ethnopharmacology final)

A Research Protocol Draft for the Department of Pharmacology

Subsection B1

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Introduction

Modern medicine vs Traditional medicinemodern medicine improved health care, high

cost and unavailability of modern medicine led to continued dependence on MPs.

“Albularyos” and their use of MPs are still widely practiced in rural areas of the country.

DOH endorses “Sampung Halamang Program”Still no systematic research strategy in

identification, characterization and evaluation of MPs used by “albularyos”.

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Importance of the topicProblem: Poverty; No access to health care. Need alternative sources of medication. Increased income for farmers and significant

contribution to the national economyIncreased awareness and attention on MPs

Results of the researchCharacterization and evaluation of our biodiversityServe as baseline or database for further studiesused by DOH to evaluate health practices of

Pulilan.Exposure for the students: community based study

and explore ethnopharmacology in the Phils.

Significance of the Study

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General Objective To document the different

medicinal plants prescribed by folk herbalist and its relationships to the Sampung Halamang Gamot endorsed by the Department of Health

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Specific Objectives

1. To determine the most common medicinal plants being prescribed for common disease indications

2. To determine the parts, formulations and prepartions of medicinal plants being prescribed for common disease indications.

3. To identify the plants used by folk herbalists for common disease indications.

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Specific Objectives

4. To determine the Informant Consensus Factor (ICF) and Fidelity Level (FL) in relation to medicinal plant use.

5. To determine which medicinal plants being used by the folk herbalists belong to the “Sampung Halamang Gamot.”

6. To determine the conformity of the folk herbalist for the use of the “Sampung Halamang Gamot” to its endorsed indications.

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Scope and Limitation

Informants of the study“Albularyos” that prescribe medicinal plants as

means to cure diseases“Albularyos” necessitate credibility.

Location of the study Pulilan, Bulacan.

Indications of focusFever, cough, bronchitis, ringworm, diabetes, gout,

kidney stone, diarrhea, sore throat, diuretic, irregular menstruation, toothache, abdominal pain, arthritis, skin disease, wounds and burns.

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Medicinal Plantsnatural herbs from plants for the treatment or prevention

of diseases, disorders and the promotion of good health

Folk Herbalist person especially in rural areas who used medicinal

plants and other alternative materials and procedures to heal

any kind of alternative medical practitioner referred by health care worker who is a resident of Pulilan ,Bulacan

knowledgeable about medicinal plants and prescribes and/or makes use of plants or plant parts in his treatment regimen.

They will be regarded as respondents in the course of the study.

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Sampung Halamang Gamot (SHG)1. Akapulko (Cassia alata)2. Ampalaya (Momordica charantia)3. Bawang (Allium sativum)4. Bayabas (Psidium guajava)5. Lagundi (Vitex negundo)6. Niyog-niyogan (Quisqualis indica L)7. Sambong (Blumea balsamifera L.)8. Tsaang Gubat or Wild Tea (Ehretia microphylla Lam.)9. Pansit-pansitan Ulasimang Bato (Peperomia pellucida)10. Yerba Buena (Mentha spicata)

Common Disease Indications fever, cough, bronchitis, ringworm, diabetes, gout,

kidney stone, diarrhea, sore throat, diuretic, irregular menstruation, toothache, abdominal pain, arthritis, skin disease, wounds and burns.

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- Tested the curative effects of herbal medicines

- Handed from generations to generations

- Moral support and psychological comfort from patients

- High social status and are well respected

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Modern drugs- cheaper- decline of herbal medicines popularity

1992 - Administrative Order No.12- Traditional Medicine Program- Senator Juan Flavier- Promotion of Traditional Medicine

RA 8423Traditional and Alternative Medicine Act

(TAMA)14Ethnopharmacological Studies

Philippine Institute of Traditional and Alternative Health Care (PITAHC)

“Traditional and alternative health care in the hands of the people”

- A Government owned and controlled corporation (GOCC)

- To deliver the traditional alternative health care.

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Alternative Healthcare - used in the prevention, diagnosis and elimination of physical or mental disorder

Traditional Medicine Recognized by the peopleinterrelations based on culture, history,

heritage and consciousness

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According to the DOH, the health sector falls short due to:

- inappropriate health delivery system - inadequate health regulatory mechanisms- poor health care financing

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Herbal Plants Indications

Akapulko (Cassia alata) ringworms and skin fungal infections, expectorant for bronchitis and dyspnea, mouthwash in stomatitis, diuretic, purgative, anti-pyretic, laxative

Ampalaya (Momordica charantia) Diabetes Mellitus, rheumatism, gout, hypertension, anti-pyretic, disinfectant, anti-diarrhea, enhances immunes system, and remedy for cough

Bawang (Allium sativum) Hypertension, hyperlipidemia, cough and cold, sore throat, toothache

Bayabas (Psidium guajava) Antiseptic, mouth wash, anti-pyretic, anti-rheumatism

Lagundi (Vitex negundo) Asthma, cough, colds, removal of worms and boils

Niyog-niyogan (Quisqualis indica L.) Elimination of intestinal worms

Sambong (Blumea balsamifera) Urinary stones, dysentery, sore throat

Tsaang Gubat (Ehretia microphylla Lam.) Intestinal motility

Ulasimang Bato (Peperomia pellucida) Arthritis, gout, pimples, headache, abdominal pain

Yerba Buena (Clinopodium douglasii) Analgesic, indigestion

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scientific study that correlates ethnic groups, their health practices, and how it relates to their physical habits and methodology in creating and using medicines

incorporates the social science of ethnology and the medical science of pharmacology.

it explores medicinal plants in indigenous cultures.

methods of collection, extraction, preparation – allowed safe usage of the substance and its safety record

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- Documentation of indigenous medical knowledge

- Scientific study of indigenous medicines

- Search for pharmacologically unique principles from existing indigenous remedies.

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- interviewing healers

- interpreting traditional terminologies into their modern counterparts

- examining patients consuming herbal remedies

- identifying the disease for which an herbal remedy is used

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- Interpretation of signs and symptoms

- Clinical studies on herbs and their interaction with modern medicines

- Advising pharmacologists

- Strengthen traditional system of medicine in a community

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Collection of information from local population concerning the use of regional medicinal plants, identified the most important species used and calculate the Informant consensus factor (ICF). The collection of data relied on a qualitative interview (Aburjai et al)

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- 92 traditional medicine practitioners/healers were interviewed to collect information on the use of herbal treatments

- Information was also collected on the method of preparation, dose and duration along with the botanical names, family and local names of the medicinal plants (Hedge et al).

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- Performed door-to-door visits in order to identify the local people with specialized knowledge on the use of the medicinal plants.

- By using the snowball method, the names of other specialists were obtained.

- Calculated the Informant consensus factor (ICF) for the data analysis.

- The rural dwellers of the community helped in collection of the information.

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People who have knowledge on traditional medicine.

Individual Interviews

Open and semi-structured questions

More than one interview session took place

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Local representatives help in identifying folk herbalists (Gazzaneo).

The local people guide in locating the folk herbalists (Akerreta).

The chosen folk herbalists have no scientific knowledge on the medicinal plants (Akerreta).

The interviewees are born or live most of their lives in the studied region (Akerreta).27Ethnopharmacological Studies

According to WHO, traditional medicine is still being used by 80% of the world population as part of their health care, especially those in developing countries.

Many African countries including Tanzania, depend on traditional healers who provide primary health care by taking care of people living with emerging diseases such as HIV/AIDS (Kisangau).

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3 criteria of triangulation

Endorsement from Barangay Health Care Office

Confirmation from folk herbalists

Interview by researchers

BHCO refers traditional medical practitioners/folk herbalists in the area

Health Care Officers (HCO) and Barangay Health Workers (BHW)

verifies authenticity of referred folk herbalists

HCOs and BHWs fills up rubric sheet to quantitatively assess the recommended

folk herbalists

Self assessment of folk herbalists using rubric sheet facilitated by

researchers

Researchers divide themselves to 5 groups, each group interviewing 2 to 3 folk

herbalists

Following a standard questionnaire folk herbalists would be asked to provide information on indications,

parts of the plant used, preparation and route of

administration.

Researchers will also fill up a rubric sheet

Score of each folk herbalist from the 3 criteria will be averaged. A score of < 75 would indicate unreliability, whereas a score of > 75

indicates reliability and gives credibility to the folk herbalist.

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Cross Sectional StudyOutline:

Description of RespondentsDescription of Study AreaTriangulationData Collection ToolData Analysis

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Residents of Pulilan, BulacanKnowledgeable of medicinal plantsEndorsed by he HCO and BHWs

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Pulilan, Bulacan19 Barangays

Industrially-competitiveNo public hospital

Medical clinics, Private tertiary hospital, folk herbalists

47 km away from Manila

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Data Collection Triangulation Proper

1. Endorsement from the Barangay HCO

2. Confirmation from the folk herbalists

3. An interview will be conducted by the researchers

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Verbal endorsementRubric Sheet

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Rubric Sheet

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Researchers– 5 subgroups Subgroup– 2-3 folk herbalists Questionnaire

a) Indicationsb) part of the plant usedc) preparation d) route of administration

Rubric Sheet

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Collection of Plant SamplesDocumentation

Proper handlingPhotograph

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• Indications will be grouped into 10-20 categories• Based on the indications of the Sampung

Halamang Gamot• Informant Consensus Factor (ICF)• Fidelity Level (FL)• comparison between the herbal plants used

by the folk herbalists and those included in the Sampung Halamang Gamot

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• Informant Consensus Factor (ICF)– will be used to identify agreements of the informants

on the reported cures for the groups ailments

ICF = (nur – nt) / (nur – 1)

where nur = number of use citations in each category

nt = number of species used

Teklehaymanot, T. et. al. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern Ethiopia. Journal of Ethnobiology and Ethnomedicine 2007,3:12.Akerreta, S. et. al. First comprehensive contribution to medical ethnobotany of Western Pyrenees. Journal of Ethnobiology and Ethnomedicine 2007,3:26.Gazzaneo, L.R.S. et. al. Knowledge and use of medicinal plants by local specialists in a region of Atlantic Forest in the state of Pernambuco (Northeastern Brazil.) Journal of Ethnobiology and Ethnomedicine 200,1:9.4Kisangau, D.P. et. al. Use of traditional medicines in the management of HIV/AIDS opportunistic infections in Tanzania: a case in the Bukoba rural district. Journal of Ethnobiology and Ethnomedicine 2007,3:29. 49Ethnopharmacological Studies

• Fidelity Level (FL)– percentage of informants claiming the use of a certain

plant for the same major purpose

FL(%) = (Np / N) x 100

where Np = number of informants that claim a use of a plant species to treat a particular disease

N = number of informants that use the plants as a medicine to treat any given disease

Teklehaymanot, T. et. al. Ethnobotanical study of medicinal plants used by people in Zegie Peninsula, Northwestern Ethiopia. Journal of Ethnobiology and Ethnomedicine 2007,3:12. 50Ethnopharmacological Studies

Species Local Name Use Parts used Preparation Dosage and Administration

Plant parts used Number of Medicinal Plant species Percentage

Method of preparation Percentage

Table C. Percentage forms of preparing herbal remedies

Table A. Medicinal Plants

Table B. Frequency of plant parts used for the preparation of remedies

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GAS ALLOWANCE 10000

TOLL ALLOWANCE 500

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BONDPAPER 500

PHOTOCOPY 100

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TOKENS 6000

MISCELLANEOUS 1000

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TRANSPORTATION 10500

SUPPLIES 600

OTHERS 7000

TOTAL 18100

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