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Botanics: Targets and Therapy 2015:5 33–44
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Open Access Full Text Article
http://dx.doi.org/10.2147/BTAT.S66308
Toward the integration and advancement
of herbal medicine: a focus on traditional
Indian medicine
Saikat Sen
Raja Chakraborty
Institute of Pharmacy, Assam
Down Town University, Guwahati,
Assam, India
Correspondence: Saikat Sen
Institute of Pharmacy, Assam Down
Town University, Chandrapur Road,
Panikhaiti, Guwahati, Assam 781026, India
Tel +91 96 7821 0021
Email saikat.pharm@rediffmail.com
Abstract: Indian traditional codified medicinal systems and folk medicine are a vast lexicon of
herbal formulations and medicinal plants. In last few decades, the popularity of herbal medicine/
products has increased worldwide, not only as part of conventional treatment strategies but also
for health care management, and thus the opportunity to promote Indian traditional medicine
is increasing globally. Recently people from several developed and developing countries have
been attracted toward traditional Indian herbal medicines. A large number of modern medi-
cines are derived from the plants used in Ayurveda and other traditional medicinal systems.
Ayurveda and other traditional herbal medicines are capable of addressing some modern unmet
medical needs, and can provide the basis for developing potential medicines. Lack of drug
standardization, information, quality control, and strict monitoring are the primary lacunae
in the promotion of traditional Indian herbal products. In recent years several regulatory and
promotional approaches have been undertaken to overcome such problems. Quality control,
rigorous research to establish the effectiveness and safety, and credible clinical trials of the
herbal products are required. Thus the careful and scientific integration of Indian traditional
herbal medicine into evidence-based clinical management of diseases is essential to provide
better health care facilities to people.
Keywords: traditional medicine, herbal drug, India, Ayurveda
Introduction
India, a rich chest of biodiversity, has a large diversity of plant species. India consists
of 2.4% of the total geographical area of the world, but accounts for 8% of global
biodiversity, with around 49,000 plant species of which 5,150 species are endemic.1–3
The Himalayan range, Western Ghats, North-Eastern Indian hills (Khasi and Mizo
hills), and Vindhya and Satpura ranges of the northern peninsula of India are the gold
mine of higher plant species. Herbal medicine has special importance in the society,
culture, and traditional medicine of India.1 Plant-based medicines are at the root of the
modern health care system, and are acknowledged for their economic importance also.4
Traditional medicinal knowledge and plants play a central role in biological research
and drug development. Herbal products or constituents are not only used directly
as curative agents, but also as lead molecule in the discovery of new drug. Current
research and understanding suggest that the use of crude herbs or herbal products can
confer real benefits on health when used long-term.2,5
Increasing population and the incidence of side effects of synthetic medicines
also accelerate the popularity of alternative medicines. The World Health Organiza-
tion acknowledged that the goal of “Health For All” cannot be accomplished without
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Sen and Chakraborty
herbal medicines. In a wider context, demand for medicinal
plants, herbal medicines, health products, pharmaceuticals,
food supplements, cosmetics, etc, is growing in all parts of
the world, which indicates the popularity and belief of people
in herbal medicines. This in turn has created great scope for
India to utilize its traditional knowledge of herbal medicine
and repository of medicinal plants in the service of the world
population and for the economic growth of India.2,6,7
Indian systems of medicine
Concepts and practices of different traditional medicinal
systems in India are about several thousand years old. A large
proportion of the Indian population still believes in and
receives traditional medical care, which is based on the prin-
ciples of three ancient codified Indian systems of medicine
(ISMs): Ayurveda, Siddha, and Unani.8–10 Though different
chemicals, minerals, and animal products are used in such
system to prepare curative agents, but use of plants have
been the basis of treatment in these system. It is estimated
that Ayurveda uses 1,200 species of plant, while Siddha and
Unani include 900 and 700 species of plant, respectively, in
their medicinal preparations.11 Ayurveda and other ISMs are
judicious combinations of modern science and contemporary
clinical medicine, which have the potential to cure a number
of diseases in better ways and leverage new leads for mod-
ern medicine.12 Currently, more that 1.5 million traditional
medical practitioners in India are using medicinal plants for
preventive, promotional, and curative purposes.13
Ayurveda, perhaps the most ancient (6000 BC) of the
different organized traditional medicinal systems, is native
to the Indian subcontinent and has been practiced since the
beginning of the Indian civilization. It can be described as
the “science of life”, accounting for an integrated observa-
tion of the mental, physical, spiritual, and social facets of
human beings.14,15 Preventive and curative measures are the
key components of the Ayurvedic system. Major treatment
approaches include the use of “aushadhi” (drugs); “anna”
(diet); and “vihara”, which includes exercises and a healthy
mode of life.14–16 The Charak Samhita, Sushrut Samhita, and
Samhitas of Vagbhat, together referred to as the Brihattrayee,
are considered the three key classics in Ayurveda. Charak
Samhita and Sushrut Samhita (100–500 BC) describe over
700 plants, along with their detailed classification, pharma-
cological, and therapeutic characteristics.12,17
In the pre-Vedic period (approx. 3000 BC-2000 BC), the
Siddha system of medicine originated in the southern part of
India,18 “siddhas” (ancient practitioners of Siddha medicine)
are believed to have developed this system which are written
in Tamil and mainly practiced in Tamil Nadu.14,18 The Siddha
medicinal system recognizes three humoural concepts: “vata”
(wind), “pitta” (bile), and “kapha” (phlegm). Examination
of the pulse, urine, and different anatomical features like the
tongue, voice, complexion, eyes, touch (to find dry, warm,
cold, sweating condition), and stools are commonly used as
diagnostic criteria in Siddha medicine.16,18,19
The basics of the Unani system of medicine were laid by
Hippocrates and later by Galen. In the eleventh century, the
Unani system was introduced in India by Arabs and Persians.
The fundamental theory of the Unani system is “humoral
theory”, which presupposes the presence of four humors –
blood, phlegm, yellow bile, and black bile – in the body, and
for Unani practitioners diagnosis mainly depends on pulse
reading, and examination of the urine and stools.20,21 The
main therapeutic approaches in this system include dieto-
therapy, or “Ilaj-bi-ghiza” (use of specific diet); regimental
therapy, or “Ilaj-bil-tadbeer” (exercise, change of climate,
massage, venesection, leaching, cupping); pharmacotherapy,
or “Ilaj-bi-dawa” (use of medicines from herbal, mineral, and
animal sources); and surgery, or “Ilaj-Bil-Yad”.20–22
Folk medicine (also known as “tribal” or “indigenous”
medicine) also plays an important role in Indian society,
mostly in rural/indigenous/ethnic communities. This type of
knowledge is usually passed verbally from ancestors of the
particular group of people without any written script. It has
been estimated that more than 8,000 species of plants are
used by the tribal and ethnic communities in India as part of
their health care systems.7,23 Approximately 25,000 effective
plant-based formulations are used in folk medicine and are
commonly used by rural and ethnic communities in India.13
Herbal medicine and modernity:
can Indian traditional medicinal
systems show the way forward?
Importance of herbal medicine
Herbal medicines are truly in a league of their own, and
have stood the test of time until now. But unfortunately the
utilization of herbal medicine for the management of diseases
is less despite of its potential. A large number of ethnic and
rural people use and stoically play a crucial role in protect-
ing the ancient medicinal knowledge related to plants from
fading away into oblivion. Herbal medicine is due a revival.
However, incorporating herbal medicine into the true main-
stream of modern health care and ensuring modern safety
and efficacy standards is not an easy task.
In India, about 65% of the population mainly uses tradi-
tional medicine for their health care needs. Inequities in the
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Integration and advancement of Indian herbal medicine
Cultivation, cell culture, and use of
other scientific approaches to save
endangered species
Record of unpublished folk information Gathering of scientific evidence
Marketed herbal formulation
Indian traditional herbal medicine
Traditional herbal formulation
Standardization and quality control
as per international guideline
Semisynthetic/synthetic molecule
Biological activity
Structural modification
New drug molecule Promoting the drug
(internationally)
Preclinical study
toxicological profile
Identify potential plant species
Pharmacological screening
of plant extract or fraction
Clinical trial
Preclinical trial
Clinical study
Isolation and characterization
of active molecule
Figure 1 Strategy for advancement and integration of traditional herbal medicine into modern medicine.
accessibility, availability, and affordability of modern health
care make herbal drugs more popular in rural and remote
areas.24,25 Demand for traditional medicine in developed coun-
tries is also increasing. About 40%–50% people in Germany,
42% in the USA, 48% in Australia, and 49% in France are
using traditional medicine. In the twenty-first century, herbal
drugs and products from plant sources are increasingly being
acknowledged in developed countries and also among the
people who can afford costlier allopathic medicines, with
the hope of a more eco-friendly, bio-friendly, and relatively
safer treatment strategy.4,24,25 Among the 49,000 plants of
the Indian subcontinent, about 20% are global species. It
was estimated that more than 3,500 higher and lower plant
species have medicinal value, although only 500 species of
medicinal plants are used by the Ayurvedic industry.1,2 Several
reports have suggested that almost 80% of drug molecules
are of natural origin or inspired by natural origin. It has been
estimated that almost 50% of drugs approved since 1994
are based on natural products.26 Undoubtedly, a lot of plants
contain substances of medicinal value which have yet to be
discovered. Indian traditional medicinal systems believe in
a holistic approach, and are considered as ancient forms of
system-biology-based medicine. Diagnosis and treatment
strategies provide more individualized methods. ISMs have
a very complex and logical approach to diagnosis, which are
based on rational observation, and use a number of potent
herbal preparations, thus have become an important target
of medical research.
A key area for the popularity of herbal products is nutri-
tional supplements. Herbal supplements afford nutrients
that are lacked or not consumed in an adequate quantity
through the diet. Herbal supplements may contain vitamins,
minerals, macronutrients, and antioxidants, etc, which
are essential for good health. Thus, the demand of several
Indian formulations – like chyawanprash, musli pak, and
ashwagandhadi lehyam – is increasing.27 Figure 1 shows the
strategy for advancement and integration of traditional herbal
medicine into modern medicine.
Present scenario and future
Review of different national pharmacopeia revels that at
least 120 distinct chemical products/moieties from herbal
sources have been utilized as lifesaving drugs. It is predicted
that among the estimated 250,000-400,000 plant species of
world only 6% have been screened systematically for their
biological activity and 15% have been investigated phy-
tochemically.28 It is predictable that natural compounds and
their derivatives comprise nearly 60% of all drugs in clini-
cal use and medicinal plants contribute not less than 25%.
Between 1981 to 2002, around 119 drugs were approved and
of those around 60% of anticancer and 75% anti-infective
drugs could be related to natural substances.29 Thirteen
natural products were approved as drugs between 2005 and
2007. Currently, more than 100 natural products (drugs) are
in clinical trials and about 100 molecules or compounds
are in the preclinical phase of drug discovery.30 Several
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Sen and Chakraborty
bioactive molecules from plants, especially from those used
in Ayurveda, have been discovered, such as reserpine for
high blood pressure, psoralens for vitiligo, alkaloids from
Holarrhena antidysenterica (L.) against amebiasis, Mucuna
pruriens for Parkinson’s disease, piperidines asbioavailabil-
ity enhancers, vasicine and vasicinone as bronchodilators,
hydroxycitric acid for obesity, bacosides to treat mental
retention, picrosides as hepatoprotective agents, phyllanthins
for viral infections, and withanolides and steroidal lactones
as immunomodulators. Current scientific knowledge, better
clinical observation, and superior thoughtful consideration
help to explore Indian traditional medicine in an advanced
way and utilize old molecules for new therapeutic applica-
tions. For instance, forskolin is currently acknowledged as a
potent adenylate cyclase activator and antimicrobial berberine
alkaloids are used to cure dyslipidemia.26,31 A typical, sys-
tematic research on plants to find new bioactive molecules
is expensive and inefficient. The high cost of and the time
taken for this process are the main hurdles. One of the most
important approaches in the discovery of a new drug would
be recourse to the information accessible in traditional Indian
medicinal systems, which are based on the proven therapeutic
utility of the medicinal plants of India.12
Indian herbal medicine makes numerous medical claims
for the treatment of many acute and chronic diseases and
symptoms, the prevention of disease, and the improvement
of quality of life. Herbal medicines also contain different
chemical constituents that could act singly or synergistically.
The advancement and success of Indian traditional medicine,
especially Ayurveda, around the world is mainly due to its
being a holistic approach to treatment.32 Ayurveda, a well-
written medical text, describes scientific view on diseases
and treatment that makes it unique. Currently, Ayurveda is
included in the Indian national health care system. Several
countries, like the UK, the United Arab Emirates, Sweden,
Indonesia, and the USA have acknowledged the Ayurvedic
health care system and more than 30 countries are on the
verge of doing the same.33 It has been estimated that almost
two-thirds of people in the USA use one or more alternative
treatment strategies, of which most are drugs from herbal
sources. The demand for dietary supplements and traditional
medicines is high in the US and thus more than 1,500 herbals
are sold for such proposes.31 A survey in 2007 revealed that
more than 200,000 American adults have used Ayurvedic
medicine.34 Ayurveda is gaining momentum as a successful
alternative to the conventional medicinal system through its
systematic strategy of curing and preventing diseases using
natural resources.35 Increased use and misuse of current allo-
pathic medicines provides enthusiasm for integrating alterna-
tive medicine and conventional medicine.36 Ayurvedic herbal
medicine confers benefits to 75% of the sub-continental
population of 1,000 million and millions of others around
the world.37 Herbal therapies or plants used in ISMs have the
potential to become the drugs of the future. Indian herbal
medicine could meet some modern unmet medical needs,
provide basic health care needs, and can offer the basis for
developing potential medicines. Increase in the demand and
utilization of herbal products provides fertile ground for the
revival of Indian herbal medicine.34
Revival of Indian traditional
herbal medicine: current
situation and impediments
Role of Indian organizations
Phytochemicals from ISMs, particularly from Ayurveda, are
beginning to attract interest across the world and huge efforts
have been initiated to include traditional herbal medicine in
modern medicine. India has enormous facilities for research;
the Central Drug Research Institute (CDRI), Council of
Scientific and Industrial Research (CSIR), Central Institute of
Medicinal and Aromatic Plants, National Botanical Research
Institute, Regional Research Laboratories, and National
Chemical Laboratory are playing vital roles in this regard.
Several government and nongovernmental organizations from
different countries have actively started researching on plants
and formulations described in Ayurveda.28
Indian traditional medicinal plants
in preclinical and clinical trial
Global acceptance of Ayurveda is increasing and demand for
medicinal plants from India is in upsurge.35 In recent years,
a number of drugs from ISMs have undergone clinical trials
to verify their efficacy. Products from Ayurveda have been
successfully evaluated in clinical trials for the treatment
of bronchial asthma, rheumatoid arthritis, ischemic heart
disease, and cancer, among other illnesses.28,38–41 Indian
medicinal herbs (eg, ashwagandha, guggulu, haridra, kutki,
shatavari, atmaupta, amruta, brahmi, guduchi, amla, and
ginger) and complex herbal formulations (rasagenthi lehyam,
brahma rasayana, semecarpus lehyam, triphala, and other
rasayanas) were evaluated through preclinical studies and
reported to possess positive effect.33,42,43 The US National
Center for Complementary and Alternative Medicine has
funded several research works based on Ayurvedic medicine –
for example, on the use of curcuminoids in cardiovascular
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Integration and advancement of Indian herbal medicine
diseases, a compound from M. pruriens (L.) used against the
side effects of anti-Parkinson’s drugs, the use of three plants
(ginger, turmeric, and Boswellia) to cure arthritis and asthma,
and to validate the effect of Centella asiatica (L.) against
Alzheimer’s disease.34 Potent vaccine adjuvant activities of
Withania somnifera (L.) and Asparagus racemosus wild have
been evaluated in experimental systems, which suggests their
importance in immunobiological preparations.
Controlled clinical trials are essential to establish the
effects of drug and to compare the potency of traditional
medicines with allopathic medicines. Clinical trials on Indian
traditional medicines are encouraging but warrant many more.
For instance, “piperine”, a bio-enhancer from pipali, has
been successfully evaluated in clinical studies; a multicenter
study found that a Vijayasar (aqueous decoction of Ptero-
carpus marsupium Roxb) was effective as a hypoglycemic
and antidiabetic drug; Lupin Ltd (Mumbai, India) filed an
Investigational New Drug (IND) application; a US patent has
been approved for the development of a herbal anti-psoriatic
medicine containing Argemone mexicana (L.); the CDRI
developed a product containing fraction of gugulipid from
Commiphora wightii for the treatment of hyperlipidemia and
atherosclerosis. Boswellia serrata Roxb. gum resin has been
commercialized by Regional Research Laboratories (Jammu)
as a nonsteroidal anti-inflammatory drug, which also demon-
strates hypolipidemic effect.28,44–47 A double-blinded clinical
trial has been carried out with “arogyawardhini” (an Ayurvedic
product containing amla, bahera, harar, guggulu, kutki, neem,
chitrak mool) in viral hepatitis, while effects of M. pruriens,
Phyllanthus amarus, and Tinospora cordifolia have been
investigated in the treatment of Parkinson’s disease, hepatitis,
and obstructive jaundice, respectively.48 The CSIR and CDRI
have developed a bacoside-enriched standardized extract of
plant brahmi (Bacopa monnieri L.) used to enhance memory
and learning; the product is already marketed in Asian and
European countries under different brand names. Brahmi is
described in the Charak Samhita and Sushruta Samhita, and
has been used as a brain tonic for 3,000 years.49
Traditional medicinal formulations
containing plants
A clinical trial of a well-known classical Ayurvedic formula-
tion, “triphala”, which is prepared by combining the fruits
(without seeds) of Terminalia chebula Retz., Terminalia
bellerica Roxb., and Emblica officinalis Gaertn., showed potent
effects against constipation and other gastric problems.50
A standardized formulation prepared with purified extract
of ashwagandha (W. somnifera), guggulu (B. serrata), and
haldi (Curcuma longa) was effective in improving a joint-
swelling condition and has a good safely profile when given
to people suffering from rheumatoid arthritis.39
Another classical example of herbal formulation is `pros-
talyn’, which contain two traditional Indian medicinal plants
(Murraya koeniggi and Tribulus terrestris) and used to treat
benign prostate hyperplasia.
A short-term clinical trial demonstrated that “tarika”,
an Ayurvedic pimple remover herbal powder (containing
T. chebula fruit, T. bellerica fruit, Santalum album heartwood
powder, Curcuma aromatica rhizome, Embelia ribes fruit,
Berberis aristata dried stem, Acorus calamus rhizome,
Embelia officinalis fruit, Taxus baccata leaf, Myristica
officinalis fruit endosperm, and Cyperus rotundus rhizome)
has good effect in patients suffering from moderate to severe
degrees of acne vulgaris.52
“Guduchyadi ghrita medhya rasayana”, an Ayurvedic
formulation containing several Indian medicinal plants like
guduchi, apamarga, vidanga, shankhapushpi, vacha, haritaki,
kushtha, and shatavari has showed promising effects in clini-
cal trials by improving the mental health, memory, stress, and
depression conditions, which might be helpful in slowing
down the aging process.53
“Amalki rasayana”, an Ayurvedic herbal product, has
showed promising effects in patients suffering from age-
related macular degeneration.54
A number of traditional plant-based formulations have
been developed by the CSIR. Some of these are α, β arteether
(E-mal – which was included in India’s National Malaria Con-
trol Programme) and elubaquine (Aablaquin) as antimalarial
drugs; Asmon® to cure asthma; Sallaki® of B. serrata to treat
rheumatoid arthritis and osteoarthritis; Livzon poly-herbal
formulation, which has been evaluated as a hepatoprotective
agent; and immines, a multi-herbal drug to cure immune-
modulatory activity.55
A number of Siddha herbal formulations like Gly Cyn
Neu ointment against diabetic neuropathic symptoms, combi-
nation of amukkara choornam and linga chenduram, and two
other poly-herbal (for internal and external use) formulations
against rheumatoid arthritis have also undergone successful
clinical trials.56–58
Since the Vedic period, ISMs have been enriched with a
number of herbal drugs to cure jaundice and viral hepatitis. It
has been estimated that more than 6,000 commercial herbal
medicines are used worldwide for the management of liver dis-
orders, and among them nearly 40% patents are for poly-herbal
formulations (including silymarin from Silybum marianum
L. Gaertn. seed, Picrorhiza kurroa Royle ex Benth extract, and
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Sen and Chakraborty
extracts of plants of different Phyllanthus sp. and glycyrrhizin
preparation) consisting of different combinations of 93 Indian
herbs, which are existing in the Indian market.48
Several patented and proprietary herbal medicines, like
Arishtas, Churnas, Rasayanas, Ghrits, and Ras, have been
marketed in the form of modern medicines such as tablets,
capsules, powders, syrups, ointments, or even as gels.
According to a survey, more than 70% of all drugs sold
as Ayurvedic medicine in the Indian market are branded
editions – patented and proprietary medicines.12
The Traditional Knowledge Digital Library (TKDL) is
a unique approach by the Government of India to compile
and preserve traditional medicinal knowledge and is in the
public domain.
Currently, a number of botanicals are undergoing clini-
cal trial using reverse pharmacology processes to find new
drugs to cure/prevent hepatotoxicity, viral hepatitis, cancer,
diabetes, and arthritis based on the traditional knowledge of
India.12 Herbal medicines and medicinal plants described
in ISMs, including folk medicine, have emerged as a great
source of new drugs.
Potent phytochemicals from Indian
medicinal plants
Turmeric (C. longa) is a classical Indian medicinal herb
recognized for its great clinical utility by ISMs. It is used
in the treatment of pain, wounds, and sprains, as well as
skin, pulmonary, gastrointestianl tract (GIT), and liver dis-
orders. “Curcumin”, the bioactive component of turmeric,
has emerged as a potential therapeutic molecule against
Alzheimer’s disease, different malignant diseases, diabetes,
allergies, and arthritis, among other disorders.59,60 Rauwolfia
serpentina L. (sarpagandha), an ancient medicinal plant
of India, is used to treat hypertension, mental disturbance,
insomnia, gastrointestinal disorders, epilepsy, anxiety,
and schizophrenia. The plant is also used to cure several
hypertension-related problems like headache, dizziness,
amenorrhea, oligomenorrhea, and dysmenorrhea in Siddha
medicine.61,62
In the beginning of 1930, R. serpentina was investigated
for its tranquilizing and sedative effects. In 1949, Indian
cardiologist Rustom Jal Vakil reported a hypotensive effect
of its root extracts, which attracted the interest of researchers.
The alkaloids ajmaline (an antiarrhythmic agent) and reser-
pine were isolated from sarpagandha root in 1931 and 1952,
respectively.63 The discovery of reserpine was a breakthrough
for the treatment of hypertension and psychotic disorders,
though this drug is seldom used now.48
B. monnieri is a potent medicinal herb of Ayurveda used
to cure epilepsy, asthma, ulcers, tumors, and inflammation,
among other things. Subsequent investigations led to the
discovery of bacosides.51,64
A labdane diterpene, “forskolin” was isolated from the
root of Indian medicinal herb Coleus forskohlii (makandi).
Forskolin has a potent and direct adenylate cyclase activating
property and could be a potent molecule to treat congestive
cardiomyopathy, glaucoma, and asthma. Clinical studies
of forskolin to manage obesity and weight are ongoing.
A number of semi-synthetic derivatives of forskolin have
been developed and have been approved for several clinical
studies.65,66
“Flavopiridol” and “P-276-00” are the novel semi-
synthetic derivatives of an alkaloid (rohitukine) isolated from
Amoora rohituka (Roxb.) Wight and Arn. and Dysoxylum
binectariferum (Hook.f.), and are in advanced stages of
clinical trials as anticancer drugs.67,68 The anti-inflammatory,
anticancer, anti-fertility, anti-implantation, and immunomod-
ulatory activities of rohitukine have also been investigated.
“Dysobinin”, a compound from D. binectariferum fruits, has
exhibited potent central-nervous-system depressant and mild
anti-inflammatory effects.69 Both the plants (A. rohituka and
D. binectariferum) have been used by physicians of ISMs for
a number of disorders related to the liver and spleen enlarge-
ment and inflammation.69,70
“Diosgenin” is a major bioactive steroidal sapogenin
isolated from several traditional medicinal plants includ-
ing Trigonella foenum-graecum L. and Dioscorea spp.
These plants are commonly used in Ayurvedic and Siddha
formulations. Dioscorea bulbifera L. (varahi) is used to treat
dysuria, urinary calculus, urine disorders, calculus, disorders
of vital point, and trauma, while T. foenum-graecum (methi)
is used against pain, facial palsy, abdominal problems, her-
nia, and neurological disorders.71,72 Catharanthus roseus L.
(nityakalyani) has a long history in ISMs as a diuretic, anti-
dysenteric, hemorrhagic, and antidiabetic drug.
Two alkaloids, vinblastine and vincristine, have been
isolated from Catharanthus roseus leaves and recognized
as anticancer agents for variety of cancers such as lympho-
cytic lymphoma, Hodgkin’s disease, testicular carcinoma,
and choriocarcinoma. Vincristine is used in acute leukemia,
lymphosarcoma, and Wilms’ tumor.73
Guggulsterone was discovered from the gum resin (gug-
gulu) of Commiphora mukul. Guggulu is an important con-
stituent of Ayurvedic medicine used to cure several disorders
like obesity, bone fractures, arthritis, inflammation, and car-
diovascular disease.74 The CDRI has successfully completed
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Integration and advancement of Indian herbal medicine
clinical trials of gugulipid as a lipid-lowering agent, and
marketed it in the form of tablets and granules.50
“Darakchasava”, an ancient Indian herbal preparation
containing grape (Vitis vinifera L.) extracts, is used as a car-
dio tonic and for the treatment of other disorders. Analysis
of darakchasava indicated the presence of resveratrol and
pterostilbene. Resveratrol was isolated in 1 940 from Veratrum
grandiflorum, and is also found in grapes, berries, and pea-
nuts. Resveratrol has been found to possess cardioprotective
and anticancer effects.74
W. somnifera L., a medicinal plant described in Ayurveda, is
known to process anti-inflammatory, cardio-active, and central
nervous system activities. Withanolides, which is extracted from
W. somnifera and used in Ayurvedic medicine to cure arthritis
and menstrual disorders, has been found to be an inhibitor of
angiogenesis, inflammation, tumor development, and oxidative
stress, as well as a promoter of cardioprotection.74
The gum resin of salai guggul (B. serrata) is used in
Ayurveda to cure rheumatic diseases and respiratory and
liver disorders. Several researchers have discovered the active
biomolecule of this resin to be boswellic acid. Boswellic
acid and its derivatives have emerged as future anticancer
agents.74,75
The chemical investigation of a few Ayurvedic anti-
arthritic drugs has led to the discovery of synthetic anti-
inflammatory drug molecules like phenylbutazone, indo-
methacin, and corticosteroids.28
Indian medicinal plants have been found to be a source of
many different modern bioactive agents; for example, quinine
from Cinchona spp., pilocarpine from Pilocarpus jaborandi,
atropine from Atropa belladonna L., cocaine from Erythroxy-
lum coca Lam., morphine and codeine from Papaver som-
niferum L., cardiac glycosides from Digitalis spp., artemisinin
from Artemisia annua L., paclitaxel from Taxus baccata L.
and Taxus brevifolia L., berberine from Berberis spp., pris-
timerin from Celastrus paniculata Willd., quassinoids from
Ailanthus spp., plumbagin from Plumbago indica L., allicin
from Allium sativum L., emetine from Cephaelis ipecacuanha
(Brot.) L.Andersson, glycyrrhizin from Glycyrrhiza glabra
L., nimbidin from Azadirachta indica A. Juss., catechin from
Acacia catechu Willd., sophoradin from Sophora subprostrata,
thevenerin and neriifolin from Thevetia spp., podophyllin from
Podophyllum emodi, homoharringtonine from Cephalotaxus,
camptothecin from Camptotheca acuminata.73
Challenges
The National Medicinal Plants Board, India, estimated
about 77% of the medicinal plants used in the country for
several traditional medicinal formulations are from forests
and wastelands. The International Union for Conservation
of Nature Species Survival Commission estimated that
there are 19 extinct, 43 extinct/endangered, 149 endan-
gered, 108 vulnerable, and 256 rare plant species in India.4
Thus reducing overexploitation, stopping deforestation,
cultivating medicinal plant, and using cell cultures and
other scientific methods are required to protect the medici-
nal plants.
Further, the incidence of biopiracy is a major impediment
to the advancement of Indian herbal medicine. A survey
by a TKDL task force based on 4,896 references revealed
that 90 medicinal plants were listed in the US Patent and
Trademark Office database, and about 80% of references
were related to seven medicinal plants (kumari, mustaka,
tamraparna, garjara, atasi, jambira, and kharbuja) of Indian
origin. The task force also revealed that 360 of 762 patents
were based on medicinal plants that could be classified as
“traditional”.76 This indicates the potential of Indian tradi-
tional knowledge and herbal drugs to address a large number
of ailments in the future.
The primary lacunae with Ayurvedic and other traditional
herbal products are the lack of drug standardization, infor-
mation, quality control, and strict monitoring.73 About 13
Asian herbal products have been found to contain a number
of contaminants. A study has found that among 260 Asian
patented medicines, about 25% contained heavy metals
beyond the limit, while undeclared drugs to increase thera-
peutic efficacy were found in 7% of those medicines. A large
number of Ayurvedic formulations are available in spurious,
adulterated, or misbranded forms, and several preparations
do not follow the traditional proper rules or texts on how to
prepare such formulations.28,77 A report on Ayurvedic medi-
cine has found that about 20% of such medicines purchased
through the Internet contained high levels of lead, mercury,
and arsenic. Recently, the US Food and Drug Administration
found that several herbal supplements contained currently
available drugs like lovastatin (eg, Mevacor®), sildenafil (eg,
Viagra®), estrogen, alprazolam (eg, Xanax®), indomethacin
(eg, Indocin®), and warfarin (eg, Coumadin®) as adulter-
ants.34,78 Herbal manufacturers from India usually follow
World Health Organization guidelines for quality control,
but the adulteration of formulations remains a major concern
for both the domestic and export markets of Indian herbal
products.28,77
The majority of Ayurvedic formulations contain crude
extracts in mixtures of different ingredients. Some studies
have showed that the active principles of such products fail to
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40
Sen and Chakraborty
produce the desired effects when isolated individually. This
may due to the synergistic activity of several components
present in a formulation. In the absence of pharmacopeial
data on such herbal formulations, it is difficult to isolate or
standardize the active components. Currently, the Ayurvedic
Pharmacopeia has been compiled on modern lines and is
updated often as per requirement.73
Quality control and drug–herb interaction are other
drawbacks. Several herbal products can interact with food,
allopathic drugs, or pharmaceuticals, but unfortunately, for
the majority of products, such information is lacking. In
general, after 1 year of collection, herbs lose their medicinal
value; powders prepared from such herbs remain effective for
nearly 6 months, while pastes or ointments are effective for 1
year.77 Several herbs may be responsible for serious adverse
effects – for example, creosote bush causes hepatotoxicity,
ephedra may be responsible for cardiovascular complications
and hepatotoxicity, and kava may induce hepatotoxicity.
Several manufacturers do not follow the appropriate methods
of preparation and do not use the proper parts of the plant,
which may be responsible for toxicity – as in the case of
kava-induced toxicity.79 This situation needs to be addressed
properly for the growth of Indian herbal medicine.
In the last 30 years ISMs, especially Ayurveda, have
became remarkably popular in European countries; it has
been estimated that over 5 million European people have
used such traditional medicine in the last few decades. Due
to the popularity of traditional medicine, thousands of under-/
nonqualified traditional medicinal practitioners/institutions
have emerged in Europe, which has led to a serious situa-
tion.37 In the last decade, the European Union demanded
bibliographic evidence and preclinical safety data before the
marketing of traditional medicinal products. Thus, proper
standardization of and research and data on products’ quan-
titative and qualitative particulars of constituents, methods of
manufacturing, therapeutic uses, contraindications, toxicity
profiles, posology, forms, and routes of administration are
essential for the promotion of Indian traditional medicine in
Europe.80 In Europe, due to some legal problems, the future
of Ayurvedic medicine is in the dark, and this requires urgent
attention.81 A recent survey has concluded that Ayurveda has
the potential to satisfy the needs of therapists and patients,
despite worldview differences in Europe.82
Herbal medicine and Indian
economy
Markets for medicinal plants and herbal medicine are lucra-
tive and important for economic growth of India. Several
pharmacopeia have included a number of important herb and
herbal products. For instance, the Ayurvedic Pharmacopoeia
of India included monographs for 258 Ayurvedic drugs,
the Indian Pharmacopoeia 2010 incorporated 89 mono-
graphs for herb and herbal products, while the Indian
Herbal Pharmacopoeia 2002, published by the Indian Drug
Manufacturers Association, included 52 monographs on
widely used medicinal plants of India.4,28 Domestic trade
of the Ayurveda, yoga and naturopathy, Unani, Siddha, and
homeopathy (AYUSH) industry is about INR80–90 billion.
Export of medicinal plants and their products from India
is about INR10 billion. In 2010, the production of herbal
drugs in India was about INR4,000 crores, with 1,650 herbal
formulations.4 Trade of herbal products is now US$120 billion
and is expected to reach to US$7 trillion by 2050.83
In spite of the vast potential, the Indian share of this trade
is at present quite low. About 500 plant species are used in
Chinese medicine, whereas more than 7,000 species are used
in ISMs. The People’s Republic of China’s global share of
medicinal plant exports is about 28%, while India’s share is
only 8.13%. India ranked second in medicinal plant exports
after the People’s Republic of China in 2009.4 A report from the
Associated Chambers of Commerce and Industry of India esti-
mated that the value of the herbal industry was about INR7,500
crores in 2010 and that its value would reach INR15,000 crores
by 2015.85 India’s share in export of AYUSH products increased
by 10.4% over 2012–2013 compared with in the previous year.
Globally, the demand for Indian herbs and herbal medicines
is increasing. Growth of about 11% in the export of herbs
and herbal medicines to the European Union was noted in
2012–2013 compared with in the previous year.83
It has been estimated that about 880 medicinal plants are
involved in Indian trade. Of these, 42 species are imported
and 48 species are exported.85 European countries hold the
greatest share of the total herbal market (45%), followed by
Association of Southeast Asian Nations countries (19%),
Japan (16%), and North America (11%).86
Some of the important medicinal plants/products of India
are E. officinalis Gaertn., isabgol (psyllium husk), the leaves
and pods of senna, the leaves and powder of henna, myrobal-
ans, jojoba seed, gymnema powder, and garcenia.4,86 Tradi-
tional Indian medicinal knowledge and the diversity of plants
in India are well recognized, thus urgent attention is required
to cherish this knowledge nationally and internationally.
Future aspects and India’s position
Currently, the paradigm of medicine has shifted from not
only curing clinical diseases but also maintaining good
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41
Integration and advancement of Indian herbal medicine
health. Today, medicines are available not only for treating
illnesses but also for enhancing quality of life and health
more broadly.87 Thus, the integration of traditional herbal
medicine into the modern health care system is the need of the
time. The inclusion of traditional herbal medicine in modern
health care offers a large benefit to society: it tenders recip-
rocal advantages to each system, improves the knowledge
of general health care, increases the number and quality of
practitioners, endorses the dissemination of primary health
care knowledge, and is also helpful in providing basic health
care to people in all parts of society.78 However, several fun-
damental problems – like basic differences between different
medicinal systems, differences in the concept of spiritualism,
fear of the harmful effects of traditional preparations, and
decline in the quality due to lack of regulation and standard-
ization – are associated with this.88
The increasing use of herbal traditional therapies like
Ayurveda insists on more systematic and sound scientific
evidence for therapies and the effectiveness of medicines.28
The promotion and globalization of Indian traditional herbal
medicine requires a more realistic and strong approach to
overcome the difficulties. The People’s Republic of China
has effectively modernized its approaches by introduc-
ing government-sponsored good agricultural policies and
good manufacturing practices for traditional medicine.
Similar integrated strategies are essential for the growth
of Ayurveda, Siddha, and Unani medicines globally. The
Government of India has started several drug-testing labo-
ratories and upgraded several existing laboratories for ISMs.
India has also introduced new regulations since the year
2000 and several approaches like the introduction of good
manufacturing practices have been initiated for traditional
systems of medicine. These measures have created high
hope for fruitful results. A classical example is that, after
such measures were put in place, a US patent was granted
to a poly-herbal formulation (Artrex®) for the treatment of
arthritis.28
Current approaches to promote Ayurvedic medicine
are in process. The Indian Government formed the Depart-
ment of AYUSH, which has accountability and authority
related to the production, development, quality assurance,
and standardization of ISMs. In 2010, the Department of
AYUSH modified several rules to facilitate the licensing and
export of Ayurvedic herbal medicines under the categories
of Ayurvedic cosmeceuticals, Ayurvedic nutraceuticals, and
Ayurvedic extracts. Several other Indian organizations, like
the Banaras Hindu University, Gujarat Ayurveda University,
National Institute of Ayurveda, Institute of Ayurveda, and
Integrative Medicine, are working on the global promotion
of Ayurveda.35
India has acknowledged the importance of Ayurveda for
providing better primary health care to all people and thus
Ayurveda was integrated into the Indian national health care
system recently.33 This will be a useful measure to provide
basic health care facilities to all and to show the effectiveness
of Ayurveda. Part two of a status report on Indian medicine
and folk healing submitted in February 2013 highlighted the
health-seeking activities of consumers, the existing policy
of the government on the integration and globalization of
Ayurveda, and Unani medicine as adjuvant therapy; the
present status of the integration of these medical systems
into health care delivery was also reviewed.89
In the 21st century, medical tourism emerged as a key
approach to attract people toward herbal medicine and to
promote international business. With globalization, people
seek better treatment strategies. In several countries, includ-
ing Japan, the USA, the UK, and European nations, the
number of elderly people has increased rapidly. At the same
time, life expectancy has also increased progressively, which
has resulted in increased demand for natural health care
strategies.90,91 India has the ability to deliver such strategies.
It was estimated that about 1.27 million medical tourists
from several countries around the globe, such as the UK, the
USA, Canada, China, Bangladesh, and Sri Lanka, visit India
with the hope of better, safer traditional herbal medicinal
treatment. It has been estimated that foreign-exchange earn-
ings for this are nearly US$1.8 billion and the market will
grow to around US$3.96 billion by 2015 due to the visits of
2.8 million medical tourists.91 This situation clearly indicates
the benefit and acceptance of Ayurveda and other Indian
medical systems around the world. The potentialities of India
are acknowledged by such conditions, which also indicate
that there is the opportunity to integrate herbal medicinal
systems/formulations into the modern health care system.
Medical tourism also presents the opportunity to boost the
country’s economic conditions and will encourage people
toward Indian traditional herbal medicinal systems.91
The Materia Medica of India contains 2,000 drugs of
natural origin along with their therapeutic utilities, which
are derived from traditional systems of medicine. Among
these, 400 are from mineral and animal sources, and the rest
are from vegetable sources.92 The TKDL contains informa-
tion regarding 500 Ayurveda, 500 Unani, and 200 Siddha
formulations and also includes information about 291
plants that are used as ingredients in different traditional
formulations.76 There are plenty of opportunities to develop
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42
Sen and Chakraborty
new products or formulations based on the therapeutic
potential of Ayurvedic medicinal plants and getting them
accepted as dietary supplements, nutraceuticals, prescription
drugs and over-the-counter preparations.24 In India a lot of
hospitals and private and government-recognized doctors
are providing treatment based on Ayurveda and other ISMs.
These approaches are showing inspiring results toward the
primary health care systems facility and have attracted the
attention of people globally.
For centuries, herbal medicine has been acknowledged as
having safer drugs and more compatibility with physiologi-
cal flora. Indian traditional medicine provides the scientific
basis and process of utilizing medicinal plants to cure several
ailments. In combination with modern science, technologies,
and approaches, Indian herbal products/medicinal plants can
provide basic and advanced medical care around the world.
Conclusion
Indian traditional herbal medicine is prevalent around
the globe and a large number of people have integrated
them along with moden medicine for their different health
needs. In spite of their popularity, the rational design,
proper standardization, and careful monitoring of Indian
traditional herbal formulations and botanicals, along with
robust scientific evidence, are essential for their promo-
tion. Approaches are required to promote Indian traditional
herbal medicine as modern evidence-based medicine. Thus,
the identification of resources and finding of molecular
mechanisms are essential, as it could be a resource for new
medicine. Current research has shown the potentiality of
Indian medicinal plants in drug discovery, though a lot of
plants have not been studied and need to be investigated. The
careful and scientific integration of herbal medicines from
ISMs into the modern system is essential in safeguarding
the interests of Indian people and to provide better health
care facilities to all.
Disclosure
The authors declare no conflicts of interest in this work.
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