native drugs of vietnam: which traditional and scientific approaches?

Journul of Ethnopharmucologv. 32 ( I99 1) 5 1-56 Elsevier Scientific Publishers Ireland Ltd

51

Native drugs of Vietnam: which traditional and scientific approaches?

De- Th Lcji and Nguy&i Xuh Dufig

Facultres of Pharmacy and Chemistr.v. Universrty of Hanoi, 13-19 LC Thrinh T&g Street, Han01 (Vietnam)

For thousands of years, our people treated diseases with herbs and plants whtch were gathered from gardens and forests. The recorded

medical literature which now remains dates only after 10th century In the htstory of Vietnamese national medicme, two names in

particular stand out before 18th century. The first one is Tue Tinh of the 17th century. author of two treatises: Nam Duoc Than Hieu (The Miraculous Efficacy of Vietnamese Medtcmes) describing 580 indigenous drugs in 3873 prescriptions for 10 chmcal spectahttes

and Hong Nghia Giac Tu Thu. (Medical book from village Hong Nghia) summarizing the indications of 630 drugs with a theormcal

part of traditional medicine. The second name would be Le Huu Trac (1720-1791) writmg as Hai Thuong Lan Ong, author of the

great treatise of traditional medicine wrth more than 30 volumes. From generation to generation by oral tradition and through literature,

people have collected a lot of medicinal plants and especially a lot of medicinal prescriptions based on a long empirical knowledge

of medicinal and toxic plants. After the August Revolution (1945). traditional medicine in our country was rehabilitated to Its state

position. Prof. Dr. Do- Tli L& one of the authors of thts paper. was busy over 40 years compiling the medtcmal plants. animal

and mineral origins into a book (more than 1200 pages): Medicinal Pkunts and Drug.5 /ram Vtetntm~. A general part. the theoretical

bases of eastern medicine. baste prmctples of drug Identification. processmg and preparation, study of drug efficaciousness and par-

ticular guides for using tradmonal drugs are presented In the second part. the author introduces more than 700 drugs common in

Vietnam. The medicinal plants and medicines are presented according to then therapeutic action. From our vtews, we get to know

the followmg problems:

(1) Traditional medicinal plants and medicines in Vietnam clearly have effecttveness for treatment of diseases on the basis of eastern

philosophy and are asymptotic to nature but it is difficult for scientists to accept. From this point there exist two attitudes.

(a) At first. traditional medicine must be studied with the help of modern methods and then can be applied to practice.

(b) Our point of view is continuing to study and apply traditional medicine spontaneously. Which kind of attitude is rtght?

(2) Traditional medicine should be introduced to people in general and especially for studuents and young scienttsts. We discuss

with them. analyse and crtticize and given them all our arguments on Eastern medicine. From there may be appear new ideas, new method for research.

(3) Traditional medicine used in two cases:

(a) Western medicine is Ineffective.

(b) Modern drugs are expensive so that poor people can’t buy, these problems are very common in the developing countries.

(4) We found that some plants, minerals etc. are used in traditional medicine and m modern medicine, but It does not mean that we do not need to continue to study.

Vietnam is a country in South-East Asia whose history started a long time ago. Although modern medicine suceeded in excluding traditional medicine until the restoration of national independence in

1945, the traditional medicine did survive with the development of the country.

For thousands of years our people treated

Correspondence to’ Nguy&i Xuan Dung. University of Hanoi,

13-19 Le Thanh Tong Street. Hanoi. Vietnam.

diseases with herbs and plants which were gathered

from gardens and forests. The remaining recorded medical literature dates

only after the 10th century (Hong and Wright, 1988). In the history of Vietnamese national

Medicine there are two particular names that stand out before the 18th century. The first one is Tue Tinh of the 17th century, author of two treatises: Nam Duoc Than Hieu (The Miraculous Efficacy of

Vietnamese Medicines) describing 580 indigenous

037%X7411$03.50 0 1991 Elsevrer Screntilic Publishers Ireland Ltd Pubhshed and Prtnted m Ireland

52

drugs in 3873 precriptions for 10 clinical specialities and Hong Nghia Giac Tu Thu (medical book from Hong Nghia, district Thuong Hong, village Nghia Phu), summarizing the indications of 630 drugs with a theoretical part of traditional medicine.

The second name is Le Huu Trac ( 1720- 179 1) known as Hai Thuong Lan Ong, author of the great treatise of traditional medicine with more than 30 volumes.

What is traditional medicine? There is no ofticial definition of traditional medicine. We agree with the definition of a group of experts from the WHO African Region at a meeting 12 years ago in Braz- zaville: Traditional medicine is “The total sum of all the knowledges and practices, whether explicable or not, used in diagnosis, prevention and elimina- tion of physical, mental or social imbalance and relying exclusively on practical experience and ob- servation handed down from generation to generation, whether verbally or in writing” (WHO, 1978). Traditional medicine is very complex and varies from country to country according to historical, economical and cultural development.

From generation to generation by oral tradition and through literature people have collected a lot of medicinal plants and especially a lot of medicinal prescriptions based on a long empirical knowledge of medicinal and toxic plants.

After the August Revolution (1945) traditional medicine in our country was rehabilitated to its of- ficial position.

Prof. Dr. Do- Tat Ldi, one of the authors of this paper, was busy himself over 40 years with his work of compiling medicinal plants and other medicines of animal and mineral origins; the final result of this hard work was a book of more than 1200 pages under the title of Medicinal Plants and Drugs from Vietnam (D6- Tat Ldi, 1987).

The theoretical philosophical bases of Eastern medicine, basic principles of drug identification, processing and preparation, study of drug efficaciousness and particular guides for using traditional drugs are presented in the first section of this book. In the second section, the author introduces more than 700 drugs commonly used in Vietnam. The medicinal plants and drugs are presented according to their therapeutic action: Drugs for the treatment of gynecologic and obstetric disorders, for

the treatment of furuncles and prurigo; antiallergic, antihelminthic drugs; drugs for dysentery; diuretics etc. . .

Many people (in our country and elsewhere) often asked Prof. Dr. Do- Tat L{i “Why do you eagerly return to popular traditional medicinal plants and drugs of this atomic era, when surgery has achieved extraordinary successes like transplantation of some humman organs, when antibiotics and syn- thetics persuade us? Why do you make research con- cerning traditional medicinal plants and drugs even they are studied all over the world?” To answer these questions it is not simple. We would like to return back to old time. In D.T. Ldi’s childhood, in a few cases, he himself was cured with popular traditional drugs and he witnessed not a few patients being cured with oriental traditional drugs which may be a single plant or only a simple inexpensive recipe. But when he entered the Faculty of Phar- macy in 1939, he was stunned by the fact that no one spoke of traditional medicinal plants and drugs. If one had spoken of them, one would have spoken scornfully. The 1939-l 945 Popular Delivery Rev- olutionary high tide and especially the August Revolution (1945) that had come to a successful end and strengthened our belief in the tradition of our ancestors, to speak generally, and particularly in our experience of treating diseases.

On one hand he attended class which never taught about traditional medicine, on the other hand he visited famous native doctors, and patients having been cured by oriental drugs after they had been treated unsuccefully by occidental drugs. D.T. LQi was adopted as a student by the traditional medical physician in his village who had cured him.

Many other people in Hanoi also came to him. D.T. LQi searched magazines and books which related about this traditional medicine to read and watch curiously the works of some French investigators.

Of course, with modern scientific knowledge acquired from faculty of Pharmacy in Hanoi (1939-l 945) he could hardly understand what the oriental medical physicians said, and he was not content with the way they explained things. But he did not have solid arguments to reject the successful results of oriental medicine in a scientific way which might not have existed. No teacher was able to tell

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him how to find such way! There is no other way but to study and to practice and to experience at the same time. Knowing the inconvenience of those who lacked documents to consult, we systematized all the new and helpful facts that we had collected or read from latest documents (traditional or modern), all the experiemental results that we had done by ourselves or under the guidance of others, until in 1986, in addition to almost 200 papers already published, we have compiled two books.

Our works may answer the following questions.

(1) What medicinal plants and drugs are there in our country? and what medicinal plants and drugs do we have to import?

(2) Many or few? The confusion in utilization of medicinal plants and drugs (to say more accurate- ly: many plants belonging to different families have the same name, the same plant may have different actions due to different preparations . . .)

(3) Have these plants and drugs been studied in our country and in foreign countries? chemical composition? pharmacological study?

(4) Does any problem remain to be studied? (5) There is one thing to remember in the in-

vestigation of traditional medicinal plants and preparations of animal or mineral origins and in the proper choice and preparation of plants; although some of them are used by both oriental and occidental medicine, they are used differently because of different preparations or different scientific basis (the basis of oriental medicine is the feminity and masculinity and the tive elements, that of occidental medicine, experimentation): 6 dlh, phu tti (Aconite) and Than sa, chu sa (Cinnabaris) are taken for examples:

Th& sa-Chu sa (Cinnabaris) In occidental medicine Cinnabaris is most used

to cure syphilis in a dose 0.2-l .5 g whereas oriental medicine looks upon it as a drug with sweet taste, cold property, which goes to channel of the heart (Tam kinh) and keeps one’s composure, stops one’s convulsions, makes one have good eyesight, and has the ability of detoxification. It is used to unchoke the vessels, make one peaceful, elevate the spirit and treat scabies. It is unsuitable for the person with real heat inside.

For a long time, the active element was not discovered. In 1963, Dam Trung Bao (Professor at Faculty of Pharmacy, Hanoi) extracted for the first time selenium from Than sa-Chu sa (Cinnabaris). Than sa contains a very high percentage of selenium (2.5-3.00/u) while Chu sa contains 2.0% selenure mercury. Later he found selenium in many other herbs and plants in Vietnam such as Morinda citrifolia (C2y nhau), Mimosa pudica (Xi6 ho’) etc. and succeeded in explaning the use and effectiveness of these pharmaceutical materials unknown or explained incorrectly so far.

Phy trl, Ha’C phy, Bqch phy (Preparative Aconiti) Radix Aconiti is looked upon by occidental

medicine as a toxic plant, sedative analgesis, sedative diaphretic, anticongestive. Only used in the form: tincture with maximal dose not more than 0.5 mg aconitine in 24 h. But according to oriental medicine, radix Aconiti (preparatus) is a drug also toxic but which makes the “duong” (masculinity) stronger and used in first-aid cases (to restore the “duong” and cure the coldness in extremities. Hai Thuong Lan Ong (Vo Xuan Minh, 1983) (celebrated Vietnamese traditional medicinal man, 18th century) said “Radix Aconiti is a miraculous drug which has the capability to restore life from dead”.

Used in the form of decoction together with radix Glycyrrhizae (Cam thao) and Zingiber officinale

(Gdhg) with dose 540 g in 24 h, a practice long time unexplained.

In recent years the experimental results have pro- ved that the prepared radix Aconiti contains much less total alcaloid than the unprepared one, and that only in the decoction radix Aconiti together boiled with Zingiber and Glycyrrhiza is detoxified, but not the prepared or unprepared radix Aconiti boiled alone. The mixing of Zingiber, radix Glycyrrhizae and radix Aconiti (all separately boiled) is not detoxified either. A lot of the same examples we can show here such as Cassia tora (Thao quyet minh) before and after preparation according to the traditional medicine has another action, the composition of Sinh dia (Rehmania glutinosa Gaertn and Thuc dia (prepared Sinh dia) has been known by which active principle the pharmacological effect of Sinh dia is tonifying to the feminity part and freshening blood, and of Thuc dia also is tonifying to feminity

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part, but a tonic drug of blood, otherwise they are

not used alone, but by combining with other prepared medicinal plants in a recipe. Another one can be seen in D.C. Khanh’s poster on Strychnos. So the determination of the pharmacological effect

is more difficult and complicated in comparison with modern medicine.

Therefore, unlike occidental medicine, oriental medicine does not use the poisonous alkaloids in

radix Aconiti. Thus, which group of active elements of prepare radix Aconiti has the action of strengthening the “duong” (masculinity)? Japanese investigators succeeded in extracting from prepared

radix Aconiti solution, higranim whose action was to make the cardiotonic effect much stronger.

It follows from these examples that:

If the experimental results agree with the experiences collected from the people, then no problem arises. Vice versa, we have to reconsider our method or our experiments and in which way they

may be negligent. It takes a long time and much labour to unders-

tand and explain the experiences of treating diseases (acupuncture, zen . . .) as well as the utilization of

drugs of our ancestors. Therefore, according to us, the most scientific basis to appreciate the treating methods as the utilization of traditional medicine drugs is as follows.

First of all, it is necessary to master the experiences of treating diseases and utilization of drugs of antique men by investigating and comparing the documents of many countries, consulting antique

and recent documents. Veteran investigators of traditional popular

medicine knowing well its complexity, appreciate that it needs time and money for investigation to

decide to continue studying and to use the knowledge acquired from the investigation to treat diseases at the same time.

The Vietnamese government has advocated this

approach since almost all the previous and present leaders of Vietnam were cured with traditional medicine during the secret activity period of time. Now those who have high positions in the health

service are occidental medical doctors. They carry out this policy reluctantly because of different con- ception and organization.

Here we present a number of our own experiences

about the guidelines of the combination of traditional oriental medicine and modern occidental medicine.

1. In scientljic investigation The preferable objects of studying are:

1.1. Those which are actually effective 1.2. Those which are confirmed by hospitals or are

witnessed by investigators 1.3. Medicinal plants and recipes already being

used, whose preparation and dosage are known

1.4. Those avaiable in the country and in great request

1.5. Drugs of which the experience have been wide- ly spread in many areas far away from one

another, or written in old medical traditinal documents and particularly witnessed by the investigators

2. In teaching and scientijic propagation Formerly, the inexplicable and unexperimental

objects were not taught or talked about, but we hold that the acquirable document which should be ful-

ly presented with criticisms to help the audiences and the readers decide. It is because of this method and advocacy that we have learned a lot of experiences from the people; for example, in what

manner to use Brucea sumatrana to treat amib dysentery.

3. In making full use of source of medicinal plants and drugs of our country

From our experience of many years we divide medicinal plants and drugs into two groups. 3.1. Group 1 includes medicinal plants and drugs

used by both occidental and oriental medicine. Being used in occidental medicine means that the active compounds are known, like rutin in Sophora japonica , oleandrin in Nerum oleander, menthol in Mentha arvensis etc., whereas some of the medicinal plants have been used in recipes of our ancestors. In do- ing this we hope that more unknown actions

and the active elements already known will be acquainted by occidental medicine.

3.2. Group 2 comprises medicinal plants and drugs

3.3.

whose active elements and action are not known, In these cases, when we have witnessed their concrete effectiveness, like that of Gecko elixir, bufe meat, fel Ursi and recipes treating allergy etc. we confirm the identity of botanical plants and animal origins, the identity of preparation avaiable for the ultilizer and we watch the experimentation. If the results are good, we will propagate. If the medicaments are not effective but not harm- ful they may be given up or not according to the requirement of the traditional medical men and the patients. Together with two activities mentioned above we put forward the problem of growing even the medicinal plants and drugs which are not yet studied deeply but actually required like derr, bear, snake etc.

From our views we get to know the following problems:

(1) Traditional medicinal plants and drugs in Viet- nam have clearly their own effectiveness for treating diseases on the basis of Eastern philosophy and are asymptotic to nature but it is diflicult for scientists to accept. From this point there exist two attitudes:

(a) At first traditional medicine must be studied with the help of modern methodology and then can be applied to practice.

(b) Our point of view is continuing to study and apply traditional medicine spontaneously.

Which kind of attitude is right? We must say that many traditional herbal

remedies are effective. even though it is not possible yet to establish this by chemical, toxicological. pharmacological and clinical work. Medicinal herbs have two properties: therapeutic and occult. Most literature reports results of in- vestigations of the therapeutic aspect of herbs only. Isolating components from herbals which are biologically active - according to folklore - has to be guided by bioassays. But what kind of activity is one looking for? The answer to this question is not simple. Continuing for several years in search of biologically active plants, a multidisciplinary type of research involving pharmacognosists, chemists,

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pharmacologists and botanists is necessary. Col- laboration of scientists of different disciplines is necessary, in order to obtain better and more elaborate results in the field of plants, animals and minerals used in traditional medicine. But it is not so easy to find a good team of scientists in the developing countries and even in the industrial countries for this research.

(2) Traditional medicine should be introduced to people in general and especially to students and young scientists. We discuss with them, analyse and critize and give to them all of our arguments con- cerning eastern medicine. From these new ideas, new methods for research can be performed. It is necessary that even the picking of the sample from plants and animal origins, the preparing etc. be organized and checked by well-trained people.

(3) Traditional medicine can be used in three cases: (a) The disorder cannot be used by the method of

western medicine. (bf The high cost of modern drugs makes them in-

accessible to the poor people, especially those of the developing countries.

(c) Traditional medicine having positive results and no side effects, for example gynecologic and obstetric disorders, rheumatism, allergy etc.

(4) We found that some plants, minerals etc. are used in traditional medicine and in modern medicine but it does not mean that we do not need to continue to study them (for examples, see Table 1).

TABLE 1

Plarit or mmeral Use

Modern

medlcme Traditional

medicme

Acomlum

nap&is L.

tl+OtO~

trgfium L.

Talcum

Gypsum

Cough. fever

(very small

amount)

(0.1 mg) Use oil only

Talcum powder

(external

usage) External usage

Anti-cold

(larger

amount)

Use dregs only

AntIfever of

children and

diuretic Antifever

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(5) Traditional medicine has its own value. Why must we combine western and eastern medicine? Is it feasible? When we do that, then what is combination? The answer to these questions is not simple. Integration of traditional medicine with the modern medicine is one of the important aspects that should be considered. These two approaches to health care have different identities and concepts, as well as separate developments. However, it is beyond doubt that modern medicine has achieved a great number of successes but has had and will have its own failures and limitations. In its own part traditional medicine has also positive results in spite of many deficiencies, for example, neuresthemic (Gecko), dysentery, reaction.

We can also visualize some kinds of integration between the two medical approaches. But a prelim- inary requirement for this integration is the presence of a new kind of medical scientist who can serve as mediator between modern medicine and traditional medicine (Tempesta, 1980).

For the study of traditional medicine it is necessary first of all to know which plant, animal and mineral is to be studied and for what type of activity. Transition of ideas from traditional

medicine into western medicine is a further problem in evaluating the use of medicinal plants. Therefore field studies on the use of traditional medicines ought to be an important additional tool in the selection of plants for further studies. The aid of medical sciences, plant taxonomy and an- thropology is a prerequisite for success at this stage of the studies (Verpoort, 1989).

Combination between modern and traditional medicine is one of the precepts of orientation of the development of our medicine, that was decided by our former president Ho Chi Minh. This policy must go through theory, practice, education, research, primary health care and treatment.

References

H&g, N.T.D. and Wright, P. (1988) Vkfnum Mdicind und

Aromuric Plunts Newsletter 2. IO.

WHO (1978) WHO Technicul Report Series No. 6222. WHO,

Geneva.

Db T&i L-i (1987) Meddwl Plunts and Drugsjrom Viemum,

5th Edn. Scientific and Technology Publish House.

VO- Xuin Minh (1983) Journul of Euaern Medicine. 22.

Tempesta. E. (1980) Journul of Ethnophurmucology 2. 163.

Verpoort, R. (1989) Journul 01 Elhnophurmucology 25. 43.

native drugs of vietnam: which traditional and scientific approaches?

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