Traditional Indian Medicine: Sourcing From The Heart Of The Earth

In spite of incredible advances in modern science, technology and allopathic medicine at large we are unable to provide quality healthcare to all. Traditional medicine particularly herbal medicine considered as a major healthcare provider around the globe particularly in rural and remote areas. A large section of people depends on such medicine for their primary healthcare mainly in underdeveloped or developing countries. Indian traditional medicinal system like Ayurveda, Siddha and Unani has a very rich history of their effectiveness; modern research has also acknowledged the importance of such medicine. Indian traditional medicine or medicinal plants are also considered as a vital source of new drugs. Mainstreaming of traditional medicine is important for the people. Several steps have been taken in India to promote such medicine and integrate them into clinical practice. The incorporation of evidence based Indian traditional medicine in clinical practice will help to provide quality healthcare to all.

The evolution of society has been parallel to the history of medicines. Humans have been continually striving to create increasingly powerful medicines to combat pathogens and disorders in order to ensure survival and longevity. The arms in this perennial struggle have always been provided by nature. Since prehistoric times, humans have used natural products, such as plants, animals, microorganisms, and marine organisms, in medicines to alleviate and treat diseases. According to fossil records, the human use of plants as medicines may be traced back at least 60,000 years. The use of natural products as medicines must, of course, have presented a tremendous challenge to early humans. It is highly probable that when seeking food, early humans often consumed poisonous plants, which led to vomiting, diarrhea, coma, or other toxic reactions - perhaps even death. However, in this way, early humans were able to develop knowledge about edible materials and natural medicines. Subsequently, humans invented fire, learned how to make alcohol, developed religions, and made technological breakthroughs, and they learned how to develop new drugs. Traditional medicines make use of natural products and are of great importance. Such forms of medicine as Ayurveda, Unani, Siddha, Traditional Chinese Medicine (TCM), folk medicine of Africa, etc employ natural products and have been practiced all over the world for hundreds or even thousands of years, and they have blossomed into orderly-regulated systems of medicine. In their various forms, they may have certain defects, but they are still a valuable repository of human knowledge.

Throughout our evolution, the importance of natural products for medicine and health has been enormous. Since our earliest ancestors chewed on certain herbs to relieve pain, or wrapped leaves around wounds to improve healing, natural products have often been the sole means to treat diseases and injuries. In fact, it has only been during the past decades that natural products have taken a secondary role in drug discovery and drug development, after the advent of molecular biology and combinatorial chemistry made possible the rational design of chemical compounds to target specific molecules. The past few years, however, have seen a renewed interest in the use of natural compounds and, more importantly, their role as a basis for drug development. The modern tools of chemistry and biology-in particular, the various '-omics' technologies—now allow scientists to detail the exact nature of the biological effects of natural compounds on the human body, as well as to uncover possible synergies, which holds much promise for the development of new therapies against many devastating diseases, including dementia and cancer. From the history of drug development, it is evident that many drugs have been derived as a result of inspiration from traditional medicine. The application of, and research into, natural products are far from satisfactory. A number of problems need to be addressed in the future. For example, synergistic effects may exist among the compounds that occur in natural products; however, the modes and mechanisms of action are seldom very clear. It is, therefore, necessary to make full use of such synergetic effects toward improving the effectiveness of drugs. However, it is also requisite that any adverse effects of natural products be properly reduced to meet safety standards.

Traditional Indian medicine is based on thousands of years of medical practice and experience, and is rich in experiential data which guarantee its effectiveness and efficacy. It has developed techniques with respect to such areas as correct dosage, methods of preparing, processing materials, and the appropriate time to collect the various medicinal parts of plants. It is notable that there is increasing convergence between traditional medicine and modern medicine. With the development of modern technology, it has become possible to determine the pharmacology and mechanisms of action of many herbs, and traditional medicine is rapidly become comprehensible in terms of modern medicine. With advances in the theoretical background, therapeutic principles, associated technologies, and understanding of the life sciences, a clearer understanding of the active compounds of traditional has become possible. At the beginning of the nineteenth century, the era of modern drugs began. In 1805, the first pharmacologically-active compound morphine was isolated by a young German pharmacist, Friedrich Sertürner, from the opium plant. Subsequently, countless active compounds have been separated from natural products. Among them, some follow their traditional uses and the others do not.

Later, the development of synthetic techniques led to a significant reduction in the importance of natural products, and there were concerns that the use of some natural products for medicinal purposes might be completely banned. However, natural products are important for the development of new drugs, and these products have been in constant use. Some type of medicines, such as anticancer, antihypertensive, and antimigraine medication, have benefited greatly from natural products. The development of new drugs relying purely on modern technology appears to be reaching something of a limit. In developing new drugs, the pharmaceutical industry has tended to adopt high-throughput synthesis and combinatorial chemistry -based drug development since the 1980s. However, the considerable efforts made in this direction have not resulted in the expected drug productivity. Some large pharmaceutical companies are facing great challenges to develop new products. Over the past dozen years, increasing attention has accordingly been paid to natural products in the search for novel drugs in combination with new technology, such as high-throughput selection. Natural products, which have evolved over millions of years, have a unique chemical diversity, which results in diversity in their biological activities and drug-like properties. Those products have become one of the most important resources for developing new lead compounds and scaffolds. It is bound to be in continual use towards meeting the urgent need to develop effective drugs, and will play a leading role in the discovery of drugs for treating human diseases, especially critical diseases.

Natural products have a wide range of diversity of multi-dimensional chemical structures and its utility as biological function modifiers has also won considerable attention. Subsequently, they have been successfully employed in the discovery of new drugs and have exerted a far-reaching impact on chemicobiology. From the past century, the high structural diversity of natural products have been realized from the perspective of physical chemistry. Their efficacy is related to the complexity of their well-organized three-dimensional chemical and steric properties, which offer many advantages in terms of efficiency and selectivity of molecular targets. As a successful example of drug development from natural products, artemisinin and its analogs are presently in wide use for the anti-malaria treatment. This shows how research using natural products has made a significant contribution in drug development. Among anticancer drugs approved in the time frame of about 1940–2002, approximately 54% were derived natural products or drugs inspired from knowledge related to such.

For instance, the Vinca alkaloids from Catharanthus roseus, and the terpene paclitaxel from Taxus baccata, are among successful anticancer drugs originally derived from plants. During the period between 1981 and 2002, the application of natural products in the development of new drugs - especially in the search for novel chemical structures - showed conspicuous success. In that 22-year time frame, drugs derived from natural products have been significant. That is especially true in the case of antihypertensives, where about 64% of newly-synthesized drugs have their origins in natural product structures. Considering their incomparable chemical diversity and novel mechanisms of action, natural products have continued to play a pivotal role in many drug development and research programs. With time, those natural products have undergone interesting and meaningful developments in their ability to interact with numerous, varied biological targets, and some have become the most important drugs in health care system. For example, plants, microorganisms, and animals manufacture small molecules, which have played a major role in drug discovery. Among 69 smallmolecule new drugs approved from 2005 to 2007 worldwide, 13 were natural products or originated from natural products, which underlines the importance of such products in drug research and development. Over the past 50 years, there has been a great diversity of new drugs developed using high-throughput screening methods and combinatorial chemistry. However, natural products and their derived compounds have continued to be highly-important components in pharmacopoeias. Of the reckoned 2,50,000 - 5,00,000 existing plant species, only a tiny proportion has been scientifically researched for bioactivities. Therefore, there is great potential for future discoveries from plants and other natural products which, thus, offer huge potential in deriving useful information about novel chemical structures and their new types of action related to new drug development.

Traditional medicine is the oldest form of health care in the world and is used in the prevention, and treatment of physical and mental illnesses. Different societies historically developed various useful healing methods to combat a variety of health and life-threatening diseases. Traditional medicine is also variously known as complementary and alternative, or ethnic medicine, and it still plays a key role in many countries today. The medicaments used in traditional medicines are mostly derived from natural products and 'clinical trials' have been conducted since ancient times. In the case of traditional Indian medicine, considerable experience and advances have been accumulated and developed over the past thousands of years with respect to methods of preparation, selection of herbs, identification of medicinal materials, and the best time for obtaining various different plants. Appropriate processing and dose regulation are urgently needed in these traditional medicinal systems to improve drug efficacy and reduce drug toxicity.

Considerable amounts of data have been acquired through clinical experiments, and in this way traditional medicine has assisted in the development of modern drugs. Through its use of natural products, traditional medicine offers merits over other forms of medicine in such areas as the following: discovery of lead compounds and drug candidates; examining drug-like activity; and exploring physicochemical, biochemical, pharmacokinetic, and toxicological characteristics. If any form of traditional medicine is applied successfully, it may surprisingly assist in the development of new drugs, thereby resulting in many benefits, such as significant cost reductions. Ayurveda along with other Indian traditional medicinal systems is now gradually getting integrated into the Indian public health system. In recent years, Ayurveda has rapidly gained considerable approval as a complementary or alternative medicine in Western countries. Indian herbal medicine, which is the most important component of traditional Indian medicine is currently used in the health care of an estimated 1.5 billion people worldwide. It should be noted that in traditional Indian medicine, several herbs and ingredients are combined according to strict rules to form prescriptions.

Traditional Indian medicine mainly comprises the following:

Ayurveda is a comprehensive scientific medicinal system indigenous to India. The term Ayurveda means 'knowledge of life' which comprises two Sanskrit words, Ayu(life) and Veda (knowledge or science). The four vedas, considered as the oldest Indian literature (5000-1000 BC) contain information about natural remedies. Ayurveda was established as a fully grown medicinal system in ancient India. The Charakha Samhita (focusing on internal medicine) and Susruta Samhita (focusing on surgery) were written systematically and considered as a classical text of Ayurveda. Vital details of Charaka Samhita and Susruta Samhita were compiled together and updated additionally in Ashtanga Sangraha and Ashtanga Hridaya. Some other ancient classics which include minor work of Ayurveda includes Madhava Nidana (focussing on diagnosis of disease), Bhava Prakasa (focusing on additional information related to plant and diet), Sarngadhara Samhita (focusing on formulation and dosage forms). Ayurveda was classically divided into eight major clinical subdivisions: Kayacikitsa (internal medicine), Salya Tantra (surgery), Salakya (diseases of supra-clavicular origin), Kaumarabhrtya (paediatrics, obstetrics and gynaecology), Bhutavidya (psychiatry), Agada Tantra (toxicology), Rasayana Tantra (rejuvenation and geriatrics), Vajikarana (aphrodisiology and eugenics).

Siddha system of medicine is considered to be a brilliant achievement and symbol of Tamil culture which originated in the southern parts of India. Siddha medicine evolved during Dravidian times and grew parallel to the Indus valley civilization. Chinese alchemy, Taoism and Taoist Patrology are considered as main sources of inspiration for Siddha alchemy. It is believed that the system was developed by eighteen siddhars(a class of Tamil sages). Though the Siddha system of medicine resembles Ayurveda in many aspects, it has own philosophy and concepts.

Unani system of medicine is the fusion of contemporary traditional medicinal system in Egypt, Syria, Iran, Iraq, China, India and several other oriental countries. It originated in Greece and later developed in the Arab region. Arab and Persian settlers in the 11th century introduced Unani medicine in India. The system got recognition and became enriched during the Mughal rule.

Amchi or Sowa Rigpa is another ancient well documented traditional medicinal system, which was popular in Tibet, Mongolia, Nepal, Bhutan, Himalayan parts of India, some parts of China and former Soviet Union. Though opinions vary on the origin place of Amchi medicine, some believe that it originated in India while others consider Tibet or China to be its source. Amchi has close similarity with Ayurveda, though the influence of Chinese traditional medicine and Tibetan home remedies are also observed in this system.

Folk medicine
Other than the codified traditional medicinal system, the uncodified folk medicine also plays a vital role in the maintenance of health and cure of diseases for a large number of people, especially the rural, indigenous and ethnic communities. This type of knowledge is not documented properly and propagates verbally through generations and regions. Nearly 8000 plants species are utilized in folk medicine and approximately 25,000 effective plant-based formulations are used by the rural and ethnic communities in India.

It has been noted by WHO that a large quantity of people in the world still depend on traditional medicine for healthcare. The current status of traditional medicine differs in different countries. In 2012, the total value of the TCM industry was equivalent to around one-third of the total for China's pharmaceutical industry. It has been determined that 80% of the population in Africa makes use of traditional medicine - either alone or in conjunction with conventional medicine. By contrast, traditional Aboriginal medicine in Australia is in danger of vanishing owing to the prevalence of conventional medicine. In many countries, modern medicine is prevailing and traditional medicine is declining. Many practitioners of Western medical science think such traditional medicinal systems as being short on reliability even though they are adopted by the majority of people in the world. It is possible to produce remarkable synergy and yield great benefits in developing reformed medicines and new drugs by connecting powerful modern scientific techniques and methods with the reasonable ethnobotanical and ethnomedical experiences of traditional medicine.

Traditional medicine is too valuable to be ignored in the research and development of modern drugs. Though it has an enigmatic character, there are also wide contexts for its use in terms of non-Western medical technology or activities. In traditional medicine, a single herb or formula may contain many phytochemical constituents, such as alkaloids, terpenoids, flavonoids, etc. Generally speaking, these chemicals function alone or in conjunction with one another to produce the desired pharmacological effect. It is notable that a lot of plant-originated drugs in clinical medicine today were derived from traditional medicine. In addition, it has been demonstrated that the many valuable drugs derived from plants were discovered through their application in traditional medicine. About 20 years back, a thorough investigation of the pharmacopoeias of developed and developing nations and the associated world scientific literature was conducted as part of the WHO's traditional medicine programme. The aim of that study was to determine whether traditional medicine really had inspired modern drug discoveries and whether there was any correlation between the current use of various compounds and their application in traditional medicine. The study focused on various compounds used in drugs derived from plants in different countries, and it established that traditional medicine had indeed played a significant role in developing effective new drugs. That study focused on 122 compounds, 80% of which were found to be related to the remedial materials used in traditional/folk medicine, and it was determined that these compounds originated from 94 plant species.

With the riches of modern technology, such as in synthesis, fermentation, pharmacology, pharmacodynamics combined with a wealth of knowledge about natural products via traditional medicine, it is possible to establish a large compound library for drug screening. This will enhance the possibilities for individual treatment and prevention of disease. Mankind needs to learn more from natural products and traditional medicines. In order to further promote the development of modern medical research on natural products, all the stakeholders have to face up to the various difficulties and challenges. Valuable information on natural products and traditional medicine has been mixed up in a large number of useful but scattered documents and useless rumors. Furthermore, one plant or formula of traditional medicines contains a large number of chemical constituents, including active, invalid, and possible synergistic components. Therefore, great effort should be made at first to remove the dross and understand the essence of these natural drugs. Furthermore, in many cases, the role of a single compound from a particular natural product receives exclusive attention at the cost of other equally significant compounds within the drug. As a matter of fact, one advantage of traditional medicine's therapeutics is the 'synergism' wherein the multiple components in a traditional medicine mixture often play a synergistic role which is greater than that of the individual active compound/component. It has increasingly become clear that the 'single disease - single target - single drug’ model cannot treat complex diseases effectively, especially cardiovascular diseases and diabetes. Thus, the treatment protocols have lately seen a shift to the 'multi-drugs and multi-targets' mode for combination therapies. Therefore, in the future, multidisciplinary collaborative research, closely embedded with network pharmacology and big data, will enable researchers to unravel the synergism and other mechanisms of traditional medicines, leading to newer and better drugs along with positive treatment outcomes.