Herbal Medicines in African Traditional Medicine

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Chapter 10
Herbal Medicines in African Traditional Medicine
Ezekwesili-Ofili Josephine Ozioma and
Okaka Antoinette Nwamaka Chinwe
Additional information is available at the end of the chapter
http://dx.doi.org/10.5772/intechopen.80348
© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Ezekwesili-Oli JosephineOzioma and
Okaka Antoinette NwamakaChinwe
Additional information is available at the end of the chapter
Abstract
African traditional medicine is a form of holistic health care system organized into
three levels of specialty, namely divination, spiritualism, and herbalism. The traditional
healer provides health care services based on culture, religious background, knowledge,
aitudes, and beliefs that are prevalent in his community. Illness is regarded as having
both natural and supernatural causes and thus must be treated by both physical and
spiritual means, using divination, incantations, animal sacrice, exorcism, and herbs.
Herbal medicine is the cornerstone of traditional medicine but may include minerals and
animal parts. The adjustment is ok, but may be replaced with –‘ Herbal medicine was
once termed primitive by western medicine but through scientic investigations there
is a beer understanding of its therapeutic activities such that many pharmaceuticals
have been modeled on phytochemicals derived from it. Major obstacles to the use of
African medicinal plants are their poor quality control and safety. Traditional medical
practices are still shrouded with much secrecy, with few reports or documentations of
adverse reactions. However, the future of African traditional medicine is bright if viewed
in the context of service provision, increase of health care coverage, economic potential,
and poverty reduction. Formal recognition and integration of traditional medicine into
conventional medicine will hold much promise for the future.
Keywords: African, traditional, medicine, spirituality, divination, herbalism
1. Introduction
The development and use of traditional herbal medicine (THM) have a very long historical back-
ground that corresponds to the Stone Age. In the continent of Africa, the practice of traditional
healing and magic is much older than some of the other traditional medical sciences [1] and seems
to be much more prevalent compared to conventional medicine. African traditional medicine is a
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

form of holistic health care system that is organized into three levels of specialty, which include
divination, spiritualism, and herbalism, though these may overlap in some situations [2, 3].
A traditional healer is one who provides medical care in the community that he lives, using
herbs, minerals, animal parts, incantations, and other methods, based on the cultures and
beliefs of his people. He must be seen to be competent, versatile, experienced, and trusted
[4]. In other denitions, priestesses, high priests, witch doctors, diviners, midwives, seers or
spiritualists, and herbalists are included. Traditional medical practitioner (TMP), however,
seems to be a modern acceptable concept agreed on by the Scientic Technical and Research
Commission (STRC) of the Organization of African Unity (OAU), which is now African Union
(AU). In specic cultures, these people go by their local names, depending on their tribe,
such as Sangoma or inyanga in South Africa, akomfo, bokomowo in Ghana, niam-niam, shaman,
or mugwenu in Tanzania, nga:nga in Zambia, shaman or laibon in Kenya, and babalawo, dibia, or
boka, etc. in Nigeria [5]. It is commonplace to see traditional healers dressed in certain peculiar
aires, with head bands, feathers, and eyes painted with native chalk.
Figure 1 below is a typically adorned traditional healer from South Africa.
Traditional medicine is viewed as a combination of knowledge and practice used in diagnosing,
preventing, and eliminating disease. This may rely on past experience and observations handed
down from generation to generation either verbally, frequently in the form of stories, or spiritu-
ally by ancestors or, in modern times, in writing [6]. It has also been said that before aaining
knowledge in traditional African medicine, one is often required to be initiated into a secret soci-
ety, as many characteristics of this form of medicine can only be passed down to initiates. The
importance of traditional medicine, however, dwindled during the colonial period, whereby it
was viewed as inferior to Western medicine. It was thus banned completely in some countries
due to its association with witchcraft /voodoo, supernatural, and magical implications, in which
case, it was also termed “juju” (Nigeria) or “native medicine,” since it made use of charms and
symbols which were used to cast or remove spells. Some forms of treatment may also involve
ritual practices such as animal sacrices to appease the gods, if the ailment was envisaged to be
caused by aictions from the gods, especially in the treatment of the mentally ill patients.
Figure 1. Spiritual healer or Sangoma from South Africa (Source—Ancient Origins).
Herbal Medicine192

2. Concept of illness and disease
In African traditional seing, there was always an explanation as to why someone was suering
from a certain disease at a particular time. According to Ayodele [7], diseases mostly revolve
around witchcraft/sorcery, gods or ancestors, natural, as well as inherited. Illness in the African
society is dierent from the allopathic Western medicine point of view. Illness is believed to
be of natural, cultural, or social origin [8]. Cultural or social illness is thought to be related to
supernatural causes such as angered spirits, witchcraft, or alien/evil spirits, even for conditions
now known to be well understood in modern medicine such as hypertension, sickle-cell anemia,
cardiomyopathies, and diabetes. African traditional beliefs consider the human being as being
made up of physical, spiritual, moral, and social aspects. The functioning of these three aspects in
harmony signied good health, while if any aspect should be out of balance, it signied sickness.
Thus, the treatment of an ill person involves not only aiding his/her physical being but may also
involve the spiritual, moral, and social components of being as well. Many traditional medical
practitioners are good psychotherapists, procient in faith healing (spiritual healing), therapeutic
occultism, circumcision of the male and female, tribal marks, treatment of snake bites, treatment
of whitlow, removal of tuberculosis lymphadenitis in the neck, cuing the umbilical cord, pierc-
ing ear lobes, removal of the uvula, extracting a carious tooth, abdominal surgery, infections,
midwifery, and so on. According to Ko-Tsekpo [9], the term “African traditional medicine” is
not synonymous with “alternative and complementary medicine.” African traditional medicine
is the African indigenous system of health care and therefore cannot be seen as an alternative.
3. Herbal medicine
Herbal medicine is a part and parcel of and sometimes synonymous with African traditional
medicine. It is the oldest and still the most widely used system of medicine in the world
today. It is used in all societies and is common to all cultures. Herbal medicines, also called
botanical medicines, vegetable medicines, or phytomedicines, as dened by World Health
Organization (WHO) refers to herbs, herbal materials, herbal preparations, and nished
herbal products that contain whole plants, parts of plants, or other plant materials, including
leaves, bark, berries, owers, and roots, and/or their extracts as active ingredients intended
for human therapeutic use or for other benets in humans and sometimes animals [10, 11].
Herbal medicine is a special and prominent form of traditional medicine, in which the tradi-
tional healer, in this case known as the herbalist, specializes in the use of herbs to treat various
ailments. Their role is so remarkable since it arises from a thorough knowledge of the medici-
nal properties of indigenous plants and the pharmaceutical steps necessary in turning such
plants into drugs such as the selection, compounding, dosage, ecacy, and toxicity. The use
of herbal medicines appears to be universal in dierent cultures. However, the plants used for
the same ailments and the modes of treatment may vary from place to place. The plants used
for medicinal purposes are generally referred to as medicinal plants, i.e., any plant in which
one or more of its organs/parts contain substances that can be used for therapeutic purposes,
or in a more modern concept, the constituents can be used as precursors for the synthesis
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of drugs. For example, a number of plants have been used in traditional medicine for many
years without scientic data to back up their ecacy. In this case, these plants, whole or
parts, which have medicinal properties, are referred to as crude drugs of natural or biological
origin. They may further be classied as “organized drugs,” if such drugs are from plant
parts with cellular structures such as leaf, bark, roots, etc., and “unorganized drugs,” if they
are obtained from acellular portions of plants such as gums, balsams, gels, oils, and exudates.
Compared with modern allopathic medicine, herbal medicine is freely available and can eas-
ily be accessed by all [12, 13]. As a result, there is limited consultation with traditional healers
because there is a fairly good knowledge of common curative herbs especially in the rural
areas except in the case of treatment of chronic diseases [12]. Even where consultation is done,
there is lack of coherence among traditional healers on the preparation procedures and cor-
rect dosage of herbal medicines [14]. However, according to WHO [15], at least 80% of people
in Africa still rely on medicinal plants for their health care. In Nigeria, and indeed the entire
West Africa, herbal medicine has continued to gain momentum, some of the advantages being
low cost, aordability, availability, acceptability, and apparently low toxicity [16, 17].
A detail of plant parts used in herbal medicines is as follows:
1. Roots—i.e., the eshy or woody roots of many African plant species are medicinal. Most
of the active ingredients are usually sequestered in the root bark rather than the woody
inner part.
2. Bulbs—A bulb is an underground structure made up of numerous leaves of eshy scales,
e.g., Allium sativa (garlic) and Allium cepa (onions).
3. Rhizomes—Woody or eshy underground stem that grows horizontally and brings out
their leaves above the ground, e.g., Zingiber ocinale (ginger), which is used for respira-
tory problems; Imperata cylindrica (spear grass) for potency in men and Curcuma longa (tur-
meric), an antioxidant, anti-inammatory, and anticancer drug.
4. Tubers—Swollen eshy underground structures which form from stems/roots, e.g., potatoes
and yams such as Dioscorea dumetorum (ona-(igbo)) for diabetes and Gloriosa superba for cancer.
5. Bark—The outer protective layer of the tree stem or trunk. It contains highly concentrated
phytochemicals with profound medicinal properties. A host of plants have barks of high
medicinal value.
6. Leaves, stems, and owers of many plants are also medicinal.
7. Fruits and seeds also contain highly active phytochemicals and essential oils.
8. Gums, exudates, and nectars, which are secreted by plants to deter insects and grazing
animals and to seal o wounds, are very useful in the pharmaceutical industries.
Sale of herbs in form of dried or fresh plant parts is as lucrative as the prepared medicines.
They are usually displayed in markets and sold with instructions on how to prepare them
for maximum ecacy.
Figure 2 is a photograph of an herbalist displaying his herbs for sale.
Herbal Medicine194

In many areas of Africa, the knowledge of plant species used and the methods of preparing and
administering the medication, especially for serious ailments, still reside with traditional heal-
ers. Secrecy and competition still surround the use of these medications, with the healers often
being reluctant to hand down their knowledge to anyone but trusted relatives and initiates [18].
3.1. Methods of preparation and dosage forms
Methods of preparation of herbal medicines may vary according to place and culture. The
plant materials may be used fresh or dry. With experience, a particular method is chosen to
increase eciency and decrease toxicity. Generally, dierent methods of preparation include:
1. Extraction—This is prepared with solvent on a weight by volume basis. Sometimes, the
solvent is evaporated to a soft mass.
2. Infusions are prepared by macerating the crude drug for a short period of time in cold or
hot water. A preservative such as honey may be added to prevent spoilage.
3. Decoctions are made by boiling woody pieces for a specied period of time and ltered.
Potash may be added to aid extraction and as preservative.
Figure 2. Herbs on display (Source—Ancient Origins).
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4. Tinctures are alcoholic infusions which if concentrated may be diluted before administration.
5. Ashing—The dried parts are incinerated to ash, then sieved and added as such to water or food.
6. Miscellaneous—Other types include liniments for external applications in liquid, semi-
liquid, or oily forms containing the active substances; lotions which are liquid preparations
intended for skin application. Poultices are prepared from macerated fresh part of plant
containing the juice from the plant and applied to skin. Snus are powdered dried plant
inhaled through the nostrils. Dried plants may be burnt, and their charcoal is used as such.
Gruels are cereals/porridges made from grains, to which dried powdered plant or its ash
is added to be taken orally. Mixtures are sometimes prepared with more than one plant to
give synergistic or potentiating eects of the composite plants.
There are also dierent methods of administration. Apart from the common routes such as
oral, rectal, topical, and nasal, other methods include smoking a crudely prepared cigar con-
taining dried plant materials or by passive inhalation. Others are steaming and inhaling the
volatile oils exuding from the boiling plant material. These can be used to relieve congestion,
headaches, or pulmonary problems. Si baths are used for piles [19, 20].
3.2. Ethnobotanical surveys
Information on plants is obtained through ethnobotanical surveys, which involves the study
of plants in relation to the culture of the people. Many plants are used in African tradi-
tional medicine, but lile information is available on their active ingredients/constituents.
Ethnobotanical surveys involve the interaction with the people and their environment and are
therefore participatory approaches, in which local people are able to contribute their knowl-
edge on the uses of plants within their environment. This may involve the identication, doc-
umentation, conservation, and utilization of medicinal plants. Much of the ethnomedicinal
information is largely not validated. In Nigeria, a number of authors have published a lot of
data on plants with their curative values [16, 20, 21]. These provide a vast array of information
for scientic research and validation. Preliminary scientic knowledge is drawn from studies
on in vitro and in vivo bioassays on crude extracts of various plants.
Using plants as medicine provides signicant advantages for treating many chronic condi-
tions. For example, information from folklore medicine in Nigeria has it that Rauvola vomito-
ria is used for treating hypertension and other nervous conditions while Ocimum gratissimum
is used for treating diarrheal diseases. Others include Citrus paradise seeds for resistant uri-
nary tract infections, pure honey for chronic wound treatment, Carica papaya seeds for intes-
tinal parasites, Garcinia kola seeds for pain and inammation, and Aloe vera for skin diseases.
The same is also true for plants from other African countries [22]. Knowledge of most of
these curative properties was accumulated over time from evidence-based observations. A
few examples of some Nigerian plants and their uses are shown in Table 1.
Table 1 shows some selected Nigerian medicinal plants and their uses.
The curative properties of herbal medicine are validated through scientic investigations,
which seek to understand the active chemistry of the plants [23]. The therapeutic activity
of a plant is due to its complex chemical nature with dierent parts of the plant providing
Herbal Medicine196

certain therapeutic eects. Chemical components or phytochemicals found in plants that are
responsible for the various therapeutic eects include alkaloids, glycosides, tannins, acids,
coumarins, sterols, phenols, etc. Many modern pharmaceuticals have been modeled on or
were originally derived from these chemicals, for example, aspirin is synthesized from sali-
cylic acid derived from the bark of Salix alba and the meadowsweet plant, Filipendula ulmaria.
Quinine from Cinchona pubescens bark and artemisinin from Artemisia annua plant are anti-
malarial drugs. Vincristine and vinblastine are anticancer drugs derived from Madagascar
periwinkle (Catharanthus roseus), used for treating leukemia. Morphine and codeine, derived
from the opium poppy (Papaver somniferum), are used in the treatment of diarrhea and pain
relief, while digitoxin is a cardiac glycoside derived from foxglove plant (Digitalis purpurea)
[22, 24]. Medicinal plants are also important materials for the cosmetic industries.
The use of herbal drugs dwindled toward the end of the 19th century due to the advent of
synthetic chemistry. However, there was a resurgence of interest in plant medicines in more
recent years, as synthetic drugs became less eective due to high levels of resistance and also
due to higher toxicity and cost. It is estimated that more than half of all synthetic drugs in use
are derived from plants [25].
4. Clinical practice of African traditional/herbal medicine
In African traditional medicine, the curative, training, promotive, and rehabilitative services
are referred to as clinical practices Clinical practice can also be viewed as the process of
Family Specie Local name Part used Medicinal uses
Acanthaceae Acanthus montanus Stem, twig Syphilis, cough, emetic, vaginal
discharge
Amaranthaceae Amaranthus spinosus Whole plant Abdominal pain, ulcers, gonorrhea
Apocynaceae Alstonia boonei Root, bark,
leaves
Breast development, larial worms
Bombacaceae Adansonia digitata leaves, fruit,
pulp, bark
Fever, antimicrobial, kidney, and
bladder disease
Combretaceae Combretum grandiorum Ikedike leaves Jaundice
Euphorbiaceae Bridelia ferruginea iri, kirni leaves,
stem, bark,
root
insomnia, mouth wash, gonorrhea
Hypericaceae Harungana madagascariensis Otoro,
alilibarra
Stem, bark,
root bark
piles, trypanosomiasis
Fabaceae Afzelia africana Apa-igbo,
akpalata
leaves,
roots, bark,
seeds
gonorrhea, hernia
Liliaceae Gloriosa superba mora, ewe aje,
baurere
tubers,
leaves
gonorrhea, headlice, antipyretic
Table 1. Some selected Nigerian medicinal plants and their uses. Source: Abd El-Ghani [51].
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evaluating conditions of ill-health of an individual and its management. These traditional
health care services are provided through tradition and culture prescribed under a particular
philosophy, in which the norms and taboos therein are strictly adhered to and form the basis
for the acceptability of traditional health practitioners in the community they serve [26].
According to the World Health Organization (WHO), health is dened as “a state of complete
physical, mental and social well-being and not merely the absence of disease or inrmity” [15, 27]
and views health as one of the fundamental rights of every human being. The combination of
physical, mental/emotional, and social well-being is commonly referred to as the health triangle.
The recognition of disease and illnesses in traditional Africa meant that every society needed
to devise means of containing its problem. Worldwide, dierent societies have dierent
herbal traditions that have evolved over a long period of time. Similar to modern day Western
treatment paerns, African traditional societies also involved herbalism, surgery, dietary
therapy, and psychotherapy, in addition to traditional exorcism, rituals, and sacrice [28].
These medical technologies had evolved even before the coming of the “white man” (Arabs
and Europeans). Successful treatments became formalized, sometimes with prescriptions
of correct methods of preparation and dosage. In addition, the ingredients and the manner
of preparation varied with the ailment but were also dependent on various factors such as
geographical, sociological, and economic, but the signicant point was that in many cases,
patients were cured of their physical or psychological ailments [29]. In African traditional
medicine, traditional health practitioners (THP) assess patients in order to diagnose, treat,
and prevent disease using their expertise by the following methods:
4.1. Divination
Divination means consulting the spirit world. It is a method by which information concerning
an individual or circumstance of illness is obtained through the use of randomly arranged
symbols in order to gain healing knowledge. It is also viewed as a way to access information
that is normally beyond the reach of the rational mind. It is a transpersonal technique in
which diviners base their knowledge on communication with the spiritual forces, such as the
ancestors, spirits, and deities [30]. It is, therefore, an integral part of an African traditional way
of diagnosing diseases. The “spirit world” is consulted to identify the cause of the disease or
to discover whether there was a violation of an established order from the side of the sick
person. This is established through the use of cowry shells, throwing of bones, shells, money,
seeds, dice, domino-like objects, or even dominos themselves, and other objects that have
been appointed by the diviner and the spirit to represent certain polarities on strips of leather
or at pieces of wood. The divining bones that form the large majority of the objects include
bones from various animals such as lions, hyenas, ant-eaters, baboons, crocodiles, wild pigs,
goats, antelopes, etc. The bones represent all the forces that aect any human being anywhere,
whatever their culture [31]. Because of the revealing powers of divination, it is usually the rst
step in African traditional treatment and medicine [32].
4.2. Interviews and medical reports
Oral interviews are sometimes used by some traditional healers to nd out the history behind
the sickness, where they have been for treatment and how long the person has been in that
Herbal Medicine198

condition. This approach enables them to know how to handle the maer at hand. In some
cases, the healer might require other family members to speak on behalf of the sick person in
cases where the patient is not able to express him/herself. In modern times, after the healing
process, they also advise their clients or patients to go for medical diagnoses to conrm that
they are healed, and the medical reports sometimes serve for record keeping for future refer-
ence and are a way of assuring other clients of their ability and credibility. Due to the holistic
approach of the healing process, the healers do not separate the natural from the spiritual or
the physical from the supernatural [33]. Thus, health issues are addressed from two major
perspectives—spiritual and physical.
4.3. Spiritual perspective
Spiritual-based cases are handled in the following manner:
i. Spiritual protection: If the cause of the disease is perceived to be an aack from evil
spirits, the person would be protected by the use of a talisman, charm, amulets, specially
designed body marks, and a spiritual bath to drive the evil spirits away. These are rites
aimed at driving o evil and dangerous powers, spirits, or elements to eliminate the evils
or dangers that may have befallen a family or community [34].
ii. Sacrices: Sacrices are sometimes oered at the request of the spirits, gods, and ances-
tors. Sometimes, animals such as dogs and cats are slaughtered or buried alive at mid-
night to save the soul of the one at the point of death, with the belief that their spirits are
strong enough to replace life [30]. There is also the view that because they are domestic
animals and are very close to people, sometimes when they see that someone very close
to them is about to die, they oer their lives for that person to live. This is true especially
where the animal dies mysteriously; thus, it is believed that it had oered its life in place
of the life of its owner. Rituals are sometimes performed in order to consecrate some
herbs without which the medicine is meaningless. Divine and ancestral sanctions are
considered necessary before and during the preparation and application of medicine [35].
iii. Spiritual cleansing: Spiritual cleansing may be required of the sick person to bathe at
specic times for a prescribed number of days either with water or animal blood poured
from head to toe. This practice is common among some communities in Ghana [34].
iv. Appeasing the gods: If a disease is perceived to be caused by an invocation of a curse
or violation of taboos, the diviner appeases the ancestors, spirits, or the gods according
to the severity of the case. The individual is often required to provide certain items for
sacrice and/or libation, such as spotless animals (dove, cat, dog, goat, and fowl), local
gin, cola nut, eggs, and plain white, red, or black cloth. These items are usually specied
by the gods. The used items may be thrown into the river, left to rot, or placed at strategic
places, usually at cross roads at the outskirts of the community, depending on the nature
and severity of the case [36].
v. Exorcism: This is a practice of expelling demons or evil spirits from people or places
that are possessed or are in danger of being possessed by them. Many of the traditional
communities believe that illness, especially mental illness, is mostly caused by evil spirits.
Exorcism can only be performed by a religious leader or a priest who has the authorities
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and powers to do so. Sometimes, an egy made of clay or wax would be used to rep-
resent the demon and would ultimately be destroyed. Exorcism may be accompanied
by dancing to the beating of drums, singing, and sometimes ogging the individual or
touching him/her with strange objects such as animal tails and other objects to chase out
the spirit. The possessed individual would be somewhat agitated but would only calm
down as soon as the spirit is removed from the body. Exorcism is practiced, not only in
Africa but also in ancient Babylonian, Greek, and other ancient cultures of the Middle
East. This practice is also performed for those who are mentally challenged. In their view,
until the possessed person is delivered from the power of that evil spirit, the person will
not have his or her freedom. Hence, the practice of exorcism is considered necessary [37].
vi. Libation: Libation involves pouring of some liquid, mostly local gin on the ground or
sometimes on objects followed by the chanting or reciting of words. It is usually regarded
as a form of prayer. The liquid could also be water or in modern times, wine, whisky,
schnapps, or gin. Some cultures also use palm wine, palm oil, and coconut water, while
some others use corn our mixed with water [38]. Libation pouring as is practiced in some
communities has three main parts, namely invocation, supplication, and conclusion.
• Invocation: They rst invoke the presence of the almighty God, mother earth, and the
ancestors. According to the practitioners of libation pouring, oering the ancestors and
spirits drink is a way of welcoming them
• Supplication: After invocation, requests are made to the invoked spirits, gods, or
ancestors to intercede on their behalf for mercy and forgiveness of oenses such as
taboo violations and to seek for spiritual consecration (cleansing) of either the com-
munity or individual(s). The content of the prayer is usually case specic [38].
• Conclusion: At the end of the libation pouring, they thank the invoked ancestors and
spirits. They nally invoke curses on those who wish them evil or failure, meaning
that in the process of prayer, it would be unwise to seek the welfare of one’s enemy.
Therefore, those who wish evil (i.e., enemies, witches, and people with evil powers)
on them should fall and die [8]. In this process, the person pouring the libation would
be pouring the drink or liquid on the ground as he is reciting the prayers, followed by
responses to each prayer point by observers.
4.4. Physical perspectives
If the illness is of a physical nature, the following approaches are exploited:
a. Prescription of herbs: Herbs are prescribed to the sick person according to the nature of
the illness. Each prescription has its own specic instructions on how to prepare the herb,
the dose, dosing regimen, and timeframe
b. Clay and herbs application: Application of a mixture of white clay with herbs may be
relevant in some of the healing processes. The mixture is applied to the entire body for a
number of days, especially in the case of skin diseases. The view is that the human body is
Herbal Medicine200

made out of the dust or ground; therefore, if the body has any problem, you would have to
go to where it came from to x it. The use of clay with some special herbs is also sometimes
used for preventive rituals to ward o the evil spirits responsible for illness.
c. Counseling: The sick person is sometimes counseled on the dos and don’ts of treatment,
the foods to eat or avoid, to be generally of good behavior as established by society and
culture, failure of which the good spirits would withdraw their blessings and protection
and therefore, open doors for illness, death, drought, and other misfortunes. This is mostly
done when it is an issue of a violation of a taboo [39].
The THPs use experience, added to the accumulated knowledge handed down by their ances-
tors in order to provide eective and aordable remedies for treating the main ailments (such
as malaria, stomach infections, respiratory problems, rheumatism, mental problems, bone
fracture, infertility, complications of childbirth, etc.) that aict populations of the African
region and in addition oer counseling/advice and solutions to prevent future reoccurrence.
5. Peculiarities in traditional herbal medicine practice from selected
African countries
As there is an African way of understanding God, in the same way, there is an African way
of understanding the visible world around us—the cale, trees, people, and cities, as well
as the unseen world, the supernatural world of spirits, powers, and diseases [40, 41]. People
developed unique indigenous healing traditions adapted and dened by their culture, beliefs,
and environment, which satised the health needs of their communities over centuries [15].
Dierent ethnic groups and cultures recognize dierent illnesses, symptoms, and causes and
have developed dierent health-care systems and treatment strategies. In spite of these, pro-
found similarities exist in the practice of traditional medicine in dierent African countries.
The increasing widespread use of traditional medicine has prompted the WHO to promote
the integration of traditional medicine and complementary and alternative medicine into the
national health care systems of some countries and to encourage the development of national
policy and regulations as essential indicators of the level of integration of such medicine within
a national health care system. The peculiar practices of some countries are described below:
5.1. Ghana
In Ghana, herbal medicine is usually the rst approach to treat any illness, especially in the
rural areas. Lack of access to medical facilities, poor roads/infrastructure, and aordability of
treatment are some of the main reasons for the prevalent use of traditional healers. Besides,
ratio of medical doctors to the patients is about 1:20000, while for traditional healers, the ratio is
1:200. This plays a major role in health care decision making. Other inuencing factors, such as
nancial situation, education, and advice from friends and family, contribute to choice of type
of health care [42]. Traditional medicine has a long history in Ghana. This knowledge is typically
in the hands of spiritual healers, but the vast majority of families have some knowledge of tradi-
tional medicine, which is often inherited and passed down through the generations via folklore.
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Most people in Ghana fully accept modern science-based medicine, but traditional medi-
cine is still held in high regard. They believe in the physical and spiritual aspects of healing.
Herbal spiritualists collectively called “bokomowo” indulge in occult practices, divinations,
and prayers and are common all over the country. Tribal vernacular names of traditional
healers include “gbedela” (Ewe), “kpeima” (Dagomba), “odunsini” (Akan), and “isofatse” (Ga).
In some Ghanaian communities, especially in the Akan communities, traditional healers and
practitioners are of the opinion that disobeying taboos is one of the ways that could lead to
severe illness to the person(s) or community involved [43]. Taboos form an important part
of African traditional religion. They are things, or a way of life, that are forbidden by a com-
munity or a group of people. One could also become sick through invocation of curses in the
name of the river deity, Antoa, upon the unknown oender.
In today’s Ghana, a traditional Medical Directorate has been established in the ministry of
health to provide a comprehensive, recognizable, and standardized complementary system
of health based on excellence in traditional and alternative medicine. Establishing centers for
integrating scientic research into plant medicines and incorporating traditional medicine
into university curricular are now the current status in Ghana [44]. Also, degree-awarding
traditional medical schools now train and graduate traditional medical doctors.
5.2. Zambia
The rst principle is diagnosis followed by complex treatment procedures using plants from the
bush, followed by many rituals, the ultimate aim being to cure disease. Serious or chronic ill-
nesses require “chizimba,” which means sealing a disease or illness away forever. This involves
killing a lizard and burning the heart with roots of certain trees and grinding with charcoal.
Tiny cuts are made on the ailing area and left breast and the mixture rubbed into the cuts.
Plants may be used singly or in combination with other plants. The plant parts are harvested
fresh, pulverized, and left to dry rst, then soaked in water or other solvents like local gin.
Some plant materials are burnt as charcoal and used as powder. Six major types of treatment
common to the 72 or more ethnic groups in Zambia include drinking, eating, drinking as
porridge, making small cut on skin and applying, bathing with herbs, dancing to exorcize
spirits, and steaming with boiling herbs. The Zambian traditional healer is called Nga:nga [45].
5.3. Tanzania
In Tanzania, traditional medicine has been practiced separately from allopathic medicine
since colonial period but is threatened by lack of documentation, coupled with the decline of
biodiversity in certain localities due to the discovery of natural resources and excessive min-
ing, climate change, urbanization, and modernization of agriculture. Traditional medicine
in Tanzania is used by people of all ages in both urban and rural areas for both simple and
chronic diseases. The traditional healers are of four dierent types: diviners, herbalists, tradi-
tional birth aendants, and bone seers. Erosion of indigenous medical knowledge occurred
as most of the traditional health practitioners were aging and dying, and the expected youths
who would inherit the practice were shying away from it and those in the rural areas dying of
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AIDS. Another constraint to the development of traditional medicine in Tanzania was lack of
data on seriously threatened or endangered medicinal plant species [46]. As it stands today,
the traditional medical practice is under the Ministry of health. Eorts are being made to
scale up traditional medical practice by creating awareness of the importance of traditional
medicine and medicinal plants in health care and training of traditional health practitioners
on good practice, conservation, and sustainable harvesting [47].
5.4. South Africa
Traditional medicine features in the lives of thousands of people in South Africa every day. In
fact, it is estimated that 80% of the population uses traditional medicines that are collectively
called muti. Muti is a word derived from medicinal plant and refers to traditionally sourced
plant, mineral, and animal-based medicines.
In addition to herbs, traditional medicine may use animal parts and minerals. However, only
plant muti is considered a sustainable source of medicines. South African traditional plant
medicines are fascinating with so many colors, forms, and eects. It is an art to know these
and to use them correctly to bring about health and harmony, which is the aim of all true
traditional healers. The plant muti is commonly sold in specic sections of the open markets
in South Africa, as shown in Figure 3.
Figure 3. Muti market in Johannesburg (Source—Ancient Origins).
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Figure 3 shows a muti market in Johannesburg.
The traditional healers known as the Sangoma or Inyanga are holders of healing power in the
southern Bantu society. In a typical practice with a female traditional practitioner, the meth-
ods used depended on the nature of the complaint. For example, headaches are cured by
snung or inhaling burning medicines, bier tonics are used to increase appetite, sedative
medicines for depression, vomiting medicines to clean the digestive system, and antibiotic or
immune boosting medicines for weakness or infection. She often counseled patients before
administering appropriate healing herbal medicines [48].
5.5. Kenya
As in many countries in Sub-Saharan Africa, Kenya is experiencing a health worker short-
age, particularly in rural areas. Anecdotal evidence suggests that globally, traditional medical
practitioners (THMPs) are the only point of contact for at least 80% of the rural poor [10].
In Kenya, very lile quantitative evidence or literature exists on indigenous medicine and
the health practices of alternative healers or the demand for traditional medical practitioners
or on the role that they play in providing particular health services for the rural poor. As a
result, TMPs currently do not have sucient formal government recognition and are often
sidelined in Human Resources in Health (HRH) planning activities; further, their activities
remain unregulated. Community-derived data show that hospitals are preferred if aordable
and within reach. There is also signicant self-care and use of pharmacies, although THMPs
are preferred for worms, respiratory problems, and other conditions that are not as life threat-
ening as infant diarrhea and tuberculosis [49].
Traditional Medicine Practitioners in Kenya generally known as “laibon” far outnumber con-
ventional or allopathic providers. Their practices are no dierent from other African coun-
tries. In many cases, they combine both modern and herbal medicines, especially if they are
aicted by chronic ailments such as HIV/AIDS, hypertension, cancer, and diabetes [50].
5.6. Nigeria
The various ethnic groups in Nigeria have dierent health care practitioners aside their west-
ern counterparts, whose mode of practice is not unlike in other tribes. The Yorubas call them
“babalawos,” the Igbos call them “dibia,” while the Northerners or Hausas call them “boka”
[5]. Traditional/herbal medicines have impacted the lives of people, especially in the rural areas
where access to orthodox medicare is limited [51]. Apart from the lack of adequate access and
the fear of expired or fake drugs, the prohibitive cost of western medicine makes traditional
medicine aractive. Various training schools exist for both herbal medicine and homeopathy,
and as such, most modern traditional health practitioners have great knowledge of pharmaceu-
tical properties of herbs and the shared cultural views of diseases in the society and they com-
bine their knowledge with modern skills and techniques in processing and preserving herbal
medicines, as well as in the management of diseases. In oral interviews with two modern tra-
ditional medicine practitioners, Dr. Anselm Okonkwo of Saint Rita’s Ethnomedical Research
Center, Enugu, Nigeria, a Veterinary doctor, and Mr. Uche Omengoli of CGP Herba-Medical
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Consultancy and Research, Enugu, Nigeria, a medical laboratory technologist, both revealed
that their knowledge and ‘gift’ of medical practice were handed down by aged relatives who
were also in the practice by both tutelage and supernatural means. Knowledge was however
improved by further training, interaction, and discussion with colleagues, consultation of
books on herbal medicine, and the Internet. They claimed that the practice was very lucrative,
especially since some ailments that deed orthodox medicine such as epilepsy and madness
could be completely treated by traditional medicine. The two men divulged that the old con-
cept of secrecy and divination is gradually fading away and being taken over by improved
skills, understanding, and use of modern equipment where necessary. Both however agreed
to the “mystic” or esoteric power of plants, which they sometimes employ in their diagnosis
and treatment. An Enugu, Nigeria-based nonprot organization, the Association for Scientic,
Identication, Conservation and Utilization of Medicinal Plants of Nigeria (ASICUMPON),
of which the writer is a member, is commied to “highlighting the usefulness of medicinal
plant resources and scientic assessment, preparation and application of these for the bet-
terment of humanity and as Africa’s contribution to modern medical knowledge,” under the
chairmanship of Reverend Father Raymond Arazu. Another prominent member of the associa-
tion, Professor J.C. Okafor, who is a renowned silviculturist and plant taxonomist, is helping
members to identify and classify plants. The group also shares and documents evidence-based
therapeutic knowledge. Such groups and training schools exist all over Nigeria. ASICUMPON
has published a checklist of medicinal plants of Nigeria and their curative values [19]. Other
books have likewise produced useful information [16, 21]. The greatest problem still facing
herbal medicine in Nigeria is lack of adequate standardization and safety regulations [52].
However, the interest and involvement of educated and scientic-minded people in herbal
medicine practice have to a great extent demystied and increased the acceptability of these
medicines by a greater percentage of would-be skeptical populace. A photograph of Dr.
Anselm Okonkwo is shown here in Figure 4, who is a veterinary doctor and a typical educated
and knowledgeable herbal practitioner with the writer after interviewing him.
Figure 4. The writer with Dr. Okonkwo of St Rita’s Ethnomedical Research Center, Enugu, after the interview.
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6. Adverse eects of herbal medicines
An adverse drug reaction is dened as “a harmful or troublesome reaction, due to interven-
tion related to the use of a healing substance, which envisages risk from future administration
and requires prevention or explicit treatment, or alteration of dose and method of adminis-
tration, or withdrawal of the medical substance.” Any substance with a healing eect can
generate unwanted or adverse side reactions. As with synthetic drugs, the quality, ecacy,
and safety of medicinal plants must also be assured. Despite the widespread use of herbal
medicines globally and their reported benets, they are not completely harmless. In as much
as medicinal herbs have established therapeutic eects, they may also have the potential to
induce adverse eects if used incorrectly or in overdose. The likelihood of adverse eects
becomes more apparent due to indiscriminate, irresponsible, or nonregulated use and lack of
proper standardization. These concerns have been the focus of many international forums on
medicinal plants research and publications [53]. The rich ora of Africa contains numerous
toxic plants, though with interesting medicinal uses. The toxic constituents (e.g., neurotoxins,
cytotoxins, and metabolic toxins) from these plants can harm the major systems of the human
body (cardiovascular system, digestive system, endocrine system, urinary system, immune
system, muscular system, nervous system, reproductive system, respiratory system, etc.) [25].
In a survey in Lagos metropolis, Nigeria, among herbal medicine users, it was found that
herbal medicine was popular among the respondents but they appeared to be ignorant of
its potential toxicities [22]. Several herbal medicines have been reported to have toxic eects.
Current mechanisms to track adverse eects of herbal medicines are inadequate [15, 54, 55].
Consumers generally consider herbal medicines as being natural and therefore safe and view
them as alternatives to conventional medications. Only very few people who use herbal medi-
cines informed their primary care physicians. It is therefore likely that many adverse drugs
reactions go unrecorded with either patients failing to divulge information to health services,
and no pharmacovigilance analyses are being carried out, or the observations are not being
reported to appropriate quarters such as health regulatory bodies. Establishing a diagnosis
of herbal toxicity can be dicult. Even when herbal-related toxicity is suspected, a denitive
diagnosis is dicult to establish without proper analysis of the product or plant material.
Very few adverse reactions have been reported for herbal medicines, especially when used
concurrently with conventional or orthodox medicines [15]. The results of many literature
reviews suggest that the reported adverse drug reactions of herbal remedies are often due to
a lack of understanding of their preparation and appropriate use.
In a research of liver and kidney functions in medicinal plant users in South-East Nigeria,
it was found that liver problems were the most prominent indices of toxicity as a result of
chronic use [56]. Figures 5 and 6 refer to the eect of consumption of herbal medicines and
length of usage respectively, on serum enzymes, as an index of liver function. Toxic compo-
nents in these herbs such as alkaloids, tannins, oxalates, etc., may likely be responsible for
such observed toxicities.
Another important source of toxicity of herbal medicines worth mentioning is microbial con-
tamination due to poor sanitary conditions during preparation [57]. Toxicity may also arise
as a result of herb-drug interaction in situations where there is co-administration of herbal
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medicines with some conventional drugs or supplements [11]. Incorrect identication and
misuse of plants may also lead to toxicity.
It is therefore pertinent at this time to present correct, timely, and integrated communication
of emerging data on risk as an essential part of pharmacovigilance, which could actually
improve the health and safety of patients. This calls for improved collaboration between tra-
ditional practitioners and modern health care professionals, researchers, and drug regulatory
authorities. The latency period between the use of a drug and the occurrence of an adverse
reaction, if determined, can also help in its causality assessment in pharmacovigilance man-
agement [25]. Such information can be invaluable in the interpretation of drug safety signals,
and facilitate decisions on further protective actions to be taken concerning future use.
7. Traditional African medicine and its relationship with modern
medicine
Plants have been the primary source of most medicines in the world, and they still continue to
provide mankind with new remedies. Natural products and their derivatives represent more
than 50% of all drugs in clinical use, of which higher plants contribute more than 25%. These
Figure 5. Serum enzyme levels in herbal medicine users (test group) and nonusers (control).
Figure 6. Eect of length of use of herbal medicine on serum enzyme levels.
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are no doubt more important in developing countries but quite relevant in industrialized
world in the sense that pharmaceutical industries have come to consider them as a source or
lead in the chemical synthesis of modern pharmaceuticals [24, 58]. A number of African plants
have found their way in modern medicine. These plants which had been used traditionally
for ages have through improved scientic expertise been the sources of important drugs.
Examples of such drugs and their sources include:
Ajmalicine for the treatment of circulatory disorders and reserpine for high blood pres-
sure and mental illness both from Rauvola serpentina, L-Dopa for parkinsonism is obtained
from Mucuna species, vinblastine and vincristine used for the treatment of leukemia from
Catharanthus roseus, physostigmine from Physostigma venenosum, or “Calabar bean,” used as a
cholinesterase inhibitor, strychnine from the arrow poison obtained from the plant Strychnos
nux-vomica, atropine and hyoscine from Atropa belladonna leaves. A host of other African
plants with promising pharmaceutical potentials include Garcinia kola, Aframomum melegueta,
Xylopia aethiopica, Nauclea latifolia, Sutherlandia frutescens, Hypoxis hemerocallidea (African wild
potato), and Chasmanthera dependens as potential sources of antiinfective agents, including
HIV, with proven activities [59], while Cajanus cajan, Balanites aegyptiaca, Acanthospermum
hispidum, Calotropis procera, Jatropha curcas, among others, as potential sources of anticancer
agents [60]. Biavonoids such as kolaviron from Garcinia kola seeds, as well as other plants,
have antihepatotoxic activity [61].
8. Advantages and disadvantages of traditional herbal medicine
Both Western or traditional medicine come with their own challenges. Currently, there are
many western drugs on the market which have several side eects, in spite of their scientic
claims. In like manner, African traditional herbal medicine or healing processes also have their
own challenges. The following are reported as some of the advantages and disadvantages:
8.1. Advantages
African herbal medicine is “holistic” in the sense that it addresses issues of the soul, spirit, and
body. It is cheap and easily accessible to most people, especially the rural population. It is also
considered to be a lot safer than orthodox medicine, being natural in origin.
8.2. Disadvantages
Some of the disadvantages include improper diagnosis which could be misleading. The
dosage is most often vague and the medicines are prepared under unhygienic conditions,
as evidenced by microbial contamination of many herbal preparations sold in the markets
[57]. The knowledge is still shrouded in secrecy and not easily disseminated. Some of the
practices which involve rituals and divinations are beyond the scope of nontraditionalists
such as Christians who nd it incomprehensible, unacceptable, and dicult to access such
services [8, 62].
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9. Conclusion
Long before the advent of Western medicine, Africans had developed their own eective way
of dealing with diseases, whether they had spiritual or physical causes, with lile or no side
eect [63]. African traditional medicine, of which herbal medicine is the most prevalent form,
continues to be a relevant form of primary health care despite the existence of conventional
Western medicine. Improved plant identication, methods of preparation, and scientic
investigations have increased the credibility and acceptability of herbal drugs. On the other
hand, increased awareness and understanding have equally decreased the mysticism and
“gimmicks” associated with the curative properties of herbs. As such, a host of herbal medi-
cines have become generally regarded as safe and eective. This, however, has also created
room for quackery, massive production, and sales of all sorts of substandard herbal medi-
cines, as the business has been found to be lucrative.
African traditional herbal medicine may have a bright future which can be achieved through
collaboration, partnership, and transparency in practice, especially with conventional health
practitioners. Such collaboration can increase service and health care provision and increase
economic potential and poverty alleviation. Research into traditional medicine will scale up
local production of scientically evaluated traditional medicines and improve access to medi-
cations for the rural population. This in turn would reduce the cost of imported medicines
and increase the countries’ revenue and employment opportunities in both industry and
medical practice. With time, large scale cultivation and harvesting of medicinal plants will
provide sucient raw materials for research, local production, and industrial processing and
packaging for export.
The scope of herbal medicines in Africa in the near future is very wide, but the issue of stan-
dardization is still paramount [64].
This therefore calls for ensuring that the raw materials should be of high quality, free from
contaminations and properly authenticated, and samples deposited in University, National,
and Regional herbaria. There is need for pharmacopeia to provide information on botanical
description of plants, microscopic details, i.e., pharmacognosy, origin, distribution, ethnobo-
tanical information, chemical constituents and structures, methods of quality control, phar-
macological prole and clinical studies, including safety data, adverse eects, and special
precautions [21, 62]. Such wealth of information will no doubt bring about uniformity in pro-
duction quality. Rather than viewing African herbal medicine to be inferior, it may yet turn
out to be the answer to the treatment of a host of both existing and emerging diseases such as
malaria, HIV/AIDS, ebola, zika, etc., that may defy orthodox medicine.
9.1. Future perspectives
Future perspectives in this area include:
a. All countries in the African region must seek to recognize traditional medical practice
by puing out regulations and policies that will be fully implemented to ensure that the
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THPs are qualied and accredited but at the same time respecting their traditions and
customs. They must also be issued with authentic licenses to be renewed frequently.
b. Incorporation of systems that will provide an enabling environment to promote capacity
building, research, and development, as well as production of traditional herbal medi-
cines of high standards.
c. Harnessing the importance of traditional herbal medicine and integrating the conven-
tional medicine to combat priority diseases such as malaria, HIV/AIDS, diabetes, sickle
cell anemia, hypertension and tuberculosis.
d. Raising the standards of African traditional herbal medicine to international standards
through intercountry collaboration.
These if achieved would put African herbal medicine in an admirable position in the World
health care system.
Author details
Ezekwesili-Oli Josephine Ozioma* and Okaka Antoinee Nwamaka Chinwe
*Address all correspondence to: ezekjojo@yahoo.com
Department of Applied Biochemistry, Nnamdi Azikiwe University, Awka, Nigeria
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