Making a Case for Traditional Ghanaian Medicine in the face of a Global Crisis

The current 2019-nCoV (novel coronavirus) outbreak is moving rapidly and the cumulative number of confirmed cases in the world has reached 2,083,048, with 510,187 recovered/discharged cases and 134,603 deaths as of 16-April-2020, and no specific drug has been discovered for Coronavirus Disease 2019 (COVID-19). However, a number of clinical practice results showed that traditional Chinese medicine (TCM) played a significant role in the treatment of COVID-19, and continues to bring new hope for the prevention and control of COVID-19. In addition, it was reported that; the combination of TCM and Western medicine effectively reduced fever; cough, fatigue, diarrhoea and other symptoms of patients with -mild-COVID-19. Furthermore, For the treatment of moderate and severe syndromes, the integrative approach was able to reduce lung exudation and inhibit the further development of the disease (OBM Integrative and Complementary Medicine,2020, volume 5, issue 1)

TCM has been a highlight in China’s efforts to fight COVID-19, said Zhang Boli, an academician of the Chinese Academy of Engineering (CAE) and one of the leading experts advising on the epidemic fight in central China’s Hubei province, epicenter of the epidemic in China. Zhang, disclosed that some academic institutions in South Korea, Japan, and Italy have sent letters to China asking it to share its experience in fighting COVID-19 and its use of TCM, and asking China to provide Chinese patent medicines. As a matter of fact the Chinese medical team that arrived at Milan, Italy to offer assistance were made up of 13 medical experts, including two TCM experts, and accompanied with nine tons of TCM supplies donated by east China’s Zhejiang province for medical treatment and protection. Responding to accusations that the TCM lacks clinical data and research mechanism, Zhang said although there are ample evidence to prove the effectiveness of TCM, some people in the US choose not to believe in the TCM because they are prejudiced against TCM. This US prejudice against TCM is regrettably, hurting its COVID-19 treatment according to Zhang.

During this COVID-19 epidemic, 70,000 confirmed COVID-19 patients in China have been treated with TCM, which is the best evidence for the effectiveness of TCM, Zhang argued, adding that researchers have published more than 10 papers on TCM, proving its function in the treatment of COVID-19 patients. When there is no specific drug and vaccine to cure the COVID-19, is it rational to argue about its research mechanism when the TCM is already tested effective among patients? Zhang asked. He further stated that TCM is not designed to kill novel coronavirus itself but helps to improve the entire body system to fight the disease, Zhang said. More than 90 percent of all coronavirus patients in China used TCM during their treatment process, including 61,000 in Wuhan, the worst-hit city by the epidemic and the TCM treatment prevented these patients from deteriorating to a critical condition, media reports said.

The President of Ghana has reiterated that we are not in normal times. Hence, in these extraordinary times, extraordinary situations require extraordinary solutions! Paracelsus, once said that; “healing comes from nature and not from the physician. Therefore the Physician must start from nature with an open mind”. Some statements in certain sections of the media attributed to the General Secretary of the Ghana Medical Association seems to portray the idea that; he will not endorse the use of herbal medicine to fight Covid-19.He went further to state that; ‘’We should follow standardised activities and when I say standardised activities, I mean the rightly prescribed drugs for the management of Covid-19.” And stressed that herbal medicine can only be used if it is certified and if not, the herbal option must go through due process to be approved, otherwise if used, it can pose a threat to human health’’. In addition, he strongly advised against the use of herbal medicine to fight coronavirus if it has not been certified. Well for his information, Plants and natural sources form the basis of today’s modern medicine and contribute largely to the commercial drug preparations manufactured today. Furthermore, about 40% of drugs prescribed worldwide are derived from plants and of the total 252 drugs in the World Health Organization’s (WHO) essential medicine list, 11% are exclusively of plant origin.

Some years back, Herbal medicine was termed primitive by western medicine but through scientific investigations there is a better understanding of its therapeutic activities such that many pharmaceuticals have been modelled on phytochemicals derived from herbal medicine. For instance, morphine originated from the herb opium poppy while Echinacea was the common treatment for respiratory infection prior to the development of antibiotics. Also, the herb bishop’s weed which the Egyptians used to treat vitiligo, has yielded the drug β-methoxypsoralen for treating psoriasis and other skin disorders. The list goes on and on. However major obstacles to the use of herbal medicines are their poor quality control and safety. Herbal medicine practices are still shrouded with much secrecy, with few reports or documentations of adverse reactions.

Standardisation remains a key limiting factor to the commercial utility of herbal medicines. The problem, though, is that in spite of the commercial merits of standardisation, the justification for it, by and large, betrays the scientific community’s understanding of herbal medicine. Standardisation runs contrary to the concept of synergy, which holds that the whole herb has greater therapeutic properties than the sum of its parts. By isolating the active compounds, other naturally occurring constituents may be displaced and render the active part less effective or lead to side effects. To explain this in lay-man's term, I shall use this example. Willow bark extract (from the willow tree of the Salix species) has long been used in native and folk medicine to relieve pain, inflammation, and fever with negative side effects. It contains salicin, which is metabolized in the body to create salicylic acid, a precursor to aspirin. In the late 1800s, chemists discovered a way to make a synthetic version of salicylic acid, called acetylsalicylic acid, which we today know as aspirin (a nonsteroidal anti-inflammatory drug). However, the usage of aspirin for the same uses of willow back comes along with frequently reported side effects such as dyspepsia, epigastric discomfort, heartburn, and nausea. Therefore herbal medicines cannot be subjected to the same standard protocols for allopathic medicines for it to be certified as a drug as suggested by the General Secretary of the Ghana Medical Association. In fact, it is estimated that about 74% of the nearly 119 pure plant derived chemical compounds used in medicine throughout the world have the same use as the plants from which they were obtained. Vinblastine, vincristine, quinine, artemisinin, celastrol, capsaicin, paclitaxel have had a significant impact on health care delivery. In fact because of the extreme difficulty in producing d-tubocurarine (a muscle relaxant in surgery) synthetically, the plant is still collected from the wild to obtain this valuable active ingredient. The discovery of these essential medicines highlights the promise the ethno pharmacological approach holds in the search for novel treatment options for dealing with many of the diseases including Covid-19, for which conventional medicine appears to have no answer. Globally, there is no specific treatment or vaccine for Covid-19. Healthcare providers are mostly using a symptomatic approach, meaning they treat the symptoms rather than target the virus, and provide supportive care (e.g. oxygen therapy, fluid management) for infected persons, which can be highly effective. Some researchers have made strong cases for hydroxychloroquine, chloroquine, lopinavir, Ritonavir, remdesivir and Azithromycin. These are drugs certified for treatment of disease conditions other than Covid-19. But these drugs are being relied on because they have proven to postpone the death of people infected with the novel coronavirus. Therefore it baffles me if the General Secretary of the Ghana Medical Association is strongly advising against the use of herbal medicine to fight coronavirus if it has not been certified. My question is; if certified as safe and effective for disease conditions other than Covid-19 or certified for Covid-19 treatment? Since we are all aware that there is no certified drug for treatment of Covid-19, it behoves on us (the good citizens of Ghana) to also consider Traditional Ghanaian Medicine (TGM) or herbal medicine certified for other disease conditions based on the same symptomatic approach as employed by TCM and Conventional medicine to provide supportive care in these perilous times. The effectiveness of herbal medicine should and can never be underestimated or downplayed by anybody. Herbal medicines hold promise and the formal recognition and integration of herbal medicine into conventional medicine practice in Ghana as done in China, will hold much promise for the future. Unlike the Chinese who have a history of Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1) and hence have documented TCM remedies that could be useful against coronavirus related human diseases, this is the first time Ghana is reporting Coronavirus related human disease and hence we do not have the priviledge of tapping into our history to come up with tried and tested herbal medicine.

Herbal medicines and standardised natural products provide a rich resource for novel antiviral drug development. The antiviral mechanisms from these natural agents has shed light on where they interact with the viral life cycle, such as viral entry, replication, assembly, and release, as well as on the targeting of virus–host-specific interactions. For example; Lycoris radiata and its active component lycorine, Artemisia annua, Pyrrosia lingua, and Lindera aggregata have shown activity against SARS-CoV. In addition, Houttuynia cordata water extract also showed activity against SARS-CoV by acting as a protease and viral polymerase inhibitor(Lin, L. T., Hsu, W. C., & Lin, C. C. ,2014). I believe that natural products will continue to play an important role and contribute to antiviral drug development in the future.

Howbeit, I am happy to say that the Ministry of Health is conducting some preliminary studies on some Traditional Ghanaian herbal medicines that may be effective in our fight against Covid-19 in collaboration with the Centre for Plant Medicine Research. However,our focus should be on symthomatic support therapy or adjuvant therapy and not necessarily to establish a cure wihich is unavaillable globally. it is also regrettable to say that in these trying moments, some people''s prejudice against herbal medicine might hurt our collective fight against COVID-19. That notwithstanding, healing always comes from nature and not from the physician. Therefore the physician Must start from nature with an open mind”- Paracelsus

By Dr Ernest Aggrey (MH), [email protected]