Traditional Medicine
Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being (Fokunang et al., 2011). The study of traditional medicine is a much neglected aspect of global health care and it faces the following challenges (Cordell and Colvard, 2012):
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Nations typically have no policies or regulations relating to all of the aspects of traditional medicine as an integral part of their overall health care system. This results in a minimal commitment to research and development funding.
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The breadth and depth of the issues related to the quality control of traditional medicine products and practices may not be known to regulators, producers, and scientists.
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Global attention (fiscal and human resources) is insufficient to enhance the basic, applied, and clinical sciences behind traditional medicine. This results in major deficiencies in the scientific evidence regarding the quality, safety, effectiveness, and/or health benefits of traditional medicine. Costs of traditional medicines may increase as investment is made to enhance product validity.
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The literature and knowledge regarding traditional medicine are highly scattered, or are in library collections and databases that are not easily accessible.
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Scientific and clinical research on traditional medicines does not always fit the Western model for medical research, which may make publication of results difficult. Health insurance coverage is very difficult to justify if traditional medicine products and practices are not evidence based.
Medicinal plants represent one of the most important fields of traditional medicine all over the world and are a natural source of nutraceuticals (Singh and Geetanjali, 2013). A crucial factor in medicinal plant research and in clinical practice is sustainability. The term “sustainable medicines” describes the importance of considering the long-term use of both traditional medicines and synthetic drugs from a perspective of reliable and non-destructive sourcing for the future (Cordell, 2009). This is of great importance since the population and the use of traditional medicines are growing fast, globalization of products is in increasing demand, and climate change may affect the growing of traditional medicines (Cordell and Colvard, 2012). In this sense, “ecopharmacognosy” becomes a research priority since it is the study of sustainable biologically active natural products, from sustainable plant materials (Cordell, 2014).
Traditional medicine, sustainable medicines and ecopharmacognosy contribute to achieve a sustainable health. Del Castillo et al. (2018) have defined “sustainable health” as: “a healthy and active ageing avoiding the risk of diseases”. Sustainable health may be accomplished by delivering high quality care and improved public health without exhausting natural resources or causing severe ecological damage (del Castillo et al., 2018). This can also be achieved by protecting and improving health now and for future generations using different strategies such as a healthy nutrition based on functional foods and the use of traditional sustainable medicines.
Herbs and Botanicals
Numerous drugs are originated from herbs or natural substances. Herbal and natural therapies have been employed for their diuretic and renal protective actions for centuries and the use of these substances may prevent the risk of CKD or complement current treatments (Wojcikowski et al., 2006).
Some plant extracts can be effective in the protection against CKD. Ecklonia cava has shown anti-inflammatory and antioxidative effects, and its effect on renal damage of high fat diet induced obese mice has been investigated (Eo et al., 2017). Natural agents that possess antioxidant and anti-inflammatory effects are expected to possess a renal protective effect. Treatment of obese mice with different doses of E. cava extract for 12 weeks lowered protein levels related to lipid accumulation (SREBP1c, ACC & FAS), inflammation (NLRP3 inflammasome, NFκB, MCP-1, TNF-α & CRP), and oxidative stress (Nrf2, HO-1, MnSOD, NQO1, GPx, 4-HNE and protein carbonyls). Moreover, this extract also significantly up-regulated renal SIRT1, PGC-1α, and AMPK, which are associated with renal energy metabolism (Eo et al., 2017). These results provide novel insights into the anti-inflammatory roles of E. cava in obesity-induced renal inflammation.
Grover et al. (2001) investigated the effects of daily oral feeding of traditional Indian herbs (Momordica charantia (MC), Eugenia jambolana (EJ), Mucuna pruriens (MP) and Tinospora cordifolia (TC)) for 40 days on blood glucose concentrations and kidney functions in streptozotocin (STZ)-diabetic rats. Plasma glucose concentrations in STZ-diabetic mice were reduced by the administration of extracts of MC, EJ, TC and MP by 24.4, 20.84, 7.45% and 9.07%, respectively. Urine volume was significantly higher in diabetic controls and Indian herb extracts prevented polyuria. After 10 days of STZ administration urinary albumin levels (UAE) were over 6 fold higher in diabetic controls as compared to normal controls. Treatment with MC, EJ, MP and TC significantly prevented the rise in UAE levels from day 0 to 40 when compared to diabetic controls. Renal hypertrophy was significantly higher in diabetic controls as compared to non-diabetic controls. Among the studied extracts, only MC and EJ prevented renal hypertrophy as compared to diabetic controls (Grover et al., 2001). Results indicate that plant extracts have the potential in the prevention of renal damage associated with diabetes.
Aster koraiensis, a vegetable and medicinal plant in traditional Korean medicine, has also been studied on the damage of renal podocytes in streptozotocin (STZ)-induced diabetic rats for 13 weeks (Sohn et al., 2010). Blood glucose, glycated haemoglobin (HbA1c), proteinuria and albuminuria were examined. Kidney histopathology, AGEs accumulation, apoptosis, and expression of Bax and Bcl-2 also were examined. In STZ-induced diabetic rats, severe hyperglycemia developed, and proteinuria and albuminuria were markedly increased. A. koraiensis extract reduced proteinuria and albuminuria in diabetic rats, and AKE prevented AGE deposition and podocyte apoptosis. Expression of Bax and Bcl-2 protein in the renal cortex were restored by treatment with the extract (Sohn et al., 2010). Since this extract showed an inhibitory effect of AGE accumulation and an anti-apoptotic effect in the glomeruli of diabetic rats, it could be beneficial in preventing the progression of diabetic nephropathy.