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      Safety of Traditional Arab Herbal Medicine

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          Abstract

          Herbal remedies are widely used for the treatment and prevention of various diseases and often contain highly active pharmacological compounds. Many medicinal herbs and pharmaceutical drugs are therapeutic at one dose and toxic at another. Toxicity related to traditional medicines is becoming more widely recognized as these remedies become popular in the Mediterranean region as well as worldwide. Most reports concerning the toxic effects of herbal medicines are associated with hepatotoxicity although reports of other toxic effects including kidney, nervous system, blood, cardiovascular and dermatologic effects, mutagenicity and carcinogenicity have also been published in the medical literature. This article presents a systematic review on safety of traditional Arab medicine and the contribution of Arab scholars to toxicology. Use of modern cell biological, biochemical, in vitro and in vivo techniques for the evaluation of medicinal plants safety is also discussed.

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          Herb-drug interactions.

          Adriane Fugh-Berman (2000)
          Concurrent use of herbs may mimic, magnify, or oppose the effect of drugs. Plausible cases of herb-drug interactions include: bleeding when warfarin is combined with ginkgo (Ginkgo biloba), garlic (Allium sativum), dong quai (Angelica sinensis), or danshen (Salvia miltiorrhiza); mild serotonin syndrome in patients who mix St John's wort (Hypericum perforatum) with serotonin-reuptake inhibitors; decreased bioavailability of digoxin, theophylline, cyclosporin, and phenprocoumon when these drugs are combined with St John's wort; induction of mania in depressed patients who mix antidepressants and Panax ginseng; exacerbation of extrapyramidal effects with neuroleptic drugs and betel nut (Areca catechu); increased risk of hypertension when tricyclic antidepressants are combined with yohimbine (Pausinystalia yohimbe); potentiation of oral and topical corticosteroids by liquorice (Glycyrrhiza glabra); decreased blood concentrations of prednisolone when taken with the Chinese herbal product xaio chai hu tang (sho-salko-to); and decreased concentrations of phenytoin when combined with the Ayurvedic syrup shankhapushpi. Anthranoid-containing plants (including senna [Cassia senna] and cascara [Rhamnus purshiana]) and soluble fibres (including guar gum and psyllium) can decrease the absorption of drugs. Many reports of herb-drug interactions are sketchy and lack laboratory analysis of suspect preparations. Health-care practitioners should caution patients against mixing herbs and pharmaceutical drugs.
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            Some aspects of toxic contaminants in herbal medicines.

            Thomas Chan (2003)
            A World Health Organisation survey indicated that about 70-80% of the world populations rely on non-conventional medicine mainly of herbal sources in their primary healthcare. In recent years, we have witnessed the increasing growth in popularity of over-the-counter (OTC) health foods, nutraceuticals, and medicinal products from plants or other natural sources in developed countries. This indirectly indicates that the public is not satisfied with their orthodox medical (OM) treatment. Such increase in popularity has also brought concerns and fears over the professionalism of practitioners, and quality, efficacy and safety of their treatment methods and products from herbal and natural sources available in the market. Over the past decade several news-catching episodes in developed communities indicated adverse effects, sometimes life threatening, allegedly arisen consequential to taking of OTC herbal products or traditional medicines from various ethnic groups. These OTC products may be contaminated with excessive or banned pesticides, microbial contaminants, heavy metals, chemical toxins, and for adulterated with orthodox drugs. Excessive or banned pesticides, heavy metals and microbial contaminants may be related to the source of these herbal materials, if they are grown under contaminated environment or during collection of these plant materials. Chemical toxins may come from unfavourable or wrong storage conditions or chemical treatment due to storage. The presence of orthodox drugs can be related to unprofessional practice of manufacturers. Some of these environment related factors can be controlled by implementing standard operating procedures (SOP) leading to Good Agricultural Practice (GAP), Good Laboratory Practice (GLP), Good Supply Practice (GSP) and Good Manufacturing Practice (GMP) for producing these medicinal products from herbal or natural sources. The public's belief that herbal and natural products are safer than synthetic medicines can only be ascertained by imposing regulatory standards on these products that should be manufactured using these Good Practices. Using Chinese medicines, as examples, this paper illustrate how advances in chemical and biomedical analysis would help to detect intentional and unintentional toxic contaminants in herbal substances. The paper also summarises how modernization and progress are being carried out to get the best out of Chinese medicines for public healthcare.
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              Ethnopharmacological survey of medicinal herbs in Israel, the Golan Heights and the West Bank region.

              O. Said, K. Khalil, S Fulder … (2002)
              An extensive ethnopharmacological survey was conducted among the most well known Arabic indigenous herbal practitioners in Israel, the Golan Heights and the West Bank in order to evaluate the potential of local plants used in treating different diseases and illnesses. Thirty-one indigenous practitioners' of Arabic traditional medicine ranging in age from 40 to 116 years, were interviewed using a previously prepared questionnaire. The current survey revealed that 129 plant species are still in use in Arabic traditional medicine for the treatments of various diseases. Among these plants, there are 40 species used for treating skin diseases, 27 species for treating kidney and urinary system, 26 species for treating diabetes, 23 species for treating digestive system including stomach and intestinal pain and inflammation, 22 species for treating liver diseases, 16 species for treating respiratory system and coughing, 13 species for treating forms of cancer and nine species for treating weight loss and cholesterol reduction. Additional findings and implications of this current survey including preparation methods and route of use are discussed in this report.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Evid Based Complement Alternat Med
                Journal ID (publisher-id): Evidence-based Complementary and Alternative Medicine
                Title: Evidence-based Complementary and Alternative Medicine
                Publisher: Oxford University Press
                ISSN (Print): 1741-427X
                ISSN (Electronic): 1741-4288
                Publication date (Print): December 2006
                Publication date (Electronic): 07 September 2006
                Volume: 3
                Issue: 4
                Pages: 433-439
                Affiliations
                1The Galilee Society R&D Center (Affiliated with Haifa University Haifa, Israel), PO Box 437, Shefa-Amr 20200, Israel
                2Faculty of Allied Medical Sciences, Arab American University Jenin, PO Box 240, Jenin, Palestine
                Author notes
                For reprints and all correspondence: Prof. Dr Bashar Saad, The Galilee Society R&D Center, PO Box 437, Shefa-Amr 20200, Israel. Tel: +972-4-950-45-23/4; Fax: +972-4-950-45-25; E-mail: bsaad@ 123456netvision.net.il / bsaad@ 123456gal-soc.org
                Article
                DOI: 10.1093/ecam/nel058
                PMC ID: 1697757
                PubMed ID: 17173106
                SO-VID: a0849753-c57a-4921-92ef-5be9cc35aa14
                Copyright © © 2006 The Author(s)
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 February 2006
                Date accepted : 04 August 2006
                Categories
                Subject: Reviews

                ScienceOpen disciplines: Complementary & Alternative medicine
                Keywords: in vivo,in vitro,arab herbal medicine,complementary and alternative medicine (cam),toxicity tests
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine
                Keywords: in vivo, in vitro, arab herbal medicine, complementary and alternative medicine (cam), toxicity tests

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