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Health Impacts of Traditional Medicines and Bio-prospecting: A World Scenario Accentuating Bhutan's Perspective Wangchuk, Phurpa between 2008-06 and 2008-08

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 Health Impacts of Traditional Medicines and Bio-
prospecting: A World Scenario Accentuating Bhutan's
Perspective*
Phurpa Wangchuk"
Abstract
Life without natural products is unimaginable. It has provided
mankind with oxygen, water, fire, food, clothing, shelter and
medicine. Its public health impact is considerably high,
especially of traditional medicines and nature-based modern
drugs. The traditional medicines, despite its limitations, are
addressing the health needs of millions of people worldwide. It
is estimated that about 65-85% of the world population uses
traditional medicines for their primary health cares. It is also
estimated that about 39% of all 520 new approved drugs in
1983-1994 were natural products and out of that 74% were
discovered as a result of bio-prospecting from plants used in
traditional medicines. Traditional medicines are increasingly
getting more popular mainly because: a) it is holistic system
with less side effects; b) it is evolving as an evidence-based
medicine; c) its ethno-medical knowledge is applicable to
modern drug discovery programs. As there are many diseases
that cannot be cured by the existing drugs and as there are
increasing cases of drug resistance, there is urgent need for
drugs that are effective against these pathogens. Probably,
traditional medicines could provide a solution in fighting them
both as a health care delivery mechanism and as a means of
chemotherapeutic pool. Bhutan is fortunate to be gifted with
rich natural bio-diversity and rich traditional medical
knowledge.   The positive  health  impacts   of the  Bhutanese
'    I    appreciate    the    comments    and    suggestions    provided    by
John.B.Bremner, who is the Emeritus Professor at the University of
Wollongong, NSW, Australia. I am also grateful to the Head of PRU,
Director     of     ITMS     and     my     fellow     researchers     for     their
encouragements,   advises  and  supports  for  making  this  paper  a
success.
** Research In-charge, PRU, ITMS, MoH.
 Impacts of Traditional Medicines
traditional medicines are resoundingly felt by Bhutanese.
Besides, there is huge potential for bio-prospecting in Bhutan.
This paper highlights world scenario on the health impacts of
the: 1) natural product-based traditional medicines, 2) the
natural product-based drug discoveries, and 3) Bhutanese
traditional medicine and potential of bio-prospecting in Bhutan.
Introduction
With the advancement in science and technology, remarkable
progress has been made in the field of medicine including
diagnosis, treatments and pharmaceutics. Recent drug
discovery techniques based on structure activity
relationships, computer modeling, combinatorial chemistry,
high throughput screening and spectroscopy (MS, NMR, and
IR) have triggered and spearheaded the discoveries of many
natural and synthetic drugs. In 1999, world sales of
pharmaceuticals (excluding veterinary medicines) were valued
at ca. US$ 325 biUion.
Despite these developments, of the known 30,000 human
diseases or disorders, only one-third can some how be treated
symptomatically with drugs and that too at a great economic
and social cost. This is because of the fact that the drugs
available today are sttil not very effective particularly with
respect to the fight against drug resistant pathogens and
newly emerging infections. This includes infectious diseases
such as AIDS, influenza, tuberculosis and malaria as weU as
other chronic disorders like cancer, autoimmune disorders
and central nervous system disabilities (e.g. Alzheimer's
disease). They are incurable and often fatal causing great
suffering and disability.
Hence, these diseases including resistant pathogens are of
special concern to communities worldwide. There is an urgent
need to find concrete solutions for combating such epidemics.
Prevention of famine, drought, poverty, flood, war, political
upheaval, economic failure, environmental depletion and
poUution would be good solutions to reduce infections and
the development of resistance. Strengthening and developing
117
 Journal of Bhutan Studies
traditional medicines through evidence-based research for
use against the diseases especiaUy the chronic ones and also
against drug resistant pathogens is another potential area.
Another most important strategy to combat both new as well
as the re-emerging infectious diseases is to develop an
arsenal of new drugs.
New drugs could be developed syntheticaUy, but experience
has taught us that the natural products are rich in
structurally diverse bioactive molecules that quite often
become potential candidates for new drugs. In fact, in 1996,
six out of the top 20 pharmaceutical prescription drugs
dispensed were natural products. Therefore, it is very
important that mankind value and appreciate the role and
impacts of natural products, traditional medicines and
modern drugs discovered from natural products.
This paper presents the role and the impacts of the natural
products, traditional medicines and the nature-based drug
discoveries. It also describes the potential, constraints and
future directions in the area of natural product-based
traditional medicines and nature-based drug discovery
programs accentuating Bhutan's perspectives.
Traditional medicines and their health impacts
Mankind has discovered medicinal plants as indispensable
cures for many ailments. Although some cultures used
individual natural products as medicines, many traditions
propounded powerful combinations with different ingredients
known as poultices, tinctures and mixtures. It is reported
that the Mesopotamians were the first people to use the herbs
tike otis of cypress, cedar, liquorice and poppy juice for
treating different ailments in 2600 B.C. Buddhist system of
medicine known as gSo-ba Rig-pa that is currently practiced
in Bhutan, Tibet and Mongolia is 2500 years old and its
pharmacopoea records the use of as many as 2200
traditional prescription drugs.
118
 Impacts of Traditional Medicines
In 1500 BC, Egyptian's developed the Ebers Papyrus that
documented some of the 700 drugs including formulas such
as gargles, snuffs, poultices, infusions, ptils and ointments.
The Chinese materia medica Wu-Shi Er-Bing Fang which
contains 52 prescriptions date back to 1100 BC and the
Indian Ayurvedic Medicine that dates to 1000 BC (Susruta
and Charaka) documents the medicinal use of plants like
datura, aconitum, canabis and sarcostemma.
From these ancient cultures, some of the knowledge reached
Mediterranean countries through traders and migrations, and
it was in Hippocrates's time in 460-377 BC that
pharmacognosy reached its summit in Greece. In 300 to 322
BC, Theophrastus, who was a philosopher and naturalist,
was the first to deal with the history of plants, which later on
helped in the classification of plants, including herbs. In 78
AD, Pedanius Dioscorides, a Greek physician produced De
materia medica, which described more than 500 medicinal
plants and their uses in detail.
Galen (ca 129-199 AD) founded "Galenics" and taught
pharmacy and medicine in Rome. Avicenna (980-1037 AD), a
Persian pharmacist, physician, phtiosopher and a poet,
described 1400 drugs and medicinal plants which greatly
contributed to the formation of a codified Graeco-Roman
Medicine in the 5th century. Paracelsus (1493-1541)
administered dosage formulations separating "Arkanum" from
non-active ingredients of drugs. Western medicine and
pharmacy originated from this medical system.
In the USA, homeopathy that includes hydrotherapy,
nutritional therapy, herbal therapy, manual manipulation
and midwifery, which were founded by German physician
Hahnemann (1755-18-43), became popular in 1830s. The
National Centre for Complementary and Alternative Medicine
(NCCAM) was established at the National Institute of Health,
USA in the 1990s to independently develop and support
research on Complementary and Alternative Medicine. The
NCCAM    categorised   seven   forms   of   therapies   practiced
119
 Journal of Bhutan Studies
worldwide such as mind-body interventions, bio-
electromagnetic therapies, alternative systems of medical
practice, manual healing methods, pharmacological and
biological treatments, herbal medicine and diet and nutrition.
The discovery of antibiotics and vaccines in the 20th century
dramaticaUy changed medical practice worldwide, and as a
result a separate field of ethno-medicine emerged as an
academic specialization focusing on traditional heating
systems. Today, traditional medicines effectively addresses
the health needs of millions of people including developed
nations by completely different strategies and well defined
approaches, and generally with minimal side effects. Current
WHO estimates show that 75% ofthe French population, 30%
of the Vietnamese population, and 40% of Indonesia's
population uses traditional medicines; 77% of pain clinics
provide acupuncture in Germany and 72% of registered
western style doctors uses kampo medicine in Japan. In
Bhutan, traditional medicine is an integral part of the health
care delivery system. Almost 100% of Hospitals and some
Basic Health Units provide traditional medical services.
Overall, traditional medicines provide primary health care
needs to almost 65-85% of the world's population, including
developed nations. In terms of economic value, traditional
therapies contribute to US $ 60 biltion a year, and the USA
alone spends US $ 2.7 biUion per year followed by China with
US $ 1.8 biUion and Australia with Aus $ 1 biUion a year. In
fact, the traditional medicine is gaining popularity worldwide
and this is attributable to four of their main salient features:
the use of natural products as ingredients, the concept of
holism with minimal side effects as opposed to aUopathic
drugs, the emerging clinical efficacy and the content of
reservoir of ethno-medical information.
As required by the WHO regulations, many traditional
medicines are strictly monitored for their quality, safety and
efficacy. Many traditional medical systems including
Japanese  Traditional   Srno-medicrne   and Tibetan  medicine
120
 Impacts of Traditional Medicines
(gso-ba-rig-pa) have emerged as evidence-based medicines.
For example, the investigation on the principal of drug action
of the Japanese Traditional Sino-medicine resulted in
obtaining many novel compounds and unknown new
mechanisms of drug action. The clinical trials of Tibetan
medicine, the PADMA Products also proved successful on
treatment of Irritable Bowel Syndrome and fibrinolysis with
stable intermittent claudication. It furnished new anti-
oxidative mechanisms at the molecular level.
Thus, aU these indicates that traditional medicines caters to
millions of peoples worldwide in their primary health care
needs.
Bio-prospecting and their health impacts
Other than providing primary health care, the natural
products also play significant role in the discovery of the
natural product-based drugs. The natural products tike
plants, animals, microorganisms, marine organisms and the
extremophiles have been an important sources of the
potential drug leads and this wiU continue for years to come.
Many bioactive molecules have been isolated from these
sources applying three main types of search strategies: bio-
rational, chemo-rational and random approaches. For
example, Conocurvone-an anti-HIV agent was discovered as a
result of random approach of screening. Drugs such as
artemisinin, morphine, quinine, and ephedrine were
discovered using bio-rational approach. Out of these three
search strategies, bio-rational approach is the most effective
one. Bio-rational approach is mostly guided by the ethno-
medical information generated from the traditional medicines.
More than 13,000 species of plants are being used in the
traditional medicines and herbal cosmetics and about 8000 of
these medicinal plants species are known in South Asia
alone. These natural products (medicinal plants) contain
reservoir of etho-medical and ethno-botanical information,
which is an important guide to discovery of many new drug
lead molecules.
121
 Journal of Bhutan Studies
Recently at the National Cancer Institute (NCI, USA),
although random high throughput screening method
furnished a large number of testing extracts, it was found by
in vitro bioassays that medicinal plants from traditional
medicines gave greater rates of bioactivity. At the University
of Illinois, Chicago, out of 800 medicinal plant extracts
coUected from Vietnam and Laos, at least 25 biologicaUy
active compounds were isolated; of these 13 were new anti-
HIV agents and 3 were anti-malarial agents. In the USA, out
of 119 plant drugs available from 1959 to 1980, 74% of these
were discovered as a result of chemical studies directed at
isolating the active substances from the plants used in
traditional medicines. In fact, Cragg et al. estimated that 39%
of all 520 new approved drugs in 1983-1994 were natural
products, and 60-80% of antibacterial and anti-cancer drugs
were derived from natural products. Analysing the USA based
community prescriptions in 1973, it was found out that
25.2% ofthe prescription drugs were plant derivatives, 13.3%
were microbial derivatives and 2.7% were animal derivatives.
The search for new drugs continues, but mostly using the
ethno-directed bio-rational approach. In 1999, the
NAPRALERT database recorded more than 88,000 natural
product isolates and many of them formed the skeletal
framework of many renowned drugs available in the market
today. For example, mevastatin (compactin) and lovastatin
which were isolated from Penicillin spp became the cholesterol
lowering drugs. Ivermectins isolated from the streptomycetes
spp became an anthelmintic and antiparasitic drug.
Reserpine was isolated from the plant rauwolfia serpentine
and was turned into antihypertensive drug. Ephedrine
isolated in 1923 from ephedra sinca formed the basis for the
synthesis of salbutamol and salmetrol which are the anti-
asthma drugs (beta agonist). Atropine comes from beUadorma
and even aspirin was derived from salicin present in willow
bark. Teprotide was isolated from the venom of the pit viper,
bothrops jaracaca and this formed the skeletal framework of
the captropril and enalopril, which are used in treating
cardiovascular diseases.
122
 Impacts of Traditional Medicines
In the class of anti-cancer drugs, the vincristine and
vinblastine isolated from catharanthus roseus are clinically
used as the anti-cancer drugs today. Another anti-cancer
agent, paclitaxel (taxol) was discovered from pacific yew,
taxus brevifolia. Semi-synthetic drugs topotecan and
irrinotecan were derived from camptothecian that was
isolated from Chinese ornamental tree, camtotheca acuminate.
An anti-tumor agent, podophylotoxin isolated from the roots
podophylum peltatum is effective in treating skin cancer and
the warts. Its semi-synthetic derivatives, etoposide and
teniposide, is used against the lung and testicular cancers,
lymphomas and leukemia and against the acute lymphatic
leukemia, neuroblastoma in chtidren, non-hodgkin's
lymphomas and tumors in adults respectively. In the mid
1980s, bryostatrn-1 was isolated from bugula neritina, a
marine bryozoans, and was found effective against ovarian
carcinoma and non-Hodgkin's' lymphoma. Aptidine, isolated
from trididemum solidum, a marine tunicate is in phase II
clinical trials in Europe. Ecternascidin 743, a metabolite from
ectelinascidia turbinate tested for in vivo activity against the
murine B16 malanoma and human MX-1 breast carcinoma
models, is currently in Phase II clinical trials in Europe and
US. Squalamine isolated from squalus acanthias is in phase-I
clinical trial.
In the tine of antimicrobial and anti-plasmodial drugs,
microorganisms have been the popular source of antibiotics,
ever since the discovery of peniciUrn from the filamentous
fungus penicillium notatum by Alexander Fleming in 1928.
Cyclosporins and rapamycin (an immunosuppressive agent),
streptomycin, chloramphenicol, tetracyclines and
cephalosporin (antibiotics) were isolated from the
streptomyces and penicillium species. Provir, an oral product
for the treatment of respiratory viral infections, and virend, a
topical antiviral product for the treatment of herpes (both in
clinical trials), were very recently developed from plant
alkaloids. The sulphonamides were the first group of effective
anti-bacterials to be developed following a chance discovery of
123
 Journal of Bhutan Studies
antibacterial activity in synthetic Azo-dye-prontosti in 1932
by Dogmak, and since then many antibacterial drugs were
developed in between the late 1940s to 1980s. By then most
of the infectious diseases were almost eradicated in the
developed world, and as a result, almost half the major
pharmaceutical companies in Japan and the USA stopped
their antibacterial drug development programs. Even today,
antibacterial agents make up only 12-15% of the total
pharmaceutical business, and thus, there are very few drugs
that are effective against the infectious bacterial pathogens
especiaUy the resistant bacteria.
As there are many diseases that cannot be treated by the
existing drugs and also as the drug resistance by many
pathogens are increasing, it is evident that there is need for
the development of new arsenal of drugs to combat them be it
synthetically or based on the natural products. The World
Health Organization has estimated that about 50,000 people
die worldwide every year from infectious diseases alone. The
lead cause of death is HIV-AIDS, foUowed by tuberculosis and
malaria. In 1996, the approximate figure showed that the HIV
virus had infected at least 21,000,000 people worldwide and
in 2001, UNAIDS estimated that over 14,000 new infections
occur daily, nearly half of them in women and strikingly
affecting Africa. While malaria continues to claim 1-3 million
lives each year, ca. 2 btition people including at least 15
million Americans are affected by tuberculosis.
These infectious diseases (microbial) will continue to be the
leading cause of premature death in human beings of both
developed and developing nations as their resistance to many
conventional drugs is increasing. For example, Plasmodium
falciparum have already developed resistance to the existing
traditional anti-malarial drugs like quinine, chloroquene
mefloquene and even to the second tine drug pyrimethamine-
sulphadoxine (fansidar) and halofantrine. The resistance to
the combined drug therapy has been reported in Africa,
Thailand, Burma, Laos, Vietnam, Cambodia and China and
there is hardly any anti-malarial drugs in line to fight the
124
 Impacts of Traditional Medicines
resistance. The latest anti-malarial drugs artrmisinin and its
derivatives, artemether and artether, isolated from artemesia
annua is the only effective anti-malarial drugs available in the
market. This is the only hope of saving millions of lives
especiaUy in Sub-Saharan Africa where chtidren are affected
worst.
SimUarly, many anti-bacterial, anti-fungal and antiviral drugs
are becoming obsolete as the microbes have evolved
numerous defenses against antimicrobial agents and drug-
resistant pathogens are on the rise. The first resistance case
was reported as soon as the introduction of chemotherapy in
staphylococcus aureus in 1941. Mycobacterium tuberculosis
that causes tuberculosis emerged resistant to streptomycin in
1940s and by 1950s and 1960s, it also developed resistance
to later drugs isoniazid and rifamycrns. Streptococci that
causes nosocomial infections showed innate resistance to
drugs, including cephalosporins, clindamycin and
aminoglycoside. The Staphylococcus aureus have currently
developed into multi-drug resistant strain and threaten to put
an end to successful chemotherapy. Vancomycin resistance
among enterococci became noticeable in 1987 and has
resulted into a true 'super bug'. The summary of bacterial
resistance to chemotherapy is shown in table 1.
Table 1
therapy.
Bacteria that have acquired resistance to some drug
Resistant
Bacteria
Disorders
Date
type
(approx.)
Penicillin
Pneumococci
Pneumonia &
Mid 1970s-
resistant
meningitis
present
Legionella
Legionnaire's
Mid 1970s-
disease
present
Borrelia
Lyme disease
1980s-
burgdorferi
present
Salmonella
Gastrointestinal
1980s-
disorders
present
Staphylococci
Toxic shock
syndrome
1980s
E.coliO!57:H7
Gastrointestinal
Mid 1980s-
125
 Journal of Bhutan Studies
disorders
present
Multi-drug
resistant
M. tuberculosis
Tuberculosis
Late 1980s-
present
Vancomycin
resistant
Enterococci
V. cholerae
Wound, blood,
enteric infections
Cholera
Late 1980s-
present
Multi-drug
resistant
"super bugs"
2002-present
Source: Dax, S.L. Antibacterial Chemotherapeutic Agents. First ed.
London, UK: Blakie Academic & Professional, Chapman & Hall. 1997.
Thus, there is immediate need to find new anti-microbial
drugs active against the resistant and re-emerging diseases.
It would be only wiser and better to turn to nature for finding
new and effective drugs. It is estimated that ca. 250,000 to
500,000 species of plants grow on earth but only 10-15% of
such species are reported to have been studied
phytochemicaUy for medicinal applications. There are 30
million species of insects and very few have been studied for
bioactive molecules. Marine world represent 70% of earth's
surface but only 5% of the marine organisms are explored.
Only an estimated 1% of bacterial and 5% of fungal species
have been examined to date. Extremophiles such as
alkalophties, halophiles, barophiles, thermophiles and
psychrophties have been neglected so far. These
extremophiles would definitely offer a potentiaUy diverse
source of novel bioactive molecules.
AU the above reviewed figures suggest only one thing: that is,
the natural sources are least explored for medicinal
applications despite the huge availability of the natural
resources and immense potential for discovery of new drugs.
When there is need for the new drugs, it is only befitting to
systematicaUy explore the rich natural resources and may be
even the drugs for HIV-AIDS can be discovered. This would
save miUions of lives worldwide and definitely this means
positive impacts to the health of the people worldwide.
126
 Impacts of Traditional Medicines
Bhutanese traditional medicine: Its health impact and the
potential of bio-prospecting.
Bhutan is rich in traditional-cultural diversity and natural
resources. Probably, the rich natural resources hosted by the
un-scalable topography of the country factiitated the growth
of luxurious traditions and cultures. Such phenomenal gifts
are rare to find in many countries. One of the tangible
traditional assets of Bhutan is the traditional medical
practices. Bhutan host two forms of traditional medicines:
local healing practices and the formalized traditional medical
system which is locaUy known as gSo-ba-rig-pa (Bhutanese
Traditional Medicine). While local healing practices are an
oral medical traditions that lacks proper documentation, gSo-
ba-rig-pa medical system is highly sophisticated and fully
documented. It is based on Buddhist philosophy and adopted
principles of Chinese Traditional Medicine, Indian Ayurvedic
Medicine and Persian Medicine.
Some sources noted that gSo-ba-rig-pa in Bhutan took shape
with the advent of Mahayana Buddhism from Tibet in the 8th
century, but there are other sources stating that gSo-ba-rig-
pa developed subsequently in Tibet and Bhutan during the
coming in of great Buddhist saint called Guru Padma
Sambhava from India in the eight century. However, for sure
it is clear that gSo-ba-rig-pa in Bhutan originated in the 8th
century under the tutelage of Guru Rimpoche. This is
substantiated by the fact that Khandro Yeshi Tshogyal, a
consort and a disciple of Guru Rimpoche meditated on rdu-
rtsi sman-gi-bchued-lan brgya-tsa brgyad at Mon-kha Nye-
ring, Singye Dzong. In 1616, during the reign of Shabdrung
Ngawang Namgyal, Minister of Religion, Tenzing Drukgyal,
who was an esteemed physician started the propagation of
gSo-ba-rig-pa in Bhutan. After the year 1885, the Penlops
and Dzongpons and Desis patronized the profession by
privately employing an esteemed physicians trained in gSo-
ba-rig-pa. Drungtsho Pemba was the personal physician to
the first King. Drungtsho Penjor and Mahaguru served at the
court ofthe second King. In 1967, the third King, Jigme Dorji
Wangchuck    ordered    the    establishment    of    a    separate
127
 Journal of Bhutan Studies
traditional medicine dispensary at Dechenchoting, Thimphu.
In 1971, formal training for Drungtshos (traditional doctors)
and sMenpas (traditional compounders) was initiated in
Bhutan, providing a solid professional base for gSo-ba-rig-pa.
Today, gSo-ba-rig-pa has been integrated with the modern
health care system and ultimately broadened the health care
choices to the patients. Only few countries support the
practices of traditional medical system along side biomedicrne
and even fewer countries (e.g. Bhutan, China, Mongolia and
Vietnam) officiaUy recognize and support one integrated
medical system under same Ministry and Health Care
Delivery System. This experience of integrating two
conceptually very different health care systems within one
ministry contain important managerial lessons to be learnt by
others.
Currently about 29 traditional medicine units attached to
modern district hospitals and the Basic Health Units (BHUs)
functions efficiently under the guardianship of the Institute of
Traditional Medicine Services (ITMS). The ITMS manufactures
about 98 different essential traditional medicines using 300
different medicinal ingredients. The National Traditional
Medicine Hospital in Thimphu alone treats more than 30,000
patients annually and the district Traditional Medicine Units
treats about 20-30% of the total daily OPD patients of the
district hospital. gSo-ba-rig-pa is getting more popular
amongst the Bhutanese populace. It is also attracting
international interests after it is being recognized by the
World Health Organization as one of the important traditional
medical system responsible for delivering primary health
cares. Such popularities would mean pressure on the supply
of traditional medicines thereby emasculating its
sustainability. To achieve sustainability in raw materials and
traditional medicines, ITMS and the Medicinal and Aromatic
Plant Section (MAPS) under Ministry of Agriculture have
jointly initiated the inventory development, domestication and
cultivation trials of the rare and endangered medicinal plants
species.
128
 Impacts of Traditional Medicines
Beside providing health cares, gSo-ba-rig-pa also forms a
unique opportunity for bio-prospecting in Bhutan since it is
rich in ethno-medical information. The Bhutanese flora and
fauna are characterized by an outstanding bio-diversity and a
large number of endemic species, many of which forms part of
the gSo-ba-rig-pa pharmacopoeia. Therefore, Bhutan's rich
bio-diversity may be hosting cures for many diseases
including AIDS, cancer and other infectious diseases.
Recently, a research carried out at the University of
Wollongong on two Bhutanese medicinal plants aconitum
orochryseum and corydalis gerdae revealed three new and
four known novel compounds with significant antimalarial
activities against resistant strains of Plasmodium falciparum.
Further study on this finding would also result in obtaining
unknown new mechanisms of drug action.
Many medicinal plants such as aquilaria agallocha, rauwolfia
serpentina, paris polyphylla, sapindus mukorossi, phyllanthus
emblica, terminalia bellirica, terminalia chebula, ephedra
gerardina, taxus bacccata, rheum nobile, rheum accuminata,
picrorhiza kurroa, podophyllum hexandrum, nardostachys
jatamansi, aconitum species, artemisia species, panax pseudo-
ginseng sub-species himalaicus and cordyceps sinensis are in
high demand for pharmaceuticals and cosmetics.
Commercializing and bio-prospecting these medicinal plants
would not only accelerate the Bhutan's economic growth, but
also contribute to the global stock of pharmaceuticals. Thus,
gSo-ba-rig-pa (Bhutanese traditional medicine) has lots of
potentials in terms of the provision of the primary health care
as well as in the discovery of new drugs if strategicaUy
managed and developed considering the innate intellectual
property rights.
Conclusion and future directions
Natural products have been the basis for the formation of
traditional medicines and for the discoveries of many modern
drugs. Without the natural products, life wiU cease to
function, and almost every cultures and traditions including
129
 Journal of Bhutan Studies
the traditional medicines and drug discoveries can be
handicapped. This is because the flora and fauna of our
planet provide at least 50% of aU pharmaceuticals and almost
85% of the world's population depend on traditional
medicines for their primary health care needs, which will
continue forever.
In many countries, traditional medicines are deeply rooted in
their cultures. It has become an indispensable treatment
regimens and a subject of interests for the pharmaceutical
companies for the foUowing reasons: a) it is holistic in nature
and has no side effects as opposed to modern aUopathic
drugs; b) the traditional medicines are cheap and easily
available in the markets (raw materials), especiaUy in
developing countries as compared to modern drugs which are
very expensive; c) most of the traditional medical systems are
supported by long clinical use with properly recorded
pharmacopoeias and are being supported by the scientific
validation processes; and d) traditional medicines are the
reservoirs of ethno-medical and ethno-botanical information
which are the keys for opening many new modern drug leads.
As the diseases are increasingly developing resistance to the
existing drugs and as there are newly emerging disorders, it is
only natural that the natural products, traditional medicines
and drug discovery programs wiU even become more
indispensable. In an effort to fight the diseases, disorders and
sufferings; there is urgent need for new and effective arsenal
of drugs (applies to allopathic as well as traditional
medicines). The world sttil has 80-85% of the natural
products unexplored for medicinal applications. The effective
medicines can be discovered only through trans-disciplinary
co-operations and coUaborations among the scientists,
medical doctors and traditional physicians. It wiU not help
anybody by professional turf butiding, working on the
professional economic gain and the potiticizations of the
medical practices and pharmaceutical works. Health care is
more likely to be integrative, holistic, safe and effective when
medical practitioners (conventional and traditional medicines)
130
 Impacts of Traditional Medicines
and scientists consider the welfare of the client or patients
above their own interests.
There is also immediate need for country to country cooperations and collaborations. Some developing countries are
extremely rich in biodiversity and traditional medical
knowledge but lacks the technologies and financial resources
to meanrngfuUy explore and add value to them. On the
contrary, the developed countries are rich in technologies and
financial resources but lacks in the natural resources and the
traditional medical knowledge. It would be better to come
together, bridge these gaps and differences and come up with
effective cures for the un-forgiving diseases.
Bhutan is fortunate to be gifted with rich biodiversity and
traditional medical knowledge that could pioneer successful
bio-prospecting. However, tike any other developing countries,
Bhutan lacks technical expertise and financial resources to
explore them meanrngfuUy. The only option Bhutan have is to
coUaborate with the developed nations and interested
pharmaceutical companies alike and jointly explore them
strategically and wisely. In doing so, the model of
coUaboration should be such that it builds the science
infrastructure within, preserve and protect the local
traditional medical knowledge reducing the brain drain, and
equaUy share the outcome of the joint projects. While bio-
prospecting should gear up, strengthening the Bhutanese
traditional medicine should be a simultaneous effort since it
has multi-pronged benefits. First, it has significant
contribution to the health of the Bhutanese; second it is
manufactured in Bhutan using the country's luxurious
medicinal plants and other raw materials benefiting many
businesses and farmers; third, it provide employment
opportunities; and fourth, it uses more than 300 medicinal
materials that could be useful for bio-prospecting. In fact, it is
the nerve centre with many development networks that
promotes ethical and sustainable utilization of bio-resources
to benefit farmers, business people, human health and the
environment   in   Bhutan.   This   traditional   medical   system
131
 Journal of Bhutan Studies
embraces aU the four ptilars of Gross National Happiness.
Also, it wiU be a yardstick for the discovery of new drug leads
that could save millions of lives. It is therefore important that
there is continuing support for protecting, promoting, and
propagating this traditional medicine and also in preserving
our rich biodiversity. Perhaps, our biodiversity may be
hosting cures for HIV-AIDS, Cancer, Hipatitis B and many
other chronic diseases.
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134

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