Traditional Medicine: Definitions
The following terms are extracted from the General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine.
Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.
Complementary/alternative medicine (CAM)
The terms “complementary medicine” or “alternative medicine” are used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.
Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products, that contain as active ingredients parts of plants, or other plant materials, or combinations.
- Herbs: crude plant material such as leaves, flowers, fruit, seed, stems, wood, bark, roots, rhizomes or other plant parts, which may be entire, fragmented or powdered.
- Herbal materials: in addition to herbs, fresh juices, gums, fixed oils, essential oils, resins and dry powders of herbs. In some countries, these materials may be processed by various local procedures, such as steaming, roasting, or stir-baking with honey, alcoholic beverages or other materials.
- Herbal preparations: the basis for finished herbal products and may include comminuted or powdered herbal materials, or extracts, tinctures and fatty oils of herbal materials. They are produced by extraction, fractionation, purification, concentration, or other physical or biological processes. They also include preparations made by steeping or heating herbal materials in alcoholic beverages and/or honey, or in other materials.
- Finished herbal products: herbal preparations made from one or more herbs. If more than one herb is used, the term mixture herbal product can also be used. Finished herbal products and mixture herbal products may contain excipients in addition to the active ingredients. However, finished products or mixture products to which chemically defined active substances have been added, including synthetic compounds and/or isolated constituents from herbal materials, are not considered to be herbal.
Traditional use of herbal medicines
Traditional use of herbal medicines refers to the long historical use of these medicines. Their use is well established and widely acknowledged to be safe and effective, and may be accepted by national authorities.
Therapeutic activity refers to the successful prevention, diagnosis and treatment of physical and mental illnesses; improvement of symptoms of illnesses; as well as beneficial alteration or regulation of the physical and mental status of the body.
Active ingredients refer to ingredients of herbal medicines with therapeutic activity. In herbal medicines where the active ingredients have been identified, the preparation of these medicines should be standardized to contain a defined amount of the active ingredients, if adequate analytical methods are available. In cases where it is not possible to identify the active ingredients, the whole herbal medicine may be considered as one active ingredient.
The World Health Organization (WHO) defines traditional medicine as:
- “the health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.”
In some Asian and African countries, up to 80% of the population relies on traditional medicine for their primary health care needs. When adopted outside of its traditional culture, traditional medicine is often called complementary and alternative medicine.
The WHO also notes, though, that “inappropriate use of traditional medicines or practices can have negative or dangerous effects” and that “further research is needed to ascertain the efficacy and safety” of several of the practices and medicinal plants used by traditional medicine systems. Core disciplines which study traditional medicine include herbalism, ethnomedicine, ethnobotany, and medical anthropology.
Traditional medicine may include formalized aspects of folk medicine, i.e. longstanding remedies passed on and practiced by lay people. Practices known as traditional medicines include Ayurveda, Siddha medicine, Unani, ancient Iranian medicine, Irani, Islamic medicine, traditional Vietnamese medicine, traditional Chinese medicine, traditional Korean medicine, acupuncture, Muti, Ifá, traditional African medicine, and many other forms of healing practices.
In the written record, the study of herbs dates back 5,000 years to the ancient Sumerians, who described well-established medicinal uses for plants. Ancient Egyptian medicine of 1000 BC are known to have used various herbs for medicine. The Old Testament also mentions herb use and cultivation in regards to Kashrut.
Many herbs and minerals used in Ayurveda were described by ancient Indian herbalists such as Charaka and Sushruta during the 1st millennium BC. The first Chinese herbal book was the Shennong Bencao Jing, compiled during the Han Dynasty but dating back to a much earlier date, which was later augmented as the Yaoxing Lun (Treatise on the Nature of Medicinal Herbs) during the Tang Dynasty. Early recognised Greek compilers of existing and current herbal knowledge include Pythagoreanism, Hippocrates, Aristotle, Theophrastus, Dioscorides and Galen.
Roman writers included Pliny the Elder and Celsus. Pedanius Dioscorides included the writings of the herbalist Krateuas, physician to Mithridates VI King of Pontus from 120 to 63 BC in his De Materia Medica. De Materia Medica was translated into several languages and Turkish, Arabic and Hebrew names were added to it throughout the centuries. Latin manuscripts of De Materia Medica were combined with a Latin herbal by Apuleius Platonicus (Herbarium Apuleii Platonici) and were incorporated into the Anglo-Saxon codex Cotton Vitellius C.III.
These early Greek and Roman compilations became the backbone of European medical theory and were translated by the Persian Avicenna (Ibn Sīnā, 980–1037), the Persian Rhazes (Rāzi, 865–925) and the Jewish Maimonides. Translations of Greek medical handbooks and manuscripts into Arabic took place in the eighth and ninth centuries.
Arabic indigenous medicine developed from the conflict between the magic-based medicine of the Bedouins and the Arabic translations of the Hellenic and Ayurvedic medical traditions. Spanish indigenous medicine was influenced by the Arabs from 711 to 1492. Islamic physicians and Muslim botanists such as al-Dinawari and Ibn al-Baitar significantly expanded on the earlier knowledge of materia medica. The most famous Arabic medical treatise was Avicenna’s The Canon of Medicine, which was an early pharmacopoeia and introduced the method of clinical trials. The Canon was translated into Latin in the 12th century and remained a medical authority in Europe until the 17th century. The Unani system of traditional medicine is also based on the Canon.
Translations of the early Roman-Greek compilations were made into German by Hieronymus Bock whose herbal published in 1546 was called Kreuter Buch. The book was translated into Dutch as Pemptades by Rembert Dodoens (1517–1585), and from Dutch into English by Carolus Clusius, (1526–1609), published by Henry Lyte in 1578 as A Nievve Herball. This became John Gerard‘s (1545–1612) Herball or General Hiftorie of Plantes. Each new work was a compilation of existing texts with new additions.
Women’s folk knowledge existed in undocumented parallel with these texts. Forty-four drugs, diluents, flavouring agents and emollients mentioned by Discorides are still listed in the official pharmacopoeias of Europe. The Puritans took Gerard’s work to the United States where it influenced American Indigenous medicine.
Francisco Hernández, physician to Philip II of Spain spent the years 1571–1577 gathering information in Mexico and then wrote Rerum Medicarum Novae Hispaniae Thesaurus, many versions of which have been published including one by Francisco Ximénez. Both Hernandez and Ximenez fitted Aztec ethnomedicinal information into the European concepts of disease such as “warm”, “cold”, and “moist”, but it is not clear that the Aztec’s used these categories. Juan de Esteyneffer‘s Florilegio medicinal de todas las enfermedas compiled European texts and added 35 Mexican plants.
Martín de la Cruz wrote an herbal in Nahuatl which was translated into Latin by Juan Badiano as Libellus de Medicinalibus Indorum Herbis or Codex Barberini, Latin 241 and given to King Carlos V of Spain in 1552. It was apparently written in haste and influenced by the European occupation of the previous 30 years. Fray Bernadino de Sahagún‘s used ethnographic methods to compile his codices that then became the Historia General de las Cosas de Nueva Espana, published in 1793. Castore Durante published his Herbario Nuovo in 1585 describing medicinal plants from Europe and the East and West Indies. It was translated into German in 1609 and Italian editions were published for the next century.
Knowledge transmission and creation
Indigenous medicine is generally transmitted orally through a community, family and individuals until “collected”. Within a given culture, elements of indigenous medicine knowledge may be diffusely known by many, or may be gathered and applied by those in a specific role of healer such as a shaman or midwife. Three factors legitimize the role of the healer – their own beliefs, the success of their actions and the beliefs of the community. When the claims of indigenous medicine become rejected by a culture, generally three types of adherents still use it – those born and socialized in it who become permanent believers, temporary believers who turn to it in crisis times, and those who only believe in specific aspects, not in all of it.Elements in a specific culture are not necessarily integrated into a coherent system, and may be contradictory. In the Caribbean, indigenous remedies fall into several classes: certain well-known European medicinal herbs introduced by the early Spaniard colonists that are still commonly cultivated; indigenous wild and cultivated plants, the uses of which have been adopted from the Amerindians; and ornamental or other plants of relatively recent introduction for which curative uses have been invented without any historical basis.
Rights of ownership may be claimed in indigenous medical knowledge. Use of such knowledge without Prior Informed Consent of or compensation to those claiming such ownership may be termed ‘biopiracy’. See Commercialization of indigenous knowledge, also the Convention on Biological Diversity (in particular Article 8j and the Nagoya Protocol).
Use of endangered species
Sometimes traditional medicines include parts of endangered species, such as the slow loris in Southeast Asia.
- African Journal of Traditional, Complementary and Alternative Medicines
- Folk medicine
- Health care providers
- Traditional birth attendants
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