University of Cambodia

College of Social Science

Herbal Medicine:

A Case Study in Cambodia

Submitted for the course of Introduction to

Anthropology

Instructor: Group members:

Mr. kep Bunly 1. Keo Chanosophea

2. Mun Thim

3. Ngoem Sophanny

4. Sao Layhour

5. Set Soriya

20 May, 2014

Content

Page

I. Introduction ............................................................................................................................ 2

1.1 Background ...................................................................................................................... 2

1.2 Problem Statement ........................................................................................................... 3

1.3 Objectives ........................................................................................................................ 3

1.4 Significance of the Study ................................................................................................. 3

1.5 Outline.............................................................................................................................. 4

II. Herbal Medicine .................................................................................................................... 5

2.1 Definition ......................................................................................................................... 5

2.2 History.............................................................................................................................. 5

2.3 Herbalism ......................................................................................................................... 6

2.3.1 Chinese herbalism: history and Yin & Yang.. .......................................................... 6

2.3.2 Ayurvedic medicine .................................................................................................. 9

2.3.3 Western Herbalism.................................................................................................... 9

2.4 Herbal Treatment ........................................................................................................... 10

2.4.1 Plants.. ..................................................................................................................... 11

2.4.2 Animal or micro-organisms.. .................................................................................. 13

2.5 Positive and Negative Effects of Herbal Medicines ...................................................... 13

2.5.1 Positive effects of herbal medicines. ...................................................................... 13

2.5.2 Negative effects of herbal medicines. ..................................................................... 14

2.6 Ensuring Safety Herbal Medicine .................................................................................. 15

III. Herbal Medicine in Cambodia ........................................................................................... 16

3.1 Overview ........................................................................................................................ 16

3.2 History............................................................................................................................ 17

3.3 Cambodian Herbal Treatment ........................................................................................ 20

3.3.1 Provider of herbal medicine. ................................................................................... 20

3.3.2 Illness identification. ............................................................................................... 21

3.3.3 Concept of Cambodian herbal treatment ................................................................ 21

3.3.4 Herbal medicine preparation.. ................................................................................. 22

3.4 Effect of Cambodian Herbal Medicine .......................................................................... 23

3.4.1 Positive effects. ....................................................................................................... 23

3.4.2 Negative effect. ....................................................................................................... 23

3.5 Ensuring Safety and Efficacy of Herbal Medicine in Cambodia ................................... 24

IV. Discussion .......................................................................................................................... 26

Conclusion ............................................................................................................................... 28

Running head: HERBAL MEDICINE 1

Herbal Medicine: A Case Study in Cambodia

Keo Chanosophea

Ngoem Sophanny

Mun Thim

Sao Layhour

Set Soriya

University of Cambodia

HERBAL MEDICINE 2

I. Introduction

1.1 Background

Long time ago, people were completely living naturally by just extracting non-timber

product for their living. One of remarkable products that has been existed even before

recoded history and still followed until now is using plants for medical purpose (Bayalan,

Villa, & Landicho, 2008). The practices of using plants including leaf, root, bark or the whole

plant for curing illness is called herbal medicine. Herbal medicine was the major medicine

available for people; however, since early 19th

century, the evolution of technology has

transferred the raw herbal into synthetic pharmaceuticals, and this has led to the decline in

using herbal medicine. The decline has not been very dramatic, for instant, in 2000 around

75%-80% of world population still deeply relay on the medicine for their health care (Pal &

Shukla, 2003). Despite of the fact that modern medicine seems to be more reliable, Pal and

Shukla (2003) believe that medical herb is still very popular because it is available for

immediate need, not costly, not time consuming, and because it is believed that a certain

disease always accompany with a certain plant for treatment.

Similarly, herbal medicine is also widely used in Cambodia. Cambodian herbal

medicine is well known as traditional medicine and usually provided through traditional

healer. The medicine has been widely used since Angkor era until present time. Ministry of

Health (2012) estimated that about half of Cambodian population relies on herbal medicine

for health care, but they are still in the need of modern medicine and pharmacies. The

ministry also states that living standard and culture influent the use of herbal medicine. In

Cambodia, people using herbal medicine are people who are poor and living in the area that

is covered much with cultural and customary spirit.

The popularity of herbal medicine in the world as well as in Cambodia has raised

questions about its quality, safety and efficacy. Understand this kind of medicine well would

HERBAL MEDICINE 3

be useful for us to decide whether or not to continue using herbal medicine, and to raise this

awareness we need to preview it deeply in term of how people use it for treatment, its quality,

safety, and efficacy. This paper, therefore, will gather theories related to herbal medicine and

use the way it is practiced in Cambodia as case study to make our final conclusion be critical.

1.2 Problem Statement

Based on the above-mentioned background, the problems necessary to be studied are:

1. How herbal medicine has been used in societies?

2. What are the positive and negative effects of herbal medicine?

3. Should herbal medicine be used in this contemporary society?

1.3 Objectives

The study on “Herbal Medicine: A Case Study in Cambodia” has the following

objectives:

- Explore origin of herbal medicine

- Understand the use of medicinal plants for treatment

- Understand quality, safety, and efficacy of using herbal medicine for treatment

- Find out whether or not herbal medicine should be used in this contemporary

society

1.4 Significance of the Study

Health care is very important for all people living wherever. This research is a

combination of theories supported with a case study of Cambodia, so it can provide basic

understanding of herbal medicine to people interested in the field and maybe it can lead to a

further research with better scope and methodology. In the same time, people in Cambodia,

whose about half of population relies on this kind of medicine, will have a better

understanding of the medicine in both general context and Cambodian context. The

awareness can help our citizen to flash back to what they have practiced in term of medicinal

HERBAL MEDICINE 4

treatment and decide whether they should rely on traditional medicine or modern medicine,

which is a result of pharmaceutical evolution. The discussion in section IV will definitely

help people to be even more critical in choosing certain medicine for curing. Lastly, the paper

will also suggest some feasible solutions to overcome some negative sides associated with the

use of medicinal plants.

1.5 Outline

This paper is divided into five main sections ranging from introduction, theory related

herbal medicine, the practice of herbal medicine in Cambodia, discussion on reliability of

herbal medicine, and conclusion.

Introduction will give you a brief background related to the topic, and inform you the

objectives and significance of the study.

Section II will give you a basic concept of herbal medicine ranging from definition

and its origin to its effects on users.

After understanding the basic concepts of herbal medicine, Section III will let you

look deeply into a specific practice of the medicine in Cambodia as a case study.

Section IV will discuss on what we have found in section II and section III in order to

drag the conclusion whether or not herbal medicine should be continued using, and what the

challenges we have to deal with.

Finally, conclusion will be the last part of this short paper, and it will wrap up the key

messages the paper aim to find out.

HERBAL MEDICINE 5

II. Herbal Medicine

2.1 Definition

Herbal medicine is the study or practice of the medicinal and therapeutic use of

plants; herbalism. Remedies and medicines made from plants. Also, herbal medicine made

from the kind of animal (wild life) or combined the insects with the plants. They are

traditional doctors prescribe herbal medicine for the prevention and treatment of illness (Qi,

2014)

2.2 History

Herbal medicine was known as traditional herbal medicine that implies substantial

historical use, and this is certainly true for many products that are available as „traditional

herbal medicines‟.

Plants had been used for medicinal purposes long before recorded history.

Archaeological evidence indicates that the use of medicinal plants dates at least to

the Paleolithic, approximately 60,000 years ago. Written evidence of herbal remedies dates

back over 5,000 years, to the Sumerians, who created lists of plants. A number of ancient

cultures wrote on plants and their medical uses. In ancient Egypt, herbs are mentioned

in Egyptian medical papyri, represented in tomb illustrations, or on rare occasions found in

medical jars containing trace amounts of herbs. The earliest known Greek herbals were those

of Diocles of Carystus, written during the 3rd century B.C, and one by Krateuas from the 1st

century B.C. Only a few fragments of these works have survived intact, but from what

remains scholars have noted that there is a large amount of overlap with the Egyptian herbals.

An example of using herbal medicine is Seeds likely used for herbalism have been found in

the archaeological sites of Bronze Age. China is one of countries that used the herbal

medicine. Ancient Chinese describe medicinal uses for plants as early as 3,000 BC. Herbs

were also common in the medicine of ancient India, where the principal treatment for

HERBAL MEDICINE 6

diseases was diet Materia Medica by Pedanius Dioscorides, a Roman physician, is a

particularly important example of such writings. The documentation of herbs and their uses

was a central part of both Western and Eastern medical scholarship through to the 1600s, and

these works played an important role in the development of the science.

2.3 Herbalism

2.3.1 Chinese herbalism: history and Yin & Yang. Chinese herbal medicine has

been practiced for thousands of years. Chinese people started to use the benefit of the plants

since the Stone Age when Chinese converted from hunter-gatherers to farmers.

Traditional Chinese medicine (TCM) dated back to the period of The Huang Di. The

Nei Jing (The Yellow Emperor‟s Canon of Internal Medicine) that is the greatest and the

oldest Chinese medical classic is milestone, which has established the theoretical foundation

for the medical system and philosophical theory.

The theory of Chinese herbalism is dramatically improving since the development of

Chinese nation; for example, in Tang dynasty, King Sun Simiao was named the Herbal King.

In addition, during Jin-Yuan dynasty, there are four branches of Chinese herbalism. Each

branch has its own characteristic and thesis which improved the theory of TCM more clearly.

The Ming dynasty, Li Shizhen and Zhang Jingyue, promoted TCM development. Later on,

the Wen Bing School was founded in the Qing dynasty. Traditional Chinese herbalism has

taken shape unique its own system and theory in practice, which develops its own way

according to internal theories.

Since the beginning of the 19th century, western medicine started entering and

developing rapidly in China and traditional Chinese medicine development was affected

severely, which was between the devil and the deep sea.

HERBAL MEDICINE 7

After the Opium Wars in China, Chinese had the incorrect belief that traditional

Chinese medicine is unscientific and feudal. Therefore, TCM had always been in

investigation, examined, queried and reform, and develop on thin ice.

After the foundation of the People‟s Republic of China, the Government affirms the

policy to protect TCM. Then, it developed noticeably. However, in the latest 20 years, the

policy of the Party Central Committee and the gist of the Constitution haven‟t been carried

out conscientiously, and TCM has been in a difficult position.

Over the past thousands years, TCM has developed both practical and theory

universal systematic healthcare system which is characterized by simplicity, convenience,

affordability, safety, efficacy and effectiveness.

Yin-Yang has become a universal philosophical concept. The concept of Yin and

Yang is deeply rooted in Chinese philosophy (Miller, 2003; Watts, 1999). This Yin-Yang

concept appeared at least 2500 years ago, and it is the important role in the formation of the

Chinese ancient civilization. The Yin and Yang describes the formula of balance and

harmony. Nowadays, the Yin and Yang does not only access to the principle of medicine, but

also access to arts, religion, sports or politics.

According to the Chinese philosophical concept, there are two opposing forces in the

world, namely Yin and Yang, which are constantly trying to gain the upper hand over each

other. However, neither one will ever succeed in doing so, though one force may temporarily

dominate the other one. Both forces cannot exist without each other; it is rather the constant

struggle between both forces that defines our world and produces the rhythm of life. Yin and

Yang are not only believed to be the foundation of our universe, but also to flow through

and affect every being. For example, typical Yin-Yang opposites are night/day, cold/hot,

rest/activity.

HERBAL MEDICINE 8

Chinese philosophy does not confine itself to a mere description of Yin and Yang; it

also provides guidelines on how to live in accordance with Yin and Yang. The central

statement is that Yin and Yang need to be in harmony. Any imbalance of an economical,

biological, physical, or chemical system can be directly attributed to a distorted equilibrium

between Yin and Yang. For example, an illness accompanied by fever is the result of Yang

being too strong and dominating Yin. On the other hand, for example, dominance of Yin

could result in a body shivering with cold. The optimal state every being, or system, should

strive for is therefore the state of equilibrium between Yin and Yang. It is this state of

equilibrium between Yin and Yang that Chinese philosophy considers the most powerful and

stable state a system can assume.

Yin and Yang already carry the seed of their opposites: A dominating Yin becomes

susceptible to Yang and will eventually turn into its opposite. On the other hand, a

dominating Yang gives rise to Yin and will turn into Yin over time. This defines the perennial

alternative cycle of Yin or Yang dominance. Only the equilibrium between Yin and Yang is

able to overcome this cycle.

HERBAL MEDICINE 9

2.3.2 Ayurvedic medicine. Ayurveda is a medical system primarily practised in India

that has been known for nearly 5000 years. . The term “Ayurveda” combines the Sanskrit

words ayur (life) and veda (science or knowledge). Thus, Ayurveda means “the science of

life.” It includes diet and herbal remedies, while emphasizing the body, mind and spirit in

disease prevention and treatment (Morgan, 2002).

Ayurveda is designed to promote good health and longevity rather than to fight

disease and was practiced by physicians and surgeons (called bheshaja or vaidya). Until 700

BC, this science was orally discussed between sages and physicians. Thereafter, two different

textbooks were assembled: one by „„Charaka‟‟ is called Charaka Samhita, and the other by

„„Sushruta‟‟ is called Sushruta Samhita. Whereas Charaka Samhita deals with the etiology,

symptomatology, pathology, prognosis, and medical management of disease, Sushruta

Samhita deals with various surgical instruments and procedures.

2.3.3 Western Herbalism. Western herbalism is a form of healing art that draw from

herbal traditions of Europe and the Americas and that emphasizes the study and use of

European and Native American herbs in the treatment and prevention of illness. Western

herbalism is based on physicians and herbalists clinical experience and traditional knowledge

of medicinal plant remedies preserved by oral tradition and in written records over thousands

of years. Western herbalism, like the much older system of traditional Chinese medicine,

relies on the synergistic and curative properties of the plant to treat symptoms and disease

and maintain health. Western herbalism is based upon pharmocognosy, the study of natural

products. Pharmocognosy includes the identification, extraction methods, and applications of

specific plant constituents responsible for specific therapeutic actions, such as the use of

digoxin from digitalis leaf for heart failure. These constituents are extracted, purified and

studied in vitro, in vivo, and in clinical research. They may be concentrated to deliver

standardized, set doses. Sometimes, the natural constituent can be synthesized in the lab, or

HERBAL MEDICINE 10

changed and patented. Practitioners may choose to use fresh medicinal plants, simple

extracts, or standardized extracts.

In standardized extracts, a specific quantity of a constituent is called a marker

compound, and it may or may not be the active constituent(s) in the plant medicine. There are

preparations with standardized active constituent quantities, and preparations with greater

emphasis on quality of crude plant material and traditional preparation methodology than on

finalized total quantity of marker compounds. The preference between the two for precision

dosing is philosophical, practical and variable. When using plant extracts in which the active

constituents and their cofactors are well established, or the therapeutic and lethal dose are

close, standardized products are often preferred. When using plant extracts whose active

constituents remain obscure, or the active constituents when purified produce weaker

therapeutic results or more undesirable side effects, the products produced under good

manufacturing processes and according to the traditional National Formulary U. S.

Dispensatory or U. S. Pharmacopeia are preferred.

2.4 Herbal Treatment

Herbal medicine had function of important role in Cambodia based on historical,

cultural, and economical. Since ancient time, there are largely important of natural products

for medicine and health care. People usually used TM that is tradition medicine to treat or

reveal the disease which could found in several places such as forest, mountain, lake, or other

place that have several kinds of this herb in term of those on regions. In addition, many

people believe that are always safe and food for them. Base on cultural, they also became the

first medicine that were wild popular plant and cultivated medicinal plant which useful to

treat the disease or illness especially they are found easily around living area or in forest. For

example, during the past, our ancestors used herbs that are plant around living area to treat

illness by using their tooth to chew on certain herb to relieve pain, or wrapped leaves around

HERBAL MEDICINE 11

wounds to improve healing. Then in term of economic is also important. If traditional

medicine didn‟t have in around living area or forest, they would have acceptable price for

every usage even poor or rich family. Since natural products have often used to treat diseases

and injuries, they were well known how to find, to use and to treat by using experimental

treatment and innovation treatment. Moreover, herbal medicine used of natural products that

are derived from natural source, has found prehistory around thousands of years, as plants,

animal or micro-organisms.

2.4.1 Plants. Cambodia treat illness with traditional strategy based on plants that

have ability to sate of being different of illness such as fever, diarrhea, urinary troubles,

respiratory problems, tiredness, muscle pains, rheumatism etc… they are also regarded as the

medicines that have their own ability to synthesize a wide variety of chemical compounds.

They are also used to perform important function, and to defend our health and body against

attack from predator such as insect, fungi and herbivorous mammals. There are chemical

compound that occur naturally in plants, is called phytochemical. Most of these plants that

contain phytochemical have effectively benefit to care long-term health when they are used

by human, and they can be used effectively for treat human diseases. At least 12000 such

compounds have been isolated so far, and a number estimate to be less than 10% of the total.

These phytochemicals are divided into two. First are primary metabolites such

as sugars and fats, which are found in all plants, and second are secondary metabolites.

Compounds which are found in a smaller range of plants, are serving a more specific

function. For example, some secondary metabolites are toxins, which are poison, used to

defend predatory and other pheromones used to attract insects for pollination. However, there

are three important differences usages of plants in herbal medicine such as whole plant using,

herb combining and diagnosis.

HERBAL MEDICINE 12

Whole plant using- Generally, herbalists use unpurified plants that contain many

different of Constituents. They said that poison is reduced when whole of the medicine‟s

substance are made component, and they also emphasize that poison is reduced when whole

herbs are used instead of isolated active Ingredients (“buffering”). Due to research, they use

two sample of herbals drug that may contain constituent compound in different proportion;

however, practitioners claim that this does not generally cause clinical problems. There is

some evidence for synergy and buffering in certain whole plant preparations, but how far this

is applicable to all herbal products is not known (Vickers and Zollman, 1999). For example:

For thousands of years, when people face problem acne that appeared on their skin, they have

relied on aloe Vera to treat various skin conditions. It can also be very effective against acne.

Aloe Vera is also better sources which contain vitamins A and C. These natural sources can

protect the body and the skin from damage and also with skin repair and maintenance.

Aloe vera

Aloe Vera Aloe Vera using

Herbs Combining- It refers to all several different herbs are used together by herbal

practitioners. They say that the principles of synergy and buffering apply to combinations of

plant, and they also claim that herb which is combining to improve efficiency and reduce

impact. In contrast, they aren‟t similar to conventional practice, where polypharmacy is

generally avoided whenever possible (Vickers and Zollman, 1999). For example:

Diagnosis- Herbalists generally use different diagnostic principles from conventional

practitioners. For example, when treating arthritis, they might observe, “Under functioning of

HERBAL MEDICINE 13

a patient‟s symptoms of elimination” and decide that the arthritis results from “an

accumulation of metabolic waste products”. A diuretic, cholerectic or laxative combination of

herbs might then be prescribed alongside herbs with anti-inflammatory properties (Vickers

and Zollman, 1999).

2.4.2 Animal or micro-organisms. Animals also are regarded as the medicines that

have their own ability to treat a variety of illness such as gout to blood loss. Due to recording

in Yuan Shih, there are many incidents where the freshly or clear blood can treat the disease,

and it usually contain a cow or an ox. Transfusion, which an act of donate blood, or other

fluid into the circulatory system of person or animal, was place a person in the stomach of an

animal. In addition, on the battlefield, when solider became unconscious because of massive

among of blood loss, he uses freshly killed animal by stripping and placing into the stomach

until he become better or conscious again. Moreover, they also found the skin of a freshly

killed ox was combined with the masticated grass in a cow's stomach to present as the

bandage to battle wounds in order to make it heal because it they believe that not only

stomach and fat of the fleshy killed animal could absorb the bad or no fresh blood, but it also

restore the wounded to be health.

2.5 Positive and Negative Effects of Herbal Medicines

There are numerous positives and negative sides of Herbal Medicines. The Herbal

Medicine can treat well or not depends on its quality.

2.5.1 Positive effects of herbal medicines. Herbal medicines can reduced risk of side

effects because most of herbal medicines tolerate by the patients than pharmaceutical drugs.

Another positive of the herbal medicines is cost. If we compare herbal medicine‟s price with

that of drugs we will see that the herbal medicines are not as expensive as drugs. It is easy for

the poor and medium people to buy for curing their ill health. On the other hand, medicinal

HERBAL MEDICINE 14

plants are widespread availability. Hers are available without a prescription from doctor;

moreover, you can grow many kinds herbal medicine at home.

2.5.2 Negative effects of herbal medicines. Although herbal medicine is proved to

be effective, it is not appropriate in all situations. For example, the serious illness or accidents

can‟t be cured herbal medicine. Herbal medicine is not applicable for many ill health such as

broken legs, cancer, heal an appendix or heart attack. These injuries and illness can only be

treated by doctors using modern diagnosis tests, surgery, drug and so on. One more thing,

lack of dosage instruction mean that herbal medicine is made by them, and most of them are

not clear about method of preparation. Additionally, herbal medicines are not hygiene

because when they treat they don‟t control themselves. Some infection can transmit from

medical practitioner to the patients, and sometime can transmit from the patients to the person

who treats. Moreover, if they use overdose of herbal medicines, it can affect the patients too.

On the other hand the main point focuses on that herbal medicine are poison risk associate

with wild herbs. Herbal medicine practitioners usually do experiment by using medicinal

herbs curing real patients. In this case, patients take very high risk to be treated in herbal

medication, and if they really have problems, they just can‟t sue or punish those practitioners

since herbal medicine practitioners will only regard themselves as unprofessional so they are

not obliged to ensure safety of their treatment.

Lastly, herbal medicines are lack of regulation. Of cause herbal medicines is illegal

because it is not checked properly by the doctor, and its quality is not good for our body. For

example, many Asian and Indian herbal remedies have been found to contain heavy mental

such as lead, arsenic and mercury (Capriotti, 1999). Furthermore, herbal medicine can result

in hypersensitivity reaction. For example tea tree oil is widely used as a topical disinfection

or chamomile can cause allergic reaction (knight and, 1994; Bussuyt and Dooms-Goossens,

HERBAL MEDICINE 15

1994). And herbal medicines are not check as conventional that is why it can be

contaminated.

2.6 Ensuring Safety Herbal Medicine

Although Herbal Medicines are very good, there is need for practitioner to ensure that

the medicines are safe before they administer it to people. Moreover, they need to do

experiment over it many times before they bring it to the markets. Most of people like Herbal

Medicines because it is made from natural and affect a bite to the humans‟ life. Herbal

Medicines treatment is the most popular form of traditional medicines and was very lucrative

on the international markets; for instance, in China the sale of Herbal Medicines products is

totally 14 billion USD in 2005, adding that the worldwide annual mark for traditional Herbal

Medicines/product was about 60 billion USD (Dominic, 2013).

HERBAL MEDICINE 16

III. Herbal Medicine in Cambodia

3.1 Overview

Herbal Medicine is strongly belief and well-know of remedy in curing illness from

natural of wild plants and animals for all Cambodians ill-health (NCTMT, 2010). The

knowledge of herbal medicine is documented only in Pali language, which makes general

people having desire to learn find difficult to learn. The knowledge about medicinal plants is

usually pass through family when young people start going to forest to get non-timber forest

products. However, the knowledge comes to limitation due to overexploitation of forest and

illegal deforestation (Savajol, Toun, & Sam, 2011).

Herbal medicine has played a very important role in health care of Cambodian

citizens since the time before Angkorian Era until present time. Around half of Cambodian

population relies heavily on the medicine, especially, people living in the area that is strongly

influenced by custom and tradition and poor people (WHO & MOH, 2012). People tend to

use herbal medicine, asides from efficacy issue, sine it is more accessible than biomedicine or

Western medicine. To illustrate, in Mondulkiri Province, western medicine is almost

inaccessible (Savajol et., 2011). To get western medicine service, people have to travel in far

distance on red road, and in rainy season, the road is almost impossible to travel by

motorbike. As a result, people continue accessing herbal medicine because the service can be

found in their neighborhood or in any place which they just need to spend a short period of

time arriving there.

Some Cambodian people receive both medicinal herbs and western medicine to cure

their illness and mostly they switch from one medicine preparation to another when they feel

their illness is not effectively cured by the medicine they are receiving. Many Cambodians,

however, are very hesitant to let western medical providers know that they are using

traditional medicine to cure their health, since they think the providers will not be happy to

HERBAL MEDICINE 17

cure them (Wetzel & Jennifer, 1996). Hence, this might affect to the tracing of illness by

modern doctor, and this would affect the medicine that they will be prescribed to consume.

3.2 History

Traditional Khmer Medicine is being used long before in Angkorean period of

Cambodia history, and it is influenced by Chinese and Indian herbalism. It is believed that

herbal medicine concept is brought into Cambodia since the first century of Christian era

during Indianization period. Indian has brought “Ayurveda” concept of medicinal plants

which associate with kinds of plants to be used and how to use it in to Cambodia. In Sanskrit,

Ayur means longevity or life, Veda means knowledge or science, so Ayurveda refers to

knowledge or science about having a long life (Kham, 2004). Herbal medicine also has a

strong relationship with Buddhism and Hinduism. Buddhist and Brahmin priests had been

experience full and high knowledge (about medicinal plants) herbal medicine practitioners.

Some of the knowledge might be obtained from learning from previous practitioners;

however, since Angkorian era, they learnt more about herbal medicine from Chinese. Chinese

traders and Cambodian has good relationship as well as trade cooperation. Chinese traders

had order many kinds of plants from Cambodia, and one of among the purpose of importing

is to use plant for medicinal purpose. Through this trade, Cambodian had chance to get to

know more plants and other natural products that are used for curing people, and hence they

applied the knowledge in treating illness. Although, Cambodian herbal medicine seems to be

influenced by both Ayurveda and Chinese, the practice of herbalists can be viewed as

influenced more by Ayurvedic herbalism; whereas, Chinese practice is just an additional

knowledge since during Jayavarman VII dynasty, health care of his people was set as a

priority sector, and the king, as a result, created a medical science which is called Vaidyas

Vedic derived from Ayurveda. Through this establishment 102 hospitals were created using

HERBAL MEDICINE 18

traditional medicine, and in each hospital there were 32 workers working to help people from

illness (Jan & Ing, 2010).

Cambodia was remarkably introduced to new kind of medicine, modern medicine or

western medicine or biomedicine during French protectorate and colony in 1950. Under

control of French, western medicines were widely used for curing disease in Cambodia;

however, only the rich people can have access to the medicine. Despite of the fact that

western medicine is practiced in Cambodia, traditional medicines were still widely used in

every corner in the country.

Later in 1970s, during Khmer Rouge regime, traditional medicine had gained its

popularity again in Cambodian society. During the regime, western teaching, including

medicinal teaching, were banned, so there were almost no western medicinal doctor to treat

people, and herbal medicine has been promoted and encouraged to use. There were hospitals,

but the medicine provided to patients were not varies. Most people were cured by offering a

kind of pill called “Rabbit Dropping”, and taking rest from hard physical labour (Jan & Ing,

2010). Nevertheless, according to experience of people alive from Pol Pot regime proves that

the medicine provided sometimes are very effective; to illustrate, diarrhea and swollen has

been the most common illnesses that old people raise to prove that medicine in Pol Pot

regime is effective.

In 1979, after falling of Pol Pot‟s regime, in order to support and promote the use of

Traditional Medicines, the Government has officially integrated the law into the National

Health System.

After Pol Pot‟s regime, we found that Cambodian herbal practice is also influenced by

Vietnamese. For instance, people in Mondulkiri, during 1970s, their villages were destroyed,

and they migrated to Koh Nhek in Vietnam. In the same time as making their living there,

Cambodian people learnt about herbal medicine in that area, and when they came back in

HERBAL MEDICINE 19

1980s they adapted those knowledge because they have already lost the home knowledge

about herbal medicine (Savajol et al., 2011).

Later, Royal Government of Cambodia has tried very hard to promote herbal

medicine in Cambodia. In 1998, due to lack of western medicine available, traditional or

herbal medicine has formally encouraged to completely use in area where western medicine

is not available and areas where western medicine existed, herbal medicine should be used as

an alternative health care. In 2004 the Royal Government committed to continuing to

encourage the use of traditional medicines with appropriate information and control in

conjunction with the use of modern medicine. The government released their Policy on

Traditional Medicine of Kingdom of Cambodia in 2010. In 2011 the Traditional Medicine

Taskforce was established to implement the 2010 Policy on Traditional Medicine. Yet, there

is no national expert committee for traditional medicine. Traditional medicine is not yet

included in the National Health Strategic Plan and is not covered by health insurance.

Cambodian Herbal medicine has such a long history starting from the main source of

medicine for health care to just an alternative health care strategy. The number of people

using herbal medicine, however, is still great. Ministry of Health (2012) estimated that

around 40-50% of Cambodian population still relies on herbal medicine. Large population of

people still use this kind of herbal medicine because of it is more accessible, affordable, and

effective. On one hand, traditional medicine is the most affordable medicine that even poor

people don‟t find difficult to have it (Kaing, 2010). Besides buying it from market, people

can even obtain the plants by themselves around their house. Differently, western medicine is

not this accessible; for example, in Mondulkiri Province, people have to travel in far distance

to arrive at health care center to receive western medical service. Additionally, in rainy

season, the road is almost impossible to travel by motorbike since the road was red pave road

(Savajol et al., 2011)

HERBAL MEDICINE 20

3.3 Cambodian Herbal Treatment

In Cambodia today, there are 1,000 plant species used for treatment in Khmer herbal

medicine, and those plants can be obtained by either going directly into the forest to find or

buying from market (Kaing, 2010). To ensure the effectiveness of medicinal plants, we need

to cut the plants in right time. Ly Bunnarith, one of famous Khmer traditional medicine

practitioners whose medicine is recognized by Ministry of Health, explains that a medicinal

plant is divided into 3 main parts such as trunk, leaves, and root. Some trees, its trunk must be

cut in the morning, leaves must be cut in the afternoon, and root must be ditch up at night.

For some trees, it is fine to cut in any time, but for some trees, if we don‟t take it in the right

time, effectiveness of it will be affected (Se, 2002).

3.3.1 Provider of herbal medicine. Herbal remedy is also practices directly by

patient himself or his family. Sometimes, people try to cure themselves without any

consultation with medicine practitioners. They just try to find medicinal plants they know

around their house or in the village, and prepare them for curing their ill-health directly by

themselves. The practice has been passing on from generation to generation in accordance

with their family‟ habit, knowledge obtaining from family or prescription they get from

healer sometime in the past when they were sick (WHO & MOH, 2012).

In Cambodia during 1890s, there were two herbal medicine providers such as “Kru

thnam” and “Kru thump”.

“Kru Thnam” are traditional herbalists; their skill is in the proper way of combining

the various roots and herbs; the mixture is boiled and the decoction is given to the

patient to drink. “Kru thump” were plain sorcerers, ignorant healers with no

professional decency who would often sell medicines that they knew were

ineffective. Nevertheless they were said to know medical secrets that enable them to

HERBAL MEDICINE 21

cure diseases that the “Kru Pet” or “Kru Thnam could not cure”. (Jan & Ing, 2010, p.

135)

Similarly, in present time, Ministry of Health in collaboration with World Health

Organization has identified herbal medicine is provided by only private sector usually Kru

Khmer, Kru Chol Ruup, and Buddhist monks. Kru Khmer simply has the same meaning as

Kru Thnam in the past, and Kru Chol Ruup are spirit mediums, mostly female, who are

possessed by their spirits who make diagnosis or direct the exorcism. The mediums

frequently recommend the use of material objects, such as amulets for protection and to ward

off bad spirits (Jan & Ing, 2010, p. 135) .

3.3.2 Illness identification. Cambodian herbal treatment is still influenced by

superstition. For instance, the identification of illness in this traditional medicine can be

conducted in to main techniques including inquiry technique and magical-religious technique.

Inquiry technique refers to the process of diagnostic identification which medical practitioner

tries to ask patient questions in order to get information about ill-health history and

examining the patient. The magical-religious technique is the process of identifying ill-health

and making explanation to patient by predicting (NCTMT, 2010).

3.3.3 Concept of Cambodian herbal treatment. It is true that Cambodian herbal

medicine is influence by Ayurvida from India, but in curing illness, providers tend to follow

the “Yin and Yang” concept of health originating from China. Professor Chheng Sun Kaing

(2010) argue that concept of treatment of illness in herbalism in Cambodia is often associated

with “hot” and “cold” notions. Hot illnesses such as fever, constipation, hyperthermia, and so

forth should be treated by a cold medication using plants with acid, bitter or astringent taste.

For example, hyperthermia can be effectively treated by Andrographis paniculata Nees (in

Khmer it is called Smao Promatmanus). Hyperthermia can be treated by dried powder of this

HERBAL MEDICINE 22

plant in a dose of 3-6 gm or decoction in dose 150ml-300ml orally taken for the specified

indications. Cold illness such as diarrhea, hypothermia, and so forth should be treated by a

Andrographis paniculata Nees (Smao Promatmanus).

hot medication using plants with spicy or sweet taste, or essential oils. For example, Cocos

nucifera or in English we call it coconut palm.

3.3.4 Herbal medicine preparation. Just about all Khmer medicine used nowadays

is derived from mostly herbal plants, bark, roots and leaves from various trees, but there are

also some minerals and other natural ingredients. Usually, herbal medical preparation is

prepared in solid form, powder form, herbal tea, fresh herb, decoction, and fluid extract

(Kaing, 2010).

- Solid form: small pills are prepared from the mixture of extracts from different plants,

especially for treatments such as blood purifiers, indigestion and liver diseases. The plant

resins itself forms the binding agent that combines the pill. The mix is kneaded into a thick

paste, rolled and cut into pills. The pill can be taken orally with water or honey.

- Powder form: prepared from fine powders that are administered orally and some

powders are prepared for external use only.

- Herbal teas: this is most common form of medicinal preparation in Cambodia. A

single dried herb or a mixture of dried herbs are sliced, infused in hot water and brewed.

HERBAL MEDICINE 23

- Fresh herb: some herbs are treated with water and triturated freshly. The water

extracted is drunk as a tea.

- Decoction: a decoction may constitute a single herb or a mixture of herbs for oral

administration to treat a variety of disorder. Either the fresh or dry herbs are used in preparing

decoctions.

- Fluid Extract: this method is used for ingredients that are water soluble and the most

common ration used is 10:1. These preparations are normally reserved for the treatment of

tuberculosis and sexually transited.

3.4 Effect of Cambodian Herbal Medicine

Herbal medicine has been said to be very effective in curing by many herbal medicine

practitioners; however, in Cambodia we haven‟t had a standard criteria for assessing the

efficacy of herbal medicine. The idea of effectiveness seems to be claimed by only the

practitioners. Like other thing, there is positive and negative effect of herbal medicine.

3.4.1 Positive effects. The biggest positive side of herbal medicine is its efficacy. Not

only herbalist themselves prove the medicine effective but also patients experience this

process of treatment claim that it is very effective and can help them to recover very quickly

(Kounilia, 2010). In addition to its effectiveness, the medicine usually doesn‟t have side

effect which can be harmful to health as western medicine does. It is true that some herb is

poisonous, but its toxicity is always much lower than western medicine if it is well prepared.

On another hand, unlike western medicine, herbal medicine is more accessible since it is

cheap and widespread everywhere (Se, 2002).

3.4.2 Negative effect. The herbal medicine itself naturally doesn‟t have bad impact,

and negative part of it come from external factors. Although medicinal plants are said to be

effective, but there is no any criteria for assessing that the medicine is really like that. Unlike

herbal medicine, western medicine quality is obviously inspected and controlled (Savajol et

HERBAL MEDICINE 24

al., 2011). Due to loose in administration, people using herbal medicine have greater chance

in facing problems arising from improper combination and preparation. The chance to have

trouble with the medicine is high in Cambodia because anybody can proclaim himself as

traditional healer (Wetzel & Jennifer, 1996). In the same time as loose administration over

the medical practice, royal government of Cambodia has never allocate any budget for

improving herbalism in Cambodia. On another view, herbal medicine harvesting and

cultivation threaten plant species. If the medicine is widely used and promoted, more people

extract more plants and animal which might lead to extinction of plants and species. Lastly,

herbal medicine practice is closely related to skill development of practitioner; however, until

now Cambodian herbal medicine is written only Sanskrit language which can‟t be generally

understood by all people, so researching would be very difficult (Jan & Ing, 2010).

3.5 Ensuring Safety and Efficacy of Herbal Medicine in Cambodia

To ensure the effectiveness of herbal medicine, royal government of Cambodia begins

to take an initial step to develop a comprehensive national policy in which incorporate the

traditional medicine policy and national strategy which include the following sectors:

1. The National Policy on Drugs was passed which states that traditional should be

boosted, particularly within primary health care, through training, scientific research and

technology to develop traditional medicine (1998).

2. Cambodia‟s Forestry Law on Forestry By-products includes, among other non-

timber forest products, the plants and animals harvested for traditional medicine. Local

communities are permitted to use such by products provided the impact on the forest is only.

It is prohibited to harvest “rare tree species” or to hunt, possess, transport, trade and export

“rare and endangered wildlife species”. Those who are caught doing so are supposed to be

fined three times the commercial value of the item and the item is confiscated (2002).

However, the Ministerial Decree that will determine the criteria by which each animal and

HERBAL MEDICINE 25

plant species is categorized and that will name those species categorized as rare and outline

the corresponding levels of protection.

3. Cambodia‟s Prime Minister declared that “The Royal Government will continue to

encourage the use of traditional medicines with appropriate information and control in

conjunction with the use of modern medicine”, in July 2004. Another sub-decree, on the

production, import, export and commerce of traditional medicine in the public sector defines

legal guidelines for the manufacture and trade of traditional medicine.

HERBAL MEDICINE 26

IV. Discussion

In both theory and case of Cambodia, using herbal medicine associates with both

advantages and disadvantages. The most important positive side of herbal medicine is its

effectiveness. Although herbal medicine seems to be practiced in traditional way rather than

standard-modern way, it can make patients recover very quickly with no any side effect like

modern medicine. Despite of the fact that some medicinal plants contains poisonous sustain

which can be dangerous for health, its toxicity can be minimized even lower than that of

western medicine. In addition to effectiveness, herbal medication cost patients very low, so it

is affordable by all kind of persons, both rich and poor. For the negative side, based on case

of Cambodia, most negative impacts derived from poor administration. It can be caused by

unprofessional healers, or herbal medical store or clinic is not well inspected by the authority.

People hesitate to trust herbal medicine since there is no any standard criteria to examine

whether or not its quality, safety and effective is good enough for curing people. Another

serious concern relating to herbal medicine is extinction of plants species. The need for

medicinal plants might lead to extinction of certain plants or species. In theory, negative side

seem to be heavier than positive side, but if we base on the picture we see in Cambodia, those

negative side would be reduced if the doctor and medicinal plants using for treatment are well

controlled and tested before using.

Base on the effects associated with herbal medicine as mentioned above, we believe

that herbal medicine should be promoted. The herbal medicine itself has no bad impact on

human health, but the bad impacts that some people experience or are afraid of mostly come

from administration and controlling which is a responsibility of practitioner and authority. If

herbal medicine is welled controlled, health care of human being will be promoted

effectively.

HERBAL MEDICINE 27

The need to improve herbal medicine administration has already been strongly paid

attention by the government, and some stake holder. There are policies and law has been

adopted to promote and control herbal medicine; however, in reality as raised in section III,

the enforcement of those policies and law is ineffective. In this situation, the most prioritized

action needed to be taken is strengthening law enforcement.

HERBAL MEDICINE 28

Conclusion

Herbal medicine refers to the natural medication using natural plants and animal to

cure ill health of people. The medicine has been used since 60,000 years ago, and there are

three main kinds of herbalism in the world including Ayurvedic herbalism, Chinese

herbalism and Western herbalism. Herbal medicine can be obtained by either going directly

to the forest or buying from stores at the market. Herbalists can cure ill-health with plants, by

using the whole plants, herbs combining and diagnosis, and animals.

Herbal medicine has been identified as a very effective medicine with no side effects

to patients being cured by it. Asides from its efficacy, in comparison to western medicine,

herbal medicine is more accessible to people since it is cheap and widespread everywhere.

Along with its goodness, the safety issue of herbal medicine is still a big concern in health

care nowadays. The safety issue is worried due to the practice of herbalism is not well

controlled. It is practiced under the lawless control, and everyone can just claim themselves

as a herbalist. Medicinal herbs are not inspected with appropriate criteria, and no one check

whether or not the medicinal herbs are stored well with good hygiene standard. This loose

administration makes herbal medicine be a dangerous for health of patient.

Herbal medicine has both positive and negative effect; however, through discussion

we believe that herbal medicine should continue being used since it is very effective with no

side effect and can be accessed by even poor people. In the same time as promoting herbal

medicine, there is an urgent need to strengthen the control over this kind of medication.

HERBAL MEDICINE 29

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