1. Introduction
The World Health
Organization (WHO) considers Natural and Traditional Medicine, which includes
treatment with medicinal plants, as the most natural, safe and effective
medicine, in addition to being accessible, it is affordable and accepted by the
population. (WHO) therefore, supports Member States in promoting the use of
Traditional Medicines in Primary Health Care (PHC), based on ensuring the
safety and quality of medicines, as well as educating professionals and consumers
to use medicinal plants properly because they could be effective as first-line
treatment and prevention for conditions such as colds, diarrhea, stomach pains,
mild fevers [1].
In the last years,
numerous studies have been carried out to know the species used in Primary
Health Care (PHC) and the results show that the use of the plants depends on
the groups studied and the habitat where they developed. In a broad
perspective, herbal medicine can and should be considered as the knowledge and
interaction between cultural resources. This would translate to the interaction
between local practices and knowledge, natural resources and the preservation
of biodiversity; users and their interaction with nature and health care team
professionals. In the Latin American context, experiences applied from an
intercultural perspective have generally been characterized for being is connected
health treatments from the rest of the problems of the population and
communities. These do not connect with the social and economic structure and therefore
ancestral medicine grows further away from the health system [2]. Although Medicinal Plants are used by more than
90% of the population in developing countries, their incorporation into PHC is
still relegated due to barriers in health systems, services and personnel, and
it is uncommon to integrate in the same service the traditional and allopathic
medicines. Thus, many practitioners of allopathic Medicine, even in countries
with a strong history of medicinal plant use, such as Paraguay, express great
reservations and often serious disbelief about the benefits of Traditional
Medicine [3].
Preventive and
curative treatments are the most popular form of traditional medicine and they have
prevailed over time through oral transmission [4].
Therefore, one of the current challenges is its incorporation into PHC, for
which constant training is needed not only of consumers and the population in
general, but also of health professionals, in order to finally fulfill one of
the fundamental strategies of PHC, which is its integration with the community
in a process of interculturality.
2. Efficacy
and Safety
The effectiveness
and safety of medicinal plants is based on three fundamental pillars that can
guarantee their innocuousness: 1) the taxonomic identity of the species to be
used, 2) the habitat from which it comes, its origin, 3) the dose, because people
have a false idea that their excess consumption does not produce toxic effects
since they are "innocuous".
3. Quality
Control
Medicinal plants
should be marketed by their scientific names ensuring that they are the same
species, in order to obtain similar therapeutic responses in the symptoms of
diseases. In Paraguay, commercialization is carried out by common name and
there may be confusions or adulterations and this constitutes an important
problem that can affect the effectiveness of medicinal products and diminish
credibility in relation to use in primary health care [5].
Although the most
frequently used medicinal organ is the leaf, when using the bark, root or
rhizome, determining the identity of the species becomes complicated and the
substitution of one species for another is frequent since there are no
regulations related to the commercialization of fresh plant organs. Therefore,
it is necessary to start working with micrographic patterns to ensure the
identity of the species that are used.
4. Origin
of medicinal species
The problems that
affect the conservation of biodiversity contribute to the disappearance of
species considered medicinal, which in many cases are replaced by others with
similar characteristics. In Paraguay, for example, the number of plants used
for medicinal purposes is increasing [6,7]. Point
out that in Asunción and in the metropolitan area, 266 species are sold for
medicinal purposes, which are used to combat, prevent or cure 57 conditions [8]. Cite 500 medicinal species used for preventive
and therapeutic purposes. These lists include the introduced, acclimated and
native species, not to mention the origin that is if their origin is crops or if
they are extracted from their natural habitat.
We must mention
that in Paraguay medicinal plants used as refreshments are generally consumed
fresh. They are crushed and macerated in cold water and they are drunk in the
"terere" which is the typical drink of the country, where the ambient
temperature is high most of the year.
5. Conservation
of Medicinal Species
Usually, in
Paraguay, plants which will be commercialized are collected from their habitat.
The attributed uses have been empirical, traditionally relating the form of the
vegetal organ with the organ of the human body in which it would exert its
action. This scheme has varied, and today the use is related not only to
morphology, but also to flavors or odors, for example, when plants have bitter
tastes, they are used to combat the increase of blood glucose starting with the
assumption that the bitter is opposed to the sweet.
According to [9], 67% of the plants mentioned as medicinal
originate from their natural habitat, while only 33% is cultivated, so the conservation
of these plants is an aspect that must be addressed, since extensive and
uncontrolled extraction may jeopardize species sustainability over time. It is
therefore necessary to know the degree of threat to the survival of the
species, and cultivation programs, especially native ones, should be initiated
prior to their use in PHC.
With regard to
species activity, it is important to remember that the use of plants may have
interactions with allopathic medicines. There are studies that show that the
simultaneous consumption of medicine and medicinal plants, organs, parts or
products of plant drug scan cause interactions, which further motivates the
need to recognize that plants should be treated as a drug. Thus, it is
important to know what are the attitudes of users and health personnel
regarding the consumption of medicinal plants as medicine [10].
In Paraguay, the
habit of consuming medicinal plants is deeply rooted. 99% of the population
that goes to the Family Health Unit recognizes that they use medicinal plants
for medicinal or preventive purposes, although in general they do not inform
the health personnel of its use because they consider that consumption is innocuous.
It is important to take into account that this medicine is the only form of
traditional medicine widely accepted by the population.
One of the current
trends in medicine has been to incorporate Traditional Medicine into
professional practice, not as an alternative method motivated by monetary
causes, but as a scientific discipline that must be permanently studied,
Perfected and
developed, for its ethical and scientific advantages. It constitutes a means of
recovering the cultural heritage of the people, which is in danger of
disappearing before the advance of "modern medicine" [11].
6. Conclusion
Medicinal plants
can be used in Primary Health Care as a more accessible, affordable, safe and
effective medicine if the conditions for it to happen are respected. As
mentioned before, the efficacy and safety in medicinal plants depends on: 1)
the taxonomic identity 2) the habitat from which it comes 3) the dose used.
The factors
mentioned should be developed jointly and from an intercultural approach in an
interconnection that allows analyzing and giving solutions to the problems of
populations and communities, linking the social and economic structure and
ancestral medicine to the official health system.
review article