Mudworm control in abalone DEVELOPMENT OF AN INTEGRATED MANAGEMENT PROGRAM FOR THE CONTROL OF SPIONID MUDWORMS IN CULTURED Judith Handlinger, Mark Lleonart & Mark Powell October 2004 FRDC Project No. 98/307 (Incorporating CRC for Aquaculture Project A.2.6.) FRDC Final Report Page Mudworm control in abalone TABLE OF CONTENTS SECTION 1 BACKGROUND
On the website Treatment methods of erectile dysfunction full Specifications how to take these tablets. Be sure to check before use.Je l'ai acheté le médicament cialis prix deux ou trois fois, l'effet est des pilules superbes, je ne ne nous a pas déçus même si je suis au dernier étage sur la pilule. Männer werden empfohlen, für mindestens 30 Minuten für den angeblichen Geschlechtsverkehr durchschnittliche Rendite von cialis 20mg zu verwenden.
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Pt. Govind Ballabh Pant Memorial Lecture - XI
Medicinal Plants for Health Care Prof. S.S. Handa
Earth Environment and Marine Sciences & Technologies, UNIDO
September 10, 2006, Mohal-Kullu, H.P.
Anbout Prof. S.S. Handa
Ex-Director, RRL-Jammu (CSIR) and formerly Professor and Head of the University Institute of Pharmaceutical
Sciences, Panjab University, Chandigarh;
Presently Senior specialist Industrial utilization of Medicinal and Aromatic Plants,
Earth Environment and Marine Sciences & Technologies United Nations Industrial Development Organization
International Centre for Science & High Technologies
Area Science Park, Padriciano 99. 34012 Trieste, Italy.
(Permanent residence: C-522A, Sushant Lok-1,Gurgaon – 122 002)
Pandit Govind Ballabh Pant Memorial Lecture
The economic value and future potential of the biological resources of a country are getting redefined in the wake of the newly emerging international trade regulations from a system, held over countries, where these resources were viewed as global heritages, they are now being treated as invaluable reserves for the future of the country with an untapped economic potential. Unlike that for physical resources, we do not have yet a system of defining 'biological resource holdings' of a country and consequently there is a greater chance of these resources leaking out to other countries even before their potentiality is realized by the host countries. Thus there is an urgent need for developing inventory systems (qualitative and quantitative) that help defining the biological holdings of a country. Databases and documenting systems of biological resources of a country are useful in conservation, commercialization and in establishing the patent rights. The Government of India has taken timely initiatives in establishing National Bioresource Development Board (NBDB) which is taking requisite measures to take care of our bioresources and GB Pant Institute of Himalayan Environment and Development has been playing a very active role with respect to MAPs by not only maintaining gene banks but making appropriate selection of rich strains for commercial exploitation. I greatly appreciate the efforts of all the members of the institute and on this gracious occasion I congratulate them for their contributions in the national endeavour. Our country is among 12 leading biodiversity centres of the world with 45,000 plant species in 16 agroclimatic and 10 vegetative zones. We have 18,000 flowering plants, 44% of which are of medicinal significance. These medicinal plants are the richest resource of our traditional medicines, phytopharmaceuticals, modern allopathic drugs, household remedies and nutraceuticals. The use of phytopharmaceuticals is increasing at the rate of 15 percent annually. Global market is booming for MAPs and their products. Our contributions in the world market are not significant. Therefore, we need to look seriously on various issues, problems and technologies. The problems include Quality parameters not being followed, unregulated trade, nearly 90 percent dependence on natural resources, agro-practices, post-harvest and post gathering practices are not appropriate, storage conditions deplorable leading to inconsistency in quality. The issues which need to be addressed include regulatory especially registration of herbal products, non-existent nutraceutical regulations, unregulated medicinal plant extract industry, safety aspects etc. We need to strengthen agro, post harvest, grinding, extraction of plants, isolation of phytoconstituents, formulation technologies. Extensive use of qualitative and quantitative techniques for quality assurance. Some of the leads obtained in medicinal plants by Indian scientists will be highlighted and certain current needs and developments in medicinal plant based products shall be discussed. Some of these would include Phytosome herbal drug delivery, raw material for synthetic drug tamif1u (birdf1u H5N1 virus), polysaccharides as safer therapeutics and for other industrial uses, promoting Indian gums through scientific inputs, sugar substitutes having least caloric values, improving quality of plant purgatives, chemotypes of medicinal significance, organic farming for Pharma products, enzymes such as phytases, systems biology, roadmap to safe, efficacious, quality assured and scientifically validated herbal drugs and plant derived allopathic drugs. Aromatic plants for global volatile oil production will be also discussed. Some of the priority disease areas such as protozoal diseases (like malaria, filarial, leishmania), cancer, rheumatic diseases, diabetes, bronchial asthma, viral diseases, liver disorders and mental disorders where medicinal plants can play a crucial role have been It is indeed an honour and privilege to be asked to deliver the Pandit Govind Ballabh Pant memorial lecture. On this occasion I would like to pay my homage to revered Pandit Govind Ballabh Pant, a great son of India, an enlightened, visionary and inspiring leader, statesman par excellence and freedom fighter of our country. Bharat Ratna Shri Govind Ballabh Pant's contributions to the nation are immense and monumental. Being one of the chief architects of free India, he held many prestigious positions including those of the Chief ministership of Uttar Pradesh and Home Ministership of the country. He hailed from Himalayan region and the Government of India has very rightly established an institute, in his cherished memory, on the occasion of his birth centenary year (1987-88), called the Govind Ballabh Pant Institute of Himalayan Environment and Development at Almora. All his life, Pandit Pant was in close contact with people and had great concern for their well being. 2. Glimpse of Himalayan Drug Plants
As Himalayan region is one of the richest repositories of medicinal and aromatic plants which contribute
immensely to the drug-armamentarium of all the traditional systems of medicines and modern
therapeutics, it is with this background that I have chosen the topic "medicinal plants for health care".
The Himalaya has been fountain head of yogic wisdom and spirituality of millions of Indians, not
withstanding their differing religious beliefs. The mountain chain has influenced the life, culture and
history of India. The holy epics like Ramayana and Mahabharata carry excellent descriptions of 2800 km
long Himalayan belt occupying an area of about 591,000 sq. km (18% of India) inhibited by nearly 52
million people covering 12 states including union territories.
Senior specialist Industrial Utilization of Medicinal and Aromatic Plants, United Nations Industrial Development Organization, International Centre for Science & High Technology, Area Science Park, Padriciano 99, 34012 Trieste, Italy To save the life of Lakshman, the younger brother of Lord Rama, Hanuman travelled to the Himalaya in search of Sanjiwani booti (life saving herb). Thus the Himalaya is well known for a whole range of medicinal and aromatic plants some of which have gone into commerce and have their centre of origin in the Himalaya. Among the important ones are Asparagus racemosus (galactagogue of Indian origin), Atropa belladonna (source of antispasmodic atropine), Aconitum heterophyllum (high value bitter tonic), Berberis species (one of the richest source of pharmacologically active alkaloid berberine), Colchicum-luteum (containing antigout colchicine), Coptis teeta (another source of berberine), Cymbopogon species (citral source for production α-ionone & β-ionone), Curcuma zedoaria (well established anti-inflammatory drug and wonderful wound healer), Digitalis purpurea, Digitalis lanata (both producing cardiotonic glycosides), Dioscorea deltoidea, D. prazeri, D. floribunda (very first and rich source of diosgenin used for the synthesis of cortocosteroidal drugs), Ephedra geradiana (contains bronchodilatory ephedrine used for the treatment of bronchial asthma), Gentiana kurrooa (hepatoprotective drug), Heracleum spp (source of xanthotoxin), Hyoscyamus niger (source of hyoscyamine and hyoscine), Inula racemosa (pushkarmool of Ayurveda for bronchitis), Mentha arvensis (commercial source of menthol), Nardostachys jatamansi (tranquilizer and sedative), Orchis latifolia (for unspecified diarrhea in children), Papaver somniferum (source of analgesic morphine and antitussive codeine), Physochlaina praelta
(commercial rich source of atropine and hyoscyamine), podophyllum hexandrum (source of
podophyllotoxin for producing anticancer drugs etoposide & tenoposide), Picrorhiza kurrooa (drug for
liver protection), Saussurea lappa (antidiarrheal, antiemetic & digestive), Swertia species (bitter tonic),
Valeriana wallichii (sedative and tranquilizer), Voila adorata (expectorant).
3. Medicinal plants: well spring of Traditional and Modern drugs
The use of plants as source of medicinal agents lies deep in the roots of autiquity. No one will ever know
what led primitive man emerging from his ancestral, origin, to select certain plant material for the
treatment of various ailments and diseases though it may be assumed that during the long transition from
instinctive behaviour to more rational action, there was a conscious realization that certain roots, leaves,
bark, fruits and even plant exudations had some beneficial action. This knowledge and the characteristics
of the plant material, or even the entire plant itself, would be remembered for future occasions and the
information passed on to others by word of mouth. Later, as different civilizations developed, man was
able to communicate his knowledge and ideas, first by carving into stones or clay and later by writing on
parchment or paper with the result that his knowledge became known to the coming generations.
Reverence may be made to the clay writings from the library of the Assyrian king, to the Ebers Papyrus
and to the writings of Dioscorides to indicate sources of our knowledge today about the crude drugs by
Arabians, Babylonians, Chinese, Egyptians, Greeks, Indians, Persians, Romans and Sumarians thousands
of years ago. The oldest treatises dealing with Ayurveda are Susruta samhita and Charaka samhita both
compiled between 500-300 B.C. The development of the Ayurvedic system of medicine was based on
scientific approach and methodology. Many of the drugs used in the traditional systems have stood the
test of time.
With the advent of European scientific methods, many of the reputed medicinal plants came under
chemical scrutiny, leading to the isolation of active principles. Beginning with A.D. 1800 there was
continuous activity in this area and many of the well known medicinal plants were chemically analysed
and their active principles characterized. Soon after their isolation and characterization, these compounds
either in pure state or in the form of well characterized extracts, became part of pharmacopoeias of several
countries. To cite well known examples reference can be made to ephedrine, morphine, quinine and
emetine which still occupy an honourable place in pharmacies. The Chinese crude drug Ma Huang has
been in use in China for over 5000 years for the treatment of fevers and respiratory ailments. Its active
component ephedrine was isolated in 1887 by Nagi and Hari in Japan. Detailed pharmacological work
follwed and the compound was introduced in western medicine in 1925 by Chen of Eli Lilly company.
Morphine was isolated from opium poppy (Papaver somniferum) in 1804 by Sertuner and was introduced
in medicine in 1818. Quinine isolated by Pelletier in 1820 from a Peruvian tree. Cinchona, was
introduced as an antimalarial drug in 1825. From a Brazilian medicinal plant Cephaelis ipecacuanha an
active principle emetine was isolated in 1894 and introduced in medicine in 1912. Thus pharmacists in
pharmaceutical industry started paying attention to the chemical constituents of drugs, especially aconite,
belladonna, cinchona, digitalis, ergot and opium. Morphine has given the organic chemists an interesting
lead on which to base a large number of opioid analgesic drugs and the same may be said for the natural
drug quinine for numerous antimalarial drugs. Many new and useful drugs based upon these natural
products are now available but they have not been able to replace effectively till today these two alkaloids
in medical practice.
It has been estimated that from 250,000 to 750,000 species of higher (flowering plants) exist on earth; some of these have not yet been botanically described. Although there is no way to determine accurately how many of these species have been used in traditional medicine, a reasonable estimate would be about 10% or from 25,000 to 75,000 species. However, perhaps only about 1% of these are acknowledged through scientific studies to have real therapeutic value when used in extract form by humans. Virtually all such plants have been discovered and put to wide spread use in traditional medical systems through information derived from their use in folk medicine, ethnomedicine or traditional medicine. World population is 5 billion today and with this rate of growth it is likely to touch 7.5 billion by the year 2020. Global estimates indicate that over 3/4th of the five billion world
population cannot afford the products of the western pharmaceutical industry and have
to rely upon the use of traditional medicines, which are mainly derived from plants. This
fact is well compiled by W.H.O. in an inventory of medicinal plants list in over 20,000
species. As a part. of strategy to reduce financial burden on developing countries which
spend 40-50% of their total health budget on drugs, W.H.O. currently encourages,
recommends and promotes the inclusion of herbal drugs in national health care
programmes because such drugs are easily available at a price within the reach of a
common man and as such are time tested and thus considered to be much safer than
the modern synthetic drugs. Resurgence of interest in herbal drugs in the western
European countries is evident from the fact that two volumes of British Herbal
Pharmacopoeia have been published and $ 33 million worth literature on herbal
products was sold in the USA in 1990. The "green wave" in the utilization of medicinal
plants resulted in higher consumption. Only recently British Pharmacopoeia
Commission and European Pharmacopoeia Commission both have decided to include
atleast 20 Ayurvedic Indian medicinal plants and 20 Chinese medicinal plants in their
respective Pharmacopoeias. International agencies like W.H.O., UNIDO and FAO are
promoting the industrial use of medicinal plants in National Health care programmes of
all countries. The current world trade in medicinal plants is nearly US$ 60 billion and as
per world Bank estimates by the year 2050 this figure will touch US$ 5 trillion for
medicinal plants trade in the world.
4. Medicinal Plants Based Drug Industries
Business opportunities in the medicinal and aromatic plants sector are exponentially expanding due to
diversified uses of the plant derived molecules in pharma, cosmetics, nutraceuticals and agri-chemical
industries. A shift from the present mind set of collection and consumption to cultivation for utilization
will automatically ensure purity, authenticity and availability of MAPs for various end-user industries.
Medicinal plant based drug industry has four major segments, viz. (i) plant drugs for Indian systems of
medicine covering Ayurvedic, Unani and Siddha systems, (ii) over the counter, non-prescription items
involving plant parts, extracts and galenicals (iii) essential oils and (iv) phytopharmaceuticals. Medicinal
plants as resource of drugs (see figure 1)
4.1 Medicinal plants based drug industries in Indian Systems of Medicine
There are at present 8000 manufacturers of drugs for Indian Systems of Medicine. Besides, there are many small manufacturing units using medicinal plants and thousands of Vaidyas preparing their own drugs from various plants. Annual herbal drug production has been estimated at around Rs.5,500 crores. Various bottlenecks in the Indian herbal drug industry have been discussed elsewhere 2. 4.2 Plant parts extract and galenicals
The direct utilization of plant material is a feature of traditional medicines not only in the developing
world but also in Europe and the U.S.A. e.g. herbal formulations on health food shops. Preparations
of decoctions, tinctures, galencials and total extracts of plants also form a part of many
pharmacopoeias of the world. The current trend of medicinal plants based drug industry is to procure
standardized extracts of plants as raw material.
At present, there are nearly twenty herbal extract manufacturers in the country (out of which 50% are
very small manufacturers) with an annual turnover of less than Rs. 4 crores. Major herbal extract
manufacturers are given below with their annual turnover in brackets:
a. Alchem International, New Delhi (80 crores) b. Sami Labs, Bangalore (65 crores) c. Chemilloids, Vijayawada (60 crores) d. Indfrag, Hosur (22 rores) e. Arjuna extracts, Alwaye, Kerala (20 crores) f. Sanat Products, Ghaziabad (17 crores) g. Amsar, Indore (12 crores) h. Dhanwantri, Bangalore (12 crores) i. Natural Remediies, Bangalore (10 crores) j. Phytotech (5 crores) 4.3 Essential oils from plants
The essential oil industry was traditionally a cottage industry in India. Since 1947, a number of industrial companies have been established for large scale production of essential oils, oleoresins and perfumes. The essential oils from plants being produced in India include ajowain oil, cedarwood oil, celery oil, citronella oil, davana oil, eucalyptus oil, geranium oil, lavender oil, lemongrass oil, Mentha oil, palmarosa oil, patchouli oil, rose oil, sandalwood oil, turpentine oil and vetiver oil (see figures 2-5). The manufacture of turpentine oil, and resin form pines is a sizable and well established industry in India having 10,000-25,000 tonnes annual production of the oil. α-pinene and δ-3 carene are the two vital components produced from the oil. α-Ionone from lemongrass oil for perfumery and β-ionone for Vitamin A synthesis are produced in India. Before, 1960, menthol was not produced in India but the introduction of Japanese mint, Mentha arvensis and subsequent improvements thereupon enabled India to produce over 500 tonnes of menthol and now tops the world market in export of natural menthol. Annual world production of limonene is 50,000 tonnes and Brazil is the biggest producer in the world market. It is a by-product of citrus industry. Though turpentine oil and eucalyptus oil also yield limonene but the best economically cheap raw material is the discarded orange and lemon peel which is being used by Brazilian phytochemcial industry. India has not yet tapped this source for limonene production. During the last five decades, the Indian essential oil industry has made excellent progress. India today is the largest producer of menthol in the world and other aromatic plants such as Mentha piperita, M. citrate, Himalayan cedarwood, Jamrosa, basil etc have become commercial essential oil yielding crops. Like wise Indian flower extracts from Jasmine, Jasmine Sambac and tuberose have become internationally established. The Indian oleoresin and spice oils have also made excellent progress in global market. The world production of essential oil is estimated around 1.2 lakh tones per year valued around US$ 1 billion. 4.4 Phytopharmaceuticals
Before 1947, the production of plant based modern drugs in India was confined to quinine from Cinchona in three state owned factories and the very first phytochemi-cal industry for quinine was established by the then British Government at Mungpoo in Darjeeling. During the past three and half decades' bulk production of plant-based modern drugs has become an important segment of Indian pharmaceutical industry. Some of the phytopharmaceuticals which are produced in India at present include morphine, codeine, papaverine, thebaine, emetine, quinine, quinidine, digoxin, caffeine, hyoscine, hyoscyamine, xanthotoxin, psoralen, colchicine, rutin, berberine, vinblastine, vincristine, nicotine, strychnine, brucine, ergot, alkaloids, senna glycosides, pyrethroids and podophyllotoxin resin. Table 1 gives some important therapeutically used constituents isolated from medicinal plants and used in modern medicine. There are 130 such phytoconstituents used in modern medicine. Phytopharmaceuticals for which technology has been developed for undertaking large scale production include L-dopa from Mucuna beans, ajmaline and ajmalicine from Rauvolfia serpentina and Catharanthus roots, respectively, and 18 β-acetyl glycyrrhetic acid from Glycyrrhiza glabra. Indian Institute of Chemical Technology (I.I.C.T.), Hyderabad has developed methods for etoposide and tenoposide production and CIPLA is now producing it on commercial basis. At present 100 mg of etoposide is sold at Rs. 400/- per vial. National Chemical Laboratory, Pune, developed the method of vincristine (VCR) and vinblastine (VLB) production. CIPLA have further improved the process and now they are the third largest manufacturer of VCR and VLB in the world. Medicinal plants based drug industry is progressing very fast in India, but it is beset with a number of problems. Most alarming problem the industry has started facing and will face in future is the dwindling supply of plant material from natural resources. A national policy on medicinal plants with a view to preserve endangered species and promoting cultivation of plants which are being extensively used by industry will help in solving the major problem of the industry. Special attention is required on medicinal plants on which significant research leads have been obtained (Table 2) and the overexploited medicinal plants are given in Table 3. Trade in medicinal plants is largely unorganised and uncertain, both in demand and price structure. There is a need to have Marketing & Development Board for Medicinal and Aromatic Plants and Phytopharmaceuticals. Such a Board could interact, with the growers and user industry to bring stability in their production, demand, price, quality and also to help in fostering international trade Important Active Constituents of Plants Used in Modern Medicine
Active Constituents Plant Source
Catharanthus roseus Berberis species Camellia sinensis Capsicum annum Topical analgesic Erythroxylum coca Local anaesthetic Papaver somn!ferum Curcuma longa Antiinflammatory Colchicum alllUfnnale Gout; Antiinflammatory Holarrhena antidyse,r?ferica Digitalis lanata Rauwolfia vamitoria Bronchodilator, sympatho- Ephedra sinica Mimetic, decongestant Cephaelis ipecacuanha Claviceps purpurea Claviceps purpurea Vasoconstrictor for headache Glyyrrhiza, glabra Parasympatholytic Atr.opa belladonna Parasympatholytic Digitalis lanata Papaver somniferum Analgesic Smooth muscle relaxant Papaver somniferum Pilocarpus jaborandi Parasympathomimetic Podophyllum peltatum Cinchona species Cinchona species Rauwolfia serpemina Rauwolfia ca/lescens Cassia acutifolia Taxus baccata Adhatoda zeylanica Vinca minor Catharanthus roseus Vinblastine Warfarin Melilotus officinalis Blood thinner for clots Pausinystalia johimbe Treatment of impotence Medicinal Plants on which significant research leads have been obtained
Commphora mukul Boswellia serrata Picrorrhiza kurroa Phyllanthus amarus Centella asiatica Curcuma longa Antiinflammatory Andrographis paniculata Withania somnifera Coleus forskholi Acorus calamus Sida rhombifolia Albizzia lebeck Valeriana wallichii Overexploited medicinal plants of Himalaya
i. Critically endangered species
Name of the species Aconitum balfourii Aconitum deinorrhizum Aconitum falconeri Aconitum heterophyllum Aconitum violaceum Angelica glauca Arnebia benthami Atropa acuminate Root/leaf Berberis kashmiriana Dactylorhiza hatagirea Delphinium denudatum Dioscorea deltoidea Fritillaria roylei Gentiana kurroa Inula racemosa Nardostachys jatamansi Podophyllum hexandrum Root/fruit Saussurea costus Swertia chirayita Taxus wallichiana Stem bark/leaf Valeriana jatamansi
ii. Endangered species
Name of the species
Berberis aristata Berberis chitria Berberis lyceum Bunium persicum Heracleum candicans Picrorhiza kurroa Polygonatum verticillatum Root/leaf Rheum emodi Whole herb Saussurea obovallata Whole herb
(iii) Vulnerable Species
Name of the species
Artemisia absinthium Aerial part Artemisia maritime Aerial herb Bergenia ligulata Hedychium spicatum Jurinea dolomiaea Lavatera cashmiriana Paeonia emodi Rheum australe Thalictrum foliolosum Tribulus terrestris
5. India's strength in Medicinal Plant Wealth
If we dwell for a moment on our glorious past, Rigveda, one of the oldest repositories of human knowledge written between 4500-1500 BC mentions the use of 67 plants for therapeutic use and Yajurveda enlists 81 plants whereas Atharveda written during 1200 BC describes 290 plants of medicinal values, "Chakra Samhita" (900 BC) describes 341 medicinal plants and the next land mark in Ayurveda "Sushruta Samhita" (600 BC) mentions 395 medicinal plants3. India unquestionably occupies the top position in the use of herbal drugs, It is one of the, foremost countries exporting plant drugs and their derivatives, and excels in home-consumption too and this is not all surprising because of the following: - great biodiversity and abundance of flora - variety of geographical climatic conditions most exotic medicinal plants can be grown here - Indian systems of medicine dwell heavily on medicinal plants - long tradition of phytochemical research and scientific cultivation of medicinal plants - well developed pharmaceutical industry - rapidly growing phytochemical and herbal drug industry India is thus in a vantage position to exploit this source both for meeting the domestic demand for drugs as also for export. Medicinal plants continue to be an important resource material for therapeutic agents both in developed and developing countries4-7. The Figure A shows the medicinal plants resource and better utilization of traditional systems of medicine. India is among the twelve leading biodiversity centres of the world, harbouring nearly 45,000 plant species in 16 agroclimatic and ten vegetative zones. The Indian population is known to have used plants in health care regimens for over 5000 years. Nearly 70% of our population is dependent on traditional plant based medicines. Over 53 million tribal people of 550 tribal communities inhabit the Indian subcontinent and are reported to use around 7500 species of plants for medicinal purposes. PHYTOPHARMACEUTICALS
INTERMEDIATES FOR DRUGS
HOUSE HOLD REMEDIES
N OVE L ST
LEADS FOR NEW DRUGS
• US$ 60 b world trade;
MEDICINAL PLANTS INDIA AMONG 12 LEADING
• by 2050-US$ 5 tr
OF THE WORLD
• India's share only 2.5%
• 45,000 DIFFERENT
• 16 AGROCLIMATIC
• 10 VEGETATIVE
• 18000 FLOWERING
• 1800 BRYOPHYTES
RENEWABLE RESOURCE • 1600 LICHENS
ENVIRONMENT FRIENDLY PRODUCTS SAFER TO USE • 2,500 ALGAE
ATER ACC EPTABILITY Figure 1: An integrated approach to use medicinal plant resource for
5.1: Domestic demand for 20 major medicinal plants
Data for top 20 medicinal plants (quantity) is given in the table 4. It is observed that top 20 plants account for 66.2 percent of the total demand for 162 medicinal plants and account for 73.1 percent of total value7a. Estimated domestic demand for selected medicinal plants
Top 20 medicinal plant quantity-wise
(Tonnes) Share (%)
Emblica officinalis Gaertn. Asparagus racemosus Willd. Shatawar/Satawar Withania somnifera Dunal. Aswagandha/Asgandh Terminalia chebula Retz. HararlHalela Zard Saraca asoca [Roxb.] Aegle marmelos Carr.  Bael [Bark]  Belgiri Cassia angustifolia Vahl. Adhatoda vasica Nees Piper longun Linn. Bacopa monnieri [Linn.] Sida cordi folia Linn. Ocimum sanctum Linn. Bambusa bambos Druce. Boerhaavia diffllsa Linn. Azadirachta indica A. Juss. Solanum nigrum Linn. Woodfordia fruticosa Kurz. Andrographis paniculata Syzygium aromaticum Tinospora cordifolia [Wild] 120816.8 100.0
5.2 Medicinal plants with higher industrial potential
Policy makers have also suggested that with some degree of R&D efforts following plants have considerable potential for increased production. The states in which increased potential may be realized are also indicated for each of the plant. Plants with potential for increased production
Aconitum heterophyllum Mizoram, Goa, Himachal Pradesh, Acorus calamus Linn. Vacha/Waj-e-Turki Arunachal Pradesh Adhatoda vasica Nees Goa, Maharashtra, Dadra & NH, Mizoram Aegle marmelos Corr. Imphal,Tripura,Dadra & Nagar Haveli, Gujarat, Uttar Pardesh, Albizzia lebbeck Benth Dadra & NH, Gujarat, Daman & Diu Anacyclus pyrethrum DC. Himachal Pradesh Andrographis paniculata Mizoram, Maharashtra Aquilaria agallocha Roxb. Aralia racemosa Linn. American spikenard Asparagus racemosus ShatawarlSatawar Goa, Maharast)tra, Arunachal Pradesh, Guiarat, Himachal Padesh, Rajasthan, Uttar Pradesh Azadirachta indica A. Juss. Imphal, Jaipur, Goa, Maharashtra, Dadra & NH, Guiarat, Daman & Diu, Uttar Pradesh Bacopa monnieri (Linn.) Goa, Gujarat, Andhra Pradesh Boerhaavia diffuse Linn. Bryonia alba Linn Carum carvi Linn. Krishnaiirak-Kalaiira Cassia fistula Linn. Amaltas/Khivarshamber (Linn.) Manduk parni Urban Cinnamomum zeylanicurn Imphal, Mizoram, Bihar Commiphora wightii [Arn.] Uttar Pardesh,Goa ,Guirat, Maharashtra nurvala Varun Maharashtra, Gujarat BuchHam. Curcuma zedoaria Rose. Mizoram, Naaaland, Meahalaya Desmodium gangeticum Embelia ribes Burm.f. VayavidanaalBaobarana Emblica officinalis Gaertn. Uttar Pradesh, Tripura, Goa, Maharashtra. Guiarat Ephedra gerardiana Wall Himachal Pradesh Gentiana kurroo Rovle. Himachal Pradesh Gloriosa superba Linn. Hemidesmus indicus R.Br. Ipomoea petaloidea Choisy VidharalKali Nishoth Lavandula stoechas Linn. Himachal Pradesh Mallotus phillippinensis Mesua terrae Linn. Nagkesara/Narmushk Mizoram, Maharashtra, Dadar & NH, Mucuna prurita Hook Nardostachvs jatamansi DC Jatamansi/Sumbul ut Teeb Himachal Pradesh Ocimum sanctum Linn. Imphal, Tripura, Goa, Dadar & NH, West Bengal, Gujarat, Andhra Pradesh, Daman & Diu Oroxylum indicum Vent. Mizoram, ArunachalPradesh Paeonia officinalis Linn. Picrorhiza kurroa Arunachal Pradesh, West Bengal, Bihar, Himachal Pradesh Piper chaba Hunter Chab, Peepal chab Imphal, Tripura, Gujarat, Uttar Pradesh Piper longum Linn. Pippali, Filfildaraz Imphal, Arunachal Pradesh, Karnataka, Gujarat PlumbaQo zeylanica Linn. Chitrak/Sheetrai Hindi Polygonatum cirrhitolium Himachal Pradesh Rosa damasena Mill Dadra, Uttar Pradesh Salmalia malabarica Saraca asoca (Roxb.) Maharashtra, Gujarat, Uttar Pradesh Sida cordifolia Linn. Meghalaya, Bihar Strychnos nux-vomica Linn. Kuchla/Azaraqi Swertia Chirata Buch. Ham. Chirayata Himachal Pradesh, Meghalaya Terminalia arjuna W. & A. Maharashtra, Andhra Pradesh Terminalia chebula Retz. Harar/Halela Zard Thuja occidentalis Linn. Tinospora cordifolia (Wild) Imphal, Maharashtra, Gujarat Trachtysperumum ammi Trichosanthes dioica Roxb. Trigonella foenum-graecum Methi/Hulba Linn. Urtica urens Linn. Vitex negundo Linn. Nirgundi/Sambhalu Withania somnifera Dunal. Aswagandha/Asgandh Gujarat, Imphal, Tripura, Maharashtra, Arunachal Pradesh, Rajasthan, Himachal Pradesh, Karnataka, West Bengal, Bihar
6. Priorities of Drugs from Plants during 21st century
It is extremely important and desirable to have "need based" approach for drug development from medicinal plants- this was the major objective of a W.H.O. regional group which met in 1980. Efforts thus should be directed to a number of diseases for which suitable or satisfactory drugs are not available in the modern system of medicine and where plant based drugs have a possibility of offering drugs for the ailing humanity, some such areas are delineated and where medicinal plants have already provided promising leads. 6.1 Antiprotozoal drugs from plants
Tropical diseases including malaria where tissue schizontocidal drugs are needed and drugs for multi-drug resistant blood schizonts are required. It has been estimated that one third of the world's population is exposed to the risk of malarial infections8,9. Most hard hit areas include Africa, India, China and East Asia. For Malaria, Quinine from Cinchora bark, the first antimalarial drug used gave birth to many synthetic antimalarials like primaquin, pamaquuin, chloroquin etc none of which nowdays work against resistant strains of malaria parasite. Artemisinin, a unique novel molecule from Artemisia annua gave birth to new antimalarial drugs like Artether which works against resistant strains of the parasite and has been approved by the WHO. Other promising antimalarial plants include Alstonia scholaris, Ceasalpinia bonducella, Picrorhiza kurrooa, Swertia chirayata, Berberis species, Triclisia patens, Tilicora triandra. Amoebiasis caused by Entamoeba histolytica is the major cause of dysentery in the. developing world where an estimated 42 million cases occur annually and untreated disease may progress to hepatic amoebiasis and other complications which are responsible for 75,000 deaths each year10. Filaria and leishmania are two other protozoal diseases affecting our population, Many plants like Peganum harmala. Celastrus paniculata, Artemisia annua, Berberis aristat.a, Tilicora triandra have been reported11,12 to have activities against various species of protozoa and a variety of such plants have been well illustrated in several recent reviews13-16. For amoebicidal drugs plants like Holarrhena antidysenterica, Berberis aristata17, Allium sativum18 and Terminalia belerica19 need serious attention. Worldwide it has been estimated that 20 million people are infected with Leishmania species and that 400,000new cases occur each year20. The plants which have given leads include Plumbago zeylanica21, Diospyros Montana22, Ricinus communis and Pytolacca23 species. 6.2 Antiulcer drugs from plants
Important plants for the treatment of gastrointestinal ulcers that have promising prospectus as useful drugs include Prosopis glandulosa, Calendula species. Arto carpus integra, Musa ferrea (pulp) and deglycyrrhizinated Glycyrrhiza glabra and many others which have been reviewed by Lewis & Hanson24. 6.3 Antirheumatic plants
Inflammatory diseases including different types of rheumatic diseases are very common throughout the world. Although rheumatism is one of the oldest known diseases of mankind and affects a large population of the world, no substantial progress has been so far achieved for permanent cure. Our review reveals that plant species of ninety six genera belonging to fifty six families have exhibited antiinflammatory activity25. Most significant plants include Aesculus hippocastanum, Azadirachta indica, Boswellia serrata, Commiphora mukul, Curcuma longa, Ochrocarpus longifolia, Pluchea lanceolata and Vitex negundo26- 6.4 Medicinal plants for diabetes
The world over there are 150 million people suffer from diabetes. In India during 2001 thirty million people were diabetic. In ten years time, India will be world capital in diabetes as per WHO. Over one hundred plants used in Prameha (diabetes) where as several plants have been reported hypoglycemic29a. About 148 plants of 50 families reported to have hypoglycaemic activity have been reviewed by us29. The most important hypoglycaemic plants which need serious clinical trials include Pterocarpus marsupium, Momordica charantia, Trigonella foenum-graecum, Salacia prinoides, Gymnema sylvestris and Cyamompis tetragonolobus. Each region of the world has developed a material medica of antidiabetic remedies based on the local flora. It is apparent that diversity as well as similarity can be found in the use of plants across the world. The extent to which various antibeietic plants have been studied differ widely. For some (fenu greek, bitter melon or Gymnema sylvestre) detailed studies in humans, animals and in-vitro have resulted in the isolation of active compounds with recognizable modes of action. An interesting finding is that plants typically have more than one active compound often associated with more than one mode of action. Additive or synergistic effects between compounds undoubtedly occur, conforming to the view of traditional medicine practitioners that the activity of a medicinal plant cannot be reproduced by the isolation of single active component. Nevertheless, identification of actives and mode of action are important for drug development and for the validation, standardization and rational use of the herbal drugs29a. 6.5 Antiasthamatic plants
In the lack of any permanent cure in the modern system of medicine for bronchial asthma, plants like Albizzia lebeck which have immunomodulatory action need serious attention. Other polyherbal ayurvedic formulations like Yastiadivati and Shereeshadi Kashaya may prove to be efficacious30. Other plants include Acalypha indica, Adhatoda zeylanica, Boswellia serrata, Inula racemosa, Tinospora cordifolia. 6.6 Antiviral plants
A global dengue pandemic that started during world war II has progressively spread to involve nearly all tropical countries resulting cumulatively in 5 million hospitalized children and causing 70,000 deaths from DHF/dengue shock syndrome (DSS)30a,30b. Currently about 2.5 billion people in over 100 tropical and subtropical countries, representing 50% of world population are at risk from dengue W.H.O. estimates 100 million cases of dengue infection worldwide every year30a,30b. Experimental work on a number of plants having antiviral activity has been done31-34. A lyophilized infusion from flowers of Sambucus nigra, aerial parts of Hypericum perforatum and roots of Saponaria officinalis exhibited antiviral effect inhibiting reproduction of different strains of influenza virus types A & B, both in vitro and invivo and herpes simplex virus type 1 in vitro35. These plants need to be carefully examined. 6.7 Iimmunomodulators and adaptogenic plants
The notion of "resistance" to disease and the idea that such resistance can be modified by life experience and by emotional states, forms one of the basic tenets of Ayurveda thus avoiding the Cartesian dichotomization of mind and body36. Concept of Rasayana and Rasaayan plants have been reviewed by the author37-38. Plant of interest in this area include Withania somnifera, Ocimum sanctum, Picrorhiza kurroa, Asparagus racemosus, Pueraria tuberose, Sida cordifolia, Desmodium gangeticum, Boerhaavia diffusa and Cissampelos. We need to develop suitable models for testing such vital plants of Ayurveda. Immunomodulatory plants have been recently reviewed 38a. 6.8 Hepatoprotective Plants
A global estimate indicates that there are about 18,000 deaths every year because of the liver cirrhosis mainly caused by hepatitis. Hepatocellular carcinoma is one of the ten most common tumours in the world with over 2,50,000 new cases each year. Although viruses are the main cause of liver diseases, the liver lesions arising from xenobiotics, excessive drug therapy, environmental pollution and alcoholic intoxication are not uncommon. Modern drugs have very little to offer for alleviation of hepatic ailments, whereas, most important representatives of phytoconstituents used for liver diseases, chiefly on regional basis, include drugs like silymarin (Si/ybum marianum), catechin (Anacardium occidentalis and others) in Europe, glycyrrhizin (Glycyrrhiza glabra) in Japan and schizandrins (Schizandra chinensis) in China39. In India, we have 140 polyherbal commercial formulations reputed to have hepatoprotective action. A review published on the subject from our laboratory indicates that 160 phytoconstituents from 101 plants belonging to 52 families have antihepatotoxic activity40-41. Our laboratory has worked extensively on Andrographis paniculata42 and hepatoprotective activity has been established due to the presence of andrographolide. Kutkoside from Picrorhiza kurroa is a potential hepatoprotectant reported by CDRI 43-47. Phyllanthus amarus is another most important plant selected for clinical trials48. Our future work in this area is bound to give fruitful dividends. Antihepatotoxic activity of Boerhavia diffusa and B.repanda has been also reported from our laboratory49. Kolaviron, a mixture of Garcinia kola (Guttiferae) biflavonoids at a dose of 100 mg/kg i.p. prevented thioacetamide induced hepatotoxicity50. Withania fruitescens (Solanaceae) leaves exhibited protective and curative action against carbontetrachloride induced liver toxicity51. Plant kingdom appears to be a fruitful ground for the discovery of effective hepatoprotective drugs, which we currently lack in the modern system of medicine.
6.9 Anti-cancer Drugs from Plants
Cancer is an insidious disease affecting mankind in every country. Work on periwinkle plant. Catharanthus roseus (L > ) G. Don was independently taken up in two different laboratories for its alleged hypoglycaemic activity as per Jamaican folklore. Though none of the groups could substantiate hypoglycaemic activity, the Canadian group of Nobel Beer and Cutts succeeded in isolating vinblastine while Eli Lilly group headed by Svoboda could isolate vinblastine and vincristine along with two other active dimeric alkaloids. These alkaloids are present in exceedingly low concentrations in a complex mixture of 50 alkaloids53. Vinblastine was introduced (Velban, Eli Lilly) in 1961 and vincristine (Oncovin, Eli Lilly) in 1963 as anticancer drugs. CIPLA has improved upon the process of isolating vinblastine and vincristine from Catharanthus roseus as developed by NCL Pune. Today we are the third largest manufacturer of vinblastine and vincristine in the world and we are exporting these alkaloids to European countries and the demand is steadily increasing54. Screening of plant extracts for anticancer activity started in 1961 by National Cancer Institute of the U.S.A., and up to 1981 (20 years) about 1,14,045 plants had been screened, of which only 3.4% (representing about 3.400 different species) have been observed to be active in one or more bioassay systems. The promising phytoconstitutents which are likely candidates for drug uevelopment include indicine N-oxide (a pyrrolizidine alkaloid) from Heliotropium illdicum. ellipticine (a monomeric indole alkaloid) from several Ochrosia species, homoharringtonine (a cephalotaxine alkaloid) from Cephalotaxus species, taxol55 from Taxus species and camptothecine (quinoline alkaloid) from Camptotheca acuminata a Chinese tree)56. The author has been successful in discovering a number of anticancer agents from plants like Ostodes paniculata57, Peddiea fischeri58, Soulamea soulameoides59, Dirca occidelltalis60 and Passerina vulgaris61. The anticancer principles of podophyllum are contained in the resin, podophyllum resin or podophyllin. American podophyllum yields 2-8% and Indian podophyllum about 6-12% of the resin. It is not only the higher amount of the resin present in Indian podophyllum (P. emodi var. hexandrum) but there are no peltatins present in contrast to American podophyllum (P.peltatum) which contains (α and β- peltatins. Thus, the Indian podophyllum has higher amount of podophyllotoxin. In certain cases Indian podophyllum has yielded 20% resin. The highest amount is in May when the plant produces flowers. Thus the Indian podophyllum, when collected at the proper season not only contains 2 ½ times or even more of the resin compared to American podophyllum, but this resin has double the amount of podophyllotoxin which is the active principle used by pharmaceutical industry for structural modifications to produce anticancer drugs tenoposide and etoposide being marketed by Sandoz. Major problem with the cultivation of this plant is that the seeds take very long time to germinate. We need to concentrate on cultivation of this plant either by propagation or by reducing the period of seed germination. Use of Taxol from Taxus brevifolia or Taxus baccata is the latest addition of anticancer drug especially in ovarian cancer62. 6.10 Plants for Urinary Stones
The very first mention of 'Pashanbhed' in Ayurvedic literature is in Charak Samhita, and is recommended for painful micturition and for breaking calcui. Sushrut Samhita mentions the drug under various synonyms - Pashanbhed for uric acid calculi and Ashnibhed for biliary calculi. Sushrut Samhita mentions decoction of Pashanbhed, Astimantaka, Satvari, Vrihati, Bhalluka, Varuna (Crataevanervula), Kultha (Dolichos bijlorus), kola and katak seeds for patients of Vataja Ashmari while Kusa, Ashmabhed, Patala, Trikanthaka, Sirisha, Punarnava (Boerhavia diffusa) and shilajit are for Pittaja Ashmari. About 4000 plants have been mentioned to be useful for dissolving stones in the urinary system in a review published seven years ago63. Cystone of Himalaya Drug Co. and Calcury of Charak Pharmaceuticals are already in the market. Crataeva nervula bark and Tribulus terrestris fruits have been put under clinical trials by Indian Council of Medical Research, Cucumis trigonus (curcurbitaceae) has been investigated for its diuretic activity64. 6.11 Plants as Sedatives/Tranquillizers
Indian valerian (Valeriana waltlchii) contains 2% valepotriates and is thus four times more potent than European valerian (V. officinalis) which contains 0.5% valepotriates. These are triesters of polyhydroxy cyclopentanop,Yran esterified with isovaleric, acetic and β-acetoxy valeric acid. Compared to known iridoids, valtrats (valepotriates) are neither glycosides nor lectones and are considered original or primary products present in the drug responsible for activity. Valtrates are used as tranquillizers and sedatives, and the action is comparable to meprobmate. Additional advantage is that these can be prescribed to alcoholic patients. Valerian also contains valernic acid having spasmolytic action. Valeranone is found in jatamansi (Nardostachys jatamansi) possessing sedative property. It will be worthwhile to produce valepotriates in India. A peruvian plant Valeriana thalictroides has been found to contain 14.5% total valepotriate content in the roots and thus yields the highest known concentration of valepotriates in plants to date65. The high yield of valepotriates in V. thalictroides roots. cannot be directly used to overcome shortage of valepotraites for therapeutic use, as the roots have very small diameter (2 cm) and a length of about 5 cm. V. edu/is ssp. procera (HBK) F.G. Mey, although having a smaller valepotriate content (7%), is a much better source for valepotriates because of its higher drug yield. However, such high yielding plants could be used to establish high yielding tissue culture for the in vitro production of valepotriates. Relation between valepotriate content and differentiation level in various tissues from valerianaceae has been studied66. Isolation and evaluation of valepotriates from Indian valerian are well known67. 6.12 Plants for mental health
For psychomimetic and/or euphoria inducing effects, 217 plant species representing 146 genera belonging to 59 families have been used at one time or another at various mental disorders. The substances of plant origin such as extracts of Gingko biloba, papaverine from Papaver somniferum fruit latex, theophylline commonly occurring purine base in tea leaves, vincamine indole alkaloid from Vinca minor hydrated semisynthetic ergot alkolids have been experimentally evaluated with regard to their cerebrovascular activity in patients. Medhya rasayana plants such as Bacopa monniera, centella asiatica, convolvulus pluricaulis, nardostaychs jatamansi and acorus calamus have been reported useful for mental disorders67a. 6.13 Plant Laxatives
Constipation is a common problem of Western and European countries because of protein rich diet. In the U.S.A., 1000 patents of vegetable origin are there which involves an annual trade of $ 500 million. On an average we export 15,000 tonnes of plantago, 7000 tonnes of senna and 1000 tonnes of rhubarb annually. Trade in plant laxatives increases by over 10% every year. India is the sole supplier of Plantago ovata seeds and husk (psyllium) in the international market. India's export of Psyllium seeds in 1980-81 were to the extent of 25,743 metric ttonnes valued at Rs.85.93 million. Indian Institute of Management, Ahmedabad has published recently a survey report on the psyllium production and marketing in India68. 6. 14 Antihyperlipidemic (lipid lowering) plants
Obesity and high lipid content constitute a serious life style problem in the developed countries and in the affluent class of the developing countries. In the year 2000 the world statin market size was US$ 16 billion with three products viz. Merck's Zocor (Simvastatin), Pfizer's Lipitor (Atorvastatin) and Bristol Meyers Squib/Sankyo's Pravachol (Pravastatin) accounting for 89 percent of sales. The world market of Statins has gone up over $ 25 billion (11 percent annual growth). Commiphora wightii, Oleogumresin (Guggul) has scientifically proven lipid lowergin property and ‘Guggulip' developed by CDRI, Lucknow commercially transformed to CIPLA has great market value but the raw material is a serious problem as not many trees ae left and new tree if cultivated takes over 10 years before it yields guggul. Other plants mentioned in Ayurveda as ‘Lekhanaya' have great potential for developing lipid lowering drugs. Potential ‘Lekhanaya' plant mentioned in Ayurveda are as follows: Lekhaniya Gana
As per Chakrapani Sutrasthan Cyprus rotundus Saussures lappa Curcuma longa Berberis aristata Picrorhiza kurroa Aconitum heterophyllum Pongamia pinnata Plumbago zeylanica Acorus calamus
6.15 Plants drugs for cardiovascular system
Cardiovascular diseases are most prevalent of all diseases. Two thirds of the deaths result from
cardiovascular diseases and number one killer in the world. Cardiovascular drug market is US$ 50 billion
per year. Most important cardiotonic, antiarrhythmic and antihypertensive plants are given below68a.
Terminalia arjuna bark
Thevetia nerrifobia Asclepiadaceae
Cinchona sps. (Rubiaceae) (quinine)
Fagara zanthoxyloids (α-fagarine)
Rauwolfia serpentine (Raunavine, ajmaline)
Cytissus scoparius (sparteine)
Rauwolfia serpendina (reserpine, rescinnamine deserpidine)
Uncaria rhynchophylla (rohynachophylline)
Nardostachy jatamansi (valeranone)
Inula helenium (alanto lactone)
Arnica Montana (helenalin)
Coleus forskohlii (forskoline, coleonol) Veratrum & Fritillaria sps (veratrum alkaloids) . 7. Pitfalls in Plant-drug Research and Implications
Medicinal pant research is beset with a number of problems and the major stumbling blocks encountered in plant drug research are listed below: (a) Medicinal plants being used by traditional practitioners in India not only bear different names in different geographical areas and in different languages, but it is also not uncommon that different plants are known by the same name which add to the confusion and has resulted in controversial identity of many plants69. (b) Major causes of inconsistancy in plant drugs include ontogenetic, ecotypic, genotypic and chemo typic besides variations due to harvesting period, method of drying and storage conditions. (c) Ayurvedic, unani practitioners invariably use polyherbal formulations, whereas, for obvious reasons, it is easier for the modern scientists to investigate single plant drug. (d) Appropriate experimental models are not available for validating claims of some very important and useful plant drugs like "Rasaayana" enjoying esteemed repute in Ayurveda and termed in modern terminology as vitalizers, rejuvenators, adaptogens, immunomodulators etc. (e) Major national laboratories resorted to more broad based screening of plants70 70 by including, apart from plants which are well known and time tested by traditional systems of medicine, those which are not mentioned by these systems. Others undertook studies largely on individual initiatives. Inspite of all these efforts, however, the ultimate goal of producing inexpensive, safe and efficaceous drugs for most diseases encountered in our country remains to be achieved. (f) The major bottleneck, however, is the lack of scientifically planned clinical trials on traditionally used medicinal plants. Though research work on medicinal plants has been carried out in Indian research establishments since long but not much has been achieved. The beneficial phase of a multidisciplinary integrated approach to the evaluation of plants initiated by the Composite Drug Research Scheme seems to have be almost lost in the pages of history. Recently, however, Indian Council of Medical Research has adopted new strategy of disease oriented approach of carrying out clinical trials on medicinal plants selecting certain 'refractory diseases' i.e. those for which modern medicine has not been able to offer, so far, a satisfactory or a lasting remedy. (g) The novelty and popular trend on the part of the phytochemists and pharma-cologists to continue efforts to find out an "active principle" responsible for the pharmacological action and therapeutic efficacy of a plant, in many instances, has also led to frustrating results. Pharmacologists and phytochemists engaged in medicinal plant research may have to change their approach to wholistic plant material or with semi pure principles or even crude extracts. Gum guggul (Commiphora wightii) is a classic example. (h) Except for Central Drug Research Institute, Lucknow, little facilities exist elsewhere in India for carrying out pre-clinical evaluation including toxicity tests on medicinal plants. (i) Clinical evaluation of plant drugs is an area which is handicapped with lack of facilities and proper orientation of scientists of different disciplines. At present, for lack of such facilities even the leads obtained so far are being lost to follow-up. 8. Herbal Drug/Intellectual Property Rights (IPR)
Medicinal plant research has been and continues to be considered as a fruitful approach for the search of new drugs71. The highly respected magazine Science calls attention in its editorial of February, 1990 to the potential of medicinal plant in the search of new drugs and expresses concern about the consequences that loss of biodiversity might have in this context. Since most of the chemically unknown flora and associated medicinal lore exist in the developing and underdeveloped countries, especially those which still possess extensive tropical forests, the rapid loss of biodiversity does indeed become an issue for the future of medicinal plant research. The traditional role of developing countries in plant drug production has been as suppliers of raw material. Most of the pharmacological and chemical studies reported in several journals start by quoting the traditional use of a given plant species promising enough to stimulate further research. It is, therefore, reasonable to assume that the indigenous knowledge did play an important role in medicinal plant research and will continue to do so. Posey72 calls for legislation to secure Intellectual Property Right for indigenous people.
9. Herbal Drug Trade
The extent of herbal drug usage is hard to quantify for traditional systems of medicine in India as by tradition many of the practitioner manufacture and formulate their own prescription, although there are now about ten well organised large scale herbal drug manufacturers whose individual annual production is of about $ 112 million (June 1988). Their total annual turnover is about $ 350 million73. In U.K. there are about 5,500 herbal products involving 1,600 herbal ingredients. It is estimated that some 6,000-7,000 tons of herbs are extracted annually for the ingredients in U.K. medicine74. Like India, China is another country which is noted for its adherence to herbal medicines for a number of therapies like in the treatment of abdominal conditions (appendicitis, perforated ulcers, pancreatitis), arthritic disease and some neurological disease. There are about 248 herbal drugs used for a number of reasons e.g., analgesic sedative, diuretic, anti-tussive, antirehumatic and antiasthmatics75. Herbs and the literature about them are big business in America. In 1985 the sales of all forms of herbs exceeded $ 190 million. Unfortunately, most of the literature prepared with a single purpose in mind-to sell a product, since to do so most effectively, it is necessary to promote or advocate all of the good features of the herb while minimizing, or even omitting, any negative aspects, such writings are generally referred to as advocacy literature76. Current federal laws do not permit the sale of herbs as drugs, that is, with claims of efficacy appearing on their labels. If such claims are made, the efficacy must be proven to the satisfaction of the Federal Food & Drug Administration, a process as much as $ 100 million per drug. Since no one is willing to spend this amount of money on a product for which patent protection is not available, herbs are sold labelled only with the name of the product, primarily in 'health food' stores. Literature purporting to explain the uses of herbs is also available in such establishments. Because the laws and regulations applied to food naturally do not require any proof of efficacy prior to sale, some manufacturers attempt to market herbal products as nutrients or food supplements, by combining a variety of herbs with standard multivitamin mineral preparation and often make extravagant claim for the products based-on their herbal contents. 10. Herbal Medicines - Medicinal Marvel or Money Spinning Malarkey
Ayurveda, with many centuries of experience and cultural support has strengths which should be used only through the experts and vaidyas in Ayurveda or by modern physicians, who have undergone practical training and experience in Ayurveda. But gross and rampant commercialization of Ayurvedic herbal remedies, by all and sundry, has to be criticized and even condemned. With the onslaught of m'edia television, radio and press several herbal formulations are promoted, often indiscriminately. Consumer associations are very quick and rightly so, when unscientific claims are made by ethical modern drugs. Should they not take up issue with very tall claims by the so-called herbal drugs by commercial interests? There is an urgent need to create an ethical code for advertising and promotion of Ayurvedic drugs.
11. Sociopolitical, Economical & Ethical Issues in Medicinal Plants
Due to enormous difference of wealth generated by supplying crude medicinal plant material versus the purified isolated phytoconstituent, the developing countries remain the worst sufferers. It therefore, calls for legislation to Secure Intellectual Property Right (IPR) for indigenous people. What are the ethics behind utilizing traditional knowledge without adequate compensation to the societies from which it originates. 12. Herbal Drug Development
One may propose a development procedure tailor made for herbal drugs. Tradi- tional medicine usually consists of if mixture of herbal drugs. In the first step the therapeutic efficacy of the traditional medicine has to be confirmed. Of course, the composition of the recipe has to be affirmed and authenticated by Pharmacognostic methods which means that we have got to be sure which plant, identified by botanical nomenclature, and which part of the plant to which percentage is used. Only in the country where the recipe has been used traditionally clinical trials can be performed. These trials have to be carried out as scientifically as possible. Well defined clinical parameters have to be evaluated in a population of patients with well defined diagnosis. In India such clinical trials on traditional medicines have been initiated by the Indian Council of Medical Research adopting disease oriented approach. In the positive outcome of such studies we proceed to the second step. We have to select one, perhaps in some cases two or three plants as the active ingredients. This
can be done by animal pharmacology or clinical pharmacology. At this stage we have to
attempt standardization employing all possible means like finger printing, TLC, HPLC or
other related techniques. The clinical trials are performed against a placebo. In each
case we have to use as much well defined clinical parameters as possible in order to
establish the efficacy of the drug. If the results are positive, we can proceed to the next
step where we use purified extract being standardized for the reprocessed extract, we
can establish mode of action and also carry out toxicological studies in animals which
become mandatory since we now use much higher concentration of the drug than used
in the original recipe. With this standardized extract we can perform placebo controlled
clinical trials, which still should be performed in the country of origin. Nevertheless, we
make our first attempt to submit something like Investigational New Drug (IND) in order
to be allowed to perform phase I or even phase II clinical studies outside the country of
origin. If the results are positive we can proceed to internationalization of the product.
There are some countries in the world where the health authorities have a positive
attitude to herbal drugs. In these countries facilitated approval may be possible. They
can be fore runners for other countries where the developmental requirement would be
the same as the synthetic compounds77.
13. Quality control and standardization of Herbal Drugs
The single and most important factor which stands in the way of wider acceptance of
traditional herbal medicines is the non-availability or inadequacy of standards for checking their quality by chemical or bioassay methods. This also prevents modernization or modification of the methods of their preparation or production. as there is no way to establish the equivalence of the product made by the modified method with the original product. Thus standardized drugs of well defined consistent quality are needed for reliable clinical trials and therapeutic use. The major reason advanced for the difficulty in developing quality control standards is that these products use whole plant or parts of plants or their total extracts, and in some cases even a mixture of a number of plants, it is thus challenging to develop suitable standards because a vegetable drug or a preparation thereof is regarded as one active ingredient in its entity, whether or not the constituents with therapeutic activity are known. Standardization, of a herbal drug and of a preparation thereof is not just an analytical operation, it does not end with the identification and assay of an active principle rather it embodies total information and controls which are necessary to guarantee constancy of composition. Standardization of plant drugs has been stressed by the World Health Organization78.
14. Concluding remarks
The following four slides exhibiting road map to development from medicinal plants and growth of the essential oil area fives a message to this institute for potentiating its endeavours in the development of medicinal and aromatic plants with in its mandate especially in the economic mapping of MAPs, development of agrotechnologies, post harvest technologies, quality control and biodiversity conservation for sustainable industrial utilization of medicinal and aromatic plants. ROAD-MAP TO DEVELOPMENT OF SAFE, EFFICACIOUS,
TRADITIONAL DRUGS AND MODERN DRUGS FROM
PLANTS: A "TRADITIONAL HERBAL DRUG"
Resort to cultivation of Taking care of post- Adopting appropriate MAPs following GAP
harvest technology to and organic farming. ensure quality of raw extn, Phytonic extn. Use appropriate drying Choose an appropriate technology e.g. Spray vacuum drying, freeze powders, liquid orals purity, quality including tablets, capsules using right excipients and ensure assay, adopt Generate safety data Pharmacovigilence human clinical trials genotoxicity herbal drug: modern drug interaction (Period 3 yrs; cost through CYP450 study MODERN DRUG FROM TRADITIONAL HERBAL SOURCE Plant selection – basis: traditional, folklore, scientific knowledge Appropriate extraction technology – Activity of each extract Bioactive extract fractionated directed by bioactivity Fractionation by Sepbox – Activity of each fraction (MTS, HTS) Isolation of bioactive molecule – confirm structural and molecular purity Reconfirmation of bioactivity by in-vivo model Examine drugability of the molecule Scale-up isolation of the bioactive Bioavailability/pharmacokinetic, ADME studies of the molecule Safety evaluation Clinical studies phase I, II, III (Period 10-12 yrs; cost US $ 1 Bn)
WORLD PRODUCTION: (Vol) BRAZIL (40%), USA (20%) INDIA (15%)
(Value) USA (26%), INDIA (21%), BRAZIL (8%) TRADE/COMMERCIAL ADVANTAGE: EXPLOIT LOW VOLUME, HIGH VALUE DERIVATIVES
INDIAN'S SHARE IN WORLD EXPORT OF ESSENTIAL OIL 0.4% AND PERFUMERY MATERIAL OUR WEAKNESS
: VERY LITTLE VALUE ADDITION IMPROVING & PROMOTING : EXTRACTION AND FRACTIONATION PROCESSES AND
• AROMATIC PLANTS OFFERING EVIDENCE OF LARGEST NUMBER OF CHEMICAL RACES : LET US EXPLOIT HIGH VALUE PHYTOCONSTITUTENT CHEMOTYPES MENTHA OIL & MENTHOL PROD. India today world leader E. Globulus (Cineolrich >70%) E. macrorrhincha (Rutin 8%) total India only 200 tonnes ORANGE/LEMON OIL
: biproduct of juice industry (lemonene) 80,000 tonnes 2000 tonnes : USA, Brazil, & Citronella oil
: CHINA, INDONESIA, INDIA LAVENDER & LAVANDIN OILS : BULGARIA MAJOR PRODUCER
1500 TONNES (NATURAL ONLY 33%) KASHMIR VALLEY CAN
GUMBENZOIN, GUMLABDANUM, BALSAMTOLU We need to introduce plants yielding these products References
1. Farnsworth NR (1985). A computerized data base for medicinal plants. The Eastern
2. Handa SS (1992). Drug Industry for Indian System of Medicine. Pharma Times 24:
3. Handa SS (1991). Harnessing Ayurveda for Modern Drug Development. The
Pharmacos 30: 13-30.
4. Bioactive Compounds from Plants (1990). Ciba Foundation Symposium 154. John
Wiley Chichester, U.K. 5. Wagner H. and Farnsworth N.R. Economic & Medicinal Plants Research, Vol. 4, Ed. Academic Press. 1990. 6. Wijesekera ROB & Tcheknavorian AA (1982). Industrial Utilization of Medicinal and Aromatic Plants - A review. 10.505, UNIDO Vienna. 7. Nitya Anand (1993). Factors Having a bearing on the Industrial Utilization of Medicinal Plants for the production of plant based medicines. Regional Consultation on Industrial Utilization of Medicinal and Aromatic Plants in Asia and Pacific, Vienna, Austria. 7 a. Medicinal Plants in India: Report and Directory (2003). Institute of Economic and Marketing Research, Hailey Road, New Delhi, 2003. 8. Anon. (1988). World Malaria Situation (1987). World Health Organization, Weekly Epidemiological Records. 9. Annon. (1990). Public Health Laboratory Service, Malaria Reference Laboratory Report, London School of Hygiene and Tropical Medicine. 9a. Willcox M., Bodekar g., Rasoanaivo (Ed), Traditional Medicinal Plants and Malaria, CRC Press, Boca Raton, London 2004. 10. Pehrson P. & Bengtsson,E. (1984). Treatment of noninvasive amoebiasis - a comparison between tinidazole and metronidazole. Ann Trop Med Parasitol 78: 505-08. 11. Pavanand K., Webster H.K., Yongvanitchit K., & Dechatiwongse T. (1989). Antimalarial activity of Tiliacora triandra Diels against Plasmodium falciparum in vitro. Phytother Res. 3: 215-17. 12. Pavanand K., Webster H.K., Youngvanitchit K., Kun-anake A,. Dechatiwongse T., Nutakul. W., & Bansiddhi J. (1989). Schizontocidal activity Celastrus paniculatus Wlld. against Plasmodium falciparum in vitro. Phytother Res. 3: 136-39. 13. 0' Neill MJ., Phillipson JD. (1989). Plants as source of antimalarial compounds. Rev Latinoam Quim 20: 111-18. 14. Phillipson J.D., O'Neill M.J. (1987). Antimalarial and Amoebicidal Natural Products. In : Biologically Active Natural Products. Eds. K. Hostettmann P.J Lea. pp. 49-64, Claredon Press, Oxford. 15. Phillipson J.D., O'Neill, M.J. (1989). New leads to the treatment of protozoal infections based upon natural product molecules. Acta Pharm Nord 1: 131-43. 16. Wright C.W., Phillipson J.D. (1990). Natural products and the development of selective antiprotozoal drugs. Phytotherapy Res. 4: 127-39. 17. Subbaiah TV., Amin A.H. (1967). Effect of berberine sulphate on Entamoeba his tolytica. Nature 215: 527-28. 18. Mirelman D., Monheit D., Varon S. (1987). Inhibition of growth of Entamoeba histoly/ica by allicin, the active principle of garlic extract (Allium sativum). J. Inf. Dis 156: 243-44. 19. Bhutani KK, Kumar V, Kaur R., Sarin AN. (1987). Potential antidysenteric candi dates from Indian plants. Indian Drugs 24: 508-13. 20. Barnaulov O.D., Manicheva O.A., Komissarenko NF. (1984). Comparative evalu- ation of the effect of some flavonoids on changes in gastric wall of reserpine - treated for immobilized mice. Khim-Farm Zh 14: 946-51 (1984); Chern. Abstr. 100: 231 (1984). 21. Croft SL., Evans AT., Neal RA. (1985). The activity of plumbagin and other electron carriers against Leisronania donovani and L mexicana Amozonensis. Ann. Trop. Med. Parasit. 79: 651-53. 22. Hazra B, Saha AK, Ratamala R., Roy DK., Sur P, Banerjee A (1987). Antiprotozoal activity of diospyrin towards Leishmania donovani promastigotes in vitro. Trans Roy Soc TropMedHyg 81:738-41. 23. Cenini P, Bolognesi A, & Stirpe F (1988). Ribosome inactivating proteins from 24. Lewis DA, Hanson PJ (1991). Antiulcer drugs of plant origin in Progress in Medicinal Chemistry, Vol. 28. eds. G.P. Ellis and G.B.West, Elsevier Science Publishers pp. 201-231. 25. Handa SS., Chawla AA, Sharma AK. (1992). Plants with antiinflammatory activity. Fitoterapia LXII, 3-31. 26. Chawla AS., Kaith BS., Handa SS., Kulshrestha DK., Srimal RC. (1990). Chemical investigation and antiinflammatory activity of Pluchea lanceolata roots. Indian J. Chem. 29B: 918- 22. 27. Chawla AS., Sharma AK., Handa SS., Dhar KL.(1991). Chemical investigation and antiinflammatory activity of Vitex negundo seeds. Part I. Indian J. Chem. 30B: 773-76. 28. Chawla AS, Handa SS., Sharma AK., Kaith B. (1987). Plant antiinflammatory agents. J. Sci. Industr. Res. 46: 214-23. 29. Handa S.S., Chawla AS., Maninder (1989). Hypoglycaemic plants - A review. Fitoterapia 60: 195-224.
29a. Soumyanath A (Ed.). Traditional Medicines for modern Times – Antidiabetic Plants
CRC Press, Boca Raton, London, 2006.
30. Handa.S.S. (1991). Future trends of plants as drugs. The Eastern Pharmacist 79-
30 a. Halstead S.B., Heinz F, Barhett AD, Rochrig J.T. (2004). Dengue virus; molecular
basis of cell entry and pathogenesis 25-27 June, Vienna Austria, p 849-856.
30b. Gubler D.J. (1997). Epidemic dengue – a global public health problem of 21st
century. WHO Dengue Bull. 21, 1-15.
31. Amoros M., Fauconnier B., Girre RL. (1988). Effect of saponins from Anagallis
arvensis on experimental herpes Simplex keratitis in rabbits. Planta Med 2: 128-31.
32. Serkedjieva J., Manolova N. (1987). Studies on the antiviral effect of a polyphenolic
complex isolated from the medicinal plant Geranium sangiuneum LV on the mechanism
of the antiviral effect in vitro Acta Microbiol Bulg 21: 66- 71.
33. Slagowska A., Zgorniak-Nowosielska I., Grzybek J. (1986). Inhibition of Herpes
simplex virus replication by flos verbasic infusion. Pol. J. Pharmaco Pharm. 39: 55-61.
34. Vlietinck A.J. (1987). Present status and prospects of plant constituents as
antimicrobial antiviral and antiparasitic agents. In: Tropics in Pharmaceutical Sciences.
Eds. DD Breimer and P Speise. pp. 256-259. Elsevier Science Publishers,
35. Serkedjieva J, Manolnva N, Zgorniak I, Zawilinska B, Grzybeck J. (1990). Antiviral activity of the infusion (SHS). 36. Shukla HC, Solomon G.F., Doshi RP (1979). The relevance of some Ayurvedic concepts to modern holistic health. J. Holistic Health 4: 125. 37. Handa SS (1993). Rasaayana Drugs Part-I. Pharmatimes 25: 9-15. 38. Handa S.S (1993). Rasaayana Drugs Part-2. Pharmatimes 26: 17-23. 38 a. Madani A., Jain S.K. (2005). Immunomodulation by herbal drugs. Proceedings of the National Academy of Sciences 75, 221-233.
39. Hikino H., KisoY (1988). Natural Products for liver diseases. In Economic & Medicinal Plant Research Vol. 2. Academic Press, London, pp. 39-72. 40. Handa SS, Sharma A, Chakraborty KK (1989). Natural products and plants as liver protecting drugs. Fitotrerapia 57: 307-51. 41. Sharma A., Charkraborty KK, Handa SS (1991). Antihepatotoxic activity of some Indian herbal formulations as compared to silymarin. Fitoterapaia 62, 229-35. 42. Handa SS, Sharma A (1990). Hepatoprotective and rographolide from Andrographis paniculata Indian J. Med Res. B. 92: 276- 92. 43. Dwivedi Y, Rastogi R, Garg NK, Dhawan BN (1991). Prevention of paracetamol induced hepatic damage in rats by picroliv - the standardized fraction from Picrorhiza kurroa. Phytother Res. 5: 115. 44. DwivediY, Rastogi R, Sharma SK, Garg N.K, Dhawan BN (1991). Picroliv affords protection against thioacetamide induced hepatic damage in rats. Planta Med 57: 25-28. 45. Shibata M,. Yoshida R, Motohashi S, Fukoshima M (1973). Pharmacological studies on Bupleurum falcatum IV. Pharmacological effects. Yakugaku Zasshi 93: 1160- 46. ShuklaB, Visen PKS, PatnaikGK, Dhawan BN (1991). Choleretic effect of picroliv. The hepatoprotective principle of Picrorrhiza kurroa. Planta Med. 57: 29-33. 47. Visen PKS, Shukla B, Patnaik GK, Kapoor NK, Kaur S, Dhawan BN (1991). Hepa toprotective activity of picroliv, the active principle of Picrorrhiza kurrooa on rat hepatocytes against paracetamol toxicity. Drug Development Res. 22: 209-19. 48. Mehrotra R, Rawat S, Kulshreshtha DK, Goyal P, Patnaik GK, Dhawan BN. (1991). In vitro effect of Phyllanthus amarus on hepatitis B. virus. Indian J. Med. Res. 93: 71-74. 49. Charkraborti KK, Handa SS (1989). Antihepatotoxic activity of Boerhavia diffusa and B. repanda. Indian Drugs 27: 19-24 and 161-166. 50. Iwu MM, Igboko OA, Elekwa OK. Tempesta MS (1990). Prevention of thioacetamide - induced hepatotoxicity by biflavonones of Garcinia kola Phytother Res.4: 157-59. 51. Montilla MP, Cabo J, Navarro MC, Risco S, Jimenez J, Aneiros J. (1990). The protective and curative action of Withania frurescens leaf extract against carbontetrachloride induced hepatotoxiciy. Phytother Res. 4: 212-15. 52. Chaudhury,R.R. (1992). Herbal Medicines for Human Health. W.H.O. Regional Office, South East Asia, New Delhi. 53. Gerzon K (1980). Dimeric Catharanthus alkaloids. In anticancer agents based on natural product models. Eds. Cassady JM, Douros JD, Academic Press, London, pp. 271-314. 54. Bhakuni DS (1990). Drugs from plants. Science Reporter. 12-17. 55. Kinghorn AD (1982). The search for antitumour agents from plants Pharmacy Internat.3: 362-66. 56. Appendino G (1993). Taxol: history and ecological aspects. Fitoterapia 64, Suppl. 57. Handa SS, Kinghorn AD, Cordell GA, Farnsworth NR (1983).Plant anticancer agents XXII. Isolation of phorbol diester and its hydroperoxide derivative from Ostodes panikulata (Euphorbiaceae) J. Nat. Prod 46: 123-26. 58. Handa SS, Kinghorn AD, Cordell GA, Farnsworth NR (1983). Plant anticancer agents XXVI. Constituents of Peddiea fischeri (Thymeleaceae). J. Nat Prod 46: 248-50. 59. Handa SS, Kinghorn AD, Cordell GA, Farnsworth NR (1983). Plant anticancer agents XXI. Constituents of Soulamea soulameoides (Simaroubaceae). J. Nat. Prod. 46:359-64. 60. Badawi MM, Handa SS, Kinghorn AD, Cordeil GA., Farnsworth. NR (1983). Plant anticancer agents. XXVII. Antileukemic and cytotoxic constituents of Dirca occidentalis (Thymeleaceae). J Pharm. Sci. 72: 1285.87. 61. Xian G, Handa SS, Pezzuto JM, Kinghorn AD, Farnsworth NR. (1984). Plant
anticancer agents. XXXIII. Constituents of Passerina vulgaris. Planta Med. 51: 358. 62. Christopher J (1993). Taxol - an anticancer drug. Bioscience 43 (3). 63. Mukherjee T, Bhalla N, Aulakh GS, Jain HC (1984). Herbal drugs for urinary stones. Indian Drugs 21: 224-28. 64. Nair VR, Agshikar NV, Abraham GJS (1981). Cucumis trigonus diuretic activity. J. Ethnopharmacol 3: 15-19. 65. Backer H, Chavadej S, Weberling F (1983). Valepotriates in Valeriana thalictroides. Plants Med. 64: 75-79. 66. Violon C, Dekegel D, Vercruysse A. (1984). Relation between valepotriate content and differentiation level in various tissues from valeriaceae J. Nat. Prod. 47: 934-40. 67. Gupta BK, Suri JL, Gupta GK, Ata1 CK (1986). Isolation and evaluation of valepotriates from Indian Valerian. Indian Drugs 23: 391-96. 67 a. Handa SS (1995). Plants & plant products for mental health. In Decade of the Brain – India/USA Research in Mental Health & Neurosciences (Ed. S.H. Koslow, RS Murthy, G.V. Coelho) US Department of Health and Human Services, National Institute of Health, National Institute of Mental Health, Rock ville, Maryland, USA pp. 163-171. 68. Mathur DP, Rangarajan B, Gupta VK (1990). Psyllium production and marketing in India. Oxford & IBH Publishing Co., New Delhi I-1 51. 68a. Handa SS, Kapoor VK (2001). Plants for cardiovascular system. Text book of Pharmacognosy. Vallabh Prakashan, New Delhi, India pp. 80-91. 69. Handa SS and Chakraborty KK (1989). Indian Plant drugs of controversial identity. Research Bull. Ph. Univ. 40, 157- I 77. 70. Dhawan BN, Patnaik GK, Rastogi RP, Singh KK, Tandon JS (1977). Screening of Indian plants for biological activity. J. Exp. Biol. 15,208-219. 71. Abelson PH. (1990). Medicines from plants. Science 247. 72. Posey DA. (1990). Intellectual property rights: What is the position of Ethnopharmacology? J. Ethnopharmacol 10, 93-98. 73. Anand N (1990). Contribution of Ayurvedic Medicines to Medicinal Chemistry. In . Comprehensive Medicinal Chemistry Vol. I. (Ed. Hansch). Pregman, pp. 113-131. 74. Phillipson JD (1981). The pros and cons of herbal medicines. The Pharm. J. 387-92. 75. Phillipson JD (1979). Natural products as drugs. Trends Pharmacol. J, 36-38. 76. Tylor VE (1987). Herbal medicines in America. Planta Med. 68, 1-4. 77. Vogel HG (1991). Similarities between various systems of traditional medicines. J. Ethnopharmacol. 35.179-190. 78. Quality Control Methods for medicinal plants. W.H.O. document No. WHO/PHARM/92/559 (1992).
Diagnostic criteria for cervical dystonia: Can botulinum neurotoxin manage, as well as, cure the problem? Jill L. Ostrem, MD Professor of Neurology UCSF Department of Neurology Movement Disorder and Neuromodulation Center Bachmann Strauss Dystonia and Parkinson's Disease Center of Excellence