Alternative Medicine: An Introduction and Market Potential

Antesh K Jha^1#, Pankaj Verma¹, Mahesh Prasad¹, Nikhil K Sachan² and Kumar Gautam³

¹Anand College of Pharmacy, U.P. Technical University, AEC Campus, Keetham, NH-2, Delhi-Agra highway, Agra, U.P, PIN-282007, India.

²Dept. of Pharm. Sciences, C.S.J.M. University, Kanpur, India.

³Scientific Sales Executive, Sanofi Avantis, Jalandhar, India.

ABSTRACT

The objective of this paper is to discuss the different aspects of alternative medicine. In India, diverse systems of medicine are official and professionalized as to their service in education and research. The term alternative medicine, as used in the modern Western world, encompasses any healing practice "that does not fall within the realm of conventional medicine. Alternative medicine spans the range of practices, from home remedies to manufactured products, from patient self-treatment to care by a skilled practitioner, from efficacious to potentially dangerous. Although alternative medicine encompasses a very broad range of practices, the area of most interest to pharmacy practitioners is herbal medicine. The present article reviews introduction of alternative medicines and their different categories, their practices, herbal medicine and their potential in Indian market.

KEYWORDS: Alternative medicine, CAM, herbal medicine, herbal potential.

INTRODUCTION

Alternative medicine is a form of medical treatment used as a substitute for conventional medicine. For example, alternative therapy can be used in the form of special diet or herbal concoction to treat cancer instead of conventional therapeutic modalities (eg. surgery, radiation therapy, or chemotherapy). This form of medicine may be based on elaborate systems of theory and clinical practice¹. The term alternative medicine, as used in the modern Western world, encompasses any healing practice "that does not fall within the realm of conventional medicine".² It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques,^3-5 under the umbrella term complementary and alternative medicine, or CAM.

Complementary and alternative medicine refers to a broad range of healing philosophies, approaches and therapies that exist largely outside the institutions where conventional health care is taught and provided. But some of these are now institutionalized. Complementary medicine is an increasing feature of health-care practice, but considerable confusion remains about what exactly it is and what position the disciplines included under this term should hold in relation to conventional medicine⁶. Often called ‘‘complementary and alternative medicine’’, this group of medical practices has also been termed ‘‘unconventional,’’ ‘‘unorthodox,’’ ‘‘unproven,’’ and even ‘‘quackery.’’[7] Alternative medicine spans the range of practices, from home remedies to manufactured products, from patient self-treatment to care by a skilled practitioner, from efficacious to potentially dangerous. Specific definitions of more common alternative medicine practices used are listed in Table 1⁷.

Table 1: Complementary and alternative medical practices [7]

Practice	Definition
Acupuncture	Ancient Chinese technique that uses needles to pierce the skin Taps into a grid of flowing energy (‘‘qi’’) that controls organ function
Aromatherapy	Uses botanical oils and essences to treat both physical and psychological disorders
Ayurveda	‘‘Life knowledge’’ Ancient Indian practice that uses diet, exercise, yoga, meditation, herbs, and massage to treat imbalances in physical, emotional, and spiritual harmony
Bioelectromagnetics	Study of living organisms and their interaction with electromagnetic fields Belief that magnetic fields penetrate the body and heal damaged tissues
Chiropractic	Practitioners use manipulation to treat disorders of the spine, joints, and muscles
Herbal medicine	Plants that are made into pills or extracts to prevent and cure physical and psychological disorders
Homeopathy	‘‘Like cures like’’ Belief that very small doses of substances that would at high doses cause adverse effects can be used to cure those effects Preparations may be so dilute that the active ingredient no longer remains
Mindfulness meditation	Belief that the mind can influence health and control physiologic responses
Naturopathy	Relies on diet, fasting, massage, herbs, homeopathy, and other natural treatments
Osteopathy	Practitioners use manipulation to expedite recovery from disease or injury Practitioners also receive conventional medical training and prescribe drugs
Reflexology	Spots on the foot are massaged to stimulate specific organs
Therapeutic touch	Caregiver moves hands inches above the patient’s body to realign disturbed energy fields or remove ‘‘blockages’’

According to Eskinazi⁸, alternative medicine can be defined as a broad set of health-care practices (i.e. already available to the public) that are not readily integrated into the dominant health care model, because they pose challenges to diverse societal beliefs and practices (cultural, scientific, medical and educational). This definition brings into focus factors that may play a major role in the prior acceptance or rejection of various alternative health-care practices by any society. Unlike criteria of current definitions, those of the proposed definition would not be expected to change significantly without significant societal change. Alternative medicine comprises a large and heterogeneous group of treatments, many of which are procedures that are not readily testable under double-blinded conditions. Furthermore, alternative medicine therapies may also possess a theoretical basis, may stem from a cultural tradition that is seemingly antithetical to a quantitative, biomedical framework, or may possess little foundational research on which to base a controlled evaluation⁸.

In the 1970s and 1980s the therapeutics that were mainly provided as an alternative to conventional health care were collectively known as ‘alternative medicine’. The name ‘complementary medicine’ developed as the two systems began to be used alongside (to complement) each other. Over the years, ‘complementary’ has changed from describing this relationship between unconventional health-care disciplines and conventional care to defining the group of disciplines itself. Some authorities use the term ‘unconventional medicine’, synonymously⁶. Other terms that are also used for CAM are unproven, unorthodox, fraudulent, dubious, integrative, questionable, quackery [9], propaganda-based medicine¹⁰ and opinion-based medicine¹¹.

Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.¹² Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine or not medicine at all. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.¹³

Practice outside of mainstream or conventional medicine has always been an important part of public healthcare in some countries, particularly in the developing world. Recently the use of complementary-alternative medicine has grown in popularity worldwide.¹⁴ A wordy definition of CAM is provided by the Cochrane Collaboration – “A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period”.¹⁵ The authors wrote that “CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed.”¹⁵

BIOMEDICINE AND CAM:

Biomedicine is founded in part on materialism (in contrast to the vital force explanation). Materialism, in this context, refers to the theory that ‘physical matter is the only or fundamental reality, and that all beings and processes and phenomena are manifestation or result of matter’.

While biomedicine does not necessarily reject religion or spirituality, it does not routinely incorporate these aspects into diagnosis and treatment (unlike the traditional system)¹¹.

Traditional medicine teaches that energy flows within, around and through all things in the universe. Traditional medicine does not exclusively view disease as an invasion or poisoning of the body by a foreign organism. Instead it sees the disease as a condition when the human body is out of balance with its milieu. Spirituality,

Table 2: List [37] of Medicinal plants whose market potential is very high

S.N	Name of the plant (family)	Common name	Medicinal uses
1	Aconitum ferox (Ranunculaceae)	Vatsnabh	Cardiac stimulant [38], Anti-rheumatic [39], Anti-inflammatory [39]
2	Aconitum heterophyllum (Ranunculaceae)	Atis	For curing stomach ache and fever [40],Tonic [41], Febrifuge [41], Tonic [41], Febrifuge [41], Anti-cough [41], Anti-cough [41]
3	Allium sativum (Liliaceae)	Garlic	Anti-hypertensive [38], Anti-hyperlipidemic [42], Platelet aggregation Suppressant [43]
4	Azadirachta indica (Meliaceae)	Neem	Anthelmintic [38], Astringent [41], Anti-septic [41], Purgative [41], Emollient [41], Anti-plaque [44]
5	Andrographis paniculata (Acanthaceae)	Kalmegh	Stomachic [38], Hepatoprotective [38], Dyspepsia [38], Anthelmintic [38], Bitter tonic [45], Febrifuge [45]
6	Asparagus recemosus (Liliaceae)	Satavatri	Galactogogue [45], Diurectic [45], Anti-dysenteric [45], Nervine disorder [45]
7	Berberis aristata (Berberidaceae)	Daru haridra	Astringent [41], Febrifuge [41], Laxative [41], In menorrhagia [41], In Liver and spleen Diseases [47]
8	Commipphora weightii (Burseraceae)	Guggul	Hypocholesteremic [41], Hypolipidemic [48] Anti-inflammatiry [49], Anti-rheumatic [49]
9	Crocus sativus (Iridaceae)	Saffron	Colouring [49] (Food Dye) and Flavouring [49] agent, Anti-spasmodic [49], Stimulant [49], Emmenagogue [50], Anti-tumor [51]
10	Nardostachys jatamansi (Valerianaceae)	Jatamansi	Diuretic [42], Stomachic [52], In constipation [52], Anti-spasmodic [52], In menstruation [52]
11	Embelica officinalis (Euphorbiaceae)	Amla	Anti-inflammatory [45], Diuretic [45], Laxative [45], Hepatoprotective [53], Anti-oxidant [54], Anti-fungal [55]
12	Garcinia camboga (Guttiferae)	Kokum	Anti-obesity [45], Hypolipidemic [56], Anti-fungal [57], Anti-ulcer [58]
13	Gymnema sylvestre (Asclepiadaceae)	Gudmar	Cardiac stimulant [50], Anti-diabetic [59], Larvicidal [59], Stomach ache [60], Diarrhea [60]
14	Holarrhena antidysenterica (Apocynaceae)	Kutuja	Amoebicidal [61], Anti-protozoal [61], Anti-tuberculous [61], In facial acne [62]
15	Ocimum teniflorum (Labiatae)	Holi basil	Aromatic [41], Stimulant [41], Tonic [41], Anti-oxidant [63], Anti-inflammatory [63], Anti-diabetic [64]
16	Picrorhiza kurroa (Scrophulariaceae)	Kutki	Hepatoprotective [65], Immunomodulatory [67], Anti-inflammatory [66], Jaundice [67], In periodic Fever [67], In Nausea and anorexia [67], Dyspepsia [67], In bronchial asthma [68]
17	Plantago ovate (Plantaginaceae)	Isabgol	Aphrodiasic [38], Anti-inflammatory [38], Diarrhea [38], Demulcent [41], Laxative [45], Emollient [45]
18	Saraca indica (Leguminosae)	Ashoka	Gynecologic disorders [53], Uterine tonic [55], Sedative [55], In menorrhagia [55]
19	Saussurea costus (Asteraceae)	Kuth	Anti-inflammatory [69], Anti-arthritic [69], Cytotoxic [70], Antioxidant [71], Aphrodisiac [72], Carminative [72], Anti-septic [72]
20	Solanum nigrum (Solanaceae)	Makoy	Sedative [73], Diaphoretic [73], Diuretic [73], Hydragogue [73], Expectorant [73], In dysentery [73], In Piles [74], Fever [74], Hypotensive [74], Antioxidant [74], In stomach ulcer [75], Hepatoprotective [76]
21	Tinospora cordifolia (Menispermaceae)	Guduchi	Anti-cancer [77], Anti-malarial [78], Anti-periodic [79], Anti-allergic [79], Anti-spasmodic [79], Anti-inflammatory [79], Anti-leprotic [79], Anti-oxidant [79]
22	Withania somnifera (Solanaceae)	Ashwgandha	Sedative [45], Anti-rheumatic [45], Diuretic [45], Anti-inflammatory [80], Anti-stress [81], Anti-tumor [82], Immunomodulator [49], Rejuvenator [83], Hypotensive [83], Hemopoetic [83]

unlike in allopathy, is an integral part of traditional medicine and, as a result, traditional medicine therapy can be very individualized, with no two people receiving the same treatment, despite similar complaints or the same disease. In contrast, Western medicine tends to divide the body into systems and compartments and measures functions by evaluating tissues and examining body fluids [16]. Like traditional medicine, biomedicine also now advocates some changes in diet, environment and lifestyle to promote health¹⁷.

CLASSIFICATION OF CAM:

CAM can be broadly divided into seven major categories¹⁸, viz.

(i) mind–body medicine,

(ii) alternative medical systems,

(iii) lifestyle and disease prevention,

(iv) biologically-based therapies,

(v) manipulative and body-based systems,

(vi) biofield, and

(vii) bioelectromagnetics.

Within each category, medical practices that are not commonly used, accepted or available in conventional medicine are designated as CAM. Those practices that fall mainly within the domains of conventional medicine are designated as ‘Behavioural Medicine’¹⁶. Mind–body medicine involves behavioural, psychological, social and spiritual approaches to health. It is divided into four subcategories: (i) mind–body system, (ii) mind–body methods (e.g. yoga, internal Qi Gong, hypnosis, meditation), (iii) religion and spirituality (e.g. confession, spiritual healing, prayer), and (iv) social and contextual areas (e.g. holistic nursing, intuitive diagnosis, community-based approaches) [16]. Alternative medical systems involve complete systems of theory and practice that have been developed outside the Western biomedical approaches. They are divided into four subcategories: (i) acupuncture and Oriental medicine; (ii) traditional indigenous systems (e.g. Ayurvedic medicine, Siddha, Unani-tibbi, native American medicine, Kampo medicine, traditional African medicine); (iii) unconventional Western systems (e.g. Homeopathy, psionic medicine, orthomolecular medicine, functional medicine, environmental medicine), and (iv) naturopathy¹⁶. Lifestyle and disease prevention category involves theories and practices designed to prevent the development of illness, identify and treat risk factors, or support the healing and recovery process. This system is concerned with integrated approaches for the prevention and management of chronic disease in general, or the common determinants of chronic disease. It is divided into three subcategories: (i) clinical prevention practices (e.g. electrodermal diagnosis, medical intuition, panchakarma, chirography); (ii) lifestyle therapies and (iii) health promotion¹⁶. Biologically-based therapy includes natural and biologically-based practices, interventions and products. Many overlap with conventional medicine’s use of dietary supplements. This category is divided into four subcategories: (i) phytotherapy or herbalism (plant-derived preparations that are used for therapeutic and prevention purpose, e.g. Ginkgo biloba, garlic, ginseng, turmeric, aloe vera, echinacea, saw palmetto, capsicum, bee pollen, mistletoe); (ii) special diet therapies (e.g. vegetarian, high fibre, pritikin, ornish, Mediterranean, natural hygiene); (iii) orthomolecular medicine (products used as nutritional and food supplements and are not covered in other categories. These are usually used in combinations for prevention or therapeutic purpose, e.g. ascorbic acid, carotenes, folic acid, vitamin-A, riboflavin, lysine, iron, probiotics, biotin), and (iv) pharmacological, biological and instrumental interventions (include product and procedures applied in an unconventional manner, e.g. Coley’s toxin, ozone, 714X, enzyme therapy, cell therapy, EDTA, induced remission therapy, chirography, neural therapy iridology, MORO device, bioresonance, apitherapy)¹⁶. Manipulative and body-based systems are based on manipulation and/or movement of the body. They are divided into three subcategories: (i) chiropractic medicine; (ii) massage and body work (e.g. osteopathic manipulative therapy, kinesiology, reflexology, Alexander technique, rolfing, Chinese tui na massage and acupressure), and (iii) unconventional physical therapies (e.g. hydrotherapy, colonics, diathermy, light and colour therapy, heat and electrotherapy)¹⁶. Biofield medicine involves systems that use subtle energy fields in and around the body for medical purpose, viz. therapeutic touch, Reiki and external Qi Gong. Bioelectromagnetics refers to the unconventional use of electromagnetic fields for medical purposes¹⁶. A number of complementary and alternative medicinal systems are popular in India, with Ayurveda being the most popular¹⁹. CAM is mostly associated with the treatment of chronic diseases. Patients are also found using naturopathy, herbal medicine, biopathy, home remedies, wheat-grass therapy, hydrotherapy, electroenergizers, auto urine therapy, vipasana and traditional healing methods for the treatment of cancer pain²⁰. Fish medicine is tried out in a large number of patients for the treatment and prevention of asthma. Mass meditation is practised for treatment of chronic problems²¹. Ayurvedic medicines are tried for epilepsy²². Other popular CAMs in India are yoga, massage, prayers, spiritual healing, tantra/mantra, astromedicine, gem therapy, hypnosis, acupuncture and magnet therapy. India, as quoted by Vaidya²³ is literally a ‘therapeutic jungle’ with awaited serendipitous discoveries as well as lurking prelature of hazardous practices.

WHY ALTERNATIVE MEDICINE?

The use of alternative medicine varies with the patient population. For example, up to 80% of cancer patients report use of alternative medicine vs. one-third in the general population. Surveys also find that two-thirds use herbal medicine.^24–27 Interestingly, cancer patients do not abandon conventional therapies when using alternative medicine, with close to 90% using both conventional and alternative medicines together.^26,28,29 Particularly with herbal medicine use, this creates the potential for conventional drug interactions. Reasons given by patients as to why alternative medicine is used include the following: the perception that conventional therapies are ineffective and/or toxic; frustration when no effective conventional therapy exists; the desire to take a more active role in their own care; distrust of conventional practitioners; and the belief that alternative practitioners focus on the whole patient.^{6, 8} Although most patients still use conventional medical practices with alternative medicine, only one-third tell their conventional practitioner that they are doing so^25,28,30.

Herbal medicines are being used by about 80% of the world population primarily in the developing countries for primary health care. They have stood the test of time for their safety, efficacy, cultural acceptability and lesser side effects. The chemical constituents present in them are a part of the physiological functions of living flora and hence they are believed to have better compatibility with the human body. Ancient literature also mentions herbal medicines for age-related diseases namely memory loss, osteoporosis, diabetic wounds, immune and liver disorders, etc. for which no modern medicine or only palliative therapy is available. These drugs are made from renewable resources of raw materials by ecofriendly processes and will bring economic prosperity to the masses growing these raw materials³¹.

HERBAL MEDICINE:

Although alternative medicine encompasses a very broad range of practices (more than 150 in fact), the area of most interest to pharmacy practitioners is herbal medicine. Interestingly, there is no definition of ‘‘herb’’ in any federal legislation or in any Food and Drug Administration (FDA) regulation³². Definitions vary considerably depending upon the source. For example, botanists define an herb as a plant whose stem dies back in winter (vs. trees or shrubs). On the contrary, pharmacognosists define herbs as the aerial parts of plants (vs. seeds or roots)³². The Herbal Trade Association, a group that has economic interests in this definition, defines an herb as a plant, plant part, or extract thereof used for flavor, fragrance, or medicinal purpose³². The World Health Organization (WHO) has recently defined traditional medicine (including herbal drugs) as comprising therapeutic practices that have been in existence, often for hundreds of years, before the development and spread of modern medicine and are still in use today³³. Or say, traditional medicine is the synthesis of therapeutic experience of generations of practicing physicians of indigenous systems of medicine. The traditional preparations comprise medicinal plants, minerals, organic matter, etc. Herbal drugs constitute only those traditional medicines which primarily use medicinal plant preparations for therapy. The earliest recorded evidence of their use in Indian, Chinese, Egyptian, Greek, Roman and Syrian texts dates back to about 5000 years. The classical Indian texts include Rigveda, Atherveda, Charak Samhita and Sushruta Samhita. The herbal medicines/traditional medicaments have, therefore, been derived from rich traditions of ancient civilizations and scientific heritage³¹.

HERBAL POTENTIAL IN INDIA:

Recently there has been a shift in universal trend from synthetic to herbal medicine, which we can say ‘Return to Nature’. Medicinal plants have been known for millennia and are highly esteemed all over the world as a rich source of therapeutic agents for the prevention of diseases and ailments. Nature has bestowed our country with an enormous wealth of medicinal plants; therefore India has often been referred to as the Medicinal Garden of the world. Countries with ancient civilizations such as China, India, South America, Egypt, etc. are still using several plant remedies for various conditions. In this regard India has a unique position in the world, where a number of recognized indigenous systems of medicine viz., Ayurveda, Siddha, Unani, Homeopathy, Yoga and Naturopathy are being utilized for the health care of people. No doubts that the herbal drugs are popular among rural and urban community of India. The one reason for the popularity and acceptability is belief that all natural products are safe. The demand for plant based medicines, health products, pharmaceuticals, food supplement, cosmetics etc are increasing in both developing and developed countries, due to the growing recognition that the natural products are non-toxic, have less side effects and easily available at affordable prices³⁴. Now a days, there is a revival of interest with herbal-based medicine due to the increasing realization of the health hazards associated with the indiscriminate use of modern medicine and the herbal drug industries is now very fast growing sector in the international market. But unfortunately, India has not done well in this international trade of herbal industry due to lack of scientific input in herbal drugs. So, it would be appropriate to highlight the market potential of herbal products and that would open floodgate for development of market potential in India³⁵.

The turnover of herbal medicines in India as over-the-counter products, ethical and classical formulations and home remedies of traditional systems of medicine is about $ one billion and export of herbal crude extract is about $ 80 million³⁶. Medicinal plants whose market potential is very high are listed in table 2³⁷.

CONCLUSION:

In conclusion, alternative medicine is a form of medical treatment used as a substitute for conventional medicine. Traditional medicine teaches that energy flows within, around and through all things in the universe. Traditional medicine does not exclusively view disease as an invasion or poisoning of the body by a foreign organism. Instead it sees the disease as a condition when the human body is out of balance with its milieu. The use of alternative medicine varies with the patient population. For example, up to 80% of cancer patients report use of alternative medicine vs. one-third in the general population. Surveys also find that two-thirds use herbal medicine. Herbal medicines are being used by about 80% of the world population primarily in the developing countries for primary health care. Ancient literature also mentions herbal medicines for age-related diseases namely memory loss, osteoporosis, diabetic wounds, immune and liver disorders, etc. for which no modern medicine or only palliative therapy is available.

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