CAMPUS HERBAL MEDICINAL GARDEN

A PROJECT REPORTFirst Semester SY 2010-2011

Republic of the PhilippinesCagayan State University Andrews Campus

Caritan, Tuguegarao CityCOLLEGE OF EDUCATION

CAMPUS HERBAL MEDICINAL GARDEN

BY THE NATURAL SCIENCE & NSTP CLASSESCAGAYAN STATE UNIVERSITYANDREWS CAMPUS

TUGUEGARAO CITY

PROJECT REPORTFirst Semester 2010-2011

PROJECT DETAILS:

Focal Discipline: Biodiversity

Project Theme: Conservation and Sustainable Use of Biological Diversity through Herbal Medicinal Gardening

Operational Phase:   Phase 1

Dates: First Semester SY 2010-2011 (September 28, 2010 to October 21, 2010)

Project Status: On-going

Project Support:

Project Supervisors:

Natural Science Students (First year BSED and BEEd enrolled in Biological Science Classes; Third Year -Biology major; Fourth Year – Physical Science students; and NSTP First Year students)

Prof. JHOANNA B. CALUBAQUIB, Ph. D.

Prof. CELIAFLOR RODRIGUEZ, Ph. D. Natural Science Professors

Prof. CRISTINA B. NATIVIDAD NSTP Teacher

Project Manager: Dr. Tomasa C. Iringan Dean, College of Education  

Rationale

CSU College of Education will be subjected for PACUCOA accreditation and one of its requirements is the putting up of a Botanical Garden. However, the growing interest in, and the increased consumption of herbal preparations as medicines have raised considerations to expand such requirement by establishing A Campus Herbal Medicinal Garden. Herbal medicine in traditional medical practice is an important resource which can be mobilized for the attainment of the common goal of health for all. The herbal medicines have contributed significantly to man's struggle against diseases and maintenance of health. In recent years, interest in the use of herbal preparations has increased.

The consumption of herbal medicines is significant and appears to be steadily increasing for a number of countries in Asia. Likewise, the consumption of herbal medicines in our locality does

not appear to be abating. DOH's policy on herbal medicines acknowledges their important role for the health of a large number of people. For particular cultural and socioeconomic groups, they form a significant part of their health services. Furthermore, DOH promotes the safe and effective use of herbal medicines and encourages their integration, wherever possible, into the delivery of mainstream health care services.

Objectives

To conserve biodiversity of medicinal plants in the area. To inculcate to the students and the members of the community that natural products are

still the safest and economical solution to cure diseases. To instill into the young minds that herbal gardening is an eco-friendly activity. To help establish a network of community members to actively participate in health and

environmental program. To establish a group of students engaging in active discovery through interdisciplinary

learning. To use the garden as a living laboratory to support teaching and learning particularly in

Natural Science classes.

Notable Community ParticipationStudents and teachers are involved in planting herbal plants for medicinal use in the school premises and their respective homes.

Promoting Public Awareness of Global Environment The students are taking action towards creating public awareness on environmental issues such as sustainable use of natural products, global warming and biodiversity conservation.

Extension Activity

Project Recipient: Pallua Elementary School

Activities:

The College of Education-CSU Andrews Campus donated 30 hills of different species of medicinal plants to Pallua Elementary School. These rare species of herbal plants served to supplement the existing local plants found in their Herbal Medicinal Garden.

The College provided some clippings which include Taxonomic Descriptions, Medicinal Indications and Preparations.

Relevant Future Programs

Raise awareness among students by circulation of leaflets and conduct seminars on the regulation and proper use of medicinal plants.

Attachments LettersStudents’ Accomplishment ReportsPhotos

Prepared by:

JHOANNA B. CALUBAQUIB, Ph.D. Bio Sci/Biochemistry Professor

STUDENTS’

ACCOMPLISHMENT REPORT

PHOTOS

LETTERS

The GEF Small Grants Programme currently comprises 85 Country Programmes supported by a Central Programme Management Team based at UNDP/New York. Each Country Programme uses a Country Programme Strategy to orient project identification and development. Each country’s CPS unites the different projects around a strategic goal - more and more the CPS’s are focused on a specific region and/or thematic area (e.g., rural renewable energy).  Each CPS is developed drawing on analyses by the National Steering Committee of global, national and regional priorities manifested in such documents as NBSAPs, NAPs, NIPS, etc. This framework – national priorities grounded in a regional focus – provides the basis for identifying desired Country Programme impacts and outcomes. Individual projects are thus identified and supported if they fulfill the essential criteria of contributing to meeting the CPS’ desired Impacts and Outcomes.

While projects produce impacts at the local level, the ensemble of projects within a Country Programme produce results that are synergistic and lead to impacts that are greater than just the sum of individual project results. When analyzing the impacts of individual projects on the production of global benefits, it is important that they are assessed in the context of Country Programme efforts to produce broader outcomes and objectives in keeping with the global and national priorities found in the NBSAPs, NIPS, NAPs, etc. Individual project impacts by themselves have little impact on the global environment, but, through synergy among projects at the region level, their impacts contribute concretely to global benefits through their effect on the national priorities found in Convention-related strategies and plans.

The SGP Impact Assessment System will combine these tools with other elements of the current M&E practice, such as the ex-post studies and portfolio reviews. The enhanced system itself will be piloted in a select number of Country Programmes to identify potential problems or opportunities for greater effectiveness, before extending the system to all Country Programmes world-wide.

The IAS is backed by and linked to an upgraded database system structured to better capture impacts and results, as well as key indicators and performance assessment generally. The current database has been an important monitoring tool and will continue now to serve impact assessment with the new indicator system. The IAS and upgraded database will not only track

quantitative information but also qualitative. 

Enhanced monitoring of and reporting on projects and country programs, with support by a database that systematizes reporting, should facilitate key reporting on impacts and help to demonstrate the link between projects, Country Programmes and the global level. The IAS therefore also comprises an enhanced focus on performance assessment and the use of indicators, to both track progress and report on successes and challenges. This will allow the SGP to be able to ‘tell a story’ about achievements of and contributions made to Impacts that is coherent and consistent, and that meets requirements of the Council.

Each project and set of projects in a particular country programme also achieve other impacts, which can be considered as being more ‘operational’ or management–related; the SGP programme itself will also generate such impacts. These operational results include, but are not limited to, the following areas:

Replication of SGP Initiatives/Catalytic Effects/SGP Programme Expansion  Resources mobilized, leveraged/Co-financing levels  Linkages with other GEF projects and non-GEF projects Knowledge Management/Lesson learning and dissemination M&E systems and processes, and reporting

These key areas of results are, in fact, fundamental to the SGP programme, as these are vital for its continued growth and success, as well as being important to programme sustainability and ongoing improvement. The IAS will therefore also facilitate and emphasize reporting on these key results, as projects, countries, and the global programme are expected to report to the GEF Council on achievements made in these areas. Therefore, in addition, Country Programme Strategies will be required to list expected results in these areas, in the context of strategies prepared for their achievement, and will be expected to report on them over time.

An Impact Assessment System is currently being developed and will be available for download from this page as soon as it is finalized.

Copyright © 2006 GEF Small Grants ProgrammeDesign and programming by Lomtec.com

Herbal Medicine

For resources on specific herbs you may want to check our FAQ's section or the Herbal Directory we have set up.

 

The History of Western Herbal Medicine          by Chanchal Cabrera    page 1 2 3 4       

Of all the brilliant minds and insightful mysticism in the ancient times, the single most influential physician was probably Claudius Galen. He lived from 131 - 200 AD and studied medicine at the famous school in Alexandria. Starting as a physician to the gladiators, he rose to become personal physician to Marcus Aurelius. Galen believed strongly in the Humoral system of medicine and developed it further. He promoted the idea of a cross with each branch representing hot, cold, wet and dry respectively and with perfect balance (ie optimum health) being in the middle. He classified all diseases and all plants into these four categories and recommended the use of opposites to

counterbalance. In this way, for example, psoriasis was classified as hot and dry and should therefore be treated with cool, wet herbs like plantain. His theories and dogmas were to become standard medical knowledge throughout Europe for several hundred years. In fact his writings were required reading in medical school up until just a few hundred years ago. 

When the Romans invaded Celtic lands (Germany, France and especially Britain) they brought with them a sophisticated system of philosophy and medicine which ousted the well established and highly developed medicine of the Myddfai school. The druidic practitioners of traditional Celtic medicine were marginalized by the Romans but, although their influence waned, it continued to be practiced as a system of healing until only about 150 years ago. 

When the Roman empire crumbled, a century after Galen died, it plunged Europe into the Dark Ages about which very little is known. Christianity had reached Ireland early on and was brought first to Scotland and thence on into the rest of Britain and Europe. The remaining druids were branded as witches and were actively discouraged. The Greek and Roman traditions of healing were kept alive by literate monks who were the only people trained to translate and transcribe Latin texts. Little new work was done at this time, merely the copying and recopying of older works. Thus we see the mistakes of one person repeating themselves in numerous later texts. The monks adhered to the Benedictine edict that it was the duty of the Church to care for the sick but they distinguished this from the pastoral duty of caring for the soul. Thus in their writing of herbals, monks removed much information that pertained to diseases of the spirit - possessions, demons and the like - because that was the domain of the Church and had no place in books on medicine. Thus they created a separation of the mind from the body, they took the soul out of healing. 

For those who could not get to a monastery to be healed by the monks, there remained folk medicine as practiced by a village healer or sometimes a wandering healer mendicant. This was still influenced by the magical and mystical and there were many irrational beliefs about medicine. One which has survived to this day, and may not be without merit, is the doctrine of signatures. This suggests that a plant or a part of a plant will look like the disease it can treat. Thus, for example, Eyebright (Euphrasia spp.) with its white flower with a deep purple center, was believed to useful in treating eye complaints. Modern studies have confirmed this traditional use. Similarly Dandelion (Taraxacum off.) has a yellow flower that caused it is to ascribed properties of stimulating bile and urine. In modern trials it has been found to indeed be effective in these areas. Perhaps the most remarkable example of the doctrine of signatures lies in autumn crocus (Colichicum autumnale).This plant has a root which is twisted and gnarled like a foot afflicted with the gout for which it was traditionally used. Modern laboratory experiments have shown it to yield a chemical called colchicine which is presently recognized as being the drug of choice to treat gout. 

While the Dark Ages continued in Europe, in the middle eastern and Arabian countries intellectual thought was reaching its zenith. Plundered Greek and Roman medical texts were stored for over two centuries in Baghdad before being translated into Arabic in the 9th. century AD. One of the greatest Arabian medical thinkers was Avicenna who lived from 980 - 1037 AD. Going on from where Galen left off, he codified the 'rationale of opposing forces' and solidified Galen’s theory of using opposite attributes of a plant to correct negative attributes of a disease. He also studied astrology extensively and wrote many treatises on the importance and relevance of astrology to medicine.

As Europe stepped out of the Dark Ages in the early 1400's and entered the age of the Renaissance so new ideas occurred in medicine. One of the most influential in the early Renaissance was Philippus Theophrastus Bombastus von Hohenheim or Paraselcus as he was more often known. The son of a poor but highly educated and literate physician, he was an early alchemist and was a great fan of tonic medicines to strengthen the patient. He refuted the ancient theories of Dioscorides, Galen and Hippocrates, publicly burning their books in the town square of Basel, and promoted the objective and empirical model of medicine. Paraselcus is often considered to be the originator of modern allopathic medicine.

Alchemy may have started with the search for the Philosophers stone which could

transform base substances into gold, but in the search, many new chemicals were discovered and inevitably these were investigated for their potentially medicinal properties. Such things as lead, arsenic, vitriol and mercury were originally given to prisoners and patients in the asylums, those who were unable to say no, and the results observed. Of course there were many deaths but occasionally a positive effect would be noted and this served to encourage the alchemists in their investigations. 

At this time syphilis was the scourge of Europe. It was not understood at all because it occurs in three distinct phases, the last one possibly 30 years after the initial sores, which made it almost impossible to track and monitor. Alchemical doctors considered that mercury would cure this dread disease if given in sufficiently high doses to cause the salivation of 5 buckets of fluid daily. This type of medicine has been called heroic medicine because it took a brave doctor to administer it and a very brave (or very desperate) patient to undergo such treatment. Over time, sufficient cures were effected to encourage the doctors who eventually came to be known as 'quacksilvers' from the old name 'quicksilver' for mercury. This is actually the origin of the word 'quack' which is used today much as it was then to denote a person experimenting with unproven therapies.

The early 'doctors' were still heavily influenced by the ancient Galenical theories and from this they developed an elegant model of disease. In it the four cardinal humors (hot, cold, wet and dry) were considered to act as energetic influences upon the four elements (fire, earth, water and air). The energetic and humoral influences within a body acted to produce the humors (yellow bile, black bile, blood and phlegm) and the temprements (choleric, melancholic, sanguine and phlegmatic). 

The Air Element

This governs the humor called blood. It is of a sanguine (full-blooded) temprement. It is fine, light, hot and moist. It refines and purifies. It is associated with movement, speed and clarity. The air of the body is the seat of the soul.

The Earth Element

This governs the humor called black bile. It is of a melancholic temprement. It is rigid, firm, heavy, dry, cold, stationary and unyielding. It gives the body structure and form.

The Water Element

This governs the humor called phlegm. It is of a dull, phlegmatic temprement. It is liquid, heavy, wet, cold, has no fixed, form, is mobile and easily displaced. It binds and protects the body.

The Fire Element

This governs the humor called yellow bile. It is of a choleric, hot-tempered temprement. It is light, hot and dry. It is penetrating and purifying. It stands above all the other elements and balances the cold elements. 

The horizontal axis (water and ) earth represents the physical body, the flesh and bones, which may be either relaxed or astringed. The vertical axis represents the energy of the body, the life-force, which may be either stimulated or sedated. The exact individual temprement is determined by the balancing of all the elements and may change subtly over time. Thus with youthfulness there is a tendency to heat and moisture eg. the child has soft bones, is very active and is prone to fevers and head colds. With increasing age coldness and dryness enter the body leading to hardening of the body eg. of the arteries or bones. Men also tend to be hotter while women tend to be colder.

Before an element can express itself as a temprement is must first exist as a humor in the body. Thus the humors are the mechanisms by which the four elements are kept in

balance and in the correct proportions to one another. 

Any imbalance in the elements, humors or temprements is called an intemperance. A simple intemperance may be hotter, colder, drier or wetter ie. an excess of any one element. A compound intemperance may be drier and colder, colder and wetter, hotter and drier or wetter and hotter. Perfect health is considered to lie in the very center of the cross and all healing measures were designed to bring the body back to this central mid-point.

In the reign of Henry VIII there was much dispute among the practitioners of the modern alchemical systems of healing and between them and the traditional botanical therapists. Eventually a Charter of Rights for Herbalists was proclaimed law and served to temporarily silence the critics of simple herbal medicine. It stated that "....it shall be lawful to every person being the King's subject, having knowledge and experience of the nature of Herbs, Roots and Waters, or of the operation of same, by speculation of practice within any part.... of the King's Dominions, to practice, use and minister in and to any outward sore, uncome, wound, apostumations, outward swelling or disease, according to their cunning, experience and knowledge in any of the diseases, sores and maladies before-said, and all other like to the same, or drinks for the Stone and Strangury, or Agues, without suit, vexation, trouble, penalty, or loss of their goods". 

Encouraged by this protection in the eyes of the Law, herbal medicine flourished in England, alongside the developing alchemical systems. In 1597 John Gerard, an English Master-surgeon published his vast herbal, one of the first to contain any original material since Galen. He described over 3500 plants, many of them new arrivals from far away lands that the English explorers were just beginning to ‘discover’.

Nicholas Culpeper in the early 1600's was another enormously influential English herbalist. Trained at Cambridge and fluent in Latin, he harbored aspirations of being a doctor which were thwarted by his lack of social standing. A love affair with a woman of noble birth, far above his class, led to an elopement. The couple arranged to meet in Brighton, then several days ride from London where they both lived. He went on ahead to secure rooms and she was to follow him. On her way there, her carriage was struck by lightening and she was killed. After this disaster Culpeper decided to throw caution to the wind and start his own medical practice. First he trained as an apothecary so that he would "... really know and understand the medicines" and then he started seeing clients and writing. Initially he translated the London Pharmacopoeia from Latin into English which made such information available for the first time to many more people than classically trained scholars. He also edited greatly, most particularly in that he decried the standard practice of vastly complex and unrealistically expensive medicaments, preferring instead locally grown plants and simple formulations that were affordable and easily made. In 1652 Culpeper published his famous Herbal which he titled 'The English Physician or an Astrologo-physical Discourse of the Vulgar Herbs of this Nation, Being a Compleat Method of Physick Whereby a Man may Preserve his Body in Health, or Cure himself being Sick, for threepence charge, with such Things as onlie Grow in England, they being Most Fit for English Bodies' He associated each plant and each disease with a planet and ascribed astrological principles to healing. He also wrote from a wealth of practical knowledge and he wrote in a way which was clearly understood and easily followed. This made his books very successful and his herbal has gone through over 40 editions to date and is still a steady seller. 

A hundred years after Culpeper, an English physician of the chemical school made a remarkable discovery. Dr. William Withering was a doctor and botanist who was the first to isolate an active constituent from a plant. A study into the beneficial effects of foxglove (Digitalis purpurea) on dropsy (cardiac oedema) led to the isolation of the 'cardio-active glycosides' which he found to contain "the potent active force". In time this came to be seen as so potent that only licensed practitioners were permitted to use it and foxglove thus became the first herb to be lost to the herbalists.

While the alchemists in Europe were experimenting with their cure or kill methodologies, on the other side of the Atlantic the picture was quite different. The early pioneers were unable to bring with them rare chemicals or fragile glass equipment. Instead they brought plant seeds and simple folk remedies. Initially the

white settlers were distrustful of the natives and refused to learn from them. But slowly it was realized that the people of the land knew a great deal about the endemic diseases and the medicinal plants. little by little knowledge was gleaned and much of it is still prevalent in modern herbal medicine. Thus we learned of Echinacea, Goldenseal, Yellow Root and Wild Yam, among many others, from the native Americans. One person was particularly influential in accumulating and spreading this knowledge and this was Samuel Thomson. 

He lived from 1769 - 1843 and was probably the most influential herbalist of his time. As a sickly child he received herbal treatments that were effective when the physic had failed. His healer was an old woman who had learned from the Natives. When Thomson’s own child was sick and was pronounced doomed by the doctors, Thomson, almost instinctively, decided to give her steam baths and she quickly recovered. Thomson never formally trained as a doctor but his practice grew as his success grew. He administered powerful emetics such as lobelia (Lobelia inflata), cathartics such like buckthorn (Rhamnus purshiana), stimulants such as cayenne (Capsicum minimum), as well as steam baths and cold showers. His treatments were unpleasant but often successful. He believed that all disease was a "derangement of the vital fluids" and a decrease in "animal warmth" of the affected part. This allowed the growth of what he called "canker" which clogged up the channels of elimination and caused congestion and stagnation in the body. His approach was to warm and stimulate the body and to open all the channels of elimination so that morbid materials could be removed.

Thomson’s fame as a healer became widespread and he began traveling from town to town in New England. He earned the wrath of the medical officials of his day and was vilified in the press as well as being taken to court on trumped up charges. He persisted never the less and in 1813 he took out a patent on his "Improved System of Botanic Practice of Medicine". He then set up what was possibly the first ever multi-level marketing program. He appointed agents in each town who made commissions selling memberships in the Friendly Botanic Society. The members received educational materials and seminars and were entitled to buy medicines from the agents who in turn bought them from Thomson. Some of the agents were also practitioners, working with the Thomsonian methods. By 1939 there were over 3,000,000 members and Thomson was a wealthy man. 

However, Thomson’s downfall lay in his arrogance. He refused to have anything to do with the modern science of medicine, disdaining even the study of anatomy and physiology and believing that his system was complete unto itself. He likewise refused to allow his adherents to have anything to do with medicine and it soon alienated some of them who formed various breakaway groups. Thomson died a bitter man, alienated from those he had once held dear.   >> continue  

The History of Western Herbal Medicine          by Chanchal Cabrera    page 1 2 3 4       

One of his early students who later became a medical doctor was Wooster Beach. He opened the United States Infirmary in New York in 1827 and this was followed by the Reformed Medical College in 1829. He practiced a skillful blend of the old and the new, using modern science to understand the body and herbs to treat the diseases he diagnosed. He called his discipline "Eclectic" and was the first of many wonderful pioneering herbal doctors in America. 

John Scudder, John King, Finley Ellingwood, Harvey Wickes Felter, and perhaps especially John Uri Lloyd all helped to make Eclectic medicine popular throughout the latter part of the 1800s and even into the twentieth century. John Uri Lloyd was a brilliant chemist who, together with his brothers, devised new and improved methods of extraction for herbal products and who founded a herbal products company in Cincinnati. When the brothers died they endowed a library in their name which now houses one of the world’s largest collections of books on herbs. 

The ‘regular’ doctors as the medical practitioners were then called were appalled at the success and popularity of the ‘irregulars’ or herbal healers, most especially the Thomsonians. In 1847 the American Medical Association was founded and it served as a

focal point for the concerted effort to wipe out natural remedies in favor of the new drug remedies that were increasingly available. One way to do this was issue licences to practice medicine based upon achieving certain standards of competence. At the turn of the century the AMA initiated a study of the medical education establishments then available, including the herbal and eclectic schools. Their requirements for approval included laboratories and texts that were not used or needed by the herbalists. When the AMA ran out of funding, the Carnegie Foundation stepped in and appointed Abraham Flexner to complete the study. The Flexner Report was released in 1910 and it was devastating to the herbal and eclectic community. Within the next 4 years 29 schools closed down because they were not approved by the AMA, even though no-one in the AMA was actually qualified to properly assess the medicine they were teaching. Herbal and Eclectic medicine in the USA virtually died out for the next 60 years, preserved only in folk tradition and by Natives. 

In the UK the story was not much better. One of Thomson’s fiercest supporters was Albert Coffin. Born around 1790 his life was twice saved by herbal medicine and he became a crusader for the cause. In his late forties, after a very successful medical practice in New York state, he sailed to England and established a chain of Friendly Botanico-Medical Societies providing educational materials and herbal remedies through agents all over the country. Coffin lectured widely, published a Botanic Guide to Health and a fortnightly Botanical Journal, and became a regular thorn in the flesh to the British Medical Association. He spoke out publicly against the common medical practices of the day - especially giving calomel and laudanum to small babies, as well as against various social injustices such as over long working hours, unhealthy working conditions, tight lacing of women’s ribs and poor nutrition. However, like Thomson, He was an arrogant and venal man and refused to advance with the times. He denied medical discoveries even when they could have helped to have explained his herbs and he became, eventually, an obstacle to the progress of the profession. One of his closest colleagues, John Skelton, defected and spoke out against him, and was joined in his complaints by Wooster Beach, visiting from America. By the 1850's herbal medicine in England was in disarray with much in-fighting and back stabbing. In 1854 when the Medical Reform Bill was introduced to parliament it threatened to make it illegal to practice medicine unless registered as a doctor by the BMA. This would remove the livelihood from an estimated 6000 herbalists and they were forced to band together to fight this threat. The bill was dropped and the various societies fell apart again until 1864 when the British Medical Reform Association was created. This eventually became the National Association, then the National Institute of Medical herbalists and it is still the major professional organization for herbal practitioners in the UK with their members being recognized worldwide. 

Today herbal medicine, according to the World Health Organization, is still the primary form of healing employed by over 80% of the world’s population. Sales of herbal products are soaring, enrollment at herbal colleges is growing steadily and the standards are rising all the time. In England now there are three different universities offering undergraduate degrees in herbal medicine and one even offers a masters degree. A survey by Prevention Magazine earlier this year revealed that one in three Americans, a whopping 60 million people, spend an average of $54 each per year on herbal remedies, totaling almost #3.24 billion annually. Another survey carried out two years ago found that 45% of Americans were aware of or had tried herbal products but that only 16% were using them regularly. The same survey repeated this year found that 70% were aware of or had tried herbal remedies and that 40% were using them regularly.

Stress Relief Tips: -

* Prepare for the morning the evening before. Set the breakfast table, make lunches, put out the clothes you plan to wear, etc.

* Do nothing which, after being done, leads you to tell a lie.

* Make duplicates of all keys. Bury a house key in a secret spot in the garden and carry a duplicate car key in your wallet, apart from your key ring.

* Play an instrument especially guitar, if you know how.

* Be prepared to wait. A book can make a wait in a post office line almost pleasant.

* Procrastination is stressful. Whatever you want to do tomorrow, do today; whatever you want to do today, do it now.

*Get up fifteen minutes earlier in the morning. The inevitable morning mishaps will be less stressful.

* Plan ahead. Don’t let the gas tank get below one-quarter full; keep a well-stocked “emergency shelf” of home staples; don’t wait until you’re down to your last bus token or postage stamp to buy more; etc.

* Get together with your girlfriends and commiserate. When you all share your dilemmas and get the frustration out in the open, it’s a pretty sure thing that you’ll be feeling better in no

time.

* Allow 15 minutes of extra time to get to appointments. Plan to arrive at an airport one hour before domestic departures.

* Take an entire night to yourself, to be completely worthless. Order take-out, walk around in your jimmies and just enjoy having nothing to do.

* Make friends with no worriers. Nothing can get you into the habit of worrying faster than associating with chronic worrywarts.

* Get up and stretch every so often if your job requires that you sit for extended periods.

* Go on a vacation. Whether you leave for a week or you take a five-minute mental vacation, sometimes an escape from reality is all it really takes to re-energize and rejuvenate yourself.

* Get enough sleep. If needed, use an alarm clock to remind you to go to bed.

Natural Stress Relief: -

Exercise for Stress Relief: - Exercise is another important part of a natural stress management routine. Experts have long known that cardiovascular exercise benefits people both physically and mentally. The reason for this is quite simple: when you exercise, stress hormones decrease and hormones that make you feel good (such as endorphins) increase.

Healthy Eating Habits: - When we reduce stressful eating habits we gain maximum benefit from

the food we eat. We also bring more sanity into our relationship with food. Healthy eating habits help us stay trim and avoid compulsive stressful overeating.

Ashwagandha hreb for Stress Relief: - The shoots of the Ashwagandha herb are used in food and in India seeds of the Ashwagandha are used to thicken milk herbal stress relief. Also use Ashwagandha to treat fevers, and other inflammations for herbal stress relief.

1. Introduction

Herbal medicine in traditional medical practice is an important resource which can be mobilized for the attainment of the common goal of health for all. These herbal medicines have contributed significantly to man's struggle against diseases and maintenance of health. In recent years, interest in the use of herbal preparations has increased. Herbal medicines are used in most countries in the Region either within the state health care system or in communities and private practices outside the state system. The growing interest in, and the increased consumption of herbal preparations as herbal medicines have also raised considerations about the need for regulation. Special attention to the nature and characteristics of herbal medicines is warranted in forming regulatory provisions and procedures.

The consumption of herbal medicines is significant and appears to be steadily increasing for a number of countries in the Region. In rural China, 35% of outpatients and 22% of inpatients are treated with traditional medicines. Herbal medicine sales accounted for 33.1% of the drug market in 1995, and represented a greater than 200% increase on production levels of 1990. In Hong Kong, 60% of the population have consulted traditional medicine practitioners. Japan saw a 15 - fold increase in herbal medicine sales between 1979 and 1989 in contrast to a 2.6 fold increase in sales of pharmaceutical drugs during the same period. In Australia, a recent survey identified 48.5% of Australians as using alternative medicines, including herbal medicine. The consumption of herbal medicines does not appear to be abating.

WHO's policy on herbal medicines acknowledges their important role for the health of a large number of people. For particular cultural and socioeconomic groups, they form a significant part of their health services. WHO promotes the safe and effective use of herbal medicines and encourages their integration, wherever possible, into the delivery of mainstream health care services.

1.1 Objectives

The objectives of the meeting were to:

(1) review the current status of the appropriate use of herbal medicines in the Region;

(2) present and discuss various issues and models for the appropriate use of herbal preparations as herbal medicines;

(3) develop draft guidelines for the appropriate use of herbal medicines; and

(4) recommend future directions for the implementation of these guidelines.

1.2 Participants

The Working Group was composed of 17 temporary advisers, two consultants, two secretariat staff from the WHO Regional Office for the Western Pacific and three observers. The list of participants is attached as Annex 2.

1.3 Organization

Dr Wong Kum Leng and Mrs Napsah binti Mahmud were elected Chairman and Vice-Chairman of the Working Group. Dr Nelia Cortes-Maramba and Dr Boun Hoong Southavong were the two Rapporteurs.

1.4 Opening ceremony

Dr S.T. Han, Regional Director for the Western Pacific, opened the meeting by pointing out that WHO recognizes the very significant contribution which traditional medicine, and in particular herbal medicine, can make to public health in the Region. He reported on the high usage figures for herbal medicines in the Region, the capacity of plant materials to offer new drugs and successful medical treatment, and the degree of integration into the official health care system of herbal medicine by some Member States. Dr Han indicated that WHO fully supports Member States in their efforts to integrate traditional medicine into their health care delivery systems. He noted that the Working Group, in preparing guidelines for the appropriate use of herbal medicines, should include technical suggestions for Member States interested in promoting the proper use of herbal medicine, which are flexible, feasible and practical.

Dr S.T. Han's opening speech is attached as Annex 4.

2. Proceedings

The agenda of the Working Group is shown in Annex 3.

2.1 Initial presentations

The meeting commenced with presentations from the two consultants and one secretariat member. These presentations briefly summarized:

• the Regional growth of herbal medicine and relevant WHO policies and programmes;• the regulation of herbal medicine in the Region; and• progress in herbal medicine research.

Dr Chen Ken, WHO Medical Officer for Traditional Medicine, outlined the current status of herbal medicines in the WHO Western Pacific Region and drew the Working Group's attention to growth statistics from a number of countries and areas. It was identified that:

• A great number of people in the Region still use herbal medicine for various reasons.• A major part of traditional therapies involves the use of herbal medicines.• Herbal medicines have a substantial share of the drug market.• Medicinal plants are important sources of pharmaceutical products.• Medicinal plants are important sources for the development of new drugs.

WHO's policy and programme on herbal medicines was also outlined. WHO's policy describes a high level of awareness of the importance of herbal medicines and the need to promote the proper use of medicinal substances. WHO's programme objectives are to:

• promote the safe and effective use of traditional medicine; and

• encourage the integration of traditional medicine into the general health services system, where applicable.

WHO will continue efforts to promote the proper use of herbal medicine through policy development, training, research and information exchange.

Mr Alan Bensoussan, Senior Lecturer, Faculty of Health, and Head, Research Unit for Complementary Medicine, University of Western Sydney, Campbelltown, Australia, summarized the essential policy elements and trends within a number of regional jurisdictions to

do with the practice of herbal medicine. Legislative structures governing the practice of herbal medicine vary significantly between neighbouring jurisdictions. Regulatory approaches to herbal medicine in different countries may be seen as a continuum, from a highly regulated model where practitioners are licensed and supervising boards are established to maintain standards and oversee qualifications; to a virtual absence of regulation, where any person may set up in practice of herbal medicine, constrained only by the prospect of personal liability for negligence and breach of contract, and general provisions relating to poisons and therapeutic goods. More extreme legislation in some jurisdictions may result in the complete exclusion of herbal medicine practitioners from the health care marketplace.

Regional and overseas trends indicate that increasing numbers of jurisdictions are contemplating the introduction of occupational regulation of herbal medicine practitioners to supplement the various forms of regulation on the materials and the conduct of herbal practice.

Professor Il-Moo Chang, Director, Natural Products Research Institute, Seoul National University, Seoul, Republic of Korea, summarized herbal medicine research activities in the Region. The major areas of activity include the following:

• There is a significant current focus on quality control methods to achieve standardization. Where a herb has unknown active ingredients, indicative constituents and/or fingerprint analysis (usually high pressure liquid chromatography patterns) have been used for the purpose of standardization and quality control.

• Classical animal cell culture, as well as gene manipulation techniques, are being applied to produce active ingredients of CITES-subjected (Convention on International Trade in Endangered Species) animal species.

• Where it is not easy to understand the efficacy of herbal medicine in terms of modern pharmacology, animal models are being developed to test the efficacy of specific herbs.

• Because of the difficulty in assessing an extensive range of herbal prescriptions (est. 100 000), efforts have been made to establish minimum safety assessment requirements. These include assessment of acute toxicity and some systematic toxicity tests. If abnormalities arise then more detailed toxicological studies are undertaken.

• Information databases and exchange mechanisms are being established.

• A coding system for nomenclature of traditional Chinese medicine prescriptions is being established.

2.2 Country reports

Country reports on the status and activity of herbal medicine were presented by the temporary advisers and are summarized below.

Australia

Ms Laurayne Bowler communicated that responsibility for the regulation of medicine is split between States and Territories on the one hand, who deal with practitioners, and the Commonwealth on the other hand, with whom the responsibility for proprietary medicines largely lies. However, there is only limited control on the dispensing of raw herbal material. The Therapeutic Goods Act, which was passed in 1989, set out for the first time in Australia a system for the regulation of herbal proprietary medicines. Approximately 1500 herbal substances are contained in some of the medicinal products entered on the Australian Register of Therapeutic Goods. A recent government review of the Therapeutic Goods Act in 1997 has made a number of further recommendations to improve regulations on advertising, herbal standards, the

regulatory process and the food/drug interface, while imposing the minimum regulatory burden on industry necessary to protect public health and safety.

The regulation of Chinese herbal medicine practitioners is due for consideration by State and Territory health ministers early in 1998.

Cambodia

Mr Seng Lim Neou reported that many valuable traditional medicine documents and skilled practitioners were lost during the time of Polpot-Khmer Rouge. In 1979, the Government officially integrated traditional medicine into the national health system and it has played a significant role in Cambodian health care. However, since 1990 and the Government's adoption of a free market policy, its importance has gradually diminished. Currently, approximately 230 traditional healers are registered with the Health Department of the Municipality of Phnom Penh. They all work in the private sector and perform all tasks - from manufacturing and sales to patient treatment. There is no quality control of their products.

The national policy on traditional medicine is to increase the importance of Cambodian traditional medicine and encourage traditional practice as a complement to modern medicine.

China

Mr Shen Yu Long indicated that the administration of Chinese herbal medicine in China has two important aspects. The first is the policy of government support, (mutual development and promotion of modern and traditional Chinese medicine), which is signified in China's constitution. The second consists of the substantial infrastructure of research, education and training in herbal medicine existent in China. There are 170 Chinese medicine research institutes with about 15 000 professional researchers. There are 30 universities and colleges with a total of 37 000 Chinese medicine students.

Both aspects are symbolic of the substantial degree of recognition, support and integration of Chinese herbal medicine as part of the mainstream health care system in China.

Hong Kong

Dr Ting-hung Leung reported that, although Chinese medicine is very much an integral part of the health care system in the Hong Kong Special Administrative Region (SAR), China, there has been no specific legal control and recognition of Chinese medicine practitioners or medicines. There are an estimated 7000 Chinese medicine practitioners in Hong Kong. Following recommendations of a Working Group report (1989), a Preparatory Committee on Chinese Medicine (PCCM) was appointed by the Secretary of Health and Welfare in 1995. Recent recommendations from the PCCM include the establishment of a statutory framework to regulate the practice, the use of and trading in Chinese medicine. The Hong Kong Government would commence statutory registration of Chinese medicine practitioners by the year 2000 and regulation of Chinese medicines would occur in phases from that date. The Basic Law of the Hong Kong SAR provides that the Government shall formulate appropriate policies to develop both western and traditional Chinese medicine.

Japan

Dr Motoyoshi Satake stated that, in Japan, the practice of herbal medicine is restricted to western medicine doctors and pharmacists. In 1976, Kampo (traditional Chinese) medicines were introduced by the National Health Insurance System and have been used in hospitals and pharmacies. Herbal medicines sold in the market are estimated to be worth about US$1.5 billion, which is about 3.5% of the total medicine market. The Japanese pharmacopoeia contains over 100 monographs on traditional Chinese herbs.

A re-evaluation process is now occurring for some of the 210 Kampo products currently available under the Pharmaceutical Affairs Law. Some debate ensued as to what was driving this new evaluation of Kampo herbal formulae for which approval was already granted. The question was raised as to whether political, economic or social reasons were behind this re-evaluation.

Republic of Korea

Dr Soo-Myung Oh and Dr Dong-Suk Park reported that oriental medicine has a long history in the Republic of Korea and plays a significant role in the health care system. A particular form of traditional medicine developed from the combination of Korean and Chinese medicines. In 1952, a national medical law was passed establishing oriental medicine and modern medicine as parallels within the health care system. There are now 11 colleges providing six-year programmes in oriental medicine. There are now more than 9000 licensed oriental medicine doctors.

So far as herbal medicines are concerned, there are specialized guidelines for manufacturers and traders, and the Government is currently standardizing the commonly used proprietary herbal medicines. In 1996, the Department of Oriental Medicine within the Ministry of Health and Welfare was opened, employing experts in herbal medicine. Previously, western medicine pharmacists were readily permitted to dispense some herbal medicines, but now western pharmacists, in order to be authorized to dispense herbal medicines, are required to take a national examination spanning some 100 traditional Chinese prescriptions. A parallel system of oriental pharmacists is also being created which will provide experts capable of dispensing the full range of herbal prescriptions. The increasing public demand for herbal medicines requires further substantial national support at Government level.

Dr Park Sang-Pyo also provided a paper entitled, “Current status of herbal medicine in Korea”.

Lao People's Democratic Republic

Dr Boun Hoong Southavong reported that in rural areas, more than 90% of communities use traditional Lao medicine to prevent and cure disease. The Government of Laos has in place a national policy which actively promotes the use of traditional medicine and has set up the Research Institute of Medicinal Plants (RIMP). The development of Lao infrastructure for traditional medicine (including the RIMP) depends very much on WHO support and is currently quite fractured across the country. There is a significant effort in progress for the revival of traditional medicine. No clear regulatory mechanisms currently exist for traditional medicine practitioners or herbal medicines.

Macao

Dr Cheong Tai stated that the majority of Macao people believe in and rely on indigenous traditional medicines to satisfy their primary health care needs. In 1994, a law came into effect to ensure control of a number of aspects of traditional Chinese medicines, including their safety, efficacy and quality, and the regulation of trade and marketing. Importers, exporters and wholesalers and traditional Chinese pharmacies are required to hold licences. There are currently 100 licensed traditional Chinese medicine pharmacies in Macao. A form of defacto registration exists which requires that all products imported into Macao be registered and sold freely in their countries of origin. Where proprietary herbal medicines are exempt from registration controls in their own countries, then Macao importers are required to produce an analysis certificate for each individual batch. All traditional medicine products must comply with general labelling requirements. Over 400 herbs, including 31 classified as toxic herbs, are restricted for sale by licensed Chinese pharmacies. The list of toxic herbs is currently being updated and perfected.

Malaysia

Mrs Napsah binti Mahmud reported that implementation of registration and licensing of traditional medicines in 1992 marked the systematic regulatory control of traditional medicines in Malaysia. The registration exercise, while ensuring safety and quality of imported and locally manufactured traditional medicines, could also be considered a starting point for the upgrade of local herbal medicine manufacture. Manufacturing methods will need to comply with the basic elements of GMP by the end of 1997.

The Ministry of Health has recently set up committees to review the possibility of traditional medicines playing a formal role in the health care system. The three main areas of focus should be:

registration of traditional medicine practitioners;

education and training of practitioners; and

the identification of products with proven safety, quality and efficacy.

A National Committee on Herbal Medicines was also established in 1995 to look into such aspects as research and development on herbal medicinal plants, the establishment of a series of Malaysian herbal monographs, and developing strategies to ensure conservation of medicinal plants and to promote the herbal medicines industry.

Mongolia

Dr Miaegombo Ambaga reported that Mongolia has an abundant diversity of plant species and a rich tradition of utilization. There have been recent increases in the usage of traditional medicine and in the number of new plant preparations. A government drug agency monitors quality control of herbal medicines. Full registration of herbal medicine practitioners includes reference to three groups: western medical practitioners with little traditional herbal training, graduates from the new schools of traditional medicine, and a number of older private practitioners for whom examinations are available.

New Zealand

Dr Paratene Ngata shared with the Working Group the distinct nature of the Maori indigenous traditional healing practices. So far as the regulation of herbal medicine practitioners is concerned, Common Law principals operate in New Zealand, as they do in Australia. Herbal medicines are listable under New Zealand law (Medicines Act 1981 and Medicines Regulations 1984) and fall under the category of 'dietary supplements'. Dr Ngata indicated that the inclusion of traditional healing in the health system may occur through a system of Government 'purchasing' services for consumers. This would impose some formalization of healing activities to develop acceptable standards, which may in turn risk autonomy or compromise certain essential characteristics of healing.

Philippines

Dr Alfonso T. Lagaya summarized that the Philippine government is very supportive of activities related to the research, education and production of traditional herbal medicines and, for these purposes, has recently approved the establishment of the Philippine Institute of Traditional and Alternative Health Care.

There are two groups of practising herbalists in the Philippines - a handful of licensed modern medicine physicians and approximately 250 000 unregulated traditional herbalists. While the integration of traditional medicine into the current health care delivery system is intended, and Philippinthe plans for the future regulation of the large unregulated traditional medicine workforce will be fully implemented until the establishment of the Philippines Institute of Traditional and Alternative Health Care.

The production and sale of herbal medicines are regulated by the Department of Health. A listing system is established for local herbal and traditional drugs but imported proprietary medicines are currently exempted. Government policy is that herbal medicines will be used nationwide within a primary health care context.

Professor Nelia Cortes-Maramba added that there are new and substantial levels of evaluation of herbal medicines commencing from point of growth to the provision of the finished product.

Singapore

Dr Wong Kum Leng stated that while western medicine is the main form of health care in Singapore, herbal medicine continues to enjoy considerable popularity. In 1994, the Ministry of Health appointed a committee to review the practice of Chinese medicine. The Committee advocated the need to regulate the more than 2000 Chinese medicine practitioners in Singapore and also recommended steps to upgrade the standard of training. In 1995, the Ministry established a departmental Chinese Medicine Unit.

Singapore has adopted a phased approach, initial self-regulation is to be followed by statutory regulation. Statutory regulation for acupuncturists will be implemented by the year 2000, while that for Chinese herbalists is intended to be in place several years later. At present, herbal medicines are exempted from product registration unless they contain controlled substances - essentially, no licences are required for their manufacture, sale or importation. However, various aspects of herbal medicines are required to comply with the various legislations. No product registration for Chinese proprietary medicines is anticipated although products will be listed by the Government. Manufacturers will be licensed on the basis of GMP standards.

There is a prohibition on labelling and advertising claims for 19 diseases. There was some discussion as to the basis upon which the 19 prescribed diseases were selected.

Viet Nam

Professor Le Van Truyen reported that, since 1955, traditional medicine has played a formal role in Viet Nam. This has involved the re-establishment of traditional medicine as a component of public health care, the establishment of an appropriate network from central government to the local level, the training of traditional medical personnel, and the introduction of a programme of scientific research and international cooperation. A number of laws have been passed on the regulation of practitioners and medicines. The Vietnamese pharmacopoeia, which was compiled in the 1970s, is now being rewritten to include herbal medicine monographs.

However, despite these efforts, some problems still exist. There are two colleges in Viet Nam specializing in training personnel in traditional medicine, but the system of training needs reorganization. Nineteen out of 63 provinces are without traditional medicine hospitals and many other hospitals do not have traditional medicine departments. The demand for this form of medical care cannot currently be met. Presently, 30% of all patients are being treated by traditional medicine and an estimated 50% of the population want to be treated by traditional medicine.

2.3 Principles and format for the development of the guidelines

Dr Chen Ken led the Working Group discussion by clarifying the purposes of the guidelines and the context of their development. One role of WHO is to provide technical advice to Member States. Furthermore, WHO has already received requests from Member States for support in this area. In the context of herbal medicine practice, Member States generally face one of three difficulties: a lack of awareness within government of the role of herbal medicines; a gap between government interest and significant support; or, finally, a lack of relevant expertise in dealing with herbal medicines.

Many different countries and regional jurisdictions are grappling with a range of issues related to the practice of herbal medicine, its widespread and increasing usage and how best to ensure it is delivered safely and effectively to consumers. Preparing informed guidelines on the appropriate use of herbal medicine will support all nations in developing an appropriate national programme which reflects their specific requirements and cultural context. The guidelines are designed to act as foundation principles for all interested countries and jurisdictions.

These guidelines are designed to assist government determine policy and practice in herbal medicine. A series of principles for the formation of the guidelines emerged during discussion. These include that the guidelines:

• promote the practice and development of the appropriate use of herbal medicines;

• represent a set of generic principles able to be flexibly implemented by different jurisdictions according to their domestic contexts;

• are able to meet the needs and different situations of countries in the Region;

• support the harmonization of the promotion, management and regulation of herbal medicine without making significant impositions on individual countries;

• respect traditional knowledge in the formation of these guidelines;

• facilitate communication and information exchange between Member States, including the development of bilateral and regional cooperation;

• act as a reference point for government and health authorities; and

• may be used by manufacturers, researchers, academics and practitioners.

The Working Group was then organized into two discussion groups. The focus of the first discussion group was to develop draft guidelines on national policy and programme formation, and the regulation of herbal medicine practitioners. The second discussion group focused on issues related to the management and regulation of herbal medicines. These groups met independently for one and a half days each and developed draft guidelines which were then debated more comprehensively in plenary sessions.

2.4 Discussions on national policy and programme development

Discussion group members agreed unanimously that the formation of a national policy and programme for herbal medicine is a critical first step in giving support to and promoting the use of herbal medicine. A national policy will support the implementation of the practice of herbal medicine into the health care services of the country. It will also aid in the national and international coordination of regulatory structures, the establishment of suitable research programmes and the ability to undertake effective international collaboration.

2.5 Discussions on regulation of herbal medicines

The second discussion group focused on issues related to the regulation of herbal medicines. The group acknowledged that some form of regulation was required of manufacturers and distributors in that their products may be used widely by consumers. However, Good Manufacturing Practice (GMP) may not be able to be implemented in some developing nations that are heavily reliant on herbal medicines. The group agreed that phased implementation of regulatory requirements was important. The appropriate training of staff involved in regulatory matters was also raised and discussed. The WHO certification scheme on the qualify of pharmaceutical products was identified as a scheme that may be of help in small countries where there are no facilities or mechanisms for the systematic evaluation of the safety of herbal products.

During the one and a half days of discussion that followed, a number of areas were considered and debated, including:

• the distinct regulatory requirements for raw plant materials, processed plant materials, and medicinal herbal products;

• marketing, labelling and advertising issues;

• regulatory measures consistent with the conservation of species;

• general aspects of safety assessment (toxicity studies, safety based on experience);

• general aspects of assessment of efficacy and intended usage; and

• monitoring of adverse reactions to herbal medicines.

2.6 Final discussion on the guidelines

After one and a half days of group discussion, the Working Group resumed activity in a plenary session, providing opportunity for further discussion. One of the principal concerns was the way in which guidelines may be interpreted by regulatory authorities. The Working Group, while wishing to provide some direction on the kind of safety data that may be required of some herbal medicines, did not wish this to result in significant impositions for some countries who might have substantial difficulties in implementing stringent regulatory measures. Furthermore, there was a strong feeling among some members of the Working Group that regulatory guidelines with long lists of potential data requirements may inappropriately encourage regulatory authorities to require more rather than less. This may overlook the fact that herbal medicines by definition have been used extensively and over long periods of time and that some modifications, such as dosage forms or indications, may not fundamentally affect the herb's safety. The history of use of a substance should in most cases be adequate evidence of its basic safety.

The regulation of practitioners was discussed at some length and it was agreed that only limited review of this area would be provided in the guidelines. Forms of professional regulation vary significantly within and between nations, reflecting the varying legislative structures, and the Working Group deemed it appropriate only to make general recommendations in this regard.

2.7 Closing ceremony

In his closing remarks, Dr S.T. Han, Regional Director of the WHO Regional Office for the Western Pacific, stated that he accepted the recommendations of the expert Working Group and that he would ask his operational staff to prepare a plan for their implementation. He commented that he was most impressed by the focused and detailed discussions and the productiveness of the Working Group in developing the guidelines. Dr Han communicated his reservations, however, that imposing GMP on the herbal medicines industry, particularly in developing countries, may not at this stage be a realistic goal. Each country will need to determine the appropriate times for the implementation of various parts of the guidelines. Dr Han expressed confidence that the final guidelines accurately reflected the substantial expertise contained within the membership of the Working Group.

Dr ST. Han's closing remarks is attached as Annex 5.

On behalf of all participants, Dr Wong acknowledged the effort and support of the WHO Regional Office for the Western Pacific in holding the Working Group meeting and thanked all temporary advisers and the two consultants for their continued efforts throughout the week in devising the final guidelines based on the discussions of the Working Group.

3. Conclusions and recommendations

3.1 Conclusions

The Working Group recognizes the significant growth that has occurred in the use of herbal medicines in the Region and the major health care role they play in many countries. Major advances have also occurred in research on herbal medicines, confirming their value and significant contribution to health care services. Their increasing use also raises the need for appropriate monitoring and evaluation of herbal medicines.

The Working Group recognizes that the work of WHO is important in providing direct guidance and support to countries and areas in the development of national herbal medicine policies and programmes. WHO can continue to make a major contribution to public health through supporting the development of policies that generate better access to quality herbal medicines.

The Working Group recommends that the WHO Regional Office for the Western Pacific continues to develop, expand and adjust as necessary the technical, managerial and administrative tools needed for the formulation and implementation of national herbal medicine policies in accordance with these proposed guidelines. It further recommends that WHO continues to strengthen its support to countries in developing and implementing national herbal medicine policies.

It is highly desirable that the WHO Regional Office for the Western Pacific plays a role in stimulating collaboration among Member States for purposes such as general information exchange, standardizing nomenclatures, and sharing research knowledge and experience.

These guidelines, which were formally adopted by the Working Group, represent a milestone in that they signal a common direction for the appropriate use of herbal medicines that, in turn, can be either adopted or adapted by Member States in the Region.

One immediate outcome of this Working Group meeting is that the Working Group volunteers to form an informal network to facilitate information exchange on herbal medicines and to collaborate in other areas with a view to expanding the networking as appropriate. This reflects the priority given by members of the Working Group to these issues.

3.2 Recommendations

The Working Group's main recommendations are reflected in the Guidelines for the Appropriate Use of Herbal Medicines. In addition, the members of the Working Group provide the following recommendations which are focused on the implementation of the Guidelines:

(1) WHO should promote the use of the Guidelines for the Appropriate Use of Herbal Medicines among Member States by:

• reporting the contents of these Guidelines to Member States;

• helping Member States to organize training courses, seminars and national workshops on the appropriate use of herbal medicines;

• helping Member States to set up an action plan for the development of a national policy on the appropriate use of herbal medicines; and

• encouraging Member States to translate the Guidelines into national official languages.

(2) Member States should be urged to develop national policies and programmes to promote the appropriate use of herbal medicines as part of the national health care services. WHO Guidelines for the Appropriate Use of Herbal Medicines could be used as a basis for developing a national policy and programme on herbal medicines. As an initial step, each Member State should assess the need and extent of regulatory mechanisms required to promote safe and effective use of

herbal medicines. Attention should be directed to the regulation of herbal medicine practitioners and related workers, regulatory provisions related to manufacturing and distribution, and evaluation mechanisms for herbal medicines.

(3) A collaborative framework among countries and areas in the Region to support the appropriate use of herbal medicines should be established. The framework should include mechanisms to facilitate the exchange of information, the preparation of monographs on medicinal plants and the development of training and education resources and programmes. The WHO Regional Office for the Western Pacific should coordinate the development of the collaborative framework. To facilitate this activity, Member States should advise WHO of:

• progress on implementation of their national policies and provide copies to WHO for distribution, including regulating structures that have been adopted;

• proposals to develop resources, such as monographs and training programmes and provide to WHO copies of these resources; and

• adverse effects or particular problems which may be of importance or interest to Member States.

The WHO Collaborating Centres for Traditional Medicine and other interested institutions could play an active role in supporting the coordinating activities of WHO. Members of the Working Group will form an informal network to facilitate information exchange and collaboration on herbal medicine matters among them and to support WHO programme activities in the area of herbal medicines.

(4) Medicinal plants represent valuable natural resources. There is an increasing concern surrounding the issue of endangered species of plants with significant therapeutic benefits. Member States are therefore urged to:

• document endangered species in their countries;

• develop a sustainable conservation plan which may include ex-situ, in-situ and on-farm conservation, natural parks, botanical gardens, and seed banks for medicinal plants; and implement appropriate regulation for the sustainable development and management of these endangered species.

(5) In consultation with indigenous people and with their involvement, Member States should actively encourage.

• the identification of indigenous plants with significant therapeutic activity;• research into their safety and efficacy; and• applied research on their use.

The private sector and industry should be encouraged to participate in these efforts.

(6) The Working Group notes the recommendations made by the WHO Working Group on the Safety and Efficacy of Herbal Medicines in 1992 encouraging research on herbal medicine. The Working Group reaffirms these recommendations and encourages WHO and Member States to maintain their efforts in promoting scientific research on herbal medicine.

(7) It is noted that several computer databases on medicinal plants and herbal medicines are available and a new database on toxicity of herbal medicines will be developed. An active programme of promotion and education should be developed to ensure that existing databases are used and information from these databases is disseminated

Rejuvenation WorksStressed, Tired, Overworked?

Feel, Look, Live, Like You Used To... Be Yourself Again, Rejuvenate…

One Price, All -Inclusive Health Rejuvenation Seminar for

EducatorsDr. Kulisz is available for public speaking on the following topics.  Every topic can be presented in two ways:  general information on the subject -- length of each lecture is about 1 - 2 hours, or conference/seminar format lasting from about 6 hrs to 16 hrs (two days) depending on the depth required.

"American health paradigm - politics and economics; treatment vs. cure."

"Today's patient expectations and the reality of the treatment outcomes."

"Natural stress relief."

"Tired of Being Sick and Tired -- Chronic Fatigue Syndrome: Recovery and Prevention"

"Getting out of depression naturally."

"The other side of cholesterol."

"How to restore and retain great health beyond the middle age."

"Rejuvenating intimacy naturally." 

"Nutritional support in cancer treatment and post-treatment recovery."

"Diabetes -- can it be corrected naturally?" 

"Healthy heart naturally."

"Fats -- the misunderstood essential nutrient."

"Female incontinence: prevention and recovery naturally."

"Yeast infections: natural prevention and recovery." 

"Nutritional support for Alzheimer's patients."

 "Healing prostate naturally."

"Proper selection and use of nutritional supplements."

"Economics of Biomedical Industry"

"Urinary Incontinence: Medical, Social and Economic Consequences"

"Objectivity of  Clinical Trials"

"Regulatory Approvals -- Scientific Proof vs. Government Bias."

"Platform Technologies in Medical Industry – a Better Approach to Affordable

Treatments"

"Incontinentce, the Secret Women don't Want to Talk About, but Should"

"Incontinence - the Investment Opportunity for the XXI Century"

"Physics in the Development of Medical Instrumentation"

"Importance of Specialized Investments in the Medical Device Industry"

"Losing Ground to Alternative Medicine"

The above topics when combined can create two and three day seminars depending on the depth of interest: Executive Health Seminar:A two-day seminar pertaining to the health improvement and prevention among highly stressed/highly driven executives.  The seminar addresses the following:

"American health paradigm - politics and economics; treatment vs. cure."

"Today's patient expectations and the reality of the treatment outcomes."

"Natural stress relief."

"Getting out of depression naturally."

"The other side of cholesterol."

"Tired of Being Sick and Tired -- Chronic Fatigue Syndrome: Recovery and Prevention"

"How to restore and retain great health beyond the middle age."

"Rejuvenating intimacy naturally." 

"Nutritional support in cancer treatment and post-treatment recovery."

"Diabetes -- can it be corrected naturally?" 

"Healthy heart naturally."

Healthy and Conscious Living Seminar

A two-day seminar pertaining to the health improvement and prevention addressed to general

population.  The seminar addresses the following:

"Today's patient expectations and the reality of the treatment outcomes."

"The vaccination debacle: how to recover naturally from undesired side effects."

"Healthy heart naturally."

"Fats -- the misunderstood essential nutrient."

"The other side of cholesterol."

"Tired of Being Sick and Tired -- Chronic Fatigue Syndrome: Recovery and Prevention"

"Female incontinence: prevention and recovery naturally."

"Yeast infections: natural prevention and recovery." 

"Nutritional support for Alzheimer's patients."

 "Healing prostate naturally."

"Proper selection and use of nutritional supplements."

Medical Economics SeminarA two-day seminar pertaining to the economic aspects of the biomedical/pharmaceutical industry.  The seminar addresses the following:

"Economics of Biomedical Industry"

"Today's Patient Expectations and the Reality of the Treatment Outcomes"

"Urinary Incontinence: Medical, Social and Economic Consequences"

"Objectivity of  Clinical Trials"

"Regulatory Approvals -- Scientific Proof vs. Government Bias."

"Platform Technologies in the Medical Industry – a Better Approach to Affordable

Treatments"

"Incontinence, the Secret Women don't Want to Talk About, but Should"

"Incontinence - the Investment Opportunity for the XXI Century"

"Physics in the Development of Medical Instrumentation"

"Importance of Specialized Investments in the Medical Device Industry"

"Losing Ground to Alternative Medicine"

 Introduction When completing interest surveys of preferred worksite health promotion activities, employees consistently identify stress management programs as a top priority. Workers understand the role that stress plays in their lives, and are searching for assistance in how to keep stress under control. In a national survey conducted by the Northwestern Life Insurance Company (1992) seven in ten American workers indicated that job stress is causing frequent health problems and has made them less productive. Among these same employees, 46 percent reported that their job was very stressful, 34 percent thought about quitting their jobs because of workplace stress, and 14 percent did leave their job because of stress. Further evidence provided by Metropolitan Life Insurance Company estimates that an average of one million workers are absent on any given day largely due to stress disorders (Rosch & Pelletier, 1984), and a study by the American Academy of Family Physicians (1979) found job stress to be the greatest cause of poor health habits.

The influence of stress on physical and psychological well being is well documented. Stress has been implicated in heart disease, eating disorders, stroke, insomnia, ulcers, accident proneness, cancer, decreased immunity, chronic headaches, diabetes, depression, substance abuse, chronic pain, irritable bowel syndrome and chronic fatigue. In fact, estimates are that 50 to 80 percent of all physical disorders have psychosomatic or stress related origins (Rice, 1992). As reported in the Northwestern National Life Insurance Company's stress in the workplace study (1992), workers who report high stress are three times more likely than workers reporting low stress to suffer from frequent illness.

These stress related illnesses severely impact on the employer as well as individual employees. Donatelle and Hawkins (1989) determined that stress on the job costs businesses over 150 billion dollars per year. Scott and Jaffe (1994) reported that stress related disability cases have doubled in the last ten years. They go to cite that in California, the average cost of each claim is $73,270 (California Worker's Compensation Institute, 1990).

In response to this health and economic threat, many worksite health promotion programs are attempting to help individuals learn to control the harmful stress in their lives. A national survey by the Office of Disease Prevention and Health Promotion (1993) found that 37% of worksites offered some form of stress reduction activities. According to the government document, Healthy People 2000, (1990) by the year 2000 the goal is to raise this to at least 40%. In Stress and Well-Being at Work, Quick, Murphy, and Hurrell, (1992) have suggested a model for occupational well-being and distress prevention which focuses on: (a) primary prevention to reduce risk factors or change the nature of occupational stressors, (b) secondary prevention to alter the ways in which individuals respond to the risks and stressors, and (c) tertiary prevention to heal those who have been traumatized or distressed at work. A comprehensive approach to stress control at the worksite will offer the most effective measure of dealing with stress related illnesses and losses in productivity. In discussing examples of each of these approaches, Scott and Jaffe (1994) offer a succinct overview of worksite stress management programs. Employers may choose to address organizational factors that contribute to workplace stress, offer rehabilitation services for stress related illnesses, or promote individual coping skills to deal with daily stress.

Stress is not the same for all people and one approach will not work for all employees. As an example, providing employee training in individual coping techniques as a preventive measure without also correcting negative stressful working environments is short sighted and may be

viewed by some as blaming the victim for the problems of the corporation. Additionally, many personal stressors are not work related and will not be improved through environmental or organizational changes. The NWNL study (1992) determined that two out of three employees felt stressed by factors outside the workplace. Clearly, an effective stress reduction program must be broad based enough to deal with a host of stress related causes and outcomes.

In light of the available research, it is unfortunate that so few of the worksite health promotion programs offer more than the occasional seminar on stress or time management for employees. Many corporations may have enlisted the services of employee assistance programs for the treatment of stress related disorders, but too often preventive programs are lacking. In examining other aspects of the health promotion program, it is common to see extensive fitness and exercise facilities staffed by well-trained personnel. One is much less likely to see qualified staff and facilities devoted to the prevention of employee stress.

Summary A stress management and relaxation center should be part of any complete worksite health promotion program. The emphasis of such a center is on allowing individuals to experience a variety of stress management techniques and to develop competence in one or more techniques. A commitment by the employer to reduce work related stress while promoting the concept of a stress management and relaxation facility, demonstrates a concern in the lives of the workers and the stress in their lives. By empowering individuals to better manage their stress and relax, health promotion professionals will ensure a healthier and more productive workforce.

TOPICS FOR SEMINAR

Workshops, Presentations and Seminar Topics

Comprehensive Acute Traumatic Stress ManagementThis presentation can be targeted to the specific audiance requesting the program. Businesses, non-profit organizations, schools, universities, emergency responders, can all benefit from policy development, situation planning, and skill building addressed in this presentation.

Stress Management and Emotional WellbeingTechniques and strategies for enhancing emotional health and happiness in today's world. This session describes what we know about people who are happy and able to deal with stressful situations effectively. It emphasizes skill building and practical suggestion for the implementation of lifestyle change strategies.

Time/Life Management: Balancing Work and Life in a Busy WorldThis interactive workshop leads people to develop a process to determine what is most important in their lives and then helps them plan how to make effective changes to increase life satisfaction.

e hold these seminars in Reading twice a year - each one has a different theme. This one was on digestive health. The objective of the seminars is firstly to give students studying our Discovering Herbal Medicine course an opportunity to meet the teaching team, and secondly to show how herbs, alongside nutrition and mainstream medicine, can be used to help regain and maintain health. While we indicate what people can do for themselves, we also emphasise those conditions which require professional guidance."