Phytotherapy to Musculoskeletal Disorders Lecture 2 PDF

Phytotherapy to Musculoskeletal disorders Lecture 2 Presented by Dr. Rehab Fikry  Complementary OR Alternative Medicine (CAM) The term for medical products and practices that are not part of standard medical care.  It inl...

Phytotherapy to Musculoskeletal disorders Lecture 2 Presented by Dr. Rehab Fikry  Complementary OR Alternative Medicine (CAM) The term for medical products and practices that are not part of standard medical care.  It inludes Physical therapy (massage, hydro magnetic, thermo-therapy… Herbal medicine Aromatherapy Vacuum cup (cupping) Acupuncture Hydrotherapy Herbal Medicine Definition: It is a type of medicine that use plants or their crude products for treatment of diseases. It may include also animal , bacteria or fungi products. It includes four branches : phytopharmacy , phytochemistry, phytopharmacology and phytotherapy. The difference between herbal drugs and purified single compound is that most herbs are dilute drugs contain low concentrations of active ingredients, so the risk associated with using herbs is minimum Since most herbs are dilute drugs, so , we use extracts of plants to increase the concentration of the active ingredients. Types of extracts : 1- Aqueous: as teas , infusions and decoctions. 2- Hydro-alcoholic: as tinctures and fluid extracts ; used when the active ingredients are not water soluble. 3- Solid extracts: the most concentrated type , prepared by evaporating the solvent Phytopharmacy It is a branch of herbal medicine deals with the preparation of natural drugs either in natural forms (medicinal teas) , or in pharmaceutical preparations (tinctures and extracts). It includes pharmacognosy that explains the identification of natural drugs either in entire or in powdered forms and the detection of their adulteration Phytochemistry It is a branch of herbal medicine that deals with the study of chemical constituents of the plants such as alkaloids , glycosides , essential oils, etc. It explains their distribution, isolation, chemical reactions and biosynthesis Phytopharmacology It is a branch of herbal medicine concerns with testing of natural drugs which have multiple effects on animals and humans Phytotherapy It is a curing ability using bioactive plants-derived medicine (Phytopharmaceuticals) as medication. Phytopharmaceutical, Phytomedicine, Herbal medicine Are terms used for those medicinal preparations made by extracting botanical products with appropriate solvents to yield plant extract, crude product and few products related to animals, fungi & bacteria. Phytotherapy is useful for treatment of simple, mild, self-limiting, non-progressive, acute or often chronic diseases as: - Indigestion, constipation, diarrhea, Loss of appetite in the elderly. - Cough and common cold. - Local ( skin & mucus membrane ) infections. - Infrequent insomnia. - Strained muscles - Headache Diseases that should not be considered for phytotherapy are severe and acute progressive diseases such as: - Rheumatic arthiritis. - Cardiac arrhythmias and Congestive heart failure - Systemic infections and Cancer Use of pure plant components e.g. atropine, reserpine, morphine or digoxin is not phytotherapy  Characteristics of herbal drugs ❖Pharmacologically active compounds in herbal drugs are present in lower concentrations than the conventional tablets and capsules. So herbal medicine are less risk and more safe. ❖They contain wide variety of pharmacologically active and inactive compounds ( sugars , cellulose and starch). ❖Certain herbs contain mixtures of components that may have a synergistic effect, an antagonizing effect such as rhubarb (which has anthraquinones and tannins ❖Herbal drugs are less expensive, cheaper than conventional medicines  Side effects/toxic reactions of herbal medicines Mislabeling Proper identification of plant & labeling it with common and latin names prevent this Addition of unnatural synthetic substances Analysis of some herbal remedies proved that they contain some synthetic drugs, which may cause some toxic reactions  Natural Toxic contaminants Plant materials used for herbal treatment may be contaminated by some micro-organisms or their by-products, which may lead to serious side effects Natural Toxic ingredients For example herbal products containing pyrrolizidine alkaloids were reported to have hepatotoxic effect; Rauwolfia preparations used to manage hypertension were found to promote breast cancer Musculoskeletal Disorders Common Musculoskeletal disorders 1- Muscle pain 2- Arthritis 3- Gout 1- Muscle pain Causes: 1- Excessive exercise of skeletal muscles 2-Prolonged rheumatic pain 3-Vertebrae problems 4-Pressure on the nerve roots coming from the spinal cord  Counter-irritant (nerve stimulation) An externally applied substance that causes irritation of the skin for the purpose of relieving pain in muscles and joints distal to the site of application. Rubefacient (vascular) A substance which is applied topically which cause redness of the skin results in dilatation of the blood vessels and so increase of blood circulation which cause cleansing & nourishment of the affected part 1- Herbal treatment of Muscle Pain 1-Oil of wintergreen It is the volatile oil obtained from the leaves of Gaultheria procumbens, Family Ericaceae. It contains methyl salicylate, which is produced by enzymatic hydrolysis of phenolic glycoside gaultherin. Oil of wintergreen is mainly used in form of ointment or liniment for rheumatism, sprains, and all kinds of muscular pains.  2-Oil of Turpentine Volatile oil is obtained by distillation of oleoresin obtained from Pinus species, Family Pinaceae. It is commonly known as the Longleaf Pine It contains monoterpenes, mainly α- and β- pinene It is used externally as a rubefacient & counterirritant as an ointment or liniment, applied not more than 3-4 times daily  3-Capsaicin It is the pungent oleoresin from the dissepiment of the fruits of the Capsicum minimum, Family Solanaceae. It has counter-irritant & rubefacient effect, applied to the affected area in form of cream or plaster as anti-rheumatic drug. It also depletes substance P (neuro peptide pain mediator) from peripheral nerve fibers, causing pain relief  Side Effects: Capsaicin may produce severe irritation It may cause burning on initial application It should not be applied near the eyes, mucous membrane or injured skin It should be avoided in children , pregnant or breast- feeding women.  They are compounds that produce a strong cooling sensation when applied to the skin 1-Menthol It is a monoterpene alcohol obtained from various mint species e.g. from the leaves & flowering tops of Mentha piperita, Family Labiatea It is also prepared synthetically It is applied to the painful area 3-4 times daily  2-Camphor A monoterpene ketone obtained from Cinnamomum camphora, F. Lauraceae In small dose: antipruritic, analgesic, local anesthetics. In high dose: refrigerant, and anti-inflammatory. It depresses cutaneous pain receptors. 2- Arthritis Arthritis is a number of disorders characterized by inflammation and tissue damage of joints. Arthritis is the second cause of chronic disability in the elderly, after cardiovascular diseases; such disability is characterized by limitation of motion, deformity, and progressive deterioration. Several types are known: A-Rheumatoid arthritis: (RA): (Most Common) It is an autoimmune disease , causing chronic inflammation and destruction mainly joints followed by internal organs affects 1-2% of population, more common in females. Patients with autoimmune diseases have antibodies and immune cells in their blood that target their own body tissues The inflammation associated with rheumatoid arthritis primarily attacks the joint lining tissue synovium ” that normally produce lubrication & nutrients of the joint. When this tissue remains inflamed , it leads to deformity (by loosening joint ligaments) and to joint destruction (by eroding away cartilage and bone). Rheumatoid arthritis can affect internal organs membranes as heart & lungs. Symptoms: 1. Joint swelling : small joints of hands & feet 2. Joint stiffness : it last from 30-60 min. especially in the morning. Patients often suffer cycles of severe and light symptoms. It may have different effects on different people, some people may suffer extreme pain while others may not. If not controlled , joints may become deformed B-Osteoarthritis (OA) : It is a disease of the cartilage of joints, known by degenerative arthritis. Osteoarthritis is not a systemic disease and not an autoimmune disease. Osteoarthritis is a result of natural aging of the joint. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. Treatment: Chondroitin sulphate. Glucosamine.  Arthritis Herbal Treatment 1-Willow Bark It is the Willow bark of Salix alba & Salix purpurea, Family Salicaceae ❑It contains the phenolic glycoside Salicin, which hydrolyzes in the stomach & intestine to salicyl alcohol, which is being absorbed to blood & oxidized to salicylic acid. ❑It has analgesic , antipyretic and anti-inflammatory effects. N.B. It is considered as the natural-occurring aspirin  2-Turmeric It is the rhizomes of Curcuma Longa, Family Zingiberaceae ❑Contains curcumin yellow pigment which has significant anti-inflammatory action ❑Rare side effects: mild stomach upset and occasional allergic reactions  3-Boswellia It is the resin herbal extract of Boswellia serrata F. Burseaceae ❑It is used in treating chronic inflammatory diseases including rheumatoid arthritis & bronchial asthma ❑It has Boswellic Acid as an active constituent ❑It has a unique anti-inflammatory action, much like NSAID moreover, it has the advantage of its safety on prolonged use. ❑It improves pain ,stiffness and joint function.  4-Avocado It is the fruits of Persea americana Family Lauraceae ❑Used in degenerative joint diseases “osteoarthritis” ❑It restores the normal cartilage structure by stimulating the synthesis of collagen and also by inhibiting collagenase enzyme. ❑It has no side effects and can be used for many months. It could be taken as a Fresh fruit “edible” OR as a drink of its extract “juice”  5-Blue Berries ❑It is the fruits of Vaccinium corymbosum Family Ericaceae ❑ Berries are rich in polyphenols “proanthocyanidins” ❑ These flavonoids exhibit membrane and collagen stabilizing effect; thus, they have protective action against Muscular Degeneration, also have anti inflammatory effect ❑They also has antioxidant activity, protecting the brain from oxidative stress and may reduce the effects of age-related conditions such as Alzheimer's disease or dementia ❑ Cardio-protective action Diet therapy for joint diseases 1. Reduce acidic food ; (food that tastes acidic) e.g. citrus 2. Reduce food that leaves an acidic residue after digestion (due to the presence of sulfates or phosphates) e.g. proteins 3. Reduce dairy products , the most acidic food is the cheese 4. Reduce processed meats e.g. lentils and peas 5. Reduce egg yolk, cola & chocolate 6. Drink tea or coffee without milk The most alkaline fruits are bananas 3- Gout It is a recurrent form of acute arthritis resulting from deposition of crystals of uric acid & monosodium urate(MSU) crystals in and around the joints. It is a very painful localized inflammation of joints particularly those of thumb and big toe, and ankles.  Acute gout is normally treated with indomethacin and other NSAIDs but not aspirin “Aspirin inhibits kidneys ability to excrete uric acid.” ❑Best drug of choice is Colchicine alkaloid. ✓Prevent deposition of urate crystals at the joints. ✓Block neutrophil inflammatory mediated by urate crystals deposited in the synovial of joints. Present in the corms, seeds and flowers of Colchicum autumnale, Fam. Liliaceae Second drug choice are Diuretics: increase the elimination of urates from the kidneys such as Celery Apium graveolens , F. Apiacea and Dandelion, they relief symptoms and prevent recurrence, specially when combined with low purine diet (reduce meat and oily fish).