This article is taken from the June 1976 issue of Impact, P.O. Box 2950, Manila, The Philippines.

The "barefoot doctors" concept of medical care which presently has several advocates in our country cannot succeed unless local medicinal plants are substituted for pharmaceutical preparations (the drugs and medicines available in our commercial drugstores) . This is true not only because of the expenditures involved in the use of pharmaceutical preparations but also because pharmaceuticals are best administered under the supervision of competent physicians which increases the cost and limits the number of patients who can be reached.

Research

In the resurgence of a modern, worldwide scientific interest in the use of medicinal plants in preventive and curative medicine, there is a timely need for an active and practical research program on local medicinal plants.

The importance of a continuing research on our Philippine medicinal plants has been stressed time and again . Although a substantial amount of research work has been done, as evidenced by the pile of graduate theses found in our different libraries, it is sad that only a limited number of researches have been found to be of immediate practical application.

Why? An analysis of the situation would indicate that the orientation of most of our researchers has been geared to an industrial economy which necessarily puts emphasis on the chemical investigation and separation of the active constituents of plant materials so that these can be isolated and prepared for mass consumption.

An industrial econ9my like the United States of America stresses the isolation and synthesis of active constituents of effective medicinal plants since it has ready access to technological processes that can produce it easier and cheaper than the farm labor force that might otherwise be necessary.

On the other hand, for a developing agricultural economy like ours, the cost of manufacturing man-made drugs is too expensive. We cannot afford the importation of much expensive equipment and apparatus. It is a burden for our people to sustain pharmaceutical production and distribution as it is done in developed economies

Availability of Medicinal Plants

But we have marginal lands and unemployed labor. We also have one of the richest flora in the world . Our temperature and climate can sustain inexpensive cultivation. Thus, we must appreciate and consider our plants as our living chemical factories that will supply inexpensively the medicinal needs that can alleviate the health problems of our people.

Economics of Medicines in the Philippines

Considering the poverty of our people, it is useful to consider that using commercial pharmaceutical preparations, it will cost P.1.80 to remedy a simple case of diarrhea, P .0.15 to alleviate a headache or a toothache, P.2.60 to relieve a cough, P.0.40 to have antiseptic tincture at hand, P.0.35 to alleviate a stomach ache, P.0.54 daily to provide for T.B therapy, P.1.20 to deworm a child. 7.50pesos • equals one dollar.

Yet for all of these ailments we have medicinal plants exerting the same therapeutic action . We do not appreciate them because we do not have to dole out so much hard-earned money to get them, for as a friend told me, the best things in life are free but the good things cost money.

According to a recent survey, we have some 400 pharmaceutical companies operating here in the Philippines . The drug industry is one of the biggest in point of sales. The total sales of 50 drug firms alone reached P.919.6 million pesos, although their equity amounted to only P.205.6 million in 1970. This means that for every P.1 invested sales of P.4.47 were generated and a net profit of 29 centavos was reported.

The drug industry gives the highest rate of return of investment.

The total drug market in the Philippines is 26% controlled by one firm alone, 70% by totally foreign -owned or controlled companies; only the remaining 4% is controlled by small Filipino-owned drug companies.

Aside from all these, recent experience have shown that our health services prove inadequate, not so much due to the lack of trained personnel but because we continually suffer from drug shortages especially in our rural areas in spite of our nearly one billion pesos expenditure on drugs.

These, therefore, point to the need of harnessing the resources of our social and economic environment especially the use of our own medicinal plants as a practical approach to solving the health problems of our people.

The Chinese Experience

The People's Government of China began paying particular attention to the centuries-old art of healing - using herbal remedies when faced with the situation of an extreme shortage of well-trained physicians and the problem of providing health care to more than 800 million people living in rural areas too isolated and poor to sustain the cost of manufacturing and distributing man-made drugs as is done in developed countries. 

China called upon its medical and pharmaceutical professions resources, its plants and herbs found abundantly in nature. 

Close cooperation between graduate physicians and village healers was established. 

Most of the army of "barefoot doctors" as they were called were trained for 6 months and then sent out to cure the ordinary common ailments and to spot illnesses that are best handled in hospitals.

A concentrated effort was made to develop a combination of Chinese traditional medicine and Western scientific medicine. All doctors trained in Western medicine were required to take an intensive eight-month course dealing solely in herbal remedies.

Up to now, the use of Chinese herbal remedies is undergoing methodical research acceptable by Western standards. They have a national program for clinical trials and research in the use of herbal drugs in diseases like hypertension, diabetes, coronary diseases, tuberculosis, cancer, intestinal parasites eradication, etc.

The successful results of the Chinese medical program have surprised even the most critical observers. As a result of it, acupuncture and an enthusiastic interest in herbal medicine is evident all around us.

The Philippines

Why can we not adopt with proper modifications China's medical program to our own health services? According to statistics, 40% of our people die without any medical attendance. This is not a cause of surprise since in areas like Bicol there is only one physician for every 8,000 residents, 40 rural health units for the more than 1,080 barrios.

The advent of the age of the "miracle drugs" like antibiotics and steroids have not been without repercussions as discovered later. Indiscriminate use of antibiotics is now known to upset the body's normal microbial balance and sometimes lead to the development of antibiotic resistant pathogens that are harder to combat. Recent estimates made in the United States show that about 80% of the strains of staphylococci taken from hospital patients are resistant to penicillin. Thus, prudent physicians prefer to hold potent antibiotics in reserve until a greater need for them arises.

I think it is about time that we examine our way of providing health care to our people and realize that the methods of providing health services can never be static. We must always adapt to the changing patterns produced by social, economic, educational and professional situations.

It is said that one of the problems confronting the delivery of health services to our people is that the training of our doctors, nurses, pharmacists, medical technologists makes them more able to practice in the sophisticated medical centers of developed countries, like New York and London, rather than in the rural areas of our own country. When placed in a rural environment, they find themselves misplaced by their own training; they feel inadequate and frustrated when confronted with the lack of facilities and medicines which is prevalent in our rural areas.

It is quite tragic that compared to an "herbolario" well versed in the use of medicinal plants, some of our doctors would sometimes find themselves helpless to alleviate their patients unless the prescription drugs they were trained to use are available.

In developed countries, man today is better able to cope with diseases than in underdeveloped countries. The credit for this is usually given to modern medicine and especially to wonder drugs. But in fact, the role of modern drugs has been secondary. The major health gains have resulted largely from social measures. Modern sanitary methods have made it possible to prevent the virulent microbes from reaching their human targets. Clean drinking water and proper waste disposal safeguard people from many intestinal diseases. Proper food education and intestinal parasites eradication prevent malnutrition and secondary infection by increasing resistance to diseases

Thus, preventive medicine is as much a social as well as a medical measure requiring attention to the social and economic environment of the individual. There is a complex interplay between socio-environmental factors, social problems, health conditions and public health programs. Each may lead to the other in myriad ways. For example, poor housing (a physical condition) may lead to the growth of slums (a social problem). which in turn increases exposure to tuberculosis (a health condition). which then requires the development of a preventive and therapeutic measure (a public health program).

The well handled use of medicinal plants as in the case of Red China where the supervised practice of herb doctors was encouraged, can lower the costs of our expenditures on drugs.

Why have we neglected the use of medicinal plants in our country and instead prefer .to use costly and imported medicines?

Maybe it was because as we went in search of new knowledge we lost interest to use existing knowledge. The empirical lore used by our forefathers were developed in response to immediate needs arising from the problems of being ill and it was based on the result of experience. But "modern" medical practice discredited medicines of folk origin and outlawed its practice by folk curers.

Instead of treating folk medicine with interest and understanding so that it could be the starting point from which erroneous folk practices may be eventually dropped
and more effective and scientifically based practices substituted, the common tendency on the part of the allied health professions was to ignore if not ridicule the folk concept of healing.

Some Examples of Folk Medicine.

If we would only take a close look at some of our folk practices in healing, we would be amazed that there is a scientific basis for their use .

Take for instance the way diarrhea is treated.

Diarrhea commonly occurs when one takes in harmful microorganisms from spoiled or contaminated food . The body reacts by actively eliminating these harmful microorganisms; it increases presstalsis movement so that elimination is hastened, sometimes so much that there is even stomach ache along with the diarrhea. Body fluid is drawn so that elimination is hastened, with watery stools resulting in the process. Actually , diarrhea is the result of the body's protective mechanism to rid itself of the harmful microorganisms ingested, which if not eliminated, are potentially harmful. Once the body is rid of these microorganisms,the diarrhea will stop even without medication.

If we take a look at the constituents of popular commercial pharmaceutical preparations effective for diarrhea we find out that they mostly contain an absorbent, usually kaolin or carbon and pectin, which acts to coagulate or precipitate the toxins and consolidate the stool as well as create an unfavorable environment for the abnormal bacterial flora causing the diarrhea .

Absorbents like kaolin or carbon are chemically inert powders used to absorb from the intestinal tract suspended toxins and bacteria. Absorbents also form a protective coating on the intestinal mucosa.

In the barrio a folk treatment for diarrhea is to roast some rice until it is carbonized. If you add some of the pectin extracted from boiled guava fruits, is it not that what you will have is an effective folk version of a pharmaceutical preparation? Which latter by the way costs P.11.40 per bottle.

For coughs, my favorite remedy is to pound some garlic and mix it with honey. Garlic has antiseptic action while honey is a demulcent. I also recommend Alagau leaves (Premmaodorata) prepared as a tea. The leaves of the Tamarind (Tamarindus indica) boiled and sweetened, preferably with honey, are also effective for coughs. 

When one has a headache and uses a medicinal plaster, the basis of its value are the volatile oils that are evaporated by the body heat and thus give relief. We have plants like Oregano (Coleus amboinicus) which when crushed and plastered on the forehead gives off volatile oil and approximate the relief given by the medicinal plasters.

For stomach aches, the medicinal plant to be used depends upon the kind of stomach ache involved . If it is due to gas pains, Mentha Arvensis (Hierba buena) is commended as well as Ocinum basilicum (Salano) or Acous calamus (Lubigan) . These plants are stomachic in character which means they act as a stomach tonic. Artemisia vulgaris (Damong Maria) and Blumea Balsamifera (Sambong) can also be classified here as well as for coughs as previously cited.

For dysmenorrhea or painful menstruation, Blumea Balsamifera is again recommended as well as a tea made of Gumamela flowers (Hibiscus Rosasinensis) .

For T.B. therapy, I wish to cite the study of Dr. Victoria Masilungan where they tested different drugs reputed to be effective against T.B. and proved that in vitro Ginger (Zingiber officinale) in the form of a drink (as Salabat) is effective against T.B. germs.

 For wounds, bruises, cuts and burns, my favorite remedy is Sabila (Aloe vera) . All one has to do is to cut a leaf, and use the mucilage freely to clean the wound. Allow to dry and apply the mucilage every so often .

Once when my son fell from our stairs he sustained a head wound. A head wound has the tendency to bleed profusely ,  but by the time we reached the hospital the bleeding has stopped. Our family physician, Dr. Nemesio Galvez, asked me if I gave my son any drug to stop the bleeding and when I answered that all I did was to apply Sabila (Aloe vera) he chuckled that I might yet be able to convince him about medicinal plants

Modified Coconut Water for Diarrhea Treatment

Coconut water is a good source of minerals since it contains significant quantities of potassium, sodium, calcium, magnesium chloride, phosphorous, reducing sugar and small amounts of protein. Stable solutions of modified coconut water will be tested clinically in patients suffering from diarrhea confined at the hospitals of greater Manila area (Philippines). This project will increase the utility of coconut water which is an abundant by-product of the coconut industry but which has not been put into any significant use. At the same time, it aims to modify the composition of coconut water in order to improve its electrolyte composition and make it a more balanced solution that can be used as an adjunct in the treatment of diarrhea. There is a need to add additives so that it would remain stable and unspoiled for reasonable periods of time, and if possible, at room temperature. 

Various formulations will be tested for taste acceptability by using initially clinically healthy subjects. And the acceptable formulation of choice will be tested clinically to diarrhea patients. Only subjects whose cases do not cal I for  intravenous infusion of water and electrolytes and whose condition clinically could be subsequently be managed by oral replacement therapy, will be included in this study. In these clinical trials, the main observation to be made are: taste acceptability of patients, possible aggravation of the symptoms, side effects (i.e. vomiting, abdominal pain). and the duration and outcome of the disease .

However, studies of the preservation qualities of the coconut water and conservation of its natural taste and flavor are essential especially in rural area where refrigeration facilities are not commonly available. It is doubtful that widespread use of coconut water as an intravenous infusion would be acceptable to both patients and practicing physicians at present. But as an oral drink, coconut water is readily acceptable even to younger age groups. It is this acceptability of the coconut water by the oral route that should be exploited in its possible use as a therapeutic agent.