 1992).
The extremely rapid development of therapeutic and prophylactic medicine in recent years , however, should not lead us to think that the knowledge of drug in past ages was insignificant . Ancient man ,having no accumulated knowledge or precedent to draw upon , made discoveries only by accident or by time consuming trial and error . Consequently , progressing medical knowledge was carried on through the course of thousands of years during man's endeavors to control nature(Egil Ramstand.,1959).
The method by which the primitive people acquired insight to therapeutic properties of drugs are still somewhat a matter of conjecture. Undoubtedly some knowledge was gained by a process of trial and error (Egil Ramstad., 1959) .It is greatly to the credit of the people of India that they were acquainted with a far larger number of medicinal plants than the natives of any other country on the face of the earth. Rig Veda and holy ethics also mentioned about the importance of uses of medicinal plants in curing fatal diseases and injuries , about 5000 years ago.
Herbs play a significant role in the modern times when the damaging effects of food processing and over medication have assumed alarm proportions . The skill of the herbalist is to use their benefits to balance and strengthen the body's own healing mechanism instead of suppressing or disturbing it as many modern drugs tend to do . Herbs are now used in cosmetics , foods , and teas as well as alternative medicines.
Several herbal folklore surveys conducted in the recent past provide a glimpse of the ethno pharmacological potential of herbs used by the villagers and tribal of India for treatment of various diseases . This increases the scope for new herbal drug development by use of pharmacognostical ,phytochemical and pharmacological methods .
Nature always stands as a golden mark to exemplify the outstanding phenomenon of symbiosis. The biotic and abiotic elements are all interdependent. The plants are indispensable to man for his life. Nature has provided a complete storehouse of remedies to cure all ailments of mankind. The knowledge of drugs has accumulated over thousands of years as a result of man inquisitive nature, so that today we possess many effective means of ensuring health care.
The human being appeared to be affiliated with more diseases than any other species. There can be little doubt that the very early sought to alleviate sufferings from injury and diseases by taking advantage on the plants growing around him. In the past almost all the medicines used were from plants, being mans only chemist for ages. The history of herbal medicine is as that as old as human civilization.1
Diseases are born and drugs came to existence since a very early period to remove the pain of diseases and to cure them. Thus the history of medicines is as old as man kind.2
The extremely rapid development of therapeutic and prophylactic medicine in recent years , however, should not lead us to think that the knowledge of drug in past ages was insignificant . Ancient man ,having no accumulated knowledge or precedent to draw upon , made discoveries only by accident or by time consuming trial and error . Consequently , progressing medical knowledge was carried on through the course of thousand of years during man's endeavours to control nature(Egil Ramstand.,1959).
In spite of the over helming influence and our dependence on modern medicine and tremendous advances in synthetic drugs, a large segment of the world population (80 % of people) cannot afford the products of the western pharmaceutical industry and has to rely upon the use traditional medicines, which are mainly derived from plant material. The fact is well recognized by the WHO which has recently compiled an inventory of medicinal plants listing over20,000 species.3
Among the 20,000 medicinal plants listed by the WHO over one hundred botanicals are reported to have consistently large demands and are traded in major drug markets of the world. The medicinal virtues of these plants have been worked out and have inclusions in national pharmacopoeias in different countries. Plant cells are known considered to be chemical factories synthesizing a large variety of chemical compounds and thus as a very important renewable source for the production of a variety of chemicals and drugs.4
There is a reluctance observed in accepting herbal remedies by modern system because of the lack of documentation regarding these called scientific validity and quality.5
Traditional use of herbal medicine is the very basis and integral part of various cultures, for thousands of years. Plant based drugs (natural drugs) may be used directly i.e., they may be collected, dried, and used as therapeutic agents (crudedrugs), or their chief constituents or active constituents are separated by various chemical processes which are employed as medicines. These active constituents are manufactured chemically to produce the synthetic drugs. The large and growing dependence on synthetic drugs are mainly due to their rapid action. The fast and continuing depletion of natural resources and plant wealth has only added to this dependence on synthetic drugs.6
Geographically our country is situated in the tropical zone. On account of her size, India is the home to a variety of environment from high snow capped mountains to tropical range forests, from cold/hot deserts, scrub lands to lush and fertile plain and valleys, so also mangroves and sea shores. This environment promotes a great variety of habitat for India's rich plant life. It is reported that almost every plant family in the world is represented in India's rich flora-plant life.7
India is perhaps the largest producer of medicinal herbs and is rightly called the 'Botanical garden of the world'. Medicinal herbs have been in use for thousands of years in one form or other in the Indigenous system of medicine like Ayurveda, Siddha and Unani.8
It is greatly to the credit of the people of India that they were acquainted with a far larger number of medicinal plants than the natives of any other country on the face of the earth. Rig Veda and holy ethics also mentioned about the importance Of uses of medicinal plants in curing fatal diseases and injuries , about 5000 years ago.
Herbs play a significant role in the modern times when the damaging effects of food processing and over medication have assumed alarm proportions . The skill of the herbalist is to use their benefits to balance and strengthen the body's own healing mechanism instead of suppressing or disturbing it as many modern drugs tend to do . Herbs are now used in cosmetics , foods , and teas as well as alternative medicines. Several herbal folklore surveys conducted in the recent past provide a glimpse of the ethno pharmacological potential of herbs used by the villagers and trials of India for treatment of various diseases . This increases the scope for new herbal drug development by use of pharmacognostical ,phytochemical and pharmacological methods .
In general natural drug substance offer vital and appreciable roles in the modern system of medicine there by adequately justifying their legitimate presence in the prevailing therapeutic assenal.
Serves as extremely useful natural drugs.
Provide basic compounds affording less toxic and more affective drug molecules
Exploration of biologically active prototypes towards newer and better synthetic drugs.
Modification of inactive natural products by suitable biological or chemical means in to potent drugs.
The isolation made improvement due to the various techniques developed such as column ,paper ,thin layer ,gas ,liquid,high performance liquid and droplet counter current chromatographic procedures .The most important factor has been the development of new spectroscopic techniques which are used to identify the structures of the isolated compounds.Various active compounds have been isolated from plants which are used in modern medicine.
Between 50 to 80 % of the developing countries depend on traditional therapies for their health care .There is an effort towards improving the therapies as much as possible with the aid of modern science and technology.
Flow chart for the study of plants used in traditional medicine 9
The method of drug development from plant sources is based on a sequence of operations leading mainly towards isolation of pure natural products.The chemical studies will bring up active chemical compounds with new structural features .They would enhance the development of quality control methods based on new analytical techniques available today and these methods may be extended for the quality control of extracts and multi component preparations as well
.Such studies would also enable the development of standardized internationally recognized techniques for quality assessment of plant derived products.
Fingerprint analysis approach using chromatography has become the most potent tools for quality control of herbal medicines because of its simplicity and reliability. It can serve as a tool for identification, authentication and quality control of herbal drugs.
The construction of chromatographic fingerprints plays an important role in the quality control of complex herbal medicines. Chemical fingerprints obtained by chromatographic techniques are strongly recommended for the purpose of quality control of herbal medicines, since they might represent appropriately the "chemical integrities" of the herbal medicines and therefore be used for authentication and identification of the herbal products. Based on the concept of phytoequivalence, the chromatographic fingerprints of herbal medicines could be utilized for addressing the problem of quality control of herbal medicines.
By definition, a chromatographic fingerprint of a herbal medicine is, in practice, a chromatographic pattern of pharmacologically active and or chemically characteristic constituents present in the extract. This chromatographic profile should be featured by the fundamental attributions of "integrity" and "fuzziness" or "sameness" and "differences" so as to chemically represent the herbal medicines investigated. This suggest that chromatographic fingerprint can successfully demonstrate both "sameness" and "differences" between various samples and the authentication and identification of herbal medicines can be accurately conducted even if the number and/or concentration of chemically characteristic constituents are not very similar in different samples of herbal medicine.
Need for development of chromatographic fingerprints:
When Herbal Medicines are concerned, there are always hundreds of components and many of them are in too low amounts. On the other hand, there usually exists variability within the different and even the same herbal materials. Consequently, to obtain reliable chromatographic fingerprints that represent pharmacologically active and chemically characteristic components is not a trivial task. The performance of a chromatographic fingerprint obtained is closely dependent on the chromatographic separation degrees and concentration distribution of all chemical components in the herbal medicine investigated. Fortunately, chromatography offers very powerful separation ability, such that the complex chemical components in herbal medicine extracts can be separated into many relatively simple sub-fractions.
Furthermore, the recent approaches of applying hyphenated chromatography and spectroscopy such as High-Performance liquid chromatography-diode array detection (HPLC-DAD), Gas chromatography-mass spectroscopy (GC-MS), capillary electrophoresis-diode array detection (CE-DAD), HPLC-MS and HPLC-NMR, could provide the additional spectral information, which will be very helpful for the qualitative analysis and even for the structural elucidation.32
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as in other organs in the body.
Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system contains a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. However, rheumatoid arthritis is typically a progressive illness that has the potential to cause joint destruction and functional disability.
Fig1 Normal and Arthritc Joints.
Fig 2 Normal and Arthritc Joints.
A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles.
In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.
Rheumatoid arthritis is a progressive inflammatory disease. This means that unless the inflammation is stopped or slowed, the condition will continue to get worse in most people. Although rheumatoid arthritis does occasionally go into remission without treatment, this is rare. Starting treatment soon after diagnosis of rheumatoid arthritis is strongly recommended. The best medical care combines medication and nondrug approaches.
Nondrug approaches include the following:
Physical therapy helps preserve and improve range of motion, increase muscle strength, and reduce pain.
Hydrotherapy involves exercising or relaxing in warm water. Being in water reduces the weight on your joints. The warmth relaxes your muscles and helps relieve pain.
Relaxation therapy teaches techniques for releasing muscle tension, which helps relieve pain.
Both heat and cold treatments can relieve pain and reduce inflammation. Some people's pain responds better to heat and other's to cold. Heat can be applied by ultrasound, microwaves, warm wax, or moist compresses. Most of these are done in the medical office, although moist compresses can be applied at home. Cold can be applied with ice packs at home.
Occupational therapy teaches you ways to use your body efficiently to reduce stress on your joints. It also can help you learn to decrease tension on the joints through the use of specially designed splints. Your occupational therapist can help you develop strategies for coping with daily life by adapting to your environment and using different assistive devices.
Prosorba column: This is not a drug but a medical device. It filters antibodies linked to rheumatoid arthritis out of the blood. This procedure is available only in some medical centers and generally is used only for very severe rheumatoid arthritis.
In some cases, reconstructive surgery and/or joint replacement operations provide the best outcome.
Drug approaches include a variety of medications used alone or in combinations.
Rheumatoid arthritis was traditionally treated in the past with a stepwise approach starting with nonsteroidal antiinflammatory drugs (NSAIDs) and progressing through more potent drugs such as glucocorticoids, disease-modifying antirheumatic drugs (DMARDs), and biologic response modifiers.
In the past, DMARDs were avoided early in the disease because of their potentially serious side effects and because they did not often bring on remission. DMARDs were usually reserved for people who showed signs of joint damage.
Over time, however, this strategy was recognized as being faulty, because people treated early with DMARDs have better long-term outcomes, with greater preservation of function, less work disability, and a smaller risk of premature death.
The goal of drug treatment is to induce remission or at least eliminate evidence of disease activity.
Early use of DMARDs not only controls inflammation better than less potent drugs but also helps prevent joint damage. Newer DMARDs work better than the older ones in long-term prevention of joint damage.
The current approach, therefore, is to treat rheumatoid arthritis aggressively with DMARDs soon after diagnosis. Treating rheumatoid arthritis early, within three to 12 months after symptoms begin, is the best way to stop or slow progression of the disease and bring about remission.
Ongoing (long-term) treatment with combinations of medications may offer the best control of rheumatoid arthritis for the majority of people.
Combinations of these agents do not usually have more severe adverse effects than one agent alone.
Disease-modifying antirheumatic drugs (DMARDs)
This is a key type of drug treatment in rheumatoid arthritis. This is not one type of drug but several different types whose main similarity is that they all help to stop the joint damage of rheumatoid arthritis.
DMARDs can slow or stop the progression of rheumatoid arthritis and thus joint destruction and disability.
Successful DMARD therapy may eliminate the need for other antiinflammatory or analgesic (pain-relieving) medications.
These drugs do not work for everyone with rheumatoid arthritis, but they give substantial relief to many.
DMARDs may not reach their full effect for two to three months. It is important to keep taking the medication for at least that long before deciding it is not working. Until the full action of your DMARD takes effect, your health-care professional may prescribe antiinflammatory or analgesic medications as bridging therapy to reduce pain and swelling.
DMARDs may be given alone or in combination with other types of drugs.
These drugs have been shown to improve signs and symptoms (as well asquality of life) in most people with rheumatoid arthritis.
Biologic response modifiers
These agents are carefully designed to block the actions of substances naturally produced by the immune system, such as tumor necrosis factor orinterleukin-1. These substances are involved in the abnormal immune reaction associated with rheumatoid arthritis. Therefore, blocking their action can slow down the underlying autoimmune reaction and thus relieve symptoms and improve your overall condition.
There are several different forms of these agents, and in some people, rheumatoid arthritis will get better with one form and not another.
These agents slow down rheumatoid arthritis in a significant proportion of people with the condition (40%-70%, depending on the form) and can lead to remission. They do not cure the disease, as symptoms often return if the drug is stopped.
These agents are often used in combination with one or more DMARDs in order to more fully suppress joint inflammation and improve function.
These agents are expensive and the long-term effects are still under study. For these reasons, these drugs are often not the first choice of treatment in rheumatoid arthritis.
Although it may take as long as three months to see whether a biologic agent is working in a specific individual, many people start to feel better within a few weeks.
You cannot take these agents if you have an infection (especiallytuberculosis), cancer now or in the recent past, or certain types of nervous system disorders.
These agents improve signs and symptoms and quality of life in many people with rheumatoid arthritis.
Glucocorticoids (steroids) are potent antiinflammatory drugs. They reduce symptoms, and they may stop or slow joint damage.
These drugs can be given as pills by mouth, by intramuscular injection, or in some cases, they can be injected directly into a joint.
These agents have many side effects. They can be safely given only for short periods -- a few weeks or months -- in most people and so are commonly used to bridge the gap while waiting for a DMARD to reach full effect.
These agents are not for everyone. For example, they can aggravate diabetes. Your health-care professional will decide whether glucocorticoids are right for you on the basis of your overall medical condition.
Typically, these drugs are started at a relatively low, safe dose. Occasionally, a high dose is given at first to have an immediate effect, and the dose is reduced gradually (tapered) over a few weeks or months.
It is very important not to stop taking a glucocorticoid abruptly, as this can be dangerous. If you are having severe side effects, talk to your health-care professional before stopping the drug.
Nonsteroidal antiinflammatory drugs
Nonsteroidal antiinflammatory agents, or NSAIDs, reduce swelling and pain in rheumatoid arthritis. They do not slow joint damage, however, and therefore are not considered adequate treatment on their own. Like glucocorticoids, they often are used as a bridge to successful DMARD therapy.
Several dozen NSAIDs are available. They can be classified into different groups of compounds, commonly used NSAIDs include ibuprofen,Naproxen,ketoprofen etc.
The most common and potentially serious adverse effects of NSAIDs occur in the digestive tract: stomach upset, belly pain, and bleeding.
Rare side effects include serious skin reactions. NSAIDs may increase risk ofheart attack and stroke.
A newer generation of these drugs is called the COX-2 inhibitors, such ascelecoxib (Celebrex). These drugs are more expensive although much less likely to cause digestive system effects.
Acetaminophen/paracetamol, tramadol, codeine, opioids, and a variety of other analgesic medications can be employed to reduce pain.
These agents do not affect swelling or joint destruction 27