Simaan Joseph A
J Med Liban. 2009 Oct-Dec;57(4):215-7.
Herbal medicine, the most major component of traditional medicine, is as old as recorded history. Beginning in the early 1800s, with the development in the science of chemistry, a new era in pharmacotherapeutics was initiated whereby active chemical ingredients in plants, historically known to produce a favorable therapeutic effect, were extracted, purified and their structure disclosed. This ushered the modern era of therapy with drugs based on exploration of pure chemical products as to chemical identity, physicochemical properties, pharmacodynamic actions, pharmacokinetic behavior in the biological system, toxicological profile and effective and safe application in therapy. This relegated herbal medicine to a secondary role. More recently, a revival in the use of herbal medicine has been witnessed, even in culturally advanced societies, probably enhanced by the false belief that natural products are safe and also by vigorous promotion. Parallel to the increase in the use of herbal preparations as remedies for major diseases, there is currently a growing concern about their efficacy, safety and control. This prompted the World Health Organization to come out with recommendations for control in the document "Research Guidelines for Evaluating the Safety and Efficacy of Herbal Medicines" in 1993. The guidelines are equal in strictness to those applicable for drugs in general. A large number of member states have adopted these guidelines. The dangers in using herbal preparations for treatment include: * unproven therapeutic benefit * undisclosed toxicities * interaction of the chemicals in herbal preparations with each other and with concomitantly taken drugs, at the level of functionally important biological entities such as the plasma proteins, receptors, ion channels, transporters and others * incompatibilities with patient-related factors such as age, sex, genetic background and the function of the organs responsible for eliminating the effects of chemicals in herbal preparations such as the liver or kidney * the difficulty in standardizing treatments and * the inclusion of regular drugs with the herbal preparations without disclosure. In Lebanon, a committee is charged with the control of herbal preparations but a stricter control is required to handle preparations with a therapeutic claim as well as the issue of promotion.
草药是传统医学的最主要组成部分,其历史与有文字记载的历史一样悠久。从19世纪初开始,随着化学科学的发展,药物治疗学开启了一个新时代,在此期间,植物中具有治疗作用的活性化学成分被提取、纯化并揭示其结构。这迎来了基于对纯化学产品的化学特性、物理化学性质、药效学作用、生物系统中的药代动力学行为、毒理学特征以及治疗中的有效和安全应用的探索的现代药物治疗时代。这使草药退居次要地位。最近,即使在文化发达的社会中,也出现了草药使用的复兴,这可能是由于认为天然产品安全的错误观念以及大力推广而加剧的。与将草药制剂用作主要疾病治疗方法的使用增加并行的是,目前人们越来越关注其疗效、安全性和管控。这促使世界卫生组织在1993年发布的《草药安全性和有效性评估研究指南》文件中提出了管控建议。这些指南的严格程度与一般适用于药物的指南相同。许多成员国已采用这些指南。使用草药制剂进行治疗存在的风险包括:* 未经证实的治疗益处 * 未公开的毒性 * 草药制剂中的化学物质彼此之间以及与同时服用的药物在功能重要的生物实体(如血浆蛋白、受体、离子通道、转运体等)水平上的相互作用 * 与患者相关因素(如年龄、性别、遗传背景以及负责消除草药制剂中化学物质影响的器官(如肝脏或肾脏)的功能)不兼容 * 治疗标准化困难 * 草药制剂中包含常规药物但未公开。在黎巴嫩,一个委员会负责管控草药制剂,但需要更严格的管控来处理有治疗宣称的制剂以及推广问题。