From Plant to Pill

Harvesting the Medicinal Potential of Philippine Plants

Written by: Rachelle Sison

Design by: Z Santillan
Plant Images: philippineherbalmedicine.org

When someone falls ill, it is fairly common practice in the Philippines to hear an elder recommend some form of herbal remedy. Obtain the leaves of this plant from a neighbor’s garden, from the wet market, or from a shrub last seen sprouting freely at the side of a certain road. Take them home and boil them, then drink the concoction like tea. Some of the more familiar remedies include: tawa-tawa for dengue, oregano for cough, guava/bayabas for washing wounds, ampalaya for diabetes, and serpentina for high blood pressure. Drink the tea from their leaves, they say. And you will surely be cured of your illness in no time. But how do we know if these herbal remedies are effective, and more importantly, safe? Are there any side effects if consumed in excess? How many leaves is one supposed to boil, and for how long? What are the standards and guidelines, and are there any to begin with?Tawa-tawa leaves, for instance, have been used extensively in folkloric and traditional medicine in the treatment of dengue since the 1980s[1]. They have been observed anecdotally to combat the sudden drop in platelet count experienced by dengue patients.[2] However, for the longest time, the medical community regularly cautioned against their use due to the absence of any clinical studies showing proof of their safety, efficacy, and dosing. [3] [4]This is typical for any herbal plant used in treating illness. Skepticism from the scientific community is expected, and justified, as unproven treatments may cause more harm than good in the path to recovery and healing.

Philippines, a biodiversity hotspot

It makes sense that many of us, especially those residing in rural areas, resort to plants as medicinal remedies. After all, the Philippines ranks among the top 17 in the world in terms of most diverse natural resources [5], with 10,107 species identified and documented to date[6]. About half of these species are endemic or found only in the Philippines[7]. This places us in a favorable position to capitalize on the vast untapped potential of plants with medicinal properties and compounds from which natural products can be derived.

Is there a way that herbal plants could undergo the same rigorous research, development, and testing that synthetic drugs do, so that they may be accepted and eventually integrated into mainstream medicine?

Developing drugs from natural products

Other countries have already been successfully doing this for decades. One US study reports that natural products have been utilized in the discovery and development of over 50% of all new drug entities approved by the US Food and Drug Administration in the last 39 years –particularly in developing new anti-cancer, anti-hypertensive, and anti-bacterial/anti-viral drugs[8] [9]. The Chinese herbal medicine market itself has been around for centuries, bringing in annual revenues of up to USD 18 billion[10].What would harnessing the medicinal potential of our plants mean for us?Less dependence on multinational pharmaceutical companies, for one. Many medicines available in the market today are produced and distributed by global conglomerates (think Pfizer and GlaxoSmithKline), making health treatment expensive and inaccessible for all Filipinos. Maintenance medicines and antibiotics typically set people back by anywhere from P500 to P5,000 a month. This just isn’t affordable for everyone, and homegrown alternatives from local plants, if they could be developed, would go a long way in bringing down the barriers to access for treatment, especially for those in far-flung and disadvantaged communities. Medicinal herbal gardens could further be grown at the barangay level, increasing the self-sufficiency of our people.Not only that, successfully developing even a single drug or herbal supplement that is proven effective through multiple clinical trials, could create opportunities for us to export these products abroad. The market potential is huge – the global herbal medicine market is valued at USD 151 billion as of 2021, and is projected to double to USD 347 billion by 2029[11]. Even one herbal supplement, for instance a tablet with anti-hypertensive properties, could be sold to the 1.5 billion people in the world who suffer from hypertension[12]. In the process, the economic gains would also extend to our farmers who would benefit from cultivating the related plant crops.This begs the question – are we already late to the game?

Early efforts

In 1974, the National Integrated Research Program on Medicinal Plants (NIRPROMP) was formed with the hope of developing a Filipino pharmaceutical industry and addressing the aforementioned issues.[13] Spearheaded by UP Manila and funded by the DOST, it was tasked with studying and scientifically validating traditional herbal remedies. [14]Interviews were conducted with 1,000 herbolaryos (traditional healers), and plants were surveyed and selected for further study based on their potential to treat the most common health problems in the country.[15] The result of these studies was a list of 10 plants or “Sampung Halamang Gamot” that were identified as safe, effective, and sustainable[16]. The list was officially endorsed by the DOH to the public in 1995.From this list, lagundi and sambong garnered the most interest, and were consequently developed into various formulations - tablets, capsules, and syrups.[17] Today, herbal drugs from both these plants are considered to be the most commercially successful products of NIRPROMP’s efforts, and are currently valued to be a Php1 billion industry[18]. Ascof lagundi and re-leaf forte sambong are now household brand names with widespread acceptance from the medical community.This goes to show what can be accomplished when the academe, the government, the medical community, and the private sector work hand-in-hand.Beyond the success of lagundi and sambong products from the 1990s however, progress has been slow. Several challenges have been hampering efforts to develop more herbal drugs. Lack of allocated funding for research and development, excessive red tape surrounding the release of funds and reimbursement of expenses for research, and the low pay and incentives for researchers, are among the obstacles facing the industry today.[19] [20] [21]

Where are we now?

In 2011, the government revitalized its commitment to herbal medicine development by launching the Tuklas Lunas program (“cure discovery”), which now forms part of the country’s national health agenda.[22] Launched by DOST’s Philippine Council for Health Research and Development (PCHRD), its mandate is “to produce world-class medicines derived from the biodiversity of the Philippines[23].” It is currently the leading program for herbal drug discovery in the country.29 universities and institutions across the country (18 in Luzon, 6 in Visayas, and 5 in Mindanao) have been designated as Tuklas Lunas Centers, each serving as research hubs to help maximize the exploration of plant species unique to various locations.[24] As labs across the country are established, hundreds of plants are now being simultaneously studied for their potential anti-cancer, anti-diabetic, anti-inflammatory, and anti-hypertensive properties.[25] A comprehensive list of ongoing Tuklas Lunas projects can be found here and here.

Source: https://www.pchrd.dost.gov.ph/funded-projects/tuklas-lunas-centers/

Recent breakthroughs

In 2012, one of the first research papers confirming the platelet-increasing properties of tawa-tawa leaves was published by a group of researchers from UST[26]. More studies have been published since[27], and in 2019, a standardized tawa-tawa herbal supplement capsule, called Daily Apple Tawa-Tawa, was released by Herbanext Laboratories in partnership with the DOST[28]. Another drug formulation was released the same year by Pharmalytics Corp in partnership with De La Salle Medical and Health Sciences Institute, which is part of the Tuklas Lunas program.[29] Clinical trials are now underway to determine both capsules’ efficacy as complementary treatments for dengue[30]. With the successful completion of clinical trials, it is hoped that dengue medicine will be the next major plant-to-pill success story since lagundi and sambong.

Our role

If we are to reap the full benefits of our country’s plant biodiversity, we must elect government officials who understand the value of scientific research and its role in developing affordable Philippine herbal medicines as a means to addressing our country’s health problems. We need voices in government that will advocate for science funding, support our national scientists, and promote a culture of scientific literacy.

It has taken several decades for us to get from anecdotal evidence to herbal supplements and medicines for the lagundi, sambong, and tawa-tawa plants. Funding remains one of the major challenges holding back our herbal medicine industry. Drastic budget cuts in the departments of health, science, and education delay progress for drug development projects, while small grants are insufficient for rolling out large-scale clinical trials[31] [32]. There is greater need for government to prioritize health research investment.If we are to reap the full benefits of our country’s plant biodiversity, we must elect government officials who understand the value of scientific research and its role in developing affordable Philippine herbal medicines as a means to addressing our country’s health problems. We need voices in government that will advocate for science funding, support our national scientists, and promote a culture of scientific literacy. Perhaps our scientists themselves could consider running for public office, a phenomenon that is gaining interest and traction in other countries [33]. The future landscape of this industry is expected to rest heavily on political will. That being the case, it starts with us, an informed citizenry. Keeping abreast of the latest scientific research and developments will allow us to assess the platforms and priorities of those who run for office. Educating ourselves on the richness of the plants that surround us could be a smaller first step - the next time an elder prescribes an herbal remedy, ask them questions or lend a hand in preparing the tea. Go look at the tree from which the leaves came, and marvel at how medicines come from our natural environment.Hopefully, with the spirit of curiosity and inquiry, the work continues and more medicine is discovered and developed from the abundance of the plants that surround us. Disclaimer: Always seek medical advice and diagnosis from medical professionals. Expert advice should be followed in deciding whether to seek modern treatment or if plant-based medicines/herbal formulas can be effectively used in treating ailments. In the event that herbal treatments are used, expert advice must be followed concerning dosage, part of plant to be used, and duration of use. For more informationThe following institutions are the recognized leading authorities on herbal research and development in the country. Follow their FB pages for the latest updates:Institute of Herbal Medicine (IHM), National Institute of Health (NIH), UP Manila – https://www.facebook.com/instituteofherbalmedicine Philippine Council for Health Research and Development (PCHRD) under the DOST - https://www.facebook.com/dostpchrdPhilippine Institute of Traditional and Alternative Healthcare (PITAHC) under the DOH - https://www.facebook.com/pitahcofficial

References:

[1] Lam HY, Montaño MNE, Sia IC, Heralde III FM, Tayao L. Ethnomedicinal Uses of tawatawa (Euphorbia hirta Linn.) in Selected Communities in the Philippines: a Non-invasive Ethnographic Survey Using Pictures for Plant Identification. Acta Med Philipp. 2018Sep.28;52(5). Available from: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/download/325/292/

[2] Ibid

[3] Dengue patients cautioned on using tawa-tawa. Sunstar. 2013 June 26. Available from: https://www.sunstar.com.ph/article/291172/dengue-patients-cautioned-on-using-tawa-tawa

[4] Sisante J. DOH: Don’t experiment with ‘tawa-tawa’ as dengue cure. GMA News Online. 2010 September 13. Available from: https://www.gmanetwork.com/news/topstories/nation/200931/doh-don-t-experiment-with-tawa-tawa-as-dengue-cure/story/

[5] Diolina Z. Mercado. Philippines – Compilation and synthesis of valuation studies on Philippine biodiversity. UNDP-BIOFIN Project. January 2016. [Online]. Available: https://www.biofin.org/knowledge-product/philippines-compilation-and-synthesis-valuation-studies-philippine-biodiversity

[6] Barcelona J., Nickrent D., Lafrankie J., Callado J. R., Pelser P. Co’s Digital Flora of the Philippines: plant identification and conservation through cybertaxonomy. http://philjournalsci.dost.gov.ph/39-vol-142-no-3-special-issue-2013/757-co-s-digital-flora-of-the-philippines-plant-identification-and-conservation-through-cybertaxonomy Philippine Journal of Science. 2013,(142),57–67.

[7] Ibid

[8] G. M. Cragg, D. J. Newman. Natural Products As Sources of New Drugs over the Nearly Four Decades from 01/1981 to 09/2019. https://doi.org/10.1021/acs.jnatprod.9b01285 Journal of Natural Products. 2020, 83 (3), 770-803.

[9] David J Newman, Natural products and drug discovery, National Science Review, Volume 9, Issue 11, November 2022, nwac206, https://doi.org/10.1093/nsr/nwac206

[10] Traditional Chinese Medicine Market, By Therapy Type (Herbal Medicine, Cupping Therapy, Compounding Therapy Magneto Therapy, Aroma Therapy, Moxibustion, Acupuncture, Others), By Disease Type (Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder), By Region Forecast to 2030. Emergen Research. 2022 December. Available from: https://www.emergenresearch.com/industry-report/traditional-chinese-medicine-market

[11] Herbal Medicine Market Size, Share, & Covid-19 Impact Analysis, By Application (Pharmaceutical & Nutraceutical, Food & Beverages, and Personal Care & Beauty Products), By Form, (Powder, Liquid & Gel, and Tablets & Capsules), and Regional Forecast, 2022-2029. Fortune Business Insights. 2022 July. Available from: https://www.fortunebusinessinsights.com/herbal-medicine-market-106320

[12] Tuklas Lunas Anti-Hypertensive Formulations. UPM TTBDO. 2021 January 10. Available from: https://ttbdo.upm.edu.ph/tuklas-lunas-anti-hypertensive-formulations/

[13] From Herbal Folklore to Modern Medicine. World Intellectual Property Organization. 2013. Available from https://www.wipo.int/ipadvantage/en/details.jsp?id=3661

[14] Ibid

[15] Ibid

[16] Ibid

[17] Ibid

[18] 2022 PCHRD Annual Report.2023 March 20. DOST-PCHRD. Available from: https://www.pchrd.dost.gov.ph/publications/2022-pchrd-annual-report/

[19] Maramba-Lazarte, C. Trials and Triumphs in Herbal Medicine Research: The NIRPROMP Experience. Available from: https://pidswebs.pids.gov.ph/CDN/EVENTS/005_maramba-lazarte_trials_amd_triumphs.pdf

[20] BOI, other gov’t agencies, and orgs on search for the NXTGEN herbal products of the PH. Philippine Board of Investments. 2022 April 29. Available from: https://boi.gov.ph/boi-other-govt-agencies-and-orgs-on-search-for-the-nxtgen-herbal-products-of-the-ph/?fbclid=IwAR3R5e8FF7uz1pTQgOgbL_8z2-dQ5TDDndyBYrTQFtPsG5ZxA7H2nn4sFIU

[21] Castro, G. M. FAST FACTS: What herbal medicines are being promoted by DOH? Rappler. 2019 November 1. Available from: https://www.rappler.com/newsbreak/iq/243056-things-to-know-herbal-plants-alternative-remedies/

[22] E. De Vera, R. Noriega, D. Nazario. Tuklas Lunas continues to pursue pharmacological discovery, development. Manila Bulletin. 2019 October 3. Available from: https://mb.com.ph/2019/10/03/tuklas-lunas-continues-to-pursue-pharmacological-discovery-development/

[23] Ibid

[24] Tuklas Lunas Centers. DOST-PCHRD. Available from: https://www.pchrd.dost.gov.ph/funded-projects/tuklas-lunas-centers/

[25] 2022 PCHRD Annual Report. 2023 March 20. DOST-PCHRD. Available from: https://www.pchrd.dost.gov.ph/publications/2022-pchrd-annual-report/

[26] J. G. Apostol, J. V. Gan, R. J. Raynes, A. A. Sabado, A. Q. Carigma, and L. A. Santiago, “Platelet-increasing effects of Euphorbia hirta Linn. (Euphorbiaceae) in ethanol-induced thrombocytopenic rat models,” International Journal of Pharmaceutical Frontier Research, vol. 2, pp. 1–11, 2012. Available from: https://pdfslide.net/documents/platelet-increasing-effects-of-euphorbia-hirta-linn-effects-of-euphorbia-hirta.html?page=12

[27] Perera SD, Jayawardena UA, Jayasinghe CD. Potential Use of Euphorbia hirta for Dengue: A Systematic Review of Scientific Evidence. J Trop Med. 2018 Apr 16;2018:2048530. doi: 10.1155/2018/2048530. PMID: 29849664; PMCID: PMC5926475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926475/

[28] TAWA-TAWA CAPSULE: Herbal Supplement for Dengue. DOST-PCHRD. Available from: https://www.pchrd.dost.gov.ph/heartnovation/tawa-tawa-capsule-herbal-supplement-for-dengue/.

[29] E. Sambatyon, Filipino science researchers develop World’s first anti-dengue medicine. Good News Pilipinas. 2019 December 22. Available from: https://www.goodnewspilipinas.com/filipino-science-researchers-develop-worlds-first-anti-dengue-medicine/

[30]Tuklas Lunas trial on herbal anti-dengue capsule to finish soon. DOST-DOSTv. 2021 September 2. Available from: https://www.dostv.ph/blog/tuklas-lunas-trial-on-herbal-anti-dengue-capsule-to-finish-soon

[31] Maramba-Lazarte, C. Trials and Triumphs in Herbal Medicine Research: The NIRPROMP Experience. Available from: https://pidswebs.pids.gov.ph/CDN/EVENTS/005_maramba-lazarte_trials_amd_triumphs.pdf

[32] Castro, G. M. FAST FACTS: What herbal medicines are being promoted by DOH? Rappler. 2019 November 1. Available from: https://www.rappler.com/newsbreak/iq/243056-things-to-know-herbal-plants-alternative-remedies/

[33] Yong, E. Here’s How The Scientists Running for Office Are Doing. The Atlantic. 2018 Feb 20. Available from: https://www.theatlantic.com/science/archive/2018/02/heres-how-the-scientists-who-are-running-for-office-are-doing/554444/

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