Complementary & Alternative

Medicine

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 1. INTRODUCTION TO
COMPLEMENTARY AND
ALTERNATIVE MEDICINE

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 1.1 Definition Of Terms
Allopathic Medicine: The system of medical practice which treats
disease by the use of remedies which produce effects different from those
produced by the disease under treatment.
Traditional medicine: "The health practices, approaches, knowledge
and beliefs incorporating plant, animal and mineral-based
medicines, spiritual therapies, manual techniques and exercises,
applied singularly or in combination to treat, diagnose and prevent
illnesses or maintain well-being." (WHO)
Ethno medicine: The study of traditional medical practice which is
concerned with the cultural interpretation of health, diseases and
illness
Complementary therapy: are non-invasive, non-pharmaceutical
techniques which are used as an adjuvant to the primary,
conventional treatment.
Alternative therapy: An alternative therapy is one which is used in
3 place of conventional medicine. Friday, October 18, 2024
1.2. Complementary & Alternative Medicine
 CAM is a group of diverse medical and health care
systems, practices, and products that are not generally
considered part of conventional medicine.
 "Integrative medicine" combines treatments from
conventional medicine and CAM for which there is some
high-quality evidence of safety and effectiveness.
The principles of integrative medicine:
 Partnership between patient and practitioner in healing process;
 Appropriate use of conventional and alternative methods to
facilitate the body's innate healing response;
 Consideration of all factors that influence health, wellness and
disease, including mind, spirit and community as well as body;

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Principles …cont
Neither rejects conventional medicine nor accepts
alternative therapy uncritically ;
Good medicine should be based in good science, be
inquiry driven, and be open to new paradigms ;
 Use of natural, effective, less-invasive interventions
whenever possible;
 Use of the broader concepts of promotion of health,
prevention of illness and the treatment of disease;
 Training of practitioners to be models of health and
healing, committed to the process of self-exploration
and self-development.

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1.3 Some Practices Of CAM
Acupuncture: the insertion of needles to different parts of the
body to activate the discharge of natural chemical painkillers.
 used for diabetes patients with painful nerve damage
 It has proven to help reduce pain in the joints
 used to treat mental illnesses
 can be conducted in people who have a low immune system
Aromatherapy: the use of plant essence for treatment of
diseases.
 Recently, it become a part of massage therapy.
 Essential oils are used for massaging the body.
 The skin absorbs the plant essence easily (due to their
molecular structure), which then stimulates the circulatory
system, lymph flow and helps in natural detoxification
process.
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Naturopathy: refers to nature cure.
 The plants, herbs, flowers and vegetables are used in combination
with the nature’s laws and elements for a self purification process.
 It comes from a philosophy that states that if one part of the body
is affected the entire system will be affected.
 Hence the cure also needs to be holistic and separate for any
particular body part.
Ayurveda: cater to the natural elements and vegetation.
 They are similar to naturopathy, but the internal constituents are
little different.
 They function on the various seasons and body type of a person.
 They involve additional techniques like Ayurvedic massages,
facials etc along with an Ayurvedic diet.

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 Homeopathy: “certain diseases can be treated with
minute doses of a natural substance that can produce symptoms
similar to those of the illness”
 Effectively stimulating the body's own defenses against the
illness resulting in a healthier balance of internal chemistry.
 Individuals are given various forms of liquid medications in a
diluted form that seems to be similar to their problems.
 Everything is treated holistically.
Chiropractic: a popular technique for treatment of ailments of
muscle, bone and joints (neuro-musculoskeletal system).
 The basic principle behind chiropractic is that the body system
has the ability to heal by itself.
 It gives more emphasis in treatment of spine problems, as spine
is the primary center for many health related problems.

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 Herbal medicines/Medical Herbalism:
 Use of herbs for treatment of varied health problems like
diabetes, respiratory disease, heart disease, circulatory problem
 Some known herbs like aloe vera and garlic can be used for
detoxification process.
 Various herbs are also identified that help to lose weight naturally.
Holistic Medicine
 is an alternative medicine approach to treatment and natural
healing of the 'whole being' (body, spirit and mind), considering
mental well-being as important as physical and that they are
closely interconnected.
 Holistic health care focuses on natural health, mind, emotional
dimensions, mental aspects and spiritual awareness along with
nutritional, environmental and lifestyle factors.

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 Nutrition therapy: has proven to be very effective for nutrient-
deficient diseases such as diabetes and chronic fatigue.
Massage therapy: helps in instant relaxing and recuperating
from fatigue and tiredness.
Tibetan medicine: works on assessing the body nerves and the
vibration a person is giving out.
 Depending on the same, several herbs, flowers, metallic
powders etc that would compliment to restore the original
configuration is suggested.
Traditional Chinese Medicine (TCM): an array of traditional
medical practices developed in China.
 Herbal medicine, dietary therapy, acupuncture and so on
 Non-insulin dependent diabetics who practiced daily qigong
(Chinese exercise) for one year had decreased in fasting blood
10 glucose and blood insulin levels. Friday, October 18, 2024
Yoga therapy:
 Studies of diabetics have shown that
practicing yoga leads to
decreased blood glucose,
increased glucose tolerance,
decreased need for diabetes medications,
and improved insulin processes.
 Yoga also enhances the sense of well-being.

Meditation and Acupressure

 are some of the other widely used types of
alternative medicine.
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1.4. Why Traditional Medicine?

Why are people using Traditional

Medicine?

Patterns of use of Traditional & Complementary

Medicine vary among and within Member
States depending on a number of factors such
as culture, historical significance and
regulations.
While there is no uniform way to examine
patterns of use, it may be helpful to consider
how people use it in terms of three general
patterns:
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1) Use in countries where TM is one of
the primary sources of health care.
 the availability and/or accessibility of
conventional medicine-based health
services is, on the whole, limited.
 Africa and some developing countries.
 For instance, the ratio of traditional
healers to population in Africa is 1:500
whereas the ratio of medical doctors to
population is 1:40 000.
 For millions of people in rural areas,
native healers therefore remain their
health providers.
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2) Use of TM due to cultural and historical
influences.
In some countries such as Singapore and the
Republic of Korea where the conventional
health-care system is quite well
established, 76% and 86% of the respective
populations still commonly use TM.

3) Use of TM as complementary therapy.

This is common in developed countries where
the health system structure is typically well
developed,
e.g. North America and many European
countries.
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1.5. Risks Associated With TM
Described risks associated with TM
products, practitioners and self-care:
 Use of poor quality, adulterated
/contaminated/ or counterfeit /forged/
products;
 Unqualified practitioners;
 Misdiagnosis, delayed diagnosis, or
failure to use effective conventional
treatments;
 Exposure to misleading or unreliable
information;
 Direct adverse events, side effects or
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unwanted treatment interactions.
 The following strategies for Improving the Role
of Traditional Medicine and Practitioners can be
followed:
 Identification and registration of the
traditional medicine practitioners;
 Assess the need for training of the
selected and registered traditional medicine
practitioners and designing appropriate skill
upgrading training programs;
 Encouraging the formation of a strong
National Association for traditional
medicine practitioners,
 Introduction of the role and importance
of traditional medicine to the public.
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 1.6. Toxicity and safety of
medicinal Plants
Herbal medicines as drugs have side effects.
However, herbal medicines are generally considered to
be safe and effective agents.
Therefore, people every year turn to herbal medicine
because they believe plant remedies are free from
undesirable side effects.
Approximately 8% of all hospital admissions in the
United State are due to adverse reactions to
synthetic drugs.
At least 100,000 people a year die from these toxicities.
It means at least three times as many people are killed
in the U.S. by pharmaceutical drugs as are killed by
drunken drivers.
Thousands die each year from supposedly “safe”

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over-the-counter remedies.
Deaths or hospitalizations due to herbs are so
rare that they are hard to find.
The United State National Poison Control
Centers does not even have a category in
their database for adverse reactions to herbs.
However, toxicity of herbal medicines needs
to be seen in context.
There are a few plants that are “drug like” and
their action approaches that of
pharmaceuticals.
The number of these plants is relatively few.
Digitalis is one of these classic examples.
Herbalists use these plants in allopathic

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treatment strategies.
 The majority of medicinal plants contain
dozens of different compounds, some of
them with great complexity.
Medicinal plants tend to have several
broad actions on physiological systems
at the same time.
These actions are usually
complementary or synergistic and
oriented in the same general therapeutic
direction, and often non-specific, and
rarely adverse.
Medicinal plants’ actions are too complex
and often cannot be adequately
19 described using the vocabulary of
 Many people seeking herbal medical treatment are
already involved in pharmaceutical therapies.
Herbal medicines may act as agonists or
potentiate some drug therapies, and an
understanding of conventional drugs is an
essential prerequisite for effective herbal
therapeutics.
In many cases, herbalists do not like to treat the
primary presenting symptom undergoing drug
treatment but rather concentrate on supporting
other systems and functions stressed by the
primary symptom.
This allows the body to recover its strength and
healing potential so it can then direct these
capabilities toward repairing the presenting
condition
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In practice, three groups of herbs can be
identified from a safety point of view.

Firstly; herbs that contain near

pharmaceutical concentrations of
poisonous constituents which should not be
taken internally by unqualified
persons.
Examples Digitalis spp.
Secondly, are the herbs with powerful
actions.
These herbs are safe under appropriate
conditions.

21 Finally, there is an idiosyncratic grouping
Pregnancy is particular condition which should be
considered as a time of minimal medical
intervention, and in particular regard pregnancy
should be considered as a “contraindication” to
taking herbal medicines.
The evidence of teratogenicity in humans arising
from herbal remedies is rare, but since such
evidence would be hard to come by, it is better to
be avoided during pregnancy.
Herbalists justifiably point out that scientific studies
with isolated compounds, on non-human or even
non mammalian organisms, or in vitro, with doses
tens or hundreds of times the equivalent medicinal
dose, have no arguable extrapolation to the
clinical situation using whole herb at appropriate
medicinal doses.
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In sum, majority of medical herbs are safe;
however, it is better to follow simple but
sensible guidelines :
Only herbs recommended in herb books
should be used.
New or unproven remedies should be
avoided.
Discontinue consumption if no benefit or
result was obtained after moderate period
of time, or if adverse reactions take place.
Patients or physicians should not engage
in drug usage for complex conditions
without knowledge.
Drug interactions and contraindications
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must be considered on an individual
 In overall although medicinal plants are
widely used and assumed to be safe, they
can potentially be toxic.

Where poisoning from medicinal plants has

been reported, it usually has been due to:
misidentification of the plants in the
form in which they are sold,
incorrectly preparation
Incorrect administration
inadequately trained personnel.

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 2. ETHIOPIAN TRADITIONAL MEDICINE

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 2.1. Introduction
 The World Health Organization (WHO) defines traditional
medicine as health practices, approaches, knowledge and
beliefs incorporating plant, animal and mineral based
medicines, spiritual therapies, manual techniques and
exercises, applied singularly or in combination to treat,
diagnose and prevent illnesses and maintain well-being.
 In Africa, up to 80% of the population uses traditional
medicine for primary health care.
 Long before the advent of Modern Medicine, Ethiopia had its
own methods for combating disease these methods are usually
referred to as Ethiopian traditional medicine.
 In Ethiopia up to 80% of the population uses traditional
medicine.
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2.2. History of Ethiopian Traditional Medicine
 Under the rule of Menelik (1865-1913) Western medicine
became significantly more incorporated into the
Ethiopian medical system.
 building hospitals, providing medical training and participating
in vaccination campaigns.
 However, were concentrated in the major cities.
 Despite this, Ethiopians tend to rely more on traditional
medicine.
 Conventional medical services remain concentrated in
urban areas and have failed to keep pace with the
growing population, keeping health care access out of
reach for most Ethiopians living in Ethiopia.
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 2.3. Why to be concerned?
Why do we need to be concerned about
traditional Ethiopian medicine?
 First, the majority of the Ethiopian people
rely mainly on traditional medicine for
satisfying their primary health care needs.
 Second, it can offer additional novel
forms of therapy to the world of modern
medicine.
 It is well known that modern medicine
has its origin from traditional medicine
and the impact of contribution of the latter
is clearly reflected in present-day practice
in a number of ways.
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 Third, it is important to learn about it and
advance its positive values while
discouraging the negative ones.
promote a better understanding
among different ethnic groups and
stimulate development within the ethnic
groups.
 Fourth, there is evidence suggesting a
decline in the number of traditional
practitioners and resources of
medicinal plants.
calls for an urgent action to document
and preserve the traditional medical
knowledge before it disappears.
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2.4. Characteristics of Ethiopian
Traditional Medicine
 Long history and diverse ways as the different cultures.
 Not only concerned with curing but also with the
protection and promotion of human physical,
spiritual, social, mental and material wellbeing.
 Skill is believed to be 'given by God’.
 Knowledge is passed orally from father to a favorite
child, usually a son or acquired by spiritual procedures.
 Knowledge is guarded by certain families/social
groups.
 Drugs obtained from natural substances:
Plants >>> animals >>> minerals.
 Various dosage forms: liquids, ointments, powders and pills.
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Characteristics … cont
 Two supernatural forces are involved:
The devil, for illnesses, & God for the healing.
The use of prayer is used as a therapy.
 Different names: debtera, tenquay (witch doctor),
weqaby kalicha.
 Debteras look upon mental disorders from evil spirits,
 treat by praying, using holy water or exercising the evil spirit.
renowned for their prayer (degmit).
Prepare holy water (tsebel) and kitab.

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 Characteristics …cont
 Drugs prescribed in a non formulated form:
 additives are usually incorporated
 more than one drug is used in a single dosage form.
 Different routes: topical, oral and respiratory.
 Antidotes for sever side effects were claimed to be used.
 Storage: containers such as bottles, papers, pieces of
cloth, leaves and horns, and kept anywhere at home.
 The issue of health is seen holistically.
 Health is seen as a 'gift of God' or 'the will of God'
and many Ethiopians generally believe that their
religion helps keep them healthy.
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Characteristics … cont
 The debteras with the degmit, claim to have the ability to
perform miracles, by the reactions of their patients.
 Tsebel is commonly used to ward off evil spirits from patients who
are believed to be possessed by the devil.
 Kitabs are worn for the purpose of protecting oneself against the
evil eye or buda, as well as snake and scorpion bites.
 The kalichas is the religious leader who, through an ecstatic
ritual, can investigate the causes of a disorder and advise the
patient on what to do.
 Mental disorders are generally explained as resulting from
disturbances in the relationship between people and divinity.
 They conduct special ceremonies to effectively perform their
practices which include the use of excessive smoke by burning
incense such as myrrh, and frankincense (etan).

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 2.5. Principles, Methods And Practices
 Some beliefs in traditional Ethiopian medicine:
 To Ethiopians, health is an-equilibrium between the body
and the outside.
 Excess sun is believed to cause mitch ("sunstroke"), leading
to skin disease.
 Blowing winds are thought to cause pain wherever they hit.
 Sexually transmitted disease is attributed to urinating
under a full moon.
 People with buda, "evil eye," are said to be able to harm
others by looking at them.
 Most Ethiopians have faith in traditional healers and
procedures.
 In children, uvulectomy (to prevent presumed suffocation
during pharyngitis in babies), the extraction of lower
incisors (to prevent diarrhea), and the incision of eyelids
(to prevent or cure conjunctivitis) are common.
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Spiritual healing practice: This practice is related
to the acceptance that supernatural forces are
involved in the causing of diseases as well as in their
treatment.
 Religion has a significant influence on this: Debteras
and Kalichas.
Preventative practice: There are certain
measures.
Example: The spread of diseases (eg. typhus) is
believed to be controlled by treating infected areas
with smokes from burning medicinal materials
having special properties (e.g., yeshikoko gomen or
senecio gigas).
 Sweeping or covering floors with particular kinds of
plants (eg. tej sar or cymbopogen citrates) is
another traditionally practiced disease preventive
35 measure.
Curative practice: Traditional medicine is
commonly used to treat a variety of disease
conditions employing medicinal substances
as recommended by expert practitioners.
Surgical practice: bone-setting,
uvulectomy, circumcisions, bleeding and
cupping, inscion-making and superficial
scarification and tooth extraction.
Midwifery: Yelmid awalajs, meaning
traditional birth attendants.
In all cases, the Yelmid awalajs are
women.
Carry out their practice with or without

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use of medicines.
During the Derg administration, there was
 2.6. National Policy of Traditional Medicine
 Provided under the Ethiopian Penal Code (512/1957)
and the Civil Code (8/1967).
 1970s and 1980s emphasis on disease prevention and
health service development in the rural areas.
 1978: the adoption of the Primary Health Care Strategy.
 1979, the Office for the Coordination of Traditional
Medicine was established.
 studies of some herbal medicines
 a total of 6,000 traditional practitioners were registered
 a monograph of 260 medicinal plants was prepared.
 Meetings and workshops to coordinate traditional and modern
medical practitioners.
 Different healers own professional associations.
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National Policy …..cont
 Current National Policy was issued as part of the Health,
Drug, Science and Technology Policy issued in 1993.
 Placed as one of the priorities (8) of the current Health Policy.
 Attention given for research and for integration into Modern
Medicine.
 The general strategies adopted include:
 identifying and encouraging the utilization of its beneficial
components,
 coordinating and encouraging research including its linkage with
modern medicine and
 developing appropriate regulation and registration of
practitioners
 One of the targets (10) of the drug policy include
38 conducting coordinated research on traditional medicines
Friday, October 18, 2024
National Policy …..cont
 Laws and regulations on traditional medicine were issued under
the Drug Administration and Control Proclamation No. 176/99.
 The national drug program is one of the responsibilities of the
FMHACA which was established by Proclamation No.
176.FMHACA.
 An Expert Committee is also a part of FMHACA.
 FMHACA is responsible for preparing standards of safety,
efficacy and quality of traditional medicine, and shall evaluate
laboratory and clinical studies.
 It gives license for the use of traditional medicine officially.
 The national research institute covering
both traditional and herbal medicine is the
Drug Research Department of the Ethiopian
39
Health and Nutrition Research
Friday,
Institute
October 18, 2024
(EHNRI).
National Policy …..cont
 Currently there is:
 No registered traditional practitioner and way of
registration.
 No regulatory requirement for manufacturing or
safety assessment.
 No herbal medicine in the essential medicines list.
No post market surveillance system.
No restriction on the sale of herbal
medicines.
No guideline for clinical trials using
traditional medicines.
 A committee from FMOH, FMHACA and

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EHNRI is preparing standardsFriday,
ofOctober
safety,
18, 2024
efficacy and the quality of traditional
 3. TRADITIONAL AFRICAN
MEDICINE

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 3.1. Introduction
 In Africa, traditional medicine is characterized by health theories
inter-mingling the human with his social, natural, spiritual and
cosmic environment.
 According to this holistic approach, disease is to be considered
and deal with as a phenomenon that appears when disharmony
affects the vital powers governing the patient's health, which
range from the most powerful deity to the smallest living
organism.
 To restore harmony, the healer combines local plants and
minerals – used both for their medicinal properties and their
symbolic and spiritual significance – with ritual actions, and
calls on his in-depth knowledge of the patient's
kinship/connection and social relations as well as locally shared
cosmologies/env’t.
42 Friday, October 18, 2024
Introduction..cont
 Two major types: the diviner and the traditional healer.
 The diviner diagnoses the cause of an illness if a supernatural
interaction is suspected.
 His tools are his wide knowledge of the village’s kinship
relations, social connections and potential current conflicts.
 The traditional healer chooses and applies appropriate remedies;
 He is usually a very powerful person with connections and
respect throughout the local society, and with indirect political
power deriving from his ability to control illness and the
linked supernatural powers.
 The traditional healer’s right and ability to heal are said to be
gifts from God and ancestors, often recognized during
childhood through specific deeds.
 Other widely called on practitioners of traditional medicine in
African countries include midwives and bone-setters.
43 Friday, October 18, 2024
Introduction....cont
 Traditional African Medicine is a holistic discipline
involving indigenous herbalism and African spirituality,
typically involving diviners, midwives, and herbalists.
 Practitioners of traditional African medicine claim to be
able to cure various and diverse conditions such as
Cancers, psychiatric disorders, high blood pressure,
cholera, most venereal diseases, epilepsy, asthma,
eczema, fever, anxiety, depression, benign prostatic
hyperplasia, urinary tract infections, gout, and
healing of wounds and burns.

44 Friday, October 18, 2024

  Diagnosis is reached through spiritual means and a
treatment is prescribed, usually consisting of an herbal
remedy that has not only healing abilities, but symbolic and
spiritual significance.
 Traditional African Medicine, with its belief that illness is
not derived from chance occurrences, but through spiritual
or social imbalance, differs greatly from Western medicine,
which is technically and analytically based.
 In the 21st century, modern pharmaceuticals and medical
procedures remain inaccessible to large numbers of African
people due to their relatively high cost and concentration of
health centers in urban centers.
 In recent years, African medical practitioners have
acknowledged that they have much to learn from traditional
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medical practice. Friday, October 18, 2024
 3.2. History
Colonial era
 Under colonial rule, traditional diviner-healers were
outlawed because they were considered by many
nations to be practitioners of witchcraft and declared
illegal by the colonial authorities, creating a war
against witchcraft and magic.
 During this time, attempts were also made to control
the sale of herbal medicines.
 After Mozambique obtained independence in 1975,
attempts to control traditional medicine went as far as
sending diviner-healers to re-education camps.

46 Friday, October 18, 2024

..cont
 As colonialism and Christianity spread through Africa, colonialists
built general hospitals and Christian missionaries built private
ones, with the hopes of making headway against widespread
diseases.
 Little was done to investigate the legitimacy of these practices, as
many foreigners believed that the native medical practices were
pagan and superstitious and could only be suitably fixed by
inheriting Western methods.
 During times of conflict, opposition has been particularly
vehement as people are more likely to call on the supernatural
realm (healing).
 Consequently, doctors and health practitioners have, in most cases,
continued to shun (avoid) traditional practitioners despite their
contribution to meeting the basic health needs of the population.

47 Friday, October 18, 2024

… cont Africa
Modern period
 In recent years, the treatments and remedies used in
traditional African medicine have gained more
appreciation from researchers in Western science.
 Developing countries have begun to realize the high
costs of modern health care systems and the
technologies that are required, thus proving Africa's
dependence to it.
 Due to this, interest has recently been expressed in to
integrating traditional African medicine into the
continent's national health care systems
48 Friday, October 18, 2024
..cont modern
 An African healer embraced this concept by making a
48-bed hospital, the first of its kind, in Kwa-Mhlanga,
South Africa, which combines traditional methods
with homeopathy, iridology, and other Western healing
methods, even including some traditional Asian
medicine.

 However, the highly sophisticated technology involved

in modern medicine, which is beginning to integrate
into Africa's health care system, could possibly destroy
Africa's deep-seated cultural values.

49 Friday, October 18, 2024

 3.3. Relationship With Western Medicine
 Western medicine doesn't have the same positive impact in the
underdeveloped African countries.
 it cannot integrate wholly into the culture and society.
 Makes traditional practitioners vital part of their health care.
 Reasons why Western medical system doesn’t work in Africa:
 Facilities are difficult for many Africans to get to.
 the lack of clinics and resources cause over-crowding.
 Patients are not told the cause of their illness/lack of
information
 no way to prevent or prepare for it.
 Poor quality technology, affecting the quality of treatment.
 too expensive, making it difficult to receive proper care.
 removes native Africans from the culture and tradition and

50
forces them into a setting that they are not comfortable with.
Friday, October 18, 2024
…..cont
 However, there has been more interest expressed recently in the
effects of some of the medicinal plants of Africa.
 Considering traditional medicine as a source for identification
of bio-active agents used for synthetic medicine.
 Looking into the medicinal effects of the most commonly and
widely used plants to use in drugs.
 In comparing the techniques of African healers and Western
techniques, a Nigerian psychiatrist, stated,
"At about three years ago, we made an evaluation, a programme
of their work, and compared this with our own, and we
discovered that actually they were scoring almost sixty percent
success in their treatment of neurosis. And we were scoring forty
percent-in fact, less than forty percent."

51 Friday, October 18, 2024

 3.4. Training & Certification

 The field is largely unregulated.

 Practitioners are uneducated people who have
accumulated a great deal of knowledge about native
plants and their actions on the human body.
 There is considerable interest in integrating
traditional African medicine more fully with the
continent's national medical systems.
 In Harare, Zimbabwe, a school of Traditional African
Medicine opened its doors in October, 1999.
 Students include both traditional healers and
university graduates.
52 Friday, October 18, 2024